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Introduction Obstetric anal sphincter injurie (OASI) in vaginal births are a serious complication, and are associated with maternal morbidity. Focus on modifiable factors in midwives clinical skills and competences contributing to prevent the occurrence of OASI are essential. The objective of this study was to investigate the association between OASI and factors related to midwife-led birth such as manual support of perineum, active delivery of baby's shoulders, maternal birth position, and pushing and breathing techniques in second stage of labour. Methods A prospective cross sectional study including primiparous (n = 129) and multiparous (n = 628) women in midwife-led non-instrumental deliveries with OASI (n = 96) or intact perineum (n = 661). Data were collected in a university hospital in Norway with two different birth settings: an alongside midwife-led unit with approximately 1500 births per year and an obstetrical unit with approximately 3500 births per year. In midwife-led births, there were a total of 2.6% OASI and 18.9% intact perineum. Results The sample consisted of 757 women, 12.7% suffered OASI and 87.3% of participating women had an intact perineum. This selected sample compares the most serious outcome (OASI), and the optimal outcome (intact perineum). In primiparous women, 61 women suffered OASI and 68 women had intact perineum, while for multipara women, 35 women suffered OASI and 593 women had intact perineum. There was an increased risk of OASI if women actively pushed when the head was crowning compared to breathing the head out (adjusted OR: 3.10; 95% CI: 1.75 to 5.47). The maternal birth position associated with the lowest risk of OASI was kneeling position (adjusted OR: 0.15; 95% CI: 0.03 to 0.70), supine maternal birth position (adjusted OR: 2.52; 95% CI: 1.04 to 4.90) and oxytocin augmentation more than 30 min in second stage (OR: 1.93; 95% CI: 1.68 to 15.63) were associated with an increased risk of OASI, when adjusting for maternal, foetal, and obstetric factors. Conclusion Our study suggests that actively pushing when the baby's head is crowning, a supine maternal birth position and oxytocin augmentation more than 30 min in second stage, were associated with increased risk of OASI when compared to intact perineum. A kneeling maternal birth position was associated with a decreased risk of OASI.

Objective: Some studies of women with polycystic ovary syndrome (PCOS) report increased prevalence of hypertensive disorders in pregnancy, while others do not. Several of these studies do not control for obesity. We aimed to study whether PCOS is associated with hypertensive disorders in pregnancy and whether it is dependent on body mass index (BMI). Study design: We present a cross-sectional analysis of 3732 women from Denmark, Estonia, Iceland, Norway and Sweden, born in 1945–72, who participated in the Respiratory Health In Northern Europe (RHINE) study and answered an extensive women's health questionnaire on menstruation, PCOS, infertility, pregnancy history and childbirth. The main outcome measurement was hypertensive disorders of pregnancy. We adjusted for smoking, age, infertility treatment and study center. Effect modification by BMI was assessed. Results: PCOS was related to hypertensive disorders in pregnancy with a relative risk (RR) of 1.62 (95% CI 1.09–2.42). This relationship was found among underweight women with a BMI of 2 [RR = 5.2 (95% CI 1.66–16.5)] and obese women with a BMI of ≥30 kg/m 2 [RR = 2.36 (95% CI 1.29–4.31)], but not among normal-weight women, BMI 18.5–25 kg/m 2 [1.08 (0.53–2.20)], or overweight women, BMI 25–30 kg/m 2 [1.24 (0.50–3.08)] (p-interaction = 0.041). Conclusion: Polycystic ovary syndrome is associated with hypertensive disorders in pregnancy. This association only occurs among underweight and obese women and not among normal-weight and slightly overweight women.

Aims To examine changes and explanatory variables for changes in health-related quality of life in patients treated with long-term mechanical ventilation over a six-year period. Background Long-term mechanical ventilation is a treatment for individuals with chronic hypercapnic respiratory failure, primarily caused by neuromuscular diseases, obesity hypoventilation syndrome, chronic obstructive pulmonary and restrictive thoracic diseases. Studies on long-term outcome on health-related quality of life and factors influencing it are lacking. Design Prospective cohort study. Methods Data were collected from the Norwegian Long-Term-Mechanical-Ventilation Registry and from patient reported questionnaire in 2008 and 2014. Health-related quality of life was measured by the Severe Respiratory Insufficiency questionnaire, containing 49 items and seven subdomains. Linear mixed effects models were used to measure changes and identify factors for changes. Results After six years, 60 patients were still participating, out of 127 at baseline. Health-related quality of life improved significantly in the total score and in four subdomains of the questionnaire. Satisfaction with training in long-term mechanical ventilation was an explanatory variable for improved ‘psychological well-being’ and follow-up for improvement of ‘anxiety’. Side effects of the treatment like facial soreness were associated with the total score. High age and high forced vital capacity were related to lower ‘physical function’ and improved ‘social functioning’, respectively. Conclusion Long-term mechanical ventilation over six years improved health-related quality of life in most patients. Patient training, follow-up and reduction of side effects, largely delivered by trained nurses, contribute to achieve the main goal of the treatment - improved health-related quality of life. This article is protected by copyright. All rights reserved.

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

Background The Severe Respiratory Insufficiency (SRI) questionnaire is a specific measure of health-related quality of life (HRQoL) in patients treated with long-term mechanical ventilation (LTMV). The aim of the present study was to examine whether SRI sum scores and related subscales are associated with mortality in LTMV patients. Methods The study included 112 LTMV patients (non-invasive and invasive) from the Norwegian LTMV registry in Western Norway from 2008 with follow-up in August 2014. SRI data were obtained through a postal questionnaire, whereas mortality data were obtained from the Norwegian Cause of Death Registry. The SRI questionnaire contains 49 items and seven subscales added into a summary score (range 0–100) with higher scores indicating a better HRQoL. The association between the SRI score and mortality was estimated as hazard ratios (HRs) with 95% confidence intervals (95% CI) using Cox regression models and HRs were estimated per one unit change in the SRI score. Results Of the 112 participating patients in 2008, 52 (46%) had died by August 2014. The mortality rate was the highest in patients with chronic obstructive pulmonary disease (75%), followed by patients with neuromuscular disease (46%), obesity hypoventilation syndrome (31%) and chest wall disease (25%) (p

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

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

Author´s accepted manuscript Impaired health-related quality of life (HRQoL) is common in bariatric surgery candidates and is often one of the motivating factors for seeking bariatric surgery. Although many studies have reported changes in HRQoL after bariatric surgery, few are long-term prospective studies and no systematic review has been conducted. A systematic database search identified studies reporting HRQoL preoperatively and ≥ 5 years after bariatric surgery. Change in HRQoL over time was the outcome variable, divided into primary and secondary outcomes. Seven prospective cohort studies met the inclusion criteria. Eight HRQoL measures and six surgical methods were identified. Longterm follow-up time ranged from 5-10 years, sample sizes from 44 to 655 patients, and follow-up rates from 61 to 92%. None of the seven studies were randomized controlled trails and only two studies used control groups. Six out of seven studies showed statistically significant improvements in all of the primary outcomes, while one study showed statistically significant improvements in one of two primary outcomes. Of the statistically significant HRQoL improvements, 92 percent were clinically meaningful. Peak improvements in primary HRQoL outcomes were typically observed during the first years of follow-up, followed by a gradual decline that seemed to stabilize five years postoperatively. Long-term HRQoL scores typically remained improved relative to preoperative scores but were somewhat below population norm scores. In conclusion, while bariatric surgery candidates reported impaired HRQoL pre-surgically, their HRQoL improved considerably after bariatric surgery and much of the initial HRQoL improvements were maintained over the long term.

OBJECTIVELung cancer (LC) patients who develop brain metastases (BMs) have a poor prognosis. Estimations of survival and risk of treatment-related deterioration in quality of life (QOL) are important when deciding on treatment. Although we know of several prognostic factors for LC patients with BMs, the role of QOL has not been established. Authors of this study set out to evaluate changes in QOL following Gamma Knife surgery (GKS) for BMs in LC patients and QOL as a prognostic factor for survival.METHODSForty-four of 48 consecutive LC patients with BMs underwent GKS in the period from May 2010 to September 2011, and their QOL was prospectively assessed before and 1, 3, 6, 9, and 12 months after GKS by using the Functional Assessment of Cancer Therapy–Brain (FACT-BR) questionnaire. A mixed linear regression model was used to identify potential predictive factors for QOL and to assess the effect of GKS and the disease course on QOL at follow-up.RESULTSMean QOL as measured by the brain cancer subscale (BRCS) of the FACT-BR remained stable from baseline (score 53.0) up to 12 months post-GKS (57.1; p = 0.624). The BRCS score improved for 32 patients (72.3%) with a total BM volume ≤ 5 cm3. Mean improvement in these patients was 0.45 points each month of follow-up, compared to a decline of 0.50 points each month despite GKS treatment in patients with BM volumes > 5 cm3 (p = 0.04). Asymptomatic BMs (p = 0.01), a lower recursive partitioning analysis (RPA) classification (p = 0.04), and a higher Karnofsky Performance Scale (KPS) score (p < 0.01) at baseline were predictors for a high, stable QOL after GKS. After multivariate analysis, a high KPS score (p < 0.01) remained the only positive predictor of a high, stable QOL post-GKS.Median survival post-GKS was 5.6 months (95% CI 1.0–10.3). A higher BRCS score (p = 0.01), higher KPS score (p = 0.01), female sex (p = 0.01), and the absence of liver (p = 0.02), adrenal (p = 0.02), and bone metastases (p = 0.03) predicted longer survival in unadjusted models. However, in multivariate analyses, a higher BRCS score (p < 0.01), female sex (p = 0.01), and the absence of bone metastases (p = 0.02) at GKS remained significant predictors. Finally, the BRCS score’s predictive value for survival was compared with the values for the variables behind well-known prognostic indices: age, KPS score, extracranial disease status, and number and volume of BMs. Both BRCS score (p = 0.01) and BM volume (p = 0.05) remained significant predictors for survival in the final model.CONCLUSIONSPatient-reported QOL according to the BRCS is a predictor of survival in patients with BMs and may be helpful in deciding on the optimal treatment. Gamma Knife surgery is a safe and effective therapeutic modality that improves QOL for LC patients with a BM volume ≤ 5 cm3 at treatment. Careful follow-up and salvage therapy on demand seem to prevent worsening of QOL due to relapse of BMs.

The aims of this study were to translate and adapt the Severe Respiratory Insufficiency (SRI) questionnaire into Norwegians and to test its reliability and validity.Data were collected from a cross-sectional survey and were linked to the Norwegian Registry of patients receiving long-term mechanical ventilation (LTMV). Of 193 potential participants, 127 responded to the SRI questionnaire. Reliability as measured with Cronbach's α varied between 0.68 and 0.88 for the subscales and was 0.94 for SRI-sum score. Construct validity was obtained with high correlations between subscales in SF-36 and SRI. The SRI questionnaire discriminated well between universally accepted clinical differences among categories of patients receiving LTMV by significant dissimilarities in SRI-sum score and SRI subscales. The Norwegian version of SRI has well-documented psychometric properties regarding reliability and validity. It might be used in clinical practice and in international studies for assessing health-related quality of life in patients receiving LTMV.

Elin Dysvik,1 Gerd Karin Natvig,2 Bodil Furnes31Faculty of Social Sciences, Department of Health Studies, University of Stavanger, Stavanger, Norway; 2Faculty of Medicine and Dentistry, Department of Public Health and Primary Care, University of Bergen, Norway; 3Faculty of Social Sciences, Department of Health Studies, University of Stavanger, Stavanger, NorwayObjective: The aim of this study was to explore grief caused by chronic pain and treatment adherence, and how these experiences are integrated into ongoing life stories.Methods: A 6-year follow-up using a qualitative mixed-methods design based on written narratives and image narratives was performed. Five women suffering from chronic pain comprised the purposive sample. They had completed an 8-week group pain-management program with two follow-ups, and thereafter continued as a self-help group. A narrative approach was used to analyze the written and image narratives guided by three analytic steps.Results: Findings showed that experiences of grief over time were commonly associated with chronic pain. The participants' past experiences reflected their grief at having to abandon jobs and social networks, and revealed loneliness and despair. The present life situation seemed to reflect adaptation, and hope for the future had been established. Overall, forward progression means an ongoing struggle towards a reintegrated body and a meaningful life.Conclusion: Through such narratives, health-care workers can identify treatment adherence related to grief and pain, and learn how people might regain their lives beyond using traditional interviews.Keywords: chronic pain, follow-up, grief, image, narrative, nursing

We present 5-year outcomes after vertical sleeve gastrectomy (VSG), including complications and revisions, weight change, obesity-related diseases and health-related quality of life (HRQOL). Patients operated from December 2005 to November 2010 were included. All variables except HRQOL (obtained using Short Form-36) were assessed prospectively. HRQOL data was assessed cross-sectionally, comparing 5-year results to both a baseline cohort of severely obese patients prior to bariatric surgery and to Norwegian norms. Of 168 operated patients (mean age, 40.3 ± 10.5 years; 71% females), 92% completed 2-year and 82% 5-year follow-up. Re-intervention for complications occurred in four patients, whereas revision surgery was performed in six patients for weight regain and in one patient for gastroesophageal reflux disease (GERD). Mean body mass index (BMI) decreased from 46.2 ± 6.4 kg/m2 at baseline to 30.5 ± 5.8 kg/m2 at 2 years and 32.9 ± 6.1 kg/m2 at 5 years. Remission of type 2 diabetes mellitus (T2DM) and hypertension occurred in 79 and 62% at 2 years, and 63 and 60% at 5 years, respectively. The percentage of patients treated for GERD increased from 12% preoperatively to 29% at 2 years and 35% at 5 years. The physical and mental SF-36 summary scores showed significantly better HRQOL at 5 years compared with the baseline cohort, but did not reach population norms. The majority of VSG patients maintained successful weight loss and improvement of T2DM, hypertension and HRQOL at 5 years. Preventing weight regain and GERD are important considerations with this procedure.

Life expectancy is increasing continuously, which increases the likelihood of developing dementia or cancer. Both dementia and cancer are serious conditions that give manifold symptoms. The interaction of these conditions is however complex and less explored. The aim of this study was to identify the prevalence of cancer and differences regarding neuropsychiatric symptoms (NPS) and medication among nursing home (NH) patients with and without dementia and cancer. This is a cross-sectional study of Norwegian NH patients (N = 1825). Participants were categorized according to degree of dementia (Clinical Dementia Rating > 1) and cancer diagnoses. Differences in NPS and other symptoms, as well as the use of medication, were explored. Eighty-four percent of NH patients had dementia, and 5.5% had comorbid dementia and cancer. Patients with comorbid dementia and cancer received significantly more analgesics compared with patients without cancer but with dementia (P < .05). Compared with patients without dementia but with cancer, patients with comorbid dementia and cancer had significantly more NPS, including sleep disturbances and agitation. Patients with comorbid dementia and cancer receive more analgesics than patients with dementia but still display more agitation and sleep disturbances than patients with cancer and patients with neither dementia nor cancer, suggesting that symptoms may not be treated adequately. The results indicate a considerable strain for patients with comorbid dementia and cancer and highlight essential challenges for the clinician who is responsible for treatment and care. Nurses should pay attention to agitation and sleep disturbances among patients with comorbid dementia and cancer. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBYNCND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

dysvik e., kvaloy j.t. & natvig g.k. (2011) The effectiveness of an improved multidisciplinary pain management programme: a 6- and 12-month follow-up study. Journal of Advanced Nursing 68(5), 1061–1072. Abstract Aim. This article is a report of a Norwegian-revised study on the effectiveness of a follow-up multidisciplinary management programme for chronic pain to investigate the change processes associated with treatment. Background. Substantial evidence supports the use of Cognitive Behavioural Therapy approaches to chronic pain. As relapse is often reported, follow-up sessions should be included. Methods. A follow-up quasi-experimental design was performed, and a previous control group was used. The study initially included 117 participants, and 104 of the sample completed the 6- and 12-month follow-up programme. The 6-month follow-up consisted of therapeutic dialogue and education combined with physical activity. At the 12-month follow-up, a telephonic consultation was conducted. The data collection period was between September 2006 and January 2008. The statistical and clinical significance were considered. Results. Findings suggest that this follow-up programme can potentially maintain the positive results of the basic programme in terms of reduced pain perception, improved health-related quality of life, and movement towards self-management. Conclusion. These results are consistent with the ultimate goal of Cognitive Behavioural Therapy approaches, which is to help patients with chronic pain to cope more effectively and to improve their health-related quality of life and functioning. To maintain treatment improvements and advance nursing, there is a clear need for research that tests the efficacy of follow-up interventions that are designed to prevent drop out and relapse.

Aims This paper is a report of a study of health-related quality of life and post-traumatic stress disorder symptoms in patients attending an Accident and Emergency department because of psychosocial crises.

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

This study examined the health-related quality of life (HRQOL) of nursing home residents (≥ 65 years) using the Short-Form-36 Health Survey subscales and how these subscale scores are related to residents' sociodemographic and medical conditions. Residents 95–102 years old reported higher HRQOL than younger respondents. Those with more education reported higher HRQOL. Residents who reported hobbies or special interests had a higher HRQOL score on vitality and mental health variables. Finally, respondents with no comorbid illness scored highest on all HRQOL dimensions, and this was statistically significant for physical functioning and bodily pain. In conclusion, respondents generally reported highly limited physical functioning and slightly limited social functioning. To improve the situation of residents, more attention should be paid to the environment of nursing homes and residents' hobbies and special interests.

Dette er en post-print forfatterversjon. For forlagsversjon, se Surgery for obesity and related diseases, tilgjengelig online at http://www.soard.org/article/S1550-7289%2808%2900835-6 Background The relationship among musculoskeletal pain, depression, and health-related quality of life in patients with severe obesity who are accepted for bariatric surgery should be explored further. Methods In this cross-sectional study, we measured the health-related quality of life using the generic questionnaire “Short-Form 36 Health Status Survey.” Multiple regression analysis was used to explore associations between the predictors (musculoskeletal pain and depression) and the physical cumulative summary (PCS) and mental cumulative summary (MCS). Age, gender, body mass index, and the number of co-morbidities were entered as covariates. Results The study subjects included 28 women and 23 men, with a mean age of 37.7 years and a mean body mass index of 51.9 kg/m2. The PCS and MCS scores were very poor compared with the age- and gender-adjusted population norm (P

Summary This study focused on work-related stress among nurses working with critically ill patients. The aim of the study was to examine the effects of workrelated stress with regard to patient safety. The study uses a qualitative design based on focus group interviews with nurses who work with acute, critically ill patients in hospitals. Two regional hospitals were chosen. Inclusion criteria for the focus group panels included the following: nurses with advanced training in anesthesiology, intensive care, or operating-room nursing. Twenty-three nurses were chosen and they were divided into four groups. This study shows that a demanding work environment together with minimal control and social support from colleagues results in increased stress that can often have an effect on patient safety. © 2007 Elsevier Ltd. All rights reserved.

The aim of this study was to evaluate an 8-week multidisciplinary pain management program offered to patients suffering from chronic pain. The study initially included 88 participants, and 61 of the sample completed a follow-up program conducted at 6 and 12 months after the initial programs. The pain management program was based on a cognitive behavioral approach with active patient participation in learning new coping skills. The intervention consisted of supervised dialog, physical activity, and education. The main goals were change of focus from pain and disability to resources and functional coping strategies. It was hypothesized that the positive changes gained at posttest registration after an 8-week program on coping, health-related quality of life, and pain intensity would be maintained during follow-up sessions. The results indicated that these hypotheses were mainly supported and further pain reduction, decreased emotion-focused coping, better social functioning, and overall physical and mental health gains were observed. The participants who did not complete the follow-up program did not differ from the patients who completed the program on background variables investigated. The study also supported the claim that professional nurses are competent to lead such programs and to evaluate treatment results. Clinical and research implications are discussed.

The aim of this multicenter study was to explore associations between psychosocial factors (general self-efficacy, perceived availability of social support, cancer-related distress) and health-related quality of life, among individuals at risk for hereditary cancer. One-hundred and twenty one participants with a family history of breast-cancer or colorectal cancer answered a questionnaire 2-4 weeks prior to genetic counseling. The two dimensions of the health-related quality of life measure, mental and physical health were both used as outcome variables. Multiple regression (linear) analyses revealed that increasing degrees of cancer-related distress was related to decreasing degrees of mental health whereas increasing degrees of self-efficacy and social support were related to increasing degrees of this outcome variable. Self-efficacy, self-esteem support and tangible aid seemed to moderate the relationship between cancer-related distress and mental health. These results suggest that self-efficacy and certain resources of social support buffer the negative association between cancer-related distress and mental health, and might be suitable for interventional efforts. Implications for genetic counseling practice are discussed.

Chronic pain, when not effectively treated and relieved, may have a harmful effect on all aspects of health-related quality of life (HRQL). Furthermore, pain beliefs are considered an important mediating psychological factor in chronic pain. The present study focused on HRQL as measured by the Medical Outcomes Survey-Short Form (SF-36) and addressed possible relationships between pain beliefs as measured by the Pain Beliefs and Perceptions Inventory (PBAPI). The possible impact of background variables such as age, gender, social support, pain intensity, pain duration, and analgesics on HRQL were controlled for in the analyses. The study sample consisted of 81 people who were recruited from a multidisciplinary pain management program. Data were collected as the first part of a routine pretreatment evaluation. The chronic-pain patients reported lower scores on all dimensions of HRQL compared to normal controls and other patient groups. No significant association was found between pain beliefs and the physical health dimension of HRQL whereas gender, pain duration, and pain intensity were significant predictors of that dimension. In addition, one of the dimensions of pain beliefs (i.e., mystery) was found to be predictive of the mental health dimension of HRQL. Social support made an additional contribution to the explained variance in mental health. The implications of these results for assessing HRQL and pain beliefs in chronic pain are discussed.

The concept of health contains aspects of social and mental well-being and not just the absence of disease. The concept of well-being is sometimes used interchangeably with the term happiness, although focus has been on other aspects as well. Here we explore associations between happiness and experience of stress at school, personal and social factors among 887 Norwegian school adolescents participating in a World Health Organization project on health-promoting schools. Happiness was measured by a one item question (ordered responses 1 4). The psychosocial factors were represented by an average score of 3-12 items. Odds ratios of feeling very/quite happy were calculated in multiple logistic regression analyses. An increasing degree of stress experience reduced the feeling of happiness significantly. Furthermore, increasing levels of general self-efficacy increased the odds of feeling happy, whereas the more specific measure of school self-efficacy showed no independent effect. Social support from teachers also enhanced happiness significantly. A less consistent pattern was found for support from peers, lout the most happy pupils experienced significantly more support than pupils who reported being unhappy. No significant trend was found with decision control, We also explored associations between happiness and psychosomatic symptoms. Pupils feeling unhappy reported a particular symptom more often and they also had the highest mean number of reported symptoms. To evaluate whether these health indicators represent different dimensions of health, a comparison of strength of associations with common risk factors is made. Implications for health promotion practice are discussed.

Background: The aims of this study were to translate the Obesity-Related Problem scale (OP scale) into the Norwegian language and test its reliability, validity and responsiveness in a Norwegian sample. Method: The questionnaire (OP scale) was translated from the original language (Swedish) into Norwegian. Patients completed the questionnaire prior to and one year after sleeve gastrectomy. Internal consistency was evaluated using Cronbach`s α. Floor and ceiling effect were calculated as percentages. Construct validity was tested by correlating the OP-scale with the SF-36 and the Cantril Ladder using the Pearson correlation coefficient. Exploratory factor analysis, using principal component analysis with varimax rotation, was used to test the unidimensionality of the OP scale. Responsiveness was tested by assessing changes in the OP scale from baseline to one year post-surgery using the paired sample t-test. Result: A total of 181 patients (123 women) accepted for bariatric surgery was included in the study. The mean age was 43.1 ± 12.5 years, and mean body mass index (BMI) before surgery was 45 ± 6.9. The mean value of the OP scale at baseline was 63.30 ± 24.43 (severe impairment) and 21.01 ± 20.98 at one year follow-up (mild impairment). Cronbach`s α was high at baseline (0. 91), as well as one year after surgery (0.88). The floor effect was small at baseline and moderate at one year. The ceiling effect was small at baseline and at one year. Exploratory factor analysis showed one factor with a high percent of explained variance (baseline and post-surgery). Correlations between OP scale at baseline, SF-36, Cantril Ladder and BMI were statistically significant and in the predicted direction to support validity of the Norwegian OP scale . After one year correlations between the change in OP scale and the change in SF-36 scores, Cantril Ladder and BMI were also statistically significant, except for the change in the Role Physical-scale. The OP scale showed greater responsiveness than either the SF-36 or Cantril Ladder. Conclusion: These results confirm that the Norwegian version of the OP scale is a valid and reliable instrument for measuring psychosocial functioning in patients with clinically severe obesity.

Background: Knowledge of long-term health related outcomes in contemporary populations born extremely preterm (EP) is scarce.We aimed to explore developmental trajectories of health-related quality of life (HRQoL) and behavior from mid-childhood to early adulthood in extremely pretermand term-born individuals. Methods: Subjects born at gestational age ≤28 weeks or with birth weight ≤1,000 g within a region of Norway in 1991–92 and matched term-born control subjects were assessed at 10 and 18 years. HRQoL was measured with the Child Health Questionnaire (CHQ) and behavior with the Child Behavior Checklist (CBCL), using parent assessment at both ages and self-assessment at 18 years. Results: All eligible EP (n = 35) and control children participated at 10 years, and 31 (89%) and 29 (83%) at 18 years. At 10 years, the EP born boys were given significantly poorer scores by their parents than term-born controls on most CHQ and CBCL scales, but the differences were minor at 18 years; i.e., significant improvements had occurred in several CHQ (self-esteem, general health and parental impact-time) and CBCL (total problem, internalizing and anxious/depressed) scales. For the girls, the differences were smaller at 10 years and remained unchanged by 18 years. Emotional/behavioral difficulties at 10 years similarly predicted poorer improvement on CHQ-scales for both EP and term-born subjects at 18 years. Self-assessment of HRQoL and behavior at 18 years was similar in the EP and term-born groups on most scales. Conclusions: HRQoL and behavior improved towards adulthood for EP born boys, while the girls remained relatively similar, and early emotional and behavioral difficulties predicted poorer development in HRQoL through adolescence. These data indicate that gender and a longitudinal perspective should be considered when addressing health and wellbeing after extremely pretermbirth. publishedVersion

Bodil Furnes,1 Gerd Karin Natvig,1,2 Elin Dysvik1 1Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway; 2Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway Objective: Chronic pain is a complex, multifaceted subjective experience that involves the whole person. Self-management is the dynamic and continuous process of adapting one’s situation to the cognitive, behavioral, and emotional responses necessary to maintain a satisfactory quality of life. Approaches based on cognitive behavioral therapy (CBT) are described as appropriate in assisting people suffering from chronic pain because they challenge maladaptive beliefs and behaviors in relation to pain. This study aimed to explore patients’ experiences of therapeutic elements from group participation in a chronic pain management program. Methods: A qualitative research design with a phenomenological hermeneutic approach was used. Six months after participation in the 8-week course, 34 participants formulated and submitted written reports based on open-ended questions related to their group participation and self-help achievement. These reports were analyzed by elements of qualitative content analysis. Results: The analysis resulted in two subthemes: “The significance of active involvement in gaining new insight” and “The significance of community and group support.” These were abstracted in the main theme: “Successful self-management is related to several significant contributions in the group.” Conclusion: An active role with writing, self-revelation, and exchanges of thoughts and feelings in the group seemed to be the key tools for success. In addition, group support and access to other group members’ experiences were significant therapeutic elements. We suggest that successful self-management requires knowledge of essential therapeutic elements. In a CBT-based group approach, such elements may offer an important health care contribution. Keywords: pain management, cognitive behavioral therapy, group therapy, self-directed therapy

Background: Researchers have emphasized a need to identify predictors that can explain the variability in weight management after bariatric surgery. Eating self-efficacy has demonstrated predictive impact on patients’ adherence to recommended eating habits following multidisciplinary treatment programs, but has to a limited extent been subject for research after bariatric surgery. Recently an American short form version (WEL-SF) of the commonly used Weight Efficacy Lifestyle Questionnaire (WEL) was available for research and clinical purposes. Objectives: We intended to translate and culturally adapt the WEL-SF to Norwegian conditions, and to evaluate the new versions’ psychometrical properties in a Norwegian population of morbidly obese patients eligible for bariatric surgery. Design: Cross-sectional Methods: A total of 225 outpatients selected for Laparoscopic sleeve gastrectomy (LSG) were recruited; 114 non-operated and 111 operated patients, respectively. The questionnaire was translated through forward and backward procedures. Structural properties were assessed performing principal component analysis (PCA), correlation and regression analysis were conducted to evaluate convergent validity and sensitivity, respectively. Data was assessed by mean, median, item response, missing values, floor- and ceiling effect, Cronbach`s alpha and alpha if item deleted. Results: The PCA resulted in one factor with eigenvalue>1, explaining 63.0% of the variability. The WEL-SF sum scores were positively correlated with the Self-efficacy and quality of life instruments (p Conclusion: The Norwegian version of WEL-SF appears to be a valid questionnaire on eating self-efficacy, with acceptable psychometrical properties in a population of morbidly obese patients

The article was originally published in PeerJ and distrubted under Creative Commons CC-BY 4.0. See DOI 10.7717/peerj.609 Background. Information on self-reported health is important for health professionals, and the aim of this study was to examine associations between lifestyle factors and self-reported health and the mediating effect of disease in a Norwegian population. Methods and Materials. The data collection was conducted as part of the Hordaland Health Study (HUSK) 1997–99, which was a cross-sectional epidemiological study. All individuals in Hordaland county born in 1953–1957 were invited to participate (aged 40–44 years). Complete information for the present study was obtained from 12,883 individuals (44% response rate). Height and weight were measured at a physical examination. Information on lifestyle factors, self-reported health, disease (heart attack, apoplexy, angina pectoris, and diabetes), and socio-demographic variables was obtained from a self-administered questionnaire. Self-reported health was measured with a one-item question. Odds ratios for fair or poor self-reported health were calculated using multiple logistic regression analyses adjusted for disease and socio-demographic variables. Results. Respondents reporting adverse lifestyle behaviours (obesity (odds ratio (OR) 1.7, p < 0 . 001), smoking (OR 1.2, p < 0 . 001), or excessive intake of alcohol (OR 3.3, p < 0 . 001)) showed an increased risk of poor self-reported health. Furthermore, a moderate intake of wine (OR 0.6, p < 0 . 001) or strenuous physical activity (OR 0.5, p < 0 . 001) decreased the risk of poor health. Disease did not mediate the effect. Conclusion. A one-item question measuring self-reported health may be a suitable measure for health professionals to identify levels of subjective health and reveal a need to target lifestyle factors in relatively young individuals with or without disease.

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

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

Neonatal pain experiences have been associated with altered processing and perception of pain in later life, but findings tend to vary among studies. We have compared experimental pain tolerance and subjective health complaints in a population-based cohort of adolescents born extremely preterm to that of matched term controls. Subjects performed a standardized cold pressor task (hand in ice water) and completed validated questionnaires regarding current subjective health complaints, including pain issues. Thirty-one (89%) of 35 eligible preterm subjects (mean gestational age 26.8 weeks) and 28 (80%) term controls participated in this follow-up study at mean age 17.8 years. Ten (32%) subjects born preterm versus 17 (61%) born at term reached the ceiling time of 180 seconds immersion time in the ice water, a hazard ratio for early withdrawal of 2.05 (95% confidence interval, 1.72 to 2.44), with males explaining most of the difference. For subjects born preterm, the risk of early withdrawal decreased significantly with more days of mechanical ventilation, more pain events, and more doses of morphine during the newborn period. Subjective pain ratings during the cold pressor task as well as health-related complaints and pain issues reported in the questionnaires were similar in the preterm and term groups. Perspective Despite reduced tolerance to experimental pain, subjects born preterm scored their pain experiences similarly to those of term controls. Surprisingly, preterm subjects exposed to most painful and invasive neonatal experiences and also to most doses of morphine had a pain response at follow-up most closely resembling that of the control group.

Associations between being a victim of bullying and psychosomatic health have been examined among 856 Norwegian school adolescents aged 13 to 15 years. Multiple logistic and linear regression analyses were applied. Pupils being bullied sometimes or more often during the previous term had significantly higher odds of every psychosomatic symptom except sleeplessness, compared to pupils who reported that they were never exposed to bullying. The highest odds ratio was observed in analysis of feeling low. No significant interactions with gender or age were seen, but the association with irritability, headache and backache tended to be strongest for boys, whereas the association with nervousness and sleeplessness was strongest for girls. Increasing exposure to bullying was associated with a highly significant increase in number of symptoms. The strong and consistent associations with different symptoms and the dose–response relationship suggest a causal relationship.

BACKGROUND: The Medical Outcome Study 36-Item Short Form Health Survey (SF-36) is one of the most commonly applied generic quality of life instruments. The construct validity of the instrument in patients with morbid obesity is not established. PARTICIPANTS AND METHODS: A total of 475 morbidly obese patients (68% women) with a mean (standard deviation) age of 44.7 (11.8) years, weight of 123.5 (24.1) kg and BMI of 41.7 (6.3) kg/m(2), who had been referred to a rehabilitation center, completed the SF-36 form. Exploratory factor analyses were performed to examine the underlying component structure of the questionnaire. Confirmatory factor analyses were performed to assess model fit. RESULTS: The analysis suggested a 6-component structure rather than the 8-component structure used in the original SF-36. The first component consisted of items from the physical functioning subscale, the role physical subscale and the general health subscale, and explained 31% of the variance. The 6 components explained 61% of the total variance. The items loaded as expected in a physical and mental component. The assessment of model fit confirmed these findings. CONCLUSION: The 2 summary scales of the SF-36 have satisfactory validity in patients with morbid obesity. However, the validity of the 8 subscales is questionable, and the subscales should be interpreted with care.

Background Cognitive behavioural therapy (CBT) has been useful in the treatment of chronic pain conditions for many years. Given the increasing number of persons with chronic pain and associated psychosocial problems, the development and implementation of effective interventions based on CBT is warranted. Objectives The aim of this study is to evaluate the effects of a multidisciplinary pain management programme on health-related quality of life (HRQL), as measured by the Short Form Health Survey (SF-36), pain perception as measured by the Brief Pain Inventory (BPI), and readiness-to-change as measured by the Pain Stages of Change Questionnaire (PSOCQ). Design A pretest–post-test quasi-experimental design, with waiting list controls and baseline and post-test measures, was used. Setting The study was conducted in the rehabilitation unit of a university hospital. Participants Of 117 people suffering from chronic pain, 113 completed the 8-week multidisciplinary pain management programme. The patients were consecutive referrals. Inclusion criteria were: adults (18–67 years), pain lasting over 6 months, motivation and no ongoing litigation. Exclusion criteria were affected by major mental disorders or major medical conditions requiring treatment. Methods The intervention was based on a cognitive behavioural approach. Therapeutic dialogues and training, combined with physical activity, were provided to a fixed plan, including homework. The programme has several features that directly address psychosocial aspects of chronic pain. Statistical and clinical significance are considered. Results The findings suggest that this programme has the potential to improve HRQL, reduce pain intensity and interference, and contribute to improvement in readiness-to-change. Statistically significant results are supplemented by results showing their clinical significance. Conclusions Improvements in HRQL, pain-related disability, and readiness-to-change suggest that the vicious cycle of chronic pain may be alleviated by our programme. As we see it, effective treatment results are about identifying and addressing the important and changeable influences maintaining pain problems such as acceptance, understanding the mind-body connection and self-management. Although further research is needed to evaluate the effectiveness of this work, such group approaches appear to represent a feasible treatment option for many patients with chronic pain.

Dette er en post-print forfatterversjon. For forlagsversjon, se Obesity Surgery, tilgjengelig online at http://www.springerlink.com/content/24357272k01k3858/ Background Morbid obesity can reduce the health-related quality of life (HRQL) and paid work participation, and the duodenal switch (DS) can induce large weight loss in patients suffering from this disease. However, data about HRQL combined with paid work participation after duodenal switch are lacking. The aim of this study was to provide longitudinal data of these issues. Methods Fifty-one consecutive morbidly obese patients accepted for DS gave their informed consent to participate in the study. Mean age was 37.7 years (SD, 8.0), and 54.9% were women. HRQL was assessed using the “Short-Form 36 Health Status Survey”. Eight subscores, the physical component summary (PCS), and the mental component summary (MCS) were calculated. Paid-work participation was assessed as performing or not performing paid work. Data were assessed before DS (T0), 1 year after DS (T1), and 2 years after DS (T2). Results All the SF-36 scores improved significantly from T0 to T1 and T2 (p

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

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

Aim. To advance the understanding of health-related quality of life among older nursing home residents by assessing their health-related quality of life and comparing this with norms from the general population. Methods. The study used a two-group cross-sectional comparative design. The samples comprised 227 nursing home residents aged 65–102 years with at least six months’ residence and a representative population sample of 1137 Norwegian citizens aged 65–102 years. All nursing home residents had a Clinical Dementia Rating Scale score ≥0·5 and were capable of conversing. The respondents provided demographic information and were surveyed using the SF-36 Health Survey. We used univariate and multivariate linear models to identify possible differences in health-related quality of life between the nursing home residents and the general population, controlled for age, sex, marital status and education. Results. After adjustment for age, group, sex, marital status and education, the nursing home residents scored significantly higher on bodily pain and on physical and emotional role limitation and significantly lower on the other SF-36 subscales, except social functioning, with the largest differences for physical functioning (mean nursing home 23·2 and mean general population 62·9). The general population scores on all subscales generally increased with increasing education but not among the nursing home residents. Conclusions. The mean SF-36 scale scores differed markedly between the nursing home residents and the general population, with the nursing home residents generally scoring lower. The association with background variables known to be related to health-related quality of life differed between the groups. Healthcare professionals should increase attention to health-related quality of life among nursing home residents, periodically assess health-related quality of life and consider interventions that may improve health-related quality of life in older institutionalised populations. Relevance to clinical practice. This study highlights the role of nurses and other health professionals in ensuring that nursing home residents have opportunities to improve their health-related quality of life.

Background. Knowledge about mixed-methods perspectives that examine anxiety, depression, social support, mental health and the phenomenon of suffering among cognitively intact NH residents is scarce. We aimed to explore suffering and mental health among cognitively intact NH residents. Methods. This study used a mixed-methods design to explore different aspects of the same phenomena of interest to gain a more comprehensive understanding. The qualitative core component comprised a qualitative interview from 18 nursing home residents (≥65 years) about experiences related to pain, grief and loss. The supplementary component comprised interview from the same respondents using the SF-36 Health Survey subscales , the Hospital Anxiety and Depression Scale and the Social Provisions Scale. Results. The individual descriptions reveal suffering caused by painful experiences during life. The quantitative results indicated that symptoms of anxiety and depression were related to mental health and symptoms of anxiety were related to bodily pain and emotional role limitations. Attachment and social integration were associated with vitality and social functioning. Discussion. To improve the situation, more attention should be paid to the residents’ suffering related to anxiety, depression and psychosocial relations.

This study examines the association between Sense of Coherence and anxiety and depression amongst patients at risk of hereditary cancer receiving genetic counseling. When writing this article, 144 patients referred for genetic counseling due to a suspicion of hereditary cancer in the family were recruited for this multicentered longitudinal study on the psychosocial aspects of genetic counseling in Norway. A total of 96 (66%) patients responded to the follow-up survey distributed 6 months after genetic counseling. This survey included the Sense of Coherence-29 Scale, Impact of Event Scale, and Hospital Anxiety and Depression Scale. Multiple regression analyses were applied. Our results show association between cancer-related distress and symptoms of anxiety and depression. Sense of Coherence is significantly associated with both anxiety and depression. The hypothesis of Sense of Coherence buffering cancer-related distress and the possible impact of these findings for genetic counseling are discussed.

The main purpose of this article is to study what nurses consider most important when focusing on patient safety. The study uses a qualitative design based on focus group interviews with nurses who work with acute, critically ill patients in hospitals. Two hospitals were chosen. The data collection was conducted in October and November 2002. The research comprised 23 nurses with specialist degrees, including one man, divided into four groups. The criterion for inclusion in the study was being a nurse with advanced training in anesthesiology, intensive care, or operating-room nursing. The nurses were between 35 and 61 years old. The job experience as nursing specialist varied from 3/4 to 32 years. The findings show that the informants were concerned with patients’ safety, and they placed a considerable emphasis on their personal responsibility for safety. The informants discussed safety in relation to themselves and their colleagues, and to a lesser degree with respect to their level in the organizational structure. The nurses were concerned with themselves, their own attitudes, and efficient teamwork with other groups of professionals. Cooperation requires speaking the same language. Different cultural and linguistic backgrounds can be problematic. They had written procedures that were not based on higher national or international standards. Both standards and individual judgment were evaluated as important for patient safety.

Background: Long-term data of health-related quality of life (HRQL) after biliopancreatic diversion with duodenal switch (BPDDS) procedure are lacking. The aim of this study was to evaluate changes in HRQL from baseline to 5 years after BPDDS. Methods: Fifty morbidly obese patients were followed for 5 years after BPDDS procedure. The sample consisted of 27 women and 23 men, the mean age was 37.8 years, and the mean body mass index (BMI) was 51.7 units. HRQL was measured with the Short Form 36 questionnaire (SF-36). Anxiety and depression were measured with the Hospital Anxiety and Depression Scale (HADS). Linear mixed model was used to investigate the change scores. The SF-36 scores and HADS scores of the sample were also compared with a Norwegian population norm, adjusted for age, gender, and BMI. Results: Mental summary scores (MCS) and physical summary scores (PCS) were very low preoperatively but significantly improved (P