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Biomedical subjects

J H Loge

Publications and source records attributed to J H Loge.

33 records · Page 2Linked to original sources
PubMed1999

Fatigue. Measures and relation to pain.

Fatigue describes reduced capacity to sustain force or power output, reduced capacity to perform multiple tasks over time and simply a subjective experience of feeling exhausted, tired, weak or having lack of energy. Pain and fatigue have several components in common, such as being subjective, prevalent in most patients with cancer and caused by multiple factors of both a physical and psychological nature. In order to explore the relationship between fatigue and pain, data from five studies were used: two random samples from the Norwegian population (n=2323 and n=1965), Hodgkin's disease survivors (n=459), palliative care patients (n=434) and patients with bone metastases (n=94). All patients had completed one or more of the following instruments: EORTC QLQ-C30, SF-36 and/or Fatigue Questionnaire. The level of fatigue was much higher in the two palliative care populations (54.4 and 63.2) as compared to the normal population samples (25.0). Patients with bone metastases had significantly more pain (72.0) than the patients in the palliative care trial (47.4) and norms (20.5). In the two palliative care and bone metastases populations fatigue was almost unchanged over time, while pain was reduced. In the palliative care population a high level of fatigue (80.3) and pain (57.8) was reported 0-1 month before death. The relationship between pain, fatigue and the health-related quality of life domains should be explored in more detail, especially in follow-up studies in order to assess possible changes over time. In addition, the validity of the existing instruments measuring fatigue should be investigated for use in patients with advanced disease and short life expectancy.

Adult↗
PubMed1999

The course of anxiety and depression during the first year after allogeneic or autologous stem cell transplantation.

Psychological distress is frequently reported in transplant survivors. We prospectively assessed anxiety and depression before transplant, in the isolation period and during a follow-up period of 1 year. The Hospital Anxiety and Depression Scale (HADS) was administered to 131 cancer patients treated with high-dose chemotherapy followed by allogeneic (SCT) or autologous (ASCT) stem cell transplantation, and a concurrent group of 123 lymphoma patients receiving standard chemotherapy (CT) who served as a reference group. Relatively low levels of anxiety and depression were found. The level of anxiety slightly declined from baseline during follow-up (mean scores SCT: from 5.3 to 3.6, CT: from 6.0 to 4.2) or remained fairly stable (ASCT: from 5.4 to 4.8). The level of depression peaked when the transplant patients were in protective isolation or shortly thereafter (SCT: 6.1, ASCT: 6.4), but stabilized at baseline levels after 4 months. The highest level of depression in the CT group was reported 4 months after start of chemotherapy (3.4). Elevated levels of anxiety and depression at baseline predicted more anxiety and depression at the later assessments (P values < 0.0001). The ASCT group had higher levels of anxiety after 1 year (mean 4.8) than those found in the other two groups (SCT: 3.6, CT: 4.2), although they were not statistically significant. This study revealed lower than expected levels of anxiety and depression after intensive chemotherapy followed by SCT or ASCT. There was a decline in psychological distress during the 1-year follow-up period.

Adolescent↗
PubMed1999

Late medical sequelae after therapy for supradiaphragmatic Hodgkin's disease.

A total of 221 consecutive early stage Hodgkin's disease (HD) patients were given mantle field irradiation only or in combination with chemotherapy in 1971-1991. In 1994 these patients responded to a mailed self-report questionnaire covering items on late medical symptoms. Of 200 patients (91%) who reported that their thyroid function had been tested, 110 patients (55% of those tested) had thyroid hypofunction at follow-up in 1994. Ninety-five patients (86% of patients with biochemical hypothyreosis) had started hormonal substitution. In 1993 and 1994, 101 of these patients who had received mantle field irradiation in 1980-1988 were called in for interview, clinical examination and thyroid function tests. Eighteen patients (18%) had started hormonal substitution treatment earlier, but 58 (70%) of the other 83 patients were found to have biochemical hypothyreosis. Of the 221 patients who completed the questionnaire, 66 patients (30%) reported dyspnoea on exertion for more than 3 years after treatment, 8 patients (4%) reported a history of myocardial infarction, 6 patients (3%) reported pericardial disease and 25 patients (11%) heart valve disease. Increased expenses incurred for dental care were reported by 106 patients (48%), increasing to 55% when Waldeyer's ring had been irradiated. The consequences of late sequelae after mantle field irradiation for future treatment are discussed.

Adolescent↗
PubMed1999

Hodgkin's disease survivors more fatigued than the general population.

PURPOSE: To estimate the level of fatigue and frequency of fatigue cases among Hodgkin's disease survivors (HDS) and compare them with normative data from the general population. PATIENTS AND METHODS: A cross-sectional follow-up study was done of 557 HDS (age range, 19 to 74 years) treated at the Norwegian Radium Hospital from 1971 to 1991. The sample was approached by mail, and their data were compared with normative data from 2,214 controls (age range, 19 to 74 years) representative of the general Norwegian population. Of the 557 HDS, 459 (82%) responded. The mean age (+/- SD) at the time of study was 44+/-12 years, and the mean observation time was 12+/-6 years. The Fatigue Questionnaire (11 items) measures physical and mental fatigue. Two systems of scoring were used, dichotomized (0, 0, 1, and 1) and Likert (0, 1, 2, and 3). Total fatigue (TF) constitutes the sum of all the Likert scores. Caseness was defined as a total dichotomized score of > or =4 and fatigue that lasted 6 months or longer. RESULTS: The HDS had significantly higher levels of TF than the controls (14.3 v 12.2) (P < .001). Fatigue among the HDS equaled that of the controls in poorest health. More HDS (61%) than controls (31%) reported fatigue symptoms lasting 6 months or longer (P < .001). Fatigue cases were more frequent among HDS (men, 24%; women, 27%) than among the controls (men, 9%; women, 12%) (P < .001). Disease stage/substage IB/IIB predicted fatigue caseness (P = .03). No significant associations were found between treatment characteristics and fatigue. CONCLUSION: Hodgkin's disease survivors are considerably more fatigued than the general population and report fatigue of a substantially longer duration.

Adult↗
PubMed1998

[Depression and Down syndrome].

Emotional and behavioural disorders are frequent complications of mental retardation that often go unrecognised or untreated. We describe a 13-year old girl with Down's syndrome and depressive illness who responded well to paroxetin. The importance of organizing comprehensive health provision for children with mental retardation in a way that focuses both psychiatric and physical illness is emphasised.

Adolescent↗
PubMed1998

Fatigue in the general Norwegian population: normative data and associations.

Population norms for interpretation of fatigue measurements have been lacking, and the sociodemographic associations of fatigue are poorly documented. A random sample of 3500 Norwegians, aged 19-80 years, was therefore investigated. A mailed questionnaire included the fatigue questionnaire (11 items) in which the sum score of the responses (each scored 0, 1, 2, 3) is designated as total fatigue (TF). Sixty-seven percent of those receiving the questionnaire responded. Women (TF mean=12.6) were more fatigued than men (TF mean=11.9), and 11.4% reported substantial fatigue lasting 6 months or longer. TF and age were weakly correlated (men: r=0.17; women: r=0.09). No firm associations between fatigue and social variables were found. Disabled and subjects reporting health problems were more fatigued than subjects at work or in good health. Fatigue is highly prevalent in somatic and psychiatric disorders, but is often neglected. This national representative sample provides age- and gender-specific norms that will allow for comparisons and interpretations of fatigue scores in future studies.

Adult↗
PubMed1998

Translation and performance of the Norwegian SF-36 Health Survey in patients with rheumatoid arthritis. I. Data quality, scaling assumptions, reliability, and construct validity.

The SF-36 was translated into Norwegian following the procedures developed by the International Quality of Life Assessment (IQOLA) Project. To test for the appropriateness of the Norwegian Version 1.1 of the SF-36 in patients with rheumatoid arthritis (RA), 1552 RA patients were mailed the form. Psychometric methods used in previous U.S. and Swedish studies were replicated. The response rate was 66%. The sample (mean age 62 years, mean disease duration 13 years) was over-represented by females (79%). Totally, 74% of the questionnaires were complete. Missing value rates per item ranged from 0.4% to 9.0% (mean 4.2%). In the Role-Emotional scale, all three items had missing value rates above average and higher than reported in the U.S. and Swedish studies. Tests of scaling assumptions confirmed the hypothesized structure of the questionnaire, but results were suboptimal in the General Health scale. In all scales the Cronbach's alphas exceeded the 0.70 standard for group comparisons. In the Physical Functioning scale, Cronbach's alpha exceeded the 0.90 standard for individual comparisons. There was good evidence for the construct validity of the questionnaire. Generally, the Norwegian SF-36 version 1.1 distributed to RA patients held the psychometric properties found in other countries and in normal populations. The translations of items in the General Health and Role-Emotional scales were reassessed. Minor deficiencies were detected and changed (SF-36 Norwegian Version 1.2).

Arthritis, Rheumatoid↗
PubMed1998

Socio-medical situation for long-term survivors of Hodgkin's disease: a survey of 459 patients treated at one institution.

We present the socio-medical situation for 459 adult disease-free long-term survivors of Hodgkin's disease (HD) 3-23 years after first line curative treatment. In 1994, 557 patients were sent a self-report questionnaire relating to their social status and 459 patients (82%) replied. Educational or professional plans were changed due to HD in 142 patients (32%). After 6, 12 and 18 months from start of treatment, 52, 82 and 95% of the patients, respectively, had returned to their job or education. The sum of full-time and part-time employment was in men 78% at diagnosis and 85% at follow-up, and in women 57% at diagnosis and 64% at follow-up. Only 2% of men and 3% of women did not have a job at follow-up in 1994. At diagnosis 2% of the patients were permanently disabled versus 19% at follow-up in 1994. Age > 40 years at diagnosis, increased the total score of psychological distress and fatigue and long-term disablement after first line treatment were predictors for permanent disablement. Transient or permanent sexual problems were reported in 16% and 13%, respectively. MVPP (mustine, vinblastine, procarbazine and prednisone) or LVPP (chlorambucil, vinblastine, procarbazine and prednisone) chemotherapy was responsible for most cases of early menopause in women older than 30 years, and of infertility in both men and women. In summary, most long-term HD survivors had adapted well to their socio-medical situation except a high number of permanently disabled patients. By focusing more on factors predisposing for permanent disablement and early treatment for these, more patients may be helped to return to their job.

Adolescent↗
PubMed1998

Short form 36 (SF-36) health survey: normative data from the general Norwegian population.

Anchoring health-related quality of life (HRQOL) measures in population norms makes clinical interpretations more meaningful and is in accordance with practice in other fields of medicine. In this paper norms for the Short Form 36 (SF-36) are presented in a random sample, representative of the general Norwegian population. In addition, sociodemographic variables affecting the scale scores are explored and discussed. The response rate was 67%, being lowest among subjects aged 70 years or over. Data-completeness strongly declined with increasing age. Physical health scales were also strongly affected by age. In all scales, with the exception of general health perceptions, women reported having poorer health than men. Marital status affected the four mental health scales. Educational status affected all the scales, but the effect was smallest in the mental scales. These norms can be employed for comparison in case-control studies, or to interpret HRQOL changes in prospective studies. Differences in social status should be given special attention. Caution should be exercised when assessing subjective health or employing the norms among subjects aged 70 years or over.

Activities of Daily Living↗
PubMed1998

Hodgkin's disease: quality of life in future trials.

It is of great importance to collect data of objective as well as subjective morbidity in patients cured for Hodgkin's disease. Such information may be used when new treatment strategies are discussed, in patients information and communication, to establish rehabilitation programs and to identify individuals who may benefit from rehabilitation. Measurement of health related quality of life (HRQOL) may give important information on how the cancer and/or the treatment has influenced the patients. There is no gold standard instrument for measurement of HRQOL in cancer. However, it is a consensus to use multidimensional patients rated measures with a standard format and scoring procedure. SF-36, EORTC QLQ-C30 and FACT are widely used in Europe and North America. Domain specific instruments includes a more comprehensive evaluation of a specific domain, for example anxiety or fatigue. Fatigue seems to be a prevalent symptom in Hodgkin's disease survivors and might affect patients' ability to perform normal activities and will often reduce their quality of life. Fatigue is defined as a subjective feeling of tiredness and might be measured by standardised and validated instruments such as the Fatigue Questionnaire (FQ) and the Multi-Dimensional Fatigue Inventory (MFI-20). Clinical significance might be defined as a meaningful difference based on consensus by the patient, the doctor and the society. In oncology there is no agreement of how long a meaningful difference in survival should be. For HRQOL a difference between 7 to 10 on a scale ranking from 0 to 100 has been regarded as clinical significant by some researchers. Another strategy to approach the issue of clinical significance is to use norms-estimates from the normal population- and/or reference estimates as guidelines. The long-term complication of the successful treatment of Hodgkin's disease reinforced the need for continued surveillance of treatment and related morbidities. Fatigue is a prevalent symptom and detailed diagnostic work-up is essential to identify patients with this problem. More knowledge about possible biological causes is required in order to understand fatigue and the impact on quality of life among Hodgkin's disease survivors.

Clinical Trials as Topic↗
PubMed1997

Disclosing the cancer diagnosis: the patients' experiences.

497 Norwegian cancer patients (346 females, 151 males, mean age = 56 years (S.D. = 12)), admitted to a cancer rehabilitation centre, were surveyed on how they were told their diagnosis. Predictors of general satisfaction with the information were assessed. 43% of the subjects were informed by phone, letter or in the corridor/on the round and estimated that the information was presented in less than 5 minutes. Satisfaction with the information was predicted by perceiving the physicians as personally interested (B = 0.528, P < 0.001), comprehending the information (B = 0.245, P < 0.001), being informed in the physicians' offices (B = 0.338, P < 0.001), being informed by physicians at oncological departments (B = 0.278, P = 0.01) and increasing time spent on the disclosure (B = 0.140, P = 0.01). Other aspects of physician-patient communication than the pure presentation of valid information is highly valued by the patients. However, a substantial proportion of physicians present the cancer diagnosis in such a manner that the possibility of engaging in conversation about the diagnosis and the effect upon the patient is very limited. The findings call for remedial attention to the subject and improvement in performance.

Adaptation, Psychological↗
PubMed1997

Psychological distress after cancer cure: a survey of 459 Hodgkin's disease survivors.

To assess the levels of psychological distress and identify predictors of anxiety/depression caseness after cancer cure, a national population of 557 Hodgkin's disease (HD) survivors was surveyed. The respondents [204 women, 255 men, mean age 44 years (SD = 12)] returned a mailed questionnaire including The Hospital Anxiety and Depression Scale (HADS). Disease and treatment variables were based on the hospital records. A total of 27% had caseness scores (anxiety, 14.5%; depression, 4%; anxiety and depression, 8.5%). In a multiple logistic regression analysis, anxiety caseness was predicted by low educational status [OR (odds ratio) = 2.07, 95% CI = 1.02-4.22], observational period 7 years or longer (7-10 years: OR = 3.07, 95% CI = 1.26-7.47), combined irradiation and chemotherapy treatment (OR = 2.77, 95% CI = 1.17-6.54) and psychiatric symptoms before HD (OR = 2.55, 95% CI = 1.40-4.65) or during treatment (OR = 3.51, 95% CI = 2.08-5.90). Depression caseness was predicted by age (OR = 1.03, 95% CI = 1.00-1.06) and psychiatric symptoms before HD (OR = 5.1, 95% CI = 2.55-10.31) Anxiety cases are more prevalent than in the general Norwegian population, and were found to be most common 7-10 years after treatment. The most intensive treatment was associated with increased risk for anxiety caseness. The subjects experienced distress during treatment precedes difficulties in long-term adjustment. Focusing on these predictors during treatment and follow-up controls may improve long-term outcome.

Adult↗
PubMed1996

Attitudes toward informing the cancer patient--a survey of Norwegian physicians.

To examine Norwegian physicians' attitudes to informing patients of a diagnosis of cancer, a random sample of 1467 were surveyed. The respondents rated their level of agreement to 14 statements, and the responses were analysed by chi-squared statistics. 990 physicians responded (67%). Only 30.5% of the responding physicians had treated more than 10 cancer patients the previous year, which included 7.8% who had treated more than 50. 40.4% had treated none. The great majority (81%) preferred full information of the diagnosis. Physicians with increasing age preferred relatives not being present and gave priority to factual information and informing patients with the same diagnosis identically. Hospital physicians (39.5%) more often preferred other health professionals being present than physicians in private practice (18%) (P < 0.001). Number of cancer patients treated was not associated with attitudes toward the disclosure of information. Norwegian physicians prefer revealing the cancer diagnosis to patients, but have divergent opinions about how to do so. Some of these indicate suboptimal information-giving.

Adult↗
PubMedDate not supplied

Compliance in quality of life data: a Norwegian experience.

Compliance is of extreme importance in assessing quality of life since lost data never can be retrieved. In order to assess this issue in various studies, a cross-sectional study in cured cancer patients, three prospective trials and a normative study were explored. In the cross-sectional study 82 per cent of the patients completed the questionnaires after one reminder. More females than males answered the questionnaires. The compliance rate varied from 99 per cent to 62 per cent in the prospective studies depending upon time after inclusion. It seems that compliance decreases during follow up, primarily because of disease progression. In one of the prospective studies low compliance rate (approximately 30 per cent) was found in the questionnaire assessing religious issues. In the normative study 68 per cent of the population completed the questionnaire. No gender differences were found, but younger males and elderly women were poor compliers. In conclusion, our data support that most patients complete quality of life questionnaires. It seems that patients with inferior education, reduced physical function and with progressive/terminal disease are low compliers. Introduction of the first quality of life questionnaires to the patients is of great importance. Detailed information about the study should be given and the importance of completing the questionnaires should be underlined.

Adult↗