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Biomedical subjects

S Kaasa

Publications and source records attributed to S Kaasa.

At least 73 records · Page 4Linked to original sources
PubMed1999

Pharmacoeconomic considerations in treating patients with acute leukaemia.

Whereas individual cost-effectiveness analyses of new agents for acute leukaemia should be performed in target populations, any meaningful pharmacoeconomic evaluation of treatment options for this condition should include the many types of costs and outcomes in unselected, representative groups of patients. Both direct costs (e.g. costs for medication and hospitalisation) and indirect costs (e.g. lost productivity costs and reduced quality of life) are important parameters to assess, as are the costs of chronic adverse effects, research and development costs for new agents, and costs of procedure-related deaths. Complete remission, cure and survival are the 'success' response criteria for acute leukaemia treatments, in addition to prolonged life with acceptable quality of life for patients with incurable acute leukaemia. Death is 'failure', caused either by resistant disease (relapse and progressive disease) inspite of optimal chemotherapy or, sometimes, by insufficient treatment. All of these parameters should be taken into account when a pharmacoeconomic evaluation is performed (either for administrative or scientific purposes) in order to ensure a comprehensive and reliable background for the evaluation in question. Treatment of acute leukaemia is expensive with a total cost of about $US3000 per patient per day during the induction. Although 80% of children with acute leukaemia are cured, only less than 50% of adults are cured. Thus, a great cost is associated with death during treatment and only optimal medical treatment with full-scale combination chemotherapy and full supportive treatment can keep the number of deaths to a minimum.

Acute Disease↗
PubMed1998

[Self-evaluation of knowledge and competence with regard to the treatment of pain].

In a survey completed at our hospital, 519 doctors and nurses were asked to evaluate their own knowledge and competence with regard to the treatment of various types of pain, including non-pharmacologic treatment methods. A total of 473 responded to the questionnaire. In the study, cancer-related pain and pain from causes other than cancer were assessed in separate population groups. Of the doctors, 58% evaluated their knowledge of nociceptive pain as very good or fairly good. The corresponding findings for neuropathic pain were 31%, for psychological pain 27%, for social pain 25% and for spiritual and existential aspects of pain 22%. The nurses scored lower than the doctors on knowledge and competence in relation to nociceptive and neuropathic pain (32% and 18% respectively), and higher on treatment of the psychological and social aspects of pain (44% and 36% respectively). Many of the doctors and nurses evaluated their knowledge as fairly poor or very poor with regard to nonpharmacologic treatment methods. In both professions 80% answered that depression was seen fairly often or very often among these patients.

Analgesia↗
PubMed1998

Malnutrition and food intake in relation to quality of life in head and neck cancer patients.

BACKGROUND: The quality of life (QL) of cancer patients has attracted an increasing interest in recent years. Patients with head and neck cancer often have troublesome symptoms due to the disease and to treatment side effects, which will have an impact on the patient's QL. The aim of this study was to evaluate the possibility of studying QL in relation to well-known clinical parameters. METHODS: Patient's QL was evaluated according to the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) combined with a diagnosis-specific questionnaire. Quality of life was measured in a cross section of head and neck cancer patients (n = 48) and related to nutritional status, energy intake, severity of disease, and 2-year survival. RESULTS: Fifty-one percent of the patients (mean age, 67 years) fulfilled the criteria proposed for malnutrition, and 55% had a negative energy balance. We did not find any correlation between the severity of the cancer disease and the patient's self-rated QL. However, we found significantly better QL ratings among the 2-year survivors (mean, 63; range 52-76 versus mean, 42; range, 31-54; p < .05). There were few correlations between the QL items and malnutrition. CONCLUSIONS: Quality of life measurements offer objective information on well-being, sometimes quite opposite that of other clinical parameters, such as tumor stage. Furthermore, QL measurements may be of prognostic value concerning the survival of head and neck cancer patients.

Adult↗
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

Translating health status questionnaires and evaluating their quality: the IQOLA Project approach. International Quality of Life Assessment.

This article describes the methods adopted by the International Quality of Life Assessment (IQOLA) project to translate the SF-36 Health Survey. Translation methods included the production of forward and backward translations, use of difficulty and quality ratings, pilot testing, and cross-cultural comparison of the translation work. Experience to date suggests that the SF-36 can be adapted for use in other countries with relatively minor changes to the content of the form, providing support for the use of these translations in multinational clinical trials and other studies. The most difficult items to translate were physical functioning items, which used examples of activities and distances that are not common outside of the United States; items that used colloquial expressions such as pep or blue; and the social functioning items. Quality ratings were uniformly high across countries. While the IQOLA approach to translation and validation was developed for use with the SF-36, it is applicable to other translation efforts.

Cross-Cultural Comparison↗
PubMed1998

Cross-cultural comparisons of the content of SF-36 translations across 10 countries: results from the IQOLA Project. International Quality of Life Assessment.

Increasingly, translated and culturally adapted health-related quality of life measures are being used in cross-cultural research. To assess comparability of results, researchers need to know the comparability of the content of the questionnaires used in different countries. Based on an item-by-item discussion among International Quality of Life Assessment (IQOLA) investigators of the content of the translated versions of the SF-36 in 10 countries, we discuss the difficulties that arose in translating the SF-36. We also review the solutions identified by IQOLA investigators to translate items and response choices so that they are appropriate within each country as well as comparable across countries. We relate problems and solutions to ratings of difficulty and conceptual equivalence for each item. The most difficult items to translate were physical functioning items that refer to activities not common outside the United States and items that use colloquial expressions in the source version. Identifying the origin of the source items, their meaning to American English-speaking respondents and American English synonyms, in response to country-specific translation issues, greatly helped the translation process. This comparison of the content of translated SF-36 items suggests that the translations are culturally appropriate and comparable in their content.

Cross-Cultural Comparison↗
PubMed1998

Testing the equivalence of translations of widely used response choice labels: results from the IQOLA Project. International Quality of Life Assessment.

The similarity in meaning assigned to response choice labels from the SF-36 Health Survey (SF-36) was evaluated across countries. Convenience samples of judges (range, 10 to 117; median = 48) from 13 countries rated translations of response choice labels, using a variation of the Thurstone method of equal appearing intervals. Judges marked a point on a 10-cm line-representing the magnitude of a response choice label (e.g., "good" relative to the anchors of "poor" and "excellent"). Ratings were evaluated to determine the ordinal consistency of response choice labels within a response scale; the degree to which differences between adjacent response choice labels were equal interval; and the amount of variance due to response choice label, country, judge, and interaction between response choice label and country. Results confirmed the hypothesized ordering of response choice labels; the percentage of ordinal pairs ranged from 88.7% to 100% (median = 98.2%) across countries and response scales. Examination of the average magnitudes of response choice labels supported the "quasi-interval" nature of the scales. Analysis of variance (ANOVA) results supported the generalizability of response choice magnitudes across countries; labels explained 64% to 77% of the variance in ratings, and country explained 1% to 3%. These results support the equivalence of SF-36 response choice labels across countries. Departures from the assumption of equal intervals, when observed, were similar across countries and were greatest for the two response scales that are recalibrated under standard SF-36 scoring. Results provide justification for scoring translations of individual items using standard SF-36 scoring; whether these items form the same scales in other countries as they do in the United States is evaluated with tests of scaling assumptions.

Analysis of Variance↗
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

Performance of the Norwegian SF-36 Health Survey in patients with rheumatoid arthritis. II. A comparison of the SF-36 with disease-specific measures.

The performance of the SF-36 was compared with disease-specific health status instruments (Arthritis Impact Measurements Scales [AIMS2], Modified Health Assessment Questionnaire [MHAQ] and visual analogue scales) in 1030 patients with rheumatoid arthritis (mean age 62.3 years, 79% females, mean disease duration 12.9 years, 48% rheumatoid factor positive). The scales performed similarly in known group comparisons (age cohorts, disease severity, disease activity, comorbidity). The SF-36 physical functioning scale correlated -0.69 and -0.73 with the MHAQ and AIMS2 physical scales, respectively. A strong negative correlation was found with the walking and bending subscale of AIMS2 (r = -0.80), a substantial negative correlation with mobility (r = -0.65), and moderate correlations with the scales for hand/finger and arm function (r = -0.52 and r = -0.53). Frequency distributions of scores revealed more skewed distributions of the AIMS2 physical scale and the MHAQ scale than the physical functioning scale of the SF36, whereas the pain and mental health scales were distributed similarly. In conclusion, the SF-36 performs well in patients with rheumatoid arthritis. The physical functioning scale of the SF-36 does not seem to capture all aspects of physical health in rheumatoid arthritis patients, but may be more sensitive than disease-specific measures to low levels of physical disability.

Activities of Daily Living↗
PubMed1998

Tests of data quality, scaling assumptions, and reliability of the SF-36 in eleven countries: results from the IQOLA Project. International Quality of Life Assessment.

Data from general population samples in 11 countries (n = 1483 to 9151) were used to assess data quality and test the assumptions underlying the construction and scoring of multi-item scales from the SF-36 Health Survey. Across all countries, the rate of item-level missing data generally was low, although slightly higher for items printed in the grid format. In each country, item means generally were clustered as hypothesized within scales. Correlations between items and hypothesized scales were greater than 0.40 with one exception, supporting item internal consistency. Items generally correlated significantly higher with their own scale than with competing scales, supporting item discriminant validity. Scales could be constructed for 93-100% of respondents. Internal consistency reliability of the eight SF-36 scales was above 0.70 for all scales, with two exceptions. Floor effects were low for all except the two role functioning scales; ceiling effects were high for both role functioning scales and also were noteworthy for the Physical Functioning, Bodily Pain, and Social Functioning scales in some countries. These results support the construction and scoring of the SF-36 translations in these 11 countries using the method of summated ratings.

Cross-Cultural Comparison↗
PubMed1998

The factor structure of the SF-36 Health Survey in 10 countries: results from the IQOLA Project. International Quality of Life Assessment.

Studies of the factor structure of the SF-36 Health Survey are an important step in its construct validation. Its structure is also the psychometric basis for scoring physical and mental health summary scales, which are proving useful in simplifying and interpreting statistical analyses. To test the generalizability of the SF-36 factor structure, product-moment correlations among the eight SF-36 Health Survey scales were estimated for representative samples of general populations in each of 10 countries. Matrices were independently factor analyzed using identical methods to test for hypothesized physical and mental health components, and results were compared with those published for the United States. Following simple orthogonal rotation of two principal components, they were easily interpreted as dimensions of physical and mental health in all countries. These components accounted for 76% to 85% of the reliable variance in scale scores across nine European countries, in comparison with 82% in the United States. Similar patterns of correlations between the eight scales and the components were observed across all countries and across age and gender subgroups within each country. Correlations with the physical component were highest (0.64 to 0.86) for the Physical Functioning, Role Physical, and Bodily Pain scales, whereas the Mental Health, Role Emotional, and Social Functioning scales correlated highest (0.62 to 0.91) with the mental component. Secondary correlations for both clusters of scales were much lower. Scales measuring General Health and Vitality correlated moderately with both physical and mental health components. These results support the construct validity of the SF-36 translations and the scoring of physical and mental health components in all countries studied.

Cross-Cultural Comparison↗
PubMed1998

The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: results from the IQOLA Project. International Quality of Life Assessment.

Data from general population surveys (n = 1771 to 9151) in nine European countries (Denmark, France, Germany, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom) were analyzed to test the algorithms used to score physical and mental component summary measures (PCS-36/MCS-36) based on the SF-36 Health Survey. Scoring coefficients for principal components were estimated independently in each country using identical methods of factor extraction and orthogonal rotation. PCS-36 and MCS-36 scores were also estimated using standard (U.S.-derived) scoring algorithms, and results were compared. Product-moment correlations between scores estimated from standard and country-specific scoring coefficients were very high (0.98 to 1.00) for both physical and mental health components in all countries. As hypothesized for orthogonal components, correlations between physical and mental components within each country were very low (0.00 to 0.12) for both estimation methods. Mean scores for PCS-36 differed by as much as 3.0 points across countries using standard scoring, and mean scores for MCS-36 differed across countries by as much as 6.4 points. In view of the high degree of equivalence observed within each country, using standard and country-specific algorithms, we recommend use of standard scoring algorithms for purposes of multinational studies involving these 10 countries.

Algorithms↗
PubMed1998

Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment.

Data from general population surveys (n = 1483 to 9151) in nine European countries (Denmark, France, Germany, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom) were analyzed to cross-validate the selection of questionnaire items for the SF-12 Health Survey and scoring algorithms for 12-item physical and mental component summary measures. In each country, multiple regression methods were used to select 12 SF-36 items that best reproduced the physical and mental health summary scores for the SF-36 Health Survey. Summary scores then were estimated with 12 items in three ways: using standard (U.S.-derived) SF-12 items and scoring algorithms; standard items and country-specific scoring; and country-specific sets of 12 items and scoring. Replication of the 36-item summary measures by the 12-item summary measures was then evaluated through comparison of mean scores and the strength of product-moment correlations. Product-moment correlations between SF-36 summary measures and SF-12 summary measures (standard and country-specific) were very high, ranging from 0.94-0.96 and 0.94-0.97 for the physical and mental summary measures, respectively. Mean 36-item summary measures and comparable 12-item summary measures were within 0.0 to 1.5 points (median = 0.5 points) in each country and were comparable across age groups. Because of the high degree of correspondence between summary physical and mental health measures estimated using the SF-12 and SF-36, it appears that the SF-12 will prove to be a practical alternative to the SF-36 in these countries, for purposes of large group comparisons in which the focus is on overall physical and mental health outcomes.

Cross-Cultural Comparison↗
PubMed1998

Use of structural equation modeling to test the construct validity of the SF-36 Health Survey in ten countries: results from the IQOLA Project. International Quality of Life Assessment.

A crucial prerequisite to the use of the SF-36 Health Survey in multinational studies is the reproduction of the conceptual model underlying its scoring and interpretation. Structural equation modeling (SEM) was used to test these aspects of the construct validity of the SF-36 in ten IQOLA countries: Denmark, France, Germany, Italy, the Netherlands, Norway, Spain, Sweden, the United Kingdom, and the United States. Data came from general population surveys fielded to gather normative data. Measurement and structural models developed in the United States were cross-validated in random halves of the sample in each country. SEM analyses supported the eight first-order factor model of health that underlies the scoring of SF-36 scales and two second-order factors that are the basis for summary physical and mental health measures. A single third-order factor was also observed in support of the hypothesis that all responses to the SF-36 are generated by a single, underlying construct--health. In addition, a third second-order factors, interpreted as general well-being, was shown to improve the fit of the model. This model (including eight first-order factors, three second-order factors, and one third-order factor) was cross-validated using a holdout sample within the United States and in each of the nine other countries. These results confirm the hypothesized relationships between SF-36 items and scales and justify their scoring in each country using standard algorithms. Results also suggest that SF-36 scales and summary physical and mental health measures will have similar interpretations across countries. The practical implications of a third second-order SF-36 factor (general well-being) warrant further study.

Cross-Cultural Comparison↗
PubMed1998

Using reference data on quality of life--the importance of adjusting for age and gender, exemplified by the EORTC QLQ-C30 (+3).

Interpretation of health related quality of life (HRQOL) results in cancer patients is facilitated by knowledge of the levels of HRQOL in the general population. However, direct comparisons can be misleading unless age and gender are considered. We demonstrate the derivation of age- and gender-specific 'expected' values from population reference values by means of simple calculations. This survey included 3000 randomly selected Norwegians above 18 years of age who received the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30 (+3) by mail. 1965 responses from 2,892 eligible persons (68%) were received. The population was divided into six disease groups based on self-reported health problems. The observed mean scale scores of the different groups deviated greatly from those obtained in the general population. The score for physical function, for example, was 72 for cancer patients and ranged from 73.3 to 82.5 in other disease groups, as opposed to 89.9 in the general population and 98.9 in those with no health problems. The range for one of the quality of life (QOL) scales was 57.7 to 84.7 compared with 73.7 in the general population. Expected mean scores for the patient groups were computed from the reference values, based on the concept of equivalence of age and gender. The differences between the observed mean scores and the reference values were strongly mediated by this method. The expected scores for physical function then ranged from 83.3 to 93.1 and from 70.3 to 75 for the QOL scale. The impact of age and gender on the reference data from the EORTC QLQ-C30 (+3) obtained in a general population shows that these variables must be considered when interpreting data on HRQOL for cancer patients. The demonstration of how to generate mean values which are adjusted according to the age and gender distribution of a population should increase the usefulness of this questionnaire among clinicians.

Adult↗
PubMed1998

Cancer patients use of nonproven therapy: a 5-year follow-up study.

PURPOSE: To investigate the prospective pattern of use of alternative medicine, here called nonproven therapy (NPT), among oncologic patients during a 5-year period, and the relationship between this use and survival, a questionnaire-based follow-up study was performed at the Department of Oncology, University of Tromsø, from 1990 to 1996. PATIENTS AND METHODS: Two-hundred fifty-two patients answered the first questionnaire during the period July 1990 to July 1991. Eligible patients were mailed follow-up questionnaires after 4, 12, 24 and 60 months. A telephone interview performed after the last follow-up questionnaire showed little disagreement with the prospective collected information as regards the number of patients reported as users of NPT (kappa, 0.92). RESULTS: The number of patients who reported ever using NPT in each cross-sectional part of the study varied between 17.4% and 27.3%. However, the estimated cumulative risk of being a user of NPT during the follow-up period was 45%. Seventy-four percent of NPT users in this north Norwegian study population used faith healing or healing by hand (spiritual NPT) alone or in combination with other forms of NPT. The proportion of patients who used spiritual versus nonspiritual forms of NPT was consistent throughout the follow-up period. Women were more often users than men (50% v 31%, P = .002). Patients older than 75 years of age seldomly used NPT. The 5-year observed survival rate was not influenced by the use of NPT. Adjusted for sex, age, and diagnosis, patients with a high educational level had a borderline higher 5-year survival rate than patients with less education (P = .06). CONCLUSION: Our results demonstrate that cross-sectionally designed studies will underestimate the number of ever-users of NPT in a cancer patient population. The use of NPT does not influence observed survival among cancer patients seen in north Norway.

Adolescent↗