Background: Previous studies showed that women with breast cancer treated in anthroposophic clinic versus conventional care had increased quality of life (QoL) parameters, fighting spirit, and anxiety coping. We have now analyzed immune and QoL factors in these 2 groups for possible differences during the first 6 months after admission, prompted by anthroposophic studies, including mistletoe extracts, showing beneficial immune system effects.

Patients and Methods: Fourteen immunological variables, including leukocyte count, lymphocyte count, activated T cells (CD4+ and CD8+), NK cells, B cells, IL1β, IL6, IL10, and oxytocin, were longitudinally analyzed in both groups (n = 2 × 26). A panel of QoL parameters were analyzed using 3 different instruments. Statistical evaluation included that each patient was its own control.

Results: Cytotoxic CD8+ T cell frequency (percent of lymphocytes analyzed by flow-cytometry) significantly decreased over time in the anthroposophic group versus the conventional group (repeated measures ANOVA, p = 0.05). No major differences were observed in other immunological parameters, whereas QoL variables, anxiety decreased and physical symptoms increased/improved significantly in the anthroposophic group (p = 0.04 and p = 0.05, respectively).

Conclusion: Overall, women with breast cancer in anthroposophic or conventional therapy did not differ in their immune profiles over time, with exception of decreased cytotoxic T cells in the anthroposophic group. Improvement in physical symptoms along with less anxiety in this group may have influenced the brain-immune axis resulting in lower frequency of CD8+ T cells, a feature associated with less aggressive cancer stages. To evaluate whether this observation is associated with good or bad prognosis, further detailed analyses of memory and naïve CD8+ T cells at tumor site and in blood circulation are essential.

Hintergrund: Bisherige Studien haben gezeigt, dass die Behandlung von Brustkrebspatientinnen in anthroposophischen Kliniken gegenüber einer konventionellen Behandlung mit einer verbesserten Lebensqualität (quality of life; QoL), größerem Kampfgeist und einer besseren Angstbewältigung einhergeht. Angespornt durch anthroposophische Studien, solche mit Mistelextrakt eingeschlossen, die eine günstige Wirkung auf das Immunsystem zeigten, haben wir nun Immun- und QoL-Faktoren in diesen beiden Gruppen während der ersten 6 Monate nach Aufnahme untersucht.

Patienten und Methoden: 14 immunologische Variablen, einschließlich Leukozyten- und Lymphozytenzahl, aktivierter T-Zellen (CD4+ und CD8+), NK-Zellen, B-Zellen, IL1β, IL6, IL10 und Oxytocin, wurden in beiden Gruppen longitudinal analysiert (n = 2 × 26). Unter Zuhilfenahme von 3 verschiedenen Instrumenten wurde eine Reihe von QoL-Parametern analysiert. Die statistische Auswertung war so angelegt, dass jeder Patient als seine eigene Kontrolle diente.

Ergebnisse: Die Häufigkeit von zytotoxischen CD8+-T-Zellen (prozentualer Anteil an Lymphozyten analysiert mittels Durchflusszytometrie) nahm in der anthroposophischen gegenüber der konventionell behandelten Gruppe im Zeitverlauf signifikant ab (wiederholte ANOVA-Messungen; p = 0,05). Während für weitere immunologische Parameter keine größeren Unterschiede festgestellt wurden, verbesserten sich die QoL-Variablen; die Angst verringerte sich und die physischen Symptome verbesserten sich signifikant in der anthroposophischen Gruppe (p = 0,04 bzw. p = 0,05).

Schlussfolgerung: Insgesamt zeigte sich, dass es während des untersuchten Zeitraums keinen Unterschied in den Immunprofilen von Brustkrebspatientinnen mit anthroposophischer gegenüber solchen mit ausschließlich konventioneller Therapie gab. Die Verbesserung der physischen Symptome sowie die verringerte Angst in dieser Gruppe könnte die Gehirnimmunachse beeinflusst und zu einer geringeren Häufigkeit der CD8+-T-Zellen, einem Kennzeichen für weniger aggressive Tumorstadien, geführt haben. Um beurteilen zu können, ob diese Beobachtung mit einer guten oder schlechten Prognose assoziiert ist, sind weitere detaillierte Untersuchungen von Gedächtnis- und naiven CD8+-T-Zellen am Tumorort und in der Blutzirkulation unerlässlich.

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Objective: Evaluation of pure-tone audiometry (PTA) in hearing screening of a population with mild to profound intellectual disability (ID).

Design: PTA was performed at six frequencies at the screening level 20 dB HL. Referral criteria were threshold levels ≥ 25 dB HL at two or more frequencies for one ear or both.

Study sample: 1478 participants aged 7–91 years were included.

Results: 1470 (99.5%) people cooperated in screening of which 1325 (90%) could be tested on both ears at all six frequencies. A majority, 987 (66.8%), performed ordinary PTA, 234 (15.8%) conditioned play audiometry, and 249 (16.9%) behavioural observation audiometry. Six hundred and sixty-nine (45%) passed and 809 (55%) failed according to referral criteria. Of those failing, 441 (54.5%) accepted referral to clinical evaluation.

Conclusions: PTA with slight modifications is applicable for screening of a population with mild to profound intellectual disability. The most challenging and time-consuming activity is to introduce the test procedure in a way that reduces anxiety and establishes trust.

PURPOSE: To estimate the proportion of locomotor disabilities in two elderly populations in Sweden and Poland, respectively. To estimate the perceived quality of life (QoL) in the disabled groups in samples from each country using a model developed by Carol Estwing Ferrans.

METHODS: The study comprised three parts: an epidemiological screening test for identification of individuals with a locomotor disability, an analysis of background data of importance and home visits with evaluations of quality of life and functional capacity. Home visits were made using the Quality of Life Index, (QLI) of Ferrans and Powers and a functional scale, the Standardized Practical Equipment (SPE). Data were collected for the period 1991-1996.

RESULTS: In the population part of the study, with 1,380 respondents (78%) comprising elderly Swedish persons, 288 reported a locomotor disability. This can be compared with 425 among 1,045 respondents (52%) in a Polish elderly group. The tests at the home visits (Sweden, n = 89; Poland, n = 84) showed that both men and women in the Swedish group reported significantly higher scores for the total QLI (max. 30.00) with men reporting 26.68 points compared to 19.73 and women reporting 21.39 points compared to 19.40 and for three of the four subscales. Also, the Polish group scored lower for balance and mobility (SPE).

CONCLUSION: The study provides an important view of the life situation measured with the QLI tool and the SPE for elderly persons with locomotor disorders in Sweden and Poland during the mid-1990s. The results are congruent with epidemiological reports on the poor health situation in Poland, particularly during that time. A new investigation among the elderly with locomotor disorders in the two countries today might provide different results.

The overall aim was to describe and compare well-being, social life, and quality care among parents of children with cancer with respect to mothers versus fathers and whether the children were on versus. off treatment. The Life Situation Scale for Parents (LSS-P) was answered by 320 parents, comprising 85 mothers and 71 fathers of children on treatment, and 93 mothers and 71 fathers of children off treatment. The results show that the well-being of parents of children with cancer is affected by their child's situation, and that they experience such things as economic strain and a sense of being dependent on the care provided, especially during the child's treatment phase. Mothers whose children are receiving treatment see their life situation as less satisfying, and report being sadder and having lower self-esteem.

To assess and identify early sign as well as to follow up the progress or regress of acute confusion are important in nursing care. For this purpose different instruments have been developed and tested psychometrically. One of these instruments is the NEECHAM Confusion Scale. The aim of this article is to describe the development and content of the NEECHAM Confusion Scale and its application in a Swedish sample. This scale is a screening instrument for rapid and non-intrusive assessment and contains nine items organized in three domains; cognitive functions; behavioral measures; physiological control and stability. Possible total score ranging from 0 (minimal responsiveness) to 30 (normal function). A score equal to or less than 24 indicated the presence of confusion. The scale has been psychometrically tested among elderly patients with hip fractures in Sweden. The internal consistency (Cronbach´s alpha coefficient) was satisfactory at two test occasions .73 versus .82 and the construct validity with a three-factor solution accounted for 69% and 73% of the variance. Four months after discharge the predictive value showed a correlation between level of confusion, quality of life, and functional capacity. The study and the literature confirmed that the NEECHAM-scale can be helpful both for patients with delirium and those responsible of the care.

The aim of this study was to explore the pattern of the Swedish version of the Philadelphia Geriatric Center Multilevel Assessment Instrument (PGCMAI), in respect of age and gender, in a sample of old people with locomotor disability from a population aged 60 years and older in Sweden and compare it with other studies in the same area for the purpose of further validation. The participants (n = 199) were selected from a population (n = 3469), age ≥60 years, in two counties in Sweden and were visited in their own homes. The measure was carried out with two instruments, the Swedish version of PGCMAI, used as an interview, and the Standardized Practical Equipment test consisting of practical tasks. We found that these two instruments distinguished the functional pattern among old men and women where women had deteriorated most with age. This is in agreement with other studies.

We examined whether the Swedish adaptation of the Philadelphia Geriatric Center Multilevel Assessment Instrument (PGCMAI) developed by Lawton meets criteria for reliability and validity in an elderly Swedish population with locomotor disability. Data were collected, using the mid-length version of the instrument, from 199 elderly people with locomotor disability in two Swedish counties. Reliability was determined by Cronbach's alpha and construct validity was tested by means of exploratory factor analysis. Comparison was made with the Standardized Practical Equipment (SPE) test. Factor analysis identified eight factors, which were comparable to the original eight domains. There was a logical correlation between the PGCMAI and the SPE test. Further psychometric testing is recommended on other groups of elderly people.