Forskningsartikler

Abstract

Background: Research has shown that a family member’s problematic substance use has significant deleterious mental and physical health impacts on other members of the family. Women are more often affected than men. These negative health effects persist as the person with problematic substance use ages, and they vary according to the relationship status.

Aim: The aim of this study was to gain a deeper understanding of how women experience and are affected by their family member’s substance use problems.

Method: A metaphorical analysis of narrative interviews with 11 daughters and five wives of older adults (>65 years) with problematic substance use.

Results: We identified four areas of signification in which metaphors were employed: (1) experiences (chaos and crash and walking on eggshells); (2) strategies (complicity and silencing); (3) dilemmas (deceit or a disease and open or closed dilemmas); and (4) consequences (obtaining or retaining an identity, health and different types of help).

Conclusion: Family life with a parent or spouse with a substance use problem was described as chaotic, unsafe, uncertain and with no prospects of change. The study illustrates how metaphors are used to mediate experiences and worldviews pertaining to existential matters founded in deep negative emotions, deceit, shame and stigma. Metaphors make up a crucial material for communicating emotions and themes that are difficult to convey due to shame and stigma.

Aud Johannessen, Anne-Sofie Helvik, Kjerstin Tevik, Thomas Tjelta, and Kirsten Thorsen

Background: More women are living with dementia than men worldwide and there is a need to investigate causes for this female preponderance. While reproductive factors have been investigated as risk factors, the results are conflicting. We aim to clarify this using a large cohort with a long observation time, adjusting for multiple health and lifestyle variables and encompassing a wider range of cognitive impairment.

Objective: To study the association between menopause age, menarche age and risk of and risk of mild cognitive impairment (MCI) and dementia.

Setting: The Trøndelag Health study (HUNT), a longitudinal population health study in Norway (1984–2019).

Participants: Women who were ≥70 years in 2017–2019 were assessed for cognitive impairment.

Measurements: Data on menopause age and menarche age were obtained from questionnaires. Diagnosis of MCI or dementia was set using a standardised procedure by a diagnostic group of nine physicians. Multinomial logistic regression was used to study the association between menopause age, menarche age and risk of MCI and dementia with adjustment for birth year, education, smoking, ApoE4, number of children, diabetes, body mass index, alcohol use and physical inactivity.

Results: We evaluated 5314 women where 900 (16.9%) had dementia, and 1747 (32.8%) had MCI. Multiple adjusted relative risk ratio (RRR) and 95% confidence intervals (CI) for dementia were: 0.96(95%CI 0.95–0.98) (p<0.001) for menopause age, 0.97(95%CI 0.94–0.99) (p=0.007) for natural menopause age (excluding hysterectomy and/or oophorectomy<55 years) and 0.97(95%CI 0.95–0.99) (p<0.001) for reproductive span (menopause age minus menarche age). Menopause age <45years was associated with a 56% higher risk compared to mean menopause age 50 years. We found no significant associations between menarche age and dementia and no associations with MCI.

Conclusions: Older menopause age and longer reproductive span corresponding to longer oestrogen exposure were associated with a lower dementia risk. Future studies should explore therapeutical options to offset this risk in women.

Yehani Wedatilake, C. Myrstad, S. E. Tom, B. H. Strand, S. Bergh & G. Selbæk

Introduction
Radiotherapy is the main treatment modality in cancer. There is sparse knowledge on how patients with cancer experience their radiotherapy trajectory, and which factors might be associated with patients’ experiences.

Objectives
The aim of the present study was to explore how adults with cancer receiving radiotherapy evaluate the quality of their care, utilizing a patient-reported experience measure, and how patient- and service-related characteristics are associated with their evaluation.

Methods
An explorative cross-sectional study using a self-completed questionnaire to assess patients’ radiotherapy experiences was performed. Participants were recruited consecutively, within their last week of treatment, from two different hospitals in Norway from January 2021 to January 2022. Four hundred and eighty paper questionnaires were distributed to recruited patients, 240 at each hospital. Questionnaires were self-completed at home and returned by mail. The instrument person-centered coordinated care experience questionnaire (P3CEQ) was used. In addition to this, participants completed the European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and The Sense of Coherence 13 scale (SOC-13). Data were analyzed using descriptive statistics, parametric tests, and unadjusted/adjusted linear regression models were estimated.

Results
The study included 373 patients. Patients evaluated quality of care in terms of P3CEQ scores, with a mean score of 19.5 (standard deviation = 5.4). Lowest scores were identified in areas concerning person-centeredness and service coordination. There were no significant differences in P3CEQ scores between the younger and older groups. Having a partner and better SOC-13 scores were independently associated with the overall patient-reported experience score, whereas age was not.

Conclusion
Patient-reported experience scores indicate that improvements are needed in some areas, such as informing and involving patients in the planning and coordination of their care. Findings suggest paying special attention to patients without a partner to offer patients the best possible care.

May Ingvild Volungholen Sollid, Marit Slaaen, Signe Danielsen, Grethe Eilertsen & Øyvind Kirkevold

Objective: We aimed to investigate the associations between age at radical prostate cancer treatment and long-term global quality of life (QoL), physical function (PF), and treatment-related side effects.

Material and Methods: This single-center, cross-sectional study included men treated for localized pros-tate  cancer  with  robotic-assisted  radical  prostatectomy  (RARP)  or  external  beam  radiotherapy  (EBRT)  in  2014–2018.  Global  QoL  and  PF  were  assessed  by  the  European  Organisation  of  Research  and  Treatment  in Cancer Quality of life Questionnaire-C30 (QLQ-C30), side effects by the Expanded Prostate Cancer Index Composite  (EPIC-26).  Adjusted  linear  regression  models  were  estimated  to  assess  associations  between  age (continuous variable) at treatment and outcomes. QLQ-C30 scores were compared to normative data after dividing the cohort in two groups, <70 years and ≥70 years at treatment.

Results: Of 654 men included, 516 (79%) had undergone RARP, and 138 (21%) had undergone EBRT com-bined with androgen deprivation therapy for 93%. Mean time since treatment was 57 months. Median age at treatment was 68 (min–max 44–84) years. We found no statistically significant independent association between age at treatment and global QoL, PF or side effects, except for sexual function (regression coeffi-cient [RC] −0.77; p < 0.001) and hormonal/vitality (RC 0.30; p = 0.006) function. Mean QLQ-C30 scores were slightly  poorer  than  age-adjusted  normative  scores,  for  men  <70  years  (n  =  411)  as  well  as  for  men  ≥70  years (n = 243) at treatment, but the differences were not beyond clinical significance.

Conclusions: In this cohort of prostate cancer survivors, age at treatment had little impact on long-term QoL and function. Due to the cross-sectional design, short term impact or variation over time cannot be ruled out.

Reidun Sletten, Ola Berger Christiansen, Line Merethe Oldervoll, Lennart Åstrøm, Håvard Kjesbu Skjellegrind, Jūratė Šaltytė Benth, Øyvind Kirkevold, Sverre Bergh, Bjørn Henning Grønberg, Siri Rostoft, Asta Bye, Paul Jarle Mork & Marit Slaaen