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.

In 2014, a book entitled ‘When Nursing Care became Science. The first decades 1970–2000’ (in Swedish ‘När omvårdnad blev vetenskap. De första decennierna 1970–2000’) was published in Stockholm by Liber AB 2014 1. The idea to write this book about the development in Sweden was first raised in 2005 at a meeting of professors in nursing science during a conference at Uppsala University. A workgroup of nurse scientists from different parts of the country have led the work. Four of them have been the formal editors, Elisabeth Hamrin, Mona Kihlgren, Alice Rinell Hermansson and Gerthrud Östlinder, and are responsible for the final work. A publisher in Liber AB with a nursing background, Kristina Iritz Hedberg, has been of great help in the publishing process. Financial support from different organisations and individuals has made this book possible, for which we are most grateful. The book has 10 chapters. The first chapter gives a background to how nursing research started in Sweden. It takes up the university reforms, the financial support from different research agencies, the development within the nurses’ association and also special support from the medical profession. The second chapter describes reforms within the universities, which opened to nursing science on an academic level. Chapter three summarises some research areas within nursing and midwifery, both clinical, administrative and educational. Chapter four is about evidence-based research, and chapter five documents the international cooperation within nursing research in Sweden, with special emphasis on the Nordic countries. Scandinavian Journal of Caring Sciences features in this history, as it was launched in 1987 and the organisation NCCS, Nordic College of Caring Sciences, had already started at that time. On page 297 in the book is a photograph of the first editorial staff of the journal, with Kerstin Andersson Segesten as chief editor and Elisabeth Hamrin as associate editor. All the five Nordic countries were represented in the first board. By volume 2, number 2 1988 of the journal, one could see that it already was very international with 33 researchers in the advisory panel, representing 17 countries and one representative from the WHO in Copenhagen. In chapter six, two medical professors, Töres Theorell and Bengt Winblad, who were involved in the development of nursing science, have given their views on the field. A local politician who became a member of the parliament, Anna-Lena Sörensen, has been interviewed by Elisabeth Hamrin about the importance of research in health care. In chapter 7, Roger Qvarsell, professor of philosophy, who was involved in the book project from the beginning, discusses how a new science is developed. In chapter 8, Ingalill Rahm Hallberg, professor of nursing, takes up future perspectives on nursing science and research. The final chapters 9 and 10 are a presentation of the editors and the workgroup for the book project and the rest of the 32 authors. One difficulty is that students today tend to buy few books and that it is possible to copy a limited number of pages. There are also many possibilities to get new knowledge through the website. It is important what literature teachers recommend and how the professors in nursing use literature on different levels. One suggestion is that all the authors of the book take contact with their local schools of nursing and offer to have seminars and discussions with both students and staff. We also hope that more research will be inspired by our book – and that researchers in the future will analyse studies in nursing science that have been published after the year 2000. Nurse researchers in Finland have documented some of their studies, for instance at Professor Katie Eriksson's department in Vasa, Department of Caring Science, Åbo Academi University, where several Swedish nurses have studied for their PhD. One example within the time limit studied in our book is their ‘Jubileumsskrift 1987–1997’ 2. The first chapter has the title ‘Vårdvetenskapens framväxt som Akademisk disciplin, ett Finlandssvenskt perspektiv’ (in English: ‘The development of Caring Science as an Academic Discipline, a Finnish/Swedish perspective’). It is important to learn from those who have gone before us. The well-known portrait of Florence Nightingale in our book (p. 17) is a copy which I got personally from the former head of the Swedish Nurses Association, Elisabeth Lind, when I visited her 1965 at Sophiahemmet in Stockholm. I wanted to learn from her experience of building up the field of nursing. She gave me her own photo of Florence Nightingale and said ‘This you should have’. This was a challenge! In the chapter about the Uppsala region (p. 83), there is a picture of Elisabet Dillner, who in 1961 became an honorary doctor of medicine at Uppsala University, the first nurse in a Nordic country to do so. Today, there are many nurses in Sweden with a doctor's degree and probably more than 100 professors in nursing science. What can we learn from the past? Professor Ulla Qvarnström was the first nurse in Sweden to gain a PhD. She studied death and dying, an area which had not been studied by nurses before. In our book, you can read about her journey into the world of science (p. 49–60). The title of her doctoral thesis was ‘Patient's reactions to impending death’ (1978). This was an important study, which has helped us better understand death and dying. One of the first nurses in Sweden to gain a doctor′s degree was Astrid Norberg, who really started a revolutionary thinking on the care of patients with dementia, which is an increasingly common disease, as we have many elderly people. But of course, there are also many elderly people today who have quite good health and live healthy lives. Today, there are many refugees from very poor countries, some of which have multiple health problems. Some diseases, such as stroke, are increasing even in younger ages. This is a field which this author has been engaged in for many years. It is hoped that those of you who read this book can learn from what nurses have seen in the past in health care, through their experiences and research, and appreciate what can be of importance with regard to the future.

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.

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.

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.

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 >or=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.

Complementary and alternative medicine is used by many cancer patients in most parts of the world, and its use is increasing. The aim of the present study was to examine, over 5 years, the perceived quality of life/life satisfaction in two samples of women with breast cancer who were treated with anthroposophic care or conventional medical treatment only. Data from admission, after 1 year and after 5 years are used for the comparisons. On admission to the study the women in anthroposophic care perceived their quality of life to be lower than that of the women in the conventional treatment group, especially for emotional, cognitive and social functioning and overall quality of life. Sixty women who actively chose treatment with anthroposophic medicine and 60 individually matched women treated with conventional medicine participated. Quality of life was measured by the EORTC QLQ-C30 and the Life Satisfaction Questionnaire. Twenty-six women within anthroposophic care and 31 women within conventional medicine survived the 5 years. Effect size (ES) estimation favored the anthroposophic group in seven of the subscales mostly measuring emotional functioning. The ES for four of the subscales favored the conventional treatment group, mostly concerning physical functioning. After 5 years there were improvements in overall quality of life and in emotional and social functioning compared to admission for the women in anthroposophic care. The improvements took place between admission and 1 year, but not further on. Only minor improvements were found in the matching group.

A person's belief is seen as a set of assumptions, depending on perceptions, and formed with the influence of experiences and social culture. With the aim of understanding the beliefs about the genesis of their illness, 118 (59 + 59) women with different stages of breast cancer were interviewed. Half of the sample had chosen complementary care in an anthroposophical hospital, and the other half was a matched group. Qualitative content analysis was used. Three themes emerged: (1) belief in a link to life lived (71%), (2) heredity as the sole genesis (4%), and (3) rejection of the question (25%). Under beliefs in a link to life lived, external aspects to the patient's own life (eg, diet and lifestyle) were cited, as well as inner aspects such as psychosocial problems and stress. The findings show that women are well informed about medical facts, although their beliefs reveal a holistic approach. The women's beliefs, where inner psychosocial factors are uppermost, point to a reverse of the causal ranking of medical advisors. The difference between the groups was that the matching sample was more likely to reject the influence of possible causes from life lived. In a caring perspective, women's perceptions of the genesis of their illness are in some cases turned to creative health activities that may increase well-being.

OBJECTIVE:Many patients with cancer, women more often than men, use complementary and alternative medicine (CAM) and care. Our aim was to examine coping over 5 years (November 1995 to January 1999) in two samples of women with breast cancer who were treated with anthroposophic care or conventional medical treatment. The present study is part of a larger study of the outcome of anthroposophic care for women with breast cancer.DESIGN:A nonrandomized controlled trial design was used with individual matching and repeated measurements on six occasions (at admission, 1 month, 3 months, 6 months, 1 year, and 5 years). The matching was based on the following variables: stage of disease at entry, age, treatment during the 3 months before entering the study, and prognosis.SETTING:An anthroposophic hospital and conventional hospitals in Sweden.SUBJECTS:Sixty (60) women treated with anthroposophic medicine and 60 women from an oncology outpatient department participated. Forty-nine (49) women in anthroposophic care and 51 in the outpatient group survived 1 year; 26 women in anthroposophic care and 31 in the outpatient group survived 5 years.INTERVENTION:An anthroposophic care program.OUTCOME MEASURE:Coping was measured using the Mental Adjustment to Cancer scale. Repeat measures of analysis of variance (ANOVA) were used for within-group comparisons, and effect size (ES) was used for between-group comparisons.RESULTS:The women in anthroposophic care showed more passive and anxious coping on admission, but this decreased over time. In the women in anthroposophic care, there were small ES improvements in fighting spirit and passive, anxious coping at 4 of the measured timepoints compared to admission.CONCLUSION:The choice of anthroposophic care could be seen as a possible way to cope with emotional distress in this group of women with breast cancer.

The aim was to study the perceived quality of life/life satisfaction in a sample of women with breast cancer who were treated in a hospital with alternative/complementary care and the same variables in individually matched patients who received only conventional medical treatment. A non-randomized controlled trial design with repeated measurements was used. Sixty women with breast cancer treated with anthroposophic medicine (ABCW) and 60 with conventional medicine (CBCW) were included and 36 matched pairs took part on all occasions. The quality of life was measured by the EORTC QLQ-C30 and the Life Satisfaction Questionnaire (LSQ). The comparisons were calculated as effect sizes (ES). The women in the ABCW group reported small or moderate effects, expressed as ES, on their quality of life/life satisfaction compared to their matched "twins'' in the CBCW group at the 1-year follow-up in 15 out of 21 scales/factors. It was concluded that the women who had chosen anthroposophic care increased their perceived quality of life/life satisfaction according to the methodology of the study.

A quadripartite concept, the Good Life for older people, was developed by the American psychologist M. P. Lawton and forms the theoretical framework of this study. Ninety Swedish and 93 Polish subjects, aged > or = 60 years who had reported locomotor disturbances in selected samples from the two countries, took part in the study. Interviews were performed using the Philadelphia Geriatric Center Multilevel Assessment Instrument (PGCMAI) and functional testing was done using the Standardized Practical Equipment (SPE). The Polish elderly scored lower in most domains of the PGCMAI, which meant a worse life situation according to the Good Life model. On the SPE, scoring was lower in the Polish group, mainly on items related to balance and mobility. There was a logic convergent validity between the PGCMAI and the SPE in the whole group. The somewhat more complicated life situation for the Polish elderly has to be further analysed.

A previous study indicated that patient narratives include experiences of suffering caused or increased by health-care encounters. The aim of this study was to interpret and understand the meaning of patients' experiences of suffering related to health care from an ethical, existential and ontological standpoint. Sixteen women with breast cancer in Sweden and Finland took part in qualitative interviews analysed with a hermeneutic, interpretive approach. The outcome showed that suffering related to health care is a complex phenomenon and constitutes an ethical challenge to health-care personnel. The women's experiences of suffering related to health care tended to be of similar seriousness as their experiences of suffering in relation to having cancer. In an ethical, existential and ontological sense, suffering related to health care is basically a matter of neglect and uncaring where the patient's existential suffering is not seen and she is not viewed as a whole human being.