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OBJECTIVES: To explore the prevalence of poor sleep quality in couples undergoing fertility treatment and study possible associations.PARTICIPANTS: 163 women and 132 partners receiving in vitro (IVF) or intracytoplasmic sperm injection (ICSI) fertility treatment.SETTING: Three public Danish fertility clinics.DESIGN AND MEASUREMENTS: Participants completed the Pittsburgh Sleep Quality Index (PSQI) at three time-points as part of a larger RCT. Additional data from patient records and questionnaires were included to evaluate possible associations with treatment protocol type, psychological distress, and pregnancy outcome.RESULTS: Mean PSQI global scores before treatment were 8.1 (standard deviation = 2.3), with 91% of participants having PSQI scores > 5, indicating poor sleep quality. Scores did not differ between women and their partners and did not change during treatment. Statistically significant associations were found between sleep quality and depressive symptoms and state anxiety (p < .001). No difference in PSQI scores was found between protocol types. While there was a trend towards higher clinical pregnancy rates among women with good sleep quality (PSQI ≤ 5 = 72.7%, PSQI 6-10 = 52.6% and PSQI ≥ 11 = 42.3%), the differences did not reach statistical significance (p = .10-.21).CONCLUSIONS: Poor sleep quality is a prevalent problem among couples undergoing fertility treatment and is associated with psychological distress and possibly with pregnancy outcomes. Success rates after fertility treatment remain moderate, and poor sleep quality, a potentially modifiable factor, could be relevant to screen for and treat among couples undergoing fertility treatment. The high prevalence of poor sleep quality calls for further investigation.

Individuals interpret events in positive and negative ways, creating positive and negative meaning in their life stories. We hypothesized that higher trait anxiety measured 10 years earlier would predict more negative meaning-making in life stories and that negative meaning-making would be related to more concurrent depressive symptoms. Participants were 272 women who had undergone fertility treatment and completed measures of trait anxiety 10 years earlier. In the present study, they described five life story events and rated these on emotional tone and meaning-making. A path analysis showed that higher trait anxiety predicted more negative meaning-making 10 years later and that negative meaning-making predicted more concurrent depressive symptoms after adjusting for baseline depressive symptoms, trait anxiety, and education. The results suggest that life stories are important to well-being.

We collected registry- and questionnaire-based data on socio-economic and health status, tumor- and treatment-related variables, and explored associations with receipt of reconstruction and information about treatment options in a nationwide cohort of Danish women, treated for primary breast cancer. A total of 594 women were available for analysis, 240 (40%) of these received reconstruction. Multivariate analyses showed that receipt of reconstruction was associated with 1) younger age at time of primary surgery (

Summary Objectives To explore the associations of religious and spiritual faith (unambiguous, ambiguous and no faith), existential considerations and disease severity with use of complementary and alternative medicine (CAM) among heart patients in a secular society, and to address patients' perceived influence of CAM on their quality of life and heart disease. Design and setting Prospective questionnaire study among 97 consecutively recruited patients (72.2% male; mean age 60.6 years) with acute coronary syndrome from a Danish cardiac university hospital unit. Main outcome measures Total CAM use in the 6 months following hospitalisation. Results Altogether 24.7% used CAM with dietary/exercise counselling and dietary/nutritional supplements being the most prevalent types. In a final multivariate logistic regression model entering faith in God, faith in a spiritual power and previous CAM use, only unambiguous faith in God predicted CAM use following the event (OR: 11.24, CI: 2.19–57.65, p =0.004). No significant association was found between heart disease severity and CAM use. The majority of CAM treatments were rated as having some degree of positive influence on quality of life (75.9%) and the heart disease (58.6%). Conclusions Faith among heart patients in a secular society was associated with CAM use. It may be speculated that believers in God were more inclined to use lifestyle-oriented CAM types such as dietary/exercise counselling. Patients' perceived benefits of CAM may be strong motivational factors for present or future use. However, considering the potential adverse effect of combining some complementary therapies with conventional medicine, an open dialogue on CAM use is warranted.

Mange mænd får seksuelle problemer efter behandling for testikelkræft, som er den mest udbredte kræftform blandt mænd i aldersgruppen 20-35 år. Det drejer sig først og fremmest om problemer med rejsning og sædafgang. Dette studie viser, at problemerne i høj grad hænger sammen med, at mange ændrer syn på deres egen krop i forbindelse med et sygdomsforløb, mens behandlingstypen generelt spiller en mindre rolle. I alt 401 overlevende efter testikelkræft deltog i en spørgeskemaundersøgelse om sammenhængen mellem behandling, ændret seksuel adfærd og ændret kropssyn. Alle havde fået fjernet en eller begge testikler og var efterfølgende til kontrol eller i behandling ved Aarhus Universitetshospital i perioden 1990-2000. Deltagerne blev inddelt i fire grupper efter behandlingstyper: under observation, strålebehandling, kemoterapi og kemoterapi kombineret med fjernelse af lymfeknuder. I alt 17 % følte sig mindre maskuline efter behandlingen, og dette var forbundet med nedsat seksuel lyst og nedsat seksuel formåen. Ældre og overvægtige mænd synes at have en højere risiko for at få seksuelle problemer efter behandling. Generelt synes behandlingstypen ikke at påvirke den seksuelle formåen - med undtagelse af fjernelse af lymfeknuder, som kan give problemer med sædafgang. Tidligere studier af behandlingens indflydelse på patienternes seksualitet og kropssyn har ikke peget i en entydig retning, og der er fortsat behov for at identificere de faktorer, som relaterer sig til seksuelle problemer for denne patientgruppe. Denne viden er en forudsætning for at kunne afhjælpe problemerne bedst muligt, fx når de præsenteres for den praktiserende læge. OBJECTIVE: This study explores sexual function and the influence of different treatment modalities on sexual function and body image among long-term survivors of testicular cancer (TCSs). METHODS: A long-term follow-up assessment of all testicular cancer patients treated at Aarhus University Hospital, Denmark, from 1990 to 2000 was conducted. A total of 401 survivors (mean age: 46.6years; response rate: 66%) completed questionnaires concerning sexuality and changes in body image. Based on the treatment received, patients were categorised into one of four groups: surveillance, radiotherapy, chemotherapy, or chemotherapy supplemented with retroperitoneal lymph node dissection (RPLND). RESULTS: Sexual dysfunctions were reported: 24% reduced sexual interest, 43% reduced sexual activity, 14% reduced sexual enjoyment, 18% erectile dysfunction, 7% ejaculatory problems and 3% increased sexual discomfort. Seventeen percent of the long-term TCSs reported changes in body image, and this was significantly associated with all six parameters of sexual dysfunction. When comparing treatments, only the RPLND procedure was associated with sexual dysfunction in the form of ejaculatory dysfunction. CONCLUSION: Apart from RPLND, which was associated with ejaculatory dysfunction, treatment strategies for testicular cancer appeared not to influence sexual dysfunction. The level of erectile dysfunction seen in this sample of TCSs seemed to be higher than the level observed in the general male population and high levels of erectile dysfunction were associated with negative changes in body image. The results suggest that changes in body image are of importance when explaining the variation in sexual dysfunctions, but further prospective studies are needed to clarify this issue.

AimThis study investigated the prevalence and predictors of use of complementary and alternative medicine (CAM) in a nationwide inception cohort of Danish women treated for early-stage breast cancer as well as differences in user patterns for individual types of CAM.MethodsUse of CAM since the time of diagnosis was assessed 12–16 weeks post-surgery for the 3343 women (age 18–70) included in the study (response rate: 68%). Socio-demographic and clinical variables were obtained from national longitudinal registries.Results40.1% of the women had used one or more types of CAM. Users were younger than non-users. Age adjusted analyses showed that CAM users were characterised by absence of comorbidity, higher educational level, higher personal income, higher social status, being divorced/separated and living in the metropolitan area of Copenhagen. Multivariate analyses revealed that chemotherapy was the only clinical and treatment-related predictor of CAM use, and that CAM users were more likely to be of normal weight and non-smokers. Of CAM users, 33.7% believed that CAM would have a positive influence upon their breast cancer. Different characteristics distinguished users of individual types of CAM.ConclusionThe results of this first nationwide study of utilisation of CAM in breast cancer show that CAM users are healthier and more likely to have higher socio-economic status than non-users. Different user patterns for individual types of CAM may be overlooked, when different types of CAM are treated as one homogeneous category. This study investigated the prevalence and predictors of use of complementary and alternative medicine (CAM) in a nationwide inception cohort of Danish women treated for early-stage breast cancer as well as differences in user patterns for individual types of CAM.

Udgivelsesdato: 2009-May Vaccination is an important public health strategy for reducing the risk of influenza at the societal level. However, at the individual level, not everyone is protected by vaccination, and increases in antibody titers may fail to reach protective levels. Several recent studies suggest that psychological stress may contribute to these individual differences. Exploring this hypothesis, we conducted a meta-analysis of 13 studies examining the influence of psychological stress on antibody responses following influenza vaccination. The studies were identified through systematic searches in MEDLINE and PsychINFO and included a total of 1158 men and women. In five studies, the increased antibody levels of caregivers following vaccination were compared to those of non-caregivers. The remaining studies focused on associations between self-reported stressful life events or perceived stress and increased antibody titers following vaccination. The meta-analysis revealed a significant negative association between psychological stress and antibody responses to influenza vaccination. While effect sizes were similar across different indicators of stress, antibody responses to the A/H1N1 and B-influenza types appeared to be more sensitive to stress than the A/H3N2 type. It was investigated whether the association between stress and antibody response differed between young and elderly, and the results revealed significant negative associations between stress and peak antibody titers in both age groups. These findings suggest the importance of additional research to explore responsible mechanisms and possible contributions of stress to the public health problem of inadequate responses to vaccination.

Elderly people report less negative affect than the young, and women report more negative affect than men. This study investigated whether age and gender differences in negative affect could be explained by emotion regulation, measured as defensiveness and rumination, while controlling for the influence of life events. One-hundred-and-ninety-five young (20–35 years) and 302 elderly (70–85 years) men and women completed the Emotional Control Questionnaire-Rehearsal, Marlowe–Crowne Social Desirability Scale, Profile of Mood States, Beck’s Depression Inventory and List of Recent Experiences. Hierarchical regressions with negative affects as dependent variables showed that age was reduced to non-significance when controlling for defensiveness, and gender was reduced to non-significance when controlling for the interaction between age and gender, which in turn was reduced when entering rumination. Life events also influenced the association between age and negative affect. The results indicate that age differences in negative affect are mediated by defensiveness and life events and that when these two influences are accounted for elderly people score higher on sadness. Gender differences in negative affect were due to the young women’s higher scores on negative affect and this is partly explained by rumination.

Rumination is related to depression as well as to anxiety and anger. However, since these negative emotions are interrelated, it is not known whether rumination is independently related to each of these emotions. Previous studies have suggested an association between rumination and poor sleep quality or sleep disturbances, and between negative emotions and sleep disturbances. However, since rumination and negative emotions are linked, it is difficult to know if both negative emotions and rumination are associated with sleep quality. The purposes of this study were to investigate how rumination is related to different negative moods and whether rumination and negative mood may be independently associated with subjective sleep quality at a non-clinical level. Subjects were 126 students, who completed questionnaires measuring rumination, mood and sleep quality. The results showed that rumination was independently associated with angry and depressive mood. There were significant associations between rumination, negative mood and subjective sleep quality. Rumination was found to be significantly associated with subjective sleep quality even after controlling for negative mood.

Background: Case reports have indicated that psychologic treatments may have a beneficial effect on psoriasis activity. Objective: Our purpose was to further investigate the hypothesis that psychologic intervention has a beneficial effect on psoriasis activity in a blinded, controlled manner. Methods: Fifty-one patients with psoriasis vulgaris were randomly assigned to a treatment or a control group. Patients in the treatment group participated in seven individual psychotherapy sessions in 12 weeks. Intervention techniques included stress management, guided imagery, and relaxation. The Psoriasis Area Severity Index (PASI), Total Sign Score (TSS), and Laser Doppler Skin Blood Flow (LDBF) of a selected reference plaque was measured in a blinded fashion at baseline (week 0), week 4, week 8, and after treatment (week 12). Results: Slight, but significant, changes in TSS and LDBF were found in the treatment group but not in the control group. When analyses were performed for both groups separately, the treatment group displayed significant reductions for all three psoriasis activity measures, whereas no changes were seen in the control group. Conclusion: Our preliminary results suggest that psychologic intervention may have a moderate beneficial effect on psoriasis activity.