Högskolan i Skövde

Studies have shown that the care should be adapted to the individual patient. The postoperative patient has a special need for information. The postoperative needs are ranked different by nurses and patients. Nurses find that competent caregivers, pain relief and the treatment should be a high priority. Patients feel that competent caregivers, communication and a good care are the most important needs that they have in the postoperative setting. The aim of this study is to describe nurses postoperative care of patients who has undergone a general anesthesia and who is treated at surgical ward. The study has a qualitative approach. The data has been collected through semistructural interviews. Six nurses’ have been interviewed. This study shows that information is an important aspect in the patients care. It is important to inform the patient about what is going to happen and what has happened, the patient should also inform the nurse about their condition. There should also be a communication between the different caregivers. Is it also essential that the nurses are attentive to the patient’s pain. Collaboration between caregivers and between the nurse and patient is vital for a good care. The care should be adapted to the individual needs of the patients.

Psychopathy is a frequently reported personality trait among violent offenders, and psychopaths have a higher rate of recidivism than inmates without psychopathic features. This systematic review aimed to investigate whether structural brain differences, measured with magnetic resonance imaging, are observed in violent offenders with psychopathy compared to violent offenders without psychopathy or healthy non-violent controls. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search utilised the academic databases Web of Science and Medline EBSCO and included original peer-reviewed articles written in English and published between 2013 and 2023. Seven articles fulfilling the inclusion criteria were selected for the review. The findings indicated that there are structural differences between violent psychopaths compared to non-violent psychopaths and healthy controls, such as reduced grey matter volume in the prefrontal cortical areas, posterior cingulate cortex and precuneus, and striatal and limbic regions. Further, the degree of structural brain differences in psychopaths correlated with the degree of psychopathic traits. The structural differences found in the brains of violent psychopaths can provide insight into the neurobiological basis and neural mechanisms of psychopathy and elucidate how changes in brain morphology relate to antisocial behaviour and psychopathic personality traits. In addition, the evidence of structural abnormalities in the brain of psychopaths may help develop targeted treatments that could reduce the risk of psychopathic individuals turning to crime and violence or committing repeated violent crimes. 

Det första mötet mellan barnmorskan och kvinnan är nyckeln till en positiv upplevelse av förlossningen. Dagens förlossningsvård strävar efter att varje förlossning ska bli en unik händelse för kvinnan. Barnmorskans ansvar med bakomliggande strategier är att se till att det här första mötet blir ett lyckat möte. Syftet med denna studie var att belysa vilka strategier barnmorskan har för att skapa ett positivt första möte, där kvinnan är i ett aktivt värkarbete. Metoden som användes var intervjuer som analyserades med kvalitativ innehållsanalys. Sex barnmorskor vilka arbetar inom förlossningsvård i ett län i Västsverige deltog i studien. De svarade på fyra öppna frågor hur de skapar ett positivt första möte med kvinnan. Barnmorskornas strategier beskrivs i huvudtemat Närvarande och Lyhörd med kategorierna: Kvinnan i fokus, Skapa trygghetskänsla och Skapa delaktighet. Det framkom även hur viktigt dialogen mellan barnmorskan och kvinnan är för att sedan utveckla en relation och skapa ett positivt första möte.

Bakgrund – Typ 2 diabetes mellitus är en av Värdens folksjukdomar som kraftigt ökar nedåt i åldrarna, med förändring i näringsvanor och stillasittande livsstil. Människor med typ 2 diabetes har stora risker att utveckla mikro- och makrovaskulära komplikationer och detta ökar behandlingskostnader och förkortar personens livslängd. Behandlingen för sjukdomen kräver att personen gör ett antal livsstilsförändringar i bland annat kost och motion. Syfte - syfte av denna studie är att beskriva patienters upplevelser av egenvård vid typ-2 diabetes. Metod - Denna studie genomfördes som en litteraturöversikt baserad på vetenskapliga artiklar med kvalitativ design. Resultat - analysen resulterade i olika upplevelser av egenvård och dessa har kategoriserats i huvudkategorier med underkategorier: 1) Att anpassa sig till de nya levnadsvanorna: Ny kosthållning och Nya motionsvanor, 2) Behöv av stöd; Stöd från närstående och Stöd från sjuksköterska, 3) Att lära sig nya levnadsvanor. Patienterna upplevde en förändrad livsstil på grund av de omständigheter diabetes gav. Information, motivation och färdigheter var tre viktiga faktorer för att patienterna skulle göra livstilförändring för att egenvård ska lyckas. Diskussion - Patienten själv och relationen till sjuksköterskan är huvudpunkter som påverkar patientens livstilförändringsprocessen för att egenvården ska lyckas. Sjuksköterskan gör allt för att uppnå maximalt stöd för patienten.

Background: Papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) are the first and second most common thyroid cancers comprising about 85% and 10% of all thyroid cancers. Simultaneous occurrence of medullary and papillary thyroid cancer has been reported with various presentations, but simultaneous occurrence of FTC in addition to PTC as differentiated cancers, is an unusual event that is rarely reported. Presentation of cases: We report our experience of six rare cases of synchronous coexistence of FTC and PTC with unique features. Case 1 is 31 old Egyptian female. Case 2 is a 61 year old Sudanese male. Case 3 is a 59 year old Sudanese male. Case 4 is a 56 years old Indian female. Case 5 is a 35 years old Filipina female. Case 6 is a 52 years old Qatari female. The six cases are special in their co-occurrence of two thyroid carcinoma, consisting of histologic features of follicular thyroid carcinomas, and classical papillary thyroid carcinoma, possibly the first case series of simultaneous occurrence of these two types of thyroid cancer in the Middle East and North Africa Region. Conclusions: We present rare cases of concurrent FTC and PTC. These six cases add more data highlighting the coincidental simultaneous coexistence of FTC and PTC. Endocrinologists and pathologists should be aware of and vigilant to this variety. © 2020 The Author(s)

Background: Emergency care is a crucial aspect of healthcare that patients seek out to obtain assistance. Nurses who encounter these patients must make important and life-changing decisions in a variety of situations where life and death hang in the balance.

Aim: Highlight the factors that influence the nurse’s decision-making in emergency care.

Method: This study is a literature review with quantitative and qualitative studies. 10 articles were selected to compile a result.

Findings: The study produced three themes: Nurse professional attributes, environment, and ethical dilemmas. Alongside eight categories.

Conclusion: Evidence-based knowledge is essential for the nurse's decision-making ability. Supported by experience and a person-centered approach that promotes patient integrity and values.

Background: Malnutrition means an imbalance between nutrition and energy that goes to the bodytissues and the existing need. With age, the physiological functions of the body change which have a bearing on the intake of food and fluid. Malnutrition can cause multiple consequences for the elderly, such as increased fall risk, reduced quality of life, increased hospitalization and mortality. The nurse has an essential role in the field of elderly care to assess, plan and implement measures regarding the nutrient and fluid intake of the elderly. Aim: The aim was to describe nurses experiences when it comes to nursing patients with malnutrition. Method: A literature review where data material consisted qualitative and quantitative article. Results: Five areas identified; knowledge by education, cooperation with different professions, nurses' work environment, dialogue for anamnesis and the use of assessment instrument. Conclusion: There is a need for increased knowledge in the care of patients with malnutrition because increased knowledge leads to less insecurity for the nurse.

Background: Depression among older adults is increasing. Since many of the older adults are seeking medical care, nurses are faced with depressed elders. Most older adults with depression have experienced insufficient care, since the knowledge about older adults with depression is lacking among nurses. This can cause older adults to experience suffering. To avoid this, it is important to describe the older adults' experiences with depression.

Method: A literature review that is based on eight qualitative articles. The articles have been both studied and analyzed and from that, a result has been produced. The databases Cinahl and PubMed have been used for article queries.

Aim: To describe older adults' experience with depression and its influence on daily life.

Findings: Older adults with depression experience both physical and psychic changes. The result brought four different categories, the influence of age on depression, a struggle against loneliness, the importance of autonomy for well-being and a strive for community and purpose.

Conclusion: The subject of depression is an area in which healthcare workers need more knowledge. Awider and more in-depth understanding of depression can both prevent and give a better understanding of the subject. This in turn can lead to that the patients get good individual healthcare which causes suffering to be avoided.

Mutations in TPM2 result in a variety of myopathies characterised by variable clinical and morphological features. We used human and mouse cultured cells to study the effects of β-TM mutants. The mutants induced a range of phenotypes in human myoblasts, which generally changed upon differentiation to myotubes. Human myotubes transfected with the E41K-β-TM(EGFP) mutant showed perinuclear aggregates. The G53ins-β-TM(EGFP) mutant tended to accumulate in myoblasts but was incorporated into filamentous structures of myotubes. The K49del-β-TM(EGFP) and E122K-β-TM(EGFP) mutants induced the formation of rod-like structures in human cells. The N202K-β-TM(EGFP) mutant failed to integrate into thin filaments and formed accumulations in myotubes. The accumulation of mutant β-TM(EGFP) in the perinuclear and peripheral areas of the cells was the striking feature in C2C12. We demonstrated that human tissue culture is a suitable system for studying the early stages of altered myofibrilogenesis and morphological changes linked to myopathy-related β-TM mutants. In addition, the histopathological phenotype associated with expression of the various mutant proteins depends on the cell type and varies with the maturation of the muscle cell. Further, the phenotype is a combinatorial effect of the specific amino acid change and the temporal expression of the mutant protein.

BACKGROUND: The formation of contractile myofibrils requires the stepwise onset of expression of muscle specific proteins. It is likely that elucidation of the expression patterns of muscle-specific sarcomeric proteins is important to understand muscle disorders originating from defects in contractile sarcomeric proteins.

METHODS: We investigated the expression profile of a panel of sarcomeric components with a focus on proteins associated with a group of congenital disorders. The analyses were performed in cultured human skeletal muscle cells during myoblast proliferation and myotube development.

RESULTS: Our culture technique resulted in the development of striated myotubes and the expression of adult isoforms of the sarcomeric proteins, such as fast TnI, fast TnT, adult fast and slow MyHC isoforms and predominantly skeletal muscle rather than cardiac actin. Many proteins involved in muscle diseases, such as beta tropomyosin, slow TnI, slow MyBPC and cardiac TnI were readily detected in the initial stages of muscle cell differentiation, suggesting the possibility of an early role for these proteins as constituent of the developing contractile apparatus during myofibrillogenesis. This suggests that in disease conditions the mechanisms of pathogenesis for each of the mutated sarcomeric proteins might be reflected by altered expression patterns, and disturbed assembly of cytoskeletal, myofibrillar structures and muscle development.

CONCLUSIONS: In conclusion, we here confirm that cell cultures of human skeletal muscle are an appropriate tool to study developmental stages of myofibrillogenesis. The expression of several disease-associated proteins indicates that they might be a useful model system for studying the pathogenesis of muscle diseases caused by defects in specific sarcomeric constituents.

Background: Revisional gastric bypass (R-RYGB) surgery is utilized for the management of inadequate weight loss or weight regain observed after some cases of bariatric surgeries. Data on the mid-term effectiveness of primary gastric bypass (P-RYGB) compared to R-RYGB (e.g., post sleeve gastrectomy or gastric banding) are controversial. Methods: Retrospective chart review of all patients who received P-RYGB and R-RYGB (January 2011 - June 2015) at our center. One hundred and twenty patients who underwent P-RYGB and 34 R-RYGB who completed 18 months follow-up were included. We compared the effectiveness of P-RYGB with R-RYGB by assessing four anthropometric, two glycemic, and four lipid parameters, as well as the control of type 2 diabetes (T2DM), hypertension and dyslipidemia in terms of remission, improvement, persistence, relapse and de novo. The current study also assessed mortality and complications rates. Results: There were no significant differences in the baseline characteristics of patients who received P-RYGB with those who received R-RYGB in terms of age, gender and preoperative BMI. However, at 18 months: a) Patients who received P-RYGB had lower mean weight (P = 0.001) and BMI (P <0.001), reflected by a higher mean delta BMI (P = 0.02), TWL%(P <0.0001) and EWL%(P < 0.0001); b) No differences were observed between the two patients groups in terms of glycemic parameters, lipid profiles, and control of T2DM, hypertension, and dyslipidemia; and, c) No deaths were reported among both patients groups, and complication rates were comparable. Conclusion: Although R-RYGB effectively addressed inadequate weight loss, weight regain and recurrence of comorbidities after restrictive bariatric surgery, R-RYGB resulted in inferior weight loss compared to P-RYGB. There were no significant differences between the two procedures in terms of their clinical control of T2DM, hypertension and dyslipidemia. Both procedures exhibited comparable complication rates. 

Background: Every year, about 90,000 to 100,000 people die in Sweden and the majority need palliative care. Nursing is the core competence of nurses and means a great responsibility in care at the end of life and can be difficult for some nurses because they provide support to patients and their relatives. Aim: The purpose of this study was to describe nurses’ experiences of caring for patients at the end of life. Method: A literature-based study with qualitative approach based on ten scientific articles. Results: Five themes emerged from the analysis; Sorrow and frustration, factors that promote well-being, being able to build a good care relationship, being able to deal with family needs and lack of experience and education.Conclusion: The results show that nurses experience negative and positive feelings when caring for dying patients. Providing care at the end of life was emotionally challenging and a great commitment for nurses. The resources that nurses have are not enough. Nurses are in dire need of more support and education to be able to care for patients and relatives in a good way at the end of life.

Background: Midwives working at maternal care center experience insufficient knowledge about how professional support can be offered to pregnant women. It´s important that pregnant women with tocophobia receive professional care from midwives during the entire pregnancy.

Purpose: The aim of the study is to highlight maternal care midwives’ experiences providing professional support for pregnant women who fear of giving birth.

Method: A qualitative interview study with inductive approach was chosen for this study to gain broader view of the BMM midwives' experiences. Seven midwives were interviewed at two BMM in southwestern Sweden.

Results: There were two main categories "Women's fear of childbirth tokophobia". There were two subcategories "Midwife's experiences about women's lack of knowledge about fear of childbirth" and "Guide pregnant women to correct care effort". Midwives offer professional support from their own experience when women express fear of birth. This through midwives being responsive when incuayaring causes to tokophobia women. in focus" and "Midwife's need for resources and knowledge about women`s

Conclusion: BMM midwives need continuous education about fear of childbirth in order to offer women prophetic support. BMM occupational managers should offer midwives right prerequisites for midwives to feel safe by providing care to women suffering from tokophobia.

Bakgrund: Stroke är en av de vanligaste folksjukdomarna i Sverige och är en sjukdom som kan ge permanenta funktionsnedsättningar. Att vara patient och i behov av vård innebär att de har ett beroendeförhållande till sjuksköterskan. Alla individers upplevelse av stroke är unik. Vidare är det också viktigt att se hela personen och hens behov, inte bara sjukdomen.Syfte: Syftet med denna uppsats är att belysa strokedrabbade individer i arbetsför ålders upplevelse av att återgå till sina vardagliga liv.Metod: Det är en litteraturstudie där 10 vetenskapliga artiklar som hämtades från databasen CINAHL är inkluderade.Resultat: Efter att artiklarna som inkluderades i studien hade analyserats framkom två huvudkategorier i resultatet; Förlorad kontroll över den egna kroppen och Behov att hantera sin nya livssituation. Det utformades totalt fem underkategorier.Slutsats: Studien bidrar med kunskap om strokedrabbade individer i arbetsför ålders upplevelse att återgå till sina vardagliga liv. Efter stroke blir personerna begränsade i sin vardag och de kan drabbas av olika funktionsnedsättningar. Att utföra aktiviteter, återgå till sina jobb och ägna sig åt övriga sysselsättningar kan bli en utmaning som kan påverka deras sociala liv. Den nya livssituationen kan påverka deras självkänsla och självförtroende negativt. Många strokedrabbade individer lider av kognitiva svårigheter, kroppsliga förändringar, trötthet och rädslor vilket kan leda till att de undviker sociala sammanhang. För att de skall kunna hantera sin nya livssituation är de i behov av att utveckla nya rutiner och strategier i sin vardag.

Background: Communication is a fundamental necessity for patient security within the healthcare organization. Earlier research within the subject is largely centred around the communication between nurses and patients or nurses and physicians. Research studying communication between nurses and healthcare personnel exist to a much smaller extent.

Aim: To explore communication with nurses within short-time residences from the perspective of the healthcare personnel and describe experiences of communication between nurses and healthcare personnel in the caring of patients at short-time residences.

Method: Questionnaire

Results: The results show that the healthcare personnel hold both good and bad experiences of communication with the nurses. According to the healthcare personnel, the communication is vital to provide good treatment for the patients, but also since certain workgroups function in teams. There is existing routines for communication, and the healthcare personnel experience that these routines functions well. On the contrary there is obscurity concerning routines in acute situations. Preferably, and most often, the communication is verbal. The healthcare personnel sometimes feel that the communication with the nurses is insufficient, but also found some information to be unnecessary.

Bakgrund: Under ungdomsåren förändras ungdomar fysiskt, emotionellt och kognitivt. De går in i en ny fas i livet och utvecklas från att vara barn till att bli vuxna. Under ungdomsåren etablerara och experimenterar ungdomar med vanor, attityder, tro samt livsstil. Vid ogynnsamma förhållanden kan olika riskbeteende öka. Bland ungdopmar idag ses en ökning av sexuellexponering på sociala medier. Etfersom internet idag är mer lättillgängligt än tidigare kan det medföra att ungdomar i högre utsträckning exponerar sig sexuellt, vilket kan leda till sexuella övergrepp och missbruk.

Syfte: Är att beskriva vad ungdomar kommunicerar om i bloggar, angående sex och relationer.

Metod: En kvalitativ innehållsanalys enligt Graneheim och Lundman användes där fem ungdomsbloggar i åldrarna 17-25 år användes och analyserades

Resultat: Utifrån de analyserade ungdomsbloggarna framkom det två huvudkategorier; Samhällets trender påverkar ungdomars sexuella hälsa och Tillit har betydelse för relationen. Under kategorierna bildades sex underkategorier. I resultatet framkom det att ungdomar kommunicerar i stor utsträckning om sex och relationer på sociala forum. De ansåg att det idag är mer accepterat med olika sexuella läggningar och familjekonstellationer samt diskuterades dagens könsideal. Det uttrycktes en negativ syn på hormonella preventivmedel. Bloggarna uttryckte att det var viktigt med bekräftelse i en relation.

Konklusion: Ungdomar kommunicerar brett om sex och relationer på nätet, där de har en possitiv inställning till alternativa familjekontellationer. Synen på preventivmedel var negativ bland annat på grund av dess biverkningar och de förespråkade istället hormonfria alternativ. Relationer kan påverkas av olika förändringar i livet och att vara offentlig på internet kan upplevas som ansträngande för relationen.

Background: Mental illness is a collective term that covers both mental disorders and psychiatric diagnoses. The healthcare system consists of a care chain where primary care, county healthcare, regional healthcare, national highly specialized care and homecare are included. The nurse should defend socially vulnerable individuals and groups at risk in society, and is responsible for ensuring that patients and relatives receive correct information in a manner that is comprehensible. Patients with mental illness experience that their physical health problems are not taken seriously by healthcare providers. Purpose: To illuminate how patients with mental illness experience the interaction with healthcare providers. Method: The study is an analysis of blogs based on a qualitative content analysis. Eleven blogs have been used as data source. Result: It is common that patients suffering from mental illness experience being labeled. The waiting time for adequate psychiatric care is long. Patients find that healthcare professionals often take the easy way out and send them home with a pillbox that is expected to solve their problems. However there is hope for a better psychiatric care. Conclusion: It is the nurse's responsibility to take these patients seriously and give them the care they deserve, regardless of mental illness.

As opposed to earlier beliefs, the brain is altering itself throughout an individual’s life. The process of functional or structural alterations is referred to as plasticity, and can be induced by several factors such as experience or physical exercise. In this thesis, the research area of experience-dependent plasticity, with focus on exercise-induced plasticity is examined critically. Evidence from a vast array of studies are reviewed and compared in order to find whether physical exercise can induce neural plasticity in the human brain, how it may be beneficial, and what some of the plausible mediators of exercise-induced plasticity are. The findings demonstrated in this thesis suggest that although there are knowledge gaps and limitations in the literature, physical exercise can indeed result in exhibited plasticity as well as being beneficial for the human brain in several ways.

Background: District nurses work has changed over time. Today patients are more informed of their health and aware of how to influence their health. In today's society, the internet is a regular source for health information, and internet has become increasingly accessible. It is important that patients feel involved in their own care. Health care providers has a responsibility to lead the patient to reliable sources of information. Aim: The aim of this study was to shed light on district nurses' experiences of patients seeking health information on the internet and how it affects their work. Method: A qualitative approach was used. Eight interviews with district nurses were conducted. Results: From the analysis of the data, three main themes emerged which were termed; The importance of knowing and understanding, The meaning of the meeting for patients, District nurses experience and new knowledge. These themes are described by nine different sub-themes. Conclusion: The results of this study may contribute to awareness that patients seek health information on internet and that it may affect district nurses work. District nurses need to relate to patient's knowledge that varies. Patients´ knowledge demands district nurses to adapt the care and the patients visit based on their knowledge and to guide patients’ right.

Early neuropathological changes characteristic of late-onset Alzheimer's disease (LOAD) involve brain stem and limbic structures that regulate neurovegetative functions, including sleep-wake rhythm. Indeed, sleep pattern is an emerging biomarker and a potential pathophysiological mechanism in LOAD. We hypothesized that cognitively asymptomatic, middle-aged offspring of patients with LOAD (O-LOAD) would display a series of circadian rhythm abnormalities prior to the onset of objective cognitive alterations. We tested 31 children of patients with LOAD (O-LOAD) and 19 healthy individuals without family history of Alzheimer's disease (control subjects, CS) with basic tests of cognitive function, as well as actigraphy measures of sleep-wake rhythm, cardiac autonomic function, and bodily temperature. Unexpectedly, O-LOAD displayed subtle but significant deficits in verbal episodic memory (Rey Auditory Verbal Learning Test delayed recall 10.6 +/- 0.4 vs. 8.6 +/- 0.6, t = 4.97, df = 49, p < 0.01) and language (Weschler's vocabulary 51.4 +/- 1.3 vs. 44.3 +/- 1.5, t = 2.49, df = 49, p < 0.001) compared to CS, even though all participants had results within the clinically normal range. O-LOAD showed a phase-delayed rhythm of body temperature (2.56 +/- 0.47 h vs. 3.8 +/- 0.26 h, t = 2.48, df = 40, p = 0.031). Cognitive performance in O-LOAD was associated with a series of cardiac autonomic sleep-wake variables; specifically indicators of greater sympathetic activity at night were related to poorer cognition. The present results suggest sleep pattern deserves further study as a potential neurobiological signature in LOAD, even in middle-aged, at risk individuals.

Introduction: Ectopic parathyroid adenoma is rare during pregnancy but poses multiple challenges in treatment. It presents as primary hyperparathyroidism which leads to symptoms and complications of hypercalcemia in both the mother and fetus. Presentation of case: A 38-year-old Sudanese female presented with diffuse bone pain and polyuria. Laboratory investigations revealed elevated serum calcium and parathyroid hormone. Ultrasound of the neck did not show any abnormal lesion, however 99mTc-sestamibi scan showed a right sided parathyroid adenoma, and an earlier CT scan showed the adenoma to be in an ectopic paraesophageal position. Focused surgical neck exploration was done, and the ectopic parathyroid adenoma was excised. Discussion: Preoperative localization of the ectopic parathyroid adenoma allows for a focused surgical procedure. Ultrasound is the safest during pregnancy, but 99mTc-sestamibi and CT scan may be necessary if ultrasound or initial bilateral neck exploration do not detect any adenoma. Mild elevations in maternal serum calcium can have detrimental effects on the fetus which suggests that a surgical approach may be necessary in the majority of cases. Conclusions: Ectopic parathyroid adenoma is rare during pregnancy and is detrimental to both the mother and fetus. Preoperative localization allows for a focused surgery which is a definitive treatment and can safely be performed during the 2nd trimester of pregnancy. 

Introduction: Papillary thyroid cancer (PTC) is the commonest form of well-differentiated endocrine carcinoma. It is categorized into indolent and aggressive, where the indolent subtypes (classic, follicular) rarely demonstrate aggressive behavior. We present a classic PTC presenting with a rapidly growing huge anterior neck mass that subsequently spontaneously ruptured subcutaneously resulting in ischemia, necrosis, and perforation of overlying skin leading to inflammation. Presentation of case: A 37-year-old female with no comorbidities presented to our emergency department with a neck swelling of 2 years duration that rapidly enlarged one week prior to presentation. Though the mass initially appeared of inflammatory nature, the tumor was a PTC, and she underwent total thyroidectomy with selective right side neck dissection and debridement of necrotic skin. The gross specimen revealed a fragmented non-intact right thyroid lobe mass causing pressure ischemia, necrosis and perforation of the skin. Histopathology showed a 9 × 9 × 5 cm classic PTC staged as pT3b N1b. Postoperative course was uneventful, she was discharged by the eighth postoperative day, and then she received a high dose of radioactive iodine ablation (RAI). Discussion: Classic PTC is usually of a smaller size and a relatively benign course compared to other PTC subtypes and thyroid cancers. It is indolent with favorable prognosis. Although it is associated with increased risk of lymph node metastases at the time of diagnosis, it is slow growing with high survival rates approaching 95%. Conclusion: Despite that classic PTC progresses slowly, it should still be suspected in neck swellings presenting with rapid and aggressive behavior. Prompt and systematic assessment is required with surgical intervention and radioactive iodine ablation therapy. 

Nonalcoholic fatty liver disease (NAFLD) is increasingly being linked to obesity. Although laparoscopic sleeve gastrectomy (LSG) is effective for weight loss that can ultimately resolve NAFLD, an initial transient deterioration of liver functions could be observed during the first few months post-operatively, after which a subsequent improvement of the liver functions might occur. Rapid weight loss, nutritional deficiencies, and protein malnutrition can all contribute to hepatic dysfunction and can affect the metabolism of medications such as acetaminophen leading to more insult to a compromised liver. We report acute liver failure after LSG associated with protein calorie malnutrition, multiple nutritional deficiencies in addition to concomitant use of therapeutic doses of acetaminophen. Treatment with N-acetylcysteine, and replacement of deficient multivitamins and trace elements resulted in significant improvement in liver functions. 

Schizophrenic symptoms and hallucinogenic effects have been thought of as similar for a long time. The aim of this paper is to review the current findings in the research of schizophrenia and hallucinogens; symptoms and effects, brain imaging studies and biochemical studies are compared. Systematic investigations show that the acute symptoms of schizophrenia are particularly similar to the effects of hallucinogens when using psychometric rating scales; APZ, EPI and AMPD, even though dissimilarities have been found. Converging evidence suggests that the acute effects of schizophrenia as well as the effects of hallucinogens act through a common receptor subtype, the 5-HT2A receptor. Brain imaging studies using PET and SPECT indicates that hallucinogenic drugs increase frontal cortical activity, studies have found it to be a result of 5-HT2A receptor stimulation. Interactions between the serotonergic system and other neurotransmitter systems might aid in the understanding of these phenomena.

The purpose of this study was to investigate why nursing students choose to start a nurse education and what perception they have about the profession? The design of the study was quantitative with a descriptive design. Data was collected from the new nursing students (n= 34) at a University, fall term 2010 using a questionnaire. The result showed that students choose nurse education for various reasons. The most common reason for the choice was to get an opportunity to continue their education within the nursing profession and for those students who have worked in health care chose the nurse education to continue as a nurse. Whatever the reason students have the will to help other people a major reason for the choice of nursing. The students felt that a nurse should be empathetic, wise, attentive, and thorough and open- minded in their professional capacity. The students thought that the most common tasks for a nurse are documentation, physical care, emotional care and medical technical tasks.

The inbred BDII rat is a valuable experimental model for the genetic analysis of hormone-dependent endometrial adenocarcinoma (EAC). One common aberration detected previously by comparative genomic hybridization in rat EAC is loss affecting mostly the middle part of rat chromosome 5 (RNO5). First, we applied an RNO5-specific painting probe and four region-specific gene probes onto tumor cell metaphases from 21 EACs, and found that rearrangements involving RNO5 were common. The copy numbers of loci situated on RNO5 were found to be reduced, particularly for the CDKN2A/2B locus. Second, polymerase chain reaction analysis was performed with 22 genes and markers and homozygous deletions of the CDKN2A exon 1β and CDKN2B genes were detected in 13 EACs (62%) and of CDKN2A exon 1α in 12 EACs (57%) Third, the occurrence of allelic imbalance in RNO5 was analyzed using 39 microsatellite markers covering the entire chromosome and frequent loss of heterozygosity was detected. Even more intriguing was the repeated finding of allele switching in a narrow region of 7 Mb across the CDKN2A/2B locus. We conclude that genetic events affecting the middle part of RNO5 (including bands 5q31q33 and the CDKN2A locus) contribute to the development of EAC in rat, with the CDKN2A locus having a primary role.

The inbred BDII rat is a valuable experimental model for the genetic analysis of endometrial adenocarcinoma (EAC). One common aberration detected by comparative genomic hybridization in rat EAC was gain/amplification affecting the proximal part of rat chromosome 6 (RNO6). We applied rat and mouse chromosome painting probes onto tumor cell metaphase preparations in order to detect and characterize gross RNO6 aberrations. In addition, the RNO6q11-q16 segment was analyzed by fluorescence in situ hybridization with probes representing 12 cancer-related genes in the region. The analysis revealed that seven tumors contained large RNO6-derived homogeneously staining regions (HSRs) in addition to several normal or near-normal RNO6 chromosomes. Five tumors (two of which also had HSRs) exhibited a selective increase of the RNO6q11-q16 segment, sometimes in conjunction with moderate amplification of one or a few genes. Most commonly, the amplification affected the region centered around band 6q16 and included the Mycn, Ddx1, and Rrm2 genes. A second region, centering around Slc8a1 and Xdh, also was affected by gene amplification but to a lesser extent. The aberrations in the proximal part of RNO6 were further analyzed using allelotyping of microsatellite markers in all tumors from animals that were heterozygous in the proximal RNO6 region. We could detect allelic imbalance (AI) in 12 of 20 informative tumors, 6 of which were in addition to those already analyzed by molecular cytogenetic methods as described. Our findings suggest that increase/amplification of genes in this chromosome region contribute to the development of this hormone-dependent tumor.

“Overworking to death” is a phenomenon that has been noticeable in developing countries. The cause of death is mainly through ischemic strokes. While the victims’ occupations differed, they all shared a common characteristic, being positioned in a sedentary work, ranging from IT workers to doctors. This project’s aim was to develop a product that prevented or decreased the strokes that derived from sedentary overwork. This was mainly tackled by preventing one of the three causes of developing blood props, slowed blood flow. In order to gather rich data of the phenomenon, a qualitative study was conducted in China, during two months. By doing an extensive structured sampling, information rich data could be gathered during a short period of time. Data were derived from observations, questionnaires and an interview, which then was interpreted to customer needs and the final product specification. The final product became a trouser with an in built dynamic compression mechanic, that can compress the veins mostly during sitting activities, in order to prevent blood stasis. The compression mechanic works like the Chinese finger trap; compressing the calves while sitting and stretching the legs forward. It is made only out of polysaccharides fibres; cotton and corn.

Objectives: To assess whether a psychosocial intervention teaching coping strategies to women can improve quality of life (QOL) in groups of Iranian women exposed to social pressures. Design: Quasi-experimental non-randomised group design involving two categories of Iranian women, each category represented by non-equivalent intervention and comparison groups. Setting: A large urban area in Iran. Participants: 44 women; 25 single mothers and 19 newly married women. Interventions: Seventh-month psychosocial intervention aimed at providing coping strategies. Primary outcome measures: Effect sizes in four specific health-related domains and two overall perceptions of QOL and health measured by the WHOQOL-BREF instrument. Results: Large effect sizes were observed among the women exposed to the intervention in the WHOQOLBREF subdomains measuring physical health (r=0.68; p<0.001), psychological health (r=0.72; p<0.001), social relationships (r=0.52; p<0.01), environmental health (r=0.55; p<0.01) and in the overall perception of QOL (r=0.72; p<0.001); the effect size regarding overall perception of health was between small and medium (r=0.20; not significant). Small and not statistically significant effect sizes were observed in the women provided with traditional social welfare services. Conclusions: Teaching coping strategies can improve the QOL of women in societies where gender discrimination is prevalent. The findings require reproduction in studies with a more rigorous design before the intervention model can be recommended for widespread distribution.

Background: The type 2 diabetes is a chronic disease that is increasing around the world. The disease causes a suffering, which leads to deterioration in health. Self-care is important so that patients are not bothered by the complications. Aim: Patient's experiences of living with type 2 diabetes. Method: A literature review was used, in which 12 qualitative articles were selected. Results: Consists of three themes; stress of living with diabetes, responsibility for lifestyle changes and support from the surrounding area. These three themes form six subthemes; the quality of life deteriorates, it creates concern, a struggle to change the diet, the will to exercise, support from relatives and health care. The results show that they create a constant struggle for the patient to manage diabetes, as it creates anxiety over the complications that diabetes can cause. It also shows how stressful it is with new lifestyle changes in terms of diet and physical activity. Relatives and care have a significant role to play in supporting patients. Conclusion: Shows how important it is for patients to receive support from both health care and their relatives in order to motivate them to change their lifestyle changes and reduce the risk of complications.

Background: Suicide is self-destructive act that leads to death and is usually a consequence of mental illness and disease. Suicide also leads to great suffering for the relatives left behind. The nurse’s role in cases like these is therefore to acknowledge and support relatives in their grieving process. Aim: Is to describe relatives’ lived experiences after their next of kin commits suicide in order to create an understanding on how nurses can respond to their needs. Method: The study was based on seven autobiographies. Dahborg-lyckhage’s method for analyzing narratives was used to analyze the chosen biographies. Results: The results describe the relatives’ feelings like guilt, shame, relief among others and reactions after their next of kin’s suicide. They experienced avoidance by people in their surroundings. They also lacked professional support to assist them in their bereavement and had to reach out for it themselves. Conclusion: Nurses have a role to fulfill with supporting relatives in their grieving process with aim to help on improving their wellbeing and relieve their suffering. Information about support groups and helpful organizations like SPES as a form of social support can be very helpful in achieving this.

The relationship between gut microbiota and intestinal epithelial cells, particularly specialized enteroendocrine cells, such as GLP-1-secreting L-cells, is a critical aspect of gastrointestinal homeostasis and the gut-brain axis. This study delves into the molecular signalling pathways activated by the interaction between Bifidobacterium breve ncfb2258, a putative probiotic, and GLP-1-secreting L-cells. Bifidobacterium breve ncfb2258 produces conjugated linoleic acids (CLAs), which activate peroxisome proliferator-activated receptors (PPARs) and free fatty acid receptors (FFARs). This study aims to shed light on whether L-cells function as crossbarrier signal transducers and the mechanisms with which they do. Significant findings emerged through immunofluorescent labelling and calcium imaging, revealing differential expression patterns of these molecules in response to exposure to Bifidobacterium breve ncfb2258 supernatants. A significant response was observed when the human colorectal cancer cell line, NCI-H716 cells, a model of human GLP-1-secreting L-cells, were exposed to Bifidobacterium breve ncfb2258 supernatants (p = 0.003). PPARα and FFAR4 were both detected on NCI-H716 cells and while exposure to Bifidobacterium breve ncfb2258 supernatants increased the intensity of their cellular expression (p = <0.001; 0.042), expressiononly decreased with the addition of PPARα antagonist (p < 0.001) and remained elevated after the addition of FFAR4 antagonist (p = 0.999). These findings suggest the NCI-H716 cell line is suitable for exploring human GLP-1-secreting L-cells as potential cross-barrier signal transducers for the putative probiotic, B. Breve ncfb2258, and identify PPARα as potentially being involved in the molecular mechanisms of this interaction.

Introduction: Evolution of antibiotic resistant bacteria poses a major threat to public health. All patients are entitled to a non-infectious care environment; despite the fact that infectious transmission in health care is possible. Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in patients, staff and in health care environment represents such a threat. 

In infection prevention in health care established routines in patient care, handling of medical equipment and cleaning in care environment are essential.

Aim: The aim of the study was to assess the fraction of MRSA positive environmental sampling following terminal cleaning of a room where a patient with confirmed MRSA was treated, and to assess whether potential patient’s risk factors and/or length of hospital stay influenced the result.

Methods: Quantitative study with consecutive material consisting of data from in total 180 environmental samplings performed in Region Halland. The material has been processed with the statistic program SPSS, and analyzed with Chi2 test. 

Results: In 14 % (25 out of 180) of the environmental samplings MRSA was detected. A statistically significant association between prevalence of patient risk factors as wounds/skin lesions, drainage, catheters, tracheostomy or other artificial body openings could not be shown. However, a hospital stay exceeding 24 hours significantly increased risk of detecting MRSA in the patient room after terminal cleaning. 

Conclusion: Quality of terminal cleaning is important in preventing transmission of MRSA in health care environment and probably more important than the impact of patient risk factors. However, length of hospital stay is a factor worth consideration and can possibly be used to influence care routines in prevention of transmission of MRSA in health care environment.

Background: A number of 9400 women is diagnosed with breast cancer every year i Sweden and increased age is a significant risk factor. Breast cancer is diagnosed with a triple diagnostics; mammography, palpation and cytology. The treatment of breast cancer consists of surgical-, radiation-, hormonal-, and chemotherapy. The human being sense and experience, which is also linked to the environment to other individuals. The sexual health is complex and is related to the woman's body perception. A good body image gives increased well-being and sexual health. The nursing of the women's sexual health is provided by the nurse, who will support and information the woman Purpose: The purpose of the study was to describe the women's sexuality after mastectomy. Method: The chosen method was a literature review of women´s experience of their body after mastectomy by analysing qualitative studies from women’s perspective in a literature study. Findings: The result shows that women who have undergone mastectomy suffer from lower self-esteem related to impaired body image. The women also experience sexual problems such as vaginal dryness, reduced sex drive and difficulty in achieving orgasm. The women find that support from partners and health care is essential for better sexual health, but there is a lack of support and information from healthcare providers. Conclusion: Women undergoing mastectomy need increased support from the health care providers to experience participation and safety in their care and everyday life.

Much has been written about measuring the feelings and impressions of women regarding their experience of miscarriage. According to the existential philosopher Heidegger life experiences such as the experience of a woman having a miscarriage can be interpreted and explained only in the context of the totality of the women’s experiences in the past, the present, and the future. Thirteen in-depth interviews with women about their experiences of miscarriage were interpreted with respect to Heidegger’s “Being and Time”. By using his inter-pretive phenomenology the essence of the miscarriage experience was explored and defined. The women’s feelings and impressions were influenced by past experiences of miscarriage, pregnancy, and births. Present conditions in the women’s lives contributing to the experience include their relationships, working situation, and living conditions. Each woman’s future prospects and hopes have been structurally altered with regard to their aspirations for their terminated pregnancy. The impact of miscarriage in a woman’s life was found to be more important than caregiver providers and society have previously attributed to in terms of scale. The results of the interviews reveal that the women believed that only women who had experienced their own miscarriages were able to fully understand this complex womanly experience and its effects on the woman who had miscarried.

Pregnancy has different meanings to different women depending upon their circumstances. A number of qualitative studies have described the experience of miscarriage by women who had desired to carry their pregnancy to full term. The aim of this meta-analysis was to identify a scale of psychological reaction to miscarriage. Meta-analysis is a quantitative approach for reviewing articles from scientific journals through statistical analysis of findings from individual studies. In this review, a meta-analytic method was used to identify and analyze psychological reactions in women who have suffered a miscarriage. Different reactions to stress associated with the period following miscarriage were identified. The depression reaction had the highest average, weighted, unbiased estimate of effect (d+= 0.99) and was frequently associated with the experience of perinatal loss. Psychiatric morbidity was found after miscarriage in 27% of cases by a diagnostic interview ten days after miscarriage. The grief reaction had a medium d+ of 0.56 in the studies included. However, grief after miscarriage differed from other types of grief after perinatal loss because the parents had no focus for their grief. The guilt is greater after miscarriage than after other types of perinatal loss. Measurement of the stress reaction and anxiety reaction seems to be difficult in the included studies, as evidenced by a low d+ (0.17 and 0.16, respectively). It has been recommended that grief after perinatal loss be measured by an adapted instrument called the Perinatal Grief Scale Short Version.

Purpose: The purpose of this study was to provide better organization and more efficient use of resources within the health care system in order to identify women with nonviable pregnancy earlier in their gestation terms and also to identify those women who experience severe grief reaction after the miscarriage. The proposed solution is to offer an appointment with a gynecologist during regular office hours after consultation with the patient’s midwife to women experiencing symptoms and who are concerned with the viability of their pregnancy. Unnecessary contact with the emergency room by the patients would be reduced as a result of this improvement in organization. The aim of the study was to give the women experiencing missed miscarriage an increased sense of well-being by applying Swanson’s Caring Theory to their recovery, in addition to the better organization and more efficient use of resources.

Method: Both the original study from 2002 to 2003 and the later study from 2004 to 2005 applied Swanson’s Caring Theory in the follow-up care management of the women, but only the later study was influenced by the changes made in the health care system. In the past, diagnosis of missed miscarriage was delayed because women experiencing minor symptoms were not highly prioritized in the health care system. More active support was introduced in order to get the proper information to the patient throughout the health care system. The size of the original study database was n=43, compared with the later study database, which was n=56. All of the women answered the Perinatal Grief Scale (PGS) questions twice, 1 month and 4 months after their diagnosis. Some additional questions about their circumstances unrelated to the PGS were also mailed to the women 4 months after their diagnosis.

Results: As a result of the more active support, women felt that they received professional care when they needed it most. The patients were satisfied that they were treated as if they were suffering from normal grief. The group score above the limits for deep grief 4 months after diagnosis was significantly lowered. The chances of receiving their diagnosis at an appointment during office hours increased (odds ratio 3.38). Sick leave time of more than a week was reduced from 44% in the original study to 22% in the later study.

Cervical cancer is the second most common type of cancer among women worldwide. In Sweden cervical cancer is the fifteenth most common cancer among women and accounts for 1.9 percent of all female cancers. The Swedish Pap smear screening program is enabling early detection of cell changes in order that treatment may be administered to prevent the development of cancerous cells. There are approximately four hundred and fifty cases of cervical cancer detected each year in Sweden and of these cases, approximately seventy five percent occur in women who do not participate in the screening and testing program. The purpose of this study was to illustrate and examine the reasons why women did not participate in the program even though they had received a notice that they had an appointment for a Pap smear test. In the study fourteen women from a district in the west of Sweden were interviewed. In order to analyse the interviews a qualitative content analysis according to Lundman and Graneheim was used. The analysis resulted in the development of three categories which were identified as communication, treatment and subterfuge (reasons or excuses for not participating). The theme of the study was the professional treatment of the women’s conditions. In the interviews the women emphasize the importance of professional treatment that is administered with respectful and sympathetic care throughout the whole healthcare system regardless of where and when the visit was conducted. Efficient organization and clear communication would minimize the inconvenience for the women during their visit.

Background: The aim of this study was to pilot test a prototype website called MODIAB-web designed to support pregnant women and mothers with type 1 diabetes.

Method: A focus group was undertaken and the results were analyzed using qualitative content analysis.

Results: Eight subthemes were identified, comprising "blood glucose versus insulin," "application for smart phones," "the time aspect," "interface and technology," "forum," "direct link to the diabetes midwife," "ask the expert," and "lack of contact information." These subthemes were condensed into two main themes. The first theme was "easily understood interface, but in need of a more blood-glucose focused orientation" and the second theme was "forum for interaction with both equals and experts."

Conclusion: The women in this study had positive impressions of several of the MODIAB-web functions, including a forum for pregnant mothers with type 1 diabetes and the possibility of being able to put their blood glucose levels into a diagram which could be sent directly to the diabetes midwife. Access to articles and information via the "fact" tab and the ability to ask questions of experts were also significantly helpful to women in the focus group. Pregnant women and mothers with type 1 diabetes can gain support from such a Web-based self-help system.

Objectives: The aim of this study was to evaluate how Swedish women describe their emotional state of being during the eighth week through the eleventh week after they have become pregnant again after suffering a previous miscarriage. Method: A qualitative content analysis with an inductive approach has been used to analyze fourteen interviews that served as the data base for this study. The content analysis resulted in the development of five categories which evolved into one primary theme. Findings: The five categories identified were Worry and preoccupation; Distance; managing their feelings; Mourning what is lost; Guarded happiness and expectations. These categories were compiled into a main theme, “Worry consumes a lot of energy, but on the other side lies happiness”. This theme focused on whether the women could feel any happiness about being pregnant again despite their concerns with the previous miscarriage. Conclusions: The emotional states of the women when they get pregnant again are typically characterized by anxiety, worry and concerns about their current pregnancy. The women have a tendency to distance themselves emotionally from their pregnancy but also strive to find the joy of being pregnant again. During the new pregnancy they find themselves in need of support from their family and friends as well as in need of support from the healthcare system.

Objective. To describe quality of life in men and women who had terminated in vitro fertilization (IVF) within the public health system 4-5.5 years previously, and for whom treatment did not result in childbirth. Design. Cross-sectional study. Setting. Reproductive Unit, Sahlgrenska University Hospital, Gothenburg, Sweden. Sample. Four hundred pairs were invited to participate, 71% accepted and 68% completed questionnaires. Methods. Questionnaire study. Study subgroups were compared with a control group with children and with each other. Main outcome measure. Psychological General Well-Being (PGWB), Sense of Coherence (SOC), experience of infertility, demographic-socio-economic and health characteristics were measured. Results. Surprisingly, 76.7% had or lived together with children; 39.6% had biological children, 34.8% had adopted and 3.7% were parents to both biological and adopted children. No differences were found between the study and the control groups, except in SOC which scored lower in the study group. The study group with children had a higher PGWB index than the 23.3% without children and the controls. SOC scored higher in the subgroup with than those without children. Infertility was still a central issue in the subgroup without children. Conclusion. Despite having undergone unsuccessful IVF within the public health system, more than 75% lived with children 4-5.5 years later. This subgroup had a better quality of life, compared to those without children. Additional IVF treatment may result in increased quality of life.

Background. Grief is a normal phenomenon but showing great variation depending on cultural and personal features. Bonanno and Kaltman have nonetheless proposed five aspects of normal grief. The aim of this study was to investigate if women with miscarriage experience normal grief. Material and methods. Content analyses of 25 transcribed conversations with women 4 weeks after their early miscarriages were classified depending on the meaning-bearing units according to Bonanno and Kaltman’s categories. In the factor analyses, these categories were compared with the Perinatal Grief Scale and women's age, number of children and number of miscarriages, and gestational weeks. Results. Women with miscarriage fulfill the criteria for having normal grief according to Bonanno and Kaltman. All of the 25 women had meaning-bearing units that were classified as cognitive disorganization, dysphoria, and health deficits, whereas disrupted social and occupational functioning and positive aspects of bereavement were represented in 22 of 25 women. From the factor analysis, there are no differences in the expression of the intensity of the grief, irrespective of whether or not the women were primiparous, younger, or had suffered a first miscarriage. Conclusion. Women’s experience of grief after miscarriage is similar to general grief after death. After her loss, the woman must have the possibility of expressing and working through her grief before she can finish her pregnancy emotionally. The care-giver must facilitate this process and accept that the intensity of the grief is not dependent on the woman’s age, or her number of earlier miscarriages.

We investigated the effect of a changed routine to identify women with a nonviable pregnancy, in order to utilize health care resources more efficiently during office hours rather than relying on emergency care services. From hospital register data about where and when women with miscarriages were treated, there was a significant trend during a nine-year period for miscarriages to be more rarely diagnosed (p-value<0.001) in the emergency ward after office hours. The proportion of miscarriages that were diagnosed and handled at the emergency ward decreased from 31% in 2001 to 17% in 2009. Furthermore, the number of women showing up with bleeding at the emergency ward, but who also had a normal viable pregnancy, declined during the same period (p-value<0.01). Women with suspected miscarriage benefit from structured information and standardized management and can effectively be scheduled for day-time assessment including ultrasound with a concomitant reduced need for emergency services.

BAKGRUND: Humant Immunbrist Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) är en pandemi som hårdast drabbat utvecklingsländer i världen. I Sydafrika är 6,300 000 HIV/AIDS positiva. Studier visar att människor som lever i fattigdom utsätts för den största risken att bli drabbad av HIV/AIDS, då utbildning och möjligheten till val av livsstil är låg. Skam och stigmatisering drabbar både människan i fråga och dess närstående. SYFTE: Syftet med studien är att beskriva Sydafrikanska människor upplevelse av sin livssituation efter en HIV/AIDS diagnos. METOD: Litteraturöversikt, åtta artiklar har analyserats för att nå arbetets resultat. RESULTAT: Resultatet är uppbyggt under tre huvudteman; Egenupplevt och samhällets skuldbeläggande hos HIV/AIDS-positiva människor, Viktiga faktorer för att uppnå en känsla av hälsa hos HIV/AIDS-positiva människor samt Behov och längtan av stöd från närstående. Resultatet beskriver att den drabbade värderar anonymitet högt för att undvika samhällets stigmatisering. Gott bemötande hos vårdpersonalen visade sig också vara en viktig faktor för välbefinnande hos människan, men även stöd från familj. Stödet från familjen upplevdes dock i vissa fall som svårt att finna. DISKUSSION: Stigma som är ett stort problem hos den drabbade skulle kunna minskas med utbildning och spridning av kunskap hos allmänheten. Bemötande som ger människan en känsla av trygghet och ett system som är gynnsamt för individens anonymitet är eftersökt. Detta trots att forskning visar att en öppenhet uppmuntras hos de HIV positiva för att minska stigma. Rädslan är dock för stor för att detta skulle kunna bli aktuellt för många

Inledning: Trots vetskapen om vikten av fysisk aktivitet rör männiksor på sig allt mindre, vilket kan bero på ändrade förutsättningar i samhället. En väletablerad faktor, som påverkar intresset för att vara fysisk aktiv, är den byggda miljön. Syftet med litteraturöversikten är därför att beskriva vilka faktorer i den byggda miljön som främjar fysisk aktiviet hos vuxna kvinnor och män. Metod: Uppsatsen utgår från metoden litteraturöersikt och är baserad på tio vetenskapliga originalartiklar. Resultat: Genom analyser av de tio vetenskapliga artiklarna kunde fyra teman urskiljas; tillgänglighet till cyckel- och gångvägar, avstånd till grönområden och parker, miljömässiga faktorer och faciliteter samt antal parker/grönområden och deras areal. Diskussion: Faktorer som lättillgänglighet till cykel- och gångvägar, litet avstånd till grönområden och parker samt faciliteter i den byggda miljön visade sig främja rörelse. Även antal parker/grönområden och deras areal gynnade fysisk aktivitet hos vuxna kvinnor och män. Några resultat visade dock andra utgångar där avståndet till gröna ytor samt att antalet parker inte var av signifikant betydelse för fysisk aktivitet. 

Background: Being diagnosed with breast cancer is an overwhelming experience,especially for young women of childbearing age, because they often find themselves in acomplex life situation. Aim: The aim of the study was to describe nurses’ experiences ofwhat is important in caring for young women with breast cancer. Method: The data wascollected by semi-structured qualitative interviews according to Kvale and Brinkmann. The transcribed interviews have been analyzed to understand their meaning. Results: Caring ofyoung women with breast cancer do not differ from other patient groups. Although allpatients should be treated on equal terms, caring should be individualized. Importantelements, such as deep conversations, are perceived as difficult in caring and referred toother professionals. However, the nurses stress the importance of these conversations to geta relationship with the patients. Discussion: A caring relationship is important in order toget access to what patients considers important in caring. Without a caring relationship, it isimpossible to give the patients the right support. Caring should be individualized becausethe perception of health is subjective. The nurses seem unfamiliar with self reflection whichshows in their unwillingness to discuss sensitive topics.