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 patients 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.
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.
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.
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.
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.
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.
Thermally stimulated diffusion of Mn through thin layers of GaAs has been studied by x-ray photoemission. (Ga, Mn)As samples with 5 at% Mn were capped with 4, 6 and 8 monolayer (ML) GaAs, and Mn diffusing through the GaAs was trapped on the surface by means of amorphous As. It was found that the out-diffusion is completely suppressed for an 8 ML thick GaAs film. The short diffusion length is attributed to an electrostatic barrier formed at the (Ga, Mn)As/GaAs interface.
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.
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.
Background: to report anthropometry and morbidity among term low birth weight infants and anthropometry of their first time mothers during the first six months in relation to breastfeeding practice. Methods: we examined data from a randomized controlled trial in Manila, the Philippines. Of the 204 mothers randomized, 68 mothers received eight postpartum breastfeeding counseling sessions, the rest did not. Maternal and infant anthropometric data at birth, 2, 4 and 6 months were taken. During seven follow-up hospital visits, an independent interviewer recorded feeding data. Results: the 24 infants exclusively breastfed from birth to six months did not have diarrhea compared to 134 partially breastfed (mean 2.3 days) and 21 non-breastfed infants (mean 2.5 days). Partially breastfed and non-breastfed infants compared to exclusively breastfed infants had more frequent, as well as more severe episodes of respiratory infections. At six months, neither overall gain in infant weight, length and head circumferences nor mean maternal weight and body mass index differed significantly between the feeding groups. Conclusions: exclusive breastfeeding for 6 months can be recommended in term low birth weight infants, who were protected from diarrhea, had fewer respiratory infections, required no hospitalization and had catch up growth. Exclusively breastfeeding mothers did not differ from mothers who breastfed partially or those who did not breastfeed with regard to weight changes at six months.
This paper makes use of data collected in a randomised controlled trial that was designed to test the efficacy of postpartum breastfeeding counselling to increase exclusive breastfeeding among term low birth weight infants in Manila during the first six months. Mothers were randomised to a control group or one of two home visit interventions: by trained breastfeeding counsellors or child care counsellors without breastfeeding support training. Sixty mothers received peer breastfeeding counselling while a further 119 mothers did not. The median duration of exclusive breastfeeding among mothers who received counselling was five weeks versus two weeks among those who received no counselling (p<0.001). Exclusive breastfeeding was interrupted to offer infants water, traditional herbal extracts or artificial baby milk. Mothers who interrupted exclusive breastfeeding claimed they had insufficient milk or that their infants had slow weight gain. Early and sustained breastfeeding support will enable mothers to exclusively breastfeed low birth weight infants for the first six months.
Death is considered a stressor to all health care personnel and previous research shows that this applies to hospice caregivers as well. In addition, a number of common coping strategies are impossible to use due to the specific environment. One study however points out low burn-out rating among the hospice caregivers and suggests the holistic nursing perspective, among others, as one of the possible reasons for this seemingly ambivalent finding. Can the hospice philosophy influence the view on death among hospice caregivers? An interview based study was conducted among caregivers working in a hospice in Sweden, where three participants took part. The manifest content relating to the purpose of the study was identified and analyzed using qualitative content analysis. The result shows that hospice caregivers indeed are influenced by the hospice philosophy in areas such as the view on end-of-life care, dying and professional cooperation. The participants displayed affection for their work style and a variety of ways in which to cope with the difficulty of their work. Work based on a philosophy that permeates the care of the patients seems to increase the appreciation of each other as co-workers. Further research in this area can be of interest.
Stevia is a perennial herb that belongs to the Asteraceae family. It is a natural sweetener plant and estimated to be 300 times sweeter than cane sugar. The leaves of stevia are the source of diterpene glycosides, viz. stevioside and rebaudioside. Stevioside is regenerated as a valuable natural sweetening agent because of its relatively good taste and chemical stability. Now it is being cultivated in Japan, Taiwan, Philippines, Hawaii, Malaysia and overall South America for food and pharmaceutical products. Products can be added to tea and coffee, cooked or baked goods, processed foods and beverages, fruit juices,
Arabidopsis thaliana is a small flowering plant belonging to the Brassicaceae family, which is adopted as a model plant for genetic research. Agrobacterium tumifaciensmediated transformation method for A. thaliana ecotype Bangladesh was established. Leaf discs of A. thaliana were incubated with A. tumefaciens strain LBA4404 containing chimeric nos. nptII. nos and intron-GUS genes. Following inoculation and co-cultivation, leaf discs were cultured on selection medium containing 50 mg/l kanamycin + 50 mg/l cefotaxime + 1.5 mg/l NAA and kanamycin resistant shoots were induced from the leaf discs after two weeks. Shoot regeneration was achieved after transferring the tissues onto fresh medium of the same combination. Finally, the shoots were rooted on MS medium containing 50 mg/l kanamycin. Incorporation and expression of the transgenes were confirmed by PCR analysis. Using this protocol, transgenic A. thaliana plants can be obtained and indicates that genomic transformation in higher plants is possible through insertion of desired gene. Although Agrobacterium mediated genetic transformation is established for A. thaliana, this study was the conducted to transform A. thaliana ecotype Bangladesh.
Sweden is one of the European countries that has successively changed from a mainly ethnically homogeneous society into a multi-ethnic society. In 2001, almost 20 per cent of the Swedish population was classified as immigrants, i.e., they were either born abroad and naturalized, of foreign nationality or born in Sweden with at least one parent who had been born abroad. Reports, statistics and research have shown that the health of female immigrants is worse than that of the total population and that the incidence of long-term sickness absence and early retirement is higher in this group. The overall aim of this article is to describe, understand and analyze factors that contribute to poor health among female immigrants in Sweden from the perspective of class, gender and ethnicity. Being unemployed, on sick leave or working in occupation with low income and low status are examples that are related to class position, gender and ethnicity. The main three aspects based on class are wage, professional status and female immigrants position in the hierarchical work organisation. Other factors are discrimination due to ethnicity and gender, unfavourable physical and psychosocial work environment and absence of opportunities for skills upgrade training. Experiences of rape, domestic violence, unanswered emotional and sexual needs and patriarchal culture are examples that are related to gender. And experiencing traumatic events (in pre-migration periods such as experiences of war, prison, etc. and in post-migration periods such as experiences of discrimination and racism) are examples that are related to ethnicity.
Introduction: Ethnic and socioeconomic inequalities in the Swedish health care system have increased. Most indicators suggest that immigrants have significantly poorer health than native Swedes. The purpose of this study was to explore the views of midwives on the factors that contribute to health care inequality among immigrants. Methods: Data were collected via semi-structured interviews with ten midwives. These were transcribed and related categories identified through content analysis. Results: The interview data were divided into three main categories and seven subcategories. The category "Communication" was divided into subcategories "The meeting", "Cultural diversity and language barriers" and "Trust and confidence". The category "Potential barriers to the use of health care services" contained two subcategories, "Seeking health care" and "Receiving equal treatment". Finally, the category "Transcultural health care" had subcategories "Education on transcultural health care" and "The concept". Conclusions: This study suggests that midwives believe that health care inequality among immigrants can be the result of miscommunication which may arise due to a shortage of meeting time, language barriers, different systems of cultural beliefs and practices and limited patient-caregiver trust. Midwives emphasized that education level, country of origin and length of stay in Sweden play a role when an immigrant seeks health care. Immigrants face more difficulties when seeking health care and in receiving adequate levels of care. However, different views among the midwives were also observed. Some midwives were sensitive to individual and intra-group differences, while some others viewed immigrants as a group of "others". Midwives' beliefs about subgroup-specific health services vs. integrating immigrants' health care into mainstream health care services should be investigated further. Patients' perspective should also be considered.
In this study our aim was to explore the experiences of doula support among foreign-born women in Sweden in the context of a “Community-Based Doula” (CBD) intervention project. We conducted interviews with ten women and analyzed the data using content analysis. Participating women reported that, in addition to support during labor; doulas provided important information and continuity of care, which apparently increased their satisfaction with and trust in maternity health care. Training of CBDs therefore has implications for delivery of equitable maternity care, which apply not only to Sweden and other European countries but wherever there are increasingly diverse populations.
To investigate variations in explanations given for disparities in health care use between migrant and nonmigrant groups, by clients and care providers in Sweden. Qualitative evidence collected during in-depth interviews with five ‘migrant’ health service clients and five physicians. The interview data generated three categories which were perceived by respondents to produce ethnic differences in health service use: ‘‘Communication issues’’, ‘‘Cultural differences in approaches to medical consultations’’ and ‘‘Effects of perceptions of inequalities in care quality and discrimination’’. Explanations for disparities in health care use in Sweden can be categorized into those reflecting social/structural conditions and the presence/absence of power and those using cultural/behavioural explanations. The negative perceptions of ‘migrant’ clients held by some Swedish physicians place the onus for addressing their poor health with the clients themselves and risks perpetuating their health disadvantage. The power disparity between doctors and ‘migrant’ patients encourages a sense of powerlessness and mistreatment among patients.
Objective: to describe and analyse midwives’ experiences of doula support for immigrant women in Sweden. Design: qualitative study, analysed using content analysis. Data were collected via interviews. Setting: interviews were conducted at the midwives’ workplaces. One midwife was interviewed at a cafe. Participants: ten midwives, who participated voluntarily and worked in maternity health care in western Sweden. Findings: the interview data generated three main categories. (1) ‘A doula is a facilitator for the midwife’ has two subcategories, ‘In relation to the midwife’ and ‘In comparison with an interpreter’, (2) ‘Confident women giving support, ’has two subcategories, ‘Personal characteristics and attitudes’ and ‘Good support,’ (3) ‘Doulas cover shortcomings’ has two subcategories, ‘In relation to maternity care’ and ‘In relation to ethnicity’. Key conclusion and implications for practice: The findings of this study show that midwives experience that doulas are a facilitator for them. Doulas provide support by enhancing the degree of peace and security and improving communication with the women in childbirth. Doulas provide increased opportunities for transcultural care. They may increase childbearing women’s confidence and satisfaction, help meet the diverse needs of childbearing women and improve care quality.
This study aimed to describe children’s experience of living with overweight or obesity, by using a literature-review. The study includes eleven articles, data is from children between ages 5-15 year. The result occurring were in the areas; Quality of life and self-esteem, Social company, Body concept and weight reduction and Psychological unhealth. BMI above what is recommended gives a negative influence on quality of live and self-esteem. The exposure of teasing is rising, which also dieting and weight–related concerns do. Depression symptoms occur in varying degree, but the correlation to BMI is not direct. Girls in ages up to 14 years seem to be most influenced by being overweight or obese. The language children are using related to their own body may act as a barrier to apply its health- consequences on themselves. Health- care professionals should treat those children in a way that reinforce their view of themselves, by doing so they can help them reaching better health. To improve treat and treatment of the children, there is a need of more qualitative investigation in the subject.
Malnutrition is a well known problem in the patient related care in Europe as well as in the rest of the world. Despite this is malnutrition something that still exists. What can that depend on? It is important to judge the patients nutrition status as a routine to be able to prevent malnutrition. The effects of malnutrition cost the community a lot of money and human suffering. The aim of this study was to see the nurse’s responsibility when it comes to prevent and treat malnutrition in his/her daily work. Our choice of method to answer this aim was a literature review. With regard to scientific quality we elected to review ten articles. The results of this study are showing that judging, preventing measures, documentation and interaction between the nurse and patient are important in the work of preventing and treating of malnutrition. The conclusion is that it’s necessary for the nurses to have more education in malnutrition to be able to identify risk patients. The interaction between the nurse and patient is also very important and has to work correctly
Palliative care is practices in all care institutions in Sweden. With this study we wanted to elucidate factories that influence’s the nurse’s assessment and value of pain to patients who are dying. We wonted to illuminate how important it is that the nurse does a correct assessment of pain because all patients deserve to die with out pain. The aim of the study was to describe factories that influence nurse’s assessment and value of the pain of patients in the palliative care. The method that’s been used was a qualitative literature study. The result showed that the nurse experiences assessment of pain as complicated because of many different reasons, for instance lack of knowledge and difficulties to communicate with certain patients groups. The result also showed that they lacked sufficient knowledge and experience in order to do assessment of pain in a correct way and they were missing of good sense of confidence in their professionals.
Myocardial infarction is a big health problem in Sweden. Between the years 1987-2004 about 56 000 people have suffered from an acute myocardial infarction. In many studies men have been the main focus. That means that the findings don’t represent women. Women may have different symptoms than men, because of this the women are often diagnosed wrong, and get treatment long after men. The aim of this study is to describe how women experience the information they are given after a Myocardial infarction, and what sort of information they request. A literature review is chosen for this study. Ten articles are analysed, they answered the question formulations and the aim of the study. The result of this study is that women’s needs of information are great and women need individual information. If this is neglected the women’s recovery is prolonged. Information can also be a form of support. Women want to know why this happened and what the illness is going to mean for their lives. When women are informed they feel supported. They can also get support and information from cardiac rehabilitation programmes. Nurses should build a relationship with the patient based on respect and trust.
Staphylococcus aureus (S. aureus) is responsible for many human diseases including septic arthritis and sepsis shock. Tumor necrosis factor alpha (TNF-α) is a pro-inflammatory cytokine involved in inflammation and produced mainly by macrophages and monocytes. It is believed to be involved in pathogenesis of septic arthritis. Time window of TNF-a in innate immunity against staphylococcal infection was studied in this project.
Two experiments were carried out: In the first experiment mice were infected with a low dose (8x106cfu/mouse) of S. aureus to induce septic arthritis whereas in the second experiment the mice were infected with a higher dose (8x107cfu/mouse) of S. aureus to induce sepsis shock. All mice were divided into three groups. The first group was treated with anti-TNF-α 20 minutes after infection. The second group was treated with the anti-TNF-α three days after infection. The third group served as control and was injected with PBS instead of anti-TNF-α. The mice were regularly weighed and signs of arthritis and mortality were recorded. Two weeks after inoculation bacteria viable counts in different organs was done, as well as histopathological assessment of joints and measurement of cytokines in blood.
We have observed that mice treated with anti-TNF-α had less severe arthritis and also less mortality. However, they had more bacteria accumulated in the kidneys and lost more weight compared to the control group. The results were mostly seen in the group early treated with TNF-α, compared to the late treated group.
We conclude that anti-TNF-α might be potentially used as a therapy against septic arthritis and sepsis shock. This should be combined with antibiotics to eliminate the bacteria while the anti-TNF-α reduces the severity of the inflammation and thus reduce the risk of permanent joint destruction and mortality. We can conclude that blocking TNF-α early on is essential in order to get the best results.
Deriving clusters of genes by different clustering techniques or finding the statistically significant variations among genes are conventional approaches to study microarray expression data. Nowadays in vitro experiments are being considered to make applications of genetical genomics more widespread in non-model species. Different bioinformatics tools are being used to investigate genetic pathways in the form of correlation based networks. In this study, a comparison was made between in vivo and in vitro gene expression data by using two software: BioLayout and GeneNet. From ten mice, five mice with the wild-type allele and five mice with the gene knock out (KO) for the gene SOCS2, a total of twenty samples were taken: five fresh samples from wildtype mice, five fresh samples from KO mice, five cultured samples from wildtype mice and five cultured samples from KO mice. After obtaining differentially expressed genes from microarray cDNA experiments, network analysis was done using the software BioLayout and GeneNet to make correlation and partial-correlation based networks. The resulting networks, or clusters derived from the networks, were subsequently analyzed for gene set enrichment analysis (GSEA) using the tool DAVID. The results from the GSEA were used to compare all the clusters and networks between the fresh and cultured samples to test for functional overlap. The GSEA results were also used to compare the clusters from BioLayout with the networks from GeneNet to compare overlap between these tools using the same data. When functional enrichment analysis and comparisons were made between the fresh and cultured data set after getting the networks and clusters from BioLayout and GeneNet, only a few functional categories were found in common. This suggested that in vitro samples are unable to give the same biological information as in vivo samples for this particular gene KO. Also the two different network tools showed only limited overlap, suggesting that the correlation based networks from BioLayout show a different type of relationship among the genes than the partial correlations from GeneNet.
Therefore, the use of different network tools can be recommended to visualize and explore the regulatory pathways among genes.
Background: Arsenic is a potent pollutant that has caused an environmental catastrophe in certain parts of the world including Bangladesh where millions of people are presently at risk due to drinking water contaminated by arsenic. Chronic arsenic exposure has been scientifically shown as a cause for liver damage, cancers, neurological disorders and several other ailments. The relationship between plasma cholinesterase (PChE) activity and arsenic exposure has not yet been clearly documented. However, decreased PChE activity has been found in patients suffering liver dysfunction, heart attack, cancer metastasis and neurotoxicity. Therefore, in this study, we evaluated the PChE activity in individuals exposed to arsenic via drinking water in Bangladesh.
Methods: A total of 141 Bangladeshi residents living in arsenic endemic areas with the mean arsenic exposure of 14.10 ± 3.27 years were selected as study subjects and split into tertile groups based on three water arsenic concentrations: low (< 129 μg/L), medium (130-264 μg/L) and high (> 265 μg/L). Study subjects were further sub-divided into two groups (≤50 μg/L and > 50 μg/L) based on the recommended upper limit of water arsenic concentration (50 μg/L) in Bangladesh. Blood samples were collected from the study subjects by venipuncture and arsenic concentrations in drinking water, hair and nail samples were measured by Inductively Coupled Plasma Mass Spectroscopy (ICP-MS). PChE activity was assayed by spectrophotometer.
Results: Arsenic concentrations in hair and nails were positively correlated with the arsenic levels in drinking water. Significant decreases in PChE activity were observed with increasing concentrations of arsenic in water, hair and nails. The average levels of PChE activity in low, medium and high arsenic exposure groups were also significantly different between each group. Lower levels of PChE activity were also observed in the > 50 μg/L group compared to the ≤50 μg/L group. Moreover, PChE activity was significantly decreased in the skin (+) symptoms group compared to those without (-).
Conclusions: We found a significant inverse relationship between arsenic exposure and PChE activity in a human population in Bangladesh. This research demonstrates a novel exposure-response relationship between arsenic and PChE activity which may explain one of the biological mechanisms through which arsenic exerts its neuro-and hepatotoxicity in humans.
Postoperative pain is still a major problem that is difficult to identify. The extent of uncontrolled pain in patients has not improved noticeably over the last decades. Nurses tend to underestimate the patients pain. The aim of this study was to examine factors influencing nurses’ assessment of postoperative pain. To obtain the aim a literature review was chosen. Search of literature was carried out in the databases: Academic Search Elite, CINAHL, SweMed +. Six articles were analysed according to a five-step- method. The result of the selected articles showed seven factors influencing how nurses assess postoperative pain: communication, experiences and attitudes, nurses knowledge, information and preparation, to interpreting pain, obstacles in pain assessment and following-up the pain assessment. Despite extensive research in this subject, there is a need for the research to continue. It would be favourable to increase the pain education for nurses.
BACKGROUND: HIV/AIDS (Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome) is an epidemic disease, with the highest prevalence in the less developed countries. Earlier studies show that healthcare providers have a negative attitude towards this patient group. The cause of this is believed to be due to ignorance and fear. AIM: The aim of this study was to describe patients with HIV/AIDS and their experiences of stigmatization and discrimination by healthcare providers. METHOD: A literature review, based on an analysis of ten scientific articles is used to answer the aim of the study. RESULT: Two main themes emerge; preconception and contempt and support and the healthcare provider/patient relationship. The result of this studie shows that patients experience contempt from the healthcare providers both verbally and nonverbally. Patients value highly the development of trust in the healthcare provider and feel that this is essential for a good relationship. A good relationship should include respect, understanding, cooperation and honesty. CONCLUSION: The authors draw the conclusion that healthcare providers are fearful of the patients with HIV and also have poor knowledge about the disease. This problem can be solved by a better knowledge and information. If nothing is done to prevent the stigmatization and discrimination against HIV/AIDS-patients the risk of significant health problems will increase.
Diabetes involves a change in life and requires the individual to understand what actions are required, since self-care is an essential part of the treatment. Physical activity is a kind of self-care and it’s important that the individual finds the motivation. The aim of this study is to clarify how people with diabetes experience physical activity in everyday life.
A qualitiative method was used and data were collected through interviews with people whom have had diabetes for between 3-48 years. They talked about their experiences related to physical activity. The interviews were recorded on a mobile telephone, transcribed and made a manifest content analysis in which the main categories and associated subcategories were created.
The results indicated that physical activity increased well-being and lead to a continuing urge to exercise. Develop routines that work in everyday life was a prerequisite for the respondents’ well-being and also increased the ability to control blood sugar. Difficulties with motivation could appear when respondents didn’t experience any positive effects from exercising. Physical activity could also lead to a very low blood sugar at night, which was perceived as very unpleasant. The importance of preparation emerged as the most important factor associated with physical activity.
Advanced practice nurses: A new resource for Swedish primary health-care teams This study is associated with the first evaluation of the four first advanced practice nurses (APNs), part of a primary health-care team in Sweden. The aim is to describe health-care teams' experiences of the new APN role and investigate what opportunities and barriers to the role exist. Eighty-one respondents answered a 14-question questionnaire with a Likert scale and one open-ended question. The Kruskal-Wallis test was used to investigate differences between professional groups' answers. The qualitative material was analysed using deductive content analysis. Though mostly positive experiences of the role were found, differences did exist between the professional groups. APNs are considered a resource in that access to care, cooperation and patient flow increased. Barriers include APNs' limited autonomy and inability to prescribe medication. To further develop the role, the right to prescribe medication and strategic leadership within the Swedish health-care system, policy and legislation are needed.
Bakgrund: Sömnen är ett grundläggande behov hos människan och är därför viktig att tillgodose inom sjukvården. Ändå är sömnstörningar ett vanligt problem bland patienter i sjukhusmiljö och särskilt inom intensivvården. Sömnstörningar på en intensivvårdsavdelning orsakas ofta av frekventa omvårdnadsinsatser, behandlingar, sjukdomstillstånd samt högljudd och ovan miljö. Detta kan leda till både psykiska och fysiska konsekvenser så som försämring av immunförsvar, minskad produktion av tillväxthormoner, förlängt sjukdomsförlopp, humörförändringar och upphov av IVA-syndrom. Därför är det viktigt att vårdpersonal får kunskap om hur de bäst arbetar för att främja dessa patienters sömn. Syfte: Syftet med studien är att sammanställa och belysa forskning som beskriver omvårdnadsåtgärder och strategier för att främja sömn hos patienter inom intensivvården. Metod: En litteraturöversikt där 15 kvalitativa och kvantitativa studier analyserades. Resultat: Resultatet redogör för de tre områden som framkom ur dataanalysen och beskriver hur omvårdnadspersonal kan hjälpa patienter inom intensivvård till en bättre sömn. Dessa tre områden var: förändring av personalens arbetssätt genom utbildning, miljöförbättringar samt omvårdnadsåtgärder. Diskussion: Flera effektiva åtgärder finns presenterade i dagens forskning men fortfarande lider intensivvårdspatienter av sömnstörningar vilket gör det angeläget att fortsätta forskningen kring sömnförbättrande åtgärder hos denna patientgrupp.