Tidigare forskning visar att patienter har olika behov postoperativt, det är sjuksköterskans uppgift att anpassa omvårdnaden till individen. Patienter har postoperativt ett extra stort behov av information. Sjuksköterskor och patienter har olika åsikter om vilka behov som ska tillgodoses först. Sjuksköterskan anser att kompetenta vårdgivare, smärtlindring och den behandling som vårdpersonal ger ska prioriteras först. Det viktigaste för patienterna var kompetenta vårdgivare, kommunikation samt god omvårdnad. Syftet med studien är att beskriva sjuksköterskans postoperativa omhändertagande av patienter som genomgått generell narkos och vårdas på kirurgavdelning. Studien har en kvalitativ ansats. Datamaterialet har samlats in genom semistrukturerade intervjuer. Sex sjuksköterskor intervjuades. Resultatet visar att information är en viktig aspekt i omhändertagandet, både när det gäller att informera patienter om vad som ska ske och vad som sker men också information som patienten själv lämnar till sjuksköterskan om tillståndet. Det är även viktigt att det finns ett fungerande informationsutbyte mellan olika vårdgivare. Ett fungerande samarbete mellan vårdpersonalen och även mellan patient och sjuksköterska behövs för att det ska bli ett bra omhändertagande. Vården som ges ska anpassas efter varje individ och dennes behov. Slutligen anser sjuksköterskorna det vara av vikt att vara lyhörd för patienternas smärttillstånd.
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: Kommunikation är en grundläggande förutsättning för patientsäkerheten inom vårdorganisationen. Tidigare forskning inom området handlar till stor del om kommunikation mellan sjuksköterska och patient eller sjuksköterska och läkare. Forskning som studerar kommunikation mellan sjuksköterska och omvårdnadspersonal finns i betydligt mindre omfattning.
Syfte: Att ur omvårdnadspersonalens perspektiv kartlägga kommunikationen med sjuksköterskor inom korttidsboende samt beskriva erfarenheter av kommunikation mellan sjuksköterskor och omvårdnadspersonal i omvårdnaden av patienter som vistas på korttidsboende.
Metod: Enkätstudie
Resultat: Resultatet visar att omvårdnadspersonalen har både bra och mindre bra erfarenheter av kommunikation med sjuksköterskor. Enligt omvårdnadspersonalen är kommunikationen betydelsefull för att patienterna ska få en god vård, men även eftersom olika yrkesgrupper arbetar i team. Rutiner för kommunikation finns och omvårdnadspersonalens erfarenhet är att dessa fungerar bra. Däremot finns oklarheter som rör rutiner vid akuta situationer. Helst och oftast sker kommunikationen genom verbal kommunikation. Omvårdnadspersonalen upplever ibland kommunkationen med sjuksköterskor som otillräcklig men samtidigt fann man också att kommunikationen ibland upplevs som överflödig.
Bakgrund: Distriktssköterskors arbete har förändrats över tid. Patienter är idag ofta välinformerade om sin hälsa och medvetna om att de kan påverka sin hälsa. I dagens samhälle är internet en vanlig källa till hälsoinformation, som har blivit allt mer tillgänglig. Det är viktigt att patienten känner delaktighet i sin egen vård. Vårdgivaren har ett ansvar att leda patienten till tillförlitliga informationskällor. Syfte: Syftet med studien var att belysa distriktssköterskors erfarenheter av att patienter söker hälsoinformation på internet och hur det påverkar deras arbete. Metod: En kvalitativ metod har använts. Åtta intervjuer har genomförts med distriktssköterskor. Resultat: Ur analysen av datamaterialet framträdde tre huvudteman som benämns; Vikten av att veta och förstå, Mötets betydelse för patienter, Distriktssköterskors erfarenhet och ny kunskap. Till dessa teman finns nio olika underteman. Konklusion: Resultatet av denna studie kan bidra till en ökad medvetenhet om att patienter söker hälsoinformation på internet och hur det påverkar distriktssköterskors arbete. Distriktssköterskor får förhålla sig till patienters kunskap som kan se mycket olika ut. Patienters kunskap ställer krav på distriktssköterskorna som får anpassa besöket och vården utifrån denna kunskap samt vägleda patienter rätt.
Syftet med denna uppsats var att undersöka varför sjuksköterskestudenter väljer att påbörja en sjuksköterskeutbildning samt vilka föreställningar de har kring yrket? Studiens design var kvantitativ med deskriptiv ansats. Data samlades in genom en enkätundersökning bland nya sjuksköterskestudenter (n= 34) vid en Högskola, HT 2010. Resultatet visade att studenterna väljer utbildningen av olika orsaker. Den vanligaste orsaken till valet var att få en möjlighet att vidareutbilda sig inom sjuksköterskeyrket och för de studenter som har arbetat inom sjukvården valde utbildningen för att vidareutbilda sig till sjuksköterska. Oberoende av vilken orsak studenterna har så är viljan att hjälpa andra människor en viktig orsak till valet av sjuksköterskeutbildningen. Studenterna ansåg att en sjuksköterska bör vara empatisk, kunnig, lyhörd, vara noggrann och fördomsfri i sin yrkesroll. Studenterna trodde att de mest förekommande arbetsuppgifterna för en sjuksköterska är dokumentation, fysisk omvårdnad, känslomässig omvårdnad och medicinska uppgifter.
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.
Bakgrund: Att få diagnosen bröstcancer sätter hela tillvaron på spel, särskilt för ungakvinnor i fertil ålder, då de ofta befinner sig i en komplex livssituation. Syfte: Syftet meddenna studie är att beskriva sjuksköterskors erfarenheter och upplevelser av vad som ärviktigt i omvårdnaden av unga kvinnor som drabbats av bröstcancer. Metod: Kvalitativmetod med halvstrukturerade forskningsintervjuer, enligt Kvale och Brinkmann haranvänts. De transkriberade intervjuerna har analyserats med kodning, meningskoncentreringoch meningstolkning. Resultat: Omvårdnaden av unga kvinnor med bröstcancer skiljer siginte från andra patientgrupper. Även om alla patienter ska behandlas på lika villkor, skaomvårdnaden individanpassas. Viktiga delar, exempelvis djupa samtal, upplevs som svåra iomvårdnaden och hänvisas till andra yrkesgrupper. Dock betonar sjuksköterskorna viktenav dessa samtal för att få en relation till patienterna. Diskussion: Vårdrelationen är viktigför att få tillgång till vad patienterna anser vara viktigt i omvårdnaden. Utan den är det intemöjligt att ge patienterna rätt stöd. Vårdandet bör vara individanpassat eftersomupplevelsen av hälsa är subjektiv. Sjuksköterskorna verkar ovana att reflektera över sigsjälva och sina erfarenheter, något som speglas i deras ovilja att diskutera känsliga ämnen.
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.
Döden anses vara en stressfaktor för hälso- och sjukvårdspersonal och tidigare forskning visar att detta även gäller vårdare vid hospice. Ett antal vanliga copingstrategier fungerar inte i hospicemiljön på grund av att döden är ett oundvikligt inslag där. En studie framhåller dock den låga utbrändhetsgraden bland vårdgivare på hospice och föreslår bland annat att det holistiska perspektivet på omvårdnad kan vara sammankopplat med detta till synes ambivalenta förhållande. Kan hospicefilosofin inverka på synen på döden och döendet bland hospicepersonal? En intervjustudie genomfördes med tre vårdare yrkesverksamma vid ett hospice i Sverige. Det manifesta innehållet som relaterade till syftet med studien identifierades och analyserades med hjälp av kvalitativ innehållsanalys. Resultatet visar att hospicevårdare påverkas av hospicefilosofin inom områden som synen på vård i livets slutskede, döendet och det professionella samarbetet. Deltagarna uttryckte att de trivs med sitt arbetssätt och uttryckte en mängd olika strategier för att hantera svårigheter i sitt arbete. Arbete som bygger på en filosofi som genomsyrar vården verkar också sammansvetsa personalgruppen. Ytterligare forskning på detta område kan vara av intresse.
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 är ett välkänt problem i den patientrelaterade vården både i Europa och i resten av världen. Trots detta är malnutrition något som fortfarande förekommer. Vad kan det bero på? Det är viktigt att man bedömer patientens nutritionsstatus rutinmässigt för att kunna förebygga malnutrition. Effekterna av malnutrition kostar samhället mycket pengar och orsakar mänskligt lidande. Syftet med denna studie var att belysa sjuksköterskans ansvar för att förebygga och behandla malnutrition. För att besvara syftet blev valet av metod en litteratur studie. Med hänsyn till vetenskaplig kvalitet granskades tio artiklar. Resultatet av denna studie visar att bedömning, åtgärder, dokumentation och interaktion mellan sjuksköterska och patient är viktig i arbetet med att förebygga och behandla malnutrition. Slutsatsen visar att det är nödvändigt för sjuksköterskorna att få mer utbildning inom malnutrition för att kunna identifiera riskpatienter. Interaktionen mellan sjuksköterska och patient är också en mycket viktig del och måste fungera fullt ut.
Palliativ vård bedrivs på alla vårdinrättningar i Sverige. Vi ville med denna studie belysa faktorer som påverkar sjuksköterskan bedömning och värdering av smärta hos patienter som är döende. Vår avsikt var att uppmärksamma hur viktigt det är att sjuksköterskan gör en korrekt bedömning av smärta. Alla patienter förtjänar att dö smärtfria. Syftet med studien var att beskriva faktorer som påverkar sjuksköterskans bedömning av smärta i den palliativa vården. Metoden som använts var en kvalitativ litteraturstudie. I resultatet framgick det att sjuksköterskan upplevde smärtbedömning som komplicerad på grund av många olika andledningar, bland annat brist på kunskap och svårigheter att kommunicera med vissa patientgrupper. Resultatet visade också att sjuksköterskorna saknade tillräckligt med kunskap och erfarenhet för att göra en smärtbedömning på bästa sätt och att de saknade god självkännedom och känslan av trygghet i sin yrkesroll.
Hjärtinfarkt är ett stort folkhälsoproblem i Sverige. Mellan åren 1987-2004 har cirka 56 000 människor insjuknat i hjärtinfarkt. I många studier har män varit i fokus. Det betyder att resultaten inte representerar kvinnor. Kvinnor kan ha andra symtom än män och på grund av det blir kvinnor ofta fel diagnostiserade, och får senare behandling än män. Syftet med denna studie att beskriva hur kvinnor upplever den information de får efter insjuknandet i hjärtinfarkt, samt vilken information de efterfrågar. En litteraturstudie valdes till denna studie. Tio artiklar analyserades, de svarade till studiens syfte och frågeställningar. Resultatet i denna studie är att kvinnors behov av information är stort och de behöver individuell information. Om detta är försummat förlängs kvinnors tillfrisknande. Information kan även vara en form av stöd. De vill veta varför de insjuknat i hjärtinfarkt och vad sjukdomen kommer att betyda för deras liv. När information ges till kvinnor känner de att de får stöd. Kvinnor kan finna stöd och information i hjärtrehabiliteringsprogram. Det är viktigt att sjuksköterskor skapar en relation till patienten som bygger på respekt och förtroende för varandra.
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.
Postoperativ smärta fortsätter att vara ett stort och svåridentifierat problem. Omfattningen av okontrollerad smärta hos patienterna har inte förändrats märkbart de senaste decennierna. Sjuksköterskor tenderar att underskatta patientens smärta. Syftet med denna studie är att undersöka olika faktorer som påverkar sjuksköterskans sätt att bedöma postoperativ smärta. För att uppnå vårt syfte valdes litteraturstudie som metod. Sökning av litteraturen gjordes utifrån syfte och problemformulering i databaserna Academic Search Elite, CINAHL och SweMed +. Sex artiklar valdes ut och analyserades i fem steg. I resultatet framkommer sju faktorer som påverkar sjuksköterskans sätt att bedöma postoperativ smärta: kommunikation, erfarenheter och attityder, sjuksköterskans kunskap, information och förberedelser, att tolka smärta, hinder i smärtbedömningen och uppföljning av smärtbedömningen. Trots att omfattande forskning finns inom detta område, bör forskning bedrivas även i framtiden. En utökad smärtutbildning för sjuksköterskor kan vara gynnsamt.
BAKGRUND: HIV/AIDS (Humant Immunbrist Virus/Acquired Immunodeficiency Syndrome) är en epidemi där världens utvecklingsländer är hårdast drabbade. I studier har det framkommit att sjukvårdspersonal har en negativ attityd gentemot denna patientgrupp. Orsaken till detta tros bero på okunskap och rädsla. SYFTE: Syftet med denna studie var att beskriva hur patienter med HIV/AIDS upplever stigmatisering och diskriminering från vårdpersonal. METOD: En litteraturöversikt, med tio stycken vetenskapliga artiklar som analyserats för att besvara studiens syfte. RESULTAT: Två huvudteman framkom; fördomar och förakt och stöd och relation. Resultatet visar att patienter upplevt att vårdpersonal visat förakt gentemot dem både verbalt och icke-verbalt. Patienter anser det betydelsefullt att bygga upp ett förtroende för sjuksköterskan, detta är viktigt för att få en god relation mellan dessa. Denna relation ska byggas på respekt, förståelse, samarbete och ärlighet. KONKLUSION: Författarnas konklusion är att vårdpersonal känner en rädsla gentemot denna patientgrupp på grund av okunskap om sjukdomen och dess smittvägar. Detta kan elimineras med hjälp av ökad kunskap och information. Om inga åtgärder vidtas för att förhindra stigmatisering och diskriminering ökar risken för ett vårdlidande avsevärt.
Att drabbas av diabetes medför en omställning i livet och kräver att individen vet vilka åtgärder som är nödvändiga eftersom egenvården är en stor del av behandlingen. Fysisk aktivitet är en typ av egenvård och det är viktigt att individen finner motivationen. Syftet med studien är att beskriva hur människor med sjukdomen diabetes upplever fysisk aktivitet i vardagen.
En kvalitativ metod användes och data samlades in via intervjuer med personer, vilka haft diabetes mellan 3-48 år. De berättade om sina upplevelser kring fysisk aktivitet. Intervjuerna spelades in via en mobiltelefon, transkriberades och därefter genomfördes en manifest innehållsanalys där huvudkategorier med tillhörande underkategorier skapades.
Resultatet visade att fysisk aktivitet ökade välbefinnandet, vilket ledde till ett ökat behov av att röra på sig. Att finna sina rutiner var en förutsättning för att respondenterna skulle må bra och ökade förmågan att kunna styra sitt blodsockervärde. Svårigheter med motivationen kunde infinna sig när respondenterna inte märkte de positiva effekterna med träningen. Den fysiska aktiviteten kunde även medföra ett lågt blodsockervärde nattetid, vilket upplevdes som väldigt obehagligt. Vikten av förberedelse framkom som den viktigaste faktorn i samband med den fysiska aktiviteten.
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.