Högskolan i Skövde

Migrating to a country with a very different culture and society from the home country can be a very big challenge. However, trying to find one's identity and role in the new society can be considered important for the individual's well-being. It is important to see how different factors can affect the integration process for migrants in order to understand the difficulties they may face when it comes to identity creation in the new country. Because migration is a global and complex phenomenon and the reasons behind migration are many and varied. Migrants can become vulnerable at different stages of their journey. Some of them endures hardships that can threaten their lives and affect their physical and mental well-being regardless of the reason for leaving their home country. The purpose of this qualitative interview study was to investigate how young adult migrant women from the Middle East experience bi-cultural identity creation. With a social psychological approach, this was studied through theories of social identity theory, social influence, conformity, integration theory and bi-cultural identity theory. Five semi-structured interviews with migrant women from the Middle East were conducted. The results show that the migrant women often experience conflicts and difficulties in finding a balance in where they see themselves as belonging, which creates difficult feelings and an identity crisis. Some respondents accept and internalize this conflict. The values that followed from the home culture are important for their identity and that it is the values that set the tone during their bi-cultural identity creation.

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

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

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

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

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

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

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

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

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

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

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

Attitudes and prejudice about ethnicity is a phenomenon that occurs in many different contexts. When working with people, attitudes about ethnicity is essential for how the workplace is experienced, both for the employees and clients. The work-life in Sweden consists of employees with different backgrounds and ethnicities. Norms about ethnicity create obstacles to achieve equality and the risk of ethnic discrimination enhances. The issue can be complex and requires employees to critically examine themselves and their colleagues. Experiences of attitudes depends on several individual factors, therefore they may differ in different workplaces. The purpose of this qualitative study was to investigate attitudes about ethnicity among Social Services' employees and how the attitudes affect the work with clients. With a social psychological approach, this study was conducted based on theories of social cognition theory, attitudes, social attribution theory and ethnicity, we and them-thinking & indirect discrimination. The essay contains ten semi-structured interviews with social workers in three different municipalities. The results show that it exists negative attitudes about ethnicity in the social services, both between employees and clients. How attitudes appear in the work is affected by several different factors such as experience, awareness of negative attitudes and open dialogues between employees. Whilst working with clients, the influence of attitudes has a basis in the employees´ level of understanding, treatment and ability to maintain the professional role. 

Individuals who have come to Sweden as unaccompanied refugee minors meet different difficulties. In previous research, the main focal points have been the unaccompanied minors' previous experiences of violence and war, and the importance of social support. The aims of this study were firstly to gain a greater understanding regarding stress and stress management among unaccompanied refugee minors, and secondly, to look at the importance of social relationships regarding stress management. This qualitative study is based upon ten semi-structured interviews. Ten young adults gave their subjective narrative. The interviewees had their roots in Afghanistan. They all came to Sweden as unaccompanied refugee minors. The interview was analyzed based on Bronfenbrenner´s Ecological systems theory and Lazarus stress theory, using thematic analysis. The results drawn were that unaccompanied refugee minors experience stress because of a) expressed and perceived demands from the family, b) for the family's situation in the home country, c) the oral interaction with ethnical Swedes, d) be able to find work, and e) not recognizing the physical environment. The result regarding stress management shows that social relations, help from professional contacts, and their own personality were of importance for the study participants. Furthermore, the results show that being able to work and to educate themselves were important stress management strategies. Friends from the homeland and the mother tongue were sources of comfort for the participants.

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

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

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

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

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

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

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

Background: Research shows that the choice of place of birth is important for the woman's birth experience. Home birth in a low-risk pregnancy is a safe alternative to giving birth in a hospital, however, interest in home birth is low in Sweden. In order for women to be able to make an active choice, an awareness of the alternatives available is required. The authors ask themselves whether women in Sweden know that home birth exists. Aim: To shed light on women's knowledge and understanding of home birth in Sweden. Aim: To shed light on women's knowledge and understanding of home birth in Sweden. Method: Questionguide analyzed with a qualitative hermeneutic text analysis. Results: Knowledge about home birth has been shown to vary. The result shows 4 main themes and 8 sub-themes. The main themes consist of "Women's interest in home birth varies", "The importance of information for decision-making", "Obstacles to home birth in Sweden" and "Home birth as a right".Conclusion: The study shows that there is risk that women do not know that homebirth exists. It also shows greater obstacles to the possibility of making an active choice of place of birth and undergoing a homebirth. 

Background: With an increasing prevalence of type 2 diabetes globally, the need for effective care and support for lifestyle changes is important. District nurses play a key role in promoting healthy behaviors in these patients. 

Aim: The aim of the study is to investigate how district nurses motivate patients with type 2 diabetes to implement lifestyle changes. 

Method: The study is based on a qualitative interview survey with an inductive approach. Semi-structured interviews were conducted with district nurses in primary care, in this study health care centers. Data were analyzed through qualitative content analysis by reflecting on the content and identifying any patterns in the district nurses' experiences and practices. 

Findings: The study shows that person-centered care, active listening and empathy are essential to motivate patients with type 2 diabetes to make lifestyle changes. The district nurses emphasize the adaptation of support to each patient's unique needs and the importance of patient involvement in care decisions. Teamwork and collaboration across professional boundaries are also central to offering coordinated care. The diabetes school and the involvement of relatives are emphasized as important resources for supporting and motivating the patients. 

Conclusion: The study highlights the central role of district nurses in promoting lifestyle changes in patients with type 2 diabetes and suggests further research to develop guidelines and educational programs that strengthen this aspect of diabetes care.  

Background: All care performed must be safe and evidence-based and must be well-founded with knowledge. Caregivers must start from person-centered care, where the patient's story is at the center. When the patient's life value is taken into account, the whole person is cared for and body, soul and spirit are respected. In the event of overcrowding and high workload, mistakes are made in the nursing care that can lead to the patient enduring a care injury and suffering. Nurses' responsibility is to care for patients and protect them from suffering and to respect their autonomy, dignity and integrity. Purpose: The purpose is to shed light on nurses' experiences of what conditions are required to maintain safe care in case of overcrowding in hospitals. Method: A literature-based method to contribute to safe and evidence-based nursing based on analysis of qualitative studies. Result: Four themes crystallized; Significance of experience at high workload and overcrowding, Person-centered care increases safety, Communication, cooperation and trust within the team, Good recovery and reduced work-related stress ensure nursing. Conclusion: Nurses who apply person-centred and evidence-based practice in their teams, create good conditions for patient-safe work even in the event of overcrowding.

Background: The use of social media has increased markedly over the past few years and is a part of everyday life among children and adolescents. This may cause both positive and negative health outcome, that may also affect the students´ self-esteem. A good self-esteem can both improve health and school performance. The school nursework with health promotion and has the opportunity to support and encouragestudents to a healthy use of social media, which can strengthen self-esteem.

Aim: The aim of this study is to describe the school nurses´ experience of how social media affects students´ self-esteem.

Method: Data were collected through interviews with nine school nurses who had experience working with students in middle school and/or in high school. The data material was analyzed according to qualitative content analysiswith an inductive approach.

Result: The findings in the interviews fell into three categories: Positive influence on self-esteem, Negative influence on self-esteem and The significance of the nurses´ work. The theme that emerged in the study was a complex and challenging work.

Conclusion: There is a two-way complexity in the impact of social media on students´ self-esteem. The nurse´s mission to work in a health promotion way with the students´ health should be based on the students´ life world in collaboration with other professions. 

Background: Breast cancer is estimated to be the most common form of cancer among women. The majority of women who develop breast cancer are diagnosed at an early stage, which increases the chance of survival. But because breast cancer is not always as prominent, accuracy is required when diagnosing. Being diagnosed with breast cancer entails physical, psychological, emotional and existential suffering, and the nurse therefore has a significant function in supporting the patient during the care process.

Aim: The purpose of this study was to investigate women's experiences of getting sick with breast cancer.

Method: This study has been conducted as a qualitative literature study based on blogs. Eight blogs were selected and analyzed through qualitative content analysis according to Graneheim and Lundman.

Findings: The analysis resulted in four themes: An inner struggle to get sick with the diagnosis, Bodily changes affect everyday life, Support from healthcare and relatives, and Different aspects of treatment in care. Being diagnosed with breast cancer was described as a wearing incident in life and support from healthcare staff and relatives and also conversations were important.

Conclusion: Getting breast cancer is a stressful event in life that affects the whole woman. Through support that is characterized by continuity, accessibility, and information, nurses can contribute to reducing suffering and promoting women's health, well-being and security when diagnosed with breast cancer.

Background: When a person suffers from disease, sexuality can be affected through direct influence of the disease or as a side effect of, for example, medicines. Sexuality is a big part of health but a difficult topic to discuss. Method: A qualitative method was used, and data were collected through semi-structured interviews. The informants were nurses with a variation of working years from six months to 28 years. They discussed their experiences of talking about sexuality with patients. The interviews were recorded, transcribed and then a manifest qualitative content analysis was performed where main categories and subcategories created. Aim: To shed light on nurses´experiences of discussing sexuality with patients. Findings: Sexuality is seen as a complex subject to discuss, still it is considered an important matter to raise with patients. However, it is unclear to nurses whose responsibility it is to raise the subject. Individually conversations and having an open climate are components that promote the conversation. Culture, religion, language barriers and cognitive impairment is perceived as hindering, while there are divided opinions about the impact of gender and age. Conclusion: Sexuality is a taboo area but an important topic for nurses to elevate with patients, regardless of illness. More training in the subject is required to increase nurses' knowledge and self-confidence.

Background

Educational environments are considered important in strengthening students’ health status and knowledge, which are associated with good educational outcomes. It has been suggested to establish healthy universities based on a salutogenic approach – namely, health promotion. The aim of this study was to describe health-promoting resources and factors among first-semester students in higher education in healthcare and social work.

Methods

This cross-sectional study is based on a survey distributed among all students in seven healthcare and social work programmes at six universities in southern Sweden. The survey was carried out in 2018 using a self-reported, web-based questionnaire focussing on general health and well-being, lifestyle factors together with three validated instruments measuring health-promoting factors and processes: the Sense of Coherence (SOC) scale, Salutogenic Health Indicator Scale (SHIS) and Occupational Balance Questionnaire (OBQ).

Results

Of 2283 students, 851 (37.3%) completed the survey, of whom 742 (87.1%) were women; 722 (84.8%) were enrolled on healthcare programmes, and 129 (15.2%) were enrolled on social work programmes. Most reported good general health and well-being (88.1% and 83.7%, respectively). The total mean scores for the SOC scale, SHIS and OBQ were, respectively, 59.09 (SD = 11.78), 44.04 (SD = 9.38) and 26.40 (SD = 7.07). Well-being and several healthy lifestyles were related to better general health and higher SOC, SHIS and OBQ scores. Multiple linear and logistic regressions showed that perceived well-being and no sleeping problems significantly predicted higher general health and higher SOC, SHIS and OBQ scores. Being less sedentary and non-smoking habits were significant predictors of higher SOC.

Conclusions

Swedish students in higher education within the healthcare and social work sector report good general health and well-being in the first semester, as well as health-promoting resources (i.e. SOC, SHIS and OBQ), and in some aspects, a healthy lifestyle. High-intensity exercise, no sleeping problems and non-smoking seem to be of importance to both general health and health-promotive resources. This study contributes to knowledge about the health promotive characteristics of students in the healthcare and social work fields, which is of importance for planning universities with a salutogenic approach.

Background: Diabetes type 1 is a chronical disease. This incurable disease requires a lot of responsibility from the patient and can involve complications. Being affected by diabetes type 1 as a child means great challenges. In the first period, focus is on the development process towards independence. In person-centered care, it is important to highlight children's feelings and experiences to promote health throughout life.

Aim: To describe children's experiences of being affected by and living with diabetes type 1.

Method: A literature review that is a compilation of 11 qualitative studies. The participants in the literature study were 7–18 years old.

Findings: The results are presented based on two main categories, these were; During the first period and The daily life changes and six subcategories. The analysis resulted in the fact that being affected by a chronic disease means a major life change. The children experienced difficult feelings psychologically from receiving the diagnosis, especially in the first period after their diagnosis.

Conclusion: Factors that proved to be important for children with diabetes type 1 were that the children receive education and support in living with diabetes type 1, knowledge about the disease for independence and acceptance of the disease. The nurse's knowledge of communication and care is the basis for good care for children with diabetes type 1.

Introduction: Loneliness and social isolation among elderly are public health problems found in large parts of the world. Elderly people are expected to increase exponentially within the next few decades. Thus, the prevalence of lonely elderly people is also expected to increase. Social contact decreases with increasing age as a result of, among other factors, an increased burden of illness.

Aim: The purpose of this study was to investigate how internet use in the form of social connection can reduce loneliness and social isolation among older people.

Method: The study was based on a structured literature review. A total of 11 scientific articles have been included in the literature review. The articles were investigated through a thematic analysis with a deductive approach.

Results: The thematic analysis has resulted in four main themes; improved health status, distance-friendly communication, digital assets and resources, as well as participation – part of prevention. Additionally, seven sub-themes were identified; less loneliness and social isolation, maintaining social relationships, digital communication as a complement, easy-to-use devices and functions, lack of knowledge and experience, education and support, and the opportunity to influence own health and well-being.

Conclusion: Altogether, there is some evidence that indicates that internet use can positively affect the health status of older people and thus reduce loneliness and social isolation. However, there are barriers, obstacles, and factors that should be taken into consideration to enable the target group to take advantage of digital opportunities that are available and also facilitate their use.

Background: Anesthesia- and operating nurses´ will encounter patients with some form of cognitive impairment during their work. Perioperative specialist nurses have a duty to provide individualized care for patients with cognitive impairment. The perioperative dialogue is a way for patients and their relatives to understand the health situation, and for specialist nurses, it serves as a tool to gather adequate information about the patient's preferences. Aim: The aim was to describe the experiences of anesthesia- and operating nurses´ in caring for patients with cognitive impairment within perioperative care. Method: A qualitative method with an inductive approach was used in the study. Six anesthesia nurses and four surgical nurses were interviewed, and the collected material was analyzed using qualitative content analysis. Results: The analysis process resulted in three categories: "team collaboration", "need for resources and aids" and "need for individualized approach and communication", along with 14 subcategories. Conclusion: The study revealed that caring for patients with cognitive impairment in the perioperative environment posed a challenge. The perioperative care can be adapted to the patient's specific needs through the involvement of close relatives, professional teamwork, and a person-centered approach.

In the media in the recent years, a negative picture of young Somali-Swedes has emerged, among other things linked to gang crime. It also affects the young Somali-Swedes who have not gone astray. As a contrast to those who ended up in crime, unemployment and exclusion, Somali-Swedish university students are highlighted in this study. The aim was to create an understanding of their identity formation and experience of meaningfulness and how it affects their well-being. The study was based on a social psychological perspective and has been analyzed with the help of the theories Sense of Coherence (SOC) and Social Identity Theory (SIT) as well as the concepts of ethnicity, in-betweenness and dual cultural belonging. The method was qualitative and qualitative semi-structured interviews were conducted with ten respondents. The respondents were university students of Somali-Swedish origin aged 21-24. The results showed that ethnicity, religious affiliation, family, friends and participation in civic society were important in the formation of identity. Religion, family and sense of purpose were described as important elements in creating meaning. In addition, it was common that adversity and negative treatment were turned into a source of motivation. The factors of success for well-being that were found were community, social support, faith, purposefulness and turning adversity into motivation. 

Background: DMT2 is a chronic public health disease that occurs when a person has an unhealthy lifestyle. DMT2 causes micro- and macrovascular complications but can be treated with lifestyle changes. Patients who are living with DMT2 experience stresses that they suffer from.

Aim: The purpose of this study is to illustrate patient's experience of lifestyle change in connection with DMT2.

Method: A qualitative general literature review, based on ten scientific articles that were analyzed from a patient perspective.

Findings: What arises is that patients with DMT2 experience difficulties in introducing physical activity and healthy eating habits into their everyday lives. The difficulty includes, time constraints, lack of motivation, and cultural and social aspects. Furthermore, it appears in the results that support from relatives and nurses is significant and important. Despite this, the majority of patients with DMT2 face challenges linked to a lack of empathy, trust and respect from healthcare.

Conclusion: Finally, it appears that when patients receive DMT2, they need to adopt lifestyle changes in their daily life. The lifestyle changes require good support and motivation from both relatives and the nurse. The changes cause emotional feelings, and therefore it is important that the nurse is sensitive and shows respect to the patient's wellbeing.

Violence in close relationships is a current and serious problem that affects both the victim and society negatively. This type of violence is often perpetrated by men against women. The number of calls to Sweden's women shelters has increased and there is also a supposed high number of women that doesn’t report their situation. The violence can be of both psychological and physical nature. Living in a destructive relationship can have drastic consequences for the victim's psychological well-being. Previous research shows that battered women find it difficult to get out of their relationship. This is a very important topic to study for these very reasons. A qualitative research method was conducted in this study. 10 women who have lived in a destructive relationship were interviewed. The result was analyzed with a thematic analysis. The purpose of the study was to investigate battered women’s experiences, in regards to how their self-image and self-esteem have changed. Theories regarding power and social support have also been used in order to analyze their social context. The results showed that the women experienced a negative self-image and self-esteem during and after the relationship. The power relationship was asymmetric, which also affected their self-image and self-esteem. Social support was perceived as important for rebuilding their self-image and self-esteem. 

Background: The number of elderly people with multiple diseases is increasing in society. When these people are treated in hospital, the problems are often complex. Many of those who are sent home need continued healthcare at home, and the district nurse then becomes the responsible nursing manager. District nurses work for the safety and satisfaction of elderly people and work in teams to provide a safe care for the patients.

Aim: To shed light on district nurses' experiences of frail elderly being discharged from hospital to municipal primary care at home.

Method: A qualitative interview study was used where data was collected through semi-structured interviews with ten district nurses. Data were analyzed according to qualitative content analysis.

Findings: The results are presented in two categories; Successfactors for a safe dischargeprocess and Obstacles for a safe and secure return home, with seven associated subcategories. To ensure safe returns home, good planning, good cooperation and clear documentation of medicines and continued care are required. Obstacles to a successful discharge are the use of different medical record systems, lack of time and a heavy workload.

Conclusion: To maintain patient´s safety when discharging frail elderly, cooperation and good communication are necessary. District nurses in municipal primary care have an important coordinating role and need to ensure good and safe care when the patient returns home.

Over a short period of time, crime in Sweden has increased and become a serious and publicized social problem. It is a complex process to leave a criminal environment that can often involve a number of different challenges. Cohesion and social ties formed in criminal environments can delay the process of leaving due to a strong identification with the group. Support and efforts by society are important for an individual to be able to change his identity as a criminal. The purpose of this qualitative study was to investigate subjective experiences of how stigmatization, labeling processes and support efforts affected the exit process in the development to a non-criminal identity. The starting point for studies was a social psychological approach that was studied through theories of social identity, stigmatization, labeling and exit process. Ten respondents from the dropout activity Criminal Revenge in Society (KRIS) participated in studies and interviews using semi-structured interviews. The results showed that KRIS's support efforts have a positive impact on the development of a non-criminal identity by contributing to a feeling of support and acceptance. The respondents who had not made a geographical separation experienced labeling and stigma in a larger sense. Stamping processes and stigmatization were found to have a negative impact on the development to a non-criminal identity in the exit process. The membership of KRIS has functioned as a protected environment from labeling and stigmatization that facilitates identity formation in the exit process.

Background: Loneliness arises when there is a desire for more social relationships. Loss of a partner, disability, and mental health issues are risk factors for loneliness. Older individuals can receive support from the municipality to remain living at home. The natural changes of aging increase the risk of illness. Loneliness impacts health negatively. A strong sense of coherence allows for recovery after health problems. Providing good and person-centered care is part of the nurse’s role. Loneliness can lead to suffering. Healthcare professionals often lack sufficient time and awareness of the consequences of loneliness.

Aim: To describe experiences of loneliness in elderly people who are enrolled in home health care.

Method: Literature based study used on ten qualitative articles.

Findings: From the analysis two categories were identified; Feeling vulnerable and exposed and Relief from seeing possible solutions, with seven subcategories.

Conclusion: The study provides an increased understanding of older individuals’ experiences of loneliness. Nurses need to ask specific questions about loneliness and tailor care to the needs of the older person in order to alleviate suffering and prevent complications related to loneliness.

Background: Midline laparotomy is the definitive treatment for sigmoid volvulus after initial colonoscopic detorsion. We successfully adopted another technique at our center on 6 patients, treating sigmoid volvulus by left iliac fossa mini-incision. Presentation of cases: We report our experience of six non-consecutive cases of sigmoid volvulus treated by left iliac fossa mini-incision. The cases were a 33 year old Egyptian female, a 21 year old Bangladeshi male, a 58 year old Qatari male, a 30 year old Ethiopian male, a 36 year old Ugandan male, and a 58 year old Indian male. The six cases are unique in the surgical technique employed in their management. This is possibly the second case series of left iliac fossa mini-incision for sigmoid volvulus in the Middle East and North Africa Region. Discussion: All patients underwent initial colonoscopic detorsion followed by sigmoidectomy and anastomosis. The procedure was successful in treating the volvulus in five patients with no complication or recurrence over a mean follow up of 8 months (range: 1–36 months). One patient required further laparotomy and resection with anastomosis due to incompletely removed sigmoid colon. Conclusions: Left iliac fossa mini-incision for sigmoid volvulus is safe, feasible, cosmetically appealing and with low morbidity.

Introduction: Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor that originates from the parafollicular C cells of the thyroid gland. MTC can be due to sporadic or hereditary causes due to gain of function germ line mutations in the RET proto-oncogene. MTC presenting as ocular symptoms due to choroidal mass is rare with bad prognosis. Presentation of case: A 38-year-old Sudanese male presented to Hamad General Hospital, complaining of sudden painless decrease of vision of the right eye of 3 weeks duration. After investigations using imaging methods, the patient was discovered to have metastatic MTC that presented as choroidal mass and metastasized to his lung, bone, brain, pituitary, liver and mediastinum. Discussion: In terms of investigations, serum levels of calcitonin have superior diagnostic accuracy. Our patient undertook diagnostic imaging including ultrasonography, fine needle aspiration and computerized tomography (CT) scan and/or MRI imaging. He undertook total thyroidectomy and left neck dissection followed by stereotactic radiosurgery for the right orbit and pituitary. He then received systemic anti-RET therapy (Selpercatinib). At 5 months follow up there was dramatic drop in CEA from 888 μg/L to 164 μg/L, and calcitonin from >585.2 pmol/L to 354 pmol/L. Conclusion: Choroidal metastasis as initial presentation of MTC is extremely rare and challenging to diagnose. Surgeons need a high index of suspicion when ocular symptoms accompany a neck mass or thyroid-related symptoms. MTC has a progressive course with involvement of blood vessels and neck lymph nodes. Choroidal metastasis of MTC is challenging to manage.

Introduction: Noninvasive follicular thyroid neoplasm with papillary-like nuclear (NIFTP) is a new entity. No previous study reported prospective cases, outlining using many quantitative and qualitative variables. Methods: Retrospective analysis of all (15) prospective NIFTP cases diagnosed between 2017 and 2021 at our institution. Statistical quantitative analysis outlined demographic, history, ultrasound, histopathology and treatment characteristics. Qualitative analysis examined the cases, with details provided on three cases to highlight the different possible presentations and configurations. Results: Mean age was 41.5 ± 9.91 years, 73.3% were females, and mean BMI was 29.49 ± 5.74 kg/m2. About 87% patients were symptomatic; 86.6% had neck swelling. Ultrasound (US) showed multiple nodules in 71.4% of cases. Fine-needle aspiration cytology (FNAC) showed that follicular lesion of undetermined significance (42.8%) was most common, followed by benign nodule (21.3%). Using the Bethesda System for Reporting Thyroid Cytopathology, 7 cases were category III, 3 category IV, 3 category II, and 1 category I. 60% of patients underwent total thyroidectomy. All cases were diagnosed postoperatively, 2 patients had additional papillary microcarcinoma. In 3 cases, the NIFTP site in the histopathology of resected specimen was different than the US-recommended site of the FNAC. Conclusion: We found discrepancies in the site and diagnosis of the preoperative US recommendation for the FNAC vs the postoperative histopathology of the specimen. These suggest that NIFTP might be incidentally and postoperatively diagnosed, irrespective of US or FNAC findings, hence its ‘true’ incidence might remain underestimated. As NIFTP cases higher BMI, Future research could predict preoperative diagnosis of NIFTP and explore associations with BMI. 

Introduction: Non-invasive follicular thyroid neoplasm with papillary-like features (NIFTP) is a recently characterized lesion with very low malignant potential. This has allowed for less aggressive management of this tumor subtype. Papillary thyroid carcinoma (PTC) has malignant potential and requires different considerations in management. Presentation of case: A 33-year-old woman presented to our Thyroid Surgery Clinic with a left neck swelling slowly enlarging over 4 years, and recent right-sided neck pain. Neck ultrasound and fine needle aspiration for cytology found bilateral thyroid nodules, labelled as ‘follicular lesion of undetermined significance’ (FLUS). Final pathology report after total thyroidectomy identified four distinct tumors: bilateral NIFTP lesions and bilateral papillary microcarcinomas. Discussion: Management of NIFTP comprises partial or total thyroidectomy without further intervention. Management of PTC is the same but with the possible addition of radioactive ablation due to the increased malignant potential. This is the first report of bilateral NIFTP lesions and bilateral papillary microcarcinomas co-occurring together in the same patient, so management was challenging. The decision was made to give the patient low dose radioactive iodine ablation and continue monitoring. Ultrasound of the neck follow up 6 months later showed no residual thyroid tissue or local recurrence. Conclusion: Although rare, NIFTP can co-occur with PTC. Bilateral NIFTP with bilateral PTC is extremely rare. Surgeons and pathologists need to be aware of this rare entity that can co-occur in both thyroid lobes. Total thyroidectomy is the definitive treatment. Post-surgery surveillance is important and follow up needs to be watchful for any recurrence or metastasis. © 2020 The Author(s)

Poor dietary habits can impact longevity and life expectancy by contributing to the development of noncommunicable diseases (NCDs) such as heart disease, cancer, and diabetes. These NCDs account for 44% of global mortality annually, with ischemic heart disease alone responsible for 16% of deaths. Metabolic syndrome (MetS), which includes obesity, hyperglycemia, hypertension, and dyslipidemia, plays a major role in increasing the risk of cardiovascular diseases and diabetes. Modifiable lifestyle factors, particularly dietary habits, are crucial in managing MetS and NCDs. A healthy diet rich in seafood and high-quality carbohydrates can reduce the risk of chronic diseases and promote longevity. Intermittent fasting has also shown promise in reducing MetS risk and improving health. Studies indicate that certain gene expressions, such as FOXO3 and CISD2, are associated with healthy aging. This study aimed to investigate the impact of an intermittent fasting and seafood-rich diet on longevity and health markers. Over four weeks, ten participants were evaluated for changes in blood parameters, gene expressions, physiological parameters, and amino acid profiling. The results showed no significant differences for the diet intervention. However, trends were observed in the participant who practiced 20-hour daily intermittent fasting with 100 percent seafood as a source of protein, including reductions in weight, blood glucose, and cholesterol levels, along with increased blood ketones, vitamin D, and B12. These findings highlight the potential benefits of the study and pave the way for future research with larger sample sizes, more significant dietary modifications, and extended intervention durations, to better understand the effect of diets on reducing chronic diseases and promoting longevity.

Introduction: Giant/large gallstones have high risk of complications, and technical difficulties during surgery. This case series is the largest ever reported. Presentation of cases: Case 1: Female (44 years), with one year intermittent right upper quadrant colicky pain. Ultrasound: large gallstone (normal gallbladder). Elective laparoscopic cholecystectomy (LC): 6 × 4 × 3.3 cm gallstone. Case 2: Female (41 years), presented to emergency room with 3 days right upper quadrant pain/tenderness, vomiting, and positive murphy's sign. Ultrasound: large gallstone, calculus cholecystitis. Emergency LC: 4.5 × 3.1 × 3.5 cm gallstone. Case 3: Male (38 years), with history of gallstones and acute cholecystitis presented with intermittent right upper quadrant pain (2 months) and vomiting. Normal abdominal examination. Ultrasound: large gallstone. Elective LC: 4.1 × 4 × 3.6 cm gallstone. Conclusions: Gallstones >5 cm are very rare, with higher risk of complications. Gallbladder should be removed even if asymptomatic. Gallstones >3 cm have increased risk for gallbladder cancer, biliary enteric fistula and ileus. LC has challenges that include grasping the gallbladder wall, exposure of Calot's triangle, and retrieval of gallbladder out of the abdomen. LC appears to be procedure of choice and should be performed by an experienced surgeon, considering the possibility of conversion to open cholecystectomy in case of inability to expose the anatomy or intraoperative difficulties. © 2020 The Author(s)

Background: Breast cancer is the most common type of cancer that affects women worldwide. In Sweden approximately 20 women fall ill with breast cancer every day, and it's most common for women from the middle age upwards to be affected. Women who are treated for breast cancer may have a reduced quality of life, which increases suffering and reduces self-confidence. Aim: To describe women’s experience of living with breast cancer. Method: A qualitative and quantitative scientific literature review, which is based on 11 scientific articles. Findings: The findings of the selected articles in the literature review gave three main categories and five subcategories, which were compiled based on previous research on women’s experiences of living with breast cancer. Discussion: Women with breast cancer diagnosis had different experiences and changed emotions. Women felt insecure and lost control of their lives which was difficult to accept. The women were presented with many different existential thoughts and questions, which increased the need to be heard and seen. The family support and healthcare support was extremely necessary to be able to continue with the treatment and be able to manage the disease.Conclusion: The diagnosis of breast cancer is a worrying disease that affected the women and their existence. Deeper research would be crucial to what help those patients can get to manage their disease and its treatments more easily.

After serving a prison sentence, an individual may experience social and economic exclusion, which further increases the risk of recidivism. Although it is expected that such individuals should be able to support themselves after serving a prison sentence, the study highlights the fact that they may encounter several obstacles in their attempt to obtain legal employment. The research questions concerned the sources of information that contribute to the individual's perceived self-efficacy. The purpose of this study is to gain an understanding of how an individual’s perceived self-efficacy affects her/his opportunities to obtain legal employment after serving a prison sentence for drug offenses. A social psychological perspective was chosen, which was studied with the help of Albert Bandura's theory. This qualitative study is based on semi-structured interviews with eight individuals who served prison sentences for drug offenses and managed to find legal employment afterwards. The collected empirical data were processed by means of thematic analysis. The results showed that perceived self-efficacy had both a positive and a negative effect on the possibility of obtaining legal employment after serving a prison sentence. All respondents stated that the motivation derived from family, acquaintance or partner support was the key to a successful transition. Society's anti-support/ in the form of criminal record as well as lack of work experience and a driving license reduced the possibility of obtaining legal employment

Aims and Objectives: To explore the lived experience of young adults diagnosed with cancer and to increase our understanding of how to help them with their caring needs. Background: Being diagnosed with cancer is normally related with an existential crisis. This indicates that the individual cannot avoid thoughts of death, loneliness, guilt, and meaninglessness. In person-centered care, the caretaker should have a holistic view of the person. Professionals must meet the patient´s different needs to strengthen health and well-being for the diagnosed. This approach encourages the traditionally passive patient to become an active consumer who works in partnership with the healthcare provider. Design: For this study, a content analysis of narratives was conducted, targeting age groups of 20–29 to take part of young adults' experiences. Methods: Qualitative analysis of narratives and followed checklist (e.g., COREQ). Results: During the analyzing phase, two main themes emerged: Interactions with Professionals and Cancer Voyager. In the results, both positive and negative feelings regarding encounters and support received from the professionals were described, this affected the young adults' well-being and their ability to participate during treatments. The young adults felt as being on a journey with no control over which direction the road may take. Conclusion: Outcome of the result shows the importance of making the young adult, one in a team. When working in a person-centered way, patients gain control by owning their own responsibility during treatments. Implications for Nursing Practice: There is a need in nursing education to address existential matters, to make nursing students ready to be approach but such questions in their professional work. Also, we believe that the experienced nurse must be given means to feel confident to handle questions about existential matters. By developing skills in the area of e-Health, collaboration through support groups, and last but not least switching to patient-centered care, we can offer effective and evidence-based care tailored for this population. 

Background: In 2008, the WHO Surgical safety checklist was introduced to reduce mortality, improve patient safety and reduce risk of medical injuries in connection to surgery by means of a communication tool ensuring that checks and interventions are performed. Previous studies show a variation in compliance to the checklist, and that different items not are entirely performed. Aim: To describe the surgical team’s compliance to time-out and sign-out in the WHO Surgical safety checklist. Method: A quantitative cross-sectional study conducted as a non-participatory observational study. Data was collected during 24 observations at two hospitals using a structured observational protocol. Data was analysed using SPSS and reported through descriptive statistics, using pie and bar charts as well as tables and discussion. Result: Time-out was initiated in 95,8 % of the observations and completed in 4,2%. Sign-out was initiated in 100 % of the observations and 29,2 % were completed. No member of the surgical team was responsible for performing the safety checks. In 19 of 22 observations, all three parts of the checklist were signed in Orbit before the sign-out was completed. Conclusion: Both time-out and sign-out are carried out to a great extent, however, compliance with all items of the checklist varies. The study shows a discrepancy between the actual use of the checklist and the administratively reported use of the checklist.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects women in their reproductive age. It is characterized by hyperandrogenism, menstrual cycle irregularities and polycystic ovarian morphology. PCOS can cause infertility and is usually associated with a number of metabolic dysfunctions such as insulin resistance and aberrant fat metabolism in major metabolic organs such as skeletal muscles. These dysfunctions increase the risk for developing diabetes and cardiovascular diseases. The exact etiology of PCOS is still unknow, but a number of genetic, epigenetic and environmental factors have been identified. In order to understand the links between PCOS and its related metabolic dysfunction, and to unravel its complex pathophysiology, extensive research is constantly done. In this study, 84 differentially expressed genes have been identified in skeletal muscles of women with PCOS (n=13) compared to controls (n=12) by array-based RNA profiling. Using gene set enrichment analysis, it is demonstrated that these genes are components of metabolic pathways that are related to fat metabolism and transport. In vitro verification of differential gene expression of 5 genes of interest in skeletal muscles from prenatally androgenized mice was done using RT-PCR, and shows statistically significant differential expression of 2 out of 5 genes. This study confirms the role of fat metabolism in PCOS pathogenesis and uses knowledge learned from obesity and diabetes to suggest directions for further research, which is warranted to develop new treatments that will; hopefully, reduce the devastating effects of PCOS on the lives of women and the economies of communities worldwide.

Background: The Covid-19 pandemic created a change in the work of organizations, as general advice was that employers should enable teleworking. This generated an intensification in the use of flexible work arrangements. FWA was previously not a priority approach in organizations, but it quickly became a necessity to be able to continue running businesses. FWA is made possible with the help of digital aids, and during the pandemic, the development of technology was also accelerated. Digital technology allows individuals to perform their work in alternative locations and at different times, this relationship is not regulated to the same extent as when organizations only work in the office. The increased use of FWA has had a positive effect on organizations, but it has also entailed new challenges.

Purpose: The thesis aims to investigate and thereby increase the understanding of how employees in organizations experienced and worked with flexible work arrangements before, during and after the pandemic.

Method: The study is based on a qualitative method with semi-structured interviews, through the interviews the authors have gained empiricism. This also collected secondary data from various sources such as scientific articles.

Empirical and Conclusion: The respondents' answers to the interview questions are presented in the empirical work, where the authors highlight different quotes and summarize different points of view that are highlighted during the interviews. The conclusion highlights how crucial digital technology is for working with FWA, as well as what challenges and opportunities there are in working with FWA and how it can play out in the future.

Introduction 

Toxoplasma gondii, a parasite that, through millennia of evolution, has the ability to infect most mammals, including humans. It is often transmitted through feces from felines, but the parasite is also found in the tissue of infected production animals. Therefore, it is considered a food-borne infection and affects many millions of people every year. The WHO estimates that nearly six billion people in the world have been exposed to the infection. 

Aim of the study 

The aim of the study is to highlight current research on latent toxoplasmosis with the intention of increasing knowledge about the disease in healthcare and in society as it is a growing global health problem according to WHO and One Health initiative. 

Method 

Structured literature review according to State-of-the-Art methodology. 

Results 

Both animal and human studies show that there is a strong link between latent toxoplasmosis and neurological and psychiatric symptoms, but more longitudinal studies on latent toxoplasmosis are needed to describe the long-term impairment of health and symptoms the disease may cause.

The parasite can cause a short and often asymptomatic acute stage but may also cause a lifelong latent phase. Infection with Toxoplasma gondii can cause cysts in tissues, internal organs and in the nervous system. It also has the ability to cause spontaneous abortions and congenital lesions in fetuses and young individuals in both animals and humans. 

In the nervous system, it can cause tissue cysts in the brain and cell-mediated immune response may cause inflammation in the brain which, together with cysts in the brain, can cause severe neurological symptoms and psychiatric diseases as well as behavioral changes in the person affected. 

Conclusion 

Toxoplasma gondii has the ability to manipulate the brain, modulate the pathway of neurotransmitters and alter the levels of neurotransmitters in the brain and create inflammation in the brain of the sufferer. These changes can lead to serious behavioural changes such as increased risk-taking, increased impulsivity, increased aggressiveness, increased risk of suicide, but can also contribute to the development of schizophrenia and other psychotic disorders as well as increased depression, anxiety and obsessive-compulsive disorder. Toxoplasmosis may well be a possible risk factor for mental illness, perhaps even a possible explanation for an increasing propensity for violence in society.

Introduction: Appendiceal mucinous neoplasm is a rare type of appendiceal tumors which can present in a variety of symptoms and is difficult to diagnose. Preoperative diagnosis depends mainly on diagnostic imaging such as ultrasonography and computerized tomography (CT) scan. This uncommon case report discusses an appendiceal mucinous neoplasm mimicking a left adnexal mass on presentation, physical examination and diagnostic imaging findings. Presentation of case: This is a 61-year-old female found to have a large left adnexal mass during follow up ultrasonography. The patient refused further imaging, and during laparotomy, she was found to have an appendicular mucocele with normal left and right ovaries. Discussion: Appendectomy was done and the final pathology came as appendiceal mucinous neoplasm. Her post-operative course and 3 years follow up were uneventful. Conclusions: The equivocal signs and symptoms along with the anatomical position of appendiceal mucocele makes it difficult to diagnose and can mimic other types of tumors. Therefore, it should be considered in the deferential diagnosis of lower abdominal and pelvic masses. 

Background: Appendicular neoplasms are rare, most commonly as carcinoids followed by appendicular mucinous neoplasms (AMN). To date, there remains controversy regarding the best treatment of AMN and factors affecting its prognosis. Method: Retrospective chart review of patients operated for appendicular pathology (January 2011–December 2018, follow up to December 2020) at our institution. For all AMN patients, data included pre-operative clinical presentation, and operative/post-operative findings. Results: 12454 patients underwent appendectomy, of whom 50 (0.4%) had AMN histopathologically (mean age = 47.2). Most patients had laparoscopic appendectomy as primary surgery. Low grade AMN was the most common subtype (n = 41, 82%), and pseudomyxoma peritonei (PMP) was found in 8 (16%) patients. Based on histopathology and margin involvement, the 50 patients were categorized into 3 prognostic categories of recurrence risk (no risk, 24 patients; low risk, 8; high recurrence risk, 18 patients). Disease-free survival (DFS) was lowest for high recurrence risk group (P < 0.001). Eleven (22%) patients had AMN involving resection margin, of whom 3 had no completion surgery and had no recurrence. Higher tumor markers were associated with lower DFS, however it was not statistically significant. Conclusion: AMNs are rare but serious due to the risk of PMP. Laparoscopic approach for AMN may be feasible. Prognostic categories were significantly inversely correlated with recurrence risk; hence useful in predicting prognosis. Contrary to previous proposals, AMNs with acellular mucin at margin or local acellular mucin spillage may not require secondary surgery, especially if the patient is in low recurrence risk group. Tumor markers may predict risk of recurrence. 

Background – Hip fracture is a global problem and the incidence increases with increasing age. The largest risk factor for hip injury is fallings combined with osteroporosis. Patients with hip fractures require a lot of care resources and have a long recovery process.Aim – Older persons experience of the aftermath within healthcare after a hip fracture.Method – This study was conducted as a literature review based on scientific articles with qualitative and quantitative design.Results/ Conclusion – Patients´ experienced impaired independence and need of help to cope with normal everyday activities. There are several factors that affect the patient's recovery process, including depression, motivation and fear of falling again. Patients need support from both healthcare professionals and relatives in order to return to an independent life. Four main findings have been identified in the literature study; the first finding is that the patient has a slow recovery, the second is deficiencies in care, the third is the patients' psychological impact on the recovery process and the fourth is reduced independence and communication.

Background: Within the surgical specialist care, both elective, acute, and palliative patients are cared for. There is research that describes nurses' experiences of caring for these patients separately. However, there is limited research on nurses' experiences of caring for these groups of patients simultaneously.

Aim: Describe nurses' experiences of caring for elective, acute and palliative patients simultaneously in a surgical ward.

Method: Qualitative interview study with seven nurses. The data was analyzed through qualitativecontent analysis.

Findings: The results revealed two main categories, with three subcategories belonging to each main category. The main category: Patient variations create stimulation and set requirements gives a description of the patients' varied nursing needs, the importance of adaptation and job satisfaction. The main category: The impact of the work environment on care and health, describes the pressured work environment, the need for prioritization and the feeling of inadequacy.

Conclusion: Caring for acute, elective and palliative patients simultaneously is described as varied and instructive. At the same time, it requires adaptation. Furthermore, the high workload creates the need to prioritize, which leads to the suffering of certain parts of the care and patient groups. The results also suggest that it’s particularly difficult to care for palliative patients in a curative ward.

Background: Violence against women in close relationships is increasing sharply in society. The consequences of being subjected to violence are multiple and affect both physical and mental stresses that affect women's life situation. The emergency department is the main care unit that abused women seek out. The work structure makes it difficult for the nurse to pay attention to abused women. Nurses have a responsibility to detect signs of violence early.

Aim: To shed light on factors that affect nurses' meeting with the abused women in close relationships at the emergency department.

Method: The study is literature-based on qualitative research consisting of 10 scientific articles.

Findings: Two main themes were presented in the results, which were organizational challenges and relational challenges. Emergency nurses experienced a lack of time and routines to be able to meet and offer good care to the abused women. There was also a lack of knowledge among nurses in caring for these women. Nurses also experienced difficulties in creating a good care relationship with women exposed to violence, which hindered the implementation of person-centred work.

Conclusion: Nurses need more training and clearer guidelines and routines in the emergency department in order to be able to offer good and safe care for women exposed to violence. The employer also needs to reduce the workload for nurses as they find their work environment stressful and exhausting.

Background: Foot drop is defined as a weakness in the ankle and foot dorsiflexors. A disruption of the neural pathway starting from the motor prefrontal cortex and ending in the peroneal nerve can lead to foot drop. Foot drop due to lower motor neuron injury is well documented. However, foot drop due to a central cause of cervical disc prolapse is very rare. Case presentation: A 55-year-old male presenting with neck pain, right and left arms radicular pain and numbness, and unilateral right foot drop following cervical disc prolapse. The patient presented with upper motor neuron lesion signs. MRI showed cervical disc prolapse at two levels, confirming central cause of foot drop. The patient underwent anterior cervical decompression and fusion surgery. Discussion: Following decompression and fusion of involved cervical spine disc pathology, the patient had complete recovery of his right foot drop. Conclusions: Central causes, although rare, should be considered in the differential diagnosis of foot drop. Causes could be due to the compression effect of the cortico-spinal tract of the cervical spinal cord. Satisfactory results can be achieved upon correcting the causative lesion.