Inflammatory bowel disease and complementary and alternative medicine - The perspectives of patients and healthcare professionals

Background: Inflammatory bowel disease (IBD) is a term that covers ulcerative colitis (UC) and Crohn’s disease (CD). The causes of IBD are unknown and the incidence is increasing. IBD is a lifelong disease with severe symptoms that affect daily life and Health Related Quality of Life (HRQOL). The medical treatment for IBD is complex and many patients suffer from side effects of medication. Complementary and Alternative Medicine (CAM) encompasses methods that are not a part of conventional healthcare and not generally provided by the Swedish healthcare system. The use of CAM is increasing, especially in chronic diseases. Aim: The overall aim of this thesis was to investigate the use of CAM in patients with IBD and to explore attitudes to and experiences of CAM in patients with IBD and healthcare professionals (HCPs). An additional aim was to investigate IBD patients’ worries and disease related concerns in relation to CAM use. Study I was a controlled cross-sectional and multicentre study. The study enrolled 648 patients with IBD from 12 IBD clinics in Sweden. The control group comprised 440 individuals selected from Statens Personadressregister (SPAR). Data were collected by means of questionnaire. The results revealed that 48.5% (n = 313) of the IBD patients had used some form of CAM in the past year, compared with 53.5% (n = 235) in the control group. The most common CAM methods used by IBD patients compared to the control group were massage 21,3% vs 31,4%, herbal remedies 18,7% vs 21,3%, relaxation 10,5% vs 11,6%, yoga 8% vs 9,6%, acupuncture 7,6% vs 8,9%, counselling 7,3% vs. 6,2 and chiropractic 5,4 vs 5,7%. Study II was an interview study in which HCPs were asked to describe their experiences and attitudes to CAM. The participants were 16 physicians and nurses who had worked with IBD patients for 1-42 years. The results demonstrated that IBD nurses and physicians had confidence in and a positive attitude to CAM, especially when used as a complement to conventional medicine. The participants were of the opinion that patients considered and tested various CAM methods. They stated that CAM has a role in healthcare, which indicates acceptance. However, attitudes that constituted an obstacle to CAM were also reported, such as lack of evidence. Some participants had a restrictive approach and considered CAM unnecessary, while a few were sceptical. Study III comprised interviews in which 15 IBD patients described their experiences of CAM both alone and in combination with conventional medical treatment. It was found that patients with IBD wished to be consulted and have a discussion about CAM. They felt disparaged and not taken seriously when they wanted to discuss CAM. HCPs need to be aware of this issue in order to meet and understand IBD patients’ needs. The IBD patients considered it easier to discuss CAM with nurses than with physicians, which underlines IBD nurses’ important role in communicating with and monitoring IBD patients’ use of CAM. HCPs should be aware that IBD patients consider dietary changes an important CAM treatment. Study IV was a controlled, cross-sectional and multicentre study. Data from 12 IBD clinics in Sweden were collected by means of questionnaires. A total of 645 IBD patients were enrolled and asked to answer two questionnaires; a studyspecifik questionnaire concerning CAM use, disease and demographic data and the Rating Form of Inflammatory Bowel Disease Patients’ Concerns (RFIPC) questionnaire. The RFIPC consists of 25 questions to which patients respond by indicating how worried they are about a particular aspect on a VAS scale from 0-100. The questionnaire also contains an open question “Is there anything more that concerns you?”, which the patients answer in their own words. Of the participants, 313 used CAM and expressed more concerns in 15 of the 25 RFIPC items compared to patients who did not do so/non-users. CAM use was related to younger age and female gender. The open question revealed that IBD had a major impact on everyday life and that IBD patients’ worry concerned: The family and self, the burden of disease and associated factors. Conclusion: Patients with IBD used CAM in an attempt to achieve improvement and wellbeing. They considered dietary changes an important CAM treatment with positive effects on their condition. HCPs attitudes to CAM were mainly positive, although a problematic aspect was lack of knowledge and evidence. The HCPs acknowledged their need for education and respected the patients’ decision to use CAM. However, patients with IBD reported reluctance on the part of HCPs, being treated in a disparaging manner and not taken seriously when wishing to discuss CAM. They wanted to be asked about their CAM use and start a dialogue, but found it easier to discuss CAM treatment with nurses than physicians. Patients using CAM generally had more disease-related concerns compared to those who did not do so. IBD affects the whole of everyday life, especially the family and the self

Эпидемиология злокачественных новообразований полости рта по Витебской области

РОТОВОЙ ПОЛОСТИ НОВООБРАЗОВАНИЯЭПИДЕМИОЛОГИ

Characterization of the Viral Microbiome in Patients with Severe Lower Respiratory Tract Infections, Using Metagenomic Sequencing

The human respiratory tract is heavily exposed to microorganisms. Viral respiratory tract pathogens, like RSV, influenza and rhinoviruses cause major morbidity and mortality from respiratory tract disease. Furthermore, as viruses have limited means of transmission, viruses that cause pathogenicity in other tissues may be transmitted through the respiratory tract. It is therefore important to chart the human virome in this compartment. We have studied nasopharyngeal aspirate samples submitted to the Karolinska University Laboratory, Stockholm, Sweden from March 2004 to May 2005 for diagnosis of respiratory tract infections. We have used a metagenomic sequencing strategy to characterize viruses, as this provides the most unbiased view of the samples. Virus enrichment followed by 454 sequencing resulted in totally 703,790 reads and 110,931 of these were found to be of viral origin by using an automated classification pipeline. The snapshot of the respiratory tract virome of these 210 patients revealed 39 species and many more strains of viruses. Most of the viral sequences were classified into one of three major families; Paramyxoviridae, Picornaviridae or Orthomyxoviridae. The study also identified one novel type of Rhinovirus C, and identified a number of previously undescribed viral genetic fragments of unknown origin

Long-term follow-up with Granulocyte and Monocyte Apheresis re-treatment in patients with chronically active inflammatory bowel disease

<p>Abstract</p> <p>Background</p> <p>Patients with IBD and chronic inflammation refractory to conventional therapy often demonstrate higher risk of serious complications. Combinations of immunosuppression and biological treatment as well as surgical intervention are often used in this patient group. Hence, there is need for additional treatment options. In this observational study, focused on re-treatment and long-term results, Granulocyte/Monocyte Adsorption (GMA, Adacolumn^®) treatment has been investigated to study efficacy, safety and quality of life in IBD-patients with chronic activity.</p> <p>Methods</p> <p>Fifteen patients with ulcerative colitis and 25 patients with Crohn's disease, both groups with chronically active inflammation refractory to conventional medication were included in this observational study. The patients received 5-10 GMA sessions, and the clinical activity was assessed at baseline, after each completed course, and at week 10 and 20 by disease activity index, endoscopy and quality of life evaluation. Relapsed patients were re-treated by GMA in this follow-up study up to 58 months.</p> <p>Results</p> <p>Clinical response was seen in 85% and complete remission in 65% of the patients. Ten patients in the UC-group (66%) and 16 patients in the CD-group (64%) maintained clinical and endoscopic remission for an average of 14 months. Fourteen patients who relapsed after showing initial remission were re-treated with GMA and 13 (93%) went into a second remission. Following further relapses, all of seven patients were successfully re-treated for the third time, all of three patients for the fourth time and one for a fifth time.</p> <p>Conclusions</p> <p>IBD-patients with chronic inflammation despite conventional therapy seem to benefit from GMA. Re-treatment of relapsing remission patients seems to be effective.</p

"Det finns inte en cell i min kropp som vill ha barn!" : En fenomenologisk fallstudie av en kvinnas upplevelser av att vara barnfri

Idag är forskningen kring barnfrihet till skillnad från barnlöshet begränsad och beskrivningar kring upplevelser av fenomenet barnfrihet beskrivs sällan. Vi kan dock hitta litteratur som beskriver en komplexitet i valet av att som kvinna välja barnfrihet, vilket vi i denna studie närmare beskriver utifrån en kvinnas upplevelser samt erfarenheter. Syftet med denna studie är att undersöka en kvinnas upplevelser kring valet av att vara barnfri. Detta syfte har vi kunnat nå genom att göra en fenomenologisk fallstudie där vi genom två intervjutillfällen med en kvinna kunnat få en djupgående berättelse om hennes upplevelser samt erfarenheter av att vara barnfri. Hon har under en lång tid varit säker på att hon inte vill ha barn och att det inte finns en cell i hennes kropp som vill det. Denna starka känsla står i kontrast till samhällets syn på kvinnan som moder. Hennes upplevelser präglas därför av konsekvenser som uttrycks i form av nedvärderande och ifrågasättande bemötanden, förväntningar som sätter press på henne att skaffa barn, en oro kring att bli ensam samt en känsla av att inte vara normal. 

”Kan man låta så kan man sjunga!” : En kvalitativ studie om sex pedagogers uppfattningar om musikens funktion, plats och syfte i förskolan

Godkännandedatum: 2015-06-07</p

Jag vill ju bara bli rättvist behandlad : en studie om avidentifierade ansökningshandlingar som rekryteringsmetod för att motverka osaklig behandling av arbetssökande

Forskning påvisar att diskriminering i rekryteringsprocesser med avseende på etnicitet, kön och ålder förekommer på den svenska arbetsmarknaden. I synnerhet tenderar kvinnor och personer med utländsk bakgrund att diskrimineras när arbetsgivare väljer vilka sökande som skall kallas till anställningsintervjuer. Detta har lett till förslag på avidentifierade, även kallat anonyma, ansökningsprocesser där variablerna etnicitet, kön och ålder döljs i rekryteringens första skede. Det finns dock ytterst lite information om hur metoden fungerar i praktiken samt vilka effekter som en sådan metod medför. Uppsatsen syftar därför till att redogöra för rekryteringsmetoden och huruvida användandet av sådana metoder kan medföra en ökad mångfald samt motverka olika typer av diskriminering i organisationer. En kvalitativ studie har genomförts, där två kommuner involverats som använt sig av avidentifiering i sin rekrytering. Studien är baserad på en kombination mellan semi- och ostrukturerade intervjuer av relevant personal från båda kommuner. Kommunerna har tillämpat metoden genom att använda sig av speciellt utformade blanketter, som de sökande uppmanats fylla i till fördel för avidentifieringen. Även om viss skillnad i utförande finns mellan de två kommunerna har vi valt att jämföra de båda, i syfte att utreda hur erfarenheterna av metoden skiljt sig från varandra samt vilka för- och nackdelar som uppmärksammats i samband med avidentifieringen. Därigenom ville vi klargöra vilka möjliga effekter som metoden kan medföra. Resultaten visar att kommunernas ståndpunkt vad gällande användandet av anonyma ansökningshandlingar skiljer sig avsevärt. Karlstads kommun anser inte att metoden på något sätt bidrar till en ökad mångfald, vilket Melleruds kommun inte håller med om. Karlstads kommun hävdar även att metoden snarare kan motarbeta sitt syfte och istället för att motverka diskriminering, kan metoden bidra till en ökad diskriminering. Melleruds kommun menar att metoden belyser diskrimineringsfrågor och på så sätt bidrar till ett motverkande av diskriminering på längre sikt. I uppsatsen redovisas även en annan kommuns utvärdering och resultat av sitt försök med avidentifierade ansökningshandlingar, vilket vi ställer i motsats till vår undersökning

Elever, deras analogier och cellen : Hur uppfattar elever cellen med dess funktioner?

The study consider similarities used by pupils when discussing the human cell. In this study teachers are given certain examples on a number of different opinions pupils may have regarding a phenomenon which is of great importance in situations of education. Through interviews a variety of pupils’ opinions has occurred. The categorization of these has then been done by a phenomenographic approach. It resulted in five main categories and a number of sub categories. Altogether the study shows that many pupils use analogies to explain and understand phenomenon. In order to assist and facilitate pupils’ understanding the teachers must show interest in their pupils and the environment in which they exist and eventually grant pupils relevant time to reflections on their analogies.Studien tar upp analogier som elever använder sig av när de resonerar om cellen. Lärare får i denna studie konkreta exempel på en variation av uppfattningar som elever har om ett fenomen vilket är av stor nytta vid undervisningssituationer. Med hjälp av intervjuer har elevers olika uppfattningar framkommit. Kategoriseringen av dessa har sedan gjorts med metoden fenomenografi. Resultatet blev fem huvudkategorier med ett antal underkategorier till dessa. Sammanfattningsvis visar studien att många elever använder sig av analogier för att förklara och förstå fenomen. För att kunna hjälpa och underlätta elevernas förståelse behöver läraren intresse för elever och deras omvärld samt ge eleverna tid för reflektion av sina analogier