Has increased nursing competence in the ambulance services impacted on pre-hospital assessment and interventions in severe traumatic brain-injured patients?

OBJECTIVE: Trauma is one of the most common causes of morbidity and mortality in modern society, and traumatic brain injuries (TBI) are the single leading cause of mortality among young adults. Pre-hospital acute care management has developed during recent years and guidelines have shown positive effects on the pre-hospital treatment and outcome for patients with severe traumatic brain injury. However, reports of impacts on improved nursing competence in the ambulance services are scarce. Therefore, the aim of this study was to investigate if increased nursing competence level has had an impact on pre-hospital assessment and interventions in severe traumatic brain-injured patients in the ambulance services. METHOD: A retrospective study was conducted. It included all severe TBI patients (>15 years of age) with a Glasgow Coma Score (GCS) of less than eight measured on admission to a level one trauma centre hospital, and requiring intensive care (ICU) during the years 2000–2009. RESULTS: 651 patients were included, and between the years 2000–2005, 395 (60.7%) severe TBI patients were injured, while during 2006–2009, there were 256 (39.3%) patients. The performed assessment and interventions made at the scene of the injury and the mortality in hospital showed no significant difference between the two groups. However, the assessment of saturation was measured more frequently and length of stay in the ICU was significantly less in the group of TBI patients treated between 2006–2009. CONCLUSION: Greater competence of the ambulance personnel may result in better assessment of patient needs, but showed no impact on performed pre-hospital interventions or hospital mortality

Jämlik vård ur ett prehospitalt akutsjukvårdsperspektiv

Bakgrund: Målsättningen för jämlik vård är enligt Världshälsoorganisationen (WHO) och Hälso- och sjukvårdslagen (HSL) 1982:763 att hälso- och sjukvården ska ge god hälsa och en vård på lika villkor för hela befolkningen, oavsett bostadsort, ålder, kön, funktionsnedsättning, utbildning, social ställning, etnisk eller religiös tillhörighet eller sexuell läggning. Tidigare forskning visar dock att det finns skillnader inom olika delar av hälso- och sjukvården som har både könsrelaterade och socioekonomiska orsaker. Även olikheter i patienters symtombild i relation till kön samt faktorer såsom kön, ålder, utbildningsnivå och attityder hos personalen som omhändertar patienten kan påverka om vården bedrivs jämlikt eller inte. Det är dock oklart om ovan beskrivna orsaker till ojämlik vård även har inverkan på vården som bedrivs prehospitalt, inom ambulanssjukvården. Syfte: Det övergripande syftet med denna avhandling var att utforska ambulanspersonalens omhändertagande av patienter ur ett jämlikhetsperspektiv. Metod: Två studier har genomförts, en med kvantitativ studiedesign (I) och en med kvalitativ studiedesign (II). Studie I, baseras på ambulanspersonalens dokumentation gällande bedömning och smärtlindring av patienter (n=722) som drabbats av höftfraktur. Studie II är en intervjustudie genomförd med ambulanspersonal (n=11). Resultat: I delstudie I framkom att ambulanspersonal med yrkeserfarenhet mindre än 10 år administrerat mer smärtstillande läkemedel jämfört med personal med yrkeserfarenhet mer än 10 år. Det som även visade sig i studien var att patienterna i stor grad (>80 %) uppgav smärta men det var en relativt låg andel som smärtlindrades enligt dokumentationen. I delstudie II framkom att bristande svensk-engelska kunskaper hos den vårdsökande var ett hinder för att utföra en optimal bedömning, identifiering av vårdbehov och initiering av behandling samt symtomlindring vilket kan riskera en ojämlik vård. Ambulanspersonalen anpassade sig emellertid till situationen och beskrev hur de använde en palett av strategier när de försökte övervinna språkbarriärerna. Konklusion: Studierna visar att det finns en risk för att vården ur ett prehospitalt akutsjukvårdsperspektiv kan vara ojämlik. Kön och yrkeserfarenhet hos ambulanspersonalen påverkade frekvensen av smärtlindring vid vård av patienter med höftfraktur. Bristande svensk-engelska kunskaper hos de vårdsökande riskerar även att orsaka en ojämlik vård men ytterligare studier behövs i ämnesområdet för att kunna bekräfta/förkasta denna slutsats

Allergen-specific IgE over time in women before, during and after pregnancy

The trajectory of IgE levels before, during and after pregnancy in sensitized individuals is characterized by significant increase in specific IgE to birch allergens but not to other allergens after multiple testing. This increase may warrant some surveillance in the antenatal care for those with clinical symptoms.The Swedish Research CouncilThe Swedish initiative for Research on Microdata in the Social And Medical Sciences (SIMSAM) framework grant no 340-2013-5867Stockholm County Council (ALF-projects)The Strategic Research Program in Epidemiology at Karolinska InstitutetDepartment of Clinical Sciences at Danderyd HospitalSwedish Medical Research CouncilSwedish Heart-Lung FoundationSwedish Asthma and Allergy Association’s Research FoundationAccepte

Nutritional niche separation between native roe deer and the nonnative fallow deer-a test of interspecific competition

On an evolutionary time scale, competition for food drives species formation by genetic adaptations to the environment and subsequent niche separation. On a short-term scale, animals use different strategies to meet their nutritional requirements, which ultimately influence their fitness. Understanding these adaptations in herbivores is especially important in temperate climates where animals have adapted both physiologically and behaviorally to seasonal variations in order to meet their nutritional requirements. The aim of this project was to investigate temporal variation in chemical composition of rumen content between two coexisting species of large herbivores, the native roe deer (Capreolus capreolus L.) and the introduced fallow deer (Dama dama L.), as well as a potential effect of competition on niche separation (interspecific differences in rumen nutrient composition). We analyzed 345 rumen samples collected from animals at one 95 km(2) estate, Koberg, in southwestern Sweden. Based on samples from all seasons, temporal variation in nutrient composition and interspecific differences between the two deer species were investigated under two contrasting fallow deer population densities. Results revealed that nutrient composition varied between species and across seasons. Roe deer had a higher proportion of rumen protein compared to fallow deer, with the highest proportions in spring. In contrast, fallow deer had a higher proportion of rumen hemicellulose compared to roe deer in spring, while no differences in nutrient composition between species could be found in fall. Overall, there were greater differences between the two species when fallow deer density was high and competition likely more pronounced than when fallow deer density was low. The results from this study can be used to understand interspecific competition and how it fosters niche separation between coexisting large herbivores

DNA Methylation Levels in Mononuclear Leukocytes from the Mother and Her Child Are Associated with IgE Sensitization to Allergens in Early Life

DNA methylation changes may predispose becoming IgE-sensitized to allergens. We analyzed whether DNA methylation in peripheral blood mononuclear cells (PBMC) is associated with IgE sensitization at 5 years of age (5Y). DNA methylation was measured in 288 PBMC samples from 74 mother/child pairs from the birth cohort ALADDIN (Assessment of Lifestyle and Allergic Disease During INfancy) using the HumanMethylation450BeadChip (Illumina). PBMCs were obtained from the mothers during pregnancy and from their children in cord blood, at 2 years and 5Y. DNA methylation levels at each time point were compared between children with and without IgE sensitization to allergens at 5Y. For replication, CpG sites associated with IgE sensitization in ALADDIN were evaluated in whole blood DNA of 256 children, 4 years old, from the BAMSE (Swedish abbreviation for Children, Allergy, Milieu, Stockholm, Epidemiology) cohort. We found 34 differentially methylated regions (DMRs) associated with IgE sensitization to airborne allergens and 38 DMRs associated with sensitization to food allergens in children at 5Y (Sidak p ≤ 0.05). Genes associated with airborne sensitization were enriched in the pathway of endocytosis, while genes associated with food sensitization were enriched in focal adhesion, the bacterial invasion of epithelial cells, and leukocyte migration. Furthermore, 25 DMRs in maternal PBMCs were associated with IgE sensitization to airborne allergens in their children at 5Y, which were functionally annotated to the mTOR (mammalian Target of Rapamycin) signaling pathway. This study supports that DNA methylation is associated with IgE sensitization early in life and revealed new candidate genes for atopy. Moreover, our study provides evidence that maternal DNA methylation levels are associated with IgE sensitization in the child supporting early in utero effects on atopy predisposition.</p

Rule-Based Models of the Interplay between Genetic and Environmental Factors in Childhood Allergy

Peer reviewe

Long-term ongoing structured support in early stage of dementia: PER-model

Dementia is a global disruption of intellectual functioning; there is a decrease of memory ability and other intellectual abilities. About 25, 000 persons are diagnosed with dementia each year in Sweden. In 2009, the Swedish Parliament passed a new law that stated that support should be given to persons caring for people with chronic illnesses, elderly people, or people with functional disabilities. A municipality in northern Sweden have a long term ongoing support to persons with dementia and their next of kin since 2006. A close collaboration with the geriatric clinic and private health centers has resulted in support being offered within 4-6 weeks after diagnose.  The overall aim of the thesis was to explore experiences of living with dementia both as a sufferer and as a next of kin; and being part of a long-term ongoing support group. Results showed that couples who had been the longest in a support group felt great comfort and support. They experienced that their knowledge about the disorder was good and that they could prepare for the changes to come. Persons with dementia who participated in the support groups experienced a great sense of coherence and felt that life was manageable, comprehensible and meaningful. The results have founded a model for support called PER-model®; Pedagogical, Emotional and Relationship based model of support.  The PER model ® focuses on creating and supporting relationships between participants and moderators, pedagogical information about dementia and supporting emotions as a means making the best of what is

Long-Term Ongoing Structured Support in Early Stage of Dementia: A Family Affair

Demenssjukdomar drabbar mer än 35 miljoner människor världen över, en summa som kommer att fördubblas vart tjugonde år.    Demens är en global störning av intellektuella funktioner: förmågan att minnas försämras, och förmågor som att orientera sig i tid och rum, språklig förmåga, tankeprocesser som att gå från tanke till handling, problemlösande, utföra saker praktiskt och känna igen föremål. Symtomen följs ofta av förändringar i beteende och personlighet, som låg initiativförmåga, irritation, grovt socialt beteende och humörsvängningar. I Sverige diagnostiseras 25 000 personer per år, totalt så lever 160 000 personer med sjukdomen i Sverige idag. I Sverige ställs diagnosen ofta utifrån blodprover, hjärnröntgen och Mini Mental Score Evaluation-Swedish Revision tillsammans med personens sjukdomshistoria.   Efter diagnosen har ofta anhöriga många frågor om hur livet kommer att te sig framöver, är det bra att flytta eller ska man bo kvar? Hur kommer sjukdomen att förändra livet och personligheten hos den drabbade? Tidigare studier visar att dessa frågor ofta förblir obesvarade, det är svårt att få en uppföljning hos läkare och det finns få länder där stöd efter diagnosen är vanligt förekommande.    Sverige har sen 2009 lagstiftat om rätten till stöd till anhöriga och närstående med demenssjukdom eller andra kroniska sjukdomar med funktionshinder. Typen av stöd som ges skiljer sig däremot åt, Socialstyrelsen kom därför hösten 2013 ut med riktlinjer för hur stödet bör se ut för att vara effektivt: 8-10 träffar under 3-6 månader med information och socialt stöd till anhöriga. En kommun i norra delen av Sverige har gett långvarigt stöd till personer med demenssjukdom och deras anhöriga sen 2006. Ett nära samarbete med Landstinget i regionen och på senare tid även privata vårdcentraler i området har lett till att stöd kan erbjudas i direkt samband med diagnostillfället. Personerna deltar ofta i stödgrupp inom ca 4-6 veckor efter sin diagnos. Avhandlingens syfte var att fördjupa kunskapen om personernas upplevelse av att vara i stödgrupp under lång tid; den längsta i 4 år. Intervjuer gjordes med anhöriga och personer med demenssjukdom. Resultaten visade att de par som varit med längst i stödgrupp kände sig trygga, de upplevde att de fick god kunskap om demens och var förberedda på den förändring som skulle komma. Resultaten visade också att vara vuxet barn till en person med demens innebar att vara tyngd av ansvar för att agera i den sjuka förälderns intresse trots en djup känsla av sorg of förlust vilket ofta leder till frustration med situationen. Relationerna inom familjen kan förändras efter demens diagnosen både till det bättre; att man sluter upp kring den demenssjuke föräldern men också till det sämre; att familjen splittras då relationerna utsätts för påfrestningar. Personerna med demenssjukdom som deltog i stödgrupperna upplevde och skattade sin känsla av sammanhang högt; att livet var meningsfullt, begripligt och hanterbart. Deras friska partner upplevde mindre begriplighet och hanterbarhet och de vuxna barnen mer meningsfullhet. Avhandlingens resultat har legat till grund för en modell för stöd till personer med demenssjukdom och deras anhöriga kallat PER-modellen®; Pedagogisk, Emotionell och Relationsbaserad modell för stöd.Dementia disorders affect more than 35 million people around the world, which will double every twenty years. Dementia is a global disruption of intellectual functioning; there is a decrease of memory ability and other intellectual abilities such as orientation, visuospatial- perceptive ability, language, thinking, executive abilities, problem solving, apraxia and agnosia.  These symptoms are often followed by behavioral changes and changes in the personality, such as loss of initiative, emotional instability, irritation, apathy, coarse social behaviour and mood changes. The most frequent symptoms were apathy, depression, irritability, and agitation. About 25, 000 persons are diagnosed with dementia each year in Sweden. Today, estimates are that 160, 000 persons in total are suffering from dementia in Sweden. In Sweden, most diagnoses are done in the primary health care setting by general practitioners  and are based on the person´s own history, interviews with next of kin and an Mini Mental Score Evaluation- Swedish Revision (MMSE-SR) along with blood work and a brain scan to rule out any other diseases. After diagnosis the next of kin often have many questions about the coming lifestyle changes and ways to handle the personality changes that the person suffering from dementia may go through. Previous studies show that in many cases these questions are left unanswered, because it is difficult to get a follow up with a physician and there are few countries where support after diagnose is common.    In 2009, the Swedish Parliament passed a new law that states that support is to be given to persons caring for people with chronic illnesses, elderly people, or people with functional disabilities. There was, however, no detailed description of the extent or kind of services to be provided, and the municipalities had extensive freedom in implementing the legislation. In the autumn of 2013 the Swedish National Health Board therefore, issued guidelines where eight to ten meetings during a three- to six-month period with information and social support were recommended.A municipality in northern Sweden have a long term ongoing support to persons with dementia and their next of kin since 2006. A close collaboration with the geriatric clinic and private health centers has resulted in support being offered within 4-6 weeks after diagnose.     The overall aim of this thesis was to explore experiences of living with dementia both as a sufferer and as a next of kin; and being part of a long-term ongoing support group, the longest for four years.     Interviews were done with persons with dementia and their next of kin. Results showed that couples who had been the longest in a support group felt great comfort and support. They experienced that their knowledge about the disorder was good and that they could prepare for the changes to come. Results also showed that to be an adult child of a person with dementia disease means being burdened with the responsibility to act on behalf of the diseased parent despite a deep sense of grief and loss, which leads to frustration with the situation.     Relationships within the family can sometimes change when a family member is affected by dementia. Sometimes for the better; where the family rallied to support the affected member and sometimes for worse; where the relationships were strained when pressure became too much. The persons with dementia who participated in the support groups experienced a great sense of coherence and felt that life was manageable, comprehensible and meaningful. Their healthy partners experienced less comprehensibility and manageability and the adult children more meaningfulness.   The results of the thesis have founded a model for support called PER-model®; Pedagogical, Emotional and Relationship based model of support

Primary Healthcare Nurses&rsquo; Views on Digital Healthcare Communication and Continuity of Care: A Deductive and Inductive Content Analysis

Primary healthcare in the Western world faces significant functional challenges, resulting in the implementation of digital communication tools. Nurses are key professionals in primary care and focusing on the impact of digital communication and continuity of care in primary care organisations is important. This qualitative descriptive study explores digital communication and continuity of care from primary healthcare nurses&rsquo; perspective. Data from individual semi-structured interviews with 12 nurses were collected; deductive and inductive content analyses were performed. Three descriptive categories emerged from the deductive (digital communication as interpersonal, information, and management continuities) and inductive (&lsquo;digital care does not suit everyone&rsquo;, &lsquo;new technology is contextually intertwined with daily work&rsquo;, and &lsquo;patient-positive aspects of digital information&rsquo;) phases. Additionally, a structural risk of obscuration of patients&rsquo; needs by the contextual conditions emerged. To ensure digital communication-aligned continuity of care, compatible information technology systems should be developed. Allowing nurses to provide high-quality care based on their own values would enhance person-centred patient care