36 research outputs found
Study circles improve the precision in nutritional care in special accommodations
Background: Disease-related malnutrition is a major health problem in the elderly population, but it has until recently received very little attention, especially are management issues under-explored. By identifying residents at the risk of undernutrition, appropriate nutritional care can be provided. Objectives: Do study circles and policy documents improve the precision in nutritional care and decrease the prevalence of low or high BMI? Design: Pre and post intervention study. Setting: Special accommodations (nursing homes) within six municipalities were involved. Participants: In 2005, 1726 (90.4%) out of 1910 residents agreed to participate and in 2007, 1526 (81.8%) out of 1866 residents participated. Intervention: Study circles in one municipality, having a policy document in one municipality and no intervention in four municipalities. Measurements: Risk of undernutrition was defined as involving any of: involuntary weight loss, low BMI, and/or eating difficulties. Overweight was defined as high BMI. Results: In 2005 and 2007, 64% of 1726 and 66% of 1526 residents respectively were at the risk of undernutrition. In 2007 significantly more patients in the study circle municipality were accurately provided protein and energy enriched food compared to in the no intervention municipalities. There was a decrease in the prevalence of low BMI in the study circle municipality and the prevalence of overweight increased in the policy document municipality between 2005 and 2007
A multi-targeted approach to suppress tumor-promoting inflammation
Cancers harbor significant genetic heterogeneity and patterns of relapse following many therapies are due to evolved resistance to treatment. While efforts have been made to combine targeted therapies, significant levels of toxicity have stymied efforts to effectively treat cancer with multi-drug combinations using currently approved therapeutics. We discuss the relationship between tumor-promoting inflammation and cancer as part of a larger effort to develop a broad-spectrum therapeutic approach aimed at a wide range of targets to address this heterogeneity. Specifically, macrophage migration inhibitory factor, cyclooxygenase-2, transcription factor nuclear factor-ÎșB, tumor necrosis factor alpha, inducible nitric oxide synthase, protein kinase B, and CXC chemokines are reviewed as important antiinflammatory targets while curcumin, resveratrol, epigallocatechin gallate, genistein, lycopene, and anthocyanins are reviewed as low-cost, low toxicity means by which these targets might all be reached simultaneously. Future translational work will need to assess the resulting synergies of rationally designed antiinflammatory mixtures (employing low-toxicity constituents), and then combine this with similar approaches targeting the most important pathways across the range of cancer hallmark phenotypes
Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease
BACKGROUND:
Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes.
METHODS:
We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization.
RESULTS:
During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events.
CONCLUSIONS:
Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)
The invisible care : As a relative caring for a family member with dementia
Bakgrund: Demenssjukdom Ă€r den fjĂ€rde största folksjukdomen i Sverige och antalet insjuknanden berĂ€knas öka. Begreppet demens inbegriper progredierande sjukdomar som framförallt pĂ„verkar minne, humör och kommunikationsförmĂ„ga. MĂ„nga personer med demenssjukdom vĂ„rdas i hemmet av en eller flera anhöriga. Att vara anhörigvĂ„rdare innebĂ€r ett stort ansvar och pĂ„verkar alla medlemmar i familjen. Syfte: Att beskriva anhörigas upplevelser av att vĂ„rda en nĂ€rstĂ„ende med demenssjukdom. Metod: En litteraturöversikt som bygger pĂ„ en analys av tio vetenskapliga artiklar med kvalitativ design. Resultat: I resultatet pĂ„visades negativa och positiva upplevelser. Vissa anhöriga upplevde sig ha blivit starkare i sig sjĂ€lva genom vĂ„rdandet av sin nĂ€rstĂ„ende men ett flertal uttryckte Ă€ven kĂ€nslor som ilska och frustration. Det framkom att anhöriga var i behov av stöd i vĂ„rdandet, men att de ofta tyckte att det var jobbigt att be om stöd dĂ„ de inte ville vara en börda till andra eller till samhĂ€llet.  Med sjukdomens uppkomst upplevde mĂ„nga en förĂ€ndrad identitet hos den nĂ€rstĂ„ende som pĂ„verkade relationen mellan dem. Vissa upplevde rollförĂ€ndringar i familjen och en saknad av social samt emotionell nĂ€rhet, medan andra vittnade om att de kommit varandra nĂ€rmare. Diskussion: Resultatet visar att det finns en stor komplexitet i anhörigvĂ„rdares attityder gentemot hjĂ€lp och stöd utifrĂ„n, detta bör uppmĂ€rksammas av sjuksköterskor. Kunskap om anhörigas resurser och styrkor samt deras upplevda börda Ă€r en viktig del i sjuksköterskans omvĂ„rdnadsarbete. Sjuksköterskan behöver Ă€ven vara medveten om att det förekommer kĂ€nslor som ilska och frustration och identifiera dessa hos anhöriga för att undvika att den demenssjuke kommer till skada. Resultatet tyder Ă€ven pĂ„ att kvinnor och mĂ€ns upplevelser kan skilja sig Ă„t och sĂ„ledes kan deras behov se vĂ€ldigt olika ut. Sjuksköterskan kan dĂ€rför dra nytta av att beakta ett genusperspektiv i mötet med anhöriga. Resultatet har att diskuterats utifrĂ„n Dorothea Orems teori om egenvĂ„rdsbalans.Background: Dementia is the fourth most common endemic disease in Sweden and the number of people diagnosed with dementia is estimated to increase. Dementia includes diseases that affect the brain with symptoms on memory function, mood and communication skills. Several people with dementia is cared for at home by family members. Being an informal caregiver is a large responsibility and affects the whole family. Aim: To describe relativeâs experiences of caring for a family member with dementia. Method: A literature review based on the analysis of ten scientific articles with qualitative design. Results: The results showed both positive and negative experiences. Some relatives expressed the feeling of becoming stronger and more resilient as a result of caring for their loved one but there where feelings of anger and frustration as well. The results showed that the relatives where in need of social and formal support but often had a hard time asking for help due to the feeling of being a burden for others and the society. Many experienced that their family memberâs identity changed with the disease, which caused a change in the relationship as well. Some expressed role changes within the family and the lack of social and emotional closeness, while others expressed a feeling of becoming closer to each other. Discussions: It became clear that there was a complexity in relativeâs attitude to social and formal support and nurses in contact with informal caregivers should be aware of this. Knowledge about informal caregiverâs perceived burden and what they perceive as their strength is an important key part for nurses in their work with dementia patients and their relatives. Nurses need to be aware of the occurrence of feelings of anger and frustration in relatives to be able to spot these and make sure the patient welfare is not compromised. Due to differences in men and womenâs experiences it could be useful for the nurse to have a gender aspect in their meeting and caring for informal caregivers. The results were discussed from the perspective of Dorothea Orems self-care theory
Is security societyâs great issue of freedom? : A qualitative study on HR's contribution in organizations' work for crime prevention
Bakgrund: Justitieminister Gunnar Strömmer pĂ„talade pĂ„ en presstrĂ€ff den 2 november 2022 att Sverige Ă€r hĂ„rt drabbat av gĂ€ngvĂ„ld, skjutningar, sprĂ€ngningar och att trygghet har blivit samhĂ€llets stora frihetsfrĂ„ga. Brottsligheten Ă€r en enorm kostnad för samhĂ€lle, kommuner och företag, idag kostar brottsligheten riktad mot företag i Sverige omkring 90 miljarder kronor om Ă„ret. Vidare sĂ„ finns det en mĂ€ngd forskning pĂ„ brottsförebyggande Ă„tgĂ€rder, dock saknas det forskning pĂ„ HRâs bidrag i brottsförebyggande Ă„tgĂ€rder. HR har en avsevĂ€rd roll i organisationers operativa och strategiska arbete, dĂ€rav blev det relevant att utforska HRâs bidrag i brottsförebyggande Ă„tgĂ€rder i en organisatorisk strategi. Syfte: Syftet med studien Ă€r att utforska HRâs bidrag i brottsförebyggande Ă„tgĂ€rder för att utveckla en organisatorisk strategi för brottsbekĂ€mpning. Metod: I studien har en induktiv ansats applicerats, dĂ„ det inte finns nĂ„gon tidigare forskning pĂ„ HRâs bidrag i brottsförebyggande Ă„tgĂ€rder utan endast forskning pĂ„ brottsförebyggande Ă„tgĂ€rder och vad det kostar företag. Med hjĂ€lp av en induktiv ansats kunde empiri samlas in och analyseras för att framstĂ€lla teori. Vidare utgörs studien av en kvalitativ strategi i design av en fallstudie för att utforska HRâs bidrag i brottsförebyggande Ă„tgĂ€rder. Empirin samlades in via semistrukturerade intervjuer med elva informanter och analyserades sedan genom en tematisk analys för att identifiera studiens huvudteman. Slutsats: Analysen av den insamlade empirin gav oss ett resultat, dĂ€r vĂ„r tolkning Ă€r att HRâs bidrag Ă€r att skapa och bibehĂ„lla strategier i en organisatorisk kontext för brottsförebyggande Ă„tgĂ€rder. Detta genom att arbeta aktivt med relationer i och utanför organisationen via samverkan med olika aktörer, att skapa arbetsmöjligheter dĂ„ anstĂ€llning reducerar kriminella handlingar samt genom att skapa strategier för organisationer att engagera sig i utbildningar
Is security societyâs great issue of freedom? : A qualitative study on HR's contribution in organizations' work for crime prevention
Bakgrund: Justitieminister Gunnar Strömmer pĂ„talade pĂ„ en presstrĂ€ff den 2 november 2022 att Sverige Ă€r hĂ„rt drabbat av gĂ€ngvĂ„ld, skjutningar, sprĂ€ngningar och att trygghet har blivit samhĂ€llets stora frihetsfrĂ„ga. Brottsligheten Ă€r en enorm kostnad för samhĂ€lle, kommuner och företag, idag kostar brottsligheten riktad mot företag i Sverige omkring 90 miljarder kronor om Ă„ret. Vidare sĂ„ finns det en mĂ€ngd forskning pĂ„ brottsförebyggande Ă„tgĂ€rder, dock saknas det forskning pĂ„ HRâs bidrag i brottsförebyggande Ă„tgĂ€rder. HR har en avsevĂ€rd roll i organisationers operativa och strategiska arbete, dĂ€rav blev det relevant att utforska HRâs bidrag i brottsförebyggande Ă„tgĂ€rder i en organisatorisk strategi. Syfte: Syftet med studien Ă€r att utforska HRâs bidrag i brottsförebyggande Ă„tgĂ€rder för att utveckla en organisatorisk strategi för brottsbekĂ€mpning. Metod: I studien har en induktiv ansats applicerats, dĂ„ det inte finns nĂ„gon tidigare forskning pĂ„ HRâs bidrag i brottsförebyggande Ă„tgĂ€rder utan endast forskning pĂ„ brottsförebyggande Ă„tgĂ€rder och vad det kostar företag. Med hjĂ€lp av en induktiv ansats kunde empiri samlas in och analyseras för att framstĂ€lla teori. Vidare utgörs studien av en kvalitativ strategi i design av en fallstudie för att utforska HRâs bidrag i brottsförebyggande Ă„tgĂ€rder. Empirin samlades in via semistrukturerade intervjuer med elva informanter och analyserades sedan genom en tematisk analys för att identifiera studiens huvudteman. Slutsats: Analysen av den insamlade empirin gav oss ett resultat, dĂ€r vĂ„r tolkning Ă€r att HRâs bidrag Ă€r att skapa och bibehĂ„lla strategier i en organisatorisk kontext för brottsförebyggande Ă„tgĂ€rder. Detta genom att arbeta aktivt med relationer i och utanför organisationen via samverkan med olika aktörer, att skapa arbetsmöjligheter dĂ„ anstĂ€llning reducerar kriminella handlingar samt genom att skapa strategier för organisationer att engagera sig i utbildningar
"Nothing can be changed if the people donât change" : Costa Rican registered nursesâ views and experiences of caring for patients with dengue fever
Dengue fever has increased to the point where it has become a major international public health and economical problem, mainly in urban and semi-urban areas in tropical and subtropical regions. Worldwide 2,5 billion people live in regions where dengue can be transmitted and approximately 100 million people get infected yearly. In 2002 there was a great outbreak in Latin America, and Costa Rica was in the top three regarding reported cases. At the time of writing, reports show that cases of dengue are currently low in Costa Rica. Although the figures vary, dengue remains a public health problem. This study aimed to describe Costa Rican registered nursesâ views and experiences of caring for patients with dengue fever. Data were collected with semi-structured interviews and conducted with eight registered nurses from Costa Rica, and analysed with qualitative content analysis method with search for similarities and differences which later were categorized. The result was divided into five categories; the conception about dengue fever, caring, patient education, prevention and the future. The result showed a similar perception of the disease and was described as terrible, causing a lot of suffering for the patient, as well as a burden on the health care, that requires large financial resources. To control dengue and suppress the proliferation it is important to have different preventive means and to educate people to achieve a change of the mindset
"Nothing can be changed if the people donât change" : Costa Rican registered nursesâ views and experiences of caring for patients with dengue fever
Dengue fever has increased to the point where it has become a major international public health and economical problem, mainly in urban and semi-urban areas in tropical and subtropical regions. Worldwide 2,5 billion people live in regions where dengue can be transmitted and approximately 100 million people get infected yearly. In 2002 there was a great outbreak in Latin America, and Costa Rica was in the top three regarding reported cases. At the time of writing, reports show that cases of dengue are currently low in Costa Rica. Although the figures vary, dengue remains a public health problem. This study aimed to describe Costa Rican registered nursesâ views and experiences of caring for patients with dengue fever. Data were collected with semi-structured interviews and conducted with eight registered nurses from Costa Rica, and analysed with qualitative content analysis method with search for similarities and differences which later were categorized. The result was divided into five categories; the conception about dengue fever, caring, patient education, prevention and the future. The result showed a similar perception of the disease and was described as terrible, causing a lot of suffering for the patient, as well as a burden on the health care, that requires large financial resources. To control dengue and suppress the proliferation it is important to have different preventive means and to educate people to achieve a change of the mindset
LÄngvarig och akut smÀrta : hos patienter och boende: en studie genomförd av studenter pÄ sjuksköterskeprogrammet
Syftet med studien var att kartlĂ€gga smĂ€rta och smĂ€rtbehandling hos patienter pĂ„ sjukhus och hos boende i sĂ€rskilt och ordinĂ€rt boende. Metod: Datainsamlingen utfördes av sjuksköterskestudenter under verksamhetsförlagd utbildning pĂ„ sjukhus och i sĂ€rskilt/ordinĂ€rt boende vĂ„ren 2009. Ăven kliniska adjunkter/kliniska lĂ€rare var behjĂ€lpliga vid datainsamlingen. Studenterna fick genom datainsamlingen trĂ€ning i att ge information till personal och patienter/boende, sammanstĂ€lla resultatet frĂ„n enheten, samt att Ă„terrapportera och reflektera över resultaten. Studien genomfördes ej som en totalundersökning, m.a.o. det Ă€r ett urval av respondenter som kommit att ingĂ„ i resultatet.  Resultat: Totalt genomfördes 419 stycken smĂ€rtbedömningar. Av respondenterna uppgav 35% att de hade lĂ„ngvarig smĂ€rta och 14% att de hade akut smĂ€rta. Personer med lĂ„ngvarig smĂ€rta var Ă€ldre (76 Ă„r respektive 69 Ă„r), oftare kvinnor (67% respektive 53%) och bodde i störst utstrĂ€ckning i sĂ€rskilt/ordinĂ€rt boende (37% respektive 17%) Ă€n de med akut smĂ€rta. Respondenterna med akut smĂ€rta angav oftare att personalen frĂ„gade om de hade ont (84% respektive73%) medan personerna med lĂ„ngvarig smĂ€rta i större utstrĂ€ckning angav att de i det lĂ€ngsta försökte lĂ„ta bli att visa att de hade ont (akut smĂ€rta: 43%, respektive lĂ„ngvarig smĂ€rta 59%). De vanligaste strategierna vid akut smĂ€rta var att be om nĂ„got för smĂ€rtan (84%), lĂ€gga sig och vila (78%), eller att försöka tĂ€nka pĂ„ nĂ„got annat (64%). De vanligaste strategierna vid lĂ„ngvarig smĂ€rta var att lĂ€gga sig och vila (83%), be om nĂ„got för smĂ€rtan (73%) eller att försöka tĂ€nka pĂ„ nĂ„got annat (70%). Av de studenter som utvĂ€rderade sin medverkan (n=51) upplevde 74% att de fick bĂ€ttre vetenskaplig förstĂ„else 51% ett ökat intresse för smĂ€rtbedömning och 55% ökade kunskaper om Ă€mnet smĂ€rta.  Konklusion: LĂ„ngvarig smĂ€rta var vanligast förekommande hos kvinnor och bland Ă€ldre personer. Strategierna för hur personer gör personalen uppmĂ€rksam pĂ„ att man har vĂ€rk/smĂ€rta och för hur man hanterar sin smĂ€rta skiljer sig Ă„t beroende pĂ„ om man har akut eller lĂ„ngvarig smĂ€rta. Att delta i datainsamling och andra forskningsaktiviteter har en positiv effekt för sjuksköterskestudenters förstĂ„else av forskning och Ă€ven för deras intresse för omrĂ„det som studeras.The aim of the study was to map out pain and pain treatment among patients in hospitals and persons in special accommodations as well as in ordinary living. Method: Nurse students collected the data during their clinical education at hospitals and in special accommodations or in ordinary living. Also the clinical teachers helped out with supporting the students during data collection. The students made assessments of pain where they had their clinical practice during the spring 2009. The students got, though collecting data, a training in how to provide information to the staff and patients/residents, compile results and to give feed-back about the findings to the department. The study was not conducted as a total survey, in other words was a selection of respondents that were included in the results. Results: In total 419 assessments of pain was made and 35% of respondents reported long standing pain and 14% reported acute pain. The respondents with long standing pain were older (76 years and 69 years respectively), more women (67% and 53% respectively) and more were in special accommodations or in ordinary living (37% and 17% respectively) than among those with acute pain. The respondents with acute pain more often agreed with that the staff asked about if he/she had pain (84% and 73% respective) while the respondents with long standing pain to a greater extent agreed with that they tried to hide their own pain (acute pain: 43% resp. long standing pain: 59%). The most common strategies to handle the pain among those with acute pain was to ask for something to alleviate the pain (84%), lie down and rest (78%) or to try thinking on something else (64%) while it among those with long standing pain was to lie down and rest (83%), ask for something to alleviate the pain (73%) or to try thinking on something else (70%). Of the students that collected the data and reported the findings to the staff 51 also evaluated their participation in the study. Of these, 74% experienced that their understanding for research increased, 51% that their interest för pain assessment had increased and 55% that their knowledge about pain had increased.  Conclusion: Long standing pain was most common among women and elderly persons. The strategies used among the participants for making staff aware about the pain, and the strategies to handle once own pain differed depending on weather the pain was acute or long standing. Participating in the data collection and other research activities has a positive effect for nursing students understanding for research and to some extent for their interest in the area under study