Artificial Nutrition and Hydration for Persons in a State with Disorders of Consciousness - an Updated Study in Theological Ethics Applied to Three Moral Cases

The Catholic Church has, over the past decade, given clear signals in the official teaching that one should not withdraw the artificial supply of nutrition and hydration from a person in a permanent vegetative state because this is not a medical treatment, but a basic human right. This master thesis considers not only the historical development, but above all the past decade's research, to investigate the advantages that the artificial supply of nutrition and hydration provide, in proportion to the burden placed on the unconscious patients. The thesis reflects on how strictly the Catholic Church's teaching should be interpreted, in light of the moral theological tradition, and the insights of the new findings. Deeper insights into different degrees of consciousness judged to be relevant to the ethical evaluation of three moral cases are of special interest

Vårdpersonalens erfarenheter av att möta äldre med depressiva symtom inom primärvården och äldreomsorgen

Bakgrund: Medellivslängden ökar generellt sett i Sverige. Cirka en tredjedel av personer över 65 år drabbas av psykisk ohälsa, vilket är cirka mer än dubbelt så många än bland yngre personer. Det är lika vanligt att som äldre drabbas av depression som av demens. Trots detta är äldres psykiska hälsa underprioriterad. Inom olika områden i sjukvården, framförallt inom äldreomsorgen och primärvården kommer vårdpersonal att träffa på äldre personer eller patienter med depressiva symtom. Syfte: Syftet var att undersöka vårdpersonalens erfarenhet av att möta äldre personer med depressiva symtom inom äldreomsorgen och primärvården. Metod: En litteraturstudie med kvalitativ studiedesign utfördes. Databaserna CINAHL, PubMed och PsychINFO användes för att hitta de tio vetenskapliga artiklar som låg till grund för resultatet. De vetenskapliga artiklarna kvalitetsgranskades och analyserades utifrån Fribergs femstegsanalys. Resultat: Tre huvudkategorier framkom efter analysen: yrkesrelaterade hinder och förutsättningar för att ge god vård, identifiering, diagnosticering och behandling samt utmaningar med patientgruppen. Yrkesrelaterade hinder för att ge god vård var tidsbrist. Förutsättningar var kunskap medan attityder bland vårdpersonal kunde vara både en förutsättning eller ett hinder. Inom identifiering, diagnosticering och behandling framkom det att informella bedömningsinstrument var mest förekommande och att relation var avgörande för hantering av depressiva symtom hos äldre personer. Utmaningar med patientgruppen i mötet var den äldre generationens inställning till depression och förmåga att uttrycka sig emotionellt. Konklusion: Vårdpersonalens erfarenheter av bra bemötande, diagnostisering och behandling av depression hos äldre personer beskrevs som en bra relation mellan vårdpersonal och patient. Förutsättningar för relationen var tid, kunskap och kontinuitet.Background: The general average life expectancy increases in Sweden and in all EU countries. About one-third of people over the age of 65 suffer from mental illness, which is more than twice as many as among younger people. It is as common for elderly to suffer from depression as from dementia. Despite this, the mental health of elderly is under-prioritized. In various areas of health care, especially in elderly care and primary care, healthcare professionals can expect to encounter elder people or patients with depressive symptoms. Aim: The aim was to explore health personnels’ experience of encountering older people with depressive symptoms within elder care and primary care. Method: A literature review with qualitative design was made. Databases CINAHL, PubMed and PsychINFO was used to find the ten scientific articles that was used for the result. Result: Three themes emerged after the analysis: occupational barriers and prerequisites for providing good care, identification, diagnosis and treatment and challenges with the patient group. Occupational barriers for providing good care was not enough time. Prerequisites was knowledge and attitudes among health personnel could be both a barrier and a prerequisite. Within identification, diagnosis and treatment, it was found that informal assessment instruments were most prevalent and that the relationship was crucial for the management of depressive symptoms in elderly. Challenges with the patientgroup in the encounter were the elder generations’ attitudes towards depression and the ability to express themselves emotionally. Conclusion: Health personnels’ experience of good personal treatment, diagnosis and treatment of depression in elderly was described as a good relationship between health personnel and patient. Prerequisites for the relationship was time, knowledge and continuity

Vårdpersonalens erfarenheter av att möta äldre med depressiva symtom inom primärvården och äldreomsorgen

Bakgrund: Medellivslängden ökar generellt sett i Sverige. Cirka en tredjedel av personer över 65 år drabbas av psykisk ohälsa, vilket är cirka mer än dubbelt så många än bland yngre personer. Det är lika vanligt att som äldre drabbas av depression som av demens. Trots detta är äldres psykiska hälsa underprioriterad. Inom olika områden i sjukvården, framförallt inom äldreomsorgen och primärvården kommer vårdpersonal att träffa på äldre personer eller patienter med depressiva symtom. Syfte: Syftet var att undersöka vårdpersonalens erfarenhet av att möta äldre personer med depressiva symtom inom äldreomsorgen och primärvården. Metod: En litteraturstudie med kvalitativ studiedesign utfördes. Databaserna CINAHL, PubMed och PsychINFO användes för att hitta de tio vetenskapliga artiklar som låg till grund för resultatet. De vetenskapliga artiklarna kvalitetsgranskades och analyserades utifrån Fribergs femstegsanalys. Resultat: Tre huvudkategorier framkom efter analysen: yrkesrelaterade hinder och förutsättningar för att ge god vård, identifiering, diagnosticering och behandling samt utmaningar med patientgruppen. Yrkesrelaterade hinder för att ge god vård var tidsbrist. Förutsättningar var kunskap medan attityder bland vårdpersonal kunde vara både en förutsättning eller ett hinder. Inom identifiering, diagnosticering och behandling framkom det att informella bedömningsinstrument var mest förekommande och att relation var avgörande för hantering av depressiva symtom hos äldre personer. Utmaningar med patientgruppen i mötet var den äldre generationens inställning till depression och förmåga att uttrycka sig emotionellt. Konklusion: Vårdpersonalens erfarenheter av bra bemötande, diagnostisering och behandling av depression hos äldre personer beskrevs som en bra relation mellan vårdpersonal och patient. Förutsättningar för relationen var tid, kunskap och kontinuitet.Background: The general average life expectancy increases in Sweden and in all EU countries. About one-third of people over the age of 65 suffer from mental illness, which is more than twice as many as among younger people. It is as common for elderly to suffer from depression as from dementia. Despite this, the mental health of elderly is under-prioritized. In various areas of health care, especially in elderly care and primary care, healthcare professionals can expect to encounter elder people or patients with depressive symptoms. Aim: The aim was to explore health personnels’ experience of encountering older people with depressive symptoms within elder care and primary care. Method: A literature review with qualitative design was made. Databases CINAHL, PubMed and PsychINFO was used to find the ten scientific articles that was used for the result. Result: Three themes emerged after the analysis: occupational barriers and prerequisites for providing good care, identification, diagnosis and treatment and challenges with the patient group. Occupational barriers for providing good care was not enough time. Prerequisites was knowledge and attitudes among health personnel could be both a barrier and a prerequisite. Within identification, diagnosis and treatment, it was found that informal assessment instruments were most prevalent and that the relationship was crucial for the management of depressive symptoms in elderly. Challenges with the patientgroup in the encounter were the elder generations’ attitudes towards depression and the ability to express themselves emotionally. Conclusion: Health personnels’ experience of good personal treatment, diagnosis and treatment of depression in elderly was described as a good relationship between health personnel and patient. Prerequisites for the relationship was time, knowledge and continuity

Lake productivity and water chemistry as governors of the uptake of persistent pollutants in fish

Factors influencing uptake and levels of persistent pollutants (PCBs, p,p'-DDE) were investigated in 341 northern pike from 61 lakes in southern Scandinavia. Although the inflow of pollutants from the atmosphere was similar throughout the area studied, large differences in levels of PCBs and DDE in predatory fish were found between lakes. The factors primarily responsible for this variation appeared to be lake trophic status and content of humic substances. Levels of persistent pollutants in the fish decreased as productivity increased. Contents of total phosphorus and chlorophyll alpha and lake water transparency (mainly influenced by phytoplankton biomass) were used as productivity indicators. The reasons for the lower levels of pollutants in fish in lakes of increasing productivity were higher growth rate of pike and higher turnover time and sedimentation of particles (phytoplankton) to which the pollutants are adsorbed. Levels of persistent pollutants decreased as the amount of humic substances (water color) increased, apparently because humus adsorbs persistent pollutants, rendering them less available for uptake in fish. The results show that it should be possible to predict levels of persistent pollutants in fish, based on the productivity and chemical properties of the lake

Multiple techniques for lake restoration

Lake Finjasjön is a shallow, eutrophic lake (area 1100 ha, mean depth 3 m, maximum depth 13 m) in southern Sweden. In the 1920s, the lake was clear, with a summer Secci depth of about 2 m. During the first half of the 20th century, untreated sewage from the town polluted the lake. In the 1930s, the lake began to show eutrophic characteristics, and in the 1940s, the cyanobacterium Gloetrichia echinulata dominated in summer. In 1949, the first municipal sewage treatment plant was built. The treatment was, however, insufficient, since the lake continued to be the recipient of the effluent with the result that the occurrence of cyanobacteria became more frequent. Species such as Microcystis and Anabaena caused skin rash and allergic symptoms among swimmers. The phosphorus load on Lake Finjasjön increased as the population of Hässleholm grew and reached a peak value of 65 tons annum1 in 1965. In 1977, the sewage plant was rebuilt to include chemical flocculation, reducing the total external phosphorus load to about 5 tons annum1. Despite this improvement the lake did not recover from its chronic and toxic cyanobacterial blooms. Phosphorus-leaking black sediments were identified as the cause of the lake’s failure to recover. Some 60 % of lakebed area is covered with sediments on average 3 m thick. Dredging the sediments was started on a large scale in 1987. Five years later, 25 % of the sediment area had been removed but the dredging was stopped since phosphorus continued to be released into the water from these areas. In 1992