Distriktssköterskans möjligheter och begränsningar att arbeta hälsofrämjande i primärvården : En systematisk litteraturstudie

Introduktion: Som distriktssköterska ska man främja och arbeta för en jämlik hälsa. I primärvården har distriktssköterskan många arbetsuppgifter och det gäller att finna balans mellan hälsofrämjande och medicinska uppgifter. Syfte: Syftet var att belysa möjligheter och begränsningar för distriktssköterskan i det hälsofrämjande arbetet i primärvården. Metod: Metoden var en systematisk litteraturstudie. Studien har baserats på tolv kvalitativa artiklar. Databaserna Cinahl och PubMed användes vid sökning. Artiklarna bearbetades enligt kvalitativ innehållsanalys. Resultat: Resultatet mynnade ut i tre teman: Första temat var Organisatoriska förutsättningar med kategorierna Brist på resurser, Brist på stöd och Riktlinjer & verktyg. Andra temat var Personcentrerad vård med kategorierna Relationsskapande, Kulturella aspekter och Patientens attityd. Tredje temat var Sjuksköterskans syn på sin roll med kategorierna Känna ansvar, Hålla sig uppdaterad, Tillfredsställelse och Sjuksköterskans attityd. Konklusion: Resultatet visade att sjuksköterskorna kände ett stort ansvar och vilja att arbeta hälsofrämjande. De främsta begränsande faktorerna var hög arbetsbelastning och tidsbrist. Sjuksköterskorna behövde stöd från ledningen för att bibehålla motivationen att ta sig an de faktorer som skapade barriärer i det hälsofrämjande arbetet

Method Development for Determining the Stability of Heat Stable Proteins Combined with Biophysical Characterization of Human Calmodulin and the Disease Associated Variant D130G

Calmodulin is a highly conserved calcium ion binding protein expressed in all eukaryotic species. The 149 amino acid residues in the primary structure are organized in seven α helices with the highly flexible central α helix connecting the two non-cooperative domains of calmodulin. Each domain contains two EF-hand motifs to which calcium ions bind in a cooperative manner, hence the binding of four calcium ions saturate one calmodulin molecule. In the cardiovascular area calmodulin is involved in the activation of cardiac muscle contraction, and mutations that arise in the genetic sequence of the protein often have severe consequences. One such consequential mutation that can arise brings about the replacement of the highly conserved aspartic acid with glycine at position 130 in the amino acid sequence. In this research, the thermal and chemical stability within the C domain of the D130G variant of human calmodulin was investigated using a new method only requiring circular dichroism spectroscopic measurements. Affinity studies within the C domain of the D130G variant of human calmodulin were performed using fluorescence spectroscopy, and the ligands chosen for this purpose were trifluoperazine and p- HTMI. All analytical experiments were performed with the C domain of wild type human calmodulin as a reference. From the new method, it was concluded that the C domain of the D130G variant of human calmodulin has a slightly decreased stability in terms of Tm and Cm values compared to the C domain of wild type human calmodulin. The affinity analyses indicated that neither trifluoperazine nor p-HTMI discriminates between the C domain of the D130G variant of human calmodulin and the C domain of wild type human calmodulin in terms of dissociation constants. The pivotal outcome from this research is that the new method is applicable for determination of the stability parameters Tm and Cm of heat stable proteins.

Low to moderate lifetime alcohol consumption is associated with less advanced stages of fibrosis in non-alcoholic fatty liver disease

Background and aim: Moderate alcohol consumption has been associated with a lower risk of disease severity in non-alcoholic fatty liver disease (NAFLD). It is unclear if this reflects current or lifetime drinking, or can be attributed to confounders such as diet and exercise. We evaluated the impact of lifetime alcohol consumption on fibrosis severity in NAFLD. Methods: We prospectively enrolled 120 subjects with biopsy-proven NAFLD and through detailed questionnaires examined lifetime alcohol consumption, diet and physical activity. Main outcome measures were odds ratios (OR) for fibrosis stage, calculated through ordinal regression after adjustment for body mass index, diabetes mellitus type 2, smoking and age at biopsy. A biomarker for recent alcohol consumption, phosphatidyl ethanol (PEth) was sampled. Results: An increase in median weekly alcohol consumption to a maximum of 13 drinks per week was associated with lower fibrosis stage (adjusted OR for each incremental unit, 0.86; 95% CI, 0.76-0.97; p = .017). The lowest risk for fibrosis was found with the lowest odds seen in the top quartile of alcohol consumption (aOR 0.23; 95% CI 0.08-0.66; p = .006). Adding soft drink and coffee consumptions, and physical activity to the model did not change the estimates. Subjects with PEth amp;gt;= 0.3 mu mol/L had higher ORs for a higher fibrosis stage (aOR 2.77; 95% CI 1.01-7.59; p = .047). Conclusion: Lifetime alcohol consumption with up to 13 units per week is associated with lower fibrosis stage in NAFLD. Elevated PEth is associated with higher stages of fibrosis.Funding Agencies|Stockholm County Council (ALF) [20140329, 20150403]; Royal Swedish Academy of Sciences Foundations [ME2015-0011]; Swedish Society of Medicine (Gastroenterology Fund); Ruth and Richard Julins Fund; ALF [2015403]</p