Vårdpersonalens kompetens inom familjecentrerad vård på NeoIVA - ett föräldraperspektiv. En kvalitativ intervjustudie

Föräldrarna till barn som vårdas på en neonatal intensivvårdsavdelning är en nödvändig del av teamet kring sitt barn. För att kunna utveckla en lyhördhet för familjernas behov och bli goda stödjare sågs behovet av studier som belyste föräldrars upplevelser. Syftet var att belysa föräldrars upplevelser av kompetens hos vårdpersonalen på en NeoIVA avseende familjecentrerad vård, och hur den upplevda kompetensen påverkade föräldrarnas välbefinnande under barnets vårdtid. Öppna intervjuer med intervjuområden som stöd genomfördes med 7 föräldrapar. Hermeneutisk-fenomenologisk tolkning gav 5 teman: Bekräftande bemötande genom vägledning och finkänslighet; Delaktighet genom känslighet eller okänslighet; Information och kommunikation vid rätt tidpunkt och med ömsesidig förståelse; Professionellt individualiserat engagemang specifikt för varje föräldrapar och lika för alla samt; Ansvar ges villkorligt eller ovillkorligt. Utöver tryggheten i vården handlade den viktigaste kompetensen om ett bekräftande bemötande

Efficacy of baby-CIMT: study protocol for a randomised controlled trial on infants below age 12 months, with clinical signs of unilateral CP

BACKGROUND: Infants with unilateral brain lesions are at high risk of developing unilateral cerebral palsy (CP). Given the great plasticity of the young brain, possible interventions for infants at risk of unilateral CP deserve exploration. Constraint-induced movement therapy (CIMT) is known to be effective for older children with unilateral CP but is not systematically used for infants. The development of CIMT for infants (baby-CIMT) is described here, as is the methodology of an RCT comparing the effects on manual ability development of baby-CIMT versus baby-massage. The main hypothesis is that infants receiving baby-CIMT will develop manual ability in the involved hand faster than will infants receiving baby-massage in the first year of life. METHOD AND DESIGN: The study will be a randomised, controlled, prospective parallel-group trial. Invited infants will be to be randomised to either the baby-CIMT or the baby-massage group if they: 1) are at risk of developing unilateral CP due to a known neonatal event affecting the brain or 2) have been referred to Astrid Lindgren Children’s Hospital due to asymmetric hand function. The inclusion criteria are age 3–8 months and established asymmetric hand use. Infants in both groups will receive two 6-weeks training periods separated by a 6-week pause, for 12 weeks in total of treatment. The primary outcome measure will be the new Hand Assessment for Infants (HAI) for evaluating manual ability. In addition, the Parenting Sense of Competence scale and Alberta Infant Motor Scale will be used. Clinical neuroimaging will be utilized to characterise the brain lesion type. To compare outcomes between treatment groups generalised linear models will be used. DISCUSSION: The model of early intensive intervention for hand function, baby-CIMT evaluated by the Hand Assessment for Infants (HAI) will have the potential to significantly increase our understanding of how early intervention of upper limb function in infants at risk of developing unilateral CP can be performed and measured. TRIAL REGISTRATION: SFO-V4072/2012, 05/22/201

Taking Health Information Behaviour into Account in the design of e-health services

The aim of this article is to bring forward the benefits of a better integration of a comprehensive understanding of individuals’ information behaviour in the design and development of e-health services. This study is a descriptive review based on a non-exhaustive selection of literature that describes the state-of-the-art, problems and opportunities identified in e-health, health information behaviour and health information literacy research. By focusing on how to tailor the information provided and the technological devices to fit the information behaviour, the approach has also potential to uncover new insights into how to adequately implement and integrate ICTs into everyday life practices of other hard-to-reach groups in society. We presuppose that it will be possible to give practical recommendations based on a combined understanding of individual differences in health information behaviour and users’ expectations and experiences, acquired through empirical studies focusing on older adults. Moreover, the usefulness of health information literacy as an indicator of the patterns and competences related to health information behaviour is highlighted

Communicating diabetes and diets on Twitter – a semantic content analysis

This paper analyses: 1) the semantic content of tweets discussing diabetes and diets: 2) the conversational connections of those tweeting and those being mentioned in the tweets. The content analysis of the tweets aims at mapping what kinds of diets are mentioned in conversations about diabetes and in what context. Our data consists of 9,042 tweets containing the words &lsquo;diabetes&rsquo; and &lsquo;diet&rsquo;. The findings indicate that analysing Twitter conversations can be a fruitful and an efficient way to map public opinions about diabetes and diets, as well as other medical issues that concern many people. The results also showed that many private persons act as diabetes advocates spreading information and news about diabetes and diets. Surveying these topics can be useful for healthcare practitioners; as these are in contact with patients with diabetes, it is important that they are aware of both the most discussed topics and the most common information sources, who are often laymen.</div

In vivo toxicity of cationic micelles and liposomes

AbstractThis study investigated toxicity of nanocarriers comprised of cationic polymer and lipid components often used in gene and drug delivery, formulated as cationic micelles and liposomes. Rats were injected intravenously with 10, 25 or 100mg/kg and sacrificed after 24 or 48h, or 24h after the last of three intravenous injections of 100mg/kg every other day. Histological evaluation of liver, lung and spleen, clinical chemistry parameters, and hematology indicated little effect of treatment. DNA strand breaks were increased in the lung and spleen. Further, in the dose response study we found unaltered expression levels of genes in the antioxidant response (HMOX1) and repair of oxidized nucleobases (OGG1), whereas expression levels of cytokines (IL6, CXCL2 and CCL2) were elevated in lung, spleen or liver. The results indicate that assessment of genotoxicity and gene expression add information on toxicity of nanocarriers, which is not obtained by histology and hematology.From the Clinical EditorThis study investigates the toxicity of cationic micelles and liposomes utilized as nanocarriers in gene and drug delivery, demonstrating its effects on the lungs, spleen and liver

Is flood defense changing in nature? Shifts in the flood defense strategy in six European countries

In many countries, flood defense has historically formed the core of flood risk management but this strategy is now evolving with the changing approach to risk management. This paper focuses on the neglected analysis of institutional changes within the flood defense strategies formulated and implemented in six European countries (Belgium, England, France, the Netherlands, Poland, and Sweden). The evolutions within the defense strategy over the last 30 years have been analyzed with the help of three mainstream institutional theories: a policy dynamics-oriented framework, a structure-oriented institutional theory on path dependency, and a policy actors-oriented analysis called the advocacy coalitions framework. We characterize the stability and evolution of the trends that affect the defense strategy in the six countries through four dimensions of a policy arrangement approach: actors, rules, resources, and discourses. We ask whether the strategy itself is changing radically, i.e., toward a discontinuous situation, and whether the processes of change are more incremental or radical. Our findings indicate that in the European countries studied, the position of defense strategy is continuous, as the classical role of flood defense remains dominant. With changing approaches to risk, integrated risk management, climate change, urban growth, participation in governance, and socioeconomic challenges, the flood defense strategy is increasingly under pressure to change. However, these changes can be defined as part of an adaptation of the defense strategy rather than as a real change in the nature of flood risk management

Assessing the legitimacy of flood risk governance arrangements in Europe: insights from intra-country evaluations

Legitimacy has received comparatively less attention than societal resilience in the context of flooding, thus methods for assessing and monitoring the legitimacy of Flood Risk Governance Arrangements (FRGA) are noticeably lacking. This study attempts to address this gap by assessing the legitimacy of FRGAs in six European countries through cross-disciplinary and comparative research methods. On the basis of this assessment, recommendation

CRIM1 is localized to the podocyte filtration slit diaphragm of the adult human kidney

Background. CRIM1 is a plasma membrane bound protein containing six cysteine-rich repeats (CRR). Through these, CRIM1 has been shown to interact with a subgroup of the TGF-β superfamily, the bone morphogenic proteins (BMP) isoforms 2, 4 and 7. The probable action is to modulate the signalling properties of these factors. CRIM1 has also been shown to regulate the release of VEGFA by podocytes during renal organogenesis. Knock-out studies in mice have shown that CRIM1 is critically involved in the development of the central nervous system, eye and kidney. Replacement of CRIM1 with a defective version leads to renal dysgenesis and perinatal death. We have analysed the distribution of CRIM1 in adult human renal tissue

The SV40 Late Protein VP4 Is a Viroporin that Forms Pores to Disrupt Membranes for Viral Release

Nonenveloped viruses are generally released by the timely lysis of the host cell by a poorly understood process. For the nonenveloped virus SV40, virions assemble in the nucleus and then must be released from the host cell without being encapsulated by cellular membranes. This process appears to involve the well-controlled insertion of viral proteins into host cellular membranes rendering them permeable to large molecules. VP4 is a newly identified SV40 gene product that is expressed at late times during the viral life cycle that corresponds to the time of cell lysis. To investigate the role of this late expressed protein in viral release, water-soluble VP4 was expressed and purified as a GST fusion protein from bacteria. Purified VP4 was found to efficiently bind biological membranes and support their disruption. VP4 perforated membranes by directly interacting with the membrane bilayer as demonstrated by flotation assays and the release of fluorescent markers encapsulated into large unilamellar vesicles or liposomes. The central hydrophobic domain of VP4 was essential for membrane binding and disruption. VP4 displayed a preference for membranes comprised of lipids that replicated the composition of the plasma membranes over that of nuclear membranes. Phosphatidylethanolamine, a lipid found at high levels in bacterial membranes, was inhibitory against the membrane perforation activity of VP4. The disruption of membranes by VP4 involved the formation of pores of ∼3 nm inner diameter in mammalian cells including permissive SV40 host cells. Altogether, these results support a central role of VP4 acting as a viroporin in the perforation of cellular membranes to trigger SV40 viral release

Type IV Secretion-Dependent Activation of Host MAP Kinases Induces an Increased Proinflammatory Cytokine Response to Legionella pneumophila

The immune system must discriminate between pathogenic and nonpathogenic microbes in order to initiate an appropriate response. Toll-like receptors (TLRs) detect microbial components common to both pathogenic and nonpathogenic bacteria, whereas Nod-like receptors (NLRs) sense microbial components introduced into the host cytosol by the specialized secretion systems or pore-forming toxins of bacterial pathogens. The host signaling pathways that respond to bacterial secretion systems remain poorly understood. Infection with the pathogen Legionella pneumophila, which utilizes a type IV secretion system (T4SS), induced an increased proinflammatory cytokine response compared to avirulent bacteria in which the T4SS was inactivated. This enhanced response involved NF-κB activation by TLR signaling as well as Nod1 and Nod2 detection of type IV secretion. Furthermore, a TLR- and RIP2-independent pathway leading to p38 and SAPK/JNK MAPK activation was found to play an equally important role in the host response to virulent L. pneumophila. Activation of this MAPK pathway was T4SS-dependent and coordinated with TLR signaling to mount a robust proinflammatory cytokine response to virulent L. pneumophila. These findings define a previously uncharacterized host response to bacterial type IV secretion that activates MAPK signaling and demonstrate that coincident detection of multiple bacterial components enables immune discrimination between virulent and avirulent bacteria