Mammors upplevelser av att avsluta eller komplettera amningen innan barnet är sex månader

Amningsfrekvensen i Sverige är sjunkande och den sjunker i takt med barnets ålder. Rekommendationerna från WHO är att helamma sitt barn i sex månader. Syftet med studien var att få en djupare förståelse för hur mammor upplever att inte helamma sitt barn i sex månader. En kvalitativ intervjustudie har genomförts med 12 mammor. En kvalitativ innehållsanalys tillämpades för att analysera materialet. Resultatet indikerade att amningsfrågan framkallade många känslor och var tätt förknippad med mammornas upplevelser av sitt moderskap. Mammorna hade en stark önskan att kunna amma. Att inte kunna amma medförde dåligt samvete och dessa känslor fanns kvar även efter avslutad amning. Mammorna i studien uttryckte osäkerhet då de inte hade kontroll över mängden bröstmjölk som barnet fick i sig. Bekräftelse och stöd var betydelsefulla delar i amningsprocessen. Slutsatsen är att de ammande mammorna efterlyser ett inkännande förhållningssätt vid amningsrådgivning och att amningsrådgivaren har förståelse för känsligheten kring amning. Det föreligger ett stort behov av stöd och bekräftelse hos mammorna

Immune mechanisms in the different phases of acute tubular necrosis

Acute kidney injury is a clinical syndrome that can be caused by numerous diseases including acute tubular necrosis (ATN). ATN evolves in several phases, all of which are accompanied by different immune mechanisms as an integral component of the disease process. In the early injury phase, regulated necrosis, damage-associated molecular patterns, danger sensing, and neutrophil-driven sterile inflammation enhance each other and contribute to the crescendo of necroinflammation and tissue injury. In the late injury phase, renal dysfunction becomes clinically apparent, and M1 macrophage-driven sterile inflammation contributes to ongoing necroinflammation and renal dysfunction. In the recovery phase, M2-macrophages and anti-inflammatory mediators counteract the inflammatory process, and compensatory remnant nephron and cell hypertrophy promote an early functional recovery of renal function, while some tubules are still badly injured and necrotic material is removed by phagocytes. The resolution of inflammation is required to promote the intrinsic regenerative capacity of tubules to replace at least some of the necrotic cells. Several immune mechanisms support this wound-healing-like re-epithelialization process. Similar to wound healing, this response is associated with mesenchymal healing, with a profound immune cell contribution in terms of collagen production and secretion of pro-fibrotic mediators. These and numerous other factors determine whether, in the chronic phase, persistent loss of nephrons and hyperfunction of remnant nephrons will result in stable renal function or progress to decline of renal function such as progressive chronic kidney disease

Comparable cellular and humoral immunity upon homologous and heterologous COVID-19 vaccination regimens in kidney transplant recipients

BackgroundKidney transplant recipients (KTRs) are at high risk for a severe course of coronavirus disease 2019 (COVID-19); thus, effective vaccination is critical. However, the achievement of protective immunogenicity is hampered by immunosuppressive therapies. We assessed cellular and humoral immunity and breakthrough infection rates in KTRs vaccinated with homologous and heterologous COVID-19 vaccination regimens.MethodWe performed a comparative in-depth analysis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–specific T-cell responses using multiplex Fluorospot assays and SARS-CoV-2-specific neutralizing antibodies (NAbs) between three-times homologously (n = 18) and heterologously (n = 8) vaccinated KTRs.ResultsWe detected SARS-CoV-2-reactive T cells in 100% of KTRs upon third vaccination, with comparable frequencies, T-cell expression profiles, and relative interferon γ and interleukin 2 production per single cell between homologously and heterologously vaccinated KTRs. SARS-CoV-2-specific NAb positivity rates were significantly higher in heterologously (87.5%) compared to homologously vaccinated (50.0%) KTRs (P < 0.0001), whereas the magnitudes of NAb titers were comparable between both subcohorts after third vaccination. SARS-CoV-2 breakthrough infections occurred in equal numbers in homologously (38.9%) and heterologously (37.5%) vaccinated KTRs with mild-to-moderate courses of COVID-19.ConclusionOur data support a more comprehensive assessment of not only humoral but also cellular SARS-CoV-2-specific immunity in KTRs to provide an in-depth understanding about the COVID-19 vaccine–induced immune response in a transplant setting

Kulturellt inlärda och överförda värderingar, normer och synsätt relaterat till fysisk smärta

Pain and pain treatment constitute a huge part of the general nurses work. For that reason the nurse is required to have great knowledge about this area. The fact that our society is getting more multicultural increase the nurses demands even more, to understand and treat pain in patients of foreign cultural background. The aim of this literature review is to examine which culturally learned and trans-ferred valuations, norms and approaches that appear related to physical pain. The aim is also to examine the most appropriate ways for the nurse to show respect and to get more information about this cultural experience in the encounter with the patient. A critical review of ten scientific articles emerged in four themes: Cultural expressions in pain, Cultural interpretations in pain, Cultural coping-strategies in pain and Cultural approaches in the care of pain. Further three course of action emerged in what way the nurse ought to conduct to get information about this cultural experience: Be a good and keen listener, Respect the patients opinions and values and Develop a relation grounded on trust with the patient. The nurse can apply the result in her nursing care of pain patients of foreign cultural background.Smärta och smärtbehandling utgör en stor del av allmänsjuksköterskans arbete. Det krävs därför goda kunskaper av sjuksköterska inom detta område. Att vårt samhälle dessutom blir allt mer mångkulturellt ökar kraven på sjuksköterskan ännu mer, för att kunna förstå och behandla smärta hos patienter med annan kulturell bakgrund. Syftet med föreliggande litteraturstudie är att undersöka vilka kulturellt inlärda och överförda värderingar, normer och synsätt som kan ses relaterat till fysisk smärta. Samt undersöka på vilket sätt sjuksköterskan bör förhålla sig för att re-spektera och få mer information om kulturella erfarenheter i mötet med patienten. Genom kritisk granskning av tio vetenskapliga artiklar framkom fyra teman: Kulturbundna uttryck vid smärta, Kulturbundna tolkningar av smärtans betydelse, Kulturbundna coping-strategier vid smärta och Kulturbundna synsätt vid smärta. Vidare framkom tre tillvägagångssätt på hur sjuksköterskan bör förhålla sig för att respektera och få mer information om dessa kulturella erfarenheter: Vara en god och lyhörd lyssnare, respektera patientens åsikter och värderingar och utveckla en relation byggd på trygghet med patienten. Resultatet kan tillämpas av sjuksköterskan i omvårdnaden av smärt patienter från främmande kulturer

Kulturellt inlärda och överförda värderingar, normer och synsätt relaterat till fysisk smärta

Pain and pain treatment constitute a huge part of the general nurses work. For that reason the nurse is required to have great knowledge about this area. The fact that our society is getting more multicultural increase the nurses demands even more, to understand and treat pain in patients of foreign cultural background. The aim of this literature review is to examine which culturally learned and trans-ferred valuations, norms and approaches that appear related to physical pain. The aim is also to examine the most appropriate ways for the nurse to show respect and to get more information about this cultural experience in the encounter with the patient. A critical review of ten scientific articles emerged in four themes: Cultural expressions in pain, Cultural interpretations in pain, Cultural coping-strategies in pain and Cultural approaches in the care of pain. Further three course of action emerged in what way the nurse ought to conduct to get information about this cultural experience: Be a good and keen listener, Respect the patients opinions and values and Develop a relation grounded on trust with the patient. The nurse can apply the result in her nursing care of pain patients of foreign cultural background.Smärta och smärtbehandling utgör en stor del av allmänsjuksköterskans arbete. Det krävs därför goda kunskaper av sjuksköterska inom detta område. Att vårt samhälle dessutom blir allt mer mångkulturellt ökar kraven på sjuksköterskan ännu mer, för att kunna förstå och behandla smärta hos patienter med annan kulturell bakgrund. Syftet med föreliggande litteraturstudie är att undersöka vilka kulturellt inlärda och överförda värderingar, normer och synsätt som kan ses relaterat till fysisk smärta. Samt undersöka på vilket sätt sjuksköterskan bör förhålla sig för att re-spektera och få mer information om kulturella erfarenheter i mötet med patienten. Genom kritisk granskning av tio vetenskapliga artiklar framkom fyra teman: Kulturbundna uttryck vid smärta, Kulturbundna tolkningar av smärtans betydelse, Kulturbundna coping-strategier vid smärta och Kulturbundna synsätt vid smärta. Vidare framkom tre tillvägagångssätt på hur sjuksköterskan bör förhålla sig för att respektera och få mer information om dessa kulturella erfarenheter: Vara en god och lyhörd lyssnare, respektera patientens åsikter och värderingar och utveckla en relation byggd på trygghet med patienten. Resultatet kan tillämpas av sjuksköterskan i omvårdnaden av smärt patienter från främmande kulturer

Improved SARS-CoV-2 Neutralization of Delta and Omicron BA.1 Variants of Concern after Fourth Vaccination in Hemodialysis Patients

Hemodialysis patients are exposed to a markedly increased risk when infected with SARS-CoV-2. To date, it is unclear if hemodialysis patients benefit from four vaccinations. A total of 142 hemodialysis patients received four COVID-19 vaccinations until March 2022. RDB binding antibody titers were determined in a competitive surrogate neutralization assay. Vero-E6 cells were infected with SARS-CoV-2 variants of concern (VoC), Delta (B.1.617.2), or Omicron (B.1.1.529, sub-lineage BA.1) to determine serum infection neutralization capacity. Four weeks after the fourth vaccination, serum infection neutralization capacity significantly increased from a 50% inhibitory concentration (IC50, serum dilution factor 1:x) of 247.0 (46.3–1560.8) to 2560.0 (1174.0–2560.0) for the Delta VoC, and from 37.5 (20.0–198.8) to 668.5 (182.2–2560.0) for the Omicron VoC (each p p p = 0.051). Our findings suggest that hemodialysis patients benefit from a fourth vaccination in particular in the light of the highly infectious SARS-CoV-2 Omicron-variants. A routinely applied four-time vaccination seems to broaden immunity against variants and would be recommended in hemodialysis patients

Locating medical information during an infodemic: information seeking behavior and strategies of health-care workers in Germany

Background: The COVID-19 pandemic has led to a flood of — often contradictory — evidence. HCWs had to develop strategies to locate information that supported their work. We investigated the information-seeking of different HCW groups in Germany. Methods: In December 2020, we conducted online surveys on COVID-19 information sources, strategies, assigned trustworthiness, and barriers — and in February 2021, on COVID-19 vaccination information sources. Results were analyzed descriptively; group comparisons were performed using χ$^2$-tests. Results: For general COVID-19-related medical information (413 participants), non-physicians most often selected official websites (57%), TV (57%), and e-mail/newsletters (46%) as preferred information sources — physicians chose official websites (63%), e-mail/newsletters (56%), and professional journals (55%). Non-physician HCWs used Facebook/YouTube more frequently. The main barriers were insufficient time and access issues. Non-physicians chose abstracts (66%), videos (45%), and webinars (40%) as preferred information strategy; physicians: overviews with algorithms (66%), abstracts (62%), webinars (48%). Information seeking on COVID-19 vaccination (2700 participants) was quite similar, however, with newspapers being more often used by non-physicians (63%) vs. physician HCWs (70%). Conclusion: Non-physician HCWs more often consulted public information sources. Employers/institutions should ensure the supply of professional, targeted COVID-19 information for different HCW groups

Impact of original, B.1.1.7, and B.1.351/P.1 SARS-CoV-2 lineages on vaccine effectiveness of two doses of COVID-19 mRNA vaccines: Results from a nationwide case-control study in France

International audienceBackgroundWe aimed to assess the effectiveness of two doses of mRNA COVID-19 vaccines against COVID-19 with the original virus and other lineages circulating in France.MethodsIn this nationwide case-control study, cases were SARS-CoV-2 infected adults with onset of symptoms between 14 February and 3 May 2021. Controls were non-infected adults from a national representative panel matched to cases by age, sex, region, population density and calendar week. Participants completed an online questionnaire on recent activity-related exposures and vaccination history. Information about the infecting virus was based on a screening RT-PCR for either B.1.1.7 or B.1.351/P.1 variants.FindingsIncluded in our analysis were 7 288 adults infected with the original SARS-CoV-2 virus, 31 313 with the B.1.1.7 lineage, 2 550 with B.1.351/P1 lineages, and 3 644 controls. In multivariable analysis, the vaccine effectiveness (95% confidence interval) seven days after the second dose of mRNA vaccine was estimated at 88% (81-92), 86% (81-90) and 77% (63-86) against COVID-19 with the original virus, the B.1.1.7 lineage, and the B.1.351/P.1 lineages, respectively. Recent (2 to 6 months) history of virologically confirmed SARS-CoV-2 infection was found to be 83% (76-88), 88% (85-91) and 83% (71-90) protective against COVID-19 with the original virus, the B.1.1.7 lineage, and the B.1.351/P.1 lineages, respectively; and more distant (> 6 months) infections were 76% (54-87), 84% (75-90), and 74% (41-89) protective against COVID-19 with the original virus, the B.1.1.7 lineage, and the B.1.351/P.1 lineages, respectively.InterpretationIn real-life settings, two doses of mRNA vaccines proved to be effective against COVID-19 with the original virus, B.1.1.7 lineage and B.1.351/P.1 lineages

DataSheet_2_Comparable cellular and humoral immunity upon homologous and heterologous COVID-19 vaccination regimens in kidney transplant recipients.pdf

BackgroundKidney transplant recipients (KTRs) are at high risk for a severe course of coronavirus disease 2019 (COVID-19); thus, effective vaccination is critical. However, the achievement of protective immunogenicity is hampered by immunosuppressive therapies. We assessed cellular and humoral immunity and breakthrough infection rates in KTRs vaccinated with homologous and heterologous COVID-19 vaccination regimens.MethodWe performed a comparative in-depth analysis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–specific T-cell responses using multiplex Fluorospot assays and SARS-CoV-2-specific neutralizing antibodies (NAbs) between three-times homologously (n = 18) and heterologously (n = 8) vaccinated KTRs.ResultsWe detected SARS-CoV-2-reactive T cells in 100% of KTRs upon third vaccination, with comparable frequencies, T-cell expression profiles, and relative interferon γ and interleukin 2 production per single cell between homologously and heterologously vaccinated KTRs. SARS-CoV-2-specific NAb positivity rates were significantly higher in heterologously (87.5%) compared to homologously vaccinated (50.0%) KTRs (P ConclusionOur data support a more comprehensive assessment of not only humoral but also cellular SARS-CoV-2-specific immunity in KTRs to provide an in-depth understanding about the COVID-19 vaccine–induced immune response in a transplant setting.</p

DataSheet_3_Comparable cellular and humoral immunity upon homologous and heterologous COVID-19 vaccination regimens in kidney transplant recipients.pdf

BackgroundKidney transplant recipients (KTRs) are at high risk for a severe course of coronavirus disease 2019 (COVID-19); thus, effective vaccination is critical. However, the achievement of protective immunogenicity is hampered by immunosuppressive therapies. We assessed cellular and humoral immunity and breakthrough infection rates in KTRs vaccinated with homologous and heterologous COVID-19 vaccination regimens.MethodWe performed a comparative in-depth analysis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–specific T-cell responses using multiplex Fluorospot assays and SARS-CoV-2-specific neutralizing antibodies (NAbs) between three-times homologously (n = 18) and heterologously (n = 8) vaccinated KTRs.ResultsWe detected SARS-CoV-2-reactive T cells in 100% of KTRs upon third vaccination, with comparable frequencies, T-cell expression profiles, and relative interferon γ and interleukin 2 production per single cell between homologously and heterologously vaccinated KTRs. SARS-CoV-2-specific NAb positivity rates were significantly higher in heterologously (87.5%) compared to homologously vaccinated (50.0%) KTRs (P ConclusionOur data support a more comprehensive assessment of not only humoral but also cellular SARS-CoV-2-specific immunity in KTRs to provide an in-depth understanding about the COVID-19 vaccine–induced immune response in a transplant setting.</p