Personers upplevelser av livet efter stroke : En litteraturstudie

Sammanfattning Bakgrund: Stroke är den tredje vanligaste dödsorsaken i Sverige och en av våra största folksjukdomar. Cirka 30 000 personer drabbas årligen av stroke i Sverige. Stroke kan ge upphov till allvarliga konsekvenser som personerna måste leva med. Att kroppsförmågan försämras på grund av stroke är vanligt och leder till att personerna inte klarar av att utföra sina dagliga aktiviteter. Att inte klara av att utföra dessa aktiviteter leder till försämrad livskvalitet för personerna. Det är därför viktigt att sjuksköterskan har en insikt i personernas livsvärld. Syfte: Syftet med studien var att beskriva personers upplevelser av livet efter stroke.  Metod: Metoden som användes var en litteraturstudie bestående av sju stycken artiklar med kvalitativ design. Kvalitetsgranskning gjordes med hjälp av Willman, Stoltz och Bahtsevanis granskningsprotokoll för kvalitativa artiklar. Analys av artiklar genomfördes med Graneheim och Lundmans beskrivning av en innehållsanalys. Resultat: I resultatet framkom tre kategorier samt tre underkategorier. Kategorierna innefattade Konsekvenser av stroke, Relationella och sociala svårigheter och möjligheter och Motivation till ett bättre liv. Underkategorier som utformades var Att förlora sin identitet, Att vara beroende och förlora självständighet samt Att inte orka och vara oviss. Resultatet visade att stroke hade en negativ inverkan på personernas liv och gav dem en försämrad livskvalitet. Personerna kände att de hade förlorat sin identitet till följd av den förlorade förmågan att utföra de aktiviteter som de klarat av att utföra innan de drabbades av en stroke. På grund av handikappen var personerna tvungna att förlita sig på andra, vilket resulterade i en förlorad självständighet. I resultatet framkom även att de personerna som satte upp mål och hade framsteg i sin rehabilitering använde det som motivation till att bli bättre. Slutsats: Denna studie visar att personerna som drabbats av en stroke får en förändrad livsvärld och upplever en försämrad livskvalitet. Det är viktigt att sjuksköterskan får en inblick i personernas livsvärld för att kunna utveckla vården och förbättra situationen för de strokedrabbade personerna

A Binational Influenza Surveillance Network - California/Baja California

In response to the 2009 H1N1 pandemic, the Early Warning Infectious Disease Surveillance Program (EWIDS) from the Office of Binational Border Health California Department of Public Health, sought to strengthen outpatient ILI surveillance along the California/Baja California border region by creating a binational outpatient provider influenza surveillance network. Since the 2009-2010 influenza season the network monitors both syndromic and virologic influenza activity. The network serves as an example of a successful binational coordinated effort to establish an early warning system for enhancing situational awareness of influenza activity in a cross-border setting

A Binational Influenza Surveillance Network - California/Baja California

OBJECTIVE: To enhance cross-border surveillance for Influenza-Like-Illness (ILI) in the California/Baja California (CA/BC) border region through the formation of a border binational surveillance network. INTRODUCTION: In response to the 2009 H1N1 pandemic, the Early Warning Infectious Disease Surveillance Program (EWIDS) Office of Binational Border Health in the California Department of Public Health sought to strengthen outpatient ILI surveillance along the CA/BC border by creating the first binational influenza surveillance network in the region. The establishment of this network was crucial for enhancing cross-border situational awareness of influenza activity, especially in a region characterized by high levels of population mobility. METHODS: During summer of 2009, an assessment of current ILI surveillance activities in the CA/BC border region was conducted. Findings were utilized to guide recruitment efforts and build a cross-border surveillance network. In CA the assessment revealed that sentinel sites in the border region participating in CDC’s ILINet surveillance program were primarily pediatric or school-based clinics and that family practice patients were not equally represented. In BC the need to enhance surveillance among the private sector was identified, particularly among patients belonging to binational healthcare service plans. These plans offer care to US workforce individuals who seek medical care in BC. Other needs identified included the need to enhance surveillance among underserved populations such as farm workers and tribal communities which were not currently being represented. Working together with partners from both sides of the border EWIDS initiated efforts to address identified gaps. Over a three-year period EWIDS recruited private and public sector clinics to participate in the network. RESULTS: As a result of the assessment recruitment efforts were focused on inviting family practice clinics, private clinics, tribal health centers and clinics that provide care to underserved populations to participate in the network. These efforts led to the establishment of the California/Baja California Border Outpatient Provider ILI Surveillance Network, which monitors syndromic and virologic influenza activity. In total EWIDS recruited 22 (13 in CA, 9 in BC) sentinel sites to participate; of these, 17 are family practice sites and 5 are pediatric sites. Additionally, prior to the EWIDS enhancement local tribal health clinics were not represented in the surveillance system. EWIDS efforts resulted in the inclusion of 8 tribal sites in CA and 1 in BC.Figure 1 shows the geographical location of network sites, which includes sites recruited by EWIDS post-assessment as well as preexisting sites. Over the past three influenza seasons (2009–2012) EWIDS recruited sites have constituted 47% of all network sites. Since the 2009–2010 influenza season 483,772 individuals have been screened for ILI by participating sites; of these, 65.8% (n=318,295) were screened by EWIDS recruited sites. Since the establishment of the network EWIDS has focused on sentinel site retention, logistical support, data collection, and dissemination of surveillance results. A weekly report summarizing syndromic and virologic activity is distributed to public health officials throughout the influenza season. CONCLUSIONS: The network serves as an example of a successful binational coordinated effort to establish an early warning system for enhancing situational awareness of influenza activity in a cross-border setting. Next steps include conducting a formal evaluation of the existing surveillance system, enhancing specimen collection for virologic testing, and continuing to foster and build public/private partnerships

Raccoons in San Diego County as Sentinels for West Nile Virus Surveillance

OBJECTIVE: To investigate the potential of utilizing raccoons as sentinels for West Nile Virus (WNV) in an effort to guide public health surveillance, prevention, and control efforts. INTRODUCTION: Since its detection in 1999 in New York, WNV spread westward across the continent, and was first detected in California in 2003 in Imperial County (1). In California and in many states, birds, especially corvids, are used as sentinel animals to detect WNV activity. Recent seroprevalence studies have shown WNV activity in different wild mammalian species (1–3); in the United States, WNV sero-prevalence in some studies in raccoons has ranged from 34–46% (3,4). In addition, it has been shown that after experimental infection, raccoons can attain high viral titers and shed WNV in their saliva and feces (5). Given their peridomestic nature, we investigated the feasibility of their use as sentinels for early warning of WNV and as indicators of WNV activity as a strategy to better localize WNV transmission foci in guiding vector control efforts. METHODS: Sick, injured or orphaned raccoons undergoing rehabilitation at Project Wildlife, one of the largest, non-profit wildlife rehabilitation organizations in the United States, located in San Diego County, were tested for WNV shedding. Project Wildlife team members who regularly care for sick, injured, or orphaned raccoons were trained to collect oral and fecal samples for viral testing during 2011 and 2012 upon raccoons’ arrival to Project Wildlife. Oral and fecal samples were tested using real-time PCR for the envelope gene of WNV. RESULTS: To date 71 raccoons have been tested for WNV and all PCR test results have been negative. Of the 71 raccoons tested from May 2011 to October 2011 and June 2012 to September 2012, 85.9% (n=61) had age classification data. The majority of these raccoons were young; 52.5% (n=32) were days or weeks old and 39.3% (n=24) were classified as juveniles. All raccoons were found primarily in urban settings at least 20 miles from the northern edge of the County. CONCLUSIONS: While none of the raccoon samples tested in this study were found to be WNV positive, surveillance data from San Diego County suggests that WNV activity during this time period was extremely low. From January–October 2011, San Diego County Vector Control reported all negative results for WNV in dead birds, sentinel chickens, horses, and humans for WNV; only 1 mosquito pool from the northern border region of the County tested positive for WNV (6). Thus, despite WNV activity throughout the state of California, the virus did not appear to be circulating widely in San Diego County in 2011 (7). To date during the 2012 season, San Diego County reported all negatives for WNV in dead birds, sentinel chickens, mosquito pools, and horses; only one human case of WNV was identified in an asymptomatic male during a routine blood donation (6). Further evaluation is needed to determine if raccoons are useful sentinel species for WNV surveillance. Testing should continue to evaluate if raccoons may serve as a more effective early warning sentinel for WNV than birds which can travel long distances from the exposure site, and to determine if raccoons may allow better localization of WNV activity

Establishment of a One Health Surveillance Initiative in the CA/Baja CA Border Region

OBJECTIVE: To showcase One Border One Health, a binational, multidiscipli-nary initiative in the California/Baja California (CA/BC) border region whose aim is to reconfigure traditional species-specific approaches to surveillance for emerging and re-emerging pathogens. INTRODUCTION: The CA/BC border region encompasses a wide range of ecosystems, topography, dense urban areas, and agricultural developments that coexist in a limited geographic area and create numerous human-animal-environmental interfaces. The region is recognized for its high biodiversity, the presence of over 85 endangered plant and animal species, its importance on the Pacific migratory pathway, high levels of population mobility, and hosts the busiest international border in the world. These interfaces pose a significant risk to animal, human, and environmental health, as evidenced by frequent wildlife die offs, antibiotic resistant bacteria in streams, beach closures due to fecal contamination, pesticide toxicities, zoonotic infectious disease outbreaks, and vector borne diseases. In the marked absence of any organization comprehensively addressing the health risks posed by these complex interfaces and recognizing that these issues necessitate a binational, cross-sectoral One Health approach, the Early Warning Infectious Disease Surveillance Program (EWIDS) founded One Border One Health (OBOH) in 2011. OBOH recognizes that early warning systems should systematically monitor animal, human, and environmental health and that early detection is key to control. Hence OBOH’s primary aim is to create and integrate early warning surveillance systems that gather data from disparate sources in order to protect and improve animal, human, and environmental health. This information can be used to inform decision makers about important public health events in the CA/BC border region. METHODS: OBOH is a unique multi-disciplinary initiative comprised of over 30 institutions from Mexico and 60 institutions from the United States, with representation from government, academia, non-profit, private and military sectors. Professionals with expertise in public health, veterinary medicine, ecology, biology, urban planning, epidemiology, wildlife health, and environmental health are working in concert rather than in the traditionally isolated human, environmental health, domestic animal and wildlife sectors. OBOH is actively seeking to translate One Health theory into practice through its diverse, binational network. This demonstration presents OBOH’s surveillance, informatics, and education activities, focusing on its strengths, challenges, and future directions. CONCLUSIONS: To the authors’ knowledge this is the first trans-border regional network established to enhance cross border epidemiologic information exchange and surveillance using One Health concepts in North America. Despite the large disparities between health systems, cultures, languages, socioeconomics, politics, animal management strategies, industries and ecosystems in the CA/BC border region, professionals from diverse disciplines are dedicated to OBOH and to the creation of a sustainable integrated surveillance system. OBOH is building the infrastructure for an early warning system in the border region, while improving regional infectious disease surveillance capacity and educating a new cadre of students and professionals about the importance of a One Health approach. Challenges include identifying cross-sectoral/multi-disciplinary funding opportunities to support activities, systematically operationalizing One Health without such funding, identifying and involving partners from different sectors, promoting data exchange, and maintaining an equal understanding of One Health surveillance within the initiative as membership increases. This demonstration provides recommendations on how to initiate and sustain cross-border, multidisciplinary, cross-sectoral surveillance engagements in resource-constrained environments

Raccoons in San Diego County as Sentinels for West Nile Virus Surveillance

The Early Warning Infectious Disease Surveillance Program (EWIDS), County of San Diego Department of Environmental Health, and Project Wildlife are evaluating raccoons as potential early warning sentinel species for West Nile Virus (WNV) surveillance. Research has indicated that raccoons shed WNV through oral and fecal routes, and that this may have important implications for public health and animal health. Raccoons are peridomestic animals; thus they may allow for better localization of WNV activity in communities and may serve as more effective early warning sentinels for WNV than traditional bird sentinels