Health care professionals’ caretaking of persons with dementia who use dietary supplements

Persons with dementia experience progressive loss of cognitive functioning and increasing need for help with activities of daily living, including help with administering their prescribed drugs (PD). This thesis describes the use of dietary supplements (DS) (including herbs) by persons with dementia and the risk related to their use, as DS may cause adverse effects. It further describes the awareness of this risk and the attributed responsibility by relevant health care professionals in primary health care. The study methods used were questionnaire-surveys of patients with dementia (n=151), employees in pharmacy (n=105) and home care service (HCS) (n=231), and individual interviews with general practitioners (GPs) (n=14). Forty-six percent of the persons with dementia used DS and 11% had potentially clinically relevant interactions between DS and PD. Only one-third of the patients received help with the administration of their DS. Several of the patients who did not receive help had cognitive decline, indicating a need for such help. Only one-third of the patients with dementia and half of their caretakers knew that DS may impose a health-risk. Half of the general practitioners (GPs) and the employees in home care service (HCS), but few pharmacy employees, expressed that they had been worried about patients’ DS use. One-third of the employees in HCS and two-third of the GPs had intervened because of possibly dangerous use. None of the studied health care professionals attributed the responsibility for the safety of these patients to their own profession. The main reason why the GPs did not want to take on the responsibility was the lack of available information about safety, effect and sometimes even DS-content. Conclusion: DS use are common in patients with dementia and may represent a risk to them, but no group of health care professionals wants to take the responsibility to increase their safety

Variable setpoint as a relaxing component in physiological control

Setpoints in physiology have been a puzzle for decades, and especially the notion of fixed or variable setpoints have received much attention. In this paper, we show how previously presented homeostatic controller motifs, extended with saturable signaling kinetics, can be described as variable setpoint controllers. The benefit of a variable setpoint controller is that an observed change in the concentration of the regulated biochemical species (the controlled variable) is fully characterized, and is not considered a deviation from a fixed setpoint. The variation in this biochemical species originate from variation in the disturbances (the perturbation), and thereby in the biochemical species representing the controller (the manipulated variable). Thus, we define an operational space which is spanned out by the combined high and low levels of the variations in (1) the controlled variable, (2) the manipulated variable, and (3) the perturbation. From this operational space, we investigate whether and how it imposes constraints on the different motif parameters, in order for the motif to represent a mathematical model of the regulatory system. Further analysis of the controller's ability to compensate for disturbances reveals that a variable setpoint represents a relaxing component for the controller, in that the necessary control action is reduced compared to that of a fixed setpoint controller. Such a relaxing component might serve as an important property from an evolutionary point of view. Finally, we illustrate the principles using the renal sodium and aldosterone regulatory system, where we model the variation in plasma sodium as a function of salt intake. We show that the experimentally observed variations in plasma sodium can be interpreted as a variable setpoint regulatory system.publishedVersio

Does Pastoralists' Participation in the Management of National Parks in Northern Norway Contribute to Adaptive Governance?

Norwegian protected areas have historically been managed by central, expertise bureaucracy; however, a governance change in 2010 decentralized and delegated the right to manage protected areas to locally elected politicians and elected Sámi representatives in newly established National Park Boards. We explore how this new governance change affects adaptive capacity within the reindeer industry, as the reindeer herders are now participating with other users in decision-making processes related to large tracts of protected areas in which they have pasture access. Aspects within adaptive capacity and resilience thinking are useful as complementary dimensions to a social-ecological system framework (Ostrom 2007) in exploring the dynamics of complex adaptive social-ecological systems. The National Park Board provides a novel example of adaptive governance that can foster resilient livelihoods for various groups of actors that depend on protected areas. Data for this paper were gathered primarily through observation in National Park Board meetings, focus groups, and qualitative interviews with reindeer herders and other key stakeholders. We have identified certain aspects of the national park governance that may serve as sources of resilience and adaptive capacity for the natural system and pastoral people that rely on using these areas. The regional National Park Board is as such a critical mechanism that provides an action arena for participation and conflict resolution. However, desired outcomes such as coproduction of knowledge, social learning, and increased adaptive capacity within reindeer husbandry have not been actualized at this time. The challenge with limited scope of action in the National Park Board and a mismatch between what is important for the herders and what is addressed in the National Park Board become important for the success of this management model

Large predators and their impact on reindeer husbandry

Several large predators (wolf, lynx, wolverine, brown bear and eagle) are present within the Fennoscandian reindeer herding area, where reindeer are often their main prey. After being more or less eradicated during the 1800s and early 1900s, predators were gradually protected leading to the recovery of all species. Growing populations of predators evidently lead to increased damage to reindeer and reindeer husbandry. In Fennoscandia, the annual loss of reindeer due to predation is probably around 50,000–100,000 animals. Herders get economic compensation for losses. In Finland and Norway, this is based on the number of predator-killed reindeer that are found, while in Sweden the compensation is based on the number of predators (wolf, lynx or wolverine) or area of the herding district (bear and golden eagle). According to national policy, reindeer husbandry should be taken into account in the management of large predators, but often population goals for the predator override the interests of reindeer husbandry. Although reindeer herders acknowledge that predators have a place in the ecosystem, there is frustration about reimbursement not compensating for actual losses, and that herders’ voices are not heard, and their knowledge not recognized, when it comes to predator management

Large predators and their impact on reindeer husbandry

Several large predators (wolf, lynx, wolverine, brown bear and eagle) are present within the Fennoscandian reindeer herding area, where reindeer are often their main prey. After being more or less eradicated during the 1800s and early 1900s, predators were gradually protected leading to the recovery of all species. Growing populations of predators evidently lead to increased damage to reindeer and reindeer husbandry. In Fennoscandia, the annual loss of reindeer due to predation is probably around 50,000–100,000 animals. Herders get economic compensation for losses. In Finland and Norway, this is based on the number of predator-killed reindeer that are found, while in Sweden the compensation is based on the number of predators (wolf, lynx or wolverine) or area of the herding district (bear and golden eagle). According to national policy, reindeer husbandry should be taken into account in the management of large predators, but often population goals for the predator override the interests of reindeer husbandry. Although reindeer herders acknowledge that predators have a place in the ecosystem, there is frustration about reimbursement not compensating for actual losses, and that herders’ voices are not heard, and their knowledge not recognized, when it comes to predator management

Intensivsykepleiers rapport ved overlevering av akutt kritisk syk pasient i vaktskifte. En observasjonsstudie.

Bakgrunn: En pasientoverlevering i vaktskiftet hvor pasientansvaret skiftes fra en intensivsykepleier til en annen, er noe som skjer daglig. Det kan være en sårbar situasjon for pasienten, og en risiko for pasientsikkerheten dersom pasientoverleveringen er mangelfull. Det er derfor viktig at pasientoverleveringen blir utført på en trygg, informativ og sikker måte. Dette bidrar til å sikre kvalitet og kontinuitet i pasientbehandlingen. Hensikt og problemstilling: Hensikten med studien var å belyse hvordan muntlig rapport ble gitt av intensivsykepleiere, i en overlevering av akutt kritisk syk pasient. I tillegg var det ønskelig å få mer kunnskap om nåværende rutiner for pasientoverlevering, og å innhente intensivsykepleieres tanker og refleksjoner om pasientoverleveringen. Problemstillingen var: “Hvordan gjennomføres pasientoverlevering av intensivsykepleiere i vaktskifte ved en intermediæravdeling, og hvordan opplevde informantene den i etterkant?” Metode: I denne studien er det brukt observasjon som metode, som inkluderte korte samtaler i etterkant med informantene. Ikke-deltakende observasjoner av 17 pasientoverleveringer fra vaktskiftet ble utført på en intermediæravdeling på et sykehus i Norge. Kvalitativ innholdsanalyse ble benyttet for å analysere og transkribere datamaterialet. Resultater: Studien identifiserte to temaer: 1) Uklare rutiner for rapportgiving i avdelingen kan påvirke ivaretakelse av pasienten. Dette handlet om ulik gjennomføring av rapporten og omgivelser som var påvirkende for pasientoverleveringen. 2) Muntlig rapport skaper rom for læring. Temaet dreide seg om samhandlingen mellom informantene og faglige innspill. Konklusjon: Funnene avdekket at pasientoverleveringen ble utført ulikt og det var delte meninger om hvilket system som ble brukt for rapportgiving i avdelingen. Det ble også observert at forstyrrelser og avbrytelser kunne påvirke pasientoverleveringen. I tillegg kunne samspillet og innspill av faglige vurderinger og råd bidra til læring hos informantene. Nøkkelord: Pasientoverlevering, vaktskifte, muntlig rapport, intensivsykepleier, intermediæravdeling, kvalitativ, observasjonsstudie.Background: A patient handover during change-of-shift happens everyday, where the patient's responsibility is changed from one intensive care nurse to another. It can be a vulnerable situation for the patient and a risk to the patient's safety if the patient handover is defective. It is therefore important that the patient handover is carried out in a safe, informative and secure manner. This helps to ensure quality and continuity in patient care. Purpose: The purpose of this study was to shed light on how reports are given by intensive care nurses, in a handover of an acute critical ill patient. In addition, it was desirable to gain more knowledge about current routines for patient handover and obtain the informant´s thoughts and reflections on the patient handover. The research question was: “How is a patient handover carried out by intensive care nurses in change-of-shift at an intermediate ward, and how did the informants experience it afterward?” Methods: Observation as a method was conducted, and included short conversations with the informants. Non-participant observation of 17 patient handovers in change-of-shift was conducted on a ward in a hospital in Norway. Qualitative content analysis was used to analyze and transcribe the data material. Results: The study identified two themes: 1) Unclear routines for change-of-shift reports in the ward could affect the patient's care. This theme addressed different execution of the report and surroundings that were affecting the patient handover. 2) Oral report makes room for learning. This theme addressed the interactions between the informants and professional assessments. Conclusions: The findings revealed that the patient handovers were done differently, and there were different opinions about which reporting system that was used in the ward. There were also observed disturbances and interruptions that could affect the patient handover. Interaction and input from professional assessments and advice could contribute to increased learning for the informants. Keywords: Patient handover, change-of-shift, oral report, intensive care nurse, intermediate ward, qualitative, observational study

Role of supplementary feeding in reindeer husbandry

The chapter discusses the practice of providing reindeer with supplementary feed in winter as part of reindeer husbandry in Finland, Sweden and Norway. It describes how feeding is practised, and the benefits and problems connected with this practice, as perceived in the scientific literature and by herders. It also reflects on the possible future role of feeding. Feeding of reindeer is more common in Finland than in the other two countries but seems to be gradually increasing across all Fennoscandia. The main reason is the continuing loss and deterioration of winter pastures due to expanding land use by forestry, mineral and energy production and other industrial and infrastructure schemes, leading to increased grazing pressure on the remaining land. Climate change increases the frequency of difficult winter grazing conditions, and growing predator populations restrict the use of pastures for reindeer grazing. Reduced access to natural pasture can be counteracted by supplementary feeding, but at high costs and risks of impaired animal health and welfare. Herders are also concerned that increased use of feeding may threaten land rights, transfer of traditional knowledge between generations and the ability of reindeer to make use of natural pasture resources, and thereby the traditional management system as a whole

Role of supplementary feeding in reindeer husbandry

The chapter discusses the practice of providing reindeer with supplementary feed in winter as part of reindeer husbandry in Finland, Sweden and Norway. It describes how feeding is practised, and the benefits and problems connected with this practice, as perceived in the scientific literature and by herders. It also reflects on the possible future role of feeding. Feeding of reindeer is more common in Finland than in the other two countries but seems to be gradually increasing across all Fennoscandia. The main reason is the continuing loss and deterioration of winter pastures due to expanding land use by forestry, mineral and energy production and other industrial and infrastructure schemes, leading to increased grazing pressure on the remaining land. Climate change increases the frequency of difficult winter grazing conditions, and growing predator populations restrict the use of pastures for reindeer grazing. Reduced access to natural pasture can be counteracted by supplementary feeding, but at high costs and risks of impaired animal health and welfare. Herders are also concerned that increased use of feeding may threaten land rights, transfer of traditional knowledge between generations and the ability of reindeer to make use of natural pasture resources, and thereby the traditional management system as a whole

Implications of norms and knowledge in customary reindeer herding units for resource governance

Pastoralist societies have developed customary institutions to respond to an unpredictable environment and fluctuation in grazing resources for their livestock. This chapter describes how reindeer herders’ customary institutions, including laws, norms and rights embedded in social networks, as well as traditional knowledge, structure these responses. Furthermore, it analyses how reindeer herders’ customary institutions are integrated into state governance of natural resources or recognized in national legislation. Central to the chapter is the Sámi siida and the corresponding Finnish tokkakunta – both represent customary herding groups that seek to balance the relationship between human–reindeer units to the spatial and temporal availability of grazing resources. The need for revitalization and a better understanding of reindeer herders’ customary institutions is identified, as well as an increased recognition of their traditional knowledge in resource management and land use planning to increase the resilience of reindeer husbandry to the cumulative challenges of climate change and resource extraction