H1N1 vaccination in Sjögren’s syndrome triggers polyclonal B cell activation and promotes autoantibody production

Objectives: Vaccination of patients with rheumatic disease has been reported to result in lower antibody titres than in healthy individuals. However, studies primarily include patients on immunosuppressive therapy. Here, we investigated the immune response of treatment-naïve patients diagnosed with primary Sjögren’s syndrome (pSS) to an H1N1 influenza vaccine. Methods: Patients with Sjögren’s syndrome without immunomodulatory treatment and age-matched and gender-matched healthy controls were immunised with an H1N1 influenza vaccine and monitored for serological and cellular immune responses. Clinical symptoms were monitored with a standardised form. IgG class switch and plasma cell differentiation were induced in vitro in purified naïve B cells of untreated and hydroxychloroquine-treated patients and healthy controls. Gene expression was assessed by NanoString technology. Results: Surprisingly, treatment-naïve patients with Sjögren’s syndrome developed higher H1N1 IgG titres of greater avidity than healthy controls on vaccination. Notably, off-target B cells were also triggered resulting in increased anti-EBV and autoantibody titres. Endosomal toll-like receptor activation of naïve B cells in vitro revealed a greater propensity of patient-derived cells to differentiate into plasmablasts and higher production of class switched IgG. The amplified plasma cell differentiation and class switch could be induced in cells from healthy donors by preincubation with type 1 interferon, but was abolished in hydroxychloroquine-treated patients and after in vitro exposure of naïve B cells to chloroquine. Conclusions: This comprehensive analysis of the immune response in autoimmune patients to exogenous stimulation identifies a mechanistic basis for the B cell hyperactivity in Sjögren’s syndrome, and suggests that caution is warranted when considering vaccination in non-treated autoimmune patients

Non-verbal communication in a care context : a literature review

Samhället har höga förväntningar på både en god patientsäkerhet och vårdkvalitet. För att uppnå en god personcentrerad och patientsäker hälso- och sjukvård måste samverkan ske på ett interpersonellt plan. Icke-verbal kommunikation är viktig för att upprätthålla en säker vård eftersom den utgör mellan 55 och 97 procent av vår kommunikation, och anses vara mer inflytelserik än verbal kommunikation.Syftet med examensarbetet var att beskriva dels hur icke-verbal kommunikation ser ut dels undersöka effekten i en vårdkontext. En litteraturöversikt har genomförts där tretton artiklar med kvantitativ ansats har använts och analyserats enligt Polit och Becks niostegsmodell för att skapa en överblick av kunskapsläget.Resultatet visade flertalet effekter som bland annat ökad patientnöjdhet, empati, dämpad oro, subjektiv smärtupplevelse, omtänksamhet och förståelse. Bemötande kan tolkas på olika sätt och det är därför viktigt att som sjuksköterska förstå att även små icke-verbala uttryck, medvetna som omedvetna, kan leda till missförstånd. Det är viktigt att man som sjuksköterska informera sig om varje patient för att lättare förstå hur icke-verbal kommunikation kan förmedlas och tydas.Society has high expectations for both good patient safety and quality of care. In order to achieve a good person-centered and patient-safe health care, collaboration must take place on an interpersonal level. Non-verbal communication is important for maintaining a safe care as it represents between 55 and 97 percent of our communication, which is considered more influential than verbal communication.The purpose of the thesis was to describe how non-verbal communication is performed and examine the effect in a care context. A literature review has been carried out where thirteen articles with a quantitative approach have been used and analyzed according to Polit and Beck's nine-step model to create an overview of the state of knowledge.The result showed several effects such as increased patient satisfaction, empathy, subdued anxiety, subjective pain experience, thoughtfulness and understanding. Treatment can be interpreted in different ways and it is therefore important that as a nurse understand that even small non-verbal expressions, conscious as unconscious, can lead to misunderstandings. It is important that nurses inform themselves about each patient in order to more easily understand how non-verbal communication can be conveyed and interpreted

Everyday Life Situations of School-Aged Children with Severe Disabilities: What are the Goals for the Future? An Exploratory Study

This study investigated present and future everyday life situations (ELS) in home, school, work, and leisure environments for a group of school-aged children with severe disabilities, including complex disorders and a combination of disabilities. The purpose was to explore universal ELS; clarify how the children can be supported in their development of autonomy; and to gather information on potential overall goals for interventions. To make data comparable, all reported ELS were linked to the International Classification of Functioning, Disability and Health, Child and Youth version (ICF-CY) and listed along with information on the setting. Both today, and in the future, recreational activities and participation in school or work were of highest importance, but few reported ELS involved directly interacting with other children. More ELS were predicted to occur outside the home and with a higher degree of autonomy. Therefore, interventions would be focused on the overall goal that children with severe disabilities take initiatives to become independent and to form relationships with others

Everyday Life Situations of School-Aged Children with Severe Disabilities: What are the Goals for the Future? An Exploratory Study

This study investigated present and future everyday life situations (ELS) in home, school, work, and leisure environments for a group of school-aged children with severe disabilities, including complex disorders and a combination of disabilities. The purpose was to explore universal ELS; clarify how the children can be supported in their development of autonomy; and to gather information on potential overall goals for interventions. To make data comparable, all reported ELS were linked to the International Classification of Functioning, Disability and Health, Child and Youth version (ICF-CY) and listed along with information on the setting. Both today, and in the future, recreational activities and participation in school or work were of highest importance, but few reported ELS involved directly interacting with other children. More ELS were predicted to occur outside the home and with a higher degree of autonomy. Therefore, interventions would be focused on the overall goal that children with severe disabilities take initiatives to become independent and to form relationships with others

Everyday Life Situations of School-Aged Children with Severe Disabilities: What are the Goals for the Future? An Exploratory Study

This study investigated present and future everyday life situations (ELS) in home, school, work, and leisure environments for a group of school-aged children with severe disabilities, including complex disorders and a combination of disabilities. The purpose was to explore universal ELS; clarify how the children can be supported in their development of autonomy; and to gather information on potential overall goals for interventions. To make data comparable, all reported ELS were linked to the International Classification of Functioning, Disability and Health, Child and Youth version (ICF-CY) and listed along with information on the setting. Both today, and in the future, recreational activities and participation in school or work were of highest importance, but few reported ELS involved directly interacting with other children. More ELS were predicted to occur outside the home and with a higher degree of autonomy. Therefore, interventions would be focused on the overall goal that children with severe disabilities take initiatives to become independent and to form relationships with others

Exposure of volunteers to microgravity by dry immersion bed over 21 days results in gene expression changes and adaptation of T cells

The next steps of deep space exploration are manned missions to Moon and Mars. For safe space missions for crew members, it is important to understand the impact of space flight on the immune system. We studied the effects of 21 days dry immersion (DI) exposure on the transcriptomes of T cells isolated from blood samples of eight healthy volunteers. Samples were collected 7 days before DI, at day 7, 14, and 21 during DI, and 7 days after DI. RNA sequencing of CD3+T cells revealed transcriptional alterations across all time points, with most changes occurring 14 days after DI exposure. At day 21, T cells showed evidence of adaptation with a transcriptional profile resembling that of 7 days before DI. At 7 days after DI, T cells again changed their transcriptional profile. These data suggest that T cells adapt by rewiring their transcriptomes in response to simulated weightlessness and that remodeling cues persist when reexposed to normal gravity