Prescription of tablets is one of most common means for treatments of patients within the healthcare sector. Not seldom, drug manufacturers supply a limited number of tablet strengths, or physicians unnecessary prescribes a to high tablet strengths. This results in the situation where patients end up splitting tablets.  Another reason for splitting tablets is that they are voluminous, and thereby hard to swallow. Upon dividing tablets, fragments can become unequal in size, and parts of the tablets can crumble, leaving a tablet dose sometimes not compliant with government issued regulation, stated in different Pharmacopeias. Major parts of split tablets are prescribed to elderly people, who require lower dosages.  Some tablets are hard and small and elderly people have difficulties in dividing them, due to e.g. trembling and insufficient muscle strength in hands. The aim of this study was to investigate, pros and cons with splitting tablets, and how it´s practically done by the patient. What advice are given from staff in pharmacies to customers, in order to get it right. During two weeks, in March 2018, structured interviews were conducted on patients who had prescriptions on divided tablets. Among 7677 customers in eight pharmacies in Sweden 188 (2, 4 %) presented a prescription with split tablets. Of them, 171 accepted to participate in a survey to find an answer to the aim of this study. Out of the 171 customers 153 (89 %) divided their tablets. 74 (49 %) broke the tablets with their hands, 47 (31 %) with a knife and 22 (14 % ) use a device for dividing tablets.  The rest had recently received a prescription on a divided tablet.  Most common split tablets were within the ATC-codes C and N, cardiovascular and psychotropic drugs. They were split by 139 (81 %) of the customers. Within ATC-code N05 benzodiazepines 53 (31 %), C09 antidepressant 23 (13 %), N06 RAS 19 (11 %) and C07 betablocker 16 (9 %) divided tablets. Among the costumers who divided their tablets, 47 (28 %) said that the tablet size was not ideal to divide. About 36 (21 %) reported that they had difficulties dividing tablets; the number was highest among women. About 50 % of the customers had been given instructions by the pharmacist about how to split a tablet. The result of this study shows a need of lower strengths of some tablets, and that prescribers should be more aware and not unnecessary prescribe split tablets, since there are many especially elderly people that have difficulties in dividing them in equal parts.

Pharmaceuticals have been developed as long as humanity has suffered from diseases. It is something today’s people take for granted and is associated with strict rules as well as social initiatives. The purpose of pharmacies has developed from being an authoritarian part in healthcare to focusing on the customer and their needs. This particular role for pharmacies is one of the main focuses in this candidate thesis. A survey was performed at seven different pharmacies located at seven different sites in Sweden. The survey illuminates relevant questions around the dialogue between the customer and pharmacist. The communication between pharmacist and customer is an important aspect in the process of a purchase, because medicine has become more advanced and precise. The communication is a complicated procedure that requires to be mastered by pharmacists and also by customers at a specific point in time and place. This interplay creates customer satisfaction. The result showed that customers were generally reassured with the treatment of their medicine. The pharmacist gave relevant and enough information according to the answers on the survey. It showed that doctors still have the most trust amongst customers regarding the medicine information, thereafter the pharmacist. Possibly the reason for this depends on the relations between doctors and patients compared to pharmacists and customers. Even though pharmacists today have a major role when it comes to medical treatment and customers are satisfied, it is still common that they search for information in other ways. Digitalisation will probably affect this subject.

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D.Ed. (Sociopedagogics) / Many students attend school throughout the year. These students vary from being happy to unhappy individuals. The reason why some of these students are unhappy gave cause to the undertaking of this study. Therefore, the essence of happiness, as well as the needs for happiness of the school student, had to be determined, all within the limits of responsible educational standards. It was furthermore a problem to determine the reasons for the unhappiness of students at school and what had to be done to keep the happy students happy and make the unhappy students happy. The ultimate problem to be solved, was to determine the extent to which a change in attitude or simply a slight change in educational approach would influence the happiness of students at school. The methods used in this study were firstly an intensive literature study, with a socio pedegogical perspective on the task of the school. This was followed by a literature study to determine the essence of happiness, with the perspective on the Bible, as well as the perspective on the meanings of several theorists. Secondly, an empirical study involving secondary school students, was done. They were asked to state their own meaning on happiness in a single paragraph. They were also asked to evaluate and arrange, ten needs of happiness determined beforehand, in order of importance. Some of the most important results that came forth from the literature study, in addition to the Biblical message, that happiness causes joy and peace of mind to the human being, are that happiness is a longing and highest aspiration of all mankind, that happiness is future directive, is permanent and is experienced with fellow men and that happiness is incomplete. The need for security and the need for self-realization are the two essences of happiness that received highest priority. The results from the empirical study show that the student has a need to be acknowledged as a person for self-realization and to be able to lead a good life. Intellectual development, human relations and communication with fellow men received less priority, while the needs for freedom, discipline and especially the need for food and clothing, received the least priority. The reason for this tendency, can be that the basic needs of these students have already been satisfied -and the fullfilment for less basic needs still excist. In the light of all these results attention must be given to the criteria for an "ideal" school that can attend to the satisfying of the needs for happiness of the school student. The ideal school must strive to meet the needs of the student in its education and training. atmosphere of security and give the student thorouh It must educate the student in an pedogogical love to self-realization, intellectual and moral education and secure order and discipline. The ideal school must guide the student to overcome his failures, teach the student what happiness is all about and brief him on how to be a happy student, now and for years to come.

The tumor microenvironment is important for tumor growth and progression, where the cancer associated fibroblast (CAF) is one central cell type. The CpG island methylator phenotype (CIMP) divides colorectal cancer (CRC) into three subgroups and in this study we investigate how the different CIMP-groups and adjacent fibroblasts affect each other. This was done with the aim of finding CIMP-specific markers and to see if different tumor-fibroblast interactions result in differently invasive tumors. Here we report that CIMP-negative tumors have increased expression of fibronectin, while CIMP-high tumors have reduced expression of E-cadherin, findings that were seen in both tumor tissue samples and tumor cell lines. We also show that CIMP-negative and CIMP-high cancer cells induce an alignment of the fibronectin fibers produced by the fibroblasts and that CIMP-high cancer cells migrate with directionality on these matrices. These findings indicate that the different tumor subgroups in fact induce different phenotypes in CAFs, resulting in CIMP-specific markers. They also indicate that CIMP-negative and CIMP-high tumors may induce an alignment of fibronectin in order to promote cancer cell migration and thereby also tumor invasion.

Colorectal cancer (CRC) has either an infiltrative or pushing growth pattern, and patients in the former group have a worse prognosis. Infiltrative tumours are linked to epithelial-mesenchymal transition, which in turn is associated with increased cellular migration. As there is no molecular model that entirely describes the difference between infiltrative and pushing configurations we investigated if differences found in cell junctions between tumour cells (in the core of the tumour) could explain the different growth patterns. A PCR array targeting cell junction genes was performed on one infiltrative and one pushing tumour. Thirteen genes were selected for verification by real-time qRT-PCR in additional tumours and normal tissue from the colorectum of patients. GJB3, Gap Junction Protein beta 3 (also known as Connexin 31) was the best candidate for separating tumours of different growth patterns. GJB3 was down-regulated in tumours compared to normal tissue, suggesting that it may act as a tumour suppressor, and it was further decreased in tumours with a pushing growth pattern. Silencing the expression of GJB3 in the colon carcinoma cell line SW480 did not affect the proliferation or the migration of the cells, suggesting that GJB3 by itself cannot regulate proliferation or metastatic spread.

Interleukin 33 (IL-33) is a dual function cytokine. It is a member of the IL-1 family and it acts as a pro-inflammatory factor (18 kilo Dalton, 18 kD) like other cytokines in IL-1 family. IL-33 is also a transcription factor (32 kD - form) which can suppress or activate gene transcription in diverse cases. A variety of cell types and tissues in the central nervous system (CNS) can release IL-33 after injury. The 18 kD IL-33 binds to the membrane receptor protein ST2 ligand, then regulates downstream gene expression, triggers cytokine synthesis, and modulates the immune system response. After traumatic brain injury (TBI) in the CNS, glial cells become key players in the nervous tissue response. Astrocytes undergo activation, proliferation, release pro-inflammatory factors and, as a consequence, a glial scar barrier around the injury is formed. Simultaneously, resting microglia are activated and able to remove debris. Lastly, oligodendrocytes together with microglia and astrocytes are activated and communicate with the immune system. In addition, as a severe kind of injury to the CNS, brain tumours share some similar characteristics of brain injury, such as hypoxia and inflammation. Therefore, IL-33 may play a role in neuroinflammation and also in brain tumours. In this project, our aim was to investigate the role of IL-33 and the IL-33/ST2 pathway in traumatic brain injury and brain tumours (e.g glioma). We found that IL-33 can influence the CNS immune resonse, and may be important in CNS pathology.

Transforming growth factor beta (TGF-β) is a multifunctional cytokine that regulates cell differentiation, proliferation and migration depending on cell context. TGF-β has a growth inhibitory effect on epithelial cells via activation of Smad proteins (R-Smad/Co-Smad complex). TGF-β signaling is negatively regulated by the proto-oncogene Ski (Sloan Kettering Institute). Ski in turn is degraded by TGF-β signaling (Smads) via ubiquitin proteasome system. TGF-β acts like a tumor suppressor in early stages of cancer due to its inhibitory growth effect, but in late stages it acts like a tumor promoter. The main aim of this thesis was to study the regulation of corepressor Ski stability in normal and transformed hepatic cells by TGF-β signaling and Smad proteins as well as determine Ski protein subcellular localization by using immunoprecipitation and Western blot assays for these studies. The obtained data showed that the TGF-β/Smad signaling pathway caused a downregulation of Ski protein through its degradation via proteasome in HepG2 cells. In addition, the Ski protein levels were restored when Smads were restored in C9 and hepatocytes even though the activated Smads were still present. In the subcellular fractionation studies it was observed that Ski protein was mainly localized in the nucleus of HepG2 cells, whereas it was localized in both nucleus and cytoplasm in hepatocytes.  The presence of Ski in the cell cytoplasm could be explained because of low sensitivity in TGF-β signaling or translocation of Ski from nucleus to cytoplasm. C184M is a protein that binds to Ski in the cytoplasm and Ski in turn binds to Smads and inhibits their translocation from cytoplasm to nucleus, which in turn means inhibition of gene transcription that instead results in growth stimulation.

Bakgrund: Hjärtsvikt blir allt vanligare. Det krävs stor förändring och anpassning av livssituationen för både patienter och anhöriga. Många av de som får diagnosen saknar kunskap om hur de påverkas fysiskt, psykiskt och socialt. Syfte: Att belysa forskning som beskriver sjuksköterskans stöd i egenvårdsåtgärder som kan ge ökat välbefinnande hos patienter med kronisk hjärtsvikt. Metod: En litteraturstudie valdes där tretton artiklar har analyserats. Resultat: Av analysen framkom fyra huvudkategorier; Egenvård, Utbildning, Välbefinnande och Stöd. Under Stöd framkom tre underkategorier; Informativt, Professionellt och Socialt. Diskussion: Sjuksköterskan ska ge individinriktat stöd, information och utbildning för att patienten själv ska kunna ta ansvar för sin hälsa. Att tidigt informera och utbilda om sjukdomen och egenvård. Påpeka vikten av att kontrollera hälsostatus regelbundet, följa läkemedelsordinationer, förändra livsstilen, samt att involvera anhöriga utgör stor trygghet för patienten. Sjuksköterskans stödinsatser är betydande för patienten och leder till ett ökat välbefinnande.

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