Sveriges åldrande befolkning ökar, vårdbehovet blir större och vård i hemmet blir allt vanligare. Äldre patienter bor oftast kvar i sina hem trots närvaro av sjukdom vilket inte alltid är självvalt. Hemmet är en meningsfull plats där äldre patienter kan uppleva trygghet och hälsa när integritet och självbestämmande beaktas. Sjuksköterskan har en viktig roll i att utföra god vård och inneha ett följsamt förhållningssätt där patienten känner sig sedd och hörd för att mötet skall erfaras som vårdande. Syftet med litteraturstudien var att belysa äldre patienters upplevelser av det vårdande mötet med sjuksköterskan vid vård i hemmet. Metoden som har valts för denna studie är en litteraturöversikt där 12 kvalitativa artiklar noga har valts ut, analyserats och format ett slutgiltigt resultat. Resultatet visar på att hemmet och dess tillhörigheter är betydelsefullt samt att förbli självständig och att få vara delaktig i sin vård kan leda till en ökad autonomi. Att känna sig maktlös kan leda till känslor av frustration och utsatthet medan ett respekterande förhållningssätt från sjuksköterskan och en god kontinuitet kan skapa en trygg relation. Metoden i studien diskuteras baserat på de fyra begreppen: trovärdighet, pålitlighet, bekräftelsebarhet och överförbarhet. Huvudfynden som diskuteras utifrån resultatet är hemmets betydelse, att vara patient i sitt eget hem, delaktighet och utsatthet, sjuksköterskans förhållningssätt, en god relation och det vårdande mötet. / Sweden's aging population is increasing, and the need for care is growing. Home care is becoming increasingly common as older patients often stay in their homes despite the presence of illness which is not always a voluntary choice. Home is a meaningful place where older patients can experience security and health when integrity and self-determination are taken into account. The nurse has an important role in providing good care and having an adaptable approach where the patient feels seen and heard so that the encounter is experienced as caring. The aim of this literature review was to illuminate older patients' experiences of the caring encounter with the nurse during home care. The method chosen for this study is a literature review where 12 qualitative articles were carefully selected, analyzed, and shaped into a final result. The results show that the home and its belongings are significant, and that maintaining independence and being involved in one's care can lead to increased autonomy. Feeling powerless can lead to feelings of frustration and vulnerability, while a respectful approach from the nurse and good continuity can create a secure relationship. The method in the study is discussed based on the four concepts: credibility, dependability, confirmability, and transferability. The main findings discussed based on the results are the significance of home, being a patient in one's own home, involvement and vulnerability, the nurse's approach, a good relationship, and the caring encounter.

No description available.

Bakgrund: Det har visat sig att äldre, i västvärlden, utgör den grupp som begår flest självmord. Hög ålder medför nedsatt reservkapacitet och minskat motstånd mot yttre påfrestningar. Många äldre drabbas av depression, vilket är den vanligaste behandlingsbara riskfaktorn för livsleda och suicid. Samtidigt upplevs ofta ångest. Orsaker till livsleda kan vara en separation från en livspartner, genomgång av en dramatisk livsfas eller somatisk sjukdom. Självmordsbenägna patenter, som kan sägas vara i en existentiell kris, kräver särskild vård vid inläggning. Vårdpersonal har upplevt det viktigt att bemöta patienter med livsleda men inte alltid tyckt att de har möjlighet på grund av tidsbrist, stress och för lite kunskap. Syfte: Att beskriva sjuksköterskors erfarenhet av att identifiera äldre patienter i psykiatrisk vård som känner livsleda och kanske inte längre vill leva och hur sjuksköterskor kan ha ett stödjande bemötande av dessa patienter och därmed främja deras psykiska hälsa. Metod: Fem semistrukturerade intervjuer gjordes med sjuksköterskor på en avdelning med inriktning att vårda äldre patienter med psykisk ohälsa. Resultat: Utifrån intervjuanalysen framkom två kategorier med vardera tre subkategorier. Kategorin Identifiering av patienter med livsleda hade subkategorierna Verbal - och icke verbal kommunikation, Åldrandets innebörd och Dödsönskan. Den andra kategorin, Stöd av patienter med livsleda hade subkategorier Acceptans, Bemötande och Vårdande miljö. Informanterna i studien uppfattade och bemötte patienternas livleda i sitt arbete och bemötte dem med psykiatrisk och somatisk vård. Genom stödsamtal, lyhördhet för de äldres behov och förutsättningar, uppmuntran till aktivering på de äldres villkor bemötte de på ett pedagogiskt vis de äldre patienterna i deras existentiella kris. Diskussion: Resultatet diskuterades i relation till resultat och litteratur. Det som framkommit i studien är att informanterna på valda avdelning på ett lyhört sätt adresserade de äldres problem och bemötte dem på ett pedagogiskt vis och med stor kunskap om de äldres problem och förutsättningar. / Background: It has been shown that elderly, in the western world, is the age group who commits the most suicides. An elderly person has a lower capacity and a lesser ability to come to terms with trying circumstances. The aging process influences psychological quickness, ability to adjust and sense of memory. Elderly are often subjected to depression, which is the most common treatable risk factor for weariness of life. Anguish is often experienced simultaneously. Reasons for weariness of life could be a separation from a partner or spouse, to go through a dramatic life phase or physical illness. Often an existential life crises is experienced and a feeling of standing on one’s own in life. Suicidal patients who experience a life crises demand special care when hospitalized. Nursing staff perceive it as important to treat patients who experience weariness of life but they do not always feel that they have the capacity to do so due to stress and lack of time and knowledge. Aim: To describe nurse ́s experiences of identifying and caring for elderly patients in psychiatric care who experience weariness of life and who might no longer want to live. Method: Five semi structured interviews were done with nurses on a ward specialized on psychiatric care of the elderly. Inductive content analysis has been used to analyze the interviews. Results: The analysis resulted in two categories: Identifying patients who experience weariness of life and Supporting patients who experience weariness of life. Three subcategories Verbal - and nonverbal communication, The signification of aging and Wishing to die are included in the category Identifying patients who experience weariness of life. Subcategories Acceptance, Caring and Environmental influence belong to the category Supporting patients who experience weariness of life. The informants in the study understood the elderly patient’s feeling of weariness of life and cared for them with psychiatric and somatic nursing. Through supporting conversation, a sensitive and empathic approach to the needs and conditions of the elderly, they encouraged them to become more active on their own terms. The informants treated the elderly with pedagogical sensitivity to support them in their existential crisis. Discussion: The results are discussed in relation to articles and literature and also in relation to the chosen theoretical basis of the study.

The Geriatric Depression Scale (GDS) was originally designed as a measure for screening depression among elderly medical patients. Although this instrument is well validated among a general medical population, it has never been evaluated with specific regard to cardiac patients, the largest single group of medical patients over 40 years of age. A general cardiac sample of 655 patients completed the GDS within 10 weeks of the cardiac event. Exploratory factor analyses were conducted on the main sample, then on several subgroups of participants with regard to diagnostic category, gender, and age. The GDS generally produces factor structures with several symptom domains with a high rate of total variance. The myocardial infarction group endorsed general symptoms of depression whereas the coronary artery bypass graft group reported greater levels of despair regarding their condition. Overall, males primarily reported agitation and hopelessness while females reported symptoms of depressed mood.

Falls are a serious issue for the elderly living in long-term care facilities, as falls contribute to signi�cant health problems such as increased dependence, loss of autonomy, confusion, immobilization, depression, restriction in daily activities, and, in some cases, death. An estimated 424,000 fatal falls in elderly patients residing in long-term facilities occur annually in the United States costing $34 billion in direct medical costs. One way to reduce falls among elderly patients in long-term care is to assess for fall risk frequently and implement evidence-based strategies to prevent falls. Patients in this project site facility had been assessed for fall risk via the Briggs Fall Risk Assessment Tool with implementation of fall risk iinterventions only upon admission or when there was a fall. The purpose of this project was to assess whether changing to weekly use of the Briggs Fall Risk Assessment Tool with implementation of fall risk interventions by nursing staff could decrease fall rates in the elderly in long-term care in Harris County, Texas. The model of prevention served as the conceptual framework for this project. Thirty participants (20 females and 10 males) between the ages of 65-115 participated in the program. Pre-implementation data were collected for 1 month and post-implementation data were collected for 1 month. The total number of falls reported weekly was counted before and after the weekly implementation of the Briggs Fall Risk Assessment Tool. The number of falls decreased from 12(70.6%) before the implementation of the assessment tool to 5(29.4%) falls afterwards. A fall prevention program in long-term care may affect social change positively by reducing fall risk in long term care by reinforcing the importance of increased awareness of risk of falls to implement fall prevention strategies

No description available.

Hintergrund: Die wachsende Anzahl älterer multimorbider Patienten und der damit zunehmende Versorgungsbedarf am Lebensende erfordern eine gut funktionierende Basisversorgung mit dem Hausarzt als zentralem Ansprechpartner. Hausärzte versorgen ihre Patienten zumeist über mehrere Jahre und bis ans Lebensende. Darüber gibt es jedoch bisher keine ausreichenden Kenntnisse. Ziel der Studie: Die Versorgungssituation und Charakteristika hausärztlich versorg-ter Patienten in der letzten Lebensphase aus hausärztlicher Sicht, durch eine retro-spektive Erhebung abzubilden. Methode: Im Raum Hannover und Göttingen wurden 30 Hausärzte (Teilnehmerrate: 19%) mittels eines selbst entwickelten standardisierten Erhebungsbogen zu ihren in den letzten 12 Monaten eines natürlichen Todes verstorbenen Patienten (n = 451) befragt. Erfasst wurden vor allem Daten zur Soziodemographie und Betreuungssituation, zu den Erkrankungen, den Symptomen und der Symptomkontrolle. Neben einer rein deskriptiven Darstellung der Ergebnisse erfolgte ein Vergleich mit Daten aus der Hospiz- und Palliativerfassung (HOPE) 2010. Ergebnisse: Im Mittel hatte jeder teilnehmende Hausarzt 15 Patienten (SD: 7,3; Me-dian: 14,5; Range: 4-36), für die er Angaben im Erhebungsbogen machte. Das durchschnittliche Sterbealter betrug 78,5 Jahren (SD: 12,9; Median: 81; Range: 19-102), 55% der Patienten waren Frauen, der Großteil der Patienten (60%) lebte zu-letzt in der eigenen Wohnung beziehungsweise im eigenen Haus. Obwohl die meisten Patienten sich ein Versterben in häuslicher Umgebung wünschen, verstarben 41% der Patienten im Krankenhaus und nur 22% zu Hause beziehungsweise in einer Alten- oder Pflegeeinrichtung. Das Krankheitsspektrum war vielfältig und zeigte eine Dominanz der chronischen Erkrankungen (beispielsweise des Herz-Kreislauf-Systems und der Psyche). Im Vergleich mit den HOPE-Daten zeigten sich im Spektrum der Erkrankungen und in der Häufigkeit der Symptome deutliche Unterschiede. Die meisten Verstorbenen wurden im Rahmen der allgemeinen hausärztlichen Basisversorgung in der letzten Lebensphase betreut. Die Häufigkeit der Arzt-Patienten-Kontakte nahm zum Lebensende zu. Bei 48% der Patienten war der Hausarzt auch in den letzten 48 Stunden vor dem Tod noch in die Versorgung involviert. Eine palliativmedizinisch spezialisierte ärztliche Betreuung erhielten in der HAVEL-Studie nur 10% der Patienten. Neben der ärztlichen Betreuung spielten Angehörige (bei 49% der Patienten), Pflegedienste (bei 29%) und Pflegeheimpersonal (bei 33%) eine bedeutende Rolle in der ambulanten Versorgung in den letzten Lebensmonaten. Schlussfolgerung: Hausärzte sind unabhängig vom Sterbeort maßgeblich in die Betreuung ihrer Patienten bis ans Lebensende involviert. Die Unterschiede in den Patientencharakteristika sowie in den Versorgungsformen zwischen hausärztlicher und spezialisierter Versorgung am Lebensende sollten in der ärztlichen Aus- und Weiterbildung stärker berücksichtigt werden. Um der aktuellen Versorgungssituation auch in der Forschung gerecht zu werden und über die Qualität der ambulanten Versorgung am Lebensende Aussagen treffen zu können, sind weitere Untersuchungen erforderlich.

Tyrimo tikslas: ištirti viršutinių galūnių lūžius patyrusių pagyvenusio amžiaus pacientų gyvenimo kokybę ir jos pokyčius ambulatorinio gydymo metu. Tyrimo uždaviniai: 1. Nustatyti viršutinių galūnių lūžius patyrusių pagyvenusio amžiaus pacientų pagrindinius slaugos poreikius ir jų kaitą vieno mėnesio laikotarpiu nuo patirtos traumos. 2. Ištirti viršutinių galūnių lūžius patyrusių pagyvenusio amžiaus pacientų gyvenimo kokybę ir jos kaitą vieno mėnesio laikotarpiu nuo patirtos traumos. 3. Nustatyti veiksnius, turinčius įtakos viršutinių galūnių lūžius patyrusių pagyvenusio amžiaus pacientų gyvenimo kokybei. Tyrimo kontingentas ir metodai. Tyrime dalyvavo 112 viršutinių galūnių lūžius patyrusių pagyvenusio amžiaus pacientų, gydytų ambulatoriškai VšĮ Kauno Klinikinės ligoninės priėmimo – skubios pagalbos ir traumų skyriuje – poliklinikoje 2013m. rugsėjo mėn. – 2014m. vasario mėn. Buvo atlikta anoniminė anketinė apklausa, kurią sudarė sociodemografiniai duomenys, slaugos poreikių klausimynas pagal gyvybines veiklas bei SF – 36 gyvenimo kokybės klausimynas, traumos dieną ir praėjus mėnesiui po jos. Tyrimui atlikti 2013-10-01 gautas Lietuvos Sveikatos Mokslų Universiteto Bioetikos centro leidimas (BEC – KS (M) – 16). Rezultatai: Po mėnesio nuo viršutinių galūnių lūžių pagyvenusio amžiaus asmenų savarankiškumas gamintis maistą, klotis lovą, valgyti, vartytis, prakaitavimas, karščiavimas, judėjimą ribojantis skausmas, sumažėjęs fizinis aktyvumas, nuskausminamųjų vartojimas, nemiga... [toliau žr. visą tekstą] / Research aim: to research the quality of life and its changes of the elderly patients with upper limb fractures during out-patient treatment. Research goals 1. To identify the main nursing needs and their changes for the elderly patients with upper limb fracture in a month since incurred trauma. 2. To research the quality of life and its changes of the elderly patients with upper limb fractures in a month since incurred trauma. 3. To determine factors influencing the quality of life of the elderly patients with upper limb fractures. Research contingent and methods. There were 112 elderly patients with upper limb fractures on out-patient treatment in the reception – emergency and trauma department at VŠĮ ( public institution) Kaunas Clinical hospital participating in the research from September 2013 to February 2014. An anonymous questionnaire was conducted, including sociodemographic data, questionnaire on nursing needs according to vital activities and SF-36 health related quality of life questionnaire on the trauma day and in a month it incurred. A permission (BEC-KS(M)-16) of 01-10-2013 to conduct a research was given by the center of Bioethics at Lithuanian University of Health Sciences Results: In a month since the elderly patients incurred upper limb fractures, their independence to prepare meals, make the bed, eat, turn over, perspiration, fever, pain restricting movements, taking anesthetics, insomnia, need of other persons help in order to comb, take a bath, change... [to full text]

Il termine malattia renale cronica (Chronic Kideny Disease: CKD) si riferisce a differenti condizioni caratterizzate da un progressivo declino della funzione renale. Le linee guida internazionali hanno definito la CKD come una condizione in cui siano presenti marcatori di danno renale e/o la velocità di filtrazione glomerulare stimata (Estimated Glomerular Filtration Rtae: eGFR) sia inferiore a 60 ml/min/1.73 m2 per almeno 3 mesi. L’insufficienza renale in stadio terminale è associata ad un alto rischio di malattia cardiovascolare (Cardiovascular Disease: CVD), la più frequente causa di morte in questi pazienti. Fattori di rischio “non-tradizionali” come: infiammazione cronica, stress ossidativo, deplezione proteico-energetica, disordini del metabolismo minerale e deficit di inibitori della calcificazione, partecipano alla patogenesi della CVD. L’infiammazione gioca un ruolo cruciale nella risposta fisiologica all’infezione e al danno renale e partecipa anche nell’evoluzione del danno renale irreversibile con la produzione di diverse molecole infiammatorie a partire da acidi grassi polinsaturi a lunga catena (Long Chain PolyuUsaturated Fatty Acids: LCPUFA) della serie Omega-6. La supplementazione di Omega-3, con effetto antinfiammatorio, nei pazienti affetti da CKD è stata ed è oggetto di molti studi, nonostante ciò, l’effetto sul danno renale è ancora poco chiaro. Comunque, è ampiamente riconosciuto che un alterato profilo lipidico possa determinare la progressione della patologia, inducendo lo stato infiammatorio. Inoltre, elevati/normali livelli di Omega-3 potrebbero essere associati al miglioramento della funzionalità renale, diminuendo quindi il rischio di peggioramento della malattia. Le concentrazioni e il rapporto di Omega-3 e Omega-6 sono strettamente associati alla salute del rene, poiché svolgono ruoli importanti in differenti vie metaboliche. Un altro aspetto, preso poco in considerazione, è l’effetto dei livelli di acidi grassi circolanti e dei loro metaboliti sullo stato infiammatorio e sulla sua modulazione. Il primo scopo di questo studio è stato quello di analizzare il profilo degli acidi grassi in soggetti anziani affetti da CKD. Sono stati arruolati 57 pazienti afferenti agli ambulatori di Nefrologia dell’Ospedale Maggiore Policlinico di Milano e sono stati raccolti campioni di sangue su cui è stata effettuata l’analisi del profilo lipidico. Negli ultimi anni, diversi studi hanno sottolineato la stretta associazione tra infiammazione a livello intestinale e peggioramento del quadro in pazienti con CKD. Il mantenimento di un ottimo stato del tratto gastrointestinale è fondamentale per assicurare lo stato di salute dell’ospite, contribuendo ai processi metabolici, fisiologici e immunologici. Le comunità batteriche instaurano un rapporto mutualistico con l’individuo che colonizzano, giocando un ruolo importante negli stati di salute e malattia. Un’anomala colonizzazione o cambiamenti nella composizione del microbiota intestinale, determina disbiosi, uno squilibrio associato a diverse condizioni patologiche come obesità, diabete di tipo II, malattia intestinale cronica, CVD e anche CKD. Il rapporto tra intestino e rene è bidirezionale, nei pazienti affetti da malattia renale cronica, la composizione del microbiota intestinale risulta essere modificata rispetto a quella del soggetto sano. Alti livelli di urea che si riversano facilmente nel tratto intestinale modificano il microambiente chimico con conseguente innalzamento del pH del colon che esercita una pressione selettiva a favore di specie ureasi-positive, responsabili della conversione dell’urea in ammoniaca. Lo strato protettivo di muco viene degradato e la permeabilità della barriera intestinale viene compromessa. In conseguenza di ciò si ha il passaggio di materiale batterico attraverso la mucosa e l’attivazione di un meccanismo infiammatorio. Nei pazienti con funzionalità renale compromessa, il rene perde progressivamente la capacità di eliminare sia le sostanze provenienti dal metabolismo umano, sia quelle della comunità microbica intestinale. Alcune di queste sostanze sono rappresentate dalle tossine uremiche, tra quelle di derivazione intestinale le principali e più studiate sono p-cresil solfato (PCS) e indossile solfato (IS). IS e p-CS, strettamente legate all’albumina sierica (Human Serum Albumin: HSA), non vengono eliminate facilmente ma rimangono nel torrente ematico. HSA è la più abbondante proteina sierica ed è la principale trasportatrice di composti esogeni ed endogeni, inclusi gli acidi grassi che sembrano rappresentare il maggior ligando endogeno della proteina. Multipli siti di legame vengono utilizzati per gli acidi grassi monoinsaturi (MonoUnsaturated Fatty Acids: MUFA) e PUFA. Acidi grassi e tossine uremiche competono quindi per gli stessi siti di legame sulla proteina. Il potenziale ruolo degli acidi grassi nel contrastare l’accumulo di tossine uremiche derivate dalla comunità batterica intestinale ne giustifica l’importanza della valutazione dei loro livelli ematici. Secondo scopo di questa tesi di dottorato è stato quello di valutare la possibile correlazione tra i livelli di acidi grassi circolanti e la composizione del microbiota intestinale in soggetti affetti da CKD. Sono stati arruolati nello studio 64 pazienti anziani con CKD non dializzati e 15 soggetti anziani con normale funzionalità renale. La composizione del microbiota intestinale è stata precedentemente caratterizzata attraverso l’impiego delle tecniche di elezione: PCR-DGGE e la PCR quantitativa (qPCR). In accordo con la letteratura scientifica, è stata evidenziata una riduzione di batteri saccarolitici e produttori di butirrato nei pazienti con CKD rispetto al gruppo di controllo. Il butirrato sembra giocare un ruolo cruciale nel mantenimento delle ottimali condizioni della barriera intestinale. Tenendo ciò in considerazione è stato deciso di approfondire lo studio e valutare l’associazione tra la comunità microbica intestinale e i livelli di acidi grassi basali in tali pazienti. Come risultato più importante ottenuto, è stata osservata una correlazione positiva statisticamente significativa tra la specie batterica Faecalibacterium Prausnitzii e i livelli totali di Omega-3 entrambi associati a proprietà antinfiammatorie. La presente tesi di dottorato evidenzia la necessità di sostenere ulteriori ricerche per supportare i risultati qui presentati. Studi futuri potrebbero essere utili per migliorare la comprensione del ruolo degli acidi grassi circolanti e i loro metaboliti sulla composizione del microbiota intestinale, sullo stato infiammatorio e sulla malattia renale cronica. / The aim of this thesis was to explore the possible associations between fatty acids (FA) profile and gut microbiota (gMb) with several conditions throughout the lifespan, from infancy to old age. In particular, we focused our attention on elderly subjects with Chronic Kidney Disease (CKD) and children with Acute Otitis Media (AOM). The terms “Chronic Kidney Disease” refers to several disorders with a progressive kidney function decline. International guidelines approved the definition of CKD as a condition with the presence of markers of kidney damage or with the estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2 or both, for at least three months. End-stage renal disease is associated with a high cardiovascular disease (CVD) risk, the major cause of death in these patients. Chronic inflammation, oxidative stress, protein-energy wasting, disordered mineral metabolism, and deficiency of endogenous calcification inhibitors, known as non-traditional risks factor, take part in cardiovascular pathology in CKD. Inflammatory processes influence the physiological response to renal infection and injury but also participate in the development of potentially irreversible kidney damage with the production of various inflammatory molecular species, among whom eicosanoids and cytokines, from parental omega-6 long-chain polyunsaturated fatty acids (LCPUFA). Several studies focused their attention on the potential role of omega-3 (n-3) LCPUFA supplementation in subjects with CKD. Despite this, their effect on kidney damage is still not clear. However, it is widely agreed that a modified FA profile in CKD can determine a progression of the disease, inducing the inflammatory state. Moreover, high/normal n-3 LCPUFA levels decrease the risk of a decline of the disease. Omega-3 and omega-6 (n-6) LCPUFA concentrations and their ratios are tightly associated with renal health, because of their important roles in different pathways. Another aspect not very considered in the field of CKD is the role of circulating FA levels and their metabolites on the modulation of inflammation. The first aim of this study is to analyze the FA profile in elderly subjects with CKD. Blood samples have been collected from 57 subjects enrolled in the study, and FA analysis has been performed. During the last years, several studies underlined the strong relationship between intestinal inflammation and adverse outcomes in CKD. The health of gastrointestinal tract is fundamental to ensure the well being of the host contributing to its nutrition, metabolism, physiology, and immune function. The bacterial communities colonizing humans have been seen in terms of mutualistic symbiosis with their hosts, a mutually beneficial coexistence, playing an important role in health and disease. Abnormal colonization or changes in the gut microbial composition determine dysbiosis, a state associated with different illnesses, such as obesity, type 2 diabetes, inflammatory bowel disease, cardiovascular disease, and also chronic kidney disease. The relationship between gut and kidney is a bi-directional relation with a mutual influence. Chronic kidney disease influences gMB characteristics, especially through high levels of urea that easily spread in the intestinal fluid where bacterial urease enzymes degrade it, then it is hydrolyzed in ammonium hydroxide that increases fecal pH with a consequent alteration of intestinal cellular junctions. Besides, high levels of urea change intestinal microbiota composition damaging permeability of intestinal barrier and promoting proteolysis with production and absorption of uremic toxins, such as indoxyl sulfate (IS) and p-cresol sulfate (p-CS). These toxins induce an inflammatory process associated with CKD. Under physiologic conditions, the kidney through the urine eliminates these compounds, but CKD patients have a compromised renal clearance. Therefore, these solutes tend to accumulate in the organs. IS and p-CS are tightly bound to human serum albumin (HSA), the most abundant plasma protein in the bloodstream. HSA is recognized as the main means of transport for endogenous and exogenous compounds, including fatty acids that seem to be the main endogenous ligand of HSA, multiple binding sites are used for monounsaturated fatty acids (MUFA) and PUFA. Thus, free fatty acids and uremic toxins compete for the same binding sites on HSA. It is important to assess fatty acid (FA) levels in patients with CKD because of the potential role to contrast the accumulation of uremic toxins derived from the intestinal bacterial community. As a consequence of this bi-directional relation between gut and kidney and the possible involvement of some compounds as metabolites of FA in the inflammatory response, we investigate the correlation between circulating FA levels and the gMB composition in the same subjects with CKD, as the second aim of this thesis. 64 old CKD non-dialysis patients (eGFR 15-45 ml/min/1.73 m2) and 15 elderly subjects (>65 years) with normal renal function (eGFR >60 ml/min/1.73 m2, CKD-EPI) are enrolled. Bacterial composition was studied in a previous observational study by denaturating gel gradient electrophoresis (DGGE), high-throughput sequencing (16S ribosomal RNA), and quantitative real-time PCR (qPCR). This study described an increased abundance of some bacteria associated with pathological conditions. In agreement with the literature, the author found a reduced abundance of saccharolytic and butyrate-producing bacteria (Prevotella, Faecalibacterium prausnitzii, Roseburia) in CKD patients respect to the control group. Butyrate plays a crucial role in the maintenance of the gut barrier function. Taking that into account, we decided to investigate the correlation between gMB composition and FA profile in these subjects. The main result of the study was the significant positive correlation between Faecalibacterium prausnitzii and total n-3 levels, both associated with the antiinflammatory action. The present doctoral thesis underlines the need to perform further investigations in order to support evidence presented. Future studies may be useful to improve understanding of the effect of circulating fatty acids levels and their metabolites on gut microbial composition, inflammation process, and pathological conditions such as kidney disease. Our results showed that CKD patients with previous cardiovascular events had lower total and specific n-3 levels comparing with patients without them. Moreover, higher docosahexaenoic acid (DHA) levels and having had previous cardiovascular events seemed to have protective effects against further cardiovascular events. Moreover, we observed a significant reduction of the genera Roseburia and Faecalibacterium in CKD patients compared to C group and a significant lower abundance of F. prausnitzii and Roseburia spp. in CKD patients. Thus, our results seem in accordance with anti-inflammatory actions of total n-3, DHA, and saccharolytic and butyrateproducing bacteria. Many gMB changes seem to be related both to CKD and CVD. If the different gMB composition might play a causal role in cardiovascular events by an unbalanced production of some toxic substances, or if the gMB changes are merely a consequence of different dietary and lifestyle behaviours of these patients, it cannot be explained by the present study and all the yet available data. Further studies, possibly utilizing new high-throughput tools, will be required to understand the potential correlations between the gMB composition and other inflammation and oxidative stress markers in these patients. Other two studies have been performed during the doctoral course, to reach a better comprehension of fatty acids, gut microbial community and inflammatory states. A prospective pilot clinical study has been performed to to explore possible changes of gMB composition in children with AOM treated with amoxicillin with or without clavulanic acid. AOM is one of the most common bacterial infections in children and is normally treated with antibiotic therapies that lead to increasing antimicrobial resistance rates among otopathogens and may impair the correct development of the microbiota in early life. No significant differences were shown in the gMB composition of the overall cohort at different time intervals of the samples collection and in subjects treated with amoxicillin with or without clavulanic acid at different time intervals (T0, T1 and T2). A literature revision on lipids in infant formulae has been performed to better understanding quality and quality of dietary lipids because of their significant impact on health outcomes, especially when fat storing and/or absorption are limited (e.g., preterm birth and short bowel disease) or when fat byproducts may help to prevent some pathologies. The lipid composition of infant formulae varies according to the different fat sources used, and the potential biological effects are related to the variety of saturated and unsaturated FAs. Instead, ruminant-derived trans FAs and metabolites of n-3 LCPUFA with their anti-inflammatory properties can modulate immune function. Furthermore, dietary fats may influence the nutrient profile of formulae, improving the acceptance of these products and the compliance with dietary schedules. During the doctoral course, I spent a period abroad at Dell Pediatric Research Institute (DPRI), The University of Texas at Austin. In particular, I attended the laboratory of Doctor Brenna. I focused my research activity on a specific regulatory insertion-deletion polymorphism in the FADS gene cluster for better understanding its influence on PUFA and lipid profile.

Den ökande och snabba utvecklingen av informations- och kommunikationsteknik har skapat ett nytt ekosystem inom hälso- och sjukvårdssektorn bestående av digitala plattformar. Detta har gjort det möjligt för patienter att söka och ta emot vård på nya sätt som tidigare inte var möjligt. Att digitalisera patientresan har visat sig vara effektivt och underlättar självständigt boende och enkel åtkomst för uppföljningskonsultationer för de som lider av kroniska sjukdomar. Trots detta är många människor, särskilt äldre, underrepresenterade i användningen av digitala vårdplattformar. Syftet med detta examensarbete är att undersöka äldre patienters beteende inom digitala vårdplattformar för att tillgodose behoven hos den större befolkningen och minimera den digitala klyftan. För att uppnå syftet formulerades följande forskningsfrågor: Vilka är skillnaderna i användningsbeteende mellan äldre och yngre primärvårdspatienter på digitala vårdplattformar? Vilka är de viktigaste förebyggande faktorerna som påverkar äldres användningsbeteende? Denna studie följde en mixad forskningsdesign. Vi använde SPSS för att utföra one-way ANOVA följt av ett Games-Howell post hoc-test för varje variabel som möjligtvis kunde förklara en skillnad i användningsbeteende mellan yngre och äldre primärvårdspatienter. För att svara på vår andra forskningsfråga genomförde vi 17 intervjuer med respondenter i åldern 60+ som tidigare använt en digital vårdplattform. Våra resultat visar att det finns en signifikant skillnad i användningsbeteende mellan äldre och yngre primärvårdspatienter. Den äldre generationen spenderar mer tid under anamnes, onboarding och i väntekö, där de i åldern 75+ sticker ut mest på alla uppmätta variabler. Den äldre generationen tenderade också att betygsätta tjänsten något lägre, uppskatta deras hälsa högre och bli tilldelad färre antal sjukvårdsexperter i processen jämfört med den yngre generationen. De viktigaste förebyggande faktorerna som påverkar äldres användningsbeteende är den upplevda användbarheten, upplevda användarvänligheten, deras digitala mognad, förtroende, och attityd till digital vård. Denna studie bidrar till den glesa litteraturen inom digitala vårdplattformar och äldres beteende efter adoption av informations- och kommunikationsteknik. Vi tillhandahöll ny kunskap om äldres användning av digitala vårdplattformar i jämförelse till den yngre generationen och lade till en förklaring angående vilka faktorer som påverkar användningsbeteendet hos den äldre generationen. Dessutom stärker vi nuvarande teori genom att betona vikten av att undersöka de påverkande faktorerna snarare än kronologisk ålder. Våra praktiska bidrag riktar sig till både plattformsägare och vårdpersonal med syftet att ge vägledning i hur dessa två aktörer ska agera för att öka användningen bland den äldre generationen, där utformning av plattformen och information är särskilt viktigt att ta hänsyn till. / The rise and rapid development of information communication technologies have created a new ecosystem in the healthcare sector consisting of digital platforms. This has enabled patients to access, seek, and receive care in new ways which was not previously possible. Digitizing the patient journey is proven to be effective while facilitating independent living and easy access for follow-up consultations for those who live in rural areas and are suffering from chronic diseases. Yet, many people, especially elderly, are underrepresented in the usage of digital healthcare platforms. The purpose of this master thesis is to investigate elderly patients’ behavior inside the digital healthcare platforms to accommodate the needs of the greater population and minimize the digital divide. To achieve the purpose, the following research questions were formulated: What are the differences in usage behavior between elderly and younger primary care patients in digital healthcare platforms? Which are the key antecedent factors that influence the usage behavior of the elderly? This study followed a mixed method research design. We used SPSS to perform a one-way ANOVA followed by a Games-Howell post hoc test for each variable that possibly could explain a difference in usage behavior between younger and elderly primary care patients. To answer our second research question, we held 17 interviews with respondents in the age of 60+ that previously had used a digital healthcare platform. Our findings reveal that there is a significant difference in usage behavior between elderly and younger primary care patients. The elderly generation spend more time during anamnesis, onboarding, and in waiting lines, where those in the age 75+ stand out the most on all measured variables. The elderly generation also tended to rate the service slightly lower, estimate their health higher and get assigned to fewer healthcare professionals in comparison to the younger generation. The key antecedent factors that influence the usage behavior of elderly is the perceived usefulness, perceived ease of use, their digital maturity, trust, and attitudes towards digital healthcare. This study contributes to the sparsely literature within digital healthcare platforms and elderly’s behavior after adoption of ICTs. We provided new knowledge regarding elderly’s usage of digital healthcare platforms in contrast to the younger generation and added an explanation of factors that influence the usage behavior. In addition, we strengthen current theory by highlighting the importance of examining influencing factors rather than chronological age. Our practical contributions address both platform owners and healthcare professionals and aims to give direction in how these two actors should act to increase usage among the elderly generation, where design of the platform and information are especially essential to take into consideration.