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Introduktion/bakgrund: Barn kan drabbas av olika sjukdomstillstånd vilket påverkar såväl deras allmänna hälsa som orala hälsa. Diabetes typ 1 är ett sjukdomstillstånd som kräver vård av god kvalitet. Alla barn är olika och personcentrerad vård som teoretisk bas kan bidra till att sätta det unika barnets behov i centrum. Syfte: Syftet med denna litteraturstudie var att beskriva riskfaktorer för orala sjukdomar hos barn med diabetes typ 1. Metod: En litteraturstudie utfördes genom att systematiskt utföra sökningar i databaserna PubMed och CINAHL. Kvalitetsgranskning med granskningsmallar från SBU utfördes i urvalsprocessen. Av totalt 766 antal artiklar inkluderades 11 artiklar. Resultat: Resultatet baseras på 11 vetenskapliga artiklar från 9 länder och redovisas med följande underrubriker; ”Oral sjukdom och okontrollerad diabetes”, ”Oral egenvård” och ”Omgivande faktorer”. Resultatet visade att kost och okontrollerad diabetes, dålig oral egenvård och bristande samhälleliga skyddsfaktorer är riskfaktorer för orala sjukdomar hos barn med diabetes typ 1. Slutsats: Denna litteraturstudie visar att det finns flera riskfaktorer för orala sjukdomar hos barn med diabetes typ 1, både på samhällelig och individuell nivå. Samhället kan bidra till ökade resurser för att öka samverkan mellan de aktuella barnen, vårdnadshavare och hälso- sjukvård, socialtjänst, tandvård och skola. På individnivå behöver vårdprocesser vara förankrade i personcentrerad vård. / Introduction/background: Children can suffer from various medical conditions which affect both their general health and oral health. Diabetes type 1 is a medical condition that requires good quality of care. All children are different and person-centred care as theoretical foundation can contribute to put every child's needs in focus. Aim: The aim of this literature study was to describe risk factors for oral diseases in children with type 1 diabetes. Method: A literature study was performed by systematically searching the databases PubMed and CINAHL. Quality review with review templates from SBU were performed in the process. Out of a total of 766 articles, 11 articles were included. Results: The result is based on 11 scientific articles from 9 countries and is reported with the following subheadings; "Oral disease and uncontrolled diabetes", "Oral self-care" and "Ambient factors". The results showed that diet and uncontrolled diabetes, bad oral self- care and lack of societal preventive factors are risk factors for oral diseases. Conclusion: This literature study shows that there are many risk factors for oral diseases in children with type 1 diabetes, at both societal and individual levels. Society can contribute to increased resources to increase professional collaboration between the children, caregivers and health care, social services, dental care and school in order to offer person-centered care.

Bakgrund: Diabetes mellitus typ2 (DMT2) är en folksjukdom som förväntas öka globalt varje år. Egenvård är avgörande för att minska utvecklingen av DMT2 och fördröja komplikationer genom att tillämpa hälsosam livsstil samt främja och bibehålla en god hälsa. Syfte: Syftet var att beskriva vuxna individers erfarenhet av egenvård vid Diabetes mellitus typ 2. Metod: En kvalitativ litteraturöversikt med en induktiv ansats användes. Fribergs femstegsmodell tillämpades under analysprocessen. Resultat: Utmaningar med egenvård inkluderade att individerna inte var följsamma och glömde att ta sina mediciner. Genom att dela erfarenheter om DMT2 bidrog individerna till kunskapsutbyte och lärde sig av varandras strategier för att främja god hälsa. Stöd från sjukvård, familj och vänner ökade motivationen för att förändra livsstil och följa behandlingsplanen. Brister i kompetens och uppföljning från sjukvården skapade osäkerhet hos individerna. Slutsats: Individens inställning och hälsosamma livsstil är avgörande för egenvården av DMT2, vilket kan minska risken för komplikationer. Stöd från sjukvården och anhöriga är betydelsefullt och kan främja en hälsosam livsstil och välbefinnande.  Nyckelord: Diabetes Mellitus Typ 2, egenvård, erfarenhet, kvalitativ, livsstil. / Title: The individual's experience of self-care in Diabetes Mellitus Type 2-A qualitative literature review.  Background: Diabetes mellitus type 2 is a complex public health issue that’s expected to increase globally each year. Self-care is crucial to reduce the progression of DMT2 and delay complications by adopting a healthy lifestyle to promote and maintain good health. Aim: The aim was to describe the experiences of adult individuals with self-care in Diabetes mellitus type 2. Methods: A qualitative literature review with an inductive approach was used. Friberg´s five-step model was applied during the analysis process. Results: Challenges with self-care included individuals not being compliant and forgetting to take their medications. By sharing experiences about DMT2, individuals contributed to knowledge exchange and learn from each other strategies to promote good health. Support from healthcare, family and friends increased motivation to change lifestyle and follow the treatment plan. Lack of competence and follow-up from healthcare providers created uncertainty among individuals.  Conclusion: The individual's attitude and healthy lifestyle are crucial for self-care of Diabetes Mellitus type 2, which can reduce the risk of complications. Support from healthcare providers and family members is significant and can promote a healthy lifestyle and well-being.  Keywords: Diabetes mellitus typ 2, experiences, lifestyle, qualitative, self-care.

Bakgrund: Sjuksköterskans specifika kompetens är omvårdnad. Personcentrerad vård fokuserar på att se varje patient som en unik person med individuella behov. Vid diabetes har sjuksköterskan en viktig pedagogisk och handledande funktion för att stärka patientens förmåga att hantera sjukdomen. Sjuksköterskans ansvarsområde vid diabetes består av att ge information och bedöma patientbehov samt ge teoretisk och praktisk utbildning till alla diabetespatienter för att underlätta egenvården. Syfte: Att beskriva personer med diabetes typ 2 erfarenheter av att utföra egenvård. Metod: En beskrivande litteraturstudie innehållande 9 kvalitativa vetenskapliga artiklar. De vetenskapliga artiklarna har hittats eftersökning i databasen PubMed. Huvudresultat: Vid sociala sammanhang förekommer det svårigheter med att hålla sin kost, vilket kan leda till skuldkänslor och bli en psykologisk börda för personer med diabetes typ 2. Flera hinder för egenvård presenterades, alla med påverkan på blodsockernivån. Användning av mobilapp resulterade i att många av användarna lärde sig tolka blodsockervärden och identifiera mönster i aktivitetsnivå, kost och blodsockernivå och samband mellan dem för att kunna hålla blodsockret på en bra nivå. Utbildning är en viktig del i att ändra beteende gällande egenvård. Tillräcklig kunskap om sjukdomen, sekundära sjukdomar och åtgärder för att påverka sjukdomen möjliggör anpassning gällande livsstilen. Slutsats: Sjuksköterskor bör arbeta personcentrerat och för att kunna göra det är det bra att de får en inblick i hur diabetes typ 2 kan påverka personens liv och att det är mer som tillhör egenvård än vad man tänker på när man hör ordet. / Background: The nurse's specific competence is nursing. Person-centered care focuses on seeing each patient as a unique person with individual needs. In the case of diabetes, the nurse has an important educational and supervisory function to strengthen the patient's ability to manage the disease, also providing information and assessing patient needs as well as providing theoretical and practical training to all diabetes patients to facilitate self-care. Purpose: To describe people with diabetes type 2 experience with self-care. Method: A descriptive literature study including 9 qualitative scientific articles. The scientific articles were found through searching the database PubMed. Main result: Social contexts can mean difficulties with maintaining one's diet and feelings of guilt. It is a psychological burden for people with type 2 diabetes. Several barriers to self-care were presented. Using the mobile app resulted in many of the users learning to interpret blood sugar values and identify patterns in activity level, diet and blood sugar level and the relationship between them to keep blood sugar at a satisfactory level. Sufficient knowledge of the disease, secondary diseases, and measures to influence the disease enable adaptation regarding the lifestyle. Conclusion: Nurses should work person-centered and to be able to do that it is good that they get an insight into how diabetes type 2 can affect the person's life and that there is more to self-care then what comes to mind when you hear the word.

Bakgrund: Diabetes mellitus typ 2 utgör en växande utmaning för global hälsa. Detta är en kronisk sjukdom som påverkar hur kroppen hanterar blodsockret. Stöd till egenvård är en central del i behandlingen av denna sjukdom. Syftet: Syftet var att beskriva sjuksköterskors erfarenheter av att ge stöd till egenvård hos patienter med diabetes mellitus typ II.Metod: En kvalitativ litteraturöversikt med induktiv ansats har tillämpats, där det baserades på 12 vetenskapliga artiklar. Dessa vetenskapliga artiklar var från år 2013–2023. Databaserna som användes var Medline och Cinahl samt Fribergs fem stegs analysmetod.Resultat: I litteraturöversikten framkom två teman: "Sjuksköterskors erfarenheter av utmaningar i egenvårdsstöd" och "Sjuksköterskors erfarenheter av att skapa möjligheter för att stödja egenvård". Utifrån teman framkom följande subteman: "bristande kunskaper om sjukdomen", "att vägleda patienter", "att samarbeta i team", "att ge personcentrerad vård" och "kommunikation med patienter".Slutsats: Inom diabetesvården visade resultatet att sjuksköterskor har olika erfarenheter av att ge stöd till egenvård.  Resultatet visade även att kommunikation och att samarbeta i team var viktiga aspekter för att möjliggöra egenvårdsstöd. Sjuksköterskor ansåg att egenvårdsstöd främjades när de arbetade personcentrerad.Nyckelord: Samarbeta i team, kommunikation, personcentrerad vård, bristande kunskaper. / Background: Type 2 diabetes mellitus poses a growing challenge to global health. This is a chronic condition that affects how the body manages blood sugar. Support for self-care is a central component in the treatment of this disease.Purpose: The purpose was to describe nurses' experiences of providing self-care support to patients with type 2 diabetes mellitus.Method: A qualitative literature review with an inductive approach was applied, based on 12 scientific articles. These scientific articles were from the years 2013–2023. The databases used were Medline and Cinahl, along with Friberg's five-step analysis method.Results: The literature review revealed two themes: "Nurses' experiences of challenges in self-care support" and "Nurses' experiences of creating opportunities to support self-care." Based on these themes, the following subthemes emerged: "lack of knowledge about the disease," "guiding patients," "collaborating in teams," "providing person-centered care," and "communication with patients."Conclusion: Within diabetes care, the results showed that nurses have different experiences of providing self-care support. The results also indicated that communication and collaboration in teams were important aspects in enabling self-care support. Nurses believed that self-care support was promoted when they worked in a person-centered manner. Keywords: Collaborate in teams, communication, person-centered care, lack of knowledge.

The mechanical properties of the arterial wall are of great importance for blood pressure regulation and cardiac load. With increasing age, large arteries are affected by increased wall stiffness. Furthermore, atherosclerotic manifestations may increase the stiffness even further, both processes acting as independent cardiovascular risk factors affecting the arterial system in a heterogeneous way. The aims of this thesis was to characterize the local mechanical properties of brachial artery (BA) with the aid of ultrasound technique and to evaluate the influence of 1) age, gender, sympathetic stimulation and examination site; 2) type 1 diabetes (DM) and its association to circulatory biomarkers; and 3) to evaluate the general properties of the arterial system with the aid of pulse wave velocity (PWV) as well as pulse wave analysis (PWA) in systemic lupus erythematosus (SLE) and correlate the findings to disease activity and circulatory biomarkers. In the most proximal arterial segment of the upper arm a pronounced age-related decrease in wall distensibility, increase in intima-media thickness (IMT), and a slight increase in diameter were seen. Sympathetic stimulation had no influence on wall mechanics. More distally in BA, no change in diameter, and only minor increase in IMT and decrease in distensibility were seen. No gender differences were found. These findings suggest that the principle transit zone between elastic and muscular artery behaviour is located in the proximal part of the upper arm. Women with uncomplicated insulin-dependent DM had similar diameter, IMT and distensibility in their distal BA as controls, whereas flow-mediated dilatation (FMD) was slightly, and nitrate mediated dilatation (NMD) markedly reduced. NMD was negatively correlated with higher HbA1c levels. Vascular smooth muscle cell function seems to be an early manifestation of vascular disease in women with DM, influenced by long-term hyperglycaemia. Women with SLE had increased aortic PWV compared to controls, a finding positively associated with increased levels of complement factor 3 (C3), but not with disease activity. The increased stiffness of central arteries may be one factor contributing to the increased cardiovascular risk seen in SLE.

In den letzten fünf Jahren gelang es, drei neue genetische Krankheitsbilder aus dem Kreis der pädiatrischen Endokrinologie klinisch zu beschreiben und deren genetische Grundlage aufzuklären. Hierbei waren vor allem die klinischen Erscheinungsbilder ungewöhnlicher Patienten, die neben bekannten hormonellen Ausfällen durch assoziierte Defekte auffielen, für die gezielte Suche nach genetischen Defekten ausschlaggebend. In allen drei Fällen konnten die assoziierten Symptome durch den primären genetischen Defekt molekular geklärt werden. Mittlerweile ist bei weiteren Patienten ein Mutationsnachweis gelungen und der zuerst von uns beschriebene Phänotyp konnte jeweils bestätigt werden. Bei den beschriebenen defekten handelt es sich um den POMC Gendefekt (klinisches Bild: Adipositas, rote Haarfarbe und Hypocortisolismus), den LHX3 gendefekt (klinisches Bild: Hypopituitarismus und Enschränkung der Haslrotation) und den NKX2.1 Gendefekt (klinisches Bild: Angeborene Hypothyreose und Choreoathetose). / In the last few years'' three new genetic syndromes were described which affect diseases within the field of paediatric endocrinology. The clinical picture of uncommon patients, which are affected beside known endocrine defects by additional associated symptoms, led to the molecular differential diagnosis which resulted in the description of new mutations. In all three cases the additional symptoms could be explained by the identified genetic defect. Meanwhile additional patients were identified with mutations in the affected genes, which confirmed the initial description of the new clinical diseases. The identified syndromes are: POMC gene defect (clinical picture: obesity, red hair, hypocortisolism), LHX3 gene defect (clinical picture: hypopituitarism and decreased neck movement) and NKX2.1 gene defect (clinical picture: congenital hypothyroidism and choreoathetosis).

Made available in DSpace on 2016-01-26T12:51:13Z (GMT). No. of bitstreams: 1 pires_tese.pdf: 363791 bytes, checksum: af03ea5388a25575042d8de8b77224dd (MD5) Previous issue date: 2003-02-23 / Acute Renal Failure can be defined as an abrupt and sustained reduction in the glomerular filtration rate with a consequent retention of nitrogenous waste products. Despite the development in treatment, mortality remains high, varying beetween 50 and 70%. In hospitalised patients the incidence is about 5% but in respect to intensive care units it varies from 10 to 30%. In the last three decades, the characteristics of patients who suffer from acute renal failure changed dramatically. Before the advent of dialytic treatment, the main causes of mortality were uraemia, hyperkalaemia and the cardiac complications arising from volume overload. Nowadays, the causes are sepsis, cardiopulmonary failure, nephrotoxic drugs, and post renal transplantation complications. Multiple organ dysfunction, disseminated intravascular coagulation and diabetes mellitus are morbid conditions that can aggravate the prognosis of acute renal failure in intensive care units. Due to the high prevalence of diabetes mellitus in the population, this study intends to evaluate its influence in the morbidity and mortality of patients suffering from acute renal failure in the intensive care unit of Hospital de Base of São José do Rio Preto, Brazil was made in the period from January 1997 to December 2000. A total of 255 (25%) of the patients were diabetic and 765 (75%) were not. Demographic data, the presence of underlying diseases, aetiology, types, the clinical features and complications of acute renal failure were evaluated. Besides these, the presence of multiple organ failure syndrome was observed. In the study population 64% were male, 46% were more than 60 years old and 85% had one or more concomitant diseases. The ischaemic aetiology predominated in 53% of cases and a clinical cause was the most common type seen at 57%. The means and standard deviations of the Apache II score and creatinine levels (mg/dL) were 20.5 + 6.7 and 3.7 + 2.0 respectively. The prevalence of disseminated intravascular coagulation, shock, liver failure and respiratory failure were 32%, 69%, 15% and 79% respectively. Among the observed complications hyperkalaemia was seen in 35%, acidosis in 70%, sepsis in 61%, systemic arterial hypertension in 14%, bleeding in 22%, central nervous system disfunction in 44% and mortality in 71% of the cases. The demographic data, clinical features, morbidity and mortality due to acute renal failure of diabetic and non-diabetic individuals were compared. The hyperkalaemia, acidosis, respiratory failure, shock, central nervous system dysfunction, hypervolaemia and the bleeding were similar in both groups. A logistic regression analysis did not demonstrate a significant association between diabetes mellitus and mortality. An ischaemic aetiology, the failure of three or more organs, hyponatraemia and acidosis exhibited significant association between mortality and acute renal failure. In conclusion, the diabetic patients were older involving fewer men, with less oliguria, disseminated intravascular coagulation, hyponatraemia and liver failure than the non-diabetic individuals. Diabetes mellitus had no influence on the mortality due to acute renal failure in the intensive care unit. / A insuficiência renal aguda pode ser definida como uma redução abrupta e sustentada da taxa de filtração glomerular com conseqüente retenção de produtos nitrogenados. Apesar da evolução terapêutica, a sua mortalidade ainda continua elevada, variando entre 50 e 70%. Em pacientes hospitalizados, a sua incidência está próxima de 5% e, especificamente, em unidades de terapia intensiva, varia entre 10 e 30%. Nas últimas três décadas, as características dos pacientes acometidos de insuficiência renal aguda alteraram-se profundamente. Antes do advento do tratamento dialítico, as principais causas de mortalidade eram a uremia, a hipercalemia e as complicações cardiológicas decorrentes da sobrecarga de volume. Atualmente, são a sepse, a insuficiência cardiopulmonar, drogas nefrotóxicas e complicações pós-transplante renal. Quanto ao prognóstico de insuficiência renal aguda em unidades de terapia intensiva, a disfunção de múltiplos órgãos, a coagulação intravascular disseminada e o diabete melito são condições mórbidas que podem piorar a sua evolução. Devido à alta prevalência de diabete melito na população, o presente trabalho propôs-se avaliar a sua influência na morbidade e mortalidade da insuficiência renal aguda em unidade de terapia intensiva. Para tal, foram estudados, retrospectivamente, 1020 pacientes com insuficiência renal aguda internados na unidade de terapia intensiva do Hospital de Base de São José do Rio Preto, Brasil, no período de janeiro de 1997 a dezembro de 2000, dos quais, 255 (25%) eram diabéticos e 765 (75%) não diabéticos. Foram avaliados dados demográficos, presença de doenças de base, etiologia, tipos, quadro clínico e complicações de insuficiência renal aguda e ainda a presença de síndrome de disfunção de múltiplos órgãos. Entre a população estudada, 64% eram do sexo masculino, 46% tinham mais de 60 anos de idade, e 85% tinham uma ou mais doenças concomitantes. Nota de Resumo A etiologia isquêmica predominou com 53%, e a causa clínica foi o tipo mais freqüente com 57%. As médias e os desvios padrão de apache II e creatinina (mg/dL) foram 20,56,7 e 3,7+2 O respectivamente. A prevalência de coagulação intravascular disseminada, de choque, de insuficiência hepática e respiratória foi 32%, 69%, 15% e 79%, respectivamente. Entre as complicações, observamos a hiperpotassemia em 35%, a acidose em 70%, a sepse em 61%, a hipertensão arterial sistêmica em 14%, os sangramentos em 22%, a disfunção do sistema nervoso central em 44% e a mortalidade em 71%. Foram comparados, entre os diabéticos e os não diabéticos, os dados demográficos, quadro clínico, morbidade e mortalidade de insuficiência renal aguda. A hipercalemia, a acidose, a insuficiência respiratória, a sepse, o choque, a disfunção do sistema nervoso central, a hipervolemia e os sangramentos foram similares em ambos os grupos. A análise de regressão logística não mostrou associação significante entre diabete melito e a mortalidade. A etiologia isquêmica, a presença de três ou mais insuficiências de órgãos, a hiponatremia e a acidose foram de forma significante associadas com a mortalidade de insuficiência renal aguda. Em conclusão, os diabéticos foram mais idosos, menor prevalência de masculinos, menos oligúria, coagulação intravascular disseminada, hiponatremia e falência hepática do que os não diabéticos. O diabete melito não teve influência na mortalidade da insuficiência renal aguda em unidade de terapia intensiva.

Made available in DSpace on 2016-01-26T12:51:10Z (GMT). No. of bitstreams: 1 marceloalexandrematos_dissert.pdf: 295732 bytes, checksum: b602897faf078224a99d93671326e504 (MD5) Previous issue date: 2006-05-24 / Objective: To evaluate the effects of sodium cyclamate on the rat placenta by its administration in the period of embryogenesis. Method: The sodium cyclamate was administered by intraperitoneal route in rats of the treated group at the dose of 60 mg/kg, from the tenth to fourteenth day of gestation, while the equivalent volume of saline solution was given to the control group, by the same route. On the twentieth day of pregnancy, 10 fetuses (5 from each group) were chosen at random for study. The technique of cariometry was utilized for evaluation of nuclear parameters of cells in deciduous and spongy layers, and of chorionic villi in the rat placenta. Results: The weights of treated fetuses and their placentas were less than those of the control group, while umbilical-cord length in the treated group was shorter than that in control fetuses. There were no alterations in the deciduous layer. In the placental spongy layer were found alterations of the following parameters: major diameter, mean diameter, perimeter, area, volume, the volume/area ratio and eccentricity. The altered parameters in chorionic villi were the following: mean diameter, perimeter, area, volume, the volume/area ratio. Conclusions: This study demonstrated placental alteration with the use of cyclamate by the pregnancy rat, and its repercussion in fetal weight and umbilical-cord length. / Objetivo: Avaliar os efeitos do ciclamato de sódio na placenta de ratas com sua administração no período da embriogênese. Método: Foi administrado por via intraperitoneal nas ratas do grupo tratado a dose de 60 mg / Kg de ciclamato de sódio, do décimo ao décimo quarto dia de gestação, e volume equivalente de solução salina no grupo controle, pela mesma via. No vigésimo dia de prenhez, 10 fetos (5 de cada grupo) foram escolhidos ao acaso para estudo. Foi utilizada a técnica de cariometria para avaliação dos parâmetros nucleares das células das camadas decídua, esponjosa e das vilosidades coriônicas da placenta de ratas. Resultados: O peso dos fetos tratados e de suas placentas foi menor que os do grupo controle, assim como o comprimento do cordão umbilical do grupo tratado foi mais curto que o dos fetos controles. Não houveram alterações na camada decídua. Na camada esponjosa placentária ocorreram alterações dos seguintes parâmetros: diâmetro maior, diâmetro médio, perímetro, área, volume, relação volume / área e excentricidade. Os parâmetros alterados nas vilosidades coriônicas foram os seguintes: diâmetro médio, perímetro, área, volume e relação volume / área. Conclusões: Este estudo demonstrou alteração placentária com o uso de ciclamato pela rata grávida, e sua repercussão no peso fetal e comprimento do cordão umbilical

This study examines the production and the introduction of a fertility treatment which gained great attention both in Sweden and internationally during the 1960s. In the procedure, hormones were extracted from human pituitary glands which had been collected from autopsies. After this, the hormones were purified and injected into the female patients as a treatment for certain kinds of sterility. Carl Gemzell, professor of obstetrics and gynecology at Uppsala University, was a key figure in the development of the treatment. He was described by the media as a medical pioneer and later became one of Sweden’s most famous doctors and scientists. The fertility treatment also gained a lot of attention in the media as ”the miracle drug that made barren women pregnant”, especially since it often resulted in multiple pregnancies. In the 1960s, pregnancies with quadruplets, quintuplets, sextuplets and even septuplets became world sensations. By using the sociology of expectations as theoretical approach, which focuses on the performativity of expectations and visions in science production, this study aims to investigate how expectations of an effective fertility method were articulated in both the scientific sphere and in the media. This of course also relates to how the risks of the multiple pregnancies were dealt with. The analysis is divided into three chapters, where the first chapter examines the politics of science in Sweden during the post-war period and how Gemzell’s work in Uppsala generated expectations of a scientific milieu on the front line of fertility research. The next chapter is focused on the media’s interest in Gemzell and how he became a celebrity. A central argument for the study is that his public status helped to create scientific credibility for the treatment, especially among the public. The final chapter focuses on the media reporting about the multiple pregnancies. They were often treated as sensations, which was somewhat paradoxical as they were hazardous and frequently resulted in the death of the premature children.