Bakgrund: Diabetes typ 2 är en folkhälsosjukdom som har ökat markant i världen. Kroppen har svårt för att reglera och hålla sockerhalten i blodet vid diabetes typ 2. En behandling kan vara livsstilsförändring i form av ökad fysisk aktivitet samt ändrade matvanor. Livsstilsförändringar bidrar till en bättre hälsa och diabeteskomplikationer minskas. Studien fokuserar på livsstilsförändringar relaterat till fysisk aktivitet och kost. Hälsofrämjande omvårdnad kan användas för att stärka patientens möjlighet till att uppnå en god egenvård vid diabetes typ 2. Sjuksköterskan ska få en förståelse hur patienten upplever livsstilsförändringar vid diabetes typ 2.  Syfte: Syftet med studien var att beskriva patienters upplevelser av att genomföra livsstilsförändringar vid diabetes typ 2. Metod:Föreliggande studie genomfördes som en litteraturstudie. Den baserades på 9 kvalitativa vetenskapliga artiklar. Analysen genomfördes av inspiration från Graneheim och Lundman, en beskrivning av en kvalitativ innehållsanalys på manifest nivå. Resultat: Det framkom i föreliggande studie två kategorier och en underkategori; stöd och utmaningar i sociala relationer, upplevelser av att hitta motivation och en ny mening med livet. De sociala relationerna kunde bidra med både positiv och negativ inverkan vid genomförandet av livsstilsförändringar. Motivationen sågs som den avgörande faktorn vid genomförandet och kunde bidra till en positiv eller negativ effekt. Negativ motivation var ett stort hinder vid genomförandet och den positiva motivationen kunde resultera med en ny mening med livet. Slutsats: I föreliggande studie framkom det att genomförandet av livsstilsförändringar var utmanande och många reagerade olika. Trots svårigheterna att upprätthålla förändringarna upplevde patienterna välbefinnande. Patienten är i behov av en personcentrerad omvårdnad för att kunna hitta motivation för att finna sin egen väg till hälsa.

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Background: The parents’ child with type 1 diabetes are responsible to make glucose measurements several times a day and by that have the primary responsibility for the child's health. This results in a new life for the parents. Aim: To describe parents' experiences to live and care for a child with type 1 diabetes. Method: A qualitative literature-based method by systematically searching through Pubmed and Cinahl about 10 selected articles. Results: The article revealed five main themes: Parents' increased responsibility, Parents' longing for a normal life, How the surroundings lack of knowledge affects you, The Healthcare system responsibility, Parents' painful emotions and feelings. Based on these five themes eleven sub themes emerged: The fight for a stable blood sugar level, Constant surveillance, Not limits the child’s daily activities, Parents' life change, School staff and friends' significant support, Constantly educating the surroundings, The importance of Care support, Your own need for knowledge, Continuous worries and fear, Feeling guilt over right treatment and care of the child, Inevitable exhaustion and burnout. Discussion: A nurse can learn a lot from the parents' experiences of living with a child diagnosed with type 1 diabetes and by that create valuable support for the parents. The discussion involves parents' worries and feelings of fear and guilt. The very important responsibility that the health care system has is discussed in relation to the parents. Mothers were mainly the ones who distributed the care of their child’s type 1 diabetes

Bakgrund: Diabetes mellitus typ 2 är den mest ökande och livshotande metaboliska sjukdomen i världen. I Sverige var 468 402 patienter diagnostiserade med sjukdomen år 2022. Patienten har ett stort ansvar för att utföra egenvård och genomföra nödvändiga livsstilsförändringar för att förebygga sjukdomsrelaterade komplikationer. Exempel är att förändra kost- och motionsvanor. Syftet: Att beskriva sjuksköterskors erfarenheter av egenvård hos patienter med diabetes mellitus typ 2. Metod: Litteraturöversikten som genomfördes hade en kvalitativ ansats. I studien inkluderades 12 kvalitativa vetenskapliga studier. Analysen av studierna genomfördes i enlighet med de fem steg som Friberg (2022a) rekommenderar. Resultat: Vid analys av studierna som ingick i materialet identifierades tre teman och sex subteman. Tema Utmaningar i att stödja till egenvård med subtema Hinder för egenvård och Kulturella värderingar och religiösa övertygelsers påverkan. Tema Betydelsen av kommunikation med subtema Att övertyga betydelsen av egenvård och Att skapa relation med patienterna. Tema Kunskapens betydelse med subtema Kunskapsbrist hos patienterna och Patientens behov av utbildning. Slutsats: I ett mångkulturellt samhälle är det viktigt att öka kulturella kompetenser bland sjuksköterskor för att kunna stödja personer med diabetes typ 2 till genomförandet av egenvård. Kommunikationen mellan sjuksköterskor och patienter bör anpassas efter de behov och förutsättningar individen har, där en god relation är central. Dessutom behövs strategier utvecklas för att öka patienternas kunskap om sjukdomen. / Background: Diabetes mellitus type 2 is the most increasing and life-threatening metabolic disease in the world. In Sweden, 468,402 patients were diagnosed with the disease in 2022.The patient has a great responsibility for performing self-care and implementing the necessary lifestyle changes to prevent disease-related complications. Examples are changing diet and exercise habits. Purpose: To describe nurses' experiences of self-care in patients with diabetes mellitus type 2. Method: The literature review conducted had a qualitative approach. The study included 12 qualitative scientific studies. The analysis of the studies was done according to the five steps Friberg (2022a) recommends. Results: When analyzing the studies included three themes and six subthemes were identified. The theme, Challenges in supporting self-care with subtheme, Obstacles to self-care and Influence of cultural values and religious beliefs. The theme, Importance of communication, with subtheme Convincing the importance of self-care and Creating a relationship with the patients. The theme, Importance of knowledge with subtheme Lack of knowledge in patientsand Patient's need for education. Conclusion: In a multicultural society, it is important to increase cultural competence among nurses to support people with type 2 diabetes to implement self-care. Communication between nurses and patients should be adapted to the needs and conditions of the individual, where a good relationship is central. In addition, strategies need to be developed to increase patients' knowledge of the disease.

Introduction: Diabetes management in very young children remains challenging. Glycaemic targets are achieved at the expense of high parental diabetes management burden and frequent hypoglycaemia, impacting quality of life for the whole family. Our objective is to assess whether automated insulin delivery can improve glycaemic control and alleviate the burden of diabetes management in this particular age group. Methods and analysis: The study adopts an open-label, multinational, multicentre, randomised, crossover design and aims to randomise 72 children aged 1-7 years with type 1 diabetes on insulin pump therapy. Following screening, participants will receive training on study insulin pump and study continuous glucose monitoring devices. Participants will be randomised to 16-week use of the hybrid closed-loop system (intervention period) or to 16-week use of sensor-augmented pump therapy (control period) with 1-4 weeks washout period before crossing over to the other arm. The order of the two study periods will be random. The primary endpoint is the between-group difference in time spent in the target glucose range from 3.9 to 10.0 mmol/L based on sensor glucose readings during the 16-week study periods. Analyses will be conducted on an intention-to-treat basis. Key secondary endpoints are between group differences in time spent above and below target glucose range, glycated haemoglobin and average sensor glucose. Participants' and caregivers' experiences will be evaluated using questionnaires and qualitative interviews, and sleep quality will be assessed. A health economic analysis will be performed. Ethics and dissemination: Ethics approval has been obtained from Cambridge East Research Ethics Committee (UK), Ethics Committees of the University of Innsbruck, the University of Vienna and the University of Graz (Austria), Ethics Committee of the Medical Faculty of the University of Leipzig (Germany) and Comité National d'Ethique de Recherche (Luxembourg). The results will be disseminated by peer-reviewed publications and conference presentations.

Ginger belongs to the family of Zingiberaceae and has been utilized by mankind since ancient times to cure the common cold, headaches, nausea and stomach ache. Scientific studies have shown that ginger possess anti-microbial, anti-inflammatory, antipyretic, antioxidative, hypoglycemic, hepatoprotective and diuretic characteristics. Newly conducted studies have indicated that ginger also has antidiabetic effects. Ginger contains several substances and two of these are the enolic compounds gingerol and shogaol which may contribute to gingers antidiabetic effect. Diabetes type 2 is a condition where the pancreas can´t produce a sufficient amount of insulin, mainly due to insulin resistance. Increased blood glucose levels can eventually damage both large and small blood vessels which increases the risk of developing atherosclerosis. When the small blood vessels are damaged it can affect the blood supply to the eyes, kidneys and various parts of the nervous system. This could lead to reduced vision, kidney failure and decreased blood circulation. Firsthand treatment for type 2 diabetes is lifestyle changes which include dietary changes, increased exercise/activity and weight loss. When this isn’t enough oral medication, that stimulate the pancreas insulin production and increases the tissues sensitivity to insulin, is given. The purpose of this report is to answer the question: Can ginger be used as a complement to pharmaceutical treatment of diabetes type 2? This is a literature study where Pubmed and Google Scholar were used to search for scientific studies about gingers effect on patients with diabetes type 2. The result showed that ginger has a hypoglycemic effect in patients with type 2 diabetes. This effect seems to be dependent on dosage. Ginger seems to affect insulin resistance and insulin sensitivity in a positive way. The result also shows that ginger affect blood lipids, this result varied in the different studies, but conclusively it showed that it could decrease triglycerides and low density lipoprotein. It can occur a mild chronic inflammation in patients with type 2 diabetes. Ginger is known to be anti-inflammatory which can be considered an antidiabetic effect. The result in this study shows that some inflammatory markers decrease in patients with diabetes type 2. Despite different results all the studies in this report show that ginger has several antidiabetic effects. Ginger seems to have a positive effect on blood glucose levels, insulin resistance, blood lipids and inflammation. So to answer the question: Can ginger be used as a complement to pharmaceutical treatment of diabetes type 2? Yes, ginger seems to contribute to a antidiabetic effect and would be an good addition to the regular treatment of a patient with diabetes type 2.

Deregulation of the epigenome is associated with the initiation and progression of various types of human cancers. Here we investigated the level of 5-hydroxymethylcytosine (5hmC), expression and function of TET1 and TET2, and DNA methylation in parathyroid tumors and small intestinal neuroendocrine tumors (SI-NETs). In Paper I, an undetectable/very low level of 5hmC in parathyroid carcinomas (PCs) compared to parathyroid adenomas with positive staining, suggested that 5hmC may represent a novel biomarker for parathyroid malignancy. Immunohistochemistry revealed that increased tumor weight in adenomas was associated with a more aberrant staining pattern of 5hmC and TET1. A growth regulatory role of TET1 was demonstrated in parathyroid tumor cells. Paper II revealed that the expression of TET2 was also deregulated in PCs, and promoter hypermethylation was detected in PCs when compared to normal parathyroid tissues. 5-aza-2′-deoxycytidine treatment of a primary PC cell culture induced TET2 expression and further supported involvement of promoter hypermethylation in TET2 gene repression. TET2 knockout demonstrated a role for TET2 in cell growth and migration, and as a candidate tumor suppressor gene. In Paper III, variable levels of 5hmC, and aberrant expression of TET1 and TET2 were observed in SI-NETs. We demonstrated a growth regulatory role for TET1, and cytoplasmic expression with absent nuclear localization for TET2 in SI-NETs. In vitro experiments supported the involvement of exportin-1 in TET2 mislocalization, and suggested that KPT-330/selinexor, an orally bioavailable selective inhibitor of exportin-1 and nuclear export, with anti-cancer effects, could be further investigated as a therapeutic option in patients with SI-NETs. In Paper IV, DNA methylation was compared between SI-NET primary tumors and metastases by reduced representation bisulfite sequencing. Three differentially methylated regions (DMR) on chromosome 18 were detected and chosen for further analyses. The PTPRM gene, at 18p11, displayed low expression in SI-NETs with high levels of methylation in the presumed CpG island shores, and in the DMR rather than the promoter region or exon 1/intron 1 boundary. PTPRM overexpression resulted in inhibition of cell growth, proliferation, and induction of apoptosis in SI-NET cells, suggesting a role for PTPRM as an epigenetically deregulated candidate tumor suppressor gene in SI-NETs.

Bakgrund: Graves sjukdom är den vanligaste formen av hypertyreos med en incidens på 20 fall per 100 000 individer och år. Graves sjukdom är ett autoimmunt tillstånd där autoantikroppar riktade mot tyreoideastimulerande hormonreceptorer (TSH-R) orsakar okontrollerad syntes och sekretion av tyreoideahormonerna trijodtyronin (T3) och tyroxin (T4). Hur tillståndet uppkommer är inte fullständigt förstått, riskfaktorer inkluderar dock rökning, kvinnligt kön och emotionell stress. Det finns i dagsläget tre etablerade behandlingsmetoder vid Graves sjukdom, dessa är tyreostatikabehandling, radiojodbehandling och tyreoidektomi. Behandling med tyreostatika pågår i regel i 12-18 månader, efter avslutad behandling är risken för recidiv mellan 50-60%. Både tyreoidektomi och radiojodbehandling är definitiva behandlingsmetoder som för majoriteten innebär övergång i hypotyreos med livslångt behov av levotyroxin-(LT4)behandling. Syfte: Syftet med examensarbetet var att undersöka långvarig effekt av radiojodbehandling vid Graves sjukdom och hur radiojodbehandling påverkar livskvalitet. Metod: Arbetet utfördes som en litteraturstudie, en sökning efter kliniska studier gjordes i PubMed med sökorden ”Graves disease” AND ”iodine radioisotopes”. Totalt åtta artiklar som i praktiken baserades på fem studier inkluderades i litteraturstudien. Resultat: Studie 1A, 1B och 1C var uppföljningsstudier av en tidigare utförd randomiserad klinisk studie. I studie 1A sågs det att samtliga individer som behandlats för Graves sjukdom hade sämre livskvalitet än den generella befolkningen 14-21 år efter behandling, ingen skillnad kunde ses beroende på behandlingsmetod. Studie 1B visade att skillnaderna i livskvalitet som funnits i studie 1A inte berodde på tyreoideahormonstatus. Resultaten i studie 1C visade att autoimmun aktivitet i form av tyreoideastimulerande hormonreceptorantikropp(TRAk)-nivåer var förhöjda bland individer som behandlats med radiojod i samtliga fem år som uppföljningen skedde, bland tyreostatika- och kirurgibehandlade individer var TRAk-nivåer normaliserade ett år efter behandling.  Studie 2 visade att tidig insättning av LT4 efter radiojodbehandling kunde förebygga försämring i livskvalitet de sex första månaderna efter radiojodbehandling. I studie 3 sågs det att större andel individer utvecklade oftalmopati efter radiojodbehandling jämfört med tyreostatika, vidare sågs sämre livskvalitet bland individer som utvecklat oftalmopati jämfört med individer utan oftalmopati. Studie 4 eftersökte optimumdosering av radiojod för att uppnå eutyreos bland individer med Graves sjukdom, det fanns att 1,85 MBq/g resulterade i eutyreos hos 72% 12 år efter behandling. I studie 5A sågs det att majoriteten av radiojodbehandlade individer övergick i hypotyreos samt att andelen som upplevde återställning 6-10 år efter diagnostisering var mindre bland de som efter behandling av Graves sjukdom var i behov av LT4-behandling. Studie 5B visade att radiojodbehandlade individer hade sämre livskvalitet jämfört med individer som behandlats med tyreostatika eller kirurgi 6-10 år efter behandling av Graves sjukdom. Vidare hade hela studiepopulationen, oavsett behandlingsmetod, sämre livskvalitet jämfört med den generella populationen. Slutsats: På grund av skillnader i upplägg och utfallsvariabler i de inkluderade studierna kan inga generella slutsatser dras utifrån samtliga studieresultat. Sammantaget sågs dock att individer som behandlats för Graves sjukdom har sämre livskvalitet jämfört med den generella befolkningen många år efter behandling. Det förefaller finnas ökad risk för sämre livskvalitet efter radiojodbehandling av Graves sjukdom jämfört med tyreostatika och tyreoidektomi, det krävs dock fler studier för att säkerställa dessa resultat samt undersöka hur och varför radiojodbehandling påverkar livskvalitet. / Graves´ disease is an autoimmune disease resulting in uncontrolled auto antibody-mediated secretion of the thyroid hormones triiodothyronine (T3) and thyroxine (T4). Graves´ disease is the most common cause of hyperthyroidism and has an annual incidence of 20 cases per 100 000 inhabitants. The pathogenesis of the disease is not yet fully understood, but risk factors include smoking, female gender and emotional stress. Since thyroid hormones act in almost every cell in the body, an imbalance in thyroid hormone levels can lead to severe consequences and affected quality of life. Symptoms of Graves´ disease include weight loss, tremor, tachycardia, heat intolerance, increased sweating, anxiety, fatigue and loss of libido.  There are three established treatment approaches for Graves´ disease including antithyroid drugs, radioiodine treatment and surgical thyroidectomy. The treatment goal for Graves´ disease is to stop the hyperthyroid state and reduce the risk of complications from the condition. Antithyroid drugs is the treatment modality most frequently used in newly diagnosed Graves´ disease and the duration of treatment is normally 12-18 months. The risk of recurrence after antithyroid drugs is 50-60%. Both radioiodine treatment and surgery are considered definitive treatments for Graves´ disease, the majority of treated individuals become hypothyroid with a life-long need for levothyroxine (LT4) treatment. The three available treatment options have both advantages and disadvantages that should be discussed with the patient in each individual case.  The aim of this study was to evaluate the long-term effects of radioiodine treatment for Graves´ disease and how radioiodine treatment affects the quality of life.  This is a literature study based on eight articles that, in practice, were based on five different clinical trials. The included studies were collected from the database PubMed. Since the included studies were different in both study design and outcome, no general conclusion can be drawn from all of the included studies. Two of the studies examined long-term effects on the quality of life of radioiodine treatment for Graves´ disease. Both studies found that persons diagnosed with Graves´ disease have a lower quality of life many years after treatment compared to the general population. The quality of life in individuals treated for Graves´ disease seems to be lower than the general population regardless of thyroid hormone state and mode of treatment. There seems to be an increased risk for lower quality of life among individuals treated with radioiodine compared to antithyroid drugs and surgery. Early administration of LT4 after radioiodine treatment could prevent worsening of quality of life according to the short form health survey (SF-36), whilst the long-term need for LT4 treatment after treatment of Graves´ disease is associated with a lower chance of feeling fully recovered 6-10 years after diagnosis.  There is a need for future studies to determine the effects of radioiodine treatment, especially regarding the long-term quality of life. There is also a need to determine the pathogenesis of Graves´ disease and to find new treatment options for the disease since the established treatment methods result in chronic illness or risk of recurrence.

Bakgrund Patienter med diabetes typ 2 kan reducera riskerna för framtida komplikationer som till exempel hjärtsjukdomar och stroke med hjälp av egenvård. En förbättring av följsamhet till egenvård kan leda till ett minskat lidande hos patienten och bidra till en bättre livskvalitet. Syfte Syftet är att sammanställa forskningsbaserad kunskap om vilka faktorer som påverkar vuxna patienters följsamhet till egenvårdsråd vid diabetes typ 2. Metod Examensarbetet är en strukturerad litteraturstudie med en inslag av den metodologi som används vid systematiska översikter. Databasen Cinahl har använts i artikelsökningen där 14 artiklar analyserats. Resultat Följsamhet till egenvård påverkas av olika faktorer varav tre identifierades: Informationsförmedling till patient, telekommunikation som hjälpmedel samt personliga och sociala faktorer som alla bidrog till en god följsamhet till egenvårdsråd. Slutsats Det är betydelsefullt att försöka uppmärksamma individens förutsättningar för att utbildning, digitala tjänster och involvering av familj kan ske anpassad efter den enskilde individen. Att stärka självtilltien hos individen är dessutom en avgörande faktor för en god följsamhet. / Background Patients with diabetes type 2 can reduce the risks for further complications like for instance cardiovascular disease and stroke by self-care. By improving adherence to selfcare the suffering can be decreased and in the same time contribute to improve the health and quality of life for the patient. Aim The purpose of this literature review was to describe factors that can influence adult patient´s compliance to self-care in type 2 diabetes. Method The database Cinahl has been used to this literature review with 14 scientific articles included. Results Compliance to self-care is influated by different factors which are dissemination of information to the patient, telecommunications assistance and personal and social factors. These factors all contribute to better adherence to self-care. Conclusions To notice the characteristics of patients is an important factor to adjust education, digital services and the involvment of the family. Another key factor to improve compliance is to strenghten the patients self-efficacy.

Gender Dysphoria (GD) is defined as significant distress or impairment caused by the discrepancy between an individual's experienced gender and the sex assigned at birth. This work explores the etiology and outcomes of GD through two studies. The first assesses its prevalence in different twin categories, and the second examines the incidence of idiopathic intracranial hypertension (IIH) in individuals undergoing gonadotropin-releasing hormone analogue (GnRHa) treatment for GD. The first study utilizes a population-based approach to analyze the prevalence of GD in twins, using data from a Swedish population-based cohort collected over a 16-year period. The objective is to assess the influence of genetic and environmental factors on the development of GD by comparing its prevalence in different-sex twins, same-sex twins, and non-twin siblings. The results indicate a higher prevalence of GD in different-sex twins and suggest a potential influence of intrauterine factors in the development of GD, necessitating further examination of current genetic and environmental theories. The second study focuses on evaluating the occurrence of IIH in individuals undergoing treatment with GnRHa for GD in Sweden between 2006 and 2016. The study did not observe any cases of IIH within the studied cohort. While better-powered studies are needed to clarify any potential association between GnRHa and IIH, the study results do not present substantial evidence to support this association.