Puumala virus, belonging to the genus hantavirus, is the causative agent of nephropathia epidemica (NE), a relatively mild form of hemorrhagic fever with renal syndrome. Puumala virus occurs endemically in Central and Northern Europe and Western Russia. In Sweden, NE is reported from the northern and central parts but virtually not at all from the southern part of the country. The bank vole (Clethrionomys glareolus) is the main reservoir of Puumala virus and humans are infected by inhalation of aerosolized animal secreta. In northern Sweden, the density of the bank vole population varies cyclically in intervals of 3-4 years and the incidence of NE shows a covariation. The prevalence of serum antibodies to hantaviruses in northern Sweden was studied in a stratified and randomly selected adult population sample comprising 1538 subjects. As expected, the prevalence increased with age. There was no difference between men and women, which was unexpected based on a male:female ratio of &gt; 2:1 in clinical reports. By use of an immunofiuorescent assay, a seroprevalence of 5.4% and by a newly developed enzyme-linked immunosorbent assay (ELISA) with recombinant Puumala virus nucleocapsid protein as antigen, a prevalence of 8.9% was recorded. This is about or more than ten times higher than what would be calculated from clinical reports. By use of the ELISA, an occupational risk of acquisition of Puumala virus infection was demonstrated. Serum samples from 910 farmers and 663 referent subjects living in various rural parts of Sweden were tested. Among farmers from the Puumala virus-endemic northern and central parts of the country, the seroprevalence (12.9%) was higher (p=0.01) than in referents (6.8%). In the southern part of Sweden, only 2/459 persons had antibodies. Only a limited number of children with NE had been previously reported. In a separate study, 32 children with Puumala virus infection were identified and the clinical picture of NE in children was found to be similar to that of adult cases. Variations in the prevalence of Puumala virus in the bank vole population within an endemic region are not well known. Here, a higher mean rodent density and a higher prevalence of Puumala virus-specific serum antibodies were recorded in the vicinity of households afflicted with NE than in rural control areas. The data indicated that the risk of exposure locally within an endemic region may vary widely and tentatively suggested that a threshold density of bank voles might be necessary to achieve before effective spread of Puumala virus within the rodent population may occur. There is no firm evidence of the occurrence of Puumala virus among wild living animals other than rodents. A study of Swedish moose, an animal which is ecologically well characterized, was performed. Convincing evidence of past Puumala virus infection was found in 5/260 moose originating from Puumala virus-endemic areas but in none of 167 animals from nonendemic areas. Based on the low seroprevalence recorded, moose seemed to serve as endstage hosts rather than being active parts of the enzootic circle of transmission. In conclusion, the present investigations confirmed that the exposure to Puumala virus is geographically well restricted in Sweden. Seroprevalence studies indicated that only a minor proportion of individuals infected with Puumala virus are clinically reported, with a bias in favour of men. NE was confirmed to occur in children, with a clinical picture similar to that of adults. An occupational risk was defined for acquisition of Puumala virus infection. Studies in rodents suggested that there may be wide local variations within a limited area in the risk of exposure to Puumala virus. The studies validated the usefulness of a newly developed ELISA based on recombinant nucleocapsid peptides of hantaviruses and finally, methodological progress was reached when Puumala virus was, for the first time, successfully isolated from a Scandinavian patient. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1998</p> / digitalisering@umu

No description available.

Aim: To conduct a systematic review and meta-analysis of all published studies studying the risk of vitamin D deficiency in tuberculosis patients and in healthy controls. Additionally, subgroup meta-analysis was performed based on the level of vitamin D to test the risk in TB groups and in healthy groups. Methods: Pubmed was searched for observational studies in human and English that discussed the association between risk of low serum vitamin D and TB. Meta-analysis was performed on all relevant studies combined and for subgroups of each vitamin D level. Results: 22 studies were selected and pooled in the analysis. The results were consistent with previous studies examining the same risk. The overall log risk ratio (log RR) of low vitamin D was significantly higher in TB patients 1.68 times than healthy controls. In 4 subgroup meta- analyses based on vitamin D level below (20 nmol/L, 30 nmol/L, 50 nmol/L, and 75 nmol/L), the risk of having low vitamin D in TB patients was (1.82, 2.89, 1.38, 1.32) respectively. That subgroup analysis showed more clearly the higher RR were below 20 and 30 nmol/L. The smallest RR was at 75 nmol/L level. Conclusion: This study verified the association between risk of low vitamin D level and TB development. It also clarified that, the risk increased by decreasing vitamin D level.

The increasing number of Extended Spectrum Beta-Lactamase (ESBL) producing Escherichia coli (E. coli) associated with sepsis in China is the reason for designing the current study. During 2014-2016, thirty hospitals representing 10 different provinces in China was involved in collecting E. coli isolates causing blood stream infections. Early treatment with suitable antibiotics have been found to be of lifesaving importance in the case of care for septic patients. Thorough understanding of the pathogens involved is therefore crucial. Using antimicrobial susceptibility testing, PCR and Multi Locus Sequence Typing (MLST), the molecular characteristics of ESBL producing E. coli isolates could be determined. This study can report that the most common ESBL producing genes found were CTX-M-14 (51 isolates, 45,5%), CTX-M-55 (23 isolates, 20,5%) CTX-M-15 (22 isolates, 19,6%). In addition, 2 isolates (1,8%) were found to be SHV-11 positive which is another ESBL producing gene. As a side finding, 5 isolates harbored Metallo-beta-lactamase (MBL) encoding genes such as NDM-5 and NDM-1 which were found to coexist with CTX-M-55 and CTX-M-14 respectively. An MLST analysis resulted in the finding of 25 different and 17 previously unknown (16,2 %) sequence types. The most common sequence types were ST131 (18 isolates, 17,1 %) as reported previously.  No significant differences in antimicrobial susceptibility were identified whether ESBL producing genes such as SHV and CTX-M was present or not. This study indicates that there could be novel resistance mechanisms present among those isolates not encoding the genes of interest. However, this finding requires further research before it can be confirmed.

Bakgrund: I slutet av 2019 upptäcktes ett nytt virus som fick namnet Covid-19. Viruset  orsakade  allvarlig  respiratorisk  sjukdomsbild  med  feber,  hosta  och andningssvårigheter.  Våren  2020  klassades  sjukdomsspridningen  som  en pandemi.  Antalet  insjuknade  steg  drastiskt vilket  medförde  hög  belastning på hälso- och sjukvården. Syfte: Att beskriva sjuksköterskors upplevelse av sin psykiska hälsa under Covid-19  pandemin. Metod: 19  kvalitativa  artiklar  analyserades  med  kvalitativ innehållsanalys  med  manifest  ansats.  Resultat:  Analysen  resulterade  i  fem kategorier:  Att  känna  psykisk  stress  av  förändringar  i  arbetsmiljön,  att  känna ångest över att bli smittad eller smitta andra, att känna skuld och sorg i patientnära arbetet,  att  känna  sig  psykologiskt  nedbruten  och  deprimerad och  att  känna välbefinnande  och  stolthet  i  sitt  yrke. Diskussion/slutsats: Sjuksköterskornas psykiska  hälsa  påverkades  negativt men även  positiva  aspekter  framkom. Sjuksköterskors psykiska hälsa och arbetsförhållanden behöver uppmärksammas. Fortsatt forskning kan bidra till att utveckla stöd att förbättra och förbygga psykisk ohälsa hos sjuksköterskor.

Background: Malaria is a major public health issue. Artemisinin-based combination therapies are the WHO recommended treatment for uncomplicated malaria. Plasmodium malariae and Plasmodium ovale infections are considered underestimated and the effectiveness of artemisinin-based combination treatments against them is poorly documented. The aim of this study was to evaluate the efficacy of dihydroartemisinin-piperaquine against low parasite density Plasmodium malariae and ovale infections.  Methods: DNA was extracted from dried blood spots on filter papers with Chelex®-100 or a column-based extraction method. Species detection and determination was conducted by SYBR Green quantitative PCR targeting the cytochrome b gene (cytb-qPCR) followed by restriction fragment length polymorphism analyses. In total, 241 samples from 53 patients enrolled in a clinical trial were analysed. The obtained molecular data were compared with the microscopy data of the study. Results: Only 69 out of 143 microscopy-positive samples were confirmed as positive by cytb-qPCR. Ninety-three samples were identified as parasite negative by both microscopy and PCR. None of the 36 microscopy-defined coinfections were detected in the molecular analysis. The cytb-qPCR success rate was 72.9% (CI95% 61.4-82.6), 75.0% (CI95% 34.9-96.8) and 14.8% (CI95% 6.9-26.2) for parasite densities above 1000 parasites/ μL, between 600-1000 parasites/ μL and below 600 parasites/ μL, respectively. The observed poor qPCR success rate is most likely due to sample degradation under poor storage conditions. Conclusions: This study highlights the impact on the preservation and quality of Plasmodium genomic DNA on dried blood spots, when filter papers are stored for more than 3 years in tropical conditions.

Healthcare-associated infections (HAI) are a problem in health care worldwide. In Sweden 7-8% of all patients treated in hospital suffer from an adverse event of varying severity, of which approximately 60,000 from a HAI. Proper hand hygiene is considered the single most important measure to reduce HAI. Despite the importance, adherence to correct hand hygiene routines are lacking among healthcare workers (HCWs). The World Health Organizations (WHO) multimodal promotion strategy promotes areas that need to be addressed in order to change the behaviour of individual HCWs to optimise adherence to hand hygiene and to improve patient safety. These areas include feedback, education, reminders at the workplace and institutional safety climate.  The overall aim of this study was to examine the possibility of adherence to hand hygiene routines and to explore factors that might influence the HCWs adherence.  The study used a descriptive research design made through qualitative method, with focus group interviews, and quantitative method, using a questionnaire survey. Eight focus group interviews were conducted with assistant nurses (n=18), nurses (n=15) and physicians (n=5) and analysed with abductive qualitative content analysis. The questionnaire survey was answered by nurses (n=84) and nursing students in their first semester (n=71) and last semester (n=46) and the data was statistically analysed. The main findings show that there are barriers to hand hygiene adherence and measures to improve these. HCWs highlighted discrepancies regarding how the organisation was supposed to give feedback and how it actually was at the workplace and expressed needs for more direct feedback to improve adherence. The study also found that hygienic knowledge gaps exists among nurses and nursing students regarding causes of HAI and how the risk of contamination of patients and HCWs can be minimized among others. Students at the beginning of the education had a lower level of knowledge than last semester students and registered nurses. The last semester students tended to have the highest level of hand hygiene knowledge.  In conclusion, the key areas presented by WHO’s multimodal promotion strategy to improve adherence all lack the appropriate measures, in some extent. The use of an electronic reminder system could give the means to improve a behaviour as long as the individual integrity is protected and development of curriculums for nursing students and continuing education of nurses is needed to further develop and maintaining knowledge.

Bakgrund:Befolkningen blir allt äldre och kräver en mer komplex vård, vilket gör att framtidens sjukvård måste kunna interagera med andra verksamheter. Intensivvårdssjuksköterskan och sjuksköterskan på akutmottagning har ett nära samarbete vid det akuta omhändertagandet av allvarligt sjuka patienter. Ett multiprofessionellt team i omhändertagandet ger snabbare diagnos ochhandläggning på akutmottagningen, vilket förkortar tiden till rätt vårdinstans. Professionerna i teamet kompletterar varandra, ökar patientsäkerheten och möjliggör personcentrerad vård. Ökad kunskap hos vårdpersonalen kring patientens upplevelse av det akuta omhändertagandet på akutmottagningen är väsentligt för att kunna förbättra vården för patienten i det initiala skedet, men fokus bör även riktas mot sjuksköterskors erfarenheter av akut omhändertagande för att identifiera riskfaktorer som kan påverka patienten negativt. Syfte:Syftet var att beskriva sjuksköterskans erfarenheter av akut omhändertagande av patienter med trauma och patienter med svår sepsis eller septisk chock.Metod: Metoden i studien utgick från en kvalitativ, induktiv ansats där 14 intervjuer genomfördes, varav sju var sjuksköterskor på akutmottagning och sju var intensivvårdssjuksköterskor på intensivvårdsavdelning. Samtliga intervjuer analyserades utifrån en kvalitativ, manifest innehållsanalys. Resultat: Analaysprocessen resulterade i fem olika kategorier: ‘Kommunikation är A och O’, ‘Vikten av att veta sin roll’, ‘Arbete över gränserna’, ‘Att arbeta utifrån en tydlig struktur’ och ‘Vård på olika villkor’. Slutsats: Det finns en otydlig struktur i det akuta omhändertagandet av patienter med svår sepsis eller septisk chock, som var en följd av otydliga roller och bristfällig kommunikation i omhändertagandet. Det framträder fördelar med att införa tydliga riktlinjer i det akuta omhändertagandet av patientgruppen med svår sepsis eller septisk chock, förslagsvis genom checklistor eller någon form av medicinskt larm i likhet med traumalarm, och där ett multiprofessionellt team samverkar kring patienten. / Background: The population is aging and requires more complex healthcare. This means that in the future, interaction with other healthcare departments is essential. Such interaction would lead to increased demand on the ability to cooperate among healthcare personnel. The intensivecare nurse and the nurse in the emergency department have a close cooperation when managing the acute severely ill patient. A multiprofessional team gives a faster diagnosis and management in the emergency department, which shortens the time to the final instance of care. The members of the team complement each other, increasing patient safety and enabling person-centered care. Increased knowledge with the nursing staff on the acute management in emergency department is essential to be able to enhance the care for the patient in the initial stage, but focus should also be at the nurse’s experience of the acute management to identify risk factors that could pose a negative influence on the patient.Aim: The aim of this study was to describe nurses’ experience of acute management of patients with trauma and patients with severe sepsis or septic shock.Method: The method used was a qualitative, inductive approach where 14 interviews were conducted, seven with nurses from the emergency department and seven intensive care nurses from the intensive care department. The interviews were analysed using a qualitative, manifest content analysis.Result:The analyzation process resulted in five different categories: ‘Communication is A&amp;O’, ‘The importance of knowing one’s role’, ‘Work over the borders’, ‘Working from a clear structure’ and ‘Care on different terms’. Conclusion: There is an unclear structure in the emergency care of patients with severe sepsis or septic shock, which was a result of unclear roles and inadequate communication in the care. It appears to be advantageous to introduce clear guidelines in the emergency care of the patient group with severe sepsis or septic shock, suggestively by checklists or some medical alert like a trauma alarm, and where a multi-professional team interacts around the patient.

Background: Human immunodeficiency virus (HIV) is still today a serious and incurable disease that requires continuous contact with healthcare and lifelong medication. If HIV is not treated, the disease will lead to acquired immune deficiency syndrome (AIDS). The biggest cause of stigma and discrimination against people living with HIV/AIDS is the attitudes of healthcare professionals. More education is needed to improve care for people with HIV/AIDS. Aim: To examine nurses' knowledge and stigma in the treatment of people with an HIV/AIDS diagnosis depending on working years in the profession. Method: A quantitative questionnaire study was conducted at 11 selected health centers, emergency centers and emergency rooms. A total of 218 questionnaires were sent out and 110 of these were answered. The respondents were divided into two groups according to years worked in the profession, 0-10 years and more than 10 years. Result: There was no significant difference among nurses in terms of knowledge and stigmain the treatment of people with HIV/AIDS correlated to years in profession. Conclusion: More education about HIV/AIDS is needed among nurses to reduce stigma and improve care for these people. It also appears that the more knowledge nurses have about the disease, the less fear of caring for people with HIV/AIDS. / Bakgrund: Humant immunbristvirus (HIV) är än idag en allvarlig och obotlig sjukdom som kräver kontinuerlig kontakt med sjukvården och livslång medicinering. Om HIV inte behandlas kommer sjukdomen att leda till aquired immunodeficiency syndrome (AIDS). Den största orsaken till stigmatisering och diskriminering av personer som lever med HIV/AIDS är vårdpersonalens attityder. Mer utbildning krävs för att förbättra vården till personer med HIV/AIDS. Syfte: Att undersöka sjuksköterskors kunskap och stigmatisering i bemötandet vid vård avpersoner med en HIV/AIDS diagnos beroende på arbetande år i yrket. Metod: En kvantitativ enkätstudie utfördes på 11 utvalda vårdcentraler, jourcentraler och akutmottagningar. Totalt skickades 218 enkäter ut och 110 av dessa besvarades. Respondenterna delades in i två grupper efter arbetade år i yrket, 0-10 år och mer än 10 år. Resultat: Det fanns ingen signifikant skillnad hos sjuksköterskor vad gäller kunskap och stigmatisering i bemötandet vid vård av personer med HIV/AIDS baserat på hur många arbetade år i yrket. Konklusion: Mer utbildning om HIV/AIDS behövs hos sjuksköterskor för att minska stigmatisering och för att förbättra vården för dessa personer. Det framkommer också att ju mer kunskap sjuksköterskor har om sjukdomen minskar det även rädslan för att vårda personer med HIV/AIDS.

Diagnosticering av neuroborrelios baseras på en kombinerad bedömning av neurologiska symtom, serologiska tester för Borrelia-specifika antikroppar och analys av cerebrospinalvätska för att räkna antalet vita blodkroppar och mäta nivåer av kemokinet CXCL13. Nyligen publicerade studier har visat på att analys av IgM-antikroppar riktade mot Borrelia inte är ett lika starkt laboratoriestöd som analys av IgG-antikroppar. Analys av IgM-antikroppar har bidragit till högre antal falskt positiva svar på grund av ospecifik reaktivitet till andra patogener och persisterande antikroppar från tidigare infektioner. Syftet med denna studie var att utvärdera det diagnostiska värdet av att analysera IgM antikroppar i cerebrospinalvätska och serumprover för patienter med misstänkt neuroborrelios. Dessutom jämfördes prestandan mellan två kemiluminiscens immunanalyser, LIAISON (DiaSorin, Italy) och VirClia (Vircell, Spain). För utvärderingen analyserades 80 patientprover på laboratoriet för Klinisk Mikrobiologi på Länssjukhuset Ryhov i Jönköping, Sverige.  För att konfirmera positiva resultatet från de två kemiluminiscens immunanalyserna användes immunoblot, EUROLINE (EUROIMMUN, Germany). Sammanfattningsvis finns det inte tillräckligt med bevis att analys av IgM har ett tillräckligt diagnostiskt värde för att bekräfta en misstänkt neuroborrelios-diagnos. Jämförelsen mellan två kemiluminiscens immunanalyser visade att VirClia kan vara ett lämpligare alternativ än LIAISON när få prover analyseras. / The diagnosis of neuroborreliosis is based on a combined evaluation of neurological symptoms, serological tests for Borrelia-specific antibodies, cerebrospinal fluid analysis to measure white blood cell count and chemokine CXCL13 levels. Recently published data has shown that analysis of IgM antibodies against Borrelia is not as supportive in establishing a clinical diagnosis as IgG antibodies. IgM analysis has contributed to higher false-positive rates because of unspecific reactivities to other biological agents and persistent antibodies from prior infections.  The purpose of this study was to assess the diagnostic value of analysing IgM antibodies in cerebrospinal fluid and serum samples from patients with suspected neuroborreliosis. The performance of two chemiluminescent immunoassays, LIAISON (DiaSorin, Italy) and VirClia (Vircell, Spain), were compared as well. For this assessment, 80 patient samples were analysed at the Laboratory of Clinical Microbiology in Jönköping County, Sweden. Immunoblotting, EUROLINE (EUROIMMUN, Germany), was utilised to validate positive results from the chemiluminescent immunoassays. In conclusion, there is no convincing evidence to suggest that IgM analysis has sufficient diagnostic value to confirm a suspected diagnosis of neuroborreliosis. The comparison of two immunoassays showed that VirClia could be a valid alternative to LIAISON when analysing fewer samples at a time.