Bakgrund:I sjuksköterskeutbildningen betonas betydelsen av samarbete med patienters anhöriga. I takt med att synen på psykisk ohälsa förändrades avvecklades den institutionsbaserade vårdformen. 1995 års psykiatrireform syftade till att stärka dessa patienters rättigheter och ställning i samhället Syfte:Beskriva anhörigas upplevelser av att ha en närstående med psykisk ohälsa. Metod:En litteraturöversikt gjord enligt Fribergs (2010) metod för litteraturöversikter. Efter sökningar i databaserna Academic search premiere, Cinahl Plus with Full Text, Medline och PsychInfo valdes tolv kvalitativa artiklar för att analyseras. Den teoretiska referensramen för arbetet är Katie Erikssons lidandebegrepp. Utifrån det har författarna svarat på två frågeställningar: 1)På vilket sätt påverkas anhörigas livvsituation och vad får det för konsekvenser? 2)Vad kan sjuksköterskan göra för att lindra anhörigas lidande? Resultat:Anhöriga bär i det tysta ett tungt ansvar i vården av sina närstående. Ansvaret genererar känslor av förlust, sorg, ensamhet, oro, frustration, skuld och självuppoffring. Många upplever att samarbetet med vården inte fungerar. Information, möjlighet till involvering, samt god vårdtillgänglighet efterfrågas. Anhöriga söker sig bortom vården för att hitta sätt att hantera situationen. Diskussion:Trots att vården skall arbeta för att inkludera anhöriga i vården av sina närstående upplever anhöriga dåligt bemötande. Brister i information, tillänglighet och involvering leder hos de anhöriga till ökat lidande. Orsak till denna upplevda ovilja till samarbete skulle kunna vara att det psykodynamiska synsättet med familjen som sjukdomsorsak lever kvar. / Background:In the nursing education the importance of cooperation with the patients nextof kin is emphasized. Following the changed view on mental illness the institutionalized mental care was phased out. The psychiatric reform of 1995 aimed to reinforce the psychiatric patients rights and positions in the society. Aim:To describe the experiences of the next of kin of mentally ill persons. Method:A literature review was performed according to Fribergs (2010) method for literature review. After searches performed in the databases Cinahl Plus withFull Text, Academic search premiere, Medline and PsychInfo twelvequalitative articles were choosed for analyzis. The theoretical framework of the review is Katie Eriksson’s concept of suffering.Based on her theory the authors have answered following questions: 1) In what way is the next of kins life and situation affected and what are the consequences? 2) How can a nurse ease the suffering of the next of kin? Results:The next of kin carry a big responsibility in the care. The responsibility creates feelings of loss, sorrow, loneliness, worry, frustration, guilt and self affacement. The next of kin experience the cooperation with health care malfunctioning. Information, involvement and availability are desirable features of the health care. The next of kin tend to look beyond the health care to find support. Discussion:Despite guidelines for involving the next of kin in care, they experience bad encounter in contact with formal care. Lack of information, availability and involvement leads to increased suffering for the next of kin. A possible reasonfor the experienced unwillingness of cooperation could be that thepsychodynamic point of view regarding the family as a cause of disease is maintained in the psychiatric care.

Syftet med litteraturstudien var att beskriva hur hälso-och sjukvårdspersonalens bemötande påverkar närstående till personer som vårdas palliativt samt beskriva närståendes behov av stöd under vårdtiden. Vidare var syftet att granska inkluderade artiklars design. Litteraturstudien var av beskrivande design och inkluderade 13 artiklar som söktes fram i databaserna PubMed och Academic Search Elite samt genom manuell sökning. Huvudresultatet visade att närstående var närvarande dygnet runt vilket begränsade deras frihet samt att bidragande stöd kunde lindra vårdtyngden och underlätta för närstående. Stödet från hälso- och sjukvårdpersonal beskrevs både som svagt och tillfredställande. Information saknades och var ibland motstridig och bristfällig. Relevant information kunde minska vårdtyngden, känslor av rädsla, osäkerhet och ensamhet samt underlätta till att behålla kontroll. Delaktighet samt involvering i omvårdnaden och beslutsfattandet var starkt stödjande samt ett sätt att behålla kontroll. Närstående tappade lätt kontroll då det professionella stödet inte var tillgängligt eller saknades helt, informationen var bristfällig samt då resurserna var otillräckliga. Det var viktigt att personalen tog sig tid, såg närstående, talade direkt till dem samt bekräftade dem. Slutsatsen bedömdes vara att närstående har ett behov av stöd under vårdtiden genom delaktighet, information och kontroll. Ett positivt och stödjande bemötande från hälso- och sjukvårdpersonalen kan stärka närstående. / The purpose of this study was to describe how health care professionals’ standard of conduct affects next of kin to people in palliative care and describe what support next of kin were in need of during time of care. A further aim was to examine the included articles´ design. The literature study was of a descriptive design and included 13 articles that were searched in PubMed, Academic Search Elite and by manual search. Main results showed that next of kin were present around the clock which limited their freedom. Contributing support could alleviate the care burden and facilitate next of kin. Support from health care professionals was described as both weak and satisfying. Information was lacking and was sometimes conflicting and inadequate. Relevant information could reduce care burden, feelings of fear, uncertainty and loneliness and also facilitate the retention of control. Participation and involvement in care and decision-making was highly supportive and a way to maintain control. Next of kin easily lost control when professional support was not available or missing entirely, when the information was incomplete and resources were inadequate. It was important that the staff took the time, saw to the next of kin, spoke directly to them and confirmed them. The conclusion were that next of kin has a need for support during the time of care through participation, information and control A positive and supporting response from health care professionals can strengthen next of kin.

Androphilia refers to sexual attraction and arousal to adult males, whereas gynephilia refers to sexual attraction and arousal to adult females. Prehistoric artifacts such as art and pottery indicate that male-male same sex behaviour has existed for millennia. Bearing this in mind, and considering that male androphilia has a genetic component yet androphilic males reproduce at a fraction of the rate than do gynephilic males, how the genes for male androphilia have been maintained in the population presents an evolutionary puzzle. This thesis tests two hypotheses that attempt to address this Darwinian paradox. Chapter one reviews the current literature on the kin selection hypothesis and the sexually antagonistic gene hypothesis. In addition, rationales for testing these hypotheses in Canada are provided. Chapter two tests the kin selection hypothesis for male androphilia within a Canadian population. Results and implications are discussed. Chapter three tests the sexually antagonistic gene hypothesis within a Canadian population. Results and implications are discussed. Chapter four summarizes the results of the two studies and discusses how these findings may be interpreted from an evolutionary perspective. The impacts of gene-environment interaction on the functional behavioral expression of traits are emphasized. / viii, 113 leaves ; 29 cm

Bakgrund: I dag upplever många närstående till personer med psykisk ohälsa svårigheter i att bli delaktiga i den professionella vården. Närstående beskriver vårdpersonalen som ointresserade av att möta personer med psykisk ohälsa. Det beskrivs att vårdpersonal har negativt bemötande gentemot personer som söker vård samt till närstående. Syfte: Att beskriva upplevelser hos närstående till personer med psykisk ohälsa i kontakten med den professionella vården. Metod: Litteraturstudie baserad på självbiografier med analysförfarande utifrån en kvalitativ innehållsanalys. Resultat: Upplevelserna från närstående till personer med psykisk ohälsa har beskrivits utifrån följande tema: Vara delaktig men samtidigt åsidosatt - Maktlöshetens ansikte. Temat har identifierats utifrån följande kategorier; Tillit för den professionella vården, När känslor tar överhand och Vårdmiljöns betydelse. Resultatet påvisar vad som gör upplevelsen hos närstående positiv eller negativ. En positiv upplevelse beskrivs ofta av närstående när de upplevt ett gott och trevligt bemötande från vårdpersonal. Negativa upplevelser beskrivs när vårdpersonal uppvisar dålig kunskap i ämnet och en sämre attityd i bemötande gentemot närstående. Vårdmiljön är också betydelsefull. Slutsats: Det finns behov av att implementera och genomföra förbättringsarbeten i professionell vård som möter närstående till personer med psykisk ohälsa. Exempelvis utvecklingsstrategier vid anställning av personal i den psykiatriska vården / Introduction: Next of kin to persons with mental illness often experience it difficult to be involved in the professional health care. Next of kin often describe the health care professionals as disinterested and negative approach towards them and the person who is ill. Aim: To describe experiences from next of kin to persons with mental illness in contact with the professional health care. Method: A study based of autobiographies with analysis method based on a qualitative content analysis. Result: This study results emerged in the main theme; To be involved but also infringed -The face of Powerless. The theme has been identified based on the following categories; Trust for the health care, Emotions taking over and The importance health care environments. The result describes what makes the experience from next of kin positive or negative. Positive experiences were often described when they experienced a good and friendly approach from a health care professional. Negative experiences are described when health care professionals have lacking knowledge and worse attitude towards them. The result also describe that the healthcare environment are important. Conclusion: There are needs to implement and carry out improvements in the professional health care in meeting next of kin of people with mental illness. For example development strategies when health care professionals are recruited in the professional health care.

By combining laboratory experiments with field work, I have looked at the following aspects of cellular slime mould (CSM) biology: (a) the genetic structure of social groups (fruiting bodies) in the wild and its relation to the role of large mammals as dispersal agents; (b) social behaviour in clonal, intra-species polyclonal and interspecies social groups and (c) fitness-related trade-offs with respect to life history traits as a possible mechanism for coexistence and cooperative behaviour in CSMs. The major findings of this study are as follows: (a) individuals belonging to different strains of a species, different species and genera occur in close proximity, even on a speck of soil (250µm-1mm) or the same dung pat; (b) social groups formed in the wild by Dictyostelium giganteum and D. purpureum are generally multiclonal; (c) genetically diverse strains can co-aggregate and form chimaeric social groups; (d) in chimaeric social groups, strains differ in their relative sporulation efficiencies; (e) the fact that strains co-exist in spite of this may be attributable in part to trade-offs between various fitness-related traits as can be demonstrated in the case of wild isolates of D. giganteum in pair wise mixes. The Dictyostelids or CSMs are haploid, eukaryotic, soil dwelling social amoebae with an unusual life cycle (Bonner, 1967; Raper, 1984). They exist as single cells in the presence of food (bacteria, yeast, fungal spores). Once the food is exhausted, they enter the social phase of their life cycle. Approximately 102 to 106 amoebae aggregate at a common collection point and form a starvation resistant structure called the fruiting body. In many species a fruiting body is made up of an aerial stalk of dead cells and a ball of viable spores on top. In other CSM species (not part of this study), all amoebae in a fruiting body differentiate into spores and the stalk is an extracellular secretion. The CSM life cycle raises fundamental questions related to the evolution of an extreme form of 'altruism' in the form of reproductive division of labour in social groups. The spore-stalk distinction in the CSMs is analogous to the germ-soma distinction in metazoans, although, the CSMs achieve multicellularity not by repeated divisions of a zygote but via the aggregation of many cells which may or may not be clonally related (Bonner, 1982; Kaushik and Nanjundiah, 2003). Social behaviour in the CSMs offers interesting parallels to what is seen in the social insects (Gadagkar and Bonner, 1994). The origin and maintenance of 'altruism' has been a long-standing issue in sociobiology. Because of their simple life cycle and experimental tractability, the CSMs are ideal for studying the evolutionary origin and maintenance of social behaviour, in particular of 'altruistic' behaviour. By elevating spores above soil level, stalk cells, protect them from noxious compounds and predators present in soil and also facilitate their passive dispersal. In the course of doing so they die. The death of stalk cells appears to be an extreme form of altruism. Knowledge of the genetic structure of social groups and populations including patterns of kinship is essential for modelling the evolution of 'altruism'. Thus, it is important to understand the genetic structure of CSM social groups in the wild. For this, social groups (fruiting bodies) of CSMs were isolated from undisturbed forest soil of the Mudumalai forest reserve in South India. Soil and animal dung samples were brought to the laboratory and quasi-natural social groups were generated by inoculating the samples on non-nutrient agar. The fruiting bodies from various CSM species were formed by these isolates. Since soil and dung samples were not perturbed in any way, the fruiting bodies were formed as they would have in nature. When compared to soil, dung samples contained a higher CSM diversity and more CSM propagules. The presence of CSMs in fresh animal dung makes it likely that they were transported and dispersed over long distances through the gut of these animals. Such dispersal is likely to be preceded by a thorough mixing of spores in the gut. That increases the probability of co-occurrence of different genotypes in a social group. This possibility was confirmed by genetically characterizing spores in social groups of Dictyostelium giganteum and D. purpureum collected from the wild. Random amplification of polymorphic DNA (RAPD), a simple and reliable molecular technique, was used for genotyping spores within a fruiting body. 17 fruiting bodies (8 from animal dung and 9 from soil) were studied. 15 out of 17 (9 out of 11 of D. giganteum and 6 out of 6 D. purpureum) were polyclonal; the minimum number of distinct clones in a single fruiting body was 3 to 7 (animal dung) and 1 to 9 (soil). Therefore in D.giganteum and D. purpureum, chimaeric social groups seem to be the norm. This suggests that other species of CSMs form intra-species chimaeric social groups in wild, though clonal fruiting bodies occur too. The next objective of this thesis was to test whether genetic heterogeneity had functional consequences. That is, when different strains come together in an aggregate, do they contribute equally to the reproductive (spore) and non-reproductive (stalk) pathways? Amoebae of different clones (strains) of D. giganteum or D. purpureum were mixed and developed together and the number of spores formed by each strain was counted. These experiments confirmed that strains of D. giganteum or D. purpureum can aggregate together and form chimaeric fruiting bodies. The ability to mix (measured as the frequency of chimaerism) depended on the strains used and varied from one mix to another. One strain was often found to 'exploit' the other during sporulation, that is, it formed more spores than its expected share. Despite this, strains are found in very close proximity in the soil, which raises an important question: when one strain is more efficient at sporulating than other, how can the two co-exist stably? To investigate what might lie behind the stable co-existence of strains, I studied various fitness-related traits in the life cycle of D. giganteum. They included the rate of cell division, the time taken to go through multicellular development, the efficiency of slug migration through various depths of soil and the probability of differentiation into a spore. Measurements were carried out on strains taken separately and on their pair wise mixes. Five different D. giganteum wild strains (46a3, 46d2, 48.1a1, F5 and F16) were used. All were isolated from the Mudumalai forest (India). 46a3 and 46d2 came from soil within 10 cm of each other, 48.1a1 from soil about 200m away from 46a3; and F5 and F16 from the same fruiting body (Kaushik et al., 2006; Sathe et al., 2010). Members of a pair differed significantly in the measured fitness-related traits. For example, in the case of 48.1a1 and 46d2, 48.a1 grew faster than 46d2 both individually and in a mix. After starvation, 48.1a1 formed fruiting bodies faster than 46d2; a mix of the two developed at the rate of the faster member, implying that the slower one (46d2) gained from the association with 48.1a1. During slug migration, slugs formed by 48.1a1 came up through a higher depth of soil than 46d2 slugs and did so earlier. Chimaeric slugs were like the more efficient member, 48.1a1, in terms of the maximum depth of soil that was covered, but like the less efficient member, 46d2, in terms of the time taken for slugs to be seen on the soil surface. 48.1a1 seems to have an advantage over 46d2 in all these respects. However, during sporulation in chimaeras, 48.1a1 formed relatively fewer spores than 46d2. Similar trade-offs were seen in all mixes. F5 and F16 displayed an unexpected feature during sporulation; the spore-forming efficiency of either strain depended on its proportion in the initial mix in a frequency-dependent manner that was consistent with a stable equilibrium. Thus, trade-offs between different fitness-related traits contribute to the co-existence of strains. Next, I studied interactions between members of different CSM species. Several species of CSMs were isolated from the same environment (Sathe et al., 2010); a question of interest was to see if amoebae of different species came together to form a chimaeric multicellular body. Five strains (two D. purpureum and three D. giganteum) were used in this study. Amoebae of D. giganteum and D. purpureum co-aggregated. However, there were factors that caused amoebae of the two species to sort out thereafter. The extent of segregation differed between strains, a characteristic that inter-species mixes share with intra-species mixes. In conclusion, the ability of cellular slime moulds to form multiclonal social groups in the wild suggests that one should look to factors in addition to close relatedness to understand the evolution of CSM social behaviour. The existence of fitness-related trade-offs between different traits indicates that individual-level selection can also contribute to the maintenance of chimaeric social groups.

Bakgrund: Inom den palliativa vården har möjligheten att få vårdas i hemmet ökat genom åren. Idag vet man att närstående utför betydande insatser inom vården och omsorgen och att deras insatser bedöms vara tidsmässigt mycket större än från den offentliga vården. Att vara närstående till någon som är sjuk är en upplevelse som är unik för varje enskild individ. Upplevelsen av isolering, att behöva ignorera sina egna känslor och kämpa för sin egen överlevnad kan uppstå hos de närstående som vårdar en sjuk i hemmet. Syfte: Att belysa närståendes upplevelser av palliativ hemsjukvård. Metod: En litteraturöversikt har gjorts baserad på elva vetenskapliga artiklar som granskats och analyserats. De databaser som använts vid artikelsökningen är Cinahl plus with Full Text, PubMed samt Medline with full text med sökorden Family, Palliative home care, Experiences och Sweden. Efter analysen av texterna i artiklarna framkom fyra teman, vilka var önskan att bli sedd av det palliativa vårdteamet, upplevelsen av maktlöshet, vikten av kommunikation och av att få information samt stöd och stödgruppens betydelse för de närstående. Resultat: Resultatet visar att många närstående känner sig förbisedda då en stor del av det palliativa vårdteamets fokus hamnar på den sjuke. Detta leder även till att de närstående upplever maktlöshet. Det palliativa vårdteamet kan genom god kommunikation och information få de närstående att känna sig uppmärksammande som individer samt att få bli inbjudna till delaktighet i vården av den sjuke. Något som också visat sig vara ovärderligt och bidrog till att skapa mening i det vardagliga livet för de närstående var stödet från omgivningen samt stöd i form av stödgruppsträffar tillsammans med andra närstående i liknande situationer. Diskussion: Diskussionen har baserats på de fyra teman som framkommit i resultatet och sedan relaterats till omvårdnadsteorin, Peaceful end-of-life theory samt konsensusbegreppen människa och vårdande. Betydelsen av kommunikation och information från det palliativa vårdteamet diskuteras, samt vikten av att göra de närstående delaktiga och uppmärksammade i vården av den sjuke. / Background: Within palliative care the opportunity to receive care in the home has increased over the years. Today we know that next of kin’s perform considerable efforts in health and social care and that their efforts, based on time, are considered to be larger than the public services efforts. To be next of kin to someone who is ill is an experience that is unique to each individual. The experience of isolation, having to ignore their own feelings and fight for their own survival may occur in the next of kin who care for an ill person at home. Aim: To highlight next of kin’s experiences of palliative home care. Methods: A literature review has been conducted based on eleven scientific articles, which have been reviewed and analyzed. The databases used in the article search are Cinahl Plus with Full Text, PubMed and MEDLINE with full text using the keywords Family, Palliative home care, Experiences and Sweden. The analysis of the articles revealed four themes which were, a desire to be seen by the palliative care team, the experience of powerlessness, the importance of communication and receiving information and also support and the support group significance for the next of kin’s. Results: The results show that many next of kin’s feel neglected as a large part of the palliative care team's focus is on the sick person. This also leads to the next of kin experiencing powerlessness. The palliative care team can through good communication and information make the next of kin feel noticed as individuals and be invited to participate in the care of the sick person. What also proved invaluable and helped to create meaning in the everyday life of the next of kin was support from the surroundings and support in terms of support group meetings together with other next of kin’s in similar situations. Discussions: The discussion was based on the four themes that emerged from the results and has then been related to the middle-range theory, Peaceful end-of-life and also the central concepts of nursing, person and nursing. The importance of communication and information from the palliative care team are discussed, and also the importance of making next of kin’s participate in the care of the sick person and to be noticed.

Bakgrund: När en person blir svårt sjuk, är döende och behöver vårdas palliativt berörs inte bara den sjuke, utan även personer i dennes närhet. Det har framkommit att närstående inte alltid uttrycker sina behov i situationen. Närståendes involvering är ett faktum, och deras upplevelser varierar. Närståendes upplevelser knyts i resultatdiskussionen an till begreppet om Känsla av sammanhang.    Syfte: Litteraturöversiktens syfte är att beskriva upplevelser av att vara närstående till en palliativ vårdtagare. Metod: En kvalitativ litteraturöversikt, inkluderande elva studier, har genomförts där dessa studier granskats, bearbetats och analyserats utifrån Fribergs femstegsmodell. Resultat: Det framkom att närstående upplevt förändringar i vardagen sedan deras närstående blivit sjuk. De upplevde åsidosättande av egna behov och intressen. Vårdpersonal fick en betydande roll i situationen, och närstående upplevde trygghet när de var närvarande, men upplevde en otrygghet när kontinuitet och löften inte hölls. Behov av information och stöd visade sig vara viktigt för hanterandet av situationen. Slutsats: Utifrån huvudfynden konstateras att närstående genomgår förändringar genom hela den sjukes palliativa period. Förändringarna upplevs olika, då varje situation är unik, de närstående har individuella behov som behöver tillfredsställas. Uttryckt behov av stöd och information gör att vårdpersonal får en betydande roll i deras liv. / Background: When a person becomes seriously ill, dying and in need of palliative care, not only the sick person get´s affected, even the next of kin´s are concerned. Next of kin´s is not always expressing their needs in such situations. That next of kin´s get´s involved is a fact, and what their experiences are varies. Next of kin’s experiences are in the discussion connected with the theory of Sence of coherence.      Aim: The aim of the literature review is to describe experiences of being next of kin to a person who´s in palliative care. Methods: A qualitative literature review, including eleven studies, have been conducted, and theese studies have been examined, processed and analyzed by the five steps of Friberg. Findings: Findings revealed that next of kin´s experienced changes in everyday life since their relative got ill. They experienced that they had to set aside their own needs and interests. The health care professionals were given a significant role in the situation, and the next of kin´s felt a sense of security when they were present, but experienced insecurity when continuty and promises were not kept. A need for information and support turned out to be important to cope with the situation. Conclusion: Based on the main findings it was stated that next of kin´s undergoes changes throughout the sick persons palliative period. The changes are experienced differently, as each situation is unique, the next of kin´s have individual needs which need to be satisfied. Expressed needs for support and information enables health professionals to have a significant role in their lives.

The aim of this thesis was to modify and evaluate effects, as well as todescribe experiences of a nurse-led multidisciplinary programme of pulmonaryrehabilitation in primary health care for patients with chronicobstructive pulmonary disease (COPD) and their next of kin.Interviews were performed with 12 COPD nurses about their experiencesof patient education (I). Forty-nine patients participated in the interventiongroup and 54 in the control group in a quasi-experimentalstudy which investigated the effects of the programme on functional capacity,quality of life and exacerbation frequency during one year (II).Interviews were performed related to the experiences of 20 patients whohad participated in the six-week programme (III) and the experiences of20 next of kin to the patients that had participated (IV).The results showed that COPD nurses fluctuated between security andinsecurity in patient education and were in need of support, time, structureand collaboration to develop their patient education (I). In Study IIthere were no differences between the groups with regard to functionalcapacity and quality of life, but the number of exacerbations decreased inthe intervention group and increased in the control group (II). The patientsin study III had allowed themselves to live at their own pace followingthe programme but a constant fear was present in spite of the programme(III). Next of kin in Study IV had a life that remained overshadowedby illness but there were positive outcomes of the programme aslong as two years afterwards. The next of kin also had constant fear,however (IV).In conclusion, the six week programme brought about results in changingeveryday life. Nevertheless, all lived in the shadow of fear and uncertaintyin spite of the programme. More research is needed to address therequirements of COPD nurses, patients and next of kin.

Thesis (Ph. D.)--University of Chicago, Dept. of Psychology. / Includes bibliographical references. Also available on the Internet.

Thesis (Ph.D.)--McMaster University, 2003. / Includes bibliographical references (p. 87-97) Also available via World Wide Web.