Kronisk njursjukdom med livsuppehållande hemodialysbehandling medförde förändrade levnadsvillkor för patienter och närstående. Närvaro av närstående var en faktor som positivt påverkade patienten och utan närståendes stöd krävdes större insatser från sjukvården. Till närstående räknas anhöriga, men även andra som har nära relationer med patienten, som till exempel vänner eller grannar. Syftet med denna litteraturstudie var att undersöka hur litteraturen beskriver situationen för närstående till hemodialyspatienter och vilken typ av stöd de efterfrågade, samt att beskriva inkluderade studiers urvalsgrupper. Det är en beskrivande litteraturstudie där 10 kvalitativa artiklar från databasen CINAHL inkluderades. Studiens resultat utmynnade i två huvudkategorier och åtta underkategorier. Situationen för de närstående präglades av oro, rädslor och osäkerhet kopplade till den sjukes hälsotillstånd och hemodialysbehandlingarna som orsakade stora begränsningar. Livssituationen påverkade många av de närståendes relationer, där den vårdande rollen och den sociala isoleringen hade framträdande platser. Resultatet visade att de närstående hade behov av att samtala om existentiella frågor, främst om döden, vilket gav en uppfattning om allvaret i de närståendes livssituation. Det var tydligt att stödet från sjukvården till de närstående upplevdes som mer betydelsefullt än stödet från övrig omgivning. De närstående hade svårigheter att uttrycka önskemål om stöd och efterfrågade initiativ till samtal från sjukvården. / Chronic kidney disease with life-sustaining hemodialysis treatment caused changes in living conditions for patients and next of kin. The presence of kin was a factor that positively affected the patient and without relatives support, greater efforts was required from health care. To next of kin families are counted, but also others who have close relationships with the patient, such as friends or neighbors. The purpose of this literature review was to examine how the literature describe the situation for relatives to hemodialysis patients and what type of support they requested, and to describe included studies’ sample groups. It´s a descriptive literature review where 10 qualitative articles from database CINAHL was included. The results of the study led to two main categories and eight subcategories. The situation for the next of kin was marked by anxiety, fears and uncertainties linked to the patient’s state of health and hemodialysis treatments that caused severe limitations. The life situation affected many of the next of kin´s relationships, where the caring role and social isolation had prominent places. The result showed that the relatives had a need to talk about existential questions, mainly about death, which gave an idea of the seriousness of the relatives’ life situation. It was clear that the support from health care to the next of kin was perceived as more important than support from others. The relatives had difficulties in expressing the wishes of support and requested initiate calls from health care.

Kronisk njursjukdom med livsuppehållande hemodialysbehandling medförde förändrade levnadsvillkor för patienter och närstående. Närvaro av närstående var en faktor som positivt påverkade patienten och utan närståendes stöd krävdes större insatser från sjukvården. Till närstående räknas anhöriga, men även andra som har nära relationer med patienten, som till exempel vänner eller grannar. Syftet med denna litteraturstudie var att undersöka hur litteraturen beskriver situationen för närstående till hemodialyspatienter och vilken typ av stöd de efterfrågade, samt att beskriva inkluderade studiers urvalsgrupper. Det är en beskrivande litteraturstudie där 10 kvalitativa artiklar från databasen CINAHL inkluderades. Studiens resultat utmynnade i två huvudkategorier och åtta underkategorier. Situationen för de närstående präglades av oro, rädslor och osäkerhet kopplade till den sjukes hälsotillstånd och hemodialysbehandlingarna som orsakade stora begränsningar. Livssituationen påverkade många av de närståendes relationer, där den vårdande rollen och den sociala isoleringen hade framträdande platser. Resultatet visade att de närstående hade behov av att samtala om existentiella frågor, främst om döden, vilket gav en uppfattning om allvaret i de närståendes livssituation. Det var tydligt att stödet från sjukvården till de närstående upplevdes som mer betydelsefullt än stödet från övrig omgivning. De närstående hade svårigheter att uttrycka önskemål om stöd och efterfrågade initiativ till samtal från sjukvården.

This thesis examines whether juvenile feral pigeons, Columba livia, form sibling alliances when competing for access to a defensible food source. When tested as a flock at a non-depletable column feeder, with room for either one or two birds to feed, siblings associated with each other more often than expected by chance. Frequency of aggression between siblings at these feeders tended to be lower than expected on the basis of their association. Removal experiments showed that sibling presence had a positive effect on relative feeding success at the single column feeder: a juvenile who lost to another juvenile on a one-to-one basis tended, in the presence of its sibling, to lose less badly to, or even beat, that same juvenile. In contrast, presence of the winner's sibling tended not to affect the relative feeding success of competitors. These results support the hypothesis that pigeon siblings form aggressive alliances when competing for food that is defensible.

Bakgrund: I Sverige drabbas mer än 50000 personer av cancer varje år. Ca 35 % av all cancer går inte att bota, och vården blir palliativ. Även de närstående påverkas, och är i behov av stöd från sjukvården. Syfte: Syftet med studien var att undersöka upplevelsen och behovet av stöd inom den onkologiska slutenvården för närstående till patienter med cancer i palliativt skede som inte är anslutna till hemsjukvård eller hospice. Metod: Studien är utförd utifrån en kvalitativ ansats och är baserad på sju intervjuer där resultatet har bearbetats med stöd av en kvalitativ innehållsanalys. Resultat: Närstående upplever sig i stort erhålla ett gott stöd från den onkologiska slutenvården. Viktigast upplevs att som närstående bli sedd och bekräftad, samt att erhålla lagom mängd information löpande under vårdtiden. Detta, tillsammans med ett gott stöd från familj och vänner, gör att närstående känner sig trygga. Det som främst upplevs saknas är chansen till avskildhet, samt tydligare information om vart man kan vända sig vid eventuellt behov av hjälp efter hemgång. Även någon form av kontaktperson efterfrågas för att minska känslan av att känna sig utlämnad och vilsen. Slutsats: Dagens slutenvård upplevs ge ett gott stöd till närstående inom den palliativa cancervården. För att sjuksköterskan ska känna sig trygg i sin profession, och orka driva utvecklingen inom vården framåt, krävs kontinuerlig fortbildning.

Bakgrund: I Sverige drabbas mer än 50000 personer av cancer varje år, men det är inte bara patienten som drabbas utan även alla närstående. Ca 35 % av all cancer går inte att bota och vården blir palliativ, vilken syftar till att förebygga och lindra lidandet för patienten och dennes familj. Att vara närstående i denna situation framkallar många olika känslor. Syfte: Syftet med studien är att belysa upplevelsen av att vara närstående till en palliativ patient med cancer. Metod: Studien är utförd utifrån en kvalitativ ansats och är baserad på sex biografier där resultatet har bearbetats med stöd av en kvalitativ innehållsanalys. Resultat: Upplevelsen av att vara närstående till en patient med cancer tar fram många motstridiga känslor såsom oro, hopp, vanmakt och frid. Vikten av att som närstående få bekräftelse från såväl den sjuke som från vården belyses, liksom vikten av att få stöd och hjälp från vården för att orka vara den starka som alltid finns där. Betydelsen av familj och vänner belyses också. Slutsats: Studien visar tydligt att vården måste bli bättre att i ett tidigt skede möta upp de närstående och även se deras behov. Hur viktigt det är med information, att få veta vad som kommer att hända, vad som kan förväntas och vilken hjälp man kan få. Många upplever att man får den hjälp och stöd man behöver först när den palliativa vården kopplas in. / Background: In Sweden, more than 50,000 people is affected of cancer every year, but it's not just patients who are affected it is also next-of-kin. About 35 % of all cancers cannot be cured and the treatment is palliative, which seeks to prevent and alleviate the suffering of the patient and their family. To be next-of-kin in this situation evokes many feelings.Purpose: The aim of this study is to illuminate the experience of being next-of-kin to a palliative patient with cancer.Method: The study was conducted based on a qualitative approach and is based on six biographies where the results have been processed by means of a qualitative content analysis.Results: The experience of being next-of-kin to a patient with cancer brings out many feelings such as anxiety, hope, despair, and peace. The importance as a next-of-kin to be confirmed from the patient and the healthcare is elucidated, as well as the importance of getting help and support from the health care system to cope and to be the strong one who is always there for the patient. The importance of family and friends is also highlighted.Conclusion: This study clearly shows that healthcare must be much better at an early phase to see the family and also to see their needs. The importance of information, to know what will happen, what can be expected and what help you can get. Many feel that they first receive the help and support they need when palliative care is a reality.

Thesis by publication. / Thesis (PhD) -- Macquarie University, School of Biological Sciences, 1990. / Bibliography: leaves 269-324. / Introduction -- Models of parental allocation -- Sex expression in homosporous pteridophytes -- The origin of heterospory -- Pollination and the origin of the seed habit -- Brood reduction in gymnosperms -- Pollination: costs and consequences -- Adaptive explanations for the rise of the angiosperms -- Parent-specific gene expression and the triploid endosperm -- New perspectives on the angiosperm female gametophyte -- Overview -- Glossary -- Kinship terms in plants -- Literature Cited. / Among vascular plants/ different life cycles are associated with characteristic ranges of propagule size. In the modern flora, isospores of homosporous pteridophytes are almost all smaller than 150 urn diameter, megaspores of heterosporous pteridophytes fall in the range 100-1000 urn diameter, gymnosperm seeds are possibly all larger than the largest megaspores, but the smallest angiosperm seeds are of comparable size to large isospores. -- Propagule size is one of the most important features of a sporophyte's reproductive strategy. Roughly speaking, larger propagules have larger food reserves, and a greater probability of successful establishment, than smaller propagules, but a sporophyte can produce more smaller propagules from the same quantity of resources. Different species have adopted very different size-versus-number compromises. The characteristic ranges of propagule size, in each of the major groups of vascular plants, suggest that some life cycles are incompatible with particular size-versus-number compromises. -- Sex expression in homosporous plants is a property of gametophytes (homosporous sporophytes are essentially asexual). Gametophytes should produce either eggs or sperm depending on which course of action gives the greatest chance of reproductive success. A maternal gametophyte must contribute much greater resources to a young sporophyte than the paternal gametophyte. Therefore, smaller gametophytes should tend to reproduce as males, and gametophytes with abundant resources should tend to reproduce as females. Consistent with these predictions, large female gametophytes release substances (antheridiogens) which induce smaller neighbouring ametophytes to produce sperm. -- The mechanism of sex determination in heterosporous species appears to be fundamentally different. Large megaspores develop into female gametophytes, and small icrospores develop into male gametophytes. Sex expression appears to be determined by the sporophyte generation. This is misleading. As argued above, the optimal sex expression of a homosporous gametophyte is influenced by its access to resources. This is determined by (1) the quantity of food reserves in its spore and (2) the quantity of resources accumulated by the gametophyte's own activities. If a sporophyte produced spores of two sizes, gametophytes developing from the larger spores' would be more likely to reproduce as females than gametophytes developing from the smaller spores, because the pre-existing mechanisms of sex determination would favor production of archegonia by larger gametophytes. Thus, the predicted mechanisms of sex determination in homosporous species could also explain the differences in sex expression of gametophytes developing from large and small spores in heterosporous species. / Megaspores of living heterosporous pteridophytes contain sufficient resources for female reproduction without photosynthesis by the gametophyte (Platyzoma excepted), whereas microspores only contain sufficient resources for male reproduction. Furthermore, many more microspores are produced than megaspores. A gametophyte's optimal sex expression is overwhelmingly determined by the amount of resources supplied in its spore by the sporophyte, and is little influenced by the particular environmental conditions where the spore lands. Gametophytes determine sex expression in heterosporous species, as well as homosporous species. A satisfactory model for the evolution of heterospory needs to explain under what circumstances sporophytes will benefit from producing spores of two distinct sizes. -- In Chapter 4, I present a model for the origin of heterospory that predicts the existence of a "heterospory threshold". For propagule sizes below the threshold, homosporous reproduction is evolutionarily stable because gametophytes must rely on their own activities to accumulate sufficient resources for successful female reproduction. Whether a gametophyte can accumulate sufficient resources before its competitors is strongly influenced by environmental conditions. Gametophytes benefit from being able to adjust their sex expression in response to these conditions. For propagule sizes above the threshold, homosporous reproduction is evolutionarily unstable, because the propagule's food reserves are more than sufficient for a "male" gametophyte to fertilize all eggs within its neighbourhood. A population of homosporous sporophytes can be invaded by sporophytes that produce a greater number of smaller spores which could land in additional locations and fertilize additional eggs. Such'spores would be male-specialists on account of their size. Therefore, both spore types would be maintained in the population because of frequency-dependent selection. -- The earliest vascular plants were homosporous. Several homosporous groups gave rise to heterosporous lineages, at least one of which was the progeniture of the seed plants. The first heterosporous species appear in the Devonian. During the Devonian, there was a gradual increase in maximum spore size, possibly associated with the evolution of trees and the appearance of the first forests. As the heterospory threshold was approached, the optimal spore size for female reproduction diverged from the optimal spore size for male reproduction. Below the threshold, a compromise spore size gave the highest fitness returns to sporophytes, but above the threshold, sporophytes could attain higher fitness by producing two types of spores. -- The evolution of heterospory had profound consequences. Once a sporophyte produced two types of spores, microspores and megaspores could become specialized for male and female function respectively. The most successful heterosporous lineage (or lineages) is that of the seed plants. The feature that distinguishes seed plants from other heterosporous lineages is pollination, the capture of microspores before, rather than after, propagule dispersal. Traditionally, pollination has been considered to be a major adaptive advance because it frees sexual reproduction from dependence on external fertilization by freeswimming sperm, but pollination has a more important advantage. In heterosporous pteridophytes, a megaspore is provisioned whether or not it will be fertilized whereas seeds are only provisioned if they are pollinated. / The total cost per seed cannot be assessed solely from the seed's energy and nutrient content. Rather, each seed also has an associated supplementary cost of adaptations for pollen capture and of resources committed to ovules that remain unpollinated. The supplementary cost per seed has important consequences for understanding reproductive strategies. First, supplementary costs are expected to be proportionally greater for smaller seeds. Thus, the benefits of decreasing seed size (in order to produce more seeds) are reduced for species with small seeds. This effect may explain minimum seed sizes. Second, supplementary costs are greater for populations at lower density. Thus, there is a minimum density below which a species cannot maintain its numbers. -- By far the most successful group of seed plants in the modern flora are the angiosperms. Two types of evidence suggest that early angiosperms had a lower supplementary cost per seed than contemporary gymnosperms. First, the minimum size of angiosperm seeds was much smaller than the minimum size of gymnosperm seeds. This suggests that angiosperms could produce small seeds more cheaply than could gymnosperms. Second, angiosperm-dominated floras were more speciose than the gymnosperm-dominated floras they replaced. This suggests that the supplementary cost per seed of angiosperms does not increase as rapidly as that of gymnosperms, as population density decreases. In consequence, angiosperms were able to displace gymnosperms from many habitats, because the angiosperms had a lower cost of rarity. -- Angiosperm embryology has a number of distinctive features that may be related to the group's success. In gymnosperms, the nutrient storage tissue of the seed is the female gametophyte. In most angiosperms, this role is taken by the endosperm. Endosperm is initiated by the fertilization of two female gametophyte nuclei by a second sperm that is genetically identical to the sperm which fertilizes the egg. Endosperm has identical genes to its associated embryo, except that there are two copies of maternal genes for every copy of a paternal gene. -- Chapter 9 presents a hypothesis to explain the unusual genetic constitution of endosperm. Paternal genes benefit from their endosperm receiving more resources than the amount which maximizes the fitness of maternal genes, and this conflict is expressed as parent-specific gene expression in endosperm. The effect of the second maternal genome is to increase maternal control of nutrient acquisition. -- Female gametophytes of angiosperms are traditionally classified as monosporic, bisporic or tetrasporic. Bisporic and tetrasporic embryo sacs contain the derivatives of more than one megaspore nucleus. Therefore, there is potential for conflict between the different nuclear types within an embryo sac, but this possibility has not been recognized by plant embryologists. In Chapter 10, I show that many previously inexplicable observations can be understood in terms of genetic conflicts within the embryo sac. / Mode of access: World Wide Web. / 324 leaves ill

Thesis (M. Sc.)(Zoology)--University of Pretoria, 2005. / Includes bibliographical references. Available on the Internet via the World Wide Web.

Background: Palliative care can be given to patients with progressive, incurable disease. In palliative care the patient is seen in a holistic perspective, the goal is to prevent and relieve physical, psychological, social and existential suffering. The four cornerstones of palliative care are symptom relief, teamwork, communication/relation and support to next of kin. The nurse in palliative care builds a relationship with the patient and next of kin. The nurse also works with symptom relief and informing patient and next of kin. Next of kin to patients in palliative care often put themselves aside to care for the patient and wish to be with the patient until the end of the patients’ life. Aim: The aim of the study was to describe next of kins’ need for support from the nurse in end-of-life care in hospitals. Method: A literature study based on nine qualitative articles retrieved through systematic search in database Cinahl. The articles were analysed with a five-step method. Results: Two categories emerged in the results. The first was A respectful nurse, with the subcategories Emotional support, To be together and The patient is well taken care of. The second was To be involved as next of kin with the subcategories To be informed and Participation. Conclusion: Next of kin to patients in end-of-life care need a nurse who cares for them, enables them to be with the patient and participate in the patients’ care, guides and informs them in the end-of-life process and takes good care of the patient.

付記する学位プログラム名: 霊長類学・ワイルドライフサイエンス・リーディング大学院 / 京都大学 / 0048 / 新制・課程博士 / 博士(理学) / 甲第22295号 / 理博第4609号 / 新制||理||1661(附属図書館) / 京都大学大学院理学研究科生物科学専攻 / (主査)教授 古市 剛史, 教授 湯本 貴和, 教授 濱田 穣 / 学位規則第4条第1項該当 / Doctor of Science / Kyoto University / DFAM

Background: Road traffic accidents are on the rise in low income countries and have a large socioeconomic impact on Uganda. In Uganda, the nurse-patient ratio is 50-100 patients per nurse which is higher than in Sweden, and the patients’ next-of-kin are involved to assist with nursing care. Victims of road traffic accidents demand a lot of nursing care but contextual limitations give patients different opportunities for recovery. A common nursing language, as NANDA and NIC, aim to make communication more efficient; ease work for the staff and make the care better for the patients. Setting: The study was conducted at Mulago Hospital in Kampala, Uganda. Method: Participant observation was used when observing the nursing care of 24 patients. Field notes were analyzed using manifest content analysis. Aim: The aim of this study was to identify the nursing panorama of patients with musculoskeletal injuries in their context. Result: The ratio between the ten most common diagnosis and interventions showed to be 222:59. The diagnostic span and the range of interventions varied according to if staff or next-of-kin performed the nursing of the patients. Conclusion: Using NANDA and NIC, revealed the next-of-kin in the study being responsible for nursing diagnoses and interventions.