Bakgrund: Sår på nedre extremiteter är vanligt förekommande, särskilt hos äldre. De sår som inte läkt inom sex veckor räknas som svårläkta och brukar medföra stora lidanden för de drabbade samt stora samhällsekonomiska kostnader. Sårens komplexitet påverkas av bakomliggande sjukdomsfaktorer och diabetespatienter är särskilt utsatta. Kosten är grundläggande för att upprätthålla kroppens livsviktiga funktioner men trots detta används sällan nutritionsbehandling för denna typ av sår. Syfte: Att sammanställa nutritionens betydelse för sår på nedre extremiteter. Metod: En litteraturstudie baserad på 15 kvantitativa empiriska studier om nutritionens betydelse för bensår och/eller diabetiska fotsår. Huvudresultat: Samband identifierades mellan nutritionsstatus och såromfattning där sämre nutritionsstatus ledde till mer allvarliga sår och ökad amputationsrisk. Näringsbrister, framför allt av mikronäringsämnena vitamin C, D, magnesium och zink, uppdagades hos deltagarna. Deltagarnas kost bestod av hög andel kolhydrater och fett medan proteinintaget i många fall var under rekommenderade nivåer. Trots påtaglig undernäring led majoriteten av deltagarna av övervikt eller fetma. Näringstillskott, särskilt av mikronäringsämnen, påskyndade sårläkningsprocessen och gav även förbättrade värden för CRP och glykemisk kontroll. Vikten av vitamin D är speciellt framträdande. Slutsats: Nutritionen har bevisligen stor betydelse för sårutvecklingen. Därför bör patienter med svårläkta sår utredas för eventuella näringsbrister oavsett kroppsvikt. Med individanpassade kostråd och nutritionsinsatser kan patienten bättre stödjas i strävan efter sårläkning genom egenvårdsinsatser. / Background: Ulcers on lower extremities are common, especially among the elderly. Ulcers not healing in six weeks are considered chronic and lead to significant suffering for those affected and substantial socioeconomic costs. Underlying medical factors contribute to ulcer complexity and patients with diabetes are particularly exposed. Nutrition is essential for maintaining and strengthening the body's vital functions. However, nutritional therapy is not as commonly used for lower extremity ulcers as for other wounds. Objective: To compile the significance of nutrition for lower extremity ulcers. Method: A literature review based on 15 quantitative primary studies on the significance of nutrition for leg ulcers and/or diabetic foot ulcers. Main Results: Relationship between nutritional status and ulcer size was identified where poorer nutritional status led to more severe ulcers and increased risk of amputation. Nutritional deficiencies, especially micronutrients vitamin C, D, magnesium, and zinc, were found among the participants. Diets consisted of a high proportion of carbohydrates and fats, while protein intake often was below recommended levels. Most participants were overweight or obese despite apparent malnutrition. Nutritional supplements, especially of micronutrients, accelerated the ulcer healing process and improved values for C-reactive protein (CRP) and glycemic control in controlled studies. The importance of vitamin D was emphasized in this literature review. Conclusion: Nutrition plays a significant role on ulcer development. Patients with chronic ulcers should be screened for potential nutritional deficiencies, regardless of body weight. With individualized dietary advice and nutritional interventions can patients receive better support in efforts for self-care and ulcer healing.

<p> Hypertension and reduced arterial distensibility are independent risk factors for cardiovascular disease. Previous research has found that isometric training reduces resting blood pressure (RBP) (Wiley et al. 1992; Taylor et al. 2003) yet the mechanisms responsible remain elusive. Improved arterial distensibility may contribute to this reduction in RBP. The purpose of the present study was threefold: 1) to replicate the RBP lowering effect of isometric handgrip (IHG) exercise; 2) to compare IHG and isometric leg press (ILP) based in their RBP lowering effects; and 3) to determine if central or peripheral arterial distensibility improved with IHG or ILP. The population examined was people whom were medicated for hypertension.</p> <p> RBP, as assessed by brachial oscillometry, and arterial distensibility, as assessed by Doppler ultrasound and applanation tonometry in the carotid, brachial and femoral arteries, were measured pre training, after 4 weeks of training, and post training. Participants performed unilateral IHG exercise (n=10) or ILP exercise (n=9) 3 times/week for 8 weeks at 30% MVC or acted as a non-exercising control group (n=5).</p> <p> Results indicated that the present study was unable to reproduce the RBP reductions noted in previous studies using IHG exercise. Also, the ILP exercise group did not experience reductions in RBP. Finally, neither central nor peripheral arterial distensibility improved in the IHG or ILP group when compared to the control group.</p> <p> Although these findings are contrary to our hypotheses one must consider that the control group examined contained very few subjects. This may have limited our ability to detect statistically significant changes in RBP and arterial distensibility.</p> / Thesis / Master of Science (MSc)

No description available.

Bakgrund: Kroniska venösa bensår är en vävnadsskada i form av svårläkta hudsår som är lokaliserade nedanför knäleden och är orsakade av försämrat blodflöde i venerna. Trots att många människor drabbas av återkommande, smärtsamma och resurskrävande sår är de en medicinskt lågprioriterad grupp. Syfte: Syftet var att beskriva hur det är att leva med venösa bensår. Metod: En litteraturöversikt baserat på tio vetenskapliga originalartiklar. För artikelsökningen använde vi oss av databaserna Cinahl Complete och PubMed. Analysen utfördes inspirerad av Fribergs metod. Resultat: Analysen av artiklarna ledde till tre temaområden: somatiska besvär, psykosocialt lidande och omgivningens förhållningssätt Slutsats: Personer med bensår upplever betydande fysiskt och emotionellt lidande, inklusive smärta, skamkänslor och social isolering. Dessa patienter är beroende av vårdpersonal och anhöriga, och behöver en holistisk vård med fokus på både såret och den mänskliga aspekten. Ytterligare forskning behövs särskilt kring relationen mellan bensårspatienter och deras närmaste familj. / Background Chronic venous leg ulcers are tissue injuries in the form of hard-to-heal skin sores located below the knee, caused by impaired blood flow in the veins. Despite affecting many individuals with recurrent, painful, and resource-intensive sores, they are a medically low-priority group. Aim The aim was to describe what it is like to live with venous leg ulcers. Method A literature review based on ten scientific articles. The databases Cinahl Complete and PubMed was used in search for the articles. The article analysis was based on Friberg's analysis model. Results The analysis of the articles resulted in three thematic areas: somatic symptoms, psychosocial suffering, and the attitudes of the surroundings. Conclusions Individuals with leg ulcers experience significant physical and emotional suffering, including pain, feelings of shame, and social isolation. These patients depend on healthcare professionals and relatives, requiring holistic care that addresses both the wound and the human aspect. Further research is particularly needed regarding the relationship between leg ulcer patients and their immediate family.

To estimate the clinical and cost-effectiveness of using a skin protectant (Cavilon No Sting Barrier Film [NSBF] or Cavilon Durable Barrier Cream [DBC]; 3M) compared with not using a skin protectant in the management of venous leg ulcers (VLUs), in the UK. Method: A decision model was constructed depicting the patient pathways and associated management of a cohort of patients with and without a Cavilon formulation, plus dressings and compression. The model was based on the case records of a cohort of matched patients from The Health Improvement Network (THIN) database, who were first diagnosed with a VLU between 1 Jan 2008 and 31 Dec 2009. The model estimated the costs and outcomes of patient management over 6 months and the cost-effectiveness of using a Cavilon formulation relative to not using a skin protectant. Results: Patients' mean age was 80.2 years and 61% were female. Sixty-five per cent (n=166) of Cavilon patients received NSBF, and 35% received DBC. Between 6% and 9% of VLUs were healed at 6 months and 53–66% became infected. Healing was affected by a patient's age (OR: 0.944 for each additional year), but not by gender, level of exudate or wound size. There was a significantly greater reduction in wound size among patients in the NSBF group than in the other two groups (p < 0.001). Additionally, there was no significant difference in the initial wound size of those VLUs that did and did not heal in the two Cavilon groups; however, initial size of the VLUs that healed in the control group was significantly smaller than those that did not (p<0.001). Resource use was similar between the three groups. Patients were predominantly managed by practice nurses, with a mean 37–38 nurse visits over the study period. Patients' dressings were changed, on average, every 4–5 days, with a mean of 3 dressings under a compression bandage. The total 6-monthly NHS cost of managing a VLU was ∼£2200. Practice nurse visits were the primary cost driver, accounting for up to 58% of the 6-monthly NHS cost, whereas dressings accounted for < 10% of the cost. Conclusion: Use of NSBF leads to significantly greater wound size reduction than that observed in the other two groups and may facilitate the healing of larger wounds without increasing costs. Hence, use of NSBF for peri-wound skin protection in patients with exuding VLUs is the preferred treatment strategy. / 3M Health Care, manufacturers of Cavillon NSBF and Cavillon DBC

No / High compression therapy, whether with bandage systems or hosiery, is the accepted treatment of lower limb venous ulceration. Compression has not only been shown to improve healing, it has been demonstrated to reduce oedema and improve tissue oxygen levels (Stacey et al, 1990), reversing some of the changes associated with chronic venous insufficiency (Vandongen and Stacey, 2000). The introduction of multilayer high compression bandage systems in the late 1980s, and subsequent improvements in bandage textiles and design, have undoubtedly improved outcomes for many patients. However, compression alone does not address the underlying pathology of venous ulceration, chronic venous insufficiency (CVI), and without treatment CVI continues to cause skin damage and increases the risk of recurrent ulceration. In 1999, Nelzen emphasised that compression treatment has been used since the days of Hippocrates and yet has not solved the problem of leg ulceration (Nelzen, 1999).

This study investigated the determination of an optimal resistive force for use during a short-term, high-intensity cycling power test. Twenty-four college females [age (yrs) x̄=22.0 ± 0.50; weight (kg) x̄=60.3 ± 1.46] gave consent and participated in a 1 repetition maximum (RM) test of the leg extensors and 5 maximal 15 s cycling tests using a modified Monark cycle ergometer. The 1 RM test was performed using a Nautilus leg extensor machine. Even increments between six to ten % 1RM test were utilized to determine the resistive force applied to the flywheel. The 5 tests were divided into a 2 testing sessions occurring at least 48 h apart. Each subject warmed-up at 50 - 60 rpms for 2 - 5 minutes without resistance prior to testing. Each test consisted of a maximal cycling bout of 15 s with 20 minutes rest between tests. The variables measured included peak power (PP), time to peak power (TTPP), power fatigue rate (PFR), power fatigue index (PFI), and average power (AP). These values were collected by a microcomputer interfaced with the cycle ergometer. In general, PP decreased at a resistance greater than 9 % 1RM. The average reported PP values were 363±15, 413±19, 465±19, 520±21, and 460±41 for loads 6 to 10 % 1RM respectively. Similar results were reported for AP. The differences in PP for loads between 8 and 10 % 1RM were statistically different. Results show that PP varies based on loads of % 1RM and the optimal range is between 8 and 10% 1RM. / Master of Science

Bakgrund: Muskelbristningar i vadmuskulaturen kan vara svårrehabiliterade varför fysioterapeuter, tillsammans med andra professioner, behöver kunskap om vilka rehabiliteringsmetoder som har starkast evidens. Samstämmighet saknas, därav intresset att kartlägga olika rehabiliteringsmetoder.   Syftet med denna litteraturöversikt var att beskriva rehabiliteringsmetoder och eventuella rapporterade effekter i samband med muskelbristningar i musculus Triceps Surae samt beskriva studiekvalitet.   Metod: Fem artiklar, tre RCT-studier och två observationsstudier, granskades utifrån syfte och frågeställningar och kvalitetsgranskades enligt SBU’s (Statens beredning för medicinsk och social utvärdering) granskningsmallar. Databassökningar gjordes i PubMed, Medline och CINAHL Plus.   Resultat: Injektioner med trombocytrik plasma, is-behandling och kompression genomfördes som tillägg till ett grundläggande rehabiliteringsprogram. Huvudsakliga utfallsmått var återgång till sport/spel samt smärta. Studiekvaliteten bedömdes vara medelhög och evidensstyrkan begränsad.   Slutsats: Rehabilitering vid muskelbristningar i vadmuskulaturen ger förkortad rehabiliteringstid varav PRICE (Protection, Rest, Ice, Compression, Elevation) är betydelsefullt i det initiala skedet. Kompression och injektion av trombocytrik plasma uppvisar positiv inverkan på rehabiliteringstiden på lång sikt, isbehandling visar ingen effekt på lång sikt. Resultatet indikerar att ökad ålder förlänger rehabiliteringstiden samt ökar risken för återfall. Området är i behov av fler randomiserade kontrollerade studier för att stärka evidensen inom området.

No description available.

Durch Umwandlung unterschiedlichster Formen von Energie in mechanische oder elektrische Energie wird die Menschheit seit Jahrhunderten bei der Umsetzung von Arbeitsprozessen im Alltag und bei der industriellen Nutzung unterstützt. Strömende Medien wie Wasser oder Wind gelten dabei als die ältesten Energielieferanten. Im Rahmen der Dissertation wird das Konzept einer zugspannungsverankerten Plattform für Offshore Windenergieanlagen (WEA) vorgestellt, wobei neben den, für diesen Plattformtyp typischen, vertikalen auch geneigte Verankerungselemente Verwendung finden. Diese Art der Verspannung einer zugspannungsverankerten Plattform, respektive ’Tension Leg Platfrom’ (TLP) ist bisher von keiner Quelle bekannt und stellt ein Alleinstellungsmerkmal dar. Folglich sollen Untersuchungen zum dynamischen Verhalten schwimmender Gründungen für Offshore WEA, im Speziellen zu einer TLP mit vertikalen und geneigten Ankerelementen, im Rahmen dieser Arbeit erstmalig vorgestellt werden. Die Plattform ist ein modular gestaltetes Tragwerk bestehend aus großen Rohren und mit integrierten zylindrischen Auftriebskörpern. Diese erzeugen im Transportzustand der Plattform vom Hafen zum Einsatzort und im Betriebszustand innerhalb eines Windparks den nötigen Auftrieb. Infolge der speziellen Art der Verspannung werden die Bewegungen der TLP durch die, aus den Belastungen resultierenden, Seildehnungen dominiert. Damit stellte die TLP im Vergleich zu anderen schwimmenden Gründungen ein bewegungsarmes System dar. Inhalt der hier vorgelegten Arbeit sind Untersuchungen zum dynamischen Verhalten schwimmender Offshoregründungen, im speziellen einer TLP für Windenergieanlagen. Es wurden unterschiedliche Tragstrukturen für TLP-Systeme entwickelt und im Rahmen von Modellversuchen getestet. Den Kern der Arbeit bildet der Vergleich des dynamischen Tragverhaltens der unterschiedlichen Plattformen unter Berücksichtigung der geometrischen und strukturellen Randbedingungen.