Background: Heart ischemia is a disease affected by behaviour, lifestyle and heredity. The disease is more common in the western world and the number of those who suffer increases. The mortality has reduced thanks to that medical resources and knowledge have approved. Purpose: The purpose of this study of the literature was to find out what patients experienced emotionally at an acute heart attack. Methods: A study of literature where scientific articles has been refereed and analyzed, then resulted into five categories presented in the result. Results: Studies shown that many of the patients have a depression and had experienced a lack of support after the hospitalisation. Conclusion: Needed in the sick care is that the nurse is able to take time for an individual care that looks through the medical diagnostic.

Background: In Sweden approximately 37 000 individuals are affected by myocardial infarction every year. It is important after an infarction to investigate and make preventive changes of lifestyle to prevent another event. Patients have different conditions on how to manage a myocardial infarction and the new life situation they are put in. Through Kim’s domains men’s experiences after a myocardial infarction are separated. Aim: The aim for this study was to elucidate men’s experiences after a myocardial infarction. Methods: Systematic literature review Result: Some men pointed out physical symptoms while others brought out psychological. Many experienced lifestyle changes as difficult. Numerous men felt support from their surrounding; nevertheless they felt that it affected their daily life by being overprotective. Multiple men where dissatisfied with the information from their care givers. Discussion: It is important to see the individual and the person’s life situation. What is the reason for patients’ dissatisfaction regarding information? How would it be possible to facilitate for the patients´ in their situation with an overprotective family and how would it be possible to find those patients´ that are considered as patients at risk without support from their surrounding? Conclusion: The individual behind the sickness is never to be overlooked witch could give negative consequences regarding nursing. For some reason there is a lack of information. This ought to be investigated so that the quality of the information to patients´ could be better. Overprotective family should be more involved in the care.

Obesity is one of the biggest threats to child- and adolescent health. The amount of obese children is today increasing more in Sweden than in the US. This may in a couple of years have bad consequences for the Swedish children’s quality of life. When a child suffers from obesity it is a big stress on the body and can lead to serious consequences in adulthood. An effective treatment in the early stages is important to prevent further obesity to develop. Purpose: The aim of this study was to bring forward the nurse role during treatment of obese children. Method: A literature study was performed and suitable articles were searched for in different Internet databases of which the result is based on. Result: The result is based on four main categories: inform and educate, recommend and motivate, follow up and co-operation. The result showed that nurses need to develop co-operation with the children’s parents. It is also important that the nurse motivates the children, especially the older ones to change their eating habits and increase their physical activity. Discussion: The nurse’s duty during treatment of child obesity needs to be clarified by for example increased education. The whole family needs to be involved for a succesful change of the child’s eating and physical habits.

To receive a diagnosis of pancreatic cancer can lead to a tremendous change in a person’s life. Thoughts regarding death may cause a personal crisis which can have negative influences on the patient’s social, mental and spiritual state. Most people with pancreatic cancer are diagnosed in a late stage of the disease. Therefore, palliative care is often one of the options that are offered to patients. Moreover, to be able to provide patients with nursing care and tend to their needs, it is very important to see them as unique individuals. The purpose with the literature review was to illustrate the experiences of palliative nursing care of patients with pancreatic cancer. A systematic literature review of scientific articles was performed. The study showed that patients’ experiences of need for information, patients’ need for time, support and personal relations, patients’ experiences of hope as well as patients’ need for symptom control were of importance in palliative nursing care.

Bakgrund/Litteraturgenomgång: Skolan spelar en viktig roll när det gäller att forma ungdomars sexuella hälsa. Samtidigt konkurrerar skolan med media som informationskanal. Forskning visar att ungdomar idag tar större sexuella risker och sexuellt överförbara infektioner ökar. En utvärdering visar att sexualundervisningen i skolorna är bristfällig och vilar på ett patogent perspektiv. Upplevelsebaserat lärande är en metod som delvis används i undervisningen. Metoden grundar sig på att eleverna skapar erfarenheter genom aktivt deltagande i olika simuleringar. Syfte: Syftet är att få en ökad förståelse för upplevelsebaserat lärande som metod i sex- och samlevnadsundervisning i åk 7-9. Metod: En kvalitativ undersökning med fem intervjuer genomfördes med undervisande personal. Resultat: Behovet av ämnet sex och samlevnad är stort. Upplevelsebaserat lärande kräver mer förarbete, tid, intresse och engagemang från den undervisande personalen än annan undervisning. Metoden når eleverna och ger en helhetsbild i lärandeprocessen. Eleverna blir tryggare och vågar mer. Metoden upplevs ej lämplig i klasser med olika etnicitet och mognadsgrad bland eleverna. Diskussion: Upplevelsebaserat lärande syftar till att genom simuleringar nå eleverna i deras livsvärld. Detta angreppssätt undviker dekontextualisering. Men detta lyckas inte alltid då det kan uppstå problem. Tid, hanterbarhet och engagemang är några av dem. Metoden har stora möjligheter för hälsofrämjande arbete.

Alcohol consumption in Sweden has reached its highest levels of the past 100 years in the wake of the country’s entry into the European Union in 1995. Increased alcohol prevention efforts in Swedish health care settings have been given high priority by the authorities. The Swedish parliament’s national action plan up to 2010 emphasises that public health must be protected by achieving reductions in alcohol consumption and limiting the negative physical, psychological, and social effects of alcohol. This thesis aims to investigate various aspects related to the current alcoholpreventive activity in 2006 among health care professionals in three important health care settings: primary health care (PHC), occupational health services (OHS), and maternity health care (MHC). The thesis includes four studies based on a total population mail questionnaire survey. Results from the studies show that alcohol issues in both PHC and OHS were addressed less frequently than all other lifestyle issues, i.e. smoking, physical activity, overweight, and stress. Important barriers to alcohol-preventive activity in these settings were perceived lack of time, scepticism regarding the effectiveness of addressing the issue of alcohol, fear of potentially negative patient responses, uncertainty about how to ask, uncertainty about how to give advice regarding alcohol, and uncertainty concerning where to refer the patient. OHS professionals generally considered themselves more skilful than their PHC counterparts in achieving change in patients’ alcohol habits and more knowledgeable about providing advice to patients with risky alcohol consumption. The overall frequency of initiating discussions about alcohol with patients in PHC and OHS was positively associated with self-assessed skills, knowledge, and education for all professional categories. Slightly more than one-third of the MHC midwives used a questionnaire to assess the woman’s alcohol intake before the pregnancy; AUDIT was the most commonly used questionnaire. Their perceived knowledge concerning alcohol and pregnancy matters was generally high, but the midwives considered themselves less proficient at detecting pregnant women with risky alcohol consumption before the pregnancy. MHC midwives had participated in more continuing professional education in handling risky drinking than all other categories investigated. PHC nurses was the category that had the highest proportion of professionals who lacked education in handling risky drinking. Professionals in PHC, OHS, and MHC to a large extent believed that provision of more knowledge about counselling techniques to use when alcohol-related symptoms are evident could facilitate increased alcohol intervention activity.

Landfill leachate is produced many years after a landfill site closes. Hence, treatment by “natural methods”, as e.g. constructed wetlands, with low management requirements is attractive. Constructed wetlands usually provide both shallow and deep areas with aerobic and anaerobic zones, which is suitable for nitrification followed by denitrification of the ammonium-rich leachates. Full-scale treatment systems are influenced by climatic variables that affect the microbial community. Also, the operational strategy can have a considerable impact on both activity and composition of the microorganisms. Many studies have measured inflow/outflow water quality in treatment systems. Such “black box” studies describe the treatment efficiency but add little to an increased understanding of theorganisms performing the treatment or the spatial distribution of their activities and treatment processes. In this thesis we investigated seasonal and annual changes in potential nitrification and denitrification, and in the corresponding bacterial communities in constructed wetlands treating landfill leachates. Variations in the potential activity in full-scale systems were investigated over several years, using short-term incubation. The composition of the bacterial communities was investigated using a group-specific PCR primer pair targeting the 16S rRNA genes or a primer pair targeting the funtional gene nosZ. The PCR products were analysed by denaturing gradient gelelectrophoresis and subsequent nucleotide sequencing and phylogentic analysis. A stable ammonia-oxidising bacterial (AOB) community composition and potential ammonia-oxidation (PAO) were detected in the system with a year-round operation. On the other hand, changes in the AOB community composition which followed the operational schedule were detected in the overland flow area (OFA) running seasonally. Furthermore, the influence of operational strategy was indicated by a low PAO in the wastewater overland flow area and compact constructed wetland receiving high hydraulic loads, indicating the value of aeration. Higher PAO was detected in the OFAs where the hydraulic load followed literature guidelines. All systems supported diverse AOB communities, represented by several Nitrosomonas and Nitrosospira populations. The number of different populations detected in these wetlands was much higher than reported in municipal wastewater treatment plants, and differed from those in a parallel OFA treating municipal wastewater. Furthermore, the large variation in both potential activity and sequences detected in replicate samples suggests that such systems are spatially heterogenic.

Molecular imaging is an emerging multidisciplinary field that addresses the visualisation of diseases at the cellular and molecular levels. This thesis focuses on the development of a synthetic Affibody molecule-based imaging tracer for the detection of HER2 expression in malignant tumours. Papers I-IV report the development of the HER2-specific Affibody molecule, ZHER2:342 by peptide synthesis and the use of different chelators attached to the N-terminus to allow 99mTc-labelling. Paper I described the optimisation of labelling of Affibody molecules using cysteine-based chelator sequences, in which the direct labelling method under alkaline conditions was the most suitable one. Papers II-IV report the development and optimisation of the in vivo properties of the HER2-specific Affibody molecule for high-contrast imaging. By using an array of mercaptoacetyl-based chelators, it was found that the substitution of a single amino acid in a 60 amino acid-long Affibody molecule can dramatically change the pharmacokinetics of the tracer. Strategic approaches that utilised hydrophilic amino acids, such as serine, glutamate and lysine, changed the excretion pathway from hepatobiliary to renal excretion. Problems with the high accumulation of radioactivity in the abdomen area and restricted imaging were resolved by the use of mercaptoacetyl-triglutamyl, maEEE or mercaptoacetyl-seryl-lysyl-seryl, maSKS chelators. Paper V reports the re-engineering of the HER2-specific Affibody molecule to provide a C-terminal SECG sequence using peptide synthesis. Incorporation of this sequence provided a multifunctional platform for labelling (with technetium or trivalent radiometals) and a flexible production route (recombinant or chemical synthesis). Combination of a serine, a glutamic acid and a thiol-bearing group in the chelating sequence reduced the renal accumulation of Affibody molecules. Altogether, the in vivo efficiency of Affibody molecules to target tumours and their biodistribution properties can be improved by strategic design and suitable chemistry. Hopefully, these observations will be applicable to other small peptide and protein scaffold-based tracers.

Norovirus (NoV) is today recognized as the most important agent of acute human gastroenteritis, causing a high number of diarrheal episodes in both adults and children. Outbreaks in hospitals, nursing homes, day-care centers, and from consumption of contaminated food and drinking water are common. Wastewater can be a source of NoV dissemination, e.g. when used for irrigation of crops, or due to shellfish cultivation near the outlet of wastewater treatment plants. Today, at least 25 different genotypes of NoV belonging to two major genogroups (GG) have been observed in humans. These genotypes are associated with different transmission patterns and disease severity in humans. Also host genetic factors, such as presence of ABO antigens and mutations in the FUT2 gene affect susceptibility, and can even render complete resistance to symptomatic infections, but only the most common NoV genotypes have been studied regarding this. In this thesis, we wanted to find prevention strategies for NoV disease through four studies of NoV epidemiology: Development of a sensitive real-time PCR assay for detection and quantification of human NoVs, characterization of NoV in children with diarrhea in Nicaragua, investigation of the prevalence and parameters influencing NoV concentration in a wastewater treatment plant in Gothenburg, Sweden, and studying host susceptibility factors in a foodborne NoV outbreak in Jönköping, Sweden. First we developed a real-time PCR assay which can detect and quantify NoV in various settings, both in stool samples of patients, and in wastewater samples from which virus was first concentrated using ultracentrifugation. This assay was found to be more sensitive than commercial immunological assays and conventional PCR methods. The assay is furthermore able to differentiate between the two major human genogroups of NoV using melting curve analysis, which provides valuable information about the circulating NoV strains. The survey of NoV in pediatric diarrhea in Nicaragua revealed a large impact of NoV, both in community and hospital based settings, with 15% of the severe diarrhea cases attributed to NoV. Peaks of clinically diagnosed NoV gastroenteritis were associated with emerging variants of genotype GGII.4, largely replacing the many different NoV genotypes circulating before the peak of diarrheal cases. Children infected with the GGII.4 genotype were found to shed more virus compared to children infected with other genotypes, which could partly explain the high transmission of GGII.4. At the wastewater treatment plant in Gothenburg, both NoV GGI and GGII were detected during a whole year, not only during the winter season when clinical cases are common. This indicates that NoV infections are frequently occurring at clinical and/or sub-clinical levels in the community. During winter, GGII was present in high concentrations, whereas GGI concentration increased to higher levels than GGII in summer, possibly due to the emergence of new genotypes following the winter outbreaks. The levels of NoV GGI were stable during the year, and hence incoming concentrations were affected by dilution factors such as rain. Primary treatment and treatment in a conventional, non-nitrifying activated sludge system reduced the NoV concentration by a factor of about 30. The detection of NoV in outgoing water, together with the low reduction and lack of correlation to indicator bacteria, suggest that better monitoring tools for virus in wastewater are warranted to reduce environmental contamination. A foodborne NoV outbreak in Jönköping in October 2007, by a NoV GGI.3 strain, revealed a surprising pattern of host susceptibility. In contrast to previous findings, this strain infected individuals irrespective of secretor status and Lewis (Le) phenotype, with non-secretors and Lea+bindividuals having a higher risk of disease. Individuals with blood group B had a partial protection to symptomatic infection, but none of the host factors investigated mediated complete resistance. Furthermore, we observed differences in susceptibility regarding homozygosity and heterozygosity in the FUT2 gene, with heterozygous secretor-positive individuals being more susceptible to symptomatic NoV infection than homozygous secretors. In summary, the developed LUX real-time PCR assay was successfully used in all studies in this thesis, which yielded important information about the prevalence and transmission of NoV. We observed the emergence of GGII.4 variants, causing the majority of diarrheal cases in children, largely replacing the other circulating genotypes, possibly due to better replication leading to a higher viral shedding. After the peak of NoV-induced diarrheal episodes, the incidence of GGII.4 decrease and other strains emerge which can infect people not previously exposed. This was observed in the foodborne outbreak in Jönköping, where individuals expected to be resistant to NoV were infected, and indeed had a higher risk of developing disease. A similar seasonal pattern was also indirectly observed in wastewater, with high levels of GGII in winter, which subsequently declined, followed by an increase of GGI in summer. Taken together, these results provide a better insight into the epidemiology of the virus, which hopefully can lead to better preventive measures for NoV gastroenteritis.

Estrogens have a remarkably wide range of actions in the mammalian brain. They not only play a pivotal role in reproductive behavior and sexual differentiation, but also contribute to e.g. thermoregulation, feeding, memory, neuronal survival and the perception of somatosensory stimuli. A multitude of studies on both animals and human subjects has demonstrated potential effects of gonadal hormones, such as estrogens, on pain transmission. These effects most likely involve multiple neuroanatomical circuits as well as diverse neurochemical systems and therefore need to be evaluated specifically in relation to the localization and intrinsic characteristics of the neurons engaged. The overall aim of this thesis is to gain specific knowledge of the possible cellular mechanisms by which estrogens may influence the transmission of nociceptive stimuli at the level of the spinal cord. The estrogen receptors, by which estrogens regulate non-genomic as well as genomic mechanisms, are crucial to estrogen signaling in general and essential to the estrogen-induced effects in the brain. In Paper I, we use immunohistochemistry to label neurons containing estrogen receptor-! (ERα) in the medullary and spinal dorsal horn of female rats. Large numbers of ER!-expressing neurons were found in lamina I and lamina II, i.e. in the areas involved in the processing of primary afferent nociceptive information. This distribution in part overlaps that of enkephalin, a potent pain-inhibiting endogenous opioid. The effects of gonadal hormones on pain modulation may, to a great extent, be blocked by the opioid antagonist naloxone, suggesting an involvement of the endogenous opioid system in the prosecution of hormonal pain regulation. By combining immunohistochemical labeling of ERα with in situ hybridization of preproenkephalin mRNA (Paper II), we demonstrate that the majority of enkephalinergic neurons in the superficial laminae of the spinal and medullary dorsal horn express ER!. This co-localization and the fact that the preproenkephalin gene contains a sequence that binds ERs, suggest that estrogens may potentially regulate enkephalin expression in these cells. This is further supported by the findings in Paper III in which we show that a single subcutaneous injection of estradiol induces a significant increase (on average 68%) in preproenkephalin mRNA content in the spinal cord after 4 hours. The expression of the enkephalin gene in the spinal cord is thus sensitive to fluctuating estradiol levels. In Paper IV, a noxious injection of formalin is used to induce activation of a neuronal population involved in nociceptive transmission from the face. By using a dual-labeling immunohistochemistry protocol, we were able to identify ER!-expressing cells within this neuronal population suggesting that nociceptive-responsive neurons in the medullary dorsal horn express ER!. In all, our findings provide morphological as well as biochemical evidence in support for an estrogen-dependent modulation of nociceptive processing at the level of the dorsal horn.