Rationale: Chronic diseases represent an important health burden that often involves major adaptations to manage the disease on a daily basis. Health professionals, such as the family physician, can help a person acquire more power over his or her health (enablement). While it would be useful to measure patient perception of enablement by the family doctor with a valid questionnaire, existing tools present important gaps. Aim and objectives: This study aimed at developing a self-administered questionnaire to measure the perception of patients with chronic diseases of enablement by their family physician. The objectives were: 1) To deepen the conceptualization of enablement by validating the proposed conceptual framework with patients presenting with chronic diseases and to specify the relative importance of its dimensions; 2) To operationalise the dimensions by proposing indicators of these dimensions (pool of items); 3) To verify the content validity of the questionnaire. Methods: An exploratory sequential mixed-method research design was chosen. The descriptive qualitative study (objectives 1 and 2) used in-depth interviews with 30 patients aged 35 to 75 presenting with at least one chronic disease, having the same family doctor for at least one year and recruited through maximum variation sampling. Taped interviews were transcribed and analyzed using Miles and Huberman's mixed coding method (2003a). A three-round e-Delphi study (objective 3) involved 15 Canadian experts in family medicine, able to read in French. The experts scored the items proposed on a 9-point scale (1 = Inappropriate to 9 = Very appropriate) and could suggest rewording and additions. Items scored 7-9 by the experts were considered consensual and were not presented in the following round. Items that were not consensual after the third round were decided upon by the team of researchers. Results: The partnership (the trusting relationship and decisions to be taken) that develops over time was found to be a major component of enablement. The enablement role of the physician goes beyond the medical consultation to defend the interests and safety of the patient's journey through the healthcare system. The trusting relationship combined with a good knowledge of the person may help the family physician better understand and legitimize the various feelings experienced while offering realistic hope . The family physician is in a privileged position to help patients develop their own expertise . Sixty-six items classified into six dimensions were submitted to the experts during the first round of the E-Delphi method. The first round was completed by 13 experts: 21 items were consensual; 25 items were resubmitted without any modification; 16 items were modified and four were rejected. Forty-one items were submitted during the second round, completed by 13 experts: eight items were consensual; 20 items were submitted without any modification; 12 items were modified and one item was rejected. Thirty-three items were submitted during the third round completed by nine experts: 29 items remained intact; three items were modified and one item was rejected. Conclusion: An initial 61-item questionnaire is proposed.

Bakgrund: Kroniska sår innefattas av bensår, fotsår, trycksår, diabetessår, sårskada, tumörer, reumatiska sår och vårdskador vid komplikationer efter kirurgiska ingrepp, som inte har läkt inom 6 veckor. Forskning visar att trots att förebyggande strategier används, utvecklas det sår som kräver behandling. I mötet med vården är en god omvårdnad och en god vårdrelation viktig. Bristen på dessa leder ofta till ett lidande som individen måste kämpa emot med copingstrategier. Syfte: Syftet med denna litteraturstudie var att belysa personers erfarenhet av att leva med kroniska sår. Metod: En litteraturöversikt gjordes i denna studie med 15 vetenskapliga artiklar, som bestod av både kvantitativ och kvalitativ metod. Resultat: 3 huvudkategorier identifierades: begränsningar, lidande samt coping. Deltagarna ansåg att en brist på information samt begränsningar i vardagen påverkade individens sociala umgänge och fysiska aktivitet. Smärta, skam och rädsla ledde till depression. För att hantera detta använde individerna sig av familjen och stöd av vårdpersonalen Slutsats: Det framkom att individernas dagliga liv påverkades av det kroniska såret. Den konstanta smärtan orsakade sömnsvårigheter hos individen, vilket ytterligare försvårade hanteringen av smärtan och vardagen. Kontinuitet hos vårdpersonal och i behandlingen gav personerna en trygghet och en ökad förståelse för sitt tillstånd. Det belystes att det var viktigt att vårdpersonalen ser individen bakom såret, och inte bara lägger sitt fokus på sårläkningen och behandlingen. / Bakground: Chronic wound comprises of leg ulcer, foot ulcer, decubitus, diabetic ulcer, damaged ulcer, tumors, rheumatic wounds and care damage with complications after surgical intervention, which hasn't healed within six weeks. Research gives the results of showing that, even though prevention of strategies are used, the ulcer is still developing and needs treatment. In the meeting with the healthcare, it is important to have a good nursing and a good relationship care. Lack of this often leads to suffering that the individual must endure with the aid of coping strategies. Aim: The aim of this study was to explore the persons experience of living with a chronic ulcer. Method: In this study a literature review was done, with 15 scientific articles, which consisted of both quantitative and qualitative methods. Results: 3 main categories where identified: restriction, pain and coping. The participants felt that it was lack of information and limitations in everyday life which affected the individual's social life and physical activity. Pain, shame and fear led to depression. To get the capability to handle the situation, the individuals turned to their families and care provider for support. Conclusion: As it is stated, the individuals where affected in their everyday life due to the chronic ulcer. The constant pain which is caused the sleeping disturbances in the individual´s made coping the pain and everyday life harder. Continuity with the healthcare provider and treatment gave an understanding and safety for the individuals for their condition. It was important that the health professionals not only put their focus on the healing of the wound and the treatment, they must also put attention to the individual with the wound.

No description available.

Chronic pain is a widespread problem, especially in the older population, and can affect various aspects of daily living. At a time when it has been acknowledged that the population is increasingly ageing, research regarding the effects of chronic pain on the daily living of older adults is essential. Furthermore, the development of innovative technology is changing the way that much research is being conducted, and can lead to the retrieval of novel information, using a fresh approach. The adoption of this technology in the field of chronic pain research has the potential to examine various aspects of the daily living of older adults living with chronic pain using a different approach to previous research. This study is underpinned by a Critical Realist ontology and Hermeneutic epistemology and follows a Generic Qualitative Research methodology (Caelli, et al., 2003). The aim of the study was not to generalise the findings but to gather a deep theoretical description of the outcomes and offer an explanation of these findings based on an analysis of the multiple research methods used within the study. This study had two main aims and was split into two sections according to the aims. Firstly, Part A of this study aimed to explore a range of day-to-day patterns and experiences of functioning in older adults suffering from chronic pain. Part B aimed to explore the usability, acceptance and experience of the technology used to measure functioning as part of the first aim of this study. Part B also aimed to look at the practicalities the participants were faced with when using the technology. A mixed methods design was used for Part A in which 15 older adults (65+) living with chronic pain (pain >3 months) took part in an in-depth study lasting seven days. As well as the 15 core participants that took part in the study, two older adults (65+) without chronic pain and two younger adults (<65) with chronic pain took part in the study in order to provide some insight into the effects of either pain, or age, on functioning. Part A used four data collection techniques to gather data upon the daily functioning of older adults with chronic pain; the Daily Reconstruction Method diary (Kahneman, Krueger, Schkade, Schwarz, Stone, 2004), the Sensecam (also known as the Vicon Revue, Vicon©), the LifeShirt (Vivometrics Inc) and a semi-structured interview. However, although the LifeShirt was validated, as part of this PhD, and used throughout the study, the gathered data was not analysed due to multiple problems with the data. The Daily Reconstruction Method, Sensecam and the semi-structured interview were each analysed separately before the results of the Daily Reconstruction Method and Sensecam were integrated into the themes derived from the semi-structured interviews. The integrated results led to the development of two themes, each with sub-themes; ‘effect on daily living’ and ‘managing pain and functioning’. The themes from Part A highlighted the way in which pain affected functioning and the modifications to daily functioning as a result of chronic pain. The way in which individuals perceived the management of their own pain and functioning, as well as strategies and assistive devices to manage pain and functioning were also discussed. This study has furthered current knowledge due to the idiographic nature of the study, as well as multiple, novel, data collection tools used, adding additional details to how tasks have been modified, reduced, or terminated. Part B of this study used the Unified Theory of Acceptance and Use of Technology (UTAUT, Venkatesh, et al., 2003), the Flow-State Scale (Jackson & Marsh, 1996) and semi-structured interviews to explore participants’ use of both the Sensecam and LifeShirt. The questionnaires and interviews were carried out with all of the individuals that carried out Part A of this research. From the semi-structured interviews two main themes were reported, each with sub-themes; ‘expectations and experiences’ and ‘awareness of equipment’. Two concepts developed from the themes within Part B that were specific to the participants’ experiences of wearing wearable technology in this study, as opposed to ‘typical’ non-wearable technology; specifically, the importance of design and the importance of others. Both of these overarching concepts affected the expectations of the technology, the experiences of using the technology, as well as the awareness of the technology during use. Furthermore, both concepts will remain and are long-lasting, despite the development of the technology in this field, but there are specific details that are contemporary and are specific to either the Sensecam or the LifeShirt as used in this study.

Background: Minor procedures in surgery and urology such as groin hernia and hydrocele repair, as well as prostate biopsies are very frequently done in routine practice. Complications and insufficient outcomes thus affecting many patients and the cumulative effect of this are of major importance in a population perspective. Aim: To explore complications and outcomes of surgical or diagnostic procedures and possible risk factors or predictors for adverse effects. Methods: By using both national quality and administrative registers, and by complementing registers with patient reported outcome measures, examine outcomes such as complications, persistent pain and recurrences. Also, in the case of hydro and spermatoceles, report incidence numbers. Further, by using a randomized trial, explore minimally invasive procedure such as sclerotheraphy compared to conventional surgery in respect to cure and adverse events. Results: When comparing with the open anterior mesh repair, endoscopic technique is advantageous in respect to the patient reported outcome of persistent pain. The drawback was an increased risk of postoperative complications and reoperation for recurrence. Incidence numbers for hydro and spematocele were 100/100000 men. Aspiration (± sclerotherapy) had a significantly lower rate of complications as compared to conventional surgery. In the interim analysis of the randomized trial, comparing sclerotherapy to Lord´s procedure for hydroceles, the cure rate was similar between treatments. Definite conclusions cannot be made due to the risk of type 2 errors, and the study will thus continue. In the case of trans-rectal prostate biopsy, the rates increased every year during the study time frame, up to an approximate risk of two per cent in 2012 for hospital readmission within 30 days, without an increased mortality within 30 days. Conclusions: The open anterior mesh procedure is still the preferred method for groin hernia repair in routine surgical practice. Hydro and spermatocele surgery is associated with high rates of complications, and the indication for repair should be scrutinized. The rates of infection after prostate biopsy is increasing and methods to reduce unnecessary biopsies as well as improved prophylaxis should be investigated.

Doctor of Philosophy / Department of Kinesiology / Craig A. Harms / The overall aim of this dissertation was to determine the impact of lifestyle (i.e. habitual and acute physical activity and diet), age, and sex on systemic and airway inflammation and oxidative stress. In study 1 (Chapter 2) we examined the impact of habitual physical activity level on the post-prandial airway inflammatory response following an acute bout of moderate intensity exercise. Results indicated that the mean exhaled nitric oxide (eNO; marker of airway inflammation) response increased for all groups at two hours post high-fat meal (HFM) (~6%) and returned to baseline by four hours post-HFM. However, there was a varying eNO response from baseline to four hours in the group that exercised in the post-prandial period compared to the group that remained sedentary. These findings suggest airway inflammation occurs after a HFM when exercise is performed in the post-prandial period, regardless of habitual physical activity level. In study 2 (Chapter 3) we investigated the post-prandial oxidative stress response to meals of varying calories and fat. Specifically, we assessed the post-prandial airway and systemic 8-isoprostane (a marker of oxidative stress) responses to meals with moderate-fat (8.5 kcal/kg of bodyweight) and high-fat content (17 kcal/kg of bodyweight) from baseline to six hours post-meal in a randomized crossover design. This study revealed that systemic 8-isoprostane increased from baseline to six hours post-meal (38.3%), but there was no difference between the moderate-fat meal (MFM) and HFM conditions. There were no changes in airway 8-isoprostane from baseline to six hours post-MFM or HFM, or between the MFM and HFM conditions. Lastly, in study 3 (Chapter 4), we were interested in examining 8-isoprostane responses in older adults, since 8-isoprostane has been reported to increase with age. Previous research also suggests that older women (OW) and older men (OM) have differences with regard to prevalence and severity of late-onset asthma. In this study, we sought to determine whether the airway 8-isoprostane response to a strenuous bout of exercise was different in OW compared to OM. A secondary aim was to determine whether post-exercise 8-isoprostane generation was correlated with decrements in lung function. Our results showed that the generation of 8-isoprostane from pre- to post-exercise increased ~74±77% in OW and decreased ~12±50% in OM. The decrease in 8-isoprostane generation was not correlated with improvements in lung function from pre- to post-exercise. These findings collectively contribute to the literature by enhancing our understanding of the impact of lifestyle factors, age and sex on modifying and potentially mitigating the risk of developing chronic diseases.

Det friska barnet påverkas av att leva med ett långvarigt sjukt syskon, precis som det påverkar den övriga familjen. Det är viktigt att sjuksköterskan inkluderar de friska syskonen i vården, ser dem som en del av familjen och hjälper dem få en känsla av sammanhang. Syftet med denna litteraturstudie var att beskriva syskonets upplevelse av att ha en syster eller bror med långvarig fysisk sjukdom. I resultatet inkluderades tio artiklar och ur dem framkom tre teman med underteman. Det första temat var förändring för syskonet med undertema utmaningar för familjen och utmaningar i vardagen. Det andra temat, som uppenbarade sig, var syskonets behov med fyra underteman: behov av familjen, behov i vardagen, behov av kunskap och behov av stöd. Det sista temat var syskonets känslor med följande underteman; känslor runt familjen, känslor runt sig själv, och känslor om omgivningen. Syskonen vill ses som en del av familjen och de upplever att deras syskonrelation fördjupas. De vill vara delaktiga i omvårdnaden av det sjuka barnet och de har ett behov av information om vad de kan göra men även behov av en ökad kunskap runt diagnos, behandling, och prognos. / The healthy child is affected by living with a sibling that has a chronic disease the same way as it affects the whole family. It is important that the nurse includes the healthy siblings in the care, sees them as a part of the family and helps them to a sense of coherence. The aim in this literature study was to describe the sibling´s experience of having a brother or sister with a chronic disease. The result includes ten articles and from them three themes with subthemes emerged. The first theme is changes for the sibling with subthemes as challenges for the family and challenges in everyday life. The second theme that emerged was the sibling’s needs with four subthemes: need of the family, need in everyday life, need of knowledge and need of support. The last theme was the sibling´s feelings with the following subthemes: feelings about the family, feelings about themselves and feelings about the environment. The siblings want to be seen as a part of the family and they feel that the sibling relationship deepens. They want to be involved in the care of the sick child and they have a need of information about what they can do, but also the need for increased knowledge about diagnosis, treatment and prognosis.

Bakgrund: Kronisk hjärtsvikt är ett globalt växande tillstånd i hela världen. Sjuksköterskan har en betydande roll i att ge kunskap och att informera kring hur det är att leva med kronisk hjärtsvikt. Syfte: Att beskriva dagligt liv för patienter med kronisk hjärtsvikt, utifrån ett patientperspektiv.    Metod: En litteraturöversikt där 13 kvalitativa artiklar har inkluderats. Studien baseras på induktiv ansats. Resultat: Personer med hjärtsvikt upplever en förändrad livssituation efter att de har fått diagnosen kronisk hjärtsvikt. Resultatet redovisas i kategorierna: Begränsningar i vardagen, Påverkan av omgivningen och Mötet med vården. Slutsats: Resultatet visar att personer som lever med hjärtsvikt genomgår fysiologiska förändringar, men även känslomässiga, sociala och andliga förändringar. För att möta dessa personer behöver sjuksköterskan ha kunskap i att identifiera individens behov och därefter utforma omvårdnaden utefter den unika individen. / Background: Chronic heart failure is an common disease worldwide. The nurse has a significant role in providing knowledge and information about how to live with chronic heart failure. Aim: To describe daily life for patients with chronic heart failure, from a patient perspective.   Method: A literature review where thirteen qualitative articles were included. The study is based on inductive approach. Results: People with heart failure experience a changed life situation after they have been diagnosed with chronic heart failure. The results are reported in categories: Limitations in everyday life, Influence of the environment and Health Care services. Conclusion: The result shows that people living with heart failure undergo physiological changes, but also emotional, social and spiritual. In order to meet these people, the nurse needs knowledge in identifying the needs of the individual in order to design nursing according to the unique individual.

Background: Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by persistent sinonasal inflammation and sinus microbiome dysbiosis. The basis of this heterogeneity is poorly understood. We sought to address the hypothesis that a limited number of compositionally distinct pathogenic bacterial microbiota exist in CRS patients and invoke discrete immune responses and clinical phenotypes in CRS patients. Results: Sinus brushings from patients with CRS (n = 59) and healthy individuals (n = 10) collected during endoscopic sinus surgery were analyzed using 16S rRNA gene sequencing, predicted metagenomics, and RNA profiling of the mucosal immune response. We show that CRS patients cluster into distinct sub-groups (DSI-III), each defined by specific pattern of bacterial co-colonization (permutational multivariate analysis of variance (PERMANOVA); p = 0.001, r(2) = 0.318). Each sub-group was typically dominated by a pathogenic family: Streptococcaceae (DSI), Pseudomonadaceae (DSII), Corynebacteriaceae [DSIII(a)], or Staphylococcaceae [DSIII(b)]. Each pathogenic microbiota was predicted to be functionally distinct (PERMANOVA; p = 0.005, r(2) = 0.217) and encode uniquely enriched gene pathways including ansamycin biosynthesis (DSI), tryptophan metabolism (DSII), two-component response [DSIII(b)], and the PPAR-gamma signaling pathway [DSIII(a)]. Each is also associated with significantly distinct host immune responses; DSI, II, and III(b) invoked a variety of pro-inflammatory, T(H)1 responses, while DSIII(a), which exhibited significantly increased incidence of nasal polyps (Fisher's exact; p = 0.034, relative risk = 2.16), primarily induced IL-5 expression (Kruskal Wallis; q = 0.045). Conclusions: A large proportion of CRS patient heterogeneity may be explained by the composition of their sinus bacterial microbiota and related host immune response-features which may inform strategies for tailored therapy in this patient population.

The toxicological screening of the numerous chemicals that we are exposed to requires significant cost and the use of animals. Accordingly, more efficient methods for the evaluation of toxicity are required to reduce cost and the number of animals used. Computational strategies have the potential to reduce both the cost and the use of animal testing in toxicity screening. The ultimate goal of this thesis is to develop computational models for the prediction of toxicological endpoints that can serve as an alternative to animal testing. In Paper I, an attempt was made to construct a global quantitative structure-activity relationship (QSAR)model for the acute toxicity endpoint (LD50 values) using the Munro database that represents a broad chemical landscape. Such a model could be used for acute toxicity screening of chemicals of diverse structures. Paper II focuses on the use of acute toxicity data to support the prediction of chronic toxicity. The results of this study suggest that for related chemicals having acute toxicities within a similar range, their lowest observed effect levels (LOELs) can be used in read-across strategies to fill gaps in chronic toxicity data. In Paper III a k-nearest neighbor (k-NN) classification model was developed to predict human ether-a-go-go related gene (hERG)-derived toxicity. The results suggest that the model has potential for use in identifying compounds with hERG-liabilities, e.g. in drug development.