This paper reviewed the mechanisms of systemic inflammation and the nutritional status of the individuals who suffer from chronic diseases including rheumatoid arthritis, systemic lupus erythematous, chronic obstructive pulmonary disease, irritable bowel diseases include ulcerative colitis and Crohn’s disease, asthma, and atherosclerosis. Treatment modalities such as diet regimens will also be discussed. The Anti-Inflammatory diet, Mediterranean Diet, and the Dash diet will be discussed. Nutritional status and inflammation go hand in hand according to the findings available today. There is still more research required to completely understand the mechanisms that occur in inflammation.

Millions of people in the US currently suffer from chronic pain but available therapeutics do not provide effective chronic pain treatment. Opiate therapy is still the gold standard for chronic pain management with detrimental side effects, such as tolerance, addiction, constipation, and respiratory depression that limit their therapeutic potential. Opiates exert their positive and negative effects by activating the μ opioid receptor (MOR). Conversely, the κ opioid receptor (KOR) has been shown to modulate the tolerance and addiction produced by MOR agonists and is also involved in mood modulation (anxiety and depression). Therefore, blocking KOR activation results in positive effects against opiate side effects and stress-related depression. Dynorphin A (Dyn A) is the endogenous opioid peptide for the KOR. Structure-activity relationship (SAR) studies were carried out to develop a KOR selective antagonist based on the Dyn A structure. A minimum Dyn A pharmacophore with improved stability, no cell toxicity, and antagonist activity was discovered. Peptidomimetic enkephalin analogues previously developed in our group as MOR and δ opioid receptor (DOR) agonists have shown multifunctional activity, with MOR/DOR agonist and KOR antagonist activities. To our knowledge, this finding is first of its class for the opioid receptors. Novel design and synthesis of KOR selective ligands based on our multifunctional enkephalin analogues was done. Successful peptide synthesis resulted in analogues with high stability in rat plasma and no cell toxicity.

Opioider har blivit en vanligare behandlingsmetod för patienter med långvarig smärta som bidrar till att patienten upplever adekvat smärtlindring. Smärtlindringen kan dock leda till att patienter utsätts för opioidinducerade risker som leder till att patienten inte erhåller adekvat smärtlindring. Syftet med studien var att belysa patienters upplevelser av att behandlas med opioider vid långvarig smärta. Litteraturstudien utgår från en induktiv ansats och resultatet grundas på 14 vetenskapliga artiklar, varav sju artiklar är kvalitativa samt sju är kvantitativa. En innehållsanalys användes vilket resulterade i tre olika teman: Det professionella och sociala stödet, Inverkan på kropp och själ samt Vilja till att bemästra opioidbehandlingen. Resultatet visade både positiva och negativa upplevelser bland patienter med långvarig smärta som behandlas med opioider. Patienterna upplevde det professionella mötet som särskilt betydelsefullt då det ingav hopp och stöd. Patienter kunde däremot också uppleva förutfattade meningar samt negativa attityder vilket bidrog till bristfällig omvårdnad för patienterna. Studien föreslår att sjuksköterskor är i behov av utbildning och kunskap angående opioider och dess inverkan på kroppen för att bidra med god patientutbildning samt god omvårdnad. / Opioids have become a common method of treatment for patients with chronic pain that contribute to adequate pain relif. Pain relief can lead to patients being exposed to opioid-induced risks that causes inadequate pain relief for the patients. The aim of the study was to highlight patients experiences of being treated with opioids for chronic pain. The literature review is based on a inductive approach and the results are based on 14 scientific articles, including seven qualitative articles and seven quantitative articles. A content analysis of the article was used which resulted in three different themes: The professional and social support, Impact on the body and mind and Will to overcome opioid-therapy. The result showed both positive and negative experiences among patients with chronic pain treated with opioids. Patients experienced the professional meeting as particularly significant because it gave them hope and support. Patients could however also experience prejudice and negative attitudes which contributed to inadequate care for the patients. The study suggests that nurses are in need of education and knowledge about opioids and their impact on the body to contribute with good patient education and good nursing care.

Nursing research has been performed during the last 20-30 years, about the next of kin’s vulnerability. Despite this, the health care system has had difficulties to integrate the next of kin in a way that gives support. The overall aim of the thesis was to describe and further explore the life situation of the next of kin to persons who are long-term ill, disabled, and/or older, and in need of care. Method: Multiple methods were used. Study I had a descriptive design, 44 next of kin of patients with multiple sclerosis were interviewed, latent content analysis was used for the analysis. Study II had a mixed method approach; the descriptive core study was analyzed with directed content analysis. The supplementary study with descriptive, correlative design was analyzed with descriptive and correlative statistics. Forty-four next of kin of patients with multiple sclerosis were interviewed; thereafter 37 of them answered a questionnaire about Quality of Life. Study III had a descriptive, explorative design. Twelve next of kin of older persons were interviewed with repeated informal conversational interviews, analyzed with latent content analysis. Study IV was cross-sectional with a descriptive, correlative design. Eighty-four next of kin of persons who were long-term ill, disabled, and/or older answered two questionnaires about Burden and Quality of Life that were analyzed with descriptive and correlative statistics. Results and Conclusions: Next of kin described a balance/imbalance in their relations to others and a high burden, but in general a good Quality of Life. Some next of kin also experienced chronic sorrow. Significant correlations were found between interpersonal relations and Quality of Life as a whole. Love and obligations were two anchor points on a continuum, describing the next of kin’s relationship to the ill/disabled person. The relationship with the health care personnel was described through cooperation and obligations. Good communication was seen as the key to balance the relationship with others. One possibility to achieve symmetrical communications is to adapt the Partnership Model, as a tool for creating good relationships. Honest and specific communication between the health care personnel, the next of kin, and the care receiver are necessary.

Chronic obstructive pulmonary disease (COPD) is one of the most widespread diseases globally. A commonly reported symptom is impaired nutritional status, which is often discussed in the literature as difficult to assess. Because nurses play a key role in the care of patients with COPD, knowledge needs to be supplemented with clinically relevant methods that can be used for identification of nutritional needs. The overall aim of this thesis is to investigate factors associated with the nutritional status of persons with COPD and to describe the assessment of nutritional status in different settings and for persons of varying ages. Both qualitative and quantitative methods were used. Two studies with descriptive and exploratory designs (I, II) and two studies with comparative (III), and correlational design (IV). In three of the studies participants were persons with COPD (I, III, IV), whereas one involved registered nurses (RNs). Qualitative data were collected using diaries (I), vignettes (II) and interviews (I, II) and analyzed using qualitative content analysis. Data collection (III, IV) included body size and body composition measurements, assessment of nutritional status using the Mini Nutritional Assessment (MNA), the Malnutrition Universal Screening Tool (MUST), the Evaluation of Nutritional Status (ENS), and lung function measurements. These were analyzed using statistical methods. The main findings from the interviews with 13 respondents in PHC in study I showed that eating difficulties alone do not cause reduced nutritional intake for persons with COPD. Eating is only one aspect in a chain of meal-related situations that involve additional physiological and psychological demands. Assessment of nutritional status, performed by 19 RNs, consisted mainly of single observations. For a half of the RNs it was more important to establish trustful relationships with patients than to give nutritional information, while the other RNs had different opinions on when it was best to provide nutritional information and assess nutritional status. Study III findings showed poor nutritional status for nearly half of the 50 older participants. Many who were identified as malnourished lived alone and were dependent on daily community services. Six out of the 81 participants in Study IV were similarly identified as malnourished by each of the three instruments (MNA, MUST and ENS). There was a significant correlation between each of the instruments and body composition, assessed as fat-free mass index (FFMI). The MNA Short Form (MNA-SF) incorrectly identified thirteen participants’ nutritional status as not needing attention for their nutritional status. To be evaluated as ‘in need of qualified help with nutrition’ by the ENS the respondents needed to be identified as malnourished by the MNA. A general conclusion is that nutritional status is complex for persons with COPD and is difficult to measure by currently recommended methods. Individuals’ experiences are important to elicit because some of their experiences, in combination with RNs’ judgement, might serve as a hindrance for nursing care and delay the sharing of important information. The methods currently recommended for identification of nutritional status should be used with caution, and assessment should not depend on one single method. The findings from this thesis can contribute to early accurate identification of nutritional status and prompt interventions that have importance for an improved disease trajectory and better quality of life for individuals with COPD.

Denna tvärsnittsstudie syftade till att undersöka samförekomst av smärtrelaterad rädsla och social ångest i ett kliniskt sample med kronisk smärtproblematik. Syftet var också att beskriva och kontrastera samvariation av transdiagnostiska faktorer i eventuella subgrupper. Datan bestod av enkätsvar från 196 deltagare i Social ångest smärta-projektet som leds av Örebro universitet och Akademiska sjukhuset i Uppsala. En klusteranalys fick fram fyra subgrupper bland deltagarna. En subgrupp utmärkte sig för hög komorbiditet. Denna grupp visade höga nivåer av tänkbara transdiagnostiska faktorer som ångestkänslighet och negativ affekt, samt hög smärtkatastrofiering. Det diskuterades kring dessa faktorers roll som sårbarhets- och vidmakthållandeprocesser, utifrån aktuella teoretiska modeller. Studiens kliniska implikationer belyser behovet av hänsyn till dessa faktorers roll vid behandling och framtida forskning. / This cross-sectional study aimed to explore co-occurrence of pain-related fear and social anxiety in a clinical sample with chronic pain. The purpose was also to describe and contrast co-variation of transdiagnostic factors in potential subgroups. The data consisted of 196 answered questionnaires from the Social anxiety pain-project led by Örebro University and the Uppsala University Hospital. A cluster analysis produced four subgroups among the participants. One subgroup was salient for its high comorbidity. This group showed high levels of potential transdiagnostic factors such as anxiety sensitivity and negative affect, as well as high pain catastrophizing. These factors are discussed in terms of their role as vulnerability and maintaining factors, in the light of current theoretical models. The clinical implications of this study suggest taking the role of these factors into account in aspects of treatment and future research.

ABSTRACT The Implications of Chronic Stress on Obesity: Allostatic Load on Body Mass Index (BMI) Classification in the United States, NHANES 2005-2006 INTRODUCTION: In this modern environment, our world is reflecting an exponential increase in not only population, but in body size. Obesity is an overwhelming public health concern among the United States population. Research has shown there is a positive correlation between adiposity and stress. Allostatic load (AL) has been presented to be a consistent measure of chronic stress damage on the body. Yet, there is few studies exemplifying the presence AL on classification of body mass index (BMI). AIM: The aim of this study is to find a relationship between allostatic load (AL) and body mass index (BMI) classification in the United States adult population on a large national scale. This complex interaction can predetermine who among the US population will be at greater risk for excess adiposity following this psychoneuroendocrinology. METHODS: A representative sample size of n=3826 was gathered using NHANES data (2005-2006). Criteria for sample included all United States adults that had numerical values for 10 biomarkers chosen to represent chronic stress damage (allostatic load) along with individual body mass index (BMI). Allostatic load (low, high) and BMI classification (underweight to class III obese) were further categorized on severity and computed in SPSS to find significance between gradients of each variable (α=.05). Cross-sectional analysis and logistical regression (multivariate) were used to further decipher an association between allostatic load and BMI category. RESULTS: A strong positive correlation between allostatic load risk and BMI category was found (p<.001). Also among the variables in the study, significance was found within the strata of age, gender, race, smoking status and poverty income ratio (PIR). Findings show a strong statistically significant relationship between allostatic load and BMI. DISCUSSION: It is imperative to decipher the directional relationship between stress and obesity to provide effective treatment. Understanding the pathology of how stress affects adiposity could open the door for many clinical and public health interventions to eradicate a very preventable outcome. By addressing the effect of chronic stress, a new avenue of prevention can be developed to combat the growing obesity rates in the United States.

Bakgrund: KOL är en relativt vanlig och obotlig sjukdom som orsakar en gradvis försämring på andningen. Hur man upplever sjukdomen kan skilja sig åt mellan individer och mellan olika stadier av sjukdomen. Det är därför av stor vikt att sjuksköterskan får insikt i dessa upplevelser för att kunna erbjuda god omvårdnad till dessa personer. Syfte: Syftet med litteraturstudien är att beskriva personers upplevelser av att leva med KOL samt att beskriva vilka datainsamlingsmetoder som använts i de inkluderade artiklarna. Metod: Litteraturstudie med en deskriptiv design. De 12 inkluderade artiklarna är av kvalitativ ansats och söktes fram via databaserna Cinahl och PubMed. Innehållet i artiklarnas resultat granskades för att urskilja likheter och skillnader samt de inkluderade artiklarnas datainsamlingsmetod.Huvudresultat: Resultatet i litteraturstudien påvisade att personer med KOL upplevde psykiska, fysiska och sociala aspekter som påverkade personernas liv. Den psykiska påverkan gjorde att personerna fick göra många förändringar i livet. Andningssvårigheterna gjorde att den fysiska förmågan blev nedsatt. Sjukdomen påverkade även den sociala samhörigheten med andra människor. För att hantera och underlätta livet med KOL använde personerna sig av olika strategier. Den vanligaste datainsamlingsmetod som framkom i artiklarna var semistrukturerade intervjuer. Slutsats: Personerna med KOL påverkades psykiskt, fysiskt och socialt av att leva med sjukdomen. Personerna använde sig av olika strategier för att hantera sitt liv med sjukdomen. Det är viktigt som sjuksköterska att ha kunskap om personernas upplevelser av att leva med KOL eftersom det gör att det blir lättare att bevara personernas integritet, värdighet, och autonomi som kan öka personernas välbefinnande. / Background: COPD is a relative common and incurable disease that causes a progressive deterioration of breathing. How to experience the disease may differ between individuals and between different stages of the disease. It is therefore essential that nurses gain insight into these experiences to provide good care to these people. Aim: The aim of this study was to describe people's experiences of living with COPD. Furthermore, the aim of this study was to describe the included articles data collection method. Method: A literature study with a descriptive design. The 12 included articles are of qualitative approach and sought out through the databases CINAHL and PubMed. The contents of the articles results were reviewed to identify similarities and differences and also the included articles data collection method. Main result: The results of the literature study showed that people with COPD experienced psychological, physical and social aspects that affect people's lives. The psychological impact was that the people had to make many changes in life. Breathing difficulties made the physical ability to reduce. The disease also affected the social affinity with other people. To manage and facilitate life with COPD people used different strategies. The most common data collection method that emerged in the articles were semi-structured interviews. Conclusion: The people with COPD were affected psychologically, physically and socially to live with the disease. The people used different strategies to manage their life with the disease. It is important that nurses having knowledge of people´s experience of living with COPD because it makes it easier to preserve people´s integrity, dignity, and autonomy that can increase people's well-being.

Die Herzinsuffizienz ist eine der häufigsten chronischen Erkrankungen mit progressivem Krankheitsverlauf. Dieser ist verschiedenen Kompensationsmechanismen geschuldet, die zunächst zur Verbesserung, über einen längeren Zeitraum hinweg jedoch zur Verschärfung der Symptomatik führen. Durch erhöhte Konzentrationen inflammatorischer Zytokine im Rahmen dieser Krankheit kommt es unter anderem zu pathologischen Veränderungen in Muskel- als auch Fettgewebe. Das kürzlich in der Literatur als PGC-1α reguliert beschriebene Molekül FNDC5 (Spaltprodukt Irisin) wird als Myokin bezeichnet, welches zwischen Muskel- und Fettgewebe vermittelt. Bis dato ist jedoch ungeklärt, ob und inwiefern es einen Zusammenhang zwischen einer Herzinsuffizienz, erhöhten Konzentrationen proinflammatorischer Zytokine und dem Molekül FNDC5 in der Skelettmuskulatur gibt. Um diesen Fragestellungen nachzugehen, wurde in der vorliegenden Arbeit zum einen durch LAD-Ligatur in Ratten eine Herzinsuffizienz induziert, um die systemischen Verhältnisse dieser Erkrankung im Tiermodell bestmöglich nachzuempfinden. Zum anderen wurden Mäuse mit TNF-α oder Ang II behandelt und C2C12-Myotuben mit TNF-α, Ang II sowie einer Zytokinkombination inkubiert, um den Einfluss der Zytokine bzw. des Hormons auf die FNDC5-Expression zu untersuchen. Anschließend wurden die Expression von FNDC5 auf mRNA- und Proteinebene sowie die Expression der PGC-1α-mRNA in Skelettmuskelbiopsien bestimmt. Es konnte nachgewiesen werden, dass eine Herzinsuffizienz sowie der Einfluss inflammatorischer Zytokine zur signifikanten Expressionsverminderung von FNDC5 führt. Ang II hingegen bewirkte nicht in allen Versuchen eine deutliche Reduktion der FNDC5-Expression. Außerdem wurde gezeigt, dass die Signaltransduktionswege über p38 und p42/44 MAPK nicht für die Wirkung der Zytokinkombination auf die FNDC5-Expression verantwortlich sind.

This research explored the role of extra-therapeutic variables contributing to recovery from chronic Post Traumatic Stress Disorder (PTSD). Within the context of dramatherapy treatment, those variables were identified as three crucial concepts: 'Client, Post Traumatic' (C.PT), ‘Imaginary Existence Zone’ (IEZ) and 'Time Adjusted Encounters' (TAE). Together they created the notion of a Curative Zone (CZ). Establishing and understanding the significance of these new concepts helped the researcher to explain the PTSD recuperation phenomenon. The research was conducted within the qualitative–naturalistic paradigm, and based on real-life dramatherapeutic occurrences. The choice of an inductive case study approach and design was possible due to the fact that a single individual was willing to participate in this research as an active partner by contributing her reflections on the therapy, four years after its termination. Iris, the client and the collaborating respondent was a childless woman aged 43, who suffered from chronic PTSD for three years following stillbirth of her baby daughter and the repetitive failure of fertility treatments. The findings reveal a direct linkage between: the neurological system and its activation, and the cardinal role of the C.PT during TAE, working through prolonged engagements in the IEZ facilitated by dramatherapy. These processes gradually integrated and synthesized to create the CZ, a development which explains this instance of recovery from chronic PTSD. The conclusions are: the chronic PTSD recovery was a holistic body-mind cure phenomenon. It resulted from the interaction between the extra-therapeutic variables, combined with the curative characteristics of the dramatherapeutic nonverbal imaginative language and activities, which compounded a new synergetic constellation. The research findings contribute to the theory and practice of dramatherapy as a discipline; additionally, the model developed by this research can be potentially applied as an appropriate treatment of PTSD. These conclusions challenge valid psychotherapy knowledge regarding effective therapeutic factors that contribute to successful outcomes. However, in this case they verified credible, dependable and transferable attributes features this naturalistic research. Therefore, they make a contribution to knowledge in the dramatherapy field.