Mastitis is one of the most costly diseases to dairy producers around the world with milk yield loss being the biggest contributor to economic losses. The objective of first study of this thesis was to determine the impacts of high somatic cell counts on milk yield loss. To accomplish this, over one million cow data records were collected from Southeastern US dairy herds. The objective of the second study was to determine optimum treatment cost of clinical mastitis by combining two economic modeling approaches used in animal health economics. The last objective of this thesis was to determine how much Southeastern US dairy producers are spending to control milk quality on farm and determine if they understand how milk quality affects them economically. This was accomplished through a collaborative project within the Southeast Quality Milk Initiative.

Bakgrund: Patienter med psykiatriska diagnoser och deras närstående upplever att den somatiska vården inte lever upp till deras förväntningar och att vårdpersonal har bristande kompetens vad gällande bedömning och bemötande. Patienter upplever sig misstrodda när de presenterar sina symtom vilket leder till känslor som skuld och skam. Psykisk sjukdom ökar i världen och sjukvården har ännu inte lyckats möta vårdbehovet för denna patientgrupp. Syfte: Att beskriva sjuksköterskors upplevelser av att vårda patienter med psykiatriska diagnoser i den somatiska vården. Metod: En litteraturöversikt genomfördes för att få kunskap inom detta område. Författarna valde ut tio vetenskapliga artiklar, som alla var av kvalitativ design och svarade till det specifika syftet. Resultat: Tre kategorier framkom: Den första var Sjuksköterskors upplevelser i praktiken med underkategori Upplevelser av patienter där författarna presenterade hur sjuksköterskor uttryckte att de saknade färdigheter, fokuserade på patienters fysiska symtom och upplevde patienter som oförutsägbara och tidskrävande vilket ledde till känslor som frustration och rädsla. Den andra kategorin, Sjuksköterskors upplevda arbetsmiljö beskrev hur den fysiska och psykosociala arbetsmiljön hindrade sjuksköterskor från att tillgodose patienternas vårdbehov. Den tredje kategorin var Sjuksköterskors upplevda kompetens med underkategori Erfarenheter av att vårda. Sjuksköterskor upplevde att de saknade adekvat utbildning vilket hade en direkt inverkan på upplevelsen av att vårda. Diskussion: Litteraturöversiktens resultat visade en upplevd kunskapsbrist hos sjuksköterskan och en arbetsmiljö som hindrade vårdandet. Detta diskuterades utifrån bakgrund, resultat och Phil Barkers omvårdnadsteori. / Background: Patients with psychiatric diagnoses and their families feel that somatic care does not live up to their expectations and that health professionals lack competence in the assessment and treatment for these diagnosis. Patients feel disbelieved when they present their symptoms, which leads to feelings of guilt and shame. Mental illness is increasing worldwide and the healthcare providers have not managed to meet the increased need for care. Aim: The aim was to describe nurses experiences of caring for patients with psychiatric diagnosis in a somatic care setting. Method: A literature review was conducted to gain a wider knowledge in this area. The authors chose ten scientific articles, all of which were of qualitative design and responded to the specific purpose. Results: Three categories emerged. The first was Nurses experience in practice with the sub-category Experiences of patients where the authors presented how nurses expressed that they lacked skills, focused on the patients physical symptoms and experienced patient´s as unpredictable and time consuming, which led to feelings of frustration and fear. The second category, Nurses experience of their work environment described how the physical and the psychosocial environment prevented nurses from meeting the patients care needs. The third category was Nurses experienced competence with the subcategory Experiences of nursing. Nurses felt that they lacked adequate education, which had a direct impact on the experience of caring for patients with psychiatric diagnosis. Discussion: The literature reviews result showed a perceived lack of knowledge for nurses and a work environment that hinder patient care. This was discussed on the basis of the background, result and Phil Barker´s nursing theory.

Le système nerveux sensoriel somatique détecte et transmet les informations sensorielles périphériques par les neurones sensoriels dont le corps cellulaire est englobé dans les ganglions de la racine dorsale et les ganglions trijumeaux. Bien que cette hétérogénéité fonctionnelle a été mise en évidence, les mécanismes moléculaires qui la caractérisent sont moins connus. Dans l’optique de contribuer à la caractérisation moléculaire de la population neuronale du DRG, nous avons identifié un nouveau gène, stac2. Nous avons pu montrer que stac2 spécifie une sous population neuronale distincte dans le DRG. L’invalidation génétique de stac2 chez la souris n’a révélé aucun effet sur la survie ni sur la maturation neuronale. L’analyse comportementale des souris dépourvues de stac2 a montré un rôle important de stac2 dans la perception et la discrimination des températures fraîches ainsi que dans la sensibilisation périphérique au froid nocif. / The somatic sensory nervous system detects and transmits sensory information from peripheral by sensory neurons that have their cell body encompassed in the dorsal root and trigeminal ganglia. Although this functional heterogeneity has been demonstrated, the molecular mechanisms characterizing it are less known. In order to contribute to the molecular characterization of the neuronal population of DRG, we have identified a new gene, stac2. We have shown that stac2 specifies a distinct neuronal subpopulation in the DRG. The genetic invalidation of stac2 in mice showed no effect of stac2 on neuronal survival and maturation. The behavioral analysis of mice lacking stac2 showed an important role of this gene in the perception and discrimination of cold temperatures and in the peripheral sensitization to noxious cold.

Bakgrund: Psykisk ohälsa betraktas idag som ett folkhälsoproblem. Patienter med psykisk ohälsa lider ofta av samsjuklighet och vårdas därför ofta inom somatisk vård. Vårdvetenskapen förespråkar ett helhetsperspektiv på människan där kropp och själ samverkar och den ena delen aldrig kan uteslutas. Vid psykisk ohälsa kan lyhördhet i vårdrelationen vara avgörande. Sjukvårdspersonal upplever dock att de saknar kunskap i att vårda patienter med psykisk ohälsa. Syfte: Syftet var att belysa patienters upplevelser av att vårdas inom somatisk sjukvård i samband med psykisk ohälsa. Metod: Litteraturöversikt genomfördes med tio vetenskapliga artiklar, åtta med kvalitativ design och två med kvantitativ design. Artiklarna analyserades enligt Fribergs (2012) metod för litteraturöversikt. Resultat: Sex huvudteman identifierades: upplevelser av att möta sjukvårdspersonal, att känna sig förstådd, att vårdgivaren följer upp, att få vara delaktig, hinder för vård och trygghet. Diskussion: Utifrån Erikssons teori om vårdrelation och lidandet diskuteras resultatet. Kunskapsbrist kring psykisk ohälsa skapar osäkerhet hos sjukvårdspersonalen och lidande för patienten. Betydelsen av att se hela människan diskuteras. / Background: Mental illness is nowadays considered a public health problem. Patients with mental illness often suffer co-morbidity and are therefore often cared for within somatic care. According to caring science the holistic perspective of the human with both body and soul is advocated where one part can never be excluded. Sensitivity in the caring relationship can be crucial for a patient suffering from mental illness. However, health personnel themselves experience a lack of knowledge caring for patients with mental illness. Aim: The aim of the literature review was to illustrate patients´ experiences of being cared for within somatic care in conjunction with mental illness. Method: Literature review including ten scientific articles was implemented, eight with a qualitative design and two with a quantitative design. The articles were analyzed according to Friberg’s (2012) method for literature review. Results: Six main themes were identified: experiences of meeting health personnel, experiences of being understood, follow-up by the caregiver, experiences of being involved, experiences of barriers for care and security. Discussion: The result is discussed according to Eriksson's theory of the caring relationship and suffering. Lack of knowledge within mental illness creates insecurity among health personnel and also creates suffering for the patient. The importance of seeing to the human as a whole is discussed.

Bakgrund: Sjuksköterskan har ansvar att tillämpa delaktighet i omvårdnad, både utifrån lagar men även utifrån ett etiskt perspektiv. Sjuksköterskans arbete på somatisk vårdavdelning påverkas av faktorer såsom hög arbetsbelastning och att bli avbruten. Detta påverkar sjuksköterskans tillämpning av delaktighet. Kunskap och förståelse om delaktighet kan underlätta främjandet av delaktighet i sjuksköterskans arbete. Orems omvårdnadsteori, som examensarbetet tagit förankring i, bygger på att sjuksköterskan ska stärka patientens förmåga till egenvård varvid delaktighet är en förutsättning. Syfte: Syftet är att belysa begreppet delaktighet för patienter på somatisk vårdavdelning i relation till sjuksköterskan. Metod: En begreppsanalytisk modell av Walker och Avant. Resultat: Delaktighet utgörs av orden del och akt och har ursprung i latinska pars. Delaktighet finns i olika former och är en aktiv handling där patientens inre resurser beaktas. Delning av information, en etablerad relation och tillit är viktigt vid ansvarsfördelning. Delaktighet som begrepp består av de sex attributen integration, informationsutbyte, partnerskap, interaktion, kapacitet och ansvar. Alla attributen är beroende av varandra för att fånga in begreppet, vilket demonstreras i olika fallbeskrivningar. Slutsats: De sex definierande attributen har tydliggjort hur delaktighet kan användas i praktiken. Med konkretisering av delaktighet finns ökad förståelse för hur sjuksköterskan kan främja patientens förmåga till egenvård. / Background: A nurse has a responsibility to apply participation in nursing, both from laws but also from an ethical point of view. A nurse’s work in a somatic ward is affected by factors as high workload and being interrupted, which affects participation. Knowledge and understanding about participation may facilitate participation in the nurse’s work. Orem’s theory of nursing, on which this bachelor thesis has taken abutment in, is based on that the nurse should consolidate the patient’s ability to self-care wherein participation is a condition. Aim: To highlight the concept of participation of patients in a somatic ward in relation to the nurse. Method: A concept analysis model by Walker and Avant. Results: Participation constitute from the words part and act and has its origin in Latin pars. Participation comes in different forms and is an active action where the patient’s inner resources are taken in regard. Sharing of information, an established relationship and trust is important for division of responsibility. Participation as a concept consists of the six attributes integration, information exchange, partnership, interaction, capacity and responsibility. All these attributes depend on each other to capture the concept, which has been demonstrated in different case studies. Conclusion: The six defining attributes have clarified how participation can be used in practice. With the concretization of participation there is greater understanding of how the nurse can promote the patient's ability to self-care.

Bakgrund: Psykisk ohälsa är ett folkhälsoproblem världen över och i Sverige har det framkommitatt patienter med psykisk ohälsa har sämre förutsättningar för att få ett adekvat omhändertagande vid somatisk sjukdom,och att allmänsjuksköterskor gör skillnad i omvårdnaden av patienter med psykisk ohälsa. Tidigare forskning har visat att allmänsjuksköterskor har haft en ytlig förståelse för psykisk ohälsa och haft svårigheteratt bedöma vad som är somatiskt och vad som är psykiskt. Syfte: Syftet med studien var att beskriva vilka faktorer som allmänsjuksköterskor upplever påverkar deras bemötande av patienter med psykisk ohälsa som söker somatisk sjukvård. Metod: En allmän litteraturstudie. Resultat: Faktorer som påverkade allmänsjuksköterskors bemötande av patienter med psykisk ohälsa identifierades i fyra teman: Rädslor, tid, psykisk ohälsa i somatisk kontext samt kompetens. Slutsats: Det krävs mer utbildning för allmänsjuksköterskor i områden som berör bemötandet och omvårdnad gentemot patienter med psykisk ohälsa, och det krävs mer utbildning för att reducera sjuksköterskors rädslor genom att öka förståelsen för patienternas beteende. Klinisk betydelse: Genom att bli medveten om kunskapsbristen så kan det leda till ett mer reflekterande förhållningssätt över hur man bemöter och uppfattar patienter med psykisk ohälsa vilket kan möjliggöra att utöka vidare kunskap. / Background: Mental health is a public health problem worldwide and in Sweden there is awareness that health care contributes to poorer care of patients with mental illness, which for instance is verified by general nurses who have made difference in the care of patients with mental illness. Overall, previous research has shown that nurses have had a superficial understanding of mental illness which has led to difficulties to estimate what is somatic and what is mental. Patients with mental disorders are a vulnerable group which been exposed by stigmatization and studies have shown that it reflects the nurse and patient relationship in the performance of the nursing care. Aim:The aim of this study was to describe the factors that general nurses experience affects their treatment of patients with mental illness who are searching for somatic health care. Method: A literature review. Results: Factors affecting general nurse’s treatment of patients with mental illness identified four themes: Fears, time, mental illness in a somatic context, and competence. Conclusion: It requires more training for general nurses in areas related to treatment and care towards patients with mental illness, and more training is required to increase nurse ́s understanding of patients behavior to reduce nurse’s fears. Clinical significance: By becoming aware of the lack of knowledge it can lead to a more reflective approach over how to respond and perceive patients with mental illness, which could enable to strengthen further knowledge.

Bakgrund: I den somatiska vården finns det patienter med psykiska sjukdomar. De vanligaste psykiska sjukdomarna är schizofreni, psykoser, depression, ångestsyndrom och bipolära sjukdomar. Behovet av somatisk vård är större för patienter med psykiska sjukdomar än de utan, på grund av ökad risk för somatiska sjukdomar. Patienter upplevde att vardagslivet påverkas av de psykiska sjukdomarna. Vårdpersonal upplevde en osäkerhet och rädsla inför denna patientgrupp. Syfte: Att beskriva hur patienter med psykisk sjukdom upplever att bli vårdad i den somatiska vården. Metod: Litteraturöversikten baserades på 13 vetenskapliga artiklar. Dessa artiklar hämtades från CINAHL Complete och Pubmed. De huvudsakliga sökorden bestod av: mental illness, mental health, healthcare experience, patients’ experience, physical illness, primary care, communication och physical care. Resultat: Fyra teman utformades i resultatet. Ett tema var upplevelser av att bli stämplad av sjukvården på grund av den psykiska sjukdomen och det gjorde att patienterna kände sig bortprioriterade. När de kände sig stämplade upplevde de känslor av skam och maktlöshet. Ett tema var upplevelser att inte bli trodd som handlade om att fysiska symtom inte blir tagna på allvar. Det tredje temat var hur upplevelser om bristande kunskap hos vårdpersonal om psykiska sjukdomar påverkade vården. Detta upplevde patienter ledde till brist på information och delaktighet. Positiva erfarenheter och önskemål var det sista temat som visades i form av upplevelser av en personcentrerad vård, då vårdpersonal visade empati. Diskussion: Valda delar i resultatet diskuterades utifrån Katie Erikssons teori om att lindra lidande. Centrala begrepp inom teorin som användes var vårdlidande och konsensusbegreppet människan. / Background: In the somatic care, there are patients with mental illnesses. The most common mental illnesses are schizophrenia, psychoses, depression, anxiety disorders and bipolar disorders. The need for somatic care is bigger for patients with mental illnesses than those without, because of an increased risk of getting a somatic disease. Patients were experiencing that their daily life was affected by the mental illness. Healthcare professionals experienced uncertainty and fear of treating these patients. Aim: To describe how patients with mental illness are experiencing to be cared in the somatic care. Method: The literature review consisted of 13 scientific articles. These articles were found in the databases CINAHL Complete and PubMed. Main search words consisted of: mental illness, mental health, healthcare experience, patients experience, physical illness, primary care, communication and physical care. Results: Four themes were formed in the result. One theme was the experience of being labeled because of the metal illnesses and that made the patients feel not prioritized. When they felt labeled, they experienced feelings of shame and powerlessness. One theme was the experiences of not being believed and included patients experience that symptoms were not taken seriously. The third theme was how the experience of a lack of knowledge among health professionals about mental illnesses affected the care. Patiens experienced that it led to lack of information and participation. Positive experiences and desires were the last theme that appeared in form of experiences of a person centred care, when health professionals showed empathy. Discussion: Based on Katie Eriksson´s theory about relieving suffering, chosen parts from the results were discussed. The key concepts in the theory that were used were care suffering and the consensus concept human.

Despite the success of available medical and psychosocial treatments, a sizable subgroup of individuals with commonly co-occurring disorders, generalized anxiety disorder (GAD) and major depressive disorder (MDD), fail to make sufficient treatment gains thereby prolonging their deficits in life functioning and satisfaction. Clinically, these patients often display temperamental features reflecting heightened sensitivity to underlying motivational systems related to threat/safety and reward/loss (e.g., somatic anxiety) as well as inordinate negative self-referential processing (e.g., worry, rumination). This profile may reflect disruption in two important neural networks associated with emotional/motivational salience (e.g., salience network) and self-referentiality (e.g., default network, DN). Emotion Regulation Therapy (ERT) was developed to target this hypothesized profile and its neurobehavioral markers. In the present study, 22 GAD patients (with and without MDD) completed resting state MRI scans before receiving 16 sessions of ERT. To test study these hypotheses, we examined the associations between baseline patterns of intrinsic functional connectivity (iFC) of the insula and of hubs within the DN (anterior and dorsal medial prefrontal cortex [MPFC] and posterior cingulate cortex [PCC]) and treatment-related changes in worry, somatic anxiety symptoms and decentering. Results suggest that greater treatment linked reductions in worry were associated with iFC clusters in both the insular and parietal cortices. Greater treatment linked gains in decentering, a metacognitive process that involves the capacity to observe items that arise in the mind with healthy psychological distance that is targeted by ERT, was associated with iFC clusters in the anterior and posterior DN. The current study adds to the growing body of research implicating disruptions in the default and salience networks as promising targets of treatment for GAD with and without co-occurring MDD.

SOMATIC CHARACTERISTICS OF FEMALE FIGURE SKATERS IN THE CZECH REPUBLIC Objectives: The aim of the thesis is to find out specific somatic characteristics and somatotypes of female figure skaters in the Czech Republic. Subsequently relationships between measured somatic characteristics and normative of general population, and relationships between actual data and previous studies of female figure skaters are being examined. Methods: We use somatometric measurements to determine selected somatic characteristics (weight, height, eg.). We use the Heath-Carter method of somatotyping. Results: Female figure skaters are smaller than general population of the same age. In terms of physical height, one half of figure skaters is above population average while second half is under the average of population. Female figure skaters in this study are taller and heavier than figure skaters in previous study (Šelingerová, 1988) and they are more endomorphic. Prevailing somatotype is mesomorphic endomorph. Keywords: figure skating, somatic characteristics, somatotype, Heath-Carter method

Title of thesis: The Benefits of Physiotherapy in the Treatment of Patients Suffering from Primary Dysmenorrhoea. The concept of the problem: Primary dysmenorrhoea is one of the most common gynecological affections, which affects the female population of working age. It is characterized as a set of symptoms associated with menstruation, of which the main is pain and general fatigue, anorexia, nausea, to the pathological changes in mood, in the sence depression or syncopes. This menstrual period becomes considerable discomfort for women and it distorts her life also from psychosocial page. Given the critical role of women in family and society, it is necessary to deal with this situation and seek effective methods of conservative treatment of primary dysmenorrhoea. Objectives: Determination the effectiveness of acupressure therapy as a possible means of medical rehabilitation in the conservative treatment of primary dysmenorrhoea. Extending expertise of physiotherapy intervention of primary dysmenorrhoea and their implementation into the attention of patients and a general public as well as into the attention of other physiotherapists, gynecologists and other health workers. Methods: The theoretical part deals with the issue at the level of the search and theoretical owerview of current knowledge of...