The phytopathogen Phytophthora ramorum (Werres, DeCock & Man in't Veld), causal agent of Sudden Oak Death (SOD) of oaks (Quercus spp.) and tanoaks (Notholithocarpus densiflorus syn. Lithocarpus densiflorus), is established in coastal forests of the western United States. Since the discovery of SOD in the Douglas-fir / tanoak forests of southwest Oregon in 2001, a multiagency effort has ensued with the goal of fully eliminating P. ramorum from this originally small and isolated area. In this study we investigated the epidemiology of SOD in Oregon, particularly as it affects the success of the eradication program. Two approaches were taken to discern the mechanism of long distance dispersal: first, a landscape analysis of the spatial relationship between SOD sites and roads or streams, features associated with movement of infested soils, and, second, a local analysis to discern if understory infection is originating from soil or stream-borne inoculum. Using a restricted randomization test we concluded that SOD sites were no closer to roads than expected by chance, which is inconsistent with soil dispersal by people. While we found evidence that SOD sites were preferentially closer to waterways, inoculum had not moved away from streams into adjacent understory foliage. The local distribution of understory infection around SOD positive trees indicated that primary inoculum is infecting overstory canopies first, suggesting that P. ramorum is dispersing in air currents. Regression modeling indicated that weather conditions two years before detection could explain variation in the maximum distance inoculum moved each year of the epidemic between 2001 and 2010. This two year delay between infection and detection has allowed ample time for infested sites to contribute to further spread. Model results were consistent with observations made the summer of 2011, when trees likely infected by secondary inoculum at non-eradicated sites developed symptoms but were still undetectable by aerial surveys. Due to the prevalence of infection on tanoak, opportunities for sporulation and infection occur more often in Oregon than in California. These data can explain the failure to eliminate P. ramorum. Nevertheless, we did find evidence that the eradication program has significantly reduced the potential size of the SOD epidemic in Oregon. / Graduation date: 2012

The spotted fever rickettsia, Rickettsia helvetica, is an endemic tick-borne bacteria in Sweden. It causes infections in humans, manifested as aneruptive fever, headache, arthralgia and myalgia, and sometimes an inoculation eschar or a rash. There have also been two known cases of human infections with R. felis in Sweden. The present thesis starts by investigating dispersal of ticks and Rickettsia spp. by migrating birds flying from Africa to Europe. Almost 15,000 birds were searched and 734 ticks collected, mainly of the species Hyalomma marginatum complex. Almost half (48%) of the ticks were infected with Rickettsia spp., 96% of which was R. aeschlimannii, the remaining R. africae and undefined species. The next study focused on questing ticks over a large area in Sweden and determining the prevalence of Rickettsia spp., Anaplasma spp. and Coxiella burnetii. Rickettsia spp. was found in 9.5-9.6% of the ticks and A. phagocytophilum in 0.7%; no C. burnetii was found. The last three papers in the thesis focused on the clinical presentation of rickettsiosis, the symptoms associated with the infection in general and particularly in patients with neurological complications. A tick-exposed population in Sweden was investigated to gain a better understanding of symptoms due to rickettsioses, also in relation to co-infections with other tick-borne bacteria. Based on symptoms, it was not possible to distinguish what pathogen caused the infections. Most patients had erythema migrans, some had serological reactions to Rickettsia spp., Borrelia spp. or co-infections by Rickettsia spp., Borrelia spp. and/or Anaplasma spp. In the fourth and fifth papers, we found associations between antibodies against Rickettsia spp. and sudden deafness (in 10-24% of patients) and facial nerve paralysis (in 8.3-25% of patients). In three patients R. felis was detected in the cerebrospinal fluids.    Briefly, the thesis helps to clarify our knowledge about tick dispersal, shows a narrower prevalence estimate of Rickettsia spp. in Swedish ticks, and illuminates symptoms of rickettsioses and co-infections with other tick-borne infections. It also shows that presence of erythema migrans may be explained by more than Lyme disease and indicates a possible association between rickettsiosis and sudden deafness and facial nerve paralysis.

This thesis explores mothers' reactions to, and methods of dealing with, the sudden death of a child, using a constructivist approach. The study focusses on the meanings that mothers construe in relation to the sudden death of their child and the role of these constructions in her "recovery" from this loss. It also explores the grieving process, the effect of the loss on the mother, including a focus on changes in her value system, her role as a mother and as a wife, as well as the impact of this loss on the family system. The study was conducted on the basis of qualitative research methodology, making use of the case study method. The sample consisted of three mothers, selected purposively. The data gathered was analysed inductively. / Psychology / M.A.(Clinical Psychology)

Thesis (PhD)-- Stellenbosch University, 2014. / ENGLISH ABSTRACT: Ventricular arrhythmias are the most important cause of sudden cardiac death (SCD) among adults living in industrialised nations. Genetic factors have substantial effects in determining population-based risk for SCD and may also account for inter-individual variability in susceptibility. Great progress has been made in identifying genes underlying various Mendelian disorders associated with inherited arrhythmia susceptibility. The most well studied familial arrhythmia syndrome is the congenital long QT syndrome (LQTS) caused by mutations in genes encoding subunits of myocardial ion channels. Not all mutation carriers have equal risk for experiencing the clinical manifestations of disease (i.e. syncope, sudden death). This observation has raised the possibility that additional genetic factors may modify the risk of LQTS manifestations. This study establishes the genetic aetiology of LQTS in South Africa and Denmark through the identification and characterisation of LQTS-causative mutations in five previously identified genes, as well as examining possible novel genetic causes of LQTS in a cohort comprising Danish and British probands. We have functionally characterised several of the mutations identified in this study and examined other cardiac phenotypes that may be explained by variants causing repolarisation disorders. / AFRIKAANSE OPSOMMING: Ventrikulêre aritmie bly die enkele belangrikste oorsaak van skielike hart dood (SCD) onder volwassenes wat in geïndustrialiseerde lande woon. Genetiese faktore het aansienlike gevolge in die bepaling van bevolking-gebaseerde risiko vir SCD en kan ook verantwoordelik wees vir die inter-individuele variasie in vatbaarheid. Groot vordering is gemaak in die identifisering van gene onderliggende verskeie Mendeliese siektes wat verband hou met geërf aritmie vatbaarheid. Die mees goed bestudeerde familie aritmie sindroom is die aangebore lang QT-sindroom (LQTS) wat veroorsaak word deur mutasies in gene kode subeenhede van miokardiale ioonkanale. Nie alle mutasie draers het 'n gelyke risiko vir die ervaring van die kliniese manifestasies van die siekte (dws sinkopee, skielike dood). Hierdie waarneming het die moontlikheid genoem dat genetiese faktore anders as die primêre siekte-verwante mutasie kan die risiko van LQTS manifestasies verander. Hierdie studie stel die genetiese oorsake van LQTS in Suid-Afrika en Denemarke deur die identifisering en karakterisering van LQTS-veroorsakende mutasies in vyf voorheen geïdentifiseer gene, asook die behandeling van moontlike nuwe genetiese oorsake van LQTS in 'n groep wat bestaan uit van die Deense en die Britse probands. Ons het funksioneel gekenmerk verskeie van die mutasies wat in hierdie studie ondersoek en ander kardiovaskulêre fenotipes wat deur variante veroorsaak repolarisasie versteurings verduidelik word. / South African National Research Foundation / Harry and Doris Crossley Foundation / Danish Strategic Research Foundation.

Les maladies rares sont définies en Europe par une prévalence inférieure à 1/2 000 cas et représentent plus de 7000 entités différentes dont 80% sont d’origine génétique. La majorité est de début pédiatrique. J’ai réalisé l’étude de cas familiaux rares avec récurrence dans la fratrie de cardiopathies congénitales avec hétérotaxie (défaut de latéralité gauche/droite) d’une part, et de mort subite cardiaque inexpliquée chez le nourrisson ou en période néonatale d’autre part. La stratégie d’identification de gène par séquençage de l’exome au sein de ces familles dans l’hypothèse d’une transmission autosomique récessive a permis d’identifier trois gènes et d’en étudier deux sur le plan fonctionnel dans différents modèles : 1) Perte de fonction de MMP21 et malformations cardiaques congénitales par anomalie de latéralité embryonnaire. MMP21 code pour une métallopeptidase matricielle dont nous démontrons le rôle très spécifique au niveau du nœud embryonnaire sur un modèle poisson zèbre et souris. Ceci ouvre de nouvelles perspectives dans la compréhension des mécanismes moléculaires qui sous-tendent la mise en place de l’asymétrie gauche/droite chez la plupart des vertébrés. De manière intéressante, alors que tous les mammifères ont le cœur latéralisé à gauche, tous n’ont pas un gène MMP21 codant. Il existe donc plusieurs voies de signalisation de l’asymétrie gauche/droite chez les vertébrés. 2) Mutations hypomorphes de PPA2 et mort subite cardiaque chez le nourrisson. PPA2 code pour une pyrophosphatase mitochondriale et les données chez la levure ont montré que la fonction de cette enzyme était essentielle au fonctionnement mitochondrial. Nous décrivons une nouvelle présentation clinique de maladie mitochondriale responsable de décès par arrêt cardiaque inattendu chez le nourrisson. 3) Perte de fonction de PLCD3 et cardiomyopathie foudroyante par apoptose et nécrose diffuse des cardiomyocytes en période néonatale. Ce résultat nécessite encore d’être confirmé par l’identification d’autres cas mais la fonction de la protéine et des données chez la souris sont des arguments majeurs en faveur de la causalité du gène. Au total, ces travaux sont déterminants à la fois sur le plan clinique dans le cadre du conseil génétique pour les familles concernées et sur le plan fondamental en éclairant les mécanismes biologiques de mise en place de l’axe gauche-droit au cours du développement embryonnaire avec MMP21, sur le rôle essentiel de PPA2 dans la mitochondrie et sur celui de PLCD3 dans la survie des cardiomyocytes en postnatal. / Rare diseases are defined in Europe by a prevalence of less than 1/2,000 individuals and represent more than 7,000 different diseases of which 80% are genetic. Most have a paediatric onset. My project involved the study of rare cardiac disorders in familial cases with recurrence in siblings, focusing on congenital heart disease in the context of heterotaxia (laterality defects) and sudden unexpected death due to cardiac arrest in infancy and the neonatal period. Whole exome sequencing was used as a tool for disease gene discovery in these families with the hypothesis of autosomal recessive inheritance. This strategy led to the identification of 3 novel disease genes. I performed functional validation for two of these genes in different models, confirming their involvement in each disease. 1) Loss of function of MMP21 and cardiac malformations due to left-right patterning defects during embryonic development. MMP21 encodes a metallopeptidase for which I demonstrated a highly specialized role in the generation of left-right asymmetry at the node using zebrafish. This gives new insight into the molecular mechanisms at the origin of left-right asymmetry in vertebrates. Interestingly, all mammals have a left-sided heart, but some species have lost the Mmp21 gene, indicating that there are different pathways leading to left-right determination in vertebrates. 2) Hypomorphic mutations in PPA2 cause sudden cardiac arrest in infants. PPA2 is a nuclear gene encoding the mitochondrial pyrophosphatase and using a yeast model we showed that this enzyme is essential for the mitochondrial energy transducing system and biogenesis. I described a novel clinical spectrum for a mitochondrial disease responsible for unexpected cardiac arrest in infancy. 3) PLCD3 loss of function and fatal cardiomyopathy by cardiomyocyte apoptosis and necrosis in neonates. Exome sequencing in one familial case with 2 siblings presenting fatal cardiomyopathy led to the identification of compound heterozygous mutations in PLCD3, a gene previously implicated in a similar pathology in a mouse model. Identification of further cases with mutations in this gene will be needed in order to confirm the role of PLCD3 in the disease. In total, these studies are crucial from a clinical point of view for the genetic counseling of the affected families and they contribute to the elucidation of biological mechanisms of embryonic development and left-right determination (MMP21), mitochondrial function (PPA2) and post-natal cardiomyocyte survival (PLCD3).

Vinte e seis pacientes com cardiomiopatia hipertrófica e fatores de risco de morte súbita, foram submetidos a implante de cardioversor-desfibrilador implantável de dupla-câmara, com seguimento médio de 19 meses. Observou-se quatro choques em arritmias letais, 4 pacientes apresentaram TVNS e 5 taquiarritmias supraventriculares. Ocorreu um óbito.Conclusões: Observamos: TPSV em 19,2%; TVNS em 15,4% e TVS/FV em 15,4%. Nenhuma variável clínica ou demográfica, discriminou o comportamento clínico ou funcional pós-implante de CDI; a recorrência de síncope pós implante de CDI, não se associou à presença de eventos arrítmicos e a hipertrofia maior que 30 mm se associou à choque precoce do CDI (p=0,003). / During 19 months of average follow-up period, we followed 26 patients with hypertrophic cardiomyopathy and high risk for sudden death, all treated by dual chamber implantable cardioverter-defibrillator. 4 patients had received appropriate ICD discharge, 4 patients with NSVT and 5 supraventricular arrhythmias. One death had occurred. Conclusions: we observed: supraventricular arrhythmias in 19,2%; NSVT in 15,4% and VT/VF in 15,4%. The clinical or demographic outcomes did not suggest any clinical or functional results after ICD implantation; syncope may occur after ICD implantation and no arrhythmias recordered by intracardiac electrograms and left-ventricular-wall thickness greater than 30 mm is associated with early ICD shocks (p=0,003).

Na última década, a podridão vermelha das raízes da soja (PVR), ou síndrome da morte súbita, causada pelo fungo Fusarium solani f.sp. glycines, tornou-se uma doença que é motivo de preocupação para os sojicultores, técnicos e pesquisadores nas regiões onde esta doença já foi constatada, sendo a única estratégia de controle viável a utilização de cultivares resistentes. Diante disto, o principal objetivo do presente trabalho foi o estudo do controle genético da reação da soja a PVR por meio de técnicas de genética clássica e molecular. Foi utilizada a geração F2 de um dialelo 5x5, sem os recíprocos, envolvendo cinco cultivares: Forrest, MG/BR-46 (Conquista), IAC-4, FT-Cristalina e FT-Estrela, sendo as duas primeiras mais resistentes a PVR que IAC-4, considerada moderadamente resistente e, as duas últimas, altamente suscetíveis. Além de testes de inoculação com as cultivares, foram conduzidos três experimentos com a geração F2: um em telado (semeadura em julho de 2001) e dois em casa de vegetação (semeadura em setembro de 2001 e julho de 2002), sendo os dois primeiros em blocos ao acaso e o terceiro no delineamento inteiramente casualizado. O patógeno foi inoculado com grãos de sorgo colonizados, colocando-se três grãos no fundo de cada cova, no momento da semeadura, fazendo-se cinco covas por vaso, cada qual constituindo uma parcela com cinco plantas. Em cada experimento, foram avaliadas individualmente 50 plantas de cada genitor e 150 plantas de cada cruzamento F2, entre os 30 e 40 dias após a emergência, utilizando-se uma escala de notas de 1 a 5 para a severidade dos sintomas foliares da PVR. A porcentagem de incidência da doença em cada parcela e um índice de doença também foram calculados. Nas análises de variância com os dados de médias de parcelas, observaram-se diferenças altamente significativas entre os genitores e entre populações F2 para a severidade e índice de doença dos sintomas foliares, na maioria dos casos, embora os genitores resistentes e suscetíveis não foram muito contrastantes. As cultivares Forrest e Conquista comportaram-se sempre como resistentes, e Cristalina e Estrela como suscetíveis, enquanto que IAC-4 apresentou comportamento instável. Pela análise dialélica de Jinks-Hayman reafirmou-se a influência do ambiente sobre o controle da resistência à manifestação dos sintomas foliares da PVR, a qual foi controlada quantitativamente. Nos experimentos de 2001, constatou-se apenas a ação de efeitos gênicos aditivos. Porém, no experimento conduzido em telado, a resistência demonstrou controle por genes recessivos, enquanto que na casa de vegetação, na maior parte, por genes dominantes. No experimento de 2002 constatou-se a presença de efeitos gênicos aditivos e de dominância, predominando o efeito destes últimos. Assim, com base no experimento de 2002, para o grupo de cultivares estudado, os parâmetros genéticos calculados permitiram verificar que: o grau médio de dominância indicou a presença de sobredominância; predominaram genes recessivos no grupo dos genitores; pelo menos três locos ou blocos gênicos que exibiram dominância foram responsáveis pelo controle da resistência a PVR; as herdabilidades estimadas no sentido restrito foram médias (0,33 a 0,62) e, no sentido amplo, altas (0,90 a 0,96), confirmando a presença de dominância; a resistência foi controlada, na maior parte, por genes dominantes e a ordem decrescente de dominância das cultivares foi a seguinte: 'Conquista', 'Cristalina', 'Forrest', 'Estrela' e 'IAC-4'; a exclusão de 'Cristalina', por suspeita de apresentar distribuição de genes correlacionada com 'Conquista' e 'Estrela', melhorou a adequação dos dados de índice de doença ao modelo genético aditivo-dominante de Jinks-Hayman. A utilização de cinco marcadores moleculares microssatélites (Satt163, Satt309, Satt354, Satt371 e Satt570), relatados como ligados a cinco QRLs da PVR, indicou a provável presença de multialelismo nestes locos, o que não invalidou a adequação dos dados ao modelo de Jinks-Hayman. Pela análise de ligação entre 126 indivíduos F2 do cruzamento 'Conquista' x 'Estrela' com os marcadores Satt163 e Satt354, no experimento conduzido em telado, houve ligação fraca (P<0,10) entre estes locos e os respectivos QRLs, havendo tendência dos alelos recessivos serem os responsáveis pelo controle da resistência nestes dois locos, concordando com os resultados da análise dialélica para este experimento. / In order to study the genetic control of soybean resistance to sudden death syndrome (SDS) by classical and molecular genetic techniques a 5x5 diallel with the F2 generation, without the reciprocals, was carried out. The following parents were used: 'Forrest', 'MG/BR-46 (Conquista)', 'IAC-4', 'FT-Cristalina' and 'FT-Estrela'. The first two cultivars are more resistant to SDS than 'IAC-4', that is considered to be moderately resistant to SDS, and the last two cultivars are highly susceptible. Tests of inoculation were done with the cultivars and three experiments with the F2 generation (two in 2001 and one in 2002) were carried out, all of them in greenhouses. The fungus was inoculated by three colonized sorghum grains placed at the bottom of the holes at the planting. It was used five-holes/clay pot, which one was considered a plot with five plants. In each experiment with the F2 generation 50 single plants of each parent and 150 single plants of each F2 population were evaluated between 30 and 40 days after emergency by using a scale (1 to 5) based on foliar severity symptoms. The disease incidence and a disease index also were calculated for each plot. In the ANOVAs with data plot average for severity and disease index highly significant differences were detected among the treatments in almost all cases, although the resistant and the susceptible parents did not differ too much. The parents 'Forrest' and 'Conquista' were always more resistant than the others. 'Cristalina' and 'Estrela' were the most susceptible parents, while 'IAC-4' was unstable. Jinks-Hayman's analysis reaffirmed the environment effect on the genetic control of the resistance to SDS foliar symptoms, which was quantitatively controlled. In the 2001 experiments there was observed only additive genic effects, but in one experiment recessive genes had controlled the resistance, while in the other, in major part, dominant genes had controlled the resistance to SDS. In the 2002 experiment it was showed mainly dominance effects and also some additive genic effects. In the last experiment, for the group of parents used, the genetic parameters indicated that: the average degree of dominance showed the presence of overdominance; there were more recessive than dominants genes in the group of the parents; at least three loci or genic blocks that exhibited dominance were responsible for the genetic control of the resistance to SDS; the heritability in the narrow-sense had middle values (0.33 to 0.62), and in the broad-sense had high values (0.90 to 0.96), reinforcing the presence of dominance effects; the resistance to SDS was controlled, mostly, by dominant genes; the decreasing order of dominance of the parents were: 'Conquista', 'Cristalina', 'Forrest', 'Estrela' and 'IAC-4'; and the exclusion of 'Cristalina' of the diallel for disease index by suspect of gene correlated distribution with 'Conquista' and 'Estrela' improved the fitting of the data to Jinks-Hayman's additive-dominant model. Five microsatellite markers (Satt163, Satt309, Satt354, Satt371 and Satt570), reported as linked to five SDS QRLs, were used and showed the possibility of occurrence of multiallelism in those loci, but this evidence did not invalidate the fitting of the data to Jinks-Hayman's model. The molecular analysis in 126 plants of 'Conquista' x 'Estrela' cross with the markers Satt163 and Satt354, in the first experiment of 2001, showed the tendency of weakly association (P<0,10), between those loci and the QRLs. This analysis showed also tendency that the recessive genes controlled the resistance to SDS in both loci, in according to the results obtained in the diallel analysis for this experiment.

Le diabète de type 2 (DT2) est devenu de plus en plus une maladie métabolique chronique fréquente, associée à de nombreuses complications micro et macro-vasculaires. Les patients diabétiques ont environ deux fois plus de risque de mort subite d'origine cardiaque (MSC) que ceux normaux. Les interventions pharmacologiques (anti-plaquettaires, anti-hypertenseurs, anti-diabétiques et hypolépimiants) nous semblent les candidats les plus efficaces, accessibles et économiques pour prévenir cet événement à long terme, par contre leurs effets sur la MSC n'ont pas été bien connus. Nous visons à estimer leur impact sur la santé publique et à optimiser leur utilisation chez les DT2, grâce à des études d'analyse, de synthèse et de modélisation.Ce travail inclut trois étapes: premièrement, de construire un score de risque permettant de prédire le risque de MSC dans le DT2 en utilisant les bases de données INDANA. Deuxièmement, d'effectuer des méta-analyses/revues systématiques de différentes stratégies thérapeutiques afin d'estimer leurs effets sur le risque de MSC. Enfin, de simuler différentes stratégies sur une population virtuelle réaliste (PVR) des diabétiques français et d'intégrés les résultats obtenus sur cette plate-forme pour estimer le risque de MSC avec et sans traitements. Cette simulation permet d'estimer leurs bénéfices absolus, par le nombre d'événements prévus (Number of Events Prevented, NEP) et le nombre de patients à traiter pour prévenir une MSC (Number Needed to Treat, NNT). Nous avons construit un score incluant 7 facteurs de risque de MSC chez les patients atteints d'hypertension artérielle (+/- diabète) et collecté les meilleures estimations sur l'effet des médicaments. Notre simulation sur la PVR générée a suggéré que chez 10% des patients ayant le risque de MSC prédit le plus haut, la co-prescription de l'inhibiteurs de l'enzyme de conversion-l'aspirine-l'empagliflozine permettait de prévenir une MSC sur 57 individus traités dans les 5 ans. Le chiffre correspondant pour toute la PVR était 135. Nous concluons que cette approche pourrait aider à mieux transposer les résultats des essais cliniques à la pratique ; et à faciliter la décision clinique aux niveaux populationnel et individuel / Type 2 diabetes (T2D) has increasingly become a common metabolic condition, associated with numerous micro and macro-vascular complications. Diabetic patients are at about two-time higher risk of sudden cardiac death (SCD), compared to non-diabetic ones. Pharmacologic intervention (anti-platelet, anti-hypertensive, lipid lowering, and to a lesser extent, anti-diabetic agents) appear to be the most efficient and economic candidate to prevent this event at long term, yet treatment effects have not well addressed. We aimed to optimize their use and estimate their impact on public health via analysis, synthesis and modeling studies.This work engaged three phases: First, to construct a risk score to predict SCD risk in T2D from the INDANA database. Second, to perform the meta-analyses/systematic reviews of different therapeutic strategies in order to estimate their effects on SCD risk. Finally, to simulate therapeutic strategies on a generated French diabetic realistic virtual population (RVP) of T2D, by estimating the occurrence of SCD with and without treatments, thus their absolute benefits, through the Number of Events Prevented (NEP) due to treatment, and the Number of patients Needed to be Treated to prevent one SCD (NNT).We built a 7-risk factor to predict 5-year risk of SCD in patients with hypertension (+/-diabetes) and collected the best evidence on drugs’ effects. Integrating and simulating altogether on a generated French diabetic RVP suggested that for every 57 individuals of the 10% highest predicted SCD risk, the co-prescription of angiotensin converting enzyme inhibitor-aspirin-empagliflozin could prevent one SCD in 5 years. For the whole population, the corresponding number was 135. In perspectives, this approach could help better transposing clinical trial results into practice and facilitating clinical decision at both public health and individual levels

<p>När döden inträffar plötsligt, har efterlevande inte fått någon chans till mental förberedelse inför dödsfallet. Efterlevande löper därmed stor risk att drabbas av komplicerade sorgereaktioner, med psykisk och fysisk ohälsa som följd. Denna grupp möts inte i tillräckligt stor utsträckning av strukturerad evidensbaserad omvårdnad, i proportion till efterlevande vid väntade dödsfall. Syftet med litteraturstudien var att belysa närståendes behov vid plötslig död samt att understryka relevanta omvårdnadsåtgärder i akuta skeden. Litteraturstudien är baserad på 13 vetenskapliga artiklar som på olika sätt behandlar närståendes behov vid plötslig död. Resultatet behandlar närståendes behov utifrån fem kategorier: bemötande, information, närvaro, avsked och uppföljning. Närstående upplever ofta brister i sjukvårdspersonalens förmåga att möta deras behov. Brister som rapporterats gäller framförallt närståendes behov av bemötande och information, vilket kan sätta djupa spår hos efterlevande. Kunskapen om nyttan av att möta efterlevandes behov av uppföljning efter plötsliga dödsfall bedöms i dagsläget inte vara tillräcklig. Kunskapen om närståendes behov vid plötsliga dödsfall behöver fördjupas. Ytterligare forskning krävs, då området i dagsläget är eftersatt. Initialt bör dock existerande forskning implementeras.</p> / <p>When sudden death occurs, the survivors do not have a chance to mentally prepare for the loss. Survivors suffer high risk of complicated grief reactions, resulting in mental and physical illness. This group is not met sufficiently by structured evidence-based care, in proportion to the care of survivors expecting the loss. The purpose of the literature study was to highlight the needs of relatives confronted with sudden death, and to emphasize relevant nursing measures in acute stages. This paper is a survey of literature based on 13 research articles, in various ways dealing with needs of bereaved confronted with sudden death. The result deals with the needs of close relatives based on five categories: caring, information, proximity, viewing the body and follow-up. Survivors often experience gaps in health professionals' ability to meet their needs. Deficiencies regarding relatives’ needs of caring and information often results in negative long lasting memories. Knowledge of the benefits of meeting the needs of survivors regarding follow-up after a sudden death, is to this date considered insufficient. Knowledge of survivors confronted with sudden death need to be further explored. Further research is required, since the area of current situation is neglected. Initially, however, existing research need to be implemented.</p>

När döden inträffar plötsligt, har efterlevande inte fått någon chans till mental förberedelse inför dödsfallet. Efterlevande löper därmed stor risk att drabbas av komplicerade sorgereaktioner, med psykisk och fysisk ohälsa som följd. Denna grupp möts inte i tillräckligt stor utsträckning av strukturerad evidensbaserad omvårdnad, i proportion till efterlevande vid väntade dödsfall. Syftet med litteraturstudien var att belysa närståendes behov vid plötslig död samt att understryka relevanta omvårdnadsåtgärder i akuta skeden. Litteraturstudien är baserad på 13 vetenskapliga artiklar som på olika sätt behandlar närståendes behov vid plötslig död. Resultatet behandlar närståendes behov utifrån fem kategorier: bemötande, information, närvaro, avsked och uppföljning. Närstående upplever ofta brister i sjukvårdspersonalens förmåga att möta deras behov. Brister som rapporterats gäller framförallt närståendes behov av bemötande och information, vilket kan sätta djupa spår hos efterlevande. Kunskapen om nyttan av att möta efterlevandes behov av uppföljning efter plötsliga dödsfall bedöms i dagsläget inte vara tillräcklig. Kunskapen om närståendes behov vid plötsliga dödsfall behöver fördjupas. Ytterligare forskning krävs, då området i dagsläget är eftersatt. Initialt bör dock existerande forskning implementeras. / When sudden death occurs, the survivors do not have a chance to mentally prepare for the loss. Survivors suffer high risk of complicated grief reactions, resulting in mental and physical illness. This group is not met sufficiently by structured evidence-based care, in proportion to the care of survivors expecting the loss. The purpose of the literature study was to highlight the needs of relatives confronted with sudden death, and to emphasize relevant nursing measures in acute stages. This paper is a survey of literature based on 13 research articles, in various ways dealing with needs of bereaved confronted with sudden death. The result deals with the needs of close relatives based on five categories: caring, information, proximity, viewing the body and follow-up. Survivors often experience gaps in health professionals' ability to meet their needs. Deficiencies regarding relatives’ needs of caring and information often results in negative long lasting memories. Knowledge of the benefits of meeting the needs of survivors regarding follow-up after a sudden death, is to this date considered insufficient. Knowledge of survivors confronted with sudden death need to be further explored. Further research is required, since the area of current situation is neglected. Initially, however, existing research need to be implemented.