Titel: Fysisk aktivitet på Recept, ur sjuksköterskors synvinkel Nyckelord: Behandlingsmetod, FaR, Fysisk aktivitet, Hälsa, Sjuksköterska. Bakgrund: Stillasittande, ohälsosamma kostvanor, inaktivitet, alkohol och tobaksmissbruk har bidragit till en ökning av kroniska sjukdomar. Dessa sjukdomar kan till stor del minskas genom bättre levnadsvanor. Sjuksköterskor är en av de yrkesgrupper inom vården som har störst kontakt med patienter och som kan påverka patienter till en ökad hälsa och mindre risk för sjukdom. Det finns en behandlingsmetod som bygger på att skriva ut fysisk aktivitet på recept. Den är dock inte etablerad och få sjuksköterskor skriver ut denna metod. Syfte: Syftet med denna studie är att undersöka åsikter om FaR inom primärvården och genom denna information få bättre kunskap om varför det skrivs ut så få FaR förskrivningar av sjuksköterskor i Sverige. Metod: Kvalitativa intervjuer användes i denna studie. Urvalet riktades till sjuksköterskor inom primärvården i Värmland. Sex sjuksköterskor som arbetar inom olika områden inom vården intervjuades. Resultat: De kategorier som bildades av resultaten var: Inställning till Fysisk aktivitet och FaR, Ersättande metoder till FaR, Sjukvårdens inställning, Ekonomiska hinder och möjligheter, Information och Kommunikation, Bemötande och motivation och Arbetsbelastning. Det fanns en positiv inställning till FaR bland sjuksköterskor. En av de huvudsakliga anledningarna till att FaR inte skrevs ut i större mängd beror på att patienter inte vill ha fysisk aktivitet utskriven och att de är svårt att motivera dem. Det fanns flera förbättringsområden för att öka förskrivningen av FaR. Diskussion: Det verkar finnas olikheter i hur sjuksköterskor, annan vårdpersonal och samhället ser på vad vården ska arbeta med. I studien ansåg alla intervjuade sjuksköterskor att vården bör arbeta förebyggande men de upplever ibland att denna mening inte delas. En av slutsatserna från studien är att det behövs mer reklam om FaR och att behandlingsmetoden borde användas oftare än det idag gör. / Title: Physical activity on Prescription, from nurses' point of view Keywords: FaR, Health, Physical activity, Nurse, Treatment method Background: Sedentary, unhealthy diets, inactivity, alcohol and tobacco abuse has contributed to an increase in chronic diseases. These diseases can be largely reduced by improved living habits. Nurses are one of the professionals in health care who have the greatest contact with the patients and may affect patients to better health and less risk of disease. There is a treatment method that is based on physical activity on prescription. It is not well established and a minority of nurses in Sweden are using this method. Objectives: The purpose of this study is to examine the opinions on FaR in health care and through this information get a better understanding of why only a minority of nurses are using the method. Method. Qualitative interviews were used in this study. The selection of respondents where nurses in primary care in Värmland. 6 nurses who work in different areas were interviewed. Result: The categories formed of the results were: Attitude to Physical Activity and FaR, Replacement methods for FaR, Opinions of healtcare, the Economic obstacles and opportunities, Information and communication, Contact and motivation and Workload. There was a positive attitude to FaR among nurses. One of the main reasons why FaR was not prescripted in large quantities was because patients do not want to have physical activity as a medicin and that it is difficult to motivate them. There were several areas of improvement to increase prescription of FaR. Discussion: There seem to be differences in how nurses, other health professionals and the community looks at what health care should work with. The nurses in this study considered healthcare should work preventively but they sometimes feel that this opinion is not shared. FaR needs to get more advertising and be used more often is something both previous research and this study agrees on.

Esse trabalho investigou a influência de diferentes origens e pré-tratamentos do inóculo na produção de biohidrogênio em reatores anaeróbios de leito fixo e fluxo ascendente. Aparas de polietileno de baixa densidade foram usadas como material suporte para fixação da biomassa e os reatores foram operados com 2 h de tempo de detenção hidráulica (TDH) e a 25ºC, alimentados com efluente sintético a base de sacarose. Duas fontes de inóculo foram estudadas: lodo anaeróbio de reator UASB aplicado ao tratamento de água residuária de abatedouro de aves (D) e lodo anaeróbio de reator UASB aplicado ao tratamento de água residuária de suinocultura (S); além da autofermentação (A), quando não há nenhum inóculo no reator. Além disso, dois tipos de pré-tratamento térmico (T) e ácido (A) foram avaliados. Os rendimentos de hidrogênio foram de 2,1, 2,0, 2,0,1,0, 1,0, 0,7, 0,7 mol \'H IND.2\' mol-1 sacarose quando os reatores foram inoculados com A, DT, DA, D, SA, ST e S, respectivamente. Nessa nomenclatura, a primeira letra se refere à origem do inóculo e a segunda, ao pré-tratamento. Embora hidrogênio (20-78%) e dióxido de carbono (21-55%) tenham sido os principais produtos no biogás, metano foi detectado nos reatores inoculados com D, DA, S, ST e SA no início e no final da operação. A produção volumétrica máxima de hidrogênio (61,6 mL \'H IND.2\' h-1.L-1) foi obtida quando DA foi usado com inóculo. Porém, o menor valor (15,1 mL \'H IND.2\' h-1.L-1) foi observado usando o inóculo S. Quando o reator não foi inoculado (A), a produção volumétrica de hidrogênio foi 47,3 mL \'H IND.2\' h-1.L-1. Etanol, ácido butírico e acético foram os principais produtos \'metabólicos detectados na fase líquida. Em resumo, os resultados demonstraram que há influência da origem e do pré-tratamento do inóculo em todos os parâmetros analisados. Inóculos sem pré-tratamento resultaram em menor rendimento de hidrogênio do que os observados nos experimentos com inóculos pré-tratados devido a seleção das bactérias produtoras de hidrogênio (BPH). Ademais, embora o pré-tratamento térmico tenha gerado os maiores valores de rendimento, o pré-tratamento ácido resultou em uma operação mais estável com os maiores valores médios. A autofermentação teve desempenho semelhante aos DT e DA e pode ser uma alternativa para a produção biológica de hidrogênio, pois seleciona as BPH naturalmente. / This paper investigated the influence of different inoculums and pretreatment of seed sludge on the biohydrogen production in up-flow anaerobic fixed-bed reactors. Particles of low-density polyethylene were used as support for biomass attachment and the reactor was operated with hydraulic retention time (HRT) of 2 h at 25ºC, fed with a sucrose-based synthetic wastewater. Two sources of inoculums were studied: anaerobic sludge from an UASB (up-flow anaerobic sludge blanket) reactor applied to treat poultry slaughterhouse wastewater (Sl) and anaerobic sludge from an UASB reactor treating swine wastewater (Sw), besides the autofermentation (A), with no inoculation of the reactor. In addition, two kinds of pretreatment heat (He) and acid (Ac) shock were evaluated. Hydrogen yields were 2.1, 2.0, 2.0,1.0, 1.0, 0.7, 0.7, mol \'H IND.2\' mol-1 sucrose when the reactors were inoculated with A, SlHe, SlAc, SwAc, Sl, Sw, and SwHe, respectively. In this nomenclature, the first two letters refer to source and the others refer to pretreatment. Although hydrogen (20-78%) and carbon dioxide (21-55%) have been the main gaseous products in the biogas, methane was detected in Sl, SlAc, Sw, SwHe and SwAc at the beginning and in the last days of the operation. Optimal \'H IND.2\' production rate (61.6 mL \'H IND.2\' h-1 L-1) was obtained when SlAc was used as seed sludge. On the other hand, the smallest value (15.1 mL \'H IND.2\' h-1 L-1) were observed using Sw inoculums. When the reactor was not inoculated (A), \'H IND.2\' production rate was 47.3 mL \'H IND.2\' h-1 L-1. Ethanol, butyric acid and acetic acid were the main soluble products detected in the liquid phase. In summary, the results have demonstrated that there are influences of the source and the pretreatment of the seed sludge in all parameters analyzed. Inoculums without pretreatment resulted in hydrogen productivity lower than those observed for experiments with pretreated inoculums due the selection of hydrogen producing bacteria (HPB). Furthermore, although the heat shock has generated the highest values of hydrogen yield, the acid-shock provided more stable operation with the highest average values. Besides, the autofermentation had almost the same performance than SlAc and SlHe and could be an alternative for biological hydrogen production due to natural selection of HPB.

Esse trabalho investigou a influência de diferentes origens e pré-tratamentos do inóculo na produção de biohidrogênio em reatores anaeróbios de leito fixo e fluxo ascendente. Aparas de polietileno de baixa densidade foram usadas como material suporte para fixação da biomassa e os reatores foram operados com 2 h de tempo de detenção hidráulica (TDH) e a 25ºC, alimentados com efluente sintético a base de sacarose. Duas fontes de inóculo foram estudadas: lodo anaeróbio de reator UASB aplicado ao tratamento de água residuária de abatedouro de aves (D) e lodo anaeróbio de reator UASB aplicado ao tratamento de água residuária de suinocultura (S); além da autofermentação (A), quando não há nenhum inóculo no reator. Além disso, dois tipos de pré-tratamento térmico (T) e ácido (A) foram avaliados. Os rendimentos de hidrogênio foram de 2,1, 2,0, 2,0,1,0, 1,0, 0,7, 0,7 mol \'H IND.2\' mol-1 sacarose quando os reatores foram inoculados com A, DT, DA, D, SA, ST e S, respectivamente. Nessa nomenclatura, a primeira letra se refere à origem do inóculo e a segunda, ao pré-tratamento. Embora hidrogênio (20-78%) e dióxido de carbono (21-55%) tenham sido os principais produtos no biogás, metano foi detectado nos reatores inoculados com D, DA, S, ST e SA no início e no final da operação. A produção volumétrica máxima de hidrogênio (61,6 mL \'H IND.2\' h-1.L-1) foi obtida quando DA foi usado com inóculo. Porém, o menor valor (15,1 mL \'H IND.2\' h-1.L-1) foi observado usando o inóculo S. Quando o reator não foi inoculado (A), a produção volumétrica de hidrogênio foi 47,3 mL \'H IND.2\' h-1.L-1. Etanol, ácido butírico e acético foram os principais produtos \'metabólicos detectados na fase líquida. Em resumo, os resultados demonstraram que há influência da origem e do pré-tratamento do inóculo em todos os parâmetros analisados. Inóculos sem pré-tratamento resultaram em menor rendimento de hidrogênio do que os observados nos experimentos com inóculos pré-tratados devido a seleção das bactérias produtoras de hidrogênio (BPH). Ademais, embora o pré-tratamento térmico tenha gerado os maiores valores de rendimento, o pré-tratamento ácido resultou em uma operação mais estável com os maiores valores médios. A autofermentação teve desempenho semelhante aos DT e DA e pode ser uma alternativa para a produção biológica de hidrogênio, pois seleciona as BPH naturalmente. / This paper investigated the influence of different inoculums and pretreatment of seed sludge on the biohydrogen production in up-flow anaerobic fixed-bed reactors. Particles of low-density polyethylene were used as support for biomass attachment and the reactor was operated with hydraulic retention time (HRT) of 2 h at 25ºC, fed with a sucrose-based synthetic wastewater. Two sources of inoculums were studied: anaerobic sludge from an UASB (up-flow anaerobic sludge blanket) reactor applied to treat poultry slaughterhouse wastewater (Sl) and anaerobic sludge from an UASB reactor treating swine wastewater (Sw), besides the autofermentation (A), with no inoculation of the reactor. In addition, two kinds of pretreatment heat (He) and acid (Ac) shock were evaluated. Hydrogen yields were 2.1, 2.0, 2.0,1.0, 1.0, 0.7, 0.7, mol \'H IND.2\' mol-1 sucrose when the reactors were inoculated with A, SlHe, SlAc, SwAc, Sl, Sw, and SwHe, respectively. In this nomenclature, the first two letters refer to source and the others refer to pretreatment. Although hydrogen (20-78%) and carbon dioxide (21-55%) have been the main gaseous products in the biogas, methane was detected in Sl, SlAc, Sw, SwHe and SwAc at the beginning and in the last days of the operation. Optimal \'H IND.2\' production rate (61.6 mL \'H IND.2\' h-1 L-1) was obtained when SlAc was used as seed sludge. On the other hand, the smallest value (15.1 mL \'H IND.2\' h-1 L-1) were observed using Sw inoculums. When the reactor was not inoculated (A), \'H IND.2\' production rate was 47.3 mL \'H IND.2\' h-1 L-1. Ethanol, butyric acid and acetic acid were the main soluble products detected in the liquid phase. In summary, the results have demonstrated that there are influences of the source and the pretreatment of the seed sludge in all parameters analyzed. Inoculums without pretreatment resulted in hydrogen productivity lower than those observed for experiments with pretreated inoculums due the selection of hydrogen producing bacteria (HPB). Furthermore, although the heat shock has generated the highest values of hydrogen yield, the acid-shock provided more stable operation with the highest average values. Besides, the autofermentation had almost the same performance than SlAc and SlHe and could be an alternative for biological hydrogen production due to natural selection of HPB.

PDT, psykodynamisk psykoterapi, och KBT, kognitiv beteendeterapi, är idag de dominerande psykoterapiinriktningarna i Sverige. Metoderna har i olika skeden rekommenderats av myndigheter och meningsmotsättningar om vilken metod som är mest lämplig har förekommit. Följande studie avsåg att utforska hur sex intervjuade KBT-psykoterapeuter samarbetar med sina PDT-kollegor och utifrån patienters behov eventuellt överväger PDT. En induktiv tematisk analys tillämpades där psykoterapeuterna beskrev upplevelsen av samarbete med PDT-terapeuter i termer av ett positivt dynamiskt utbyte samtsom en negativ upplevelse av fördomsfullt bemötande från PDT-terapeuter och mindre metodologiskt utbyte. Bilden av PDT som komplementär metod hos de intervjuade KBT-psykoterapeuterna speglade ambivalens kring PDT:s effektivitet och användbarhet. Alliansens kvalitet beskrevs som avgörande för om byte sker till PDT-kollega under pågående KBT-behandling. Studiens resultat jämfördes med en tidigare enkätstudie i vilken gruppsykologiska mekanismer antagits påverka samarbetet mellan terapeuter av olika metodinriktning.En tentativ beskrivning ges av processen bakom dessa gruppmekanismer.

Aim: To evaluate different parameters potentially affecting the efficacy of air-polishing devices in disinfecting implant surfaces in a non-surgical treatment approach of peri-implantitis lesions. Material and method: Altogether, 56 turned and 56 moderately rough implants were coated with a simulated biofilm. The implants were mounted in customized resin models simulating peri-implant 30° bone-defects, 3- and 5-mm deep; soft tissues were simulated with ballistic gelatin. Each implant was cleaned for 30 or 90 seconds in total (6 sites pr. implant; 5 or 15 seconds pr. site) with one of two different air-polishing devices (W&H and EMS). Implants were photographed in three different angulations and the amount of residual biofilm on the implant surface was measured digitally. Beta-regression models were used to assess the outcome. Results: Implant surface, treatment time and air-polishing device significantly affected the amount of residual biofilm. Turned implant surface, longer treatment time, and using the EMS device resulted in significantly less residual biofilm. In the most apical part of the defect, both air-polishing devices performed similarly, however, this was also the area with most biofilm left compared to more coronal aspects. Defect depth had no significant effect.  Conclusion: Superior biofilm removal is achieved at implants with turned surface, and when applying longer treatment time. At the deepest aspect of the defect, implant decontamination is compromised. / Syfte: Syftet med denna laborativa studie är att utvärdera olika parametrar som potentiellt kan påverka effekten av air-polishing maskiner vid icke-kirurgisk rengöring av implantat för behandling av peri-implantit. Material och metod: Sammanlagt, 56 turned (maskin bearbetade) och 56 moderately rough (måttlig ytråhet) implantat var belagda med en biofilmimitation. Implantaten var placerade i en specialgjord resin-modell som simulerar en 30° bendefektmodell med 3- respektive 5 mm defektdjup; mjukvävnaden simulerades med ballistiskt gelatin. Varje implantat rengjordes i totalt 30 eller 90 sekunder (6 sidor per implantat; 5 eller 15 sekunder per sida) med en av två air-polishing maskiner (W&H och EMS). Implantaten fotograferades sedan ur tre olika vinklar för att digitalt bedöma kvarstående biofilm. Implantatyta, tillverkare, defektdjup och behandlingstid analyserades som prediktionsvariabler för kvarstående biofilm (%). Beta-regressionsanalys användes för att bedöma resultatet. Resultat: Implantat-yta, tillverkare och behandlingstid påverkade mängden kvarvarande biofilmsimulation signifikant. Maskinbearbetade implantatytor, en längre behandlingstid, användande av EMS maskinen, resulterade alla i signifikant mindre kvarvarande biofilm. De två tillverkarna presterade endast lika i de mest apikala delarna av defekten, men detta var också det område med mest kvarvarande biofilm jämfört med mer koronala aspekter. Defekt djup hade ingen signifikant effekt på resultatet. Slutsats: Man kan förvänta sig bättre borttagning av biofilm när man behandlar maskinbearbetade implantatytor samt när man använder en längre behandlingstid.Vid den djupaste aspekten av defekten, äventyras dekontaminering av implantat