国立情報学研究所で電子化したコンテンツを使用している。

Background: An increasing number of patients with an oncology diagnose will be seen in the future. The oncology care is complex and in great need of nurses with a high level of competence. There is a lack of previous research in the specialist oncology nurses competence and therefore knowledge of their skills can reveal an understanding of their competence. Aim: The aim of the study was to describe the competence of the specialist oncology nurse. Method: Four oncology nurses and two directors of oncology care were interviewed. The interview text was analyzed using qualitative content analysis. Results: The result showed that the oncology nurses had developed six different competences within different areas. These competence areas were assertiveness, patient-centered care, ethical and moral-, pedagogical-, to lead and develop- and theoretical competence. They described their competences in a way of feeling more confident and they had a deeper theoretical knowledge. They also described that the needs of the patient as central. They found it easier to communicate and to give information and had a greater ambition to develop the oncology care. Conclusion: Deeper theoretical knowledge is a necessity to develop new competence. Theoretical knowledge seems essential in order to develop new competence. To be able to use their new competences, time, opportunities and support must be given to the specialist oncology nurse. It is also important for the specialist oncology nurse to claim and believe in her competence.

<p>The aim of the present study was to gain a deeper understanding of the experiences of the contact with the ”fear of childbirth”-team (called Aurora-team) made by women who feared childbirth. Qualitative content analyses according to Graneheim and Lundman was used to analyse 91 womens own written notes made at the end of a questionnaire which (with a quantitative approach) evaluated the counseling made by the Aurora-team at a hospital in the south of Sweden. The following five categories developed during the analyses; experience of the conversation, not knowing creates fear, thoughts regarding mode of delivery, the importance of how the birth plan is managed and the personnel´s standpoint regarding fear of childbirth. These categories can be seen as parts of the themes of experiences which made the fear of childbirth easier or which made it worse. This study shows the importance of meeting the individual woman in the Aurora-consultation in order for the woman to feel respected by the midwife. In order to do so education in communicative techniques should be offered to the Aurora-midwives. It would benefit the feeling of security of the women if the personnel would treat and acknowledge fear of childbirth in the same way, ie from a uniform and professional standpoint. Most women wanted someone to talk to about the delivery experience. This show of the preventive role the postpartum-consultation could have of fear of childbirth.</p>

United States post-secondary education continues to see an increase in Hispanic enrollment, particularly those of Mexican heritage. The present study was designed to examine this population’s experience of stress, anxiety and academic approach-avoidance conflict. Data were collected at North Texas postsecondary institutions. Participants (N = 197) completed an online survey including a Picture Story Exercise (PSE), open-ended responses to hypothetical scenarios, and self-report measures. The current study utilized a mixed-method approach integrating content analysis measures and self-reports. Results indicated that anxiety symptoms expressed to academic, familial, and minority social situations differed, partial η2=.39; with the academic scenario including the highest and minority social scenario the lowest anxiety. Results suggested that Mexican-American college students may express cognitive and affective symptoms of anxiety more frequently than physical symptoms on scenarios but not on self-report scales (Personality Assessment Inventory Anxiety; PAI Anxiety). PSE responses suggested that Conflict and Drive for Goal Orientation were frequent among this sample. Academic Total Anxiety and Academic Physical Anxiety related positively to PSE Conflict, while Academic Cognitive Anxiety related negatively to PSE Positive Outcomes. Exploratory models predicting PSE variables from Academic Anxiety and PAI Anxiety were inconclusive but suggested that gender accounted for significant variance in PSE scores.

The aim of the present study was to gain a deeper understanding of the experiences of the contact with the ”fear of childbirth”-team (called Aurora-team) made by women who feared childbirth. Qualitative content analyses according to Graneheim and Lundman was used to analyse 91 womens own written notes made at the end of a questionnaire which (with a quantitative approach) evaluated the counseling made by the Aurora-team at a hospital in the south of Sweden. The following five categories developed during the analyses; experience of the conversation, not knowing creates fear, thoughts regarding mode of delivery, the importance of how the birth plan is managed and the personnel´s standpoint regarding fear of childbirth. These categories can be seen as parts of the themes of experiences which made the fear of childbirth easier or which made it worse. This study shows the importance of meeting the individual woman in the Aurora-consultation in order for the woman to feel respected by the midwife. In order to do so education in communicative techniques should be offered to the Aurora-midwives. It would benefit the feeling of security of the women if the personnel would treat and acknowledge fear of childbirth in the same way, ie from a uniform and professional standpoint. Most women wanted someone to talk to about the delivery experience. This show of the preventive role the postpartum-consultation could have of fear of childbirth.

Bakgrund: Vård av patienter med smittsam lungtuberkulos har blivit allt vanligare. Ett antal fall där personal smittats har förekommit i landet under de senaste åren. Många av dessa patienter har en annan etnisk bakgrund och talar ett annat språk än personalen. Syfte: Att studera sjuksköterskors upplevelser av att vårda patienter med lungtuberkulos på infektionsklinik. Metod: Semi-strukturerade intervjuer genomfördes med sex sjuksköterskor på en infektionsklinik. Materialet analyserades med kvalitativ innehållsanalys. Resultat: Tre kategorier skapades; Sjuksköterskans upplevelse av vårdandet, Sjuksköterskans upplevelse av kommunikationen, Sjuksköterskans upplevelser och tankar kring smittspridning. Sjuksköterskorna upplevde att skillnader utifrån språk och etnisk bakgrund gjorde det svårt att ge den vården de önskade, vilket ledde till frustration och stress. Sjuksköterskorna upplevde glädje och tillfredställelse när de upplevde att de kunde ge god vård och att patienten var nöjd. Avvikelser från riktlinjer och rutiner gav upphov till en oro för smittspridning. Resultatet diskuteras utifrån Hendersons omvårdnadsdefinition. Slutsats: Det behövs bättre kunskaper om interkulturell omvårdnad, och ökade möjligheter till användning av tolk för att förbättra vården av patienterna. Tydliga riktlinjer avseende handläggning av patienterna med lungtuberkulos som är kända och efterföljs av all personal behövs för att öka tryggheten. Att kunna ge en god vård ger sjuksköterskorna en känsla av tillfredställelse i arbetet. / Background: Caring for patients with infectious pulmonary tuberculosis has become increasingly common. A number of cases of employees being infected have occurred in the country in recent years. Many of the patients have a different ethnic background and speak a language other than the staff. Aim: Study nurses experiences of caring for patients with pulmonary tuberculosis at a clinic for infectious diseases. Method: Semi-structured interviews were conducted with six nurses at a clinic for infectious diseases. The material was analysed with qualitative content analysis. Results: Three categories was created; Nurse's experience of caring, nurse's experience of communication, the nurse experiences and thoughts about the spread of infection. The nurses felt that differences based on language and ethnic background made it difficult to provide the care they wanted, leading to frustration and stress. The nurses experienced joy and satisfaction when they felt that they could provide good care and the patient was satisfied. Deviations from the guidelines and procedures gave rise to fears of contamination. The results are discussed on the basis of Henderson's nursing definition. Conclusion: We need a better understanding of cross-cultural care, and increased opportunities for the use of interpreters to improve patient care. Clear guidelines for management of patients with pulmonary TB who are known and followed by all staff needed to increase security. Being able to provide good care gives nurses a feeling of satisfaction at work.

Herbivorous fishes include a diverse assemblage of species that target primarily benthic autotrophs. This is perhaps one of the most well-studied groups of coral reef fishes, often reputed to be key components of coral reef communities, contributing to coral reef health in numerous ways. Through their feeding ecology and benthic interactions, they help mediate algae-coral interactions which can allow for improved coral survival and health. Despite the wealth of literature documenting the prominent roles of these fishes in coral reef ecosystems, studies from the Red Sea are surprisingly lacking. The Red Sea is a marginal reef environment, with a host of unique environmental and biological characteristics making it a unique environment where dynamics of herbivory may differ. This dissertation aims to fill key gaps in our knowledge of herbivorous fishes through the study of their distribution and trophic ecology. Herein, I describe habitat-specific partitioning of Red Sea herbivorous fish assemblages, discovering higher diversity and abundance found in reefs closer to shower, dissimilar to findings from other regions. Cross-shelf variation in assemblage structure seems to be quite robust through time, indicating short-term stability in herbivore assemblages. Through the use of stomach contents and stable isotope analyses, I then investigate the trophic ecology of browsing herbivores across the same shelf-gradient. I found higher trophic redundancy on nearshore reefs through time, with increased variation in diet and high levels of complementarity on offshore reefs where macroalgae are scarce. Stable isotope analyses of both liver and muscle revealed the stability of this resource partitioning through time, demonstrating for the first-time temporal stability of resource partitioning within this group. This dissertation broadens our knowledge of herbivorous fishes, filling important gaps. It offers new insight into the role of habitat in structuring trophic ecology and how flexible the diets of browsing species can be. Together, this information creates a foundation where improved knowledge of herbivorous fish ecology could be incorporated into future management plans of ongoing giga projects within the Kingdom. Incorporating herbivores into these plans could allow for increased resiliency for Red Sea coral reefs in the face of future development and shifting climatology.

An increasingly older population will most likely lead to greater demands on the health care system, as older age is associated with an increased risk of having acute and chronic conditions. The number of diseases or disabilities is not the only marker of the amount of health care utilized, as persons may seek hospitalization without a disease and/or illness that requires hospital healthcare. Hospitalization may pose a severe risk to older persons, as exposure to the hospital environment may lead to increased risks of iatrogenic disorders, confusion, falls and nosocomial infections, i.e., disorders that may involve unnecessary suffering and lead to serious consequences. Aims: The overall aim of this thesis was to describe and explore individual trajectories of cognitive development in relation to hospitalization and risk factors for hospitalization among older persons living in different accommodations in Sweden and to explore older persons' reasons for being transferred to a hospital. Methods: The study designs were longitudinal, prospective and descriptive, and both quantitative and qualitative methods were used. Specifically, latent growth curve modelling was used to assess the association of cognitive development with hospitalization. The Cox proportional hazards regression model was used to analyse factors associated with hospitalization risk overtime. In addition, an explorative descriptive design was used to explore how home health care patients experienced and perceived their decision to seek hospital care. Results: The most common reasons for hospitalization were cardiovascular diseases, which caused more than one-quarter of first hospitalizations among the persons living in ordinary housing and nursing home residents (NHRs). The persons who had been hospitalized had a lower mean level of cognitive performance in general cognition, verbal, spatial/fluid, memory and processing speed abilities compared to those who had not been hospitalized. Significantly steeper declines in general cognition, spatial/fluid and processing speed abilities were observed among the persons who had been hospitalized. Cox proportional hazards regression analysis showed that the number of diseases, number of drugs used, having experienced a fall and being assessed as malnourished according to the Mini Nutritional Assessment scale were related to an increased hospitalization risk among the NHRs. Among the older persons living in ordinary housing, the risk factors for hospitalization were related to marital status, i.e., unmarried persons and widows/widowers had a decreased hospitalization risk. In addition, among social factors, receipt of support from relatives was related to an increased hospitalization risk, while receipt of support from friends was related to a decreased risk. The number of illnesses was not associated with the hospitalization risk for older persons in any age group or for those of either sex, when controlling for other variables. The older persons who received home health care described different reasons for their decisions to seek hospital care. The underlying theme of the home health care patients’ perceptions of their transfer to a hospital involved trust in hospitals. This trust was shared by the home health care patients, their relatives and the home health care staff, according to the patients. Conclusions: This thesis revealed that middle-aged and older persons who had been hospitalized exhibited a steeper decline in cognition. Specifically, spatial/fluid, processing speed, and general cognitive abilities were affected. The steeper decline in cognition among those who had been hospitalized remained even after controlling for comorbidities. The most common causes of hospitalization among the older persons living in ordinary housing and in nursing homes were cardiovascular diseases, tumours and falls. Not only health-related factors, such as the number of diseases, number of drugs used, and being assessed as malnourished, but also social factors and marital status were related to the hospitalization risk among the older persons living in ordinary housing and in nursing homes. Some risk factors associated with hospitalization differed not only between the men and women but also among the different age groups. The information provided in this thesis could be applied in care settings by professionals who interact with older persons before they decide to seek hospital care. To meet the needs of an older population, health care systems need to offer the proper health care at the most appropriate level, and they need to increase integration and coordination among health care delivered by different care services.

O planejamento de moduladores da dinâmica dos microtúbulos, a partir da ligação à &alpha;&beta;-tubulina, constitui importante estratégia para a terapia do câncer. Os efeitos de inibição da polimerização da tubulina ou de estabilização dos microtúbulos são promovidos pela interação de compostos em cavidades específicas da proteína alvo. A interferência com a dinâmica dos microtúbulos nas células em rápida multiplicação provoca o bloqueio do ciclo celular, disparando sinais bioquímicos que culminam em apoptose. Os taxanos são os agentes antimitóticos mais importantes dentre os estabilizadores de microtúbulos, ao passo que os alcalóides da vinca e a colchicina são membros representativos dos inibidores da polimerização. Entretanto, o aparecimento de resistência, baixa biodisponibilidade e reações adversas graves são fatores que têm impulsionado a pesquisa por novos agentes anticâncer. Dentre os ligantes identificados recentemente para o sítio do taxol, o discodermolídeo e a dictiostatina, produtos naturais de origem marinha, são potentes estabilizadores de microtúbulos que apresentam maior solubilidade que o taxol e atividade contra células de câncer resistentes aos taxanos. Por essa razão, o modo de ligação desses compostos à cavidade de interação da &beta;-tubulina tem sido objeto de investigação. Modelos preditivos de HQSAR foram desenvolvidos para derivados sintéticos do discodermolídeo e utilizados em conjunto com estudos baseados na estrutura do receptor, em concordância com evidências experimentais, para a proposição de modelos de interação para os análogos na cavidade do taxol. Os modelos de conformação bioativa foram utilizados no alinhamento estrutural do conjunto de dados para estudos de QSAR 3D CoMFA e comparação com o alinhamento baseado nas estruturas minimizadas dos ligantes. A caracterização de padrões de reconhecimento molecular foi útil para a proposição de um modelo farmacofórico baseado nas estruturas dos produtos naturais estabilizadores de microtúbulos. Um modelo farmacofórico simplificado foi integrado ao processo de triagem virtual consistindo na aplicação de filtros hierárquicos sucessivos para a identificação de novos estabilizadores de microtúbulos. Caseobliquinas foram ensaiadas como estabilizadoras de microtúbulos, enquanto que intermediários sintéticos da dictiostatina foram avaliados quanto aos seus efeitos na polimerização da tubulina. Nos últimos anos, tem sido intensificada a busca por novos ligantes do sítio da colchicina, dentre os quais os indóis estão entre os mais relevantes. Para quatro conjuntos de dados totalizando 170 derivados de indóis, modelos de HQSAR foram desenvolvidos para a avaliação virtual de uma base de dados. Estudos de QSAR 3D CoMFA e CoMSIA baseados nos farmacóforos foram comparados para 3 conjuntos de dados. Os resultados sugerem que o núcleo indólico pode interagir de maneiras diferentes na cavidade de interação da proteína. Chalconas do tipo 1, inspiradas em ligantes clássicos do sítio da colchicina, foram avaliadas em ensaios celulares e de polimerização da tubulina, levando a síntese e avaliação de uma nova série de chalconas com propriedade antiproliferativa significativa. Por outro lado, derivados de N-acil-hidrazonas apresentaram atividade antimitótica semelhante à colchicina, enquanto as tiosemicarbazonas citotóxicas não interagiram diretamente com a tubulina. / Inhibition of microtubule function is one of the most important approaches to anticancer therapy. Two main effects can be elicited by tubulin/microtubule-interactive agents: inhibition of tubulin assembly or microtubule stabilization. Interference with either the assembly or disassembly of microtubules within the mitotic spindle in rapidly dividing cells disrupts the normal process of cell division and provokes chemical signals that induce apoptosis. On one hand, taxanes are the most prominent among the microtubule-stabilizing antimitotic agents, while on the other hand, colchicine and the vinca alkaloids are representative members of the tubulin polymerization inhibitors. However, due to poor pharmacokinetic properties, high toxicity and resistance, their clinical utility has been limited, generating new opportunities for the development of novel anticancer agents. In recent years, structurally diverse taxoid-site ligands have been identified, including the potent microtubule-stabilizers discodermolide and dictyostatin. These marine sponge-derived natural products have higher water solubility than taxol and exhibit activity against taxane-resistant cell lines. Therefore, the elucidation of their binding modes is important in drug design. Predictive conformation-independent hologram QSAR models were developed for a series of synthetic discodermolide analogs as antiproliferative agents. Receptor-based studies were integrated with molecular recognition patterns, in agreement with experimental evidences, leading to ligand-binding conformations for discodermolide analogs in the taxol-site. The bioactive conformation models were used to the structural alignment of the data set for the development of 3D QSAR CoMFA models, and for comparison with the models constructed with the rigid-body alignment based on minimized structures of the ligands. A set of structural features related to the interaction with the taxol cavity was identified and the molecular recognition patterns were employed to the construction of pharmacophore models based on the microtubule-stabilizing natural products. A final simplified pharmacophore model was integrated in a virtual screening procedure consisting of consecutive hierarchical filters targeting the identification of novel microtubule-stabilizers. Caseobliquins were screened as microtubule-stabilizers, while intermediates for the synthesis of dictyostatin were evaluated by their effects on tubulin assembly. Recently, the search for more simple anti-tubulin agents has renewed the interest in the development of colchicine analogs, often discarded for their high toxicity. Considering the structurally diverse ligands of the colchicine site, the indole derivatives are among the most important ones. Hologram QSAR models were developed for four data sets consisting of 170 indole derivatives, and used to evaluate a data set of commercially available compounds. Pharmacophore-based 3D QSAR CoMFA and CoMSIA models were constructed and compared to three of the individual data sets. The results indicated that the indole nucleus bind to the protein cavity in different ways. Type 1 chalcones, designed based on classical colchicine site ligands, have been screened for their anti-proliferative activity and tubulin assembly inhibition, leading to the synthesis and assessment of a novel series of chalcone analogs with substantial antiproliferative properties. Some N-acylhydrazone derivatives behaved as mitotic arresters in a way similar to that of colchicine, while cytotoxic thiosemicarbazones did not exhibit tubulin-interacting properties.

Bakgrund: Alla, som vårdas inom rättspsykiatrisk vård, har någon form av psykiskt funktionshinder och har också begått ett eller flera brott. Vården regleras av ett antal lagar. I rehabiliteringen ingår utslussning av patienten till öppna vårdformer genom så kallad permission. Ett antal av de patienter som har permission återintas emellanåt till slutenvården av olika orsaker. De benämns ibland som svängdörrspatienter. Syfte: Syftet var att belysa olika berörda personalgruppers syn på och erfarenheter av vad som har betydelse för om en patient som vårdas enligt lagen om rättspsykiatrisk vård, lyckas eller misslyckas med sin permission. Metod: En kvalitativ ansats valdes och två fokusgruppsintervjuer med sex deltagare i varje grupp genomfördes. Texten analyserades med hjälp av en kvalitativ innehållsanalys. Resultat: Tre huvudteman som hade betydelse för om en permission lyckades framkom: samsjuklighet, hur grundläggande behov mötts och samverkan runt patienten. Under dessa framkom 14 subteman: rätt psykiatrisk diagnos, samtidigt missbruk, följsamhet i medicinering, socialt nätverk, sysselsättning, tryggt boende, patientens ekonomi, se patientens behov, tydlig planering, kunskap och motivation, otydlig ansvarsfördelning, samverkan inför permission, kontaktmannaskap och uppföljning i öppenvård. Konklusion: Mycket fungerar bra i vården runt patienten inom rättspsykiatrisk vård. Brister finns dock som behöver förbättras och utvecklas. Det är viktigt att patienterna är delaktiga i vården och att olika instanser skapar individuella förutsättningar och flexibla lösningar för att permissionen ska lyckas. Ordnad ekonomi är av stor betydelse för att permissionen ska lyckas, då det påverkar många delar i patientens vardag. När patienten misslyckas med permissionen kan orsaken vara att man inte har tagit reda på dennes verkliga behov eller inte tagit tillräcklig hänsyn till dessa i permissionsplaneringen. Bristande resurser i samhället bidrar ibland till att patienter inom rättspsykiatrisk vård inte får rätt eller tillräckliga insatser, vilket är ett problem. / Background: Everyone in forensic care has some type of psychiatric disability and has carried out one or more criminal acts. The care is regulated in a number of laws. One part of the patient’s rehabilitation is the transition from closed to open care by so-called leave. A number of the patients that are on leave are sometimes readmitted to closed care for different reasons. These patients are sometimes referred to as “revolving door patients”. Aim: The aim was to determine different concerned personnel groups’ opinions and experiences of what is important, if a patient that is cared for according to the law of forensic care, is to be successful or unsuccessful with his/her leave. Method: A qualitative approach was chosen and two focus group interviews, with six participants in each group, were performed. The text was analyzed with the help of a qualitative content analysis. Results: Three main themes came to light that have significance as to how successful a leave is: comorbidity, how fundamental needs are taken care of and collaboration concerning the patient. 14 subthemes were found under the three main themes: correct psychiatric diagnosis, concurrent misuses, compliance in medication, social networks, employment, safe accommodation, the patient’s economy, seeing the patients needs, clear planning, knowledge and motivation, indistinct line of responsibility, collaboration prior to leave, contacts and follow-up in open care. Conclusion: Many functions are adequate in the care of patients within forensic care. Though there are deficiencies that need to be improved and developed. It is important that the patients participate in the care and that different authorities create individual conditions and flexible solutions if a leave is to be successful. Arranged economy is important if a leave is to be successful, as much of the patient’s everyday existence is affected. When the patient is unsuccessful with a leave, the reason could be that the patient’s real needs are not known, or not enough consideration has been taken to the patients needs when planning the leave. Inadequate public recourses sometimes contribute to patients, in forensic care, not receiving correct or sufficient measures (help), which is a problem.