Bakgrund: Diabetes mellitus typ 2 (DMT2) är ett globalt växande kronisk sjukdom. Cirka 500 000 personer i Sverige lider av diabetes, varav 90 procent har diabetes typ 2. Förekomsten av DMT2 ökar bland personer som har immigrerat till Sverige, vilket bedöms orsakas av en kombination av genetiska faktorer, livsstilsfaktorer och socioekonomiska omständigheter. För att effektivt hantera sjukdomen är det avgörande med noggrann egenvård, som inkluderar regelbunden självkontroll av blodsockernivåer, anpassad kost och fysisk aktivitet. Syfte: Syftet var att beskriva erfarenheter av egenvård hos immigrerade patienter som har diabetes typ 2. Metod: Kvalitativ litteraturöversikt baserad på 13 utvalda vetenskapliga artiklar som publicerades mellan 2003–2023. Litteratur söktes i databaserna CINAHL och Medline.  Artiklarna analyserades enligt Fribergs femstegsmodell. Resultat: En rad olika faktorer påverkade patienternas upplevelse av egenvård. Bristande kommunikation och språkfärdigheter samt otillräcklig kunskap om diabetes utgjorde stora utmaningar för patienterna när det gällde att förstå sin sjukdom. Patienterna hade olika uppfattningar om varför de drabbats av sjukdomen, ofta kopplade till kulturella och religiösa orsaker. Dessutom beskrivs frustration över vårdgivarnas bemötande och svårigheter för patienterna att bibehålla livsstilsförändringar. Slutsats: Patienternas uppfattning av DMT2 och egenvård spelar en avgörande roll. Det finns ett behov av ökad kunskap om kost, motion och medicinering för att möjliggöra kontinuerlig egenvård och förbättra hälsa. Socialt stöd underlättar acceptans av förändringar i livsstilen och främjar därmed egenvården. / Background: Diabetes mellitus type 2 (DMT2) is a globally growing chronic disease. Approximately 500 000 people in Sweden suffer from diabetes, of which 90 percent have DMT2. The prevalence of DMT2 is increasing among individuals who have immigrated to Sweden, which is assessed to be caused by a combination of genetic factors, lifestyle choices and social economic circumstances. To effectively manage DMT2, self-care is crucial, including regular monitoring of blood sugar levels, a tailored diet and physical activity. Aim: Describe self-care experiences among immigrant patients with diabetes type 2. Method: Qualitative literature review based on 13 selected articles published between 2003 and 2023. Literature was searched in the CINAHL and Medline databases. The articles were analysed using Friberg’s five-step model. Results: Several factors influenced a patient’s experience in managing their self-care. Lack of communication and language skills and insufficient knowledge about diabetes posed significant challenges for patients in understanding their illness. Patients held diverse perceptions regarding the causes for their diabetes, often linked to cultural and religious reasons. Furthermore, there was frustration regarding the healthcare providers’ attitudes and difficulties for patients in maintaining lifestyle changes. Conclusions: The patients’ perception of DMT2 and self-care plays a crucial role. There’s a need for increased knowledge about diet, exercise, and medication to enable continuous self-care and improve health. Social support facilitates the acceptance of lifestyle changes, thereby promoting self-care.

Introduktion/bakgrund: Barn kan drabbas av olika sjukdomstillstånd vilket påverkar såväl deras allmänna hälsa som orala hälsa. Diabetes typ 1 är ett sjukdomstillstånd som kräver vård av god kvalitet. Alla barn är olika och personcentrerad vård som teoretisk bas kan bidra till att sätta det unika barnets behov i centrum. Syfte: Syftet med denna litteraturstudie var att beskriva riskfaktorer för orala sjukdomar hos barn med diabetes typ 1. Metod: En litteraturstudie utfördes genom att systematiskt utföra sökningar i databaserna PubMed och CINAHL. Kvalitetsgranskning med granskningsmallar från SBU utfördes i urvalsprocessen. Av totalt 766 antal artiklar inkluderades 11 artiklar. Resultat: Resultatet baseras på 11 vetenskapliga artiklar från 9 länder och redovisas med följande underrubriker; ”Oral sjukdom och okontrollerad diabetes”, ”Oral egenvård” och ”Omgivande faktorer”. Resultatet visade att kost och okontrollerad diabetes, dålig oral egenvård och bristande samhälleliga skyddsfaktorer är riskfaktorer för orala sjukdomar hos barn med diabetes typ 1. Slutsats: Denna litteraturstudie visar att det finns flera riskfaktorer för orala sjukdomar hos barn med diabetes typ 1, både på samhällelig och individuell nivå. Samhället kan bidra till ökade resurser för att öka samverkan mellan de aktuella barnen, vårdnadshavare och hälso- sjukvård, socialtjänst, tandvård och skola. På individnivå behöver vårdprocesser vara förankrade i personcentrerad vård. / Introduction/background: Children can suffer from various medical conditions which affect both their general health and oral health. Diabetes type 1 is a medical condition that requires good quality of care. All children are different and person-centred care as theoretical foundation can contribute to put every child's needs in focus. Aim: The aim of this literature study was to describe risk factors for oral diseases in children with type 1 diabetes. Method: A literature study was performed by systematically searching the databases PubMed and CINAHL. Quality review with review templates from SBU were performed in the process. Out of a total of 766 articles, 11 articles were included. Results: The result is based on 11 scientific articles from 9 countries and is reported with the following subheadings; "Oral disease and uncontrolled diabetes", "Oral self-care" and "Ambient factors". The results showed that diet and uncontrolled diabetes, bad oral self- care and lack of societal preventive factors are risk factors for oral diseases. Conclusion: This literature study shows that there are many risk factors for oral diseases in children with type 1 diabetes, at both societal and individual levels. Society can contribute to increased resources to increase professional collaboration between the children, caregivers and health care, social services, dental care and school in order to offer person-centered care.

Bakgrund: Diabetes mellitus typ2 (DMT2) är en folksjukdom som förväntas öka globalt varje år. Egenvård är avgörande för att minska utvecklingen av DMT2 och fördröja komplikationer genom att tillämpa hälsosam livsstil samt främja och bibehålla en god hälsa. Syfte: Syftet var att beskriva vuxna individers erfarenhet av egenvård vid Diabetes mellitus typ 2. Metod: En kvalitativ litteraturöversikt med en induktiv ansats användes. Fribergs femstegsmodell tillämpades under analysprocessen. Resultat: Utmaningar med egenvård inkluderade att individerna inte var följsamma och glömde att ta sina mediciner. Genom att dela erfarenheter om DMT2 bidrog individerna till kunskapsutbyte och lärde sig av varandras strategier för att främja god hälsa. Stöd från sjukvård, familj och vänner ökade motivationen för att förändra livsstil och följa behandlingsplanen. Brister i kompetens och uppföljning från sjukvården skapade osäkerhet hos individerna. Slutsats: Individens inställning och hälsosamma livsstil är avgörande för egenvården av DMT2, vilket kan minska risken för komplikationer. Stöd från sjukvården och anhöriga är betydelsefullt och kan främja en hälsosam livsstil och välbefinnande.  Nyckelord: Diabetes Mellitus Typ 2, egenvård, erfarenhet, kvalitativ, livsstil. / Title: The individual's experience of self-care in Diabetes Mellitus Type 2-A qualitative literature review.  Background: Diabetes mellitus type 2 is a complex public health issue that’s expected to increase globally each year. Self-care is crucial to reduce the progression of DMT2 and delay complications by adopting a healthy lifestyle to promote and maintain good health. Aim: The aim was to describe the experiences of adult individuals with self-care in Diabetes mellitus type 2. Methods: A qualitative literature review with an inductive approach was used. Friberg´s five-step model was applied during the analysis process. Results: Challenges with self-care included individuals not being compliant and forgetting to take their medications. By sharing experiences about DMT2, individuals contributed to knowledge exchange and learn from each other strategies to promote good health. Support from healthcare, family and friends increased motivation to change lifestyle and follow the treatment plan. Lack of competence and follow-up from healthcare providers created uncertainty among individuals.  Conclusion: The individual's attitude and healthy lifestyle are crucial for self-care of Diabetes Mellitus type 2, which can reduce the risk of complications. Support from healthcare providers and family members is significant and can promote a healthy lifestyle and well-being.  Keywords: Diabetes mellitus typ 2, experiences, lifestyle, qualitative, self-care.

Bakgrund: Sjuksköterskans specifika kompetens är omvårdnad. Personcentrerad vård fokuserar på att se varje patient som en unik person med individuella behov. Vid diabetes har sjuksköterskan en viktig pedagogisk och handledande funktion för att stärka patientens förmåga att hantera sjukdomen. Sjuksköterskans ansvarsområde vid diabetes består av att ge information och bedöma patientbehov samt ge teoretisk och praktisk utbildning till alla diabetespatienter för att underlätta egenvården. Syfte: Att beskriva personer med diabetes typ 2 erfarenheter av att utföra egenvård. Metod: En beskrivande litteraturstudie innehållande 9 kvalitativa vetenskapliga artiklar. De vetenskapliga artiklarna har hittats eftersökning i databasen PubMed. Huvudresultat: Vid sociala sammanhang förekommer det svårigheter med att hålla sin kost, vilket kan leda till skuldkänslor och bli en psykologisk börda för personer med diabetes typ 2. Flera hinder för egenvård presenterades, alla med påverkan på blodsockernivån. Användning av mobilapp resulterade i att många av användarna lärde sig tolka blodsockervärden och identifiera mönster i aktivitetsnivå, kost och blodsockernivå och samband mellan dem för att kunna hålla blodsockret på en bra nivå. Utbildning är en viktig del i att ändra beteende gällande egenvård. Tillräcklig kunskap om sjukdomen, sekundära sjukdomar och åtgärder för att påverka sjukdomen möjliggör anpassning gällande livsstilen. Slutsats: Sjuksköterskor bör arbeta personcentrerat och för att kunna göra det är det bra att de får en inblick i hur diabetes typ 2 kan påverka personens liv och att det är mer som tillhör egenvård än vad man tänker på när man hör ordet. / Background: The nurse's specific competence is nursing. Person-centered care focuses on seeing each patient as a unique person with individual needs. In the case of diabetes, the nurse has an important educational and supervisory function to strengthen the patient's ability to manage the disease, also providing information and assessing patient needs as well as providing theoretical and practical training to all diabetes patients to facilitate self-care. Purpose: To describe people with diabetes type 2 experience with self-care. Method: A descriptive literature study including 9 qualitative scientific articles. The scientific articles were found through searching the database PubMed. Main result: Social contexts can mean difficulties with maintaining one's diet and feelings of guilt. It is a psychological burden for people with type 2 diabetes. Several barriers to self-care were presented. Using the mobile app resulted in many of the users learning to interpret blood sugar values and identify patterns in activity level, diet and blood sugar level and the relationship between them to keep blood sugar at a satisfactory level. Sufficient knowledge of the disease, secondary diseases, and measures to influence the disease enable adaptation regarding the lifestyle. Conclusion: Nurses should work person-centered and to be able to do that it is good that they get an insight into how diabetes type 2 can affect the person's life and that there is more to self-care then what comes to mind when you hear the word.

Bakgrund: Diabetes mellitus typ 2 utgör en växande utmaning för global hälsa. Detta är en kronisk sjukdom som påverkar hur kroppen hanterar blodsockret. Stöd till egenvård är en central del i behandlingen av denna sjukdom. Syftet: Syftet var att beskriva sjuksköterskors erfarenheter av att ge stöd till egenvård hos patienter med diabetes mellitus typ II.Metod: En kvalitativ litteraturöversikt med induktiv ansats har tillämpats, där det baserades på 12 vetenskapliga artiklar. Dessa vetenskapliga artiklar var från år 2013–2023. Databaserna som användes var Medline och Cinahl samt Fribergs fem stegs analysmetod.Resultat: I litteraturöversikten framkom två teman: "Sjuksköterskors erfarenheter av utmaningar i egenvårdsstöd" och "Sjuksköterskors erfarenheter av att skapa möjligheter för att stödja egenvård". Utifrån teman framkom följande subteman: "bristande kunskaper om sjukdomen", "att vägleda patienter", "att samarbeta i team", "att ge personcentrerad vård" och "kommunikation med patienter".Slutsats: Inom diabetesvården visade resultatet att sjuksköterskor har olika erfarenheter av att ge stöd till egenvård.  Resultatet visade även att kommunikation och att samarbeta i team var viktiga aspekter för att möjliggöra egenvårdsstöd. Sjuksköterskor ansåg att egenvårdsstöd främjades när de arbetade personcentrerad.Nyckelord: Samarbeta i team, kommunikation, personcentrerad vård, bristande kunskaper. / Background: Type 2 diabetes mellitus poses a growing challenge to global health. This is a chronic condition that affects how the body manages blood sugar. Support for self-care is a central component in the treatment of this disease.Purpose: The purpose was to describe nurses' experiences of providing self-care support to patients with type 2 diabetes mellitus.Method: A qualitative literature review with an inductive approach was applied, based on 12 scientific articles. These scientific articles were from the years 2013–2023. The databases used were Medline and Cinahl, along with Friberg's five-step analysis method.Results: The literature review revealed two themes: "Nurses' experiences of challenges in self-care support" and "Nurses' experiences of creating opportunities to support self-care." Based on these themes, the following subthemes emerged: "lack of knowledge about the disease," "guiding patients," "collaborating in teams," "providing person-centered care," and "communication with patients."Conclusion: Within diabetes care, the results showed that nurses have different experiences of providing self-care support. The results also indicated that communication and collaboration in teams were important aspects in enabling self-care support. Nurses believed that self-care support was promoted when they worked in a person-centered manner. Keywords: Collaborate in teams, communication, person-centered care, lack of knowledge.

The mechanical properties of the arterial wall are of great importance for blood pressure regulation and cardiac load. With increasing age, large arteries are affected by increased wall stiffness. Furthermore, atherosclerotic manifestations may increase the stiffness even further, both processes acting as independent cardiovascular risk factors affecting the arterial system in a heterogeneous way. The aims of this thesis was to characterize the local mechanical properties of brachial artery (BA) with the aid of ultrasound technique and to evaluate the influence of 1) age, gender, sympathetic stimulation and examination site; 2) type 1 diabetes (DM) and its association to circulatory biomarkers; and 3) to evaluate the general properties of the arterial system with the aid of pulse wave velocity (PWV) as well as pulse wave analysis (PWA) in systemic lupus erythematosus (SLE) and correlate the findings to disease activity and circulatory biomarkers. In the most proximal arterial segment of the upper arm a pronounced age-related decrease in wall distensibility, increase in intima-media thickness (IMT), and a slight increase in diameter were seen. Sympathetic stimulation had no influence on wall mechanics. More distally in BA, no change in diameter, and only minor increase in IMT and decrease in distensibility were seen. No gender differences were found. These findings suggest that the principle transit zone between elastic and muscular artery behaviour is located in the proximal part of the upper arm. Women with uncomplicated insulin-dependent DM had similar diameter, IMT and distensibility in their distal BA as controls, whereas flow-mediated dilatation (FMD) was slightly, and nitrate mediated dilatation (NMD) markedly reduced. NMD was negatively correlated with higher HbA1c levels. Vascular smooth muscle cell function seems to be an early manifestation of vascular disease in women with DM, influenced by long-term hyperglycaemia. Women with SLE had increased aortic PWV compared to controls, a finding positively associated with increased levels of complement factor 3 (C3), but not with disease activity. The increased stiffness of central arteries may be one factor contributing to the increased cardiovascular risk seen in SLE.

This study examines the production and the introduction of a fertility treatment which gained great attention both in Sweden and internationally during the 1960s. In the procedure, hormones were extracted from human pituitary glands which had been collected from autopsies. After this, the hormones were purified and injected into the female patients as a treatment for certain kinds of sterility. Carl Gemzell, professor of obstetrics and gynecology at Uppsala University, was a key figure in the development of the treatment. He was described by the media as a medical pioneer and later became one of Sweden’s most famous doctors and scientists. The fertility treatment also gained a lot of attention in the media as ”the miracle drug that made barren women pregnant”, especially since it often resulted in multiple pregnancies. In the 1960s, pregnancies with quadruplets, quintuplets, sextuplets and even septuplets became world sensations. By using the sociology of expectations as theoretical approach, which focuses on the performativity of expectations and visions in science production, this study aims to investigate how expectations of an effective fertility method were articulated in both the scientific sphere and in the media. This of course also relates to how the risks of the multiple pregnancies were dealt with. The analysis is divided into three chapters, where the first chapter examines the politics of science in Sweden during the post-war period and how Gemzell’s work in Uppsala generated expectations of a scientific milieu on the front line of fertility research. The next chapter is focused on the media’s interest in Gemzell and how he became a celebrity. A central argument for the study is that his public status helped to create scientific credibility for the treatment, especially among the public. The final chapter focuses on the media reporting about the multiple pregnancies. They were often treated as sensations, which was somewhat paradoxical as they were hazardous and frequently resulted in the death of the premature children.

Type 1 diabetes affects a person’s life on many levels in terms of quality of life, health, and socioeconomic costs both for the patients but also their families. As of now there is no therapy that targets the underlying mechanism of the disease. Intralymphatic administration of Diamyd® is being evaluated in a phase IIb clinical trial, DIAGNODE-2. The aim was to examine if the intralymphatic administration is feasible for both patients and medical professionals, and to identify any aspects of the procedure that can be improved. This feasibility study is based on interviews and answers received from questionnaires. The medical professionals that were selected were radiologists and study nurses that are involved in the DIAGNODE-2 trial. The radiologists were the prime focus and were thus interviewed through face-to-face/skype or phone and answered a questionnaire. Study nurses, having more contact with the patient, answered a survey in order to gain additional insights into the patient perspective.   The results show that the radiologists has a positive view towards the administration procedure, which was described as easy and safe. According to the study nurses the patients accept the procedure and they agreed that the patients understand the injection procedure once they received the information. In terms of the emotional state of the patients they were a bit nervous, but they became calmer after receiving the first injection. Based on the above-mentioned findings the intralymphatic injection procedure is described as feasible and has the potential to become a part of the standard clinical routine.

Fibroblast growth factor-23 (FGF23) is a novel, bone-produced hormone that regulates renal phosphate (Pi) reabsorption and calcitriol metabolism. Disorders of mineral and bone metabolism, such as autosomal dominant hypophosphatemic rickets (ADHR) and hyperostosis-hyperphosphatemia syndrome (HHS), witness the importance of well-balanced serum levels of FGF23. Patients with chronic kidney disease (CKD) are highly morbid due to Pi retention/hyperphosphatemia and calcitriol deficiency, which lead to elevated serum levels of parathyroid hormone (PTH) and secondary hyperparathyroidism (sHPT). As a response to hyperphosphatemia, CKD patients have also remarkably high serum FGF23 levels, which are associated with cardiovascular risk factors and increased mortality in CKD. The overall aim of this dissertation was to discern a possible role of FGF23 in parathyroid biology. Our in vitro experiments on isolated bovine parathyroid cells demonstrate that FGF23 directly and dose-dependently suppresses the PTH production and secretion, while increasing the expression of the 25-hydroxyvitamin D3-activating enzyme 1α-hydroxylase. We investigated possible expressional changes in the FGF23 receptor co-factor Klotho in hyperparathyroid disorders and found that Klotho expression is decreased or absent and inversely correlated to serum calcium (Ca) in adenomas of primary HPT (pHPT). In the hyperplastic parathyroid glands of sHPT, Klotho expression declines in parallel with the kidney function and correlates with the glomerular filtration rate. Moreover, Klotho expression is suppressed by Ca and FGF23, increased by calcitriol, but unaffected by Pi and PTH in vitro. Finally, we identified a novel missense mutation in the gene encoding GALNT3, which is normally involved in the post-translational glycosylation of FGF23, as the cause of aberrant FGF23 processing in a patient with HHS. In summary, we provide evidence for a novel bone/parathyroid axis in which FGF23 functions as a direct, negative regulator of the PTH production. High extracellular Ca is a major determinant of the Klotho expression in pHPT, whereas the Klotho levels in sHPT may be attributed to a combination of the high FGF23 and Ca, and low calcitriol levels associated with CKD. Hence, the decreased Klotho expression in sHPT could explain the concomitantly high FGF23 and PTH levels, as well as the failure of FGF23 to prevent or mitigate the development of sHPT in CKD.

Background Animal models can be used to mimic human conditions of psychopathology, and also as pre-clinical models to evaluate candidate drugs. With hormonal treatment it is possible to produce behavior in the rat which corresponds to the mental symptoms of pre-menstrual syndrome (PMS), and pre-menstrual dysphoric disorder (PMDD). PMS affects 25-30 % of all women in fertile age and 3-8% are diagnosed with the more severe condition PMDD. The cardinal mental symptoms are; irritability, mood-swings, depression, anxiety, fatigue, insomnia, difficulties with concentration and memory and learning difficulties. The symptoms of PMS/PMDD occur in the luteal phase in conjunction with increasing concentrations of progesterone (P4) and P4-metabolites. In anovulatory cycles the symptoms are absent. The hormones which produce the monthly reoccurring negative symptoms on mood are foremost the neuroactive metabolites; allopregnanolone (ALLO) and tetrahydro-deoxycorticosterone (THDOC). ALLO is produced by the corpus luteum, but can also be synthesized in the brain, both ALLO and THDOC can also be released from the adrenal cortex during stress. These steroids are active on the inhibitory GABA neurotransmitter system through the GABAA receptor, and the effects are similar to that of alcohol and benzodiazepines. These steroids have strong sedative and hypnotic effects. A paradox is that some individuals seem to react with negative mood on sex steroids while all fertile women have the cyclical steroid changes during the menstrual cycle. Some individuals are more sensitive to neuroactive steroids with influences of personality, heritability and stress factors. Aims The thesis aims were to develop pre-clinical animal models of PMS/PMDD and to investigate induction of ALLO tolerance, individual sensitivity to neurosteroids and the interactions between chronic social stress and neurosteroids. Methods In these studies male and female Wistar rats were used to test steroid hormone effects on learning and memory and behaviors analogous to negative mood symptoms. This was accomplished through hormonal treatment and a subsequent withdrawal period from P4 (P4) + estradiol (E2) (PEWD), or ALLO. To assess tolerance, memory and learning in the Morris water maze (MWM) was studied. Anxiety-like behaviors were tested with the elevated plus maze (EPM), open field test (OFT), and the intruder test (IT). The EPM or OFT was used to classify the rats as high or low responders on risk-taking and explorative behavior (HR/LR). For social ranking order assessment the tube test (TT) and food competition test (FCT) were used. Chronic social stress was accomplished through co-habituation with two older rats (chronic subordination stress). In female rats the estrous cycle followed using staining of vaginal smears. Concentration of corticosterone (CORT) was measured by radio-immuno-assay (RIA). Results In the MWM ALLO pre-treatment produced tolerance to the acute negative ALLO effects. Both male and female rats showed behavioral correlations between the EPM and OFT tests, and correlations were also seen in CORT levels. Individuals with the stable trait of high risk-taking and explorative behavior (HR) were more sensitive to PEWD induction of anxiety-like behavior. These animals also showed decreased CORT levels during withdrawal. Chronic subordination stress enhanced the response to PEWD on measures of locomotor activity and social anxiety-like behavior. Conclusions It is possible to induce tolerance to the negative ALLO effects on learning and memory. The animal models of anxiety-like behavior show an individual PEWD response profile where HR rats are more sensitive. Exposure to chronic social stress enhanced the PEWD response. Hence there are both inherent and environmental factors behind the behavioral response to steroid hormones in rats. / Stress- och könshormoners verkningar på centrala nervsystemet