Thesis (MPH.) -- University of Limpopo, 2019 / Background- care of the mentally ill by family members is done with little or no supervision by skilled health workers. Therefore, the purpose of the study was to investigate the experiences of family members of patients living with mental illness in the Capricorn District of Limpopo Province in South Africa. Objective- to explore and describe the experiences of family members caring for patients living with mental illness. Methods- A qualitative, descriptive and exploratory design was used. Non-probability sampling of the purposive and convenient type was used to explore and describe the experiences of family members of patients living with mental illness in the Capricorn District. Data were collected from fifteen family members caring for MHCUs, by using open-ended semi-structured face-to-face interviews. Data were audio recorded and observations were done during interviews. Trustworthiness was ensured by applying credibility, transferability, confirmability and dependability. Data were analysed using Tech’s open-coding method. Results- family members experience disruptive behaviour from MHCUs and they also have to adapt to new routines that are at times unfavourable. As a result, the family members’ health and quality of life are affected, thus making them susceptible to having mental illness and other medical conditions as well. Conclusion- There is a need for family members caring for persons living with mental illness to be given emotional and social support. community projects such as support groups for family members caring for MHCUs and goal directed standard operations procedures at the Psychiatric Ward – specifically designed and implemented for family members caring for MHCUs, are recommended.

Bakgrund Stroke är en vanlig sjukdom och är en av de vanligaste orsakerna till död i Sverige. Stroke är något som sker neurologiskt och kan leda till förlamning och andra problem. Hopp är något som kan leda till positiva konsekvenser hos patienter, uppgiftspecifik träning och emotionellt stöd kan leda till positiva konsekvenser hos patienterna.   Syfte Syftet är att beskriva betydelsen av hopp hos personer som genomgått stroke och ur anhörigas perspektiv   Metod Litteraturöversikt, där databaserna PubMed och Cinahl har använts, artiklar med patienter som haft stroke och anhöriga har inkluderats. Tio artiklar har sökts fram med hjälp av databaserna och delats upp i olika kategorier beroende på begrepp i artiklarna.   Resultat Begreppet hopp förekommer vid återhämtning efter stroke, rehabilitering och olika aktiviteter har betydelse för hopp om att gå vidare i livet. Vårdpersonal har en viktig roll när det kommer till att inge hopp till patienterna och även familjemedlemmarna behöver stöd och hopp så att de kan fokusera på sin familjemedlem. Holistiska metoder har en positiv inverkan på hopp om att bli bättre hos patienterna och innebär att man sett på hela hälsan, dvs helheten.   Slutsats Emotionella, existentiella faktorer, rehabilitering, vårdpersonal och familjemedlemmar är viktiga begrepp som förekommer inom det här området och har en inverkan på patienter med stroke. / Background Stroke is a common disease and one of the most common reasons for death in Sweden. It is a neurological disorder and can lead to disability and other problems. Hope is a something that can lead to positive consequences, specific training, rehabilitation and emotional support can lead to better outcomes.   Aim Describe the meaning of hope among patients that have been through stroke and their family members and relatives.   Method                                                                 Literature review, where the databases PubMed and Cinahl were used, articles with strokepatients and their relatives and families were included, the articles have been divided into different categories.     Results Hope is the most important factor when it comes to recovery, rehabilitation affect the hope, health care workers also plays an important role and family members also need support and hope to be able to focus on their family member. Holistic methods have a positive effect on the wellbeing and the hope to become better.   Conclusions Emotional, existential factors, rehabilitation, nursing staff and family members have an important role and impact on patients with stroke and their care.

Indiana University-Purdue University Indianapolis (IUPUI) / Human papillomaviruses (HPVs) are one of the most common causes of sexually transmitted disease in the world. HPVs are divided into high-risk (HR) or low-risk (LR) types based on their oncogenic potential. HPVs 16 and 18 are considered HR types and can cause cervical cancer. HPVs 6 and 11 are classified as LR and are associated with condyloma acuminata (genital warts). Viral proteins of both HR and LR HPVs must be able to facilitate a replication competent environment. The E7 proteins of LR and HR HPVs are responsible for maintenance of S-phase activity in infected cells. HR E7 proteins target all pRb family members (pRb, p107 and p130) for degradation. LR E7 does not target pRb or p107 for degradation, but does target p130 for degradation. Immunohistochemistry experiments on HPV 6 infected patient biopsies of condyloma acuminata showed that detection of p130 was decreased in the presence of the whole HPV 6 genome. Further, the effect of HR HPV 16 E7 and LR HPV 6 E7 on p130 intracellular localization and half-life was examined. Experiments were performed using human foreskin keratinocytes transduced with HPV 6 E7, HPV 16 E7 or parental vector. Nuclear/cytoplasmic fractionation and immunofluorescence showed that, in contrast to control and HPV 6 E7-expressing cells, a greater amount of p130 was present in the cytoplasm in the viii presence of HPV 16 E7. The half-life of p130, relative to control cells, was decreased in the cytoplasm in the presence of HPV 6 E7 or HPV 16 E7, but only decreased by HPV 6 E7 in the nucleus. Inhibition of proteasomal degradation extended the half-life of p130, regardless of intracellular localization. Experiments were also conducted to detect E7-binding partners. Cyclin C and cullin 5 were identified as proteins capable of binding to both HPV 6 E7 and HPV 16 E7. Preliminary experiments showed that decreasing protein levels of p600, a binding partner of both HPV 6 E7 and HPV 16 E7, by RNA interference might affect p130 stability. Elucidating the mechanisms of p130 degradation may identify potential targets for preventing degradation of p130 and allowing restoration of cell cycle control.

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Bakgrund: Sjuksköterskor står inför utmaningar vid hjärtstoppsituationer där deras tidiga insatser är avgörande för patientens överlevnad. Med cirka 13 000 fall av hjärtstopp årligen i Sverige är hjärt-lungräddning en central del i omhändertagandet. Närstående lyfter att närvaro vid hjärt-lungräddning är en viktig rättighet som kan bidra till en känsla av trygghet. Syfte: Beskriva sjuksköterskans upplevelse av hjärt-lungräddning med närvarande närstående. Metod: En kvalitativ litteraturöversikt med induktiv ansats har genomförts, där tio vetenskapliga artiklar analyserades utifrån Fribergs femstegsmodell. Databaserna CINAHL, MEDLINE och PubMed har använts. Resultat: Sjuksköterskor övervägde faktorer som patientens tillstånd, närståendes önskemål och den potentiellt traumatiska effekten samt att varje hjärt-lungräddningssituation är unik. Det uppgavs brister inom organisationen som försvårade för närstående att närvara. Förslag på förbättringar såsom en vald familjestödperson, tydligare riktlinjer samt policys lyfts av sjuksköterskorna. Slutsats: Sjuksköterskors perspektiv på närståendes närvaro vid hjärt-lungräddning visar på delade åsikter och en komplex dynamik. Farhågor kring störningar och påverkan på patientsäkerheten kontrasteras mot betoningen av närståendes roll för emotionellt stöd och sorgeprocessen. Identifierade organisatoriska utmaningar, inklusive behovet av en ansvarig personal och tydliga riktlinjer, betonar behovet av en balans mellan säkerhet och stöd i vårdmiljön. / Background: Nurses face challenges in cardiac arrest situations where their early interventions are crucial for patient survival. With approximately 13 000 cases of cardiac arrest annually in Sweden, cardiopulmonary resuscitation is a vital component of care. Family members raises that presence during cardiopulmonary resuscitation is an important right that can contribute to a sense of security.  Aim: To describe the nurse’s experience of cardiopulmonary resuscitation with the presence of family members.  Method: A qualitative literature review with an inductive approach was conducted, analysing ten scientific articles using Friberg’s five-step model. The databases CINAHL, MEDLINE and PubMed were utilized.  Result: Nurses considered factors such as the patient’s condition, the wishes of close relatives, the potentially traumatic effects, and the uniqueness of each cardiopulmonary resuscitation situation. Organizational shortcomings hindering family presence were reported. Suggestions for improvements, such as the nurses highlighted a designated family support person and clearer guidelines and policies. Conclusion: Nurses’ perspectives on the presences of family members during cardiopulmonary resuscitation reveal divergent opinions and a complex dynamic. Concerns about disruptions and their impact on patient safety contrast with the emphasis on the role of family members for emotional support and the grieving process. Identified organizational challenges, including the need for designated personnel and clear guidelines, underscore the necessity of valancing safety and support in the healthcare environment.

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Bakgrund: Sjukhusens vårdavdelningar är den sista vårdplatsen för många människor, vilket innebär att många också dör i den kontexten. Organisationen är i huvudsak utformad för akutsjukvård och vård i livets slutskede är inte prioriterat, vilket gör att akutsjukvårdsmiljön är sämre utformad för den döende personen och närstående. Det finns behov av fler studier som fokuserar på vård i livets slutskede från dessa vårdkontexter.                                                                                                                                                                                                   Syfte: Syftet var att utforska närståendes erfarenheter av vad som är betydelsefullt i vårdmiljön inom akutsjukvården vid vård i livets slutskede. Metod: Den här studien är kvalitativ och designad utifrån tolkande beskrivning. Två akutsjukvårdsavdelningar i södra-mellersta Sverige rekryterades. Nio närstående, sex kvinnor och tre män, i åldrarna 23-63 år, deltog i studien. De blev individuellt intervjuade vid ett tillfälle. Vid intervjun användes fotoelicitering med utgångspunkt från bilder de själva hade tagit. Intervjuerna spelades in digitalt (ljud) och transkriberades ordagrant. Tolkande beskrivning användes för analys av materialet. Resultat: Närståendes erfarenheter av vårdmiljön presenteras i tre mönster, vilka är relaterade till varandra: Sensoriska upplevelser i den fysiska vårdmiljön som inkluderar visuella intryck, ljud och oljud samt ljus; Utrymme för privatliv och sociala relationer i den personliga vårdmiljön och avslutningsvis; Personalen som representanter för den institutionella vårdmiljön som omfattar förhållningssätt, möjliggöra orientering samt struktur och kontinuitet. Slutsats: Studien påvisar tre mönster som omfattar närståendes erfarenheter av det som är betydelsefullt. Betydelsen av sensoriska upplevelser, privatliv och sociala relationer samt personalen förhållningssätt och agerande beskrivs. Erfarenheter i och av vårdmiljön kunde öka eller minska deras stress i en svår livssituation. Utifrån dessa fynd är det av stor betydelse med ökad medvetenhet hos personalen om hur viktig vårdmiljön är och att miljön för vård i livets slutskede vid akutsjukvårdsavdelningar behöver uppmärksammas och tas om hand i större omfattning. / Background: Hospitals are and will continue to be the last place for care for many people, which also means that a lot of people die in these settings, within organizations for acute care. The main focus is not care at end-of-life and it is not prioritized, which means that these acute care environments not are adapted to the needs of dying persons and family members. More studies aiming at end-of-life care in acute care settings are needed.              Aim: The aim with this study was to explore important dimensions of the care environment in acute care settings from family members´ perspective during end-of-life care.                                                                Method: The design for this study was qualitative and used interpretive description. We recruited two acute care units from different hospitals in south-mid Sweden. The participants were nine family members, six women and three men, aged 23-63 years. They were at one occasion individually interviewed with the use of photo-elicitation and these photographs were participant-produced. These interviews were digitally audio-recorded and transcribed verbatim. The interviews were analysed with interpretive description.                                               Findings: These findings show family members´ experiences of the acute care environment, as described in three, interrelated patterns: Sensory experiences in the physical care environment including visual impressions, sound and noises, lighting; Space for privacy and social relations in the personal care environment; and Staff as representatives for the institutional care environment including attitude and manner, orientation, and structure and continuity.                                                                                                                                                              Conclusions: According to these findings three patterns are described from family members´ perspective, increasing or decreasing their distress in a demanding situation. Sensory experiences, privacy and social relations are of importance, just as staff. In line with these findings it is crucial with increased awareness among staff of how important the care environment is and the need for focusing more on and taking care of the end-of-life care environment in acute care settings. / Forskningsprogrammet DöBra / Plats och rum för vård i livets slutskede

Bakgrund: Nuförtiden har det blivit mer vanligt att patienter som lider av obotliga sjukdomar vill vårdas och dö i hemmet vid palliativt skede. Trots insatser från hälso- och sjukvården spelar närstående ofta en avgörande roll i vården. Närstående tar ofta på sig rollen som vårdare för att uppfylla den sjukes önskan. Att engagera sig i vårdandet av en anhörig lägger ett stort ansvar på närstående vilken kan påverka de närståendes fysiska och psykiska hälsa. Syfte: Syftet var att beskriva närståendes upplevelse av att vårda sin anhöriga i hemmet vid palliativt skede. Metod: Metoden för studien var en litteraturöversikt som grundade på tio vetenskapliga kvalitativa artiklar. Vid sökning användes tre databaser; CINAHL Complete, PubMed och PsycINFO. Artiklarna kvalitetsgranskades och analyserades enligt Friberg (2017). Resultat: I resultatet framkom tre huvudkategorier och nio subkategorier. De första huvudkategorierna var positiv upplevelse av att vårda anhöriga med tre subkategorier; förbättrade relationer, att känna sig delaktighet i sin vårdande roll och att uppfylla önskan. De andra huvudkategorierna var negativ upplevelse av att vårda anhöriga med subkategorier; vårdbördan och ansvar, isolering och ensamhet, att vara osäker och rädslan och ångest. De tredje huvudkategorierna var närståendes upplevelse av hälso – och sjukvården med två subkategorier; otillfredsställelse - och tillfredsställelse med hälso-och sjukvård. Diskussion: Resultatet diskuteras utifrån Meleis transitionsteori, områdets utgångspunkt som beskrivs i litteraturöversiktens bakgrund och annan forskning. Utgångspunkten tas framförallt ifrån Meleis transitionsteori som var relaterad till närståendes upplevelse av rollövergångar. / Background: Nowadays, it has become more common for patients suffering from incurable diseases to be cared for and die at home at palliative stages. Despite efforts from the health and medical care, next-of-kin often play a crucial role in the care. Next-of-kin often take on the role of carer to fulfil the sick person's desire. Engaging in caring for a family member adds great responsibility to the next-of-kin which can affect their physical and mental health. Aim: The purpose was to describe the next-of-kin experiences of caring for their relatives in the home at the palliative stage. Method: The method of the study was a literature review based on ten scientific qualitative articles. When searching, three databases were used; CINAHL Complete, PubMed and PsycINFO. The articles were quality-reviewed and analysed according to Friberg (2017). Results: The result showed three main categories and nine subcategories. The first major categories were positive experiences of caring for relatives with three subcategories; improved relationships, feeling involved in their caring role and fulfilling desire. The other main categories were negative experiences of caring relatives with subcategories; care burden and responsibility, isolation and loneliness, being insecure and fear and anxiety. The third main categories were next-of-kin experiences of health professionals with two subcategories; satisfaction and dissatisfaction. Discussion: The result is discussed based on Melei's transition theory, the background of the literature review and other research. The starting point is mainly taken from Melei's transition theory, which was related to the next-of-kin experience of role transfers.

<p>Mast cells are long-lived effector cells of importance for both acute and chronic inflammations. Mast cells can be activated in many different ways, leading to the release of inflammatory mediators. In contrast to most other inflammatory cells, activated mast cells have the capacity to recover, regranulate and thereby be activated again. </p><p>In this thesis I have investigated the mechanisms involved in regulating activation-induced mast cell survival. We have found that cross-linking of FcεRI-bound IgE with an antigen (IgER-CL) induces a survival program in mast cells. Upon IgER-CL, mouse and human mast cells upregulate the pro-survival Bcl-2 family gene A1/Bfl-1. A1^-/- mast cells degranulate upon FcεRI activation but they cannot recover most likely due to the lack of A1. Sensitized and provoked A1^-/- mice exhibit lower amounts of mast cells compared to littermate controls. In contrast to mast cells, no Bfl-1 expression or survival promotion can be detected in basophils after IgER-CL. Another mast cell secretagogue, an adenosine receptor agonist, neither promoted upregulation of A1 nor survival.</p><p>Although it is well established that mast cell survival is dependent on stem cell factor (SCF), it has not been described how this process is regulated. We have found that SCF promotes survival through Akt-mediated inhibition of the forkhead transcription factor FOXO3a and its transcriptional target Bim, a BH3-only pro-apoptotic protein. SCF-treatment prevents upregulation of Bim protein expression and leads to an upregulation of Bim phosphorylation through PI3-kinase and MEK-dependent pathways. Overexpression of FOXO3a causes an upregulation of Bim and induces mast cell apoptosis, even in the presence of SCF. </p><p>Taken together, the work in this thesis demonstrates that A1/Bfl-1 and Bim play key roles in mast cell survival. These findings might be of importance in understanding the mechanisms of mast cell longevity and hence for possible new therapeutics used for mast cell-associated inflammations.</p>