Background: Domestic violence occurs in many forms and is a public health problem all over the world. Many women described the importance of how they are received by nurses when they seek medical care for the violence. Trust, empathy and a feeling of safety were things women described as mostly valuable. Feelings of not being listened to or even trusted were on top of the list of negative experiences. Aim: The aim was to highlight nurses’ experiences of meeting women exposed to domestic violence. Method: A litterature review was implemented, which included analysis of 12 scientific articles, whence seven qualitative, four quantitative and one mixed method. Results: Nurses mentioned difficulties understanding the women due to cultural- and linguistical differences. Enabling factors to get women to talk about the violence were feelings of trust and safety, as well as routine screening. Conclusion: Encouraging victims of domestic violence to talk about their experience, requires trust and safety. Cultural- and linguistical differences constitutes the main obstacles to achieve this. Appreciation of the women’s situation, as well as the culture they come from, needs to improve and this requires further education.

Bakgrund  Livmoderhalscancer är en ledande dödsorsak hos kvinnor. Det är en sjukdom som går att förebygga genom vaccination och screening. Screening riktar sig till friska personer och syftar till att upptäcka och behandla tidiga förstadier av cancer. Ett avvikande resultat från screening för livmoderhalscancer kan påverka en kvinnas upplevelse av sin hälsa och orsaka lidande. Genom att belysa kvinnors upplevelser av ett avvikande resultat från screening för livmoderhalscancer kan sjuksköterskan få mer kunskap för att kunna främja hälsa och lindra lidande. Syfte Syftet var att belysa kvinnors upplevelser av ett avvikande resultat från screening för livmoderhalscancer. Metod En icke-systematisk litteraturöversikt med 16 vetenskapliga kvantitativa och kvalitativa originalartiklar användes som metod för denna litteraturstudie. Databaserna PubMed och CINAHL användes för sökningen och artiklarna kvalitetsgranskades enligt Sophiahemmet Högskolas bedömningsunderlag. Artiklarna analyserades sedan enligt metoden integrerad analys. Resultat Utifrån den integrerade dataanalysen identifierades två kategorier: psykiskt lidande vid avvikande resultat och behov av information vid avvikande resultat. Slutsats Litteraturstudiens två huvudfynd var att ett avvikande resultat från screening för livmoderhalscancer orsakar psykiskt lidande hos de kvinnor som screenas och att kvinnorna har ett behov av mer information från främst vårdpersonal. Sjuksköterskan bär ett ansvar i sitt omvårdnadsarbete att främja hälsa och lindra lidande och att säkerställa att patienten får rätt, tillräcklig och lämplig information under hela vårdprocessen. Resultatet av denna studie kan hjälpa sjuksköterskan få mer kunskap för att främja hälsa och för att minska onödigt lidande. / Background Cervical cancer is a leading cause of death for women. It is a disease that can be prevented through vaccination and screening. Screening is aimed at healthy individuals and aims to detect and treat early pre-stages of cancer. An abnormal result from screening can affect a woman’s experience of her health and cause suffering. By highlighting women’s experiences of an abnormal result from cervical cancer screening, nurses can gain knowledge to promote health and alleviate suffering. Aim The aim was to highlight women’s experiences of an abnormal result from screening for cervical cancer. Method This non-systematic literature review was based on 16 original research articles. PubMed and CINAHL were used to search for the articles. The articles were quality reviewed according to Sophiahemmet University’s assessment manual. The method for analysis was an integrated analysis. Results Based on the integrated data analysis, two categories were identified: psychological distress when notified with abnormal results and need for information when notified with abnormal results. Conclusions The two main findings of this literature study were that an abnormal result from screening for cervical cancer causes psychological distress and that there is a need for more information, mainly from healthcare professionals. Nurses bear a responsibility to promote health and alleviate suffering and to ensure that the patient receives correct, sufficient and appropriate information throughout the nursing process. The results of this study can help nurses gain more knowledge to promote health and to reduce unnecessary suffering.

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No description available.

Bakgrund: Våld i nära relation är ett folkhälsoproblem som drabbar kvinnor och förekommer i alla samhällen. Utsatta kvinnor söker ofta vård men stigmatisering gör det svårt att berätta om sin utsatthet. Sjuksköterskan har omvårdnad som huvudkompetens och har därför ett ansvar i mötet med kvinnor. Syfte: Syftet var att beskriva aspekter av omvårdnad relaterade till sjuksköterskans förmåga att fråga kvinnor om våld i nära relation. Metod: En allmän litteraturstudie med kvalitativ och induktiv ansats. Design i enlighet med Polit och Becks nio-stegsmodell. Data har analyserats genom att använda Braun och Clarkes modell för tematisk analys. Resultat: Två teman identifierades med sex subteman. Utmaningar i vårdmötet, med subtemana Sjuksköterskans färdigheter, Påverkad av känslor, Formad av samhällets normer och Begränsningar i vårdmiljön, med subtemana Tillgång till resurser, Riktlinjer, Arbetsplatskultur. Slutsatser: Omvårdnaden för våldsutsatta kvinnor kan utvecklas genom förståelsen för utmaningar i vårdmötet samt begränsningar i vårdmiljön. Det stärker litteraturstudiens kliniska relevans. Ytterligare forskning behövs för att förstå komplexiteten av identifierade aspekter samt hur de samverkar i sjuksköterskans omvårdnadsarbete med kvinnor som utsatts för våld i nära relation. / Background: Intimate partner violence is a public health problem that affects women and occurs in all communities. Abused women often seek health care, but stigma makes it difficult to disclose violence. Nursing care is the nurse’s main competence and therefore the nurse has a responsibility when encountering women. Aim: The aim was to describe aspects of nursing related to the nurse's ability to ask women about intimate partner violence. Method: A general literature study with a qualitative and inductive approach. Design in accordance with Polit and Beck's nine-step model. Data was analyzed using Braun and Clarke's model for thematic analysis. Results: Two themes were identified with six subthemes. Challenges in the healthcare meeting, with subthemes The nurse's skills, Influenced by emotions, Shaped by society's norms and Limitations in the healthcare environment, with subthemes Access to resources, Guidelines, Workplace culture. Conclusions: Nursing care for abused women can be developed through the understanding of challenges in the care meeting and limitations in the care environment. This strengthens the clinical relevance of the literature study. Further research is needed to understand the complexity of identified aspects and how they interact in the nurse's work with women who have been subjected to intimate partner violence.

Biomarker testing, wherein the concentration of a biochemical marker is measured to predict the presence or absence of a certain binary characteristic (e.g., a disease) in a subject, is an essential component of public health screening. For many diseases, the concentration of disease-related biomarkers may exhibit a wide range, particularly among the disease positive subjects, in part due to variations caused by external and/or subject-specific factors. Further, a subject's actual biomarker concentration is not directly observable by the decision maker (e.g., the tester), who has access only to the test's measurement of the biomarker concentration, which can be noisy. In this setting, the decision maker needs to determine a classification scheme in order to classify each subject as test negative or test positive. However, the inherent variability in biomarker concentrations and the noisy test measurements can increase the likelihood of subject misclassification. We develop an optimal data-driven framework, which integrates optimization and data analytics methodologies, for subject classification in disease screening, with the aim of minimizing classification errors. In particular, our framework utilizes data analytics methodologies to estimate the posterior disease risk of each subject, based on both subject-specific and external factors, coupled with robust optimization methodologies to derive an optimal robust subject classification scheme, under uncertainty on actual biomarker concentrations. We establish various key structural properties of optimal classification schemes, show that they are easily implementable, and develop key insights and principles for classification schemes in disease screening. As one application of our framework, we study newborn screening for cystic fibrosis in the United States. Cystic fibrosis is one of the most common genetic diseases in the United States. Early diagnosis of cystic fibrosis can substantially improve health outcomes, while a delayed diagnosis can result in severe symptoms of the disease, including fatality. We demonstrate our framework on a five-year newborn screening data set from the North Carolina State Laboratory of Public Health. Our study underscores the value of optimization-based approaches to subject classification, and show that substantial reductions in classification error can be achieved through the use of the proposed framework over current practices. / Doctor of Philosophy / A biomarker is a measurable characteristic that is used as an indicator of a biological state or condition, such as a disease or disorder. Biomarker testing, where a biochemical marker is used to predict the presence or absence of a disease in a subject, is an essential tool in public health screening. For many diseases, related biomarkers may have a wide range of concentration among subjects, particularly among the disease positive subjects. Furthermore, biomarker levels may fluctuate based on external factors (e.g., temperature, humidity) or subject-specific characteristics (e.g., weight, race, gender). These sources of variability can increase the likelihood of subject misclassification based on a biomarker test. We develop an optimal data-driven framework, which integrates optimization and data analytics methodologies, for subject classification in disease screening, with the aim of minimizing classification errors. We establish various key structural properties of optimal classification schemes, show that they are easily implementable, and develop key insights and principles for classification schemes in disease screening. As one application of our framework, we study newborn screening for cystic fibrosis in the United States. Cystic fibrosis is one of the most common genetic diseases in the United States. Early diagnosis of cystic fibrosis can substantially improve health outcomes, while a delayed diagnosis can result in severe symptoms of the disease, including fatality. As a result, newborn screening for cystic fibrosis is conducted throughout the United States. We demonstrate our framework on a five-year newborn screening data set from the North Carolina State Laboratory of Public Health. Our study underscores the value of optimization-based approaches to subject classification, and show that substantial reductions in classification error can be achieved through the use of the proposed framework over current practices.

Peroxisome proliferator-activated receptor γ (PPARγ) is associated with a wide range of diseases, including type 2 diabetes mellitus (T2D). Thiazolidinediones (TZDs) are agonists of PPARγ which have an insulin sensitizing effect, and are therefore used as a treatment for T2D. However, TZDs cause negative side effects in patients, such as weight gain, edema, and increased risk of bone fracture. Partial agonists could be an alternative to TZD-based drugs with fewer side effects. However, there is a lack of understanding of the types of PPARγ partial agonists and how they differ from full agonists. In silico techniques, like virtual screening, molecular docking, and pharmacophore modeling, allow us to determine and characterize markers of varying levels of agonism. An extensive search of the RCSB Protein Data Bank found 62 structures of PPARγ resolved with partial agonists. Cross-docking was performed and found that two PDB structures, 3TY0 and 5TWO, would be effective as receptor structures for virtual screening. By clustering known partial agonists by common pharmacophore features, we found several distinct groups of partial agonists. Interaction and pharmacophore models were created for each group of partial agonists. Virtual screening of FDA-approved compounds showed that the models were able to predict potential partial agonists of PPARγ. This study provides additional insight into the different binding modes of partial agonists of PPARγ and their characteristics. These models can be used to assist drug discovery efforts for intelligently designing novel therapeutics for T2D which have fewer negative side effects. / Master of Science in Life Sciences / The peroxisome proliferator-activated receptor γ (PPARγ) protein is associated with a wide range of diseases, including type 2 diabetes mellitus (T2D). Thiazolidinediones (TZDs) are compounds that activate PPARγ, and increase insulin sensitivity in patients with T2D. However, TZDs cause negative side effects in patients, such as weight gain, increased fluid retention, and increased risk of bone fracture. Partial agonists could be an alternative to TZD-based drugs with fewer side effects. However, there is a lack of understanding of the types of PPARγ partial agonists and how they differ from full agonists. Computational techniques allow us to investigate common features between known partial agonists. An extensive search of the RCSB Protein Data Bank found 62 structures of PPARγ which contained partial agonists. Each known partial agonist was docked into twelve complete PPARγ structures, and it was found that two structure models would be effective as receptor structures for virtual screening. A set of known partial agonists were grouped based on common chemical features, and three distinct groups of partial agonists were found. Binding criteria for each of these three groups were developed. A library of FDA-approved compounds was screened using the criteria for binding to identify potential novel partial agonists. Three potential novel partial agonists were found in the screening. This study provides additional insight into how different compounds activate PPARγ. These methods can be used to assist drug discovery efforts for intelligently designing novel therapeutics for T2D which have fewer negative side effects.

Introduktion Lungcancer är den tredje vanligaste cancersjukdomen i Sverige och den främsta orsaken till cancerrelaterade dödsfall i världen. Den har en dålig prognos med en 5 års överlevnad på under 25%. Detta främst på grund av att den ofta upptäcks i ett sent skede då bot inte längre är möjligt. Den vanligaste orsaken till lungcancer är rökning. Ungefär 90% av alla som drabbats av lungcancer är eller har varit rökare. Med hjälp av screening av individer med en hög konsumtion av rökning “högriskindivider” kan lungcancer hittas i ett tidigt skede och förhindra att individer dör av sjukdomen. Syfte Syftet med detta examensarbete är belysa högriskindividers upplevelser av deltagande i lungcancerscreening samt deras eventuella behov av stöd från sjukvården för att öka motivationen till att delta i lungcancerscreening. Metod En allmän litteraturstudie baserat på 18 vetenskapliga artiklar med kvalitativ ansats varav 3 med mixad-metod Resultat Resultatet baseras på 18 vetenskapliga artiklar. Fyra kategorier och tio subkategorier blev syntesen av dessa studier. De fyra kategorier som presenteras är: 1. Fördelar med screening, 2. Nackdelar med screening, 3. Delaktighet i beslutsprocessen och förtroendet för vården samt 4. Personcentrerad individanpassad information. Resultatet visar på vikten av personcentrerad och individanpassad information samt betydelsen av förtroendet för vården inför och under screeningprocessen. Slutsats Fördelarna med att screenas för lungcancer övervägde nackdelarna. Det kunde även motivera individer att sluta röka och behålla kontrollen över sin hälsosituation och minska rädslan för det okända. Nackdelarna var att individer kunde uppleva psykisk oro och stress under screeningprocessen och en rädsla för en cancerdiagnos. Bemötandet från vårdpersonalen var 3av stor betydelse och behovet av individanpassad information var stort. Pilotstudier pågår i Sverige för en eventuell implementering av lungcancerscreening i Sverige i framtiden. / BackgroundLung cancer is the leading cause of cancer-related deaths worldwide and the third most common in Sweden. It has a poor prognosis with a 5-year survival rate of below 25%. This is mainly due to the fact that it is often discovered at a late stage where cure is no longer possible. The most common cause of lungcancer is smoking. Approximately 90% of all people affected by lungcancer are or have been smokers. With the help of screening "highrisk individuals" lung cancer can be found at an early stage and thus prevent individuals from dying of the disease. Research questionThe purpose of this thesis is to illustrate high-risk individuals' experiences of participation in lung cancer screening and their possible need for support from health care to increase the motivation to participate in lung cancer screening. MethodA general literature review based on 18 scientific articles with a qualitative approach, of which 3 with mixed-method ResultsThe result is based on 18 scientific articles. Four categories and ten subcategories became the synthesis of these studies. The four categories presented are: 1. Advantages of screening, 2. Disadvantages of screening, 3. Participation in the decision-making process and trust in health care, and 4. Person-centered personalized information. The results show the importance of person-centered and individualized information as well as the importance of trust from the healthcare system before and during the screening process. ConclusionThe advantages of being screened for lung cancer outweighed the disadvantages. It could also motivate individuals to quit smoking and maintain control over their health situation and reduce fear of the unknown. The disadvantages were that individuals could experience 4psychological anxiety and stress during the screening process and a fear of a cancer diagnosis. How the individual was treated by the care staff was of great importance and the need for individually tailored information was great.Pilotstudies are ongoing in Sweden for a possible implementation of lung cancer screening in Sweden in the future.

Despite the existence of breast cancer screening that could promote early diagnosis and survival of breast cancer, high mortality rates of breast cancer persist among Filipino women. The purpose of the qualitative study was to describe the perceptions, beliefs, and behaviors of Filipino women working as Overseas Filipino Workers (OFWs) in Saudi Arabia. Face-to-face interviews were conducted with 20 Filipino women between the ages of 40 to 60 years who were recruited voluntarily using purposeful sampling technique. Guided by the structures of health belief model (HBM), the study used an inductive coding technique to elicit common themes from the raw data. The study established that the participants' screening behaviors were influenced by family history of breast cancer, the financial and emotional burden of the disease and its treatment, the benefit of early detection, mobility to participate, culture and language barriers, and the social media. The study also demonstrated that the desire to participate in breast cancer screening is influenced by the participants' perception of susceptibility and perception of severity to breast cancer. The findings of the study could create a positive social change as it may inform the practice of public health providers, influence the drafting of informed policies for comprehensive breast health care, and improve access to preventive health services for Filipino women OFWs. Furthermore, the study could empower Filipino women in their personal health decision making, especially when working in other countries where good health is the working capital and a precondition for survival.

Bakgrund: Våld i nära relation ses som ett globalt folkhälsoproblem där kvinnor världen över faller offer för våldet. Det som kännetecknar våld i nära relation är att det finns en relation och känslomässigt band mellan offer och förövare. Våldet kan ge uttryck fysiskt, psykiskt, sexuellt, materiellt, ekonomiskt och socialt. Tidigare forskning visade att cirka var tredje kvinna som varit i en relation har utsatts för någon form av våld. Enligt Världshälso-organisationen (WHO) bör hälso- och sjukvården vara drivande i arbetet mot våld i nära relationer. Syfte: Syftet med studien var att undersöka hur yrkesverksamma inom hälso- och sjukvården kan identifiera tecken på att kvinnor blivit utsatta för våld i nära relation. Metod: Litteraturöversikt användes som metod till studien. Åtta kvalitativa och en kvantitativ artikel valdes ut. Resultat: Hälso- och sjukvårdspersonal var ofta de första som mötte kvinnor som utsatts för våld i nära relation. Sjukvården arbetar utifrån olika screeningmetoder där bland annat frågor ställs för att utforska kvinnans situation och hälsa. Det var viktigt att screening genomfördes för att identifiera om eventuell våldsproblematik fanns. Utifrån artiklarnas resultat framträdde tre subteman och ett huvudtema som svarade till studiens syfte. Konklusion: Studiens resultat visade att hälso- och sjukvården var medvetna om kvinnans utsatthet för våld i nära relation. Sjukvården hade ett flertal metoder som rekommenderades att arbeta efter, dock fanns det hinder som resulterade i att screening inte användes på rätt sätt och i vissa fall inte användes alls. Det finns förbättringsområden i sjukvårdens arbete med våldsutsatta kvinnor. / Background: Intimate partner violence is a global public health problem where women all around the world fall victims to violence. Intimate partner violence is the relationship and emotional bond between victim and perpetrator. Violence can manifest in several different ways, such as physical, mental, sexual, material, economic or social. Previous research showed that about every third woman who had been in a relationship were victims to some form of violence. According to the World Health Organization (WHO) health care services should be a driving force in the work against intimate partner violence.  Aim: The aim of the study was to investigate how health care professionals can identify expose of intimate partner violence among women.  Method: A literature review was conducted. Eight qualitative and one quantitative article were selected.  Results: Health care professionals are often the first to meet the woman who has been subjected to violence. The health care services used various screening methods where, questions are asked to explore the woman's situation. Based on the results of the articles, a main theme and three sub-themes were constructed.  Conclusion: The result of this study shows that the health care services are aware of the woman's exposure to violence. The health care system has several methods that they should work with, however there are many obstacles that result in both screening not being used correctly and in some not being used at all. There are areas for improvement in health care work with women exposed to violence.