Bakgrund: Diagnostiserade fall av personer med typ 1-diabetes ökar globalt och komplikationer kan uppstå i samband med sjukdomen. Lågkolhydratkost har visat sig vara en potentiell metod för att förbättra blodsockerreglering. Sjuksköterskor ansvarar för kostrådgivning och därav behövs mer kunskap om ämnet då det vetenskapliga underlaget är otillräckligt. Syfte: Uppsatsens syfte var att undersöka påverkan av lågkolhydratkost hos personer med typ 1-diabetes. Metod: En litteraturstudie av 10 vetenskapliga artiklar genomfördes med en induktiv ansats. Resultat: Följande huvudkategorier presenterades i studiens resultat: kroppsliga förändringar och upplevelser. Underkategorierna var: blodsocker, insulin, blodfetter, ketoner, vikt och BMI, vitalparametrar, positiva erfarenheter och utmaningar. Effekter av lågkolhydratkost varierade avseende blodsocker, insulin, blodfetter, vikt och blodtryck. BMI förbättrades, ketonnivåer höjdes och diabetes ketoacidos förekom i samband med lågkolhydratkost. Erfarenheter av lågkolhydratkost varierade. Konklusion: Sjuksköterskor och sjuksköterskestudenter behöver information om lågkolhydratkost och typ 1-diabetes. På så sätt kan adekvat information, evidensbaserad vård och personcentrerad vård erbjudas till personer med typ 1- diabetes. / Background: Diagnosed cases of people with type 1 diabetes are growing globally and complications can occur in correlation with the disease. Low carbohydrate diets have shown to be a potential method to improve blood sugar regulation. Nurses are responsible for dietary advice and therefore more knowledge is needed on the subject as the scientific basis is insufficient. Aim: The aim of this thesis was to examine the impact of a low carbohydrate diet for people with type 1 diabetes. Method: A literature study of 10 scientific articles was conducted with an inductive approach. Results: The following main categories was presented: bodily changes and experiences. The subcategories were: blood sugar, insulin, blood fats, ketones, weight and BMI, vital parameters, positive experiences and challenges. The effects of low carbohydrate diets varied regarding blood sugar, insulin, blood fats, weight and blood pressure. BMI improved, ketone levels were raised, diabetic ketoacidosis occurred and experiences with a low-carbohydrate diet varied. Conclusion: Nurses and nursing students need information about low carbohydrate diets and type 1 diabetes. In this way adequate information, evidence-based care and person-centered care can be offered to people with type 1 diabetes.

Bakgrund: Långvarig sjukdom innebär en förändrad vardag på många sätt. Det behövs resurser för att hantera och acceptera sjukdomen för att uppnå en överkomlig vardag. Diabetes typ 1 är en av de snabbast växande kroniska sjukdomarna i världen och det finns cirka 1,1 miljoner barn med sjukdomen. Föräldrarna har viktig roll i deras omvårdnad. Familjefokuserad omvårdnad innebär att lägga fokuset på omvårdnad på hela familjen och inte enbart patienten. En stor roll hos sjuksköterskan är att ha ett bra samspel mellan alla involverade i familjen. Syfte: Syftet var att beskriva föräldrars erfarenheter av att leva med ett barn med diabetes typ 1. Metod: En litteraturstudie har framställts med hjälp av 13 kvalitativa vetenskapliga artiklar, funna i databaserna PubMed och CINAHL. Huvudresultat: Tre huvudteman identifierades: Anpassning till den nya vardagen, Emotionella aspekter och Behov av stöd. Anpassning till den nya vardagen berörde erfarenheter hos föräldrar när barnet diagnostiserats med diabetes typ 1, rädslan för hypoglykemi och ge över ansvaret till andra. Emotionella aspekter handlade om vilka känslor som föräldrarna hade erfarenheter av under sjukdomens gång samt det stora orosmomentet, framtiden. Behov av stöd innefattade både hälso- och sjukvård och nära relationer, vilket påvisades hos föräldrarna som stort. Slutsats: Föräldrars erfarenheter var övergripande negativa, då de kände stor oro för sitt barn på grund av vad barnet fick utstå relaterat till sjukdomen. För föräldrarnas egen del kände de ett behov av större stöd från både hälso- och sjukvård och nära relationer. Detta är någonting som bör utvecklas inom en snar framtid, både för föräldrarnas och barnens upplevda hälsa. / Background: Long-term illness means a change of the daily life in many aspects. Resources are needed to manage and accept the disease in order to achieve an equitable everyday life. Type 1 diabetes is one of the fastest growing long-term illness in the entire world and there are approximately 1,1 million children with this illness. Parents are an important part in the care of the children. Family-based care means that the focus should be on caring for the entire family, not only for the patient. The nurse plays a great part in having to deal with the interplay between everyone involved in the family. Aim: The aim was to describe parents’ experiences of living with their child with type 1 diabetes. Method: A literature review has developed by using 13 qualitative studies, found in PubMed and CINAHL. Findings: Three main themes were identified: Adapting to the new daily life, Emotional aspects and Need of support. Adapting to the new daily life refered to parents’ experiences when their child were newly diagnosed, fear of hypoglycemia and transfer responsibility to others. Emotional aspects was about which emotions parents’ are dealing with throughout the illness, together with the big worry about the future. Need of support involves both healthcare and close relations, which were exposed as momentous to the parents. Conclusion: Parents’ experiences were overall negative, since they were worrying about their children and what they endured during their illness. The parents felt that a greater support system was necessary, both from the healthcare and from close relations. This is something that needs to be developed within a near future, both regarding parents’ and childrens’ perceived health.

Bakgrund: Omkring 900 barn och ungdomar insjuknar i typ 1-diabetes (T1D) varje år i Sverige, vilket gör den till en av landets vanligaste kroniska sjukdomar hos barn. Sjukdomen påverkar livet fysiskt och psykiskt och leder till allvarliga och potentiellt livshotande komplikationer om behandlingen inte sköts. Kunskap om sjukdomen är grunden för att behandlingen ska skötas optimalt, varför information och stöd från omgivningen och hälso- och sjukvården är av stor betydelse. Syfte: Syftet med denna litteraturstudie var att beskriva barn och ungdomars upplevelser av att leva med T1D. Metod: Litteraturstudie baserad på 12 kvalitativa originalartiklar hämtade från databaserna PubMed och CINAHL. Artiklarna har efter kvalitetsgranskning erhållit medelhög till högkvalitet. Resultatet har bearbetats och analyserat, därefter har huvudteman samt underteman identifierats. Resultat: Resultatet visade att barn och ungdomar med T1D upplevde många svårigheter. Sjukdomen innebar stora praktiska och psykosociala förändringar i vardagen och bidrog till flera negativa känslor samt oro gällande egenvård och komplikationer. Känslor av att vara annorlunda jämfört med jämnåriga var vanligt förekommande liksom känslor av ensamhet och utanförskap. Stödet från familj, vänner, skolpersonal samt hälso- och sjukvården var emellanåt bristfälligt men samtidigt viktigt och betydelsefullt och underlättade de negativa upplevelserna av att leva med T1D. Slutsats: Litteraturstudien visar på att barn och ungdomar med T1D möter svårigheter i vardagen och att sjukdomen påverkar livets fysiska som psykosociala aspekter. Sjukdomsförståelse och stöd från omgivningen har positiva effekter och underlättar livet förden drabbade. God kommunikation, ett personcentrerat förhållningssätt och gott bemötande från hälso- och sjukvården är andra faktorer som kan påverka sjukdomsupplevelsen positivt och bidra med de förutsättningar som krävs för att leva ett så gott liv som möjligt, trots sjukdom. / Background: About 900 children and adolescents are diagnosed with type 1 diabetes (T1D) every year in Sweden, which makes it one of the country's most common chronic diseases in children. The disease affects life physically and mentally and leads to severe and potentially life-threatening complications if left untreated. Knowledge of the disease is the key to successful treatment, which highlights the importance of information and support from a personal support system as well as the health care service. Aim: The aim of this literature review was to describe children and adolescents experiences of living with T1D. Method: A literature review based on 12 qualitative original articles retrieved from the databases PubMed and CINAHL. After quality analysis, the articles have been received medium to high quality. The results have been processed and analyzed, thereafter main themes and sub-themes were identified. Results: The results showed that children and adolescents with T1D experienced many difficulties. The disease involved major practical and psychosocial changes in everyday life and contributed to several negative emotions as well as concerns regarding self-care and complications. Feelings of being different from peers were common, as well as feelings of loneliness and exclusion. The support from family, friends, school staff and the health care service was sometimes deficient but at the same time important and significant and facilitated the negative experiences of living with T1D. Conclusion: This literature review shows that children and adolescents with T1D face difficulties in everyday life and that the disease affects the physical and psychosocial aspects of life. Understanding of the disease and support from the people in the child’s and adolescents surroundings has positive effects and makes life easier for the affected. Good communication, a person-centered approach and good treatment from the health care service are other factors that can positively affect the experience of T1D and contribute with the conditions required to live as good a life as possible, despite the disease.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23094号 / 医博第4721号 / 新制||医||1050(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 髙橋 良輔, 教授 井上 治久, 教授 伊佐 正 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Background and Purpose: Children diagnosed with Type 1 Diabetes face significant challenges in the day to day management of their disease. Parents play an important role in supporting children at every stage of their lives and helping them transition to independence in the management of T1D. The purpose of this study was to learn from parents who have raised their children with T1D to adulthood and identify strategies for parents who are currently raising a child with T1D. Methods: Using a biographical method, a qualitative design, two in-depth interviews with open-ended prompts were completed with purposively selected parents of children with Type 1 Diabetes (T1D) who have grown into adulthood (18 parents, 36 interviews). The first interview invited participants to share their experience raising a child with T1D. The second interview asked specific questions about challenges, things that went well, things that didn't go well and advice for parents currently raising a child with T1D. Qualitative content analysis was used. Results: Analysis of the data identified recommendations for parents currently raising children with T1D. Advice for the parents included, 1) Parental attitude toward diabetes will be reflected in the child – Keep it positive, 2) Learn as much as you can about diabetes, 3) Find a good diabetes provider – Make your endocrinologist your best friend, 4) Don't make diabetes the definition of the child – treat them as normal, 5) Empower self-management – Teach them along the way then step back and let them take over, 6) Be your child's advocate, 7) Find support – Formal or informal, 8) Listen to your child – Don't judge. Conclusions and Implications: Nurses and nurse practitioners can share strategies identified by parents that were helpful in raising their child with Type 1 Diabetes.

OBJECTIVE: Many youth do not use the hybrid closed-loop system for type 1 diabetes effectively. This study evaluated the impact of financial incentives for diabetes-related tasks on use of the 670G hybrid closed-loop system and on glycemia. METHODS: At auto mode initiation and for 16 weeks thereafter, participants received a flat rate for wearing and calibrating the sensor ($1/day), administering at least 3 mealtime insulin boluses per day ($1/day), and uploading ($5/week). Weekly bonuses were given for maintaining at least 70% of the time in auto mode, which were increased for persistent auto mode use from $3/week to a maximum of $13/week. If a participant failed to maintain auto mode for a week, the rewards were reset to baseline. Data from 17 participants aged 15.9 years ± 2.5 years (baseline hemoglobin A1c [HbA1c] 8.6% ± 1.1%) were collected at 6, 12, and 16 weeks. The reinforcers were withdrawn at 16 weeks, with a follow-up assessment at 24 weeks. RESULTS: With reinforcers, the participants administered an average of at least 3 mealtime insulin boluses per day and wore the sensor over 70% of the time. However, auto mode use waned. HbA1c levels decreased by 0.5% after 6 weeks, and this improvement was maintained at 12 and 16 weeks (P < .05). Upon withdrawal of reinforcers, HbA1c levels increased back to baseline at 24 weeks. CONCLUSION: Compensation for diabetes-related tasks was associated with lower HbA1c levels, consistent administration of mealtime insulin boluses, and sustained sensor use. These results support the potential of financial rewards for improving outcomes in youth with type 1 diabetes.

Bakgrund: Diabetes typ 1 är en autoimmun sjukdom som främst barn och unga drabbas av, behandlingen är livslång eftersom det inte går att bota sjukdomen.  Syfte: Att belysa föräldrars erfarenhet att leva med ett barn med diabetes typ 1. Metod: En kvalitativ litteraturstudie som sammanställer de befintliga kunskaper inom ämnet. Sökningen genomfördes i databaserna Cinahl och PubMed. Resultaten från åtta empiriska och kvalitativa studier granskades, analyserades och sammanställdes. Resultatet analyserades enligt Forsberg &amp; Wengström femstegs analysmetod. Resultat: Resultat sammanställdes i två kategorier: Erfara egna och andras kunskapsbrister, möta förändringar i det dagliga livet. I resultatet visade det sig att barnets diabetes påverkar föräldrarnas dagliga liv på många olika sätt såsom fysiskt, psykiskt och socialt.  Konklusion: Barnets diabetes medför en stor förändring i föräldrarnas liv. Föräldrarna upplever att både de själva och de i barnets omgivning inte har tillräcklig kompetens gällande barnets diabetes och tillhörande diabetesvård. Därmed bör sjuksköterskan förmedla kunskap och utbilda föräldrarna för att de ska kunna hantera barnets diabetesvård på ett bra sätt. Skolpersonal och anhöriga bör erbjudas utbildning för att föräldrarna ska kunna släppa taget när barnet befinner sig i skolan, hos anhöriga eller vänner. / Background: Diabetes type 1 is an autoimmune disease that mainly affects children and young people, the treatment is lifelong because it is not possible to cure the disease. Aim: To illuminate parents' experience of living with a child with type 1 diabetes Methods: A qualitative literature study that compiles the existing knowledge in the subject. The search was performed in the databases Cinahl and PubMed. The results of eight empirical and qualitative studies were reviewed, analyzed and compiled. The result was analyzed according to Forsberg &amp; Wengström five steps analysis method.  Results: The results were compiled into two categories: Experience of their own and others' lack of knowledge, face changes in daily life. The results showed that the child's diabetes affects the parents' daily lives in many different ways, such as physical, mental and social. Conclusion: The child's diabetes causes major changes in the parents' lives. The parents feel that both themselves and those in the child's environment do not have sufficient competence regarding the child's diabetes and associated diabetes care. Thus, nurses should convey knowledge and educate parents so that they can handle the child's diabetes care in a good way. School staff and relatives should be offered education so that the parents feel safe when the child is at school, with relatives or friends.

La dépression majeure représente l’une des affections les plus lourdes dans le monde, touchant plus de 350 millions depersonnes. La 5e édition du Diagnostic and Statistical Manual of Mental Disorders (DSM-V) est la référence mondiale utiliséepour poser le diagnostic de la pathologie chez l’humain. Bien que très nombreux, les antidépresseurs prescrits à ce jour restentencore malheureusement inefficaces pour 30% des patients. Dans ce contexte, il est fondamental de développer de nouvellesstratégies thérapeutiques pour soigner les patients. Des études récentes suggèrent, sans toutefois le démontrer véritablement,l’implication de l’axe « activateur tissulaire du plasminogène / inhibiteur de l’activateur tissulaire du plasminogène de type 1 »(axe tPA/PAI-1) dans la pathogenèse de la dépression majeure.La première partie de mes travaux a été consacrée à la mise au point d’un nouveau système d’évaluation comportementalede la dépression majeure chez la souris en modélisant de manière exhaustive et standardisée les symptômes cliniques du DSMV.La seconde partie de mes travaux a consisté à étudier les mécanismes d’action potentiels de l’axe tPA/PAI-1 dans ladépression majeure. Pour ce faire, j’ai tout d’abord caractérisé le phénotype comportemental de souris déficientes en tPA (souristPA-/-) et en PAI-1 (souris PAI-1-/-), ainsi que de leurs homologues de type sauvage, grâce au système fonctionnel d’évaluationinitialement mis en place. Par ailleurs, du fait de la forte comorbidité entre anxiété et dépression, les comportements de typeanxieux ont également été analysés chez ces animaux. Mes expériences ont révélé un phénotype de type dépressif, indépendantdu tPA, chez les souris déficientes en PAI-1, associé à des diminutions des concentrations de deux monoamines (sérotonine etdopamine) dans des structures cérébrales connues pour être impliquées dans la dépression majeure (hippocampe et noyau du litde la strie terminale). De surcroît, l’enrichissement modéré de l’environnement n’amenuise pas les symptômes de type dépressifdes souris PAI-1-/- mais conduit cependant à la disparition des troubles anxieux dépendants, quant à eux, de l’axe tPA/PAI-1.La troisième partie de ma thèse a été dédiée à des manipulations pharmacologiques visant à tester l’efficacitéd’antidépresseurs de type inhibiteurs de la recapture de la sérotonine. L’escitalopram produit un effet anxiolytique chez les sourisdéficientes en PAI-1, sans toutefois contrebalancer le phénotype dépressif chez ces mêmes sujets. Qui plus est, la fluoxétine, àla même dose que l’escitalopram, est toxique pour ces souris.Les résultats de ma thèse apportent ainsi la première démonstration de l’implication de PAI-1 dans la dépression majeurepar un mécanisme indépendant de son interaction avec le tPA. Ces travaux démontrent également que la souris PAI-1-/- constitueun outil essentiel et innovant pour étudier les mécanismes cellulaires et moléculaires sous-jacents à la dépression majeure, ainsique pour la recherche de cibles thérapeutiques visant à améliorer l’efficacité des traitements. / Major depressive disorder is one of the heaviest mental disorders in the world, affecting more than 350 people worldwide.It is in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-V) that the basis for an internationallyadmitted diagnosis was laid. Albeit diverse, existing antidepressants still remain ineffective for 30% of the patients. Under suchcircumstances, the necessity of developing new therapeutical strategies has arisen. Recent studies tend to suggest, withoutabsolute demonstration, the implication of the axis "Tissue Plasminogen Activator / Plasminogen Activator Inhibitor type-1"(tPA/PAI-1 axis) in the pathogenesis of major depressive disorders.The first section of my works has been devoted to the development of a new system of behavioural assessment in micefor depressive-like disorders, through a comprehensive and standardised modelling of clinical symptoms of DSM-V.The second section of my works has consisted in studying the potential action mechanisms of the tPA/PAI-1 axis in theemergence of depressive-like disorders. To do so, I first had to identify the behavioural phenotype of mice having from a tPA(tPA-/- mice) and PAI-1 (PAI-1-/-mice) deficiency as well as their wild-type counterparts through the system of assessment setup in the beginning of my research. In addition, due to the significant comorbidity between anxiety and depression, anxious-likebehaviours have been analysed as well. Among PAI-1-deficient mice, my experiments have disclosed a depressive-likephenotype, independent of tPA, and correlated with a decrease in the concentration of two monoamines (serotonin and dopamine)in brain structures known to be involved in major depressive disorder (hippocampus and bed nucleus of the stria terminalis).Besides, the moderate enrichment of the environment does not reduce the depressive-like symptoms of PAI-1-/- mice, yet inducesthe dissipation of dependent-tPA/PAI-1 axis anxious disorders.The third section of my PhD has been devoted to pharmacological experiments meant to assess the effectiveness ofantidepressants classified among selective serotonin reuptake inhibitors (SSRIs). Escitalopram produces anxiolytic falloutsamong PAI-1-deficient mice without for all that offsetting the depressive phenotype among these same mice. Moreover,fluoxetine administered in the same concentration as escitalopram has proven to be toxic for these mice.The results of these doctoral experiments have therefore demonstrated for the first time the implication of PAI-1 in theprocess of major depressive disorder through a mechanism independent from its interaction with tPA. These works have alsodemonstrated that PAI-1-/- mice make up a fundamental and cutting edge tool to study the cellular and molecular mechanismsunderlying major depressive disorder as well as to develop competent therapeutical targets intended to improve the efficiency oftreatments.

Background: When a child suffers from chronic illness, it affects the whole family. Type 1 diabetes in children is becoming more common and over 900 children in Sweden per year suffer from the disease. Self-care becomes a fact and parents have the greatest responsibility for nursing. There will be major changes in life and previous routines changed to new ones. The nurse has an important responsibility in supporting and guiding the parents in an individualized and appropriate manner. Aim: The purpose of this literature study was to elucidate parents' experience of living with a child with type 1 diabetes. Method: The method used was a literature-based study based on qualitative studies. Nine qualitative articles were analyzed according to Friberg's five-step model. Results: The result is presented in two themes as; When life changes and New challenges. When life changed, three sub-themes meant describing the parents' experience of the changed life situation. New challenges with three subthemes focus on the parents 'experience of balancing the parent's perspective with the carers' perspective. Conclusion: Understanding the parents 'experience of living with a child with type 1 diabetes can help the nurse meet the parents' nursing needs by taking the responsibility of nursing and using their core competencies.

Welche Schrift für welchen Zweck? Lohnt es sich, Fonts zu kaufen? Was sollte man beim Einsatz neuer Schriften beachten? Wie unterscheidet man überhaupt Fonts?