To deliver quality care, social and healthcare professionals should be competent both in their own professional work and interprofessionally. The aim of this integrative review was to describe ...interprofessional teamwork and the required competencies for teamwork in specialized palliative care. Totally 14 studies published between 2003 and 2020 were included in the review. Interprofessional teamwork was described from the patients and professionals’ perspective. The required interprofessional competencies were described as teamwork knowledge, skills, attitudes, and values. Interprofessional teamwork is one of the essential factors in providing holistic and ethically sustainable care to palliative patients. The way how professionals confront death and dying effects the whole team; this suggests that support practices are important in palliative care settings. Ascertaining the interprofessional competence in palliative care will produce better collaborative practices and increase the care outcomes. The findings can be used as a framework when developing interventions to promote clinical and educational practices.
To strengthen palliative care for children in the Nordic countries, an updated status of current needs, resources, clinical services, education, and research is necessary to align and consolidate ...future research. A Nordic research collaboration initiative for children with palliative care needs was assembled in 2023. Building on this initiative, this paper presents an overview of pediatric palliative care (PPC) in the Nordic countries' (a) population characteristics, (b) care models and setting of care, (c) education and training, and (d) research.
The Nordic initiative researchers collaboratively gathered and assessed available data on the characteristics of PPC within Denmark, Finland, Greenland, Iceland, Norway, the Faroe Islands, Sweden, and Åland. Data were compiled in a matrix with population characteristics, models- and setting of care, education and training, and areas of research in a Nordic context. The findings are narratively and descriptively presented, providing an overview of Nordic PPC.
In total, the Nordic child population comprises around six million children (0-19 years), of which about 41.200 are estimated to be living with a life-limiting and/or life-threatening condition. Healthcare services are provided through various care models, ranging from specialized care to homecare settings. Overall, there remain few opportunities for education and training with some exceptions. Also, Nordic research within PPC has been shown to be a growing field although much remains to be done.
This overview is the first outline of the current PPC in Nordic countries. Although some differences remain important to acknowledge, overall, the strengths and challenges faced within PPC in the Nordic countries are comparable and call for joint action to increase evidence, services, and education to better serve the children, families, and healthcare personnel within PPC. Despite the varying structural premises for PPC, research endeavors aiming to provide evidence in this field seem increasing, timely and relevant for the Nordic countries, as well as the international context.
Aim
To explore nurses' perceptions to alleviate dyspnoea in inpatients with advanced cancer while receiving palliative care.
Design
A descriptive qualitative design.
Methods
Seven focus groups were ...conducted with nurses (n = 27) from five specialized palliative care wards in four hospitals in south and southwest Finland. The focus groups were conducted between June and November 2019, and the transcripts were analysed using inductive analysis.
Results
The findings revealed three categories: recognizing dyspnoea is a multi‐faceted problem, dealing with the complexity of assessment of dyspnoea and strategies for relieving dyspnoea. Nurses perceived the complexity of dyspnoea as a symptom and emphasized the importance of utilizing patients' subjective experiences and consistent assessment scales to determine its severity. Furthermore, nonpharmacological interventions are as pertinent as pharmacological and medical interventions. The findings can assist nurses in selecting appropriate interventions for dyspnoea care, ultimately enhancing the quality of patient care and patient safety.
Dyspnoea, a commonly reported symptom among patients with cancer, necessitates the need for appropriate non-pharmacological interventions for its management and suitable assessment scales.
To explore ...the nursing interventions and assessment scales for managing dyspnoea in patients with cancer receiving palliative care.
Systematic review. Five databases (CINAHL Complete, PubMed, Web of Science, Scopus and the Cochrane Central Register of Controlled Trials) were searched, and seven studies were identified. Only studies that comprised randomised controlled trials (RCTs), non-randomised controlled trials or quasi-experimental settings were included.
Nursing interventions, that support a patient's physical breathing and mental functioning, are effective in managing dyspnoea. It is crucial to use both subjective and physical assessment methods to accurately measure the outcomes of these interventions.
These interventions have been proven to be effective, with outcomes centred on changes in physiological measurements and patients' subjective expressions.
The aim of the paper is to present a structure for nursing education simulation that incorporates elements of blended and online simulation in a socially constructivist, culturally sensitive ...environment. To develop the structure for nursing education, a descriptive literature review was conducted in spring 2022 on simulations implemented in mental health nursing education. Nurses require the skills and knowledge to provide mental health care in every area of health care. According to the descriptive literature review, simulation-based learning such as high-fidelity mental health simulation resulted in increased confidence, knowledge gains and improved communication skills. Simulation is a wide concept and allows nurse lecturers to implement the pedagogy as they see it best. The Simulation structure helps especially beginners to follow the simulation as a process. The structure eases the planning phase as well as the debriefing part of the simulation. As it has been shown in the analysis of the literature simulation can be effectively implemented in a blended and / or online environment. It is expected that in the future, simulation games and virtual, online simulations will be more typical ways to conduct a simulation.
Eutrophication, a surplus of nutrients, is a problem in aquatic environments and one of the Swedish Environmental Goals is that there should be no eutrophication caused by human activities. ...Constructed wetlands (CW:s) is a measure that could be implemented to decrease the transport of nutrients to water bodies through retention. To optimize the placement of CW:s, this project aims to understand how different factors affect the retention of P (phosphorus) and N(nitrogen) in constructed CW:s and if there are geographical and seasonal variations in retention. Water samples were collected during three sampling periods from CW:s in Halland, in south-western and Mälardalen in eastern Sweden. The variation in retention of P and N between Halland and Mälardalen and between the different sampling occasions was then investigated. The effect of different factors in the catchment area such as percentage of clay, silt and sand, agricultural land, P-AL (phosphorus extracted with ammonium lactate) in the soil, erosion riskclass and the depth of the CW:s on the retention of P and N was also tested. The TP (total phosphorus) load and retention differed between the CW:s in Halland and Mälardalen. In Mälardalen, the load was slightly higher, and had a higher variation in TP load, which can be related to the differences in erosion risk classes as more easily eroded soils usually release P during periods with a lot of runoff. TP retention deviated more from zero in Mälardalen compared with Halland. The retention of TN (total nitrogen) seemed to be higher during August despite the lower TN load. This could be because during the warmer season, there is more retention of inorganic N through denitrification and plant uptake. Many factors such as soil type, erosion risk class, share of agricultural land and hydraulic load (HL) was found to be positively correlated with the load. However, most of the examined factors in the catchment area showed no correlation with the retention of N or P. The percentage of clay in the area had a negative effect on the retention of TP, which is not coherent with previous studies. This could be because the TP retention was mostly zero or negative, which was thought to be because most of the sampling was during periods with high HL and colder weather, especially in Mälardalen, which may have resulted in poor retention and resuspension of nutrients from the sediments. For TN the only factor which had a correlation was the depth of the CW, which had a negative correlation.
Övergödning, överskott av näringsämnen, är ett problem i vattenmiljöer. Ett av de svenska miljömålen är att det inte ska ske någon övergödning orsakad av människan. Anläggning av våtmarker är en åtgärd som kan vidtas för att minska transporten av näringsämnen till vattendrag genom retention. Anlagda våtmarkers effektivitet beror på olika faktorer såsom jordtyp, markanvändning, utformning och årstid. För att optimera placeringen av anlagda våtmarker, syftar detta projekt till att förstå hur de olika faktorerna påverkar retentionen av fosfor (P) och kväve (N) i anlagda våtmarker och om det finns geografiska och säsongsmässiga variationer i retention. Vattenprover togs vid tre provtagningstillfällen från anlagda våtmarker i Halland, i sydvästra Sverige och Mälardalen i östra Sverige. Variationen i retentionen av P och N mellan Halland och Mälardalen och mellan de olika provtagningstillfällena undersöktes därefter. Effekten på retentionen av olika faktorer i avrinningsområdet såsom andel lera, silt och sand, jordbruksmark, P-AL (fosfor extraherat från jord med ammoniumlaktat) i marken, erosionsriskklass och medeldjupet av de anlagda våtmarkerna på retentionen av P och N undersöktes också.Belastningen och retentionen av TP (totalfosfor) skiljde sig mellan de anlagda våtmarkerna i Mälardalen och Halland. I Mälardalen var belastningen något högre, samt hade högre variation i TP-belastning, vilket kan relateras till skillnaderna i erosionsriskklasser då mer lätteroderade jordarter oftast släpper P under perioder med mycket avrinning. TP retentionen avvek mer från noll i Mälardalen jämfört med Halland. Retentionen av TN (totalkväve) var förhållandevis hög under augusti trots den förhållandevis lägre TN-belastningen jämfört med höst-och vinterprovtagningarna. Detta kan bero på att det under den varmare årstiden skermer retention av oorganiskt kväve genom denitrifikation och växtupptag.Många faktorer såsom jordart, erosionsriskklass, andel jordbruksmark och hydraulisk belastning (HL) var positivt korrelerade med näringsbelastningen. Däremot visade de flesta av de undersökta faktorerna i avrinningsområdet inget samband med retentionen av N eller P. Andelen lera i området hade en negativ effekt på retentionen av TP, vilket inte stämmer överens med tidigare studier. Detta kan bero på att TP-retentionen mestadels var noll eller negativ, vilket ansågs bero på att det mesta av provtagningen skedde under perioder med hög HL, vilket kan ha resulterat i dålig retention och resuspension av P från sediment. Den enda faktorn som var relaterad med TN retentionen var djupet i de anlagda våtmarkerna, som minskade med våtmarkens djup.
Detta projekt genomfördes på uppdrag av Forskningsrådet för miljö, areella näringar och samhällsbyggande, Formas, som en mindre del av en större forskningssammanställning om de hydrologiska ...effekterna av anlagda och restaurerade våtmarker. Syftet med studien var i första hand att se om det gick att karaktärisera svenska våtmarker anlagda eller restaurerade för hydrologiska syften utifrån fem utvalda faktorer; jordart, marktäcke, topografiskt läge i avrinningsområdet, placering i förhållande till tätort och typ av åtgärd. Studien tittade också på om det fanns data för att undersöka våtmarkers effekt på hydrologin, och i sådana fall om några effekter kunde ses. I ett tidigt skede av projektet skapades en databas i vilken det samlades information om våtmarker anlagda, restaurerade eller planerade för hydrologiska syften. Informationen erhölls från länsstyrelser, kommuner och Naturvårdsverket. Den slutgiltiga databasen innehöll totalt 51 våtmarker med fakta såsom koordinater, areor, anläggningsår och beskrivning av åtgärder. Denna databas tillsammans med kartlager från SGU, Lantmäteriet och SMHI var grunden för de faktoranalyser som gjordes i ArcMap. Resultaten från karaktäriseringen visade att våtmarkerna till stor del var lokaliserade vid underliggande jordarter såsom lera-silt, morän och torv. Vidare förekom våtmarkerna vanligen på områden av åkermark, men även i ganska stor utsträckning på andra marktäcken, såsom skog eller öppen mark. Från analysen av läge i avrinningsområdet konstaterades det att våtmarkerna generellt sett topografiskt låg i lägre terräng i delavrinningsområdet. Våtmarkernas placering i förhållande till tätorter visade på att över hälften av våtmarkerna som analyserades låg inom 2 km från närmaste tätort. I de fall det gick att undersöka förhållandet noggrannare visade det sig att de flesta våtmarkerna låg uppströms tätorten i fråga. För den hydrologiska analysen hittades data för att kunna analysera våtmarkers effekter på vattenflöden och grundvattennivåer i ett fåtal delavrinningsområden. Två anlagda våtmarker med respektive delavrinningsområde ansågs lämpliga för att studera effekten på vattenflöden och tre områden med våtmarker ansågs lämpliga för att undersöka grundvattennivåer. Vad gäller vattenföringen sågs ingen tydlig effekt på flödena som skulle kunna ha orsakats av de anlagda våtmarkerna. Resultatet för grundvattennivåer visade en sänkning av nivåerna sedan våtmarkerna anlades, men en något mindre sänkning i områdena med våtmarker jämfört med referensområdena utan våtmark. Mycket osäkerhet råder dock kring om den mindre sänkningen faktiskt hade med våtmarkerna att göra.
Apolipoprotein E ε4 allele (APOE4) has been shown to associate with increased susceptibility to SARS-CoV-2 infection and COVID-19 mortality in some previous genetic studies, but information on the ...role of APOE4 on the underlying pathology and parallel clinical manifestations is scarce. Here we studied the genetic association between APOE and COVID-19 in Finnish biobank, autopsy and prospective clinical cohort datasets. In line with previous work, our data on 2611 cases showed that APOE4 carriership associates with severe COVID-19 in intensive care patients compared with non-infected population controls after matching for age, sex and cardiovascular disease status. Histopathological examination of brain autopsy material of 21 COVID-19 cases provided evidence that perivascular microhaemorrhages are more prevalent in APOE4 carriers. Finally, our analysis of post-COVID fatigue in a prospective clinical cohort of 156 subjects revealed that APOE4 carriership independently associates with higher mental fatigue compared to non-carriers at six months after initial illness. In conclusion, the present data on Finns suggests that APOE4 is a risk factor for severe COVID-19 and post-COVID mental fatigue and provides the first indication that some of this effect could be mediated via increased cerebrovascular damage. Further studies in larger cohorts and animal models are warranted.
Tremendous efforts are applied in the ferroalloy industry to control and reduce exposure to dust generated during the production process, as inhalable Mn-containing particulate matter has been linked ...to neurodegenerative diseases. This study aimed to investigate the toxicity and biological effects of dust particles from laboratory-scale processes where molten silicomanganese (SiMn) was exposed to air, using a human astrocytoma cell line, 1321N1, as model system. Characterization of the dust indicated presence of both nano-sized and larger particles averaging between 100 and 300 nm. The dust consisted mainly of Si, Mn and O. Investigation of cellular mechanisms showed a dose- and time-dependent effect on cell viability, with only minor changes in the expression of proteins involved in apoptosis. Moreover, gene expression of the neurotoxic biomarker
(
) increased, whereas APP protein expression decreased. Finally, induction of gap junctional intercellular communication (GJIC) increased with higher doses and correlated with the other endpoints. Thus, the effects of SiMn dust on 1321N1 cells are highly dependent on the dose of exposure and involves changes in APP, apoptosis-related proteins and intercellular communication.
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