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  • Ehnfors, Margareta, et al. (författare)
  • Kvalitetsindikatorer för prevention av undernäring
  • 2007
  • Ingår i: Kvalitetsindikatorer inom omvårdnad. - Stockholm : Gothia. - 9789172055193 - 978-91-7205-519-3 ; s. 155-165
  • Bokkapitel (populärvet., debatt m.m.)abstract
    • En självklar del i sjuksköterskans ansvar är att ständigt utveckla omvårdnadsarbetet i syfte att förbättra vården för patienter och vårdtagare. Med hjälp av en indikator, eller ett kvalitetsmått, kan vårdens resultat och genomförande följas och mätas. I boken presenteras förslag på kvalitetsindikatorer inom olika omvårdnasområden. Syftet är att ge verktyg för registrering, utvärdering och förbättring av omvårdnadskvaliteten. Förhoppningen är att boken ska motivera sjuksköterskor att använda kvalitetsindikatorer så att omvårdnaden kan beskrivas och utvärderas. Denna femte upplaga är utökad med en kvalitetsindikator för fall och fallskadeprevention.
  • Latorre-Margalef, Neus, et al. (författare)
  • Effects of influenza A virus infection on migrating mallard ducks
  • 2009
  • Ingår i: Proceedings of the Royal Society of London. Biological Sciences. - 0962-8452. ; 276:1659, s. 1029-1036
  • Tidskriftsartikel (refereegranskat)abstract
    • The natural reservoir of influenza A virus is waterfowl, particularly dabbling ducks (genus Anas). Although it has long been assumed that waterfowl are asymptomatic carriers of the virus, a recent study found that low-pathogenic avian influenza (LPAI) infection in Bewick's swans (Cygnus columbianus bewickii) negatively affected stopover time, body mass and feeding behaviour. In the present study, we investigated whether LPAI infection incurred ecological or physiological costs to migratory mallards (Anas platyrhynchos) in terms of body mass loss and staging time, and whether such costs could influence the likelihood for long-distance dispersal of the avian influenza virus by individual ducks. During the autumn migrations of 2002-2007, we collected faecal samples (n = 10 918) and biometric data from mallards captured and banded at Ottenby, a major staging site in a flyway connecting breeding and wintering areas of European waterfowl. Body mass was significantly lower in infected ducks than in uninfected ducks (mean difference almost 20 g over all groups), and the amount of virus shed by infected juveniles was negatively correlated with body mass. There was no general effect of infection on staging time, except for juveniles in September, in which birds that shed fewer viruses stayed shorter than birds that shed more viruses. LPAI infection did not affect speed or distance of subsequent migration. The data from recaptured individuals showed that the maximum duration of infection was on average 8.3 days (s.e. 0.5), with a mean minimum duration of virus shedding of only 3.1 days (s.e. 0.1). Shedding time decreased during the season, suggesting that mallards acquire transient immunity for LPAI infection. In conclusion, deteriorated body mass following infection was detected, but it remains to be seen whether this has more long-term fitness effects. The short virus shedding time suggests that individual mallards are less likely to spread the virus at continental or intercontinental scales.
  • Wallensten, Anders, et al. (författare)
  • Surveillance of influenza A virus in migratory waterfowl in northern Europe
  • 2007
  • Ingår i: Emerging Infectious Diseases. - 1080-6040. - 1080-6040 ; 13:3, s. 404-411
  • Tidskriftsartikel (refereegranskat)abstract
    • We conducted large-scale, systematic sampling of influenza type A virus in migratory waterfowl (mostly mallards [Anas platyrhynchos]) at Ottenby Bird Observatory, southeast Sweden. As with previous studies, we found a higher prevalence in fall than spring, and among juveniles compared with adults. However, in contrast to other studies, we found that prevalence in spring was sometimes high (mean 4.0%, highest 9.5%). This finding raises the possibility that ducks are capable of perpetuating influenza A virus of different subtypes and subtype combinations throughout the year and from 1 year to the next. Isolation of the H5 and H7 subtypes was common, which suggests risk for transmission to sensitive domestic animals such as poultry. We argue that wild bird screening can function as a sentinel system, and we give an example of how it could have been used to forecast a remote and deadly outbreak of influenza A in poultry.
  • Carlsson, Noomi, et al. (författare)
  • How to minimize children's environmental tobacco smoke exposure
  • 2013
  • Ingår i: BMC Pediatrics. - 1471-2431. - 1471-2431 (Electronic) 1471-2431 (Linking) ; 13:76
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Despite the low prevalence of daily smokers in Sweden, children are still being exposed to environmental tobacco smoke (ETS), primarily by their smoking parents. A prospective intervention study using methods from Quality Improvement was performed in Child Health Care (CHC). The aim was to provide nurses with new methods for motivating and supporting parents in their efforts to protect children from ETS exposure. METHOD: Collaborative learning was used to implement and test an intervention bundle. Twenty-two CHC nurses recruited 86 families with small children which had at least one smoking parent. Using a bundle of interventions, nurses met and had dialogues with the parents over a one-year period. A detailed questionnaire on cigarette consumption and smoking policies in the home was answered by the parents at the beginning and at the end of the intervention, when children also took urine tests to determine cotinine levels. RESULTS: Seventy-two families completed the study. Ten parents (11%) quit smoking. Thirty-two families (44%) decreased their cigarette consumption. Forty-five families (63%) were outdoor smokers at follow up. The proportion of children with urinary cotinine values of >6 ng/ml had decreased. CONCLUSION: The intensified tobacco prevention in CHC improved smoking parents' ability to protect their children from ETS exposure.
  • Gunnarsson, Gunnar, et al. (författare)
  • Zero prevalence of influenza A virus in two raptor species by standard screening
  • 2010
  • Ingår i: Vector Borne and Zoonotic Diseases. - 1530-3667. ; 10:4, s. 387-390
  • Tidskriftsartikel (refereegranskat)abstract
    • Disease can have severe impact on animal populations, especially in rare species. Baseline data for atypical host species are missing for a range of infectious diseases, although such hosts are potentially more affected than the normal vectors and reservoir species. If highly pathogenic avian influenza strikes rare birds of prey, this may have crucial impact on the predator species itself, but also on the food web in which it interacts. Here we present the first large-scale screening of raptors that regularly consume birds belonging to the natural reservoir of influenza A viruses. Influenza A virus prevalence was studied in two rare raptors, the white-tailed sea eagle (Haliaeetus albicilla) and the peregrine falcon (Falco peregrinus). Nestlings were screened for active (181 white-tailed sea eagles and 168 peregrine falcons) and past (123 white-tailed sea eagles and 6 peregrine falcons) infection in 2006-2007, and an additional 20 succumbed adult white-tailed sea eagles were sampled in 2003-2006. Neither high- nor low-pathogenic influenza infections were found in our sample, but this does not rule out that the former may have major impact on rare raptors and their food webs.
  • Hedov, Gerth, et al. (författare)
  • First information and support provided to parents of children with Down syndrome : clinical goals and parental experiences
  • 2002
  • Ingår i: Acta Paediatrica. - 0803-5253. ; 91:2, s. 1344-1349
  • Tidskriftsartikel (refereegranskat)abstract
    • When parents are informed that their newborn child has Down syndrome (DS), they often respond with a traumatic crisis reaction. The aims of this study were to assess the clinical goals regarding the first information and support provided to parents of newborn children with DS at the Swedish paediatric departments, and to analyse the parents' experiences of how they were first informed and treated. Data were collected during 1992-1993 from all of the 51 departments of paediatrics in Sweden. Information on the parents' experiences, collected retrospectively in 1996, was based on recollection by 165 parents of 86 children with DS born between 1989 and 1993 at 10 of the paediatric departments considered representative for Sweden. Seventy-five percent of the families were informed about the diagnosis within 24 h post partum. Some parents felt they were informed too late, and a few parents that they were told too soon. Half of the parents were satisfied with the timing. About 70% of the parents considered the information insufficient and 60% felt that they had been unsupported. Seventy percent would have liked more frequent information. Parental criticisms concerning the way in which the information was provided were that they received too much negative information about DS and that both the communication skills and the basic knowledge of DS on the part of the professionals could have been better. CONCLUSION: The Swedish paediatric departments fall short of their reported strong clinical goals regarding the initial information in Sweden, and improvements in this area are desirable.
  • Hedov, G, et al. (författare)
  • Self-perceived health in Swedish parents of children with Down's syndrome
  • 2000
  • Ingår i: Quality of Life Research. - 0962-9343. ; 9:4, s. 415-422
  • Tidskriftsartikel (refereegranskat)abstract
    • In this comparative study, self-perceived health was investigated in 165 parents of 86 children with Down's syndrome (DS), using the Swedish version of the SF-36 questionnaire. Questionnaires were mailed to parents of children with DS in a defined Swedish population. The results were compared with those in a randomised control group of parents from the Swedish SF-36 norm population. Mothers and fathers replied separately. Student's t-test with the Bonferroni correction was used for multiple statistical comparisons. The mothers of children with DS ('DS mothers') had significantly lower, less favourable scores than did the fathers of DS children ('DS fathers') in the Vitality (p < 0.0005) domain. Further, DS mothers spent significantly more time in caring for their child with DS than did the DS fathers (p < 0.0001). DS mothers also had lower scores than the mothers of the control group in the Vitality (p < 0.001) and Mental Health (p < 0.001) domains. DS fathers and control fathers differed significantly in the Mental Health domain (p < 0.002), but not otherwise. In conclusion, DS mothers showed poorer health than their spouses and the control mothers. No differences similar to those found between the DS mothers and DS fathers were observed between control mothers and control fathers.
  • Järhult, Josef D., et al. (författare)
  • Environmental levels of the antiviral oseltamivir induce development of resistance mutation H274Y in influenza A/H1N1 virus in mallards.
  • 2011
  • Ingår i: PLoS ONE. - 1932-6203. ; 6:9, s. e24742
  • Tidskriftsartikel (refereegranskat)abstract
    • Oseltamivir (Tamiflu®) is the most widely used drug against influenza infections and is extensively stockpiled worldwide as part of pandemic preparedness plans. However, resistance is a growing problem and in 2008-2009, seasonal human influenza A/H1N1 virus strains in most parts of the world carried the mutation H274Y in the neuraminidase gene which causes resistance to the drug. The active metabolite of oseltamivir, oseltamivir carboxylate (OC), is poorly degraded in sewage treatment plants and surface water and has been detected in aquatic environments where the natural influenza reservoir, dabbling ducks, can be exposed to the substance. To assess if resistance can develop under these circumstances, we infected mallards with influenza A/H1N1 virus and exposed the birds to 80 ng/L, 1 µg/L and 80 µg/L of OC through their sole water source. By sequencing the neuraminidase gene from fecal samples, we found that H274Y occurred at 1 µg/L of OC and rapidly dominated the viral population at 80 µg/L. IC₅₀ for OC was increased from 2-4 nM in wild-type viruses to 400-700 nM in H274Y mutants as measured by a neuraminidase inhibition assay. This is consistent with the decrease in sensitivity to OC that has been noted among human clinical isolates carrying H274Y. Environmental OC levels have been measured to 58-293 ng/L during seasonal outbreaks and are expected to reach µg/L-levels during pandemics. Thus, resistance could be induced in influenza viruses circulating among wild ducks. As influenza viruses can cross species barriers, oseltamivir resistance could spread to human-adapted strains with pandemic potential disabling oseltamivir, a cornerstone in pandemic preparedness planning. We propose surveillance in wild birds as a measure to understand the resistance situation in nature and to monitor it over time. Strategies to lower environmental levels of OC include improved sewage treatment and, more importantly, a prudent use of antivirals.
  • Wallensten, Anders, et al. (författare)
  • Multiple gene segment reassortment between Eurasian and American lineages of influenza A virus (H6N2) in Guillemot (Uria aalge).
  • 2005
  • Ingår i: Archives of Virology. - 0304-8608. - 0304-8608 ; 150:8, s. 1685-92
  • Tidskriftsartikel (refereegranskat)abstract
    • Guillemots banded in the northern Baltic Sea were screened for influenza A virus (IAV). Three out of 26 sampled birds tested positive by RT-PCR. Two of these were characterized as subtype H6N2. Phylogenetic analyses showed that five gene segments belonged to the American avian lineage of IAVs, whereas three gene segments belonged to the Eurasian lineage. Our findings indicate that avian IAVs may have a taxonomically wider reservoir spectrum than previously known and we present the first report of a chimeric avian IAV with genes of American and Eurasian origin in Europe.
  • Årestedt, Kristofer, et al. (författare)
  • Social support and its association with health-related quality of life among older patients with chronic heart failure
  • 2013
  • Ingår i: European Journal of Cardiovascular Nursing. - Elsevier / SAGE Publications (UK and US). - 1474-5151. ; 12:1, s. 69-77
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Social support is generally known to influence health-related quality of life (HRQoL), but this association is not well explored among older patients with chronic heart failure. less thanbrgreater than less thanbrgreater thanAims: (1) To describe social support in older patients with chronic heart failure in relation to gender. (2) To investigate if age, gender, cohabitation, perceived financial situation, and disease severity are associated with social support. (3) To investigate if social support is associated with HRQoL after controlling for age, gender, and disease severity. less thanbrgreater than less thanbrgreater thanMethods: Data were collected in a sample of 349 patients (andgt;= 65 years) with chronic heart failure. Patients HRQoL was measured with the Minnesota Living with Heart Failure Questionnaire and the Short Form-12 Health Survey Questionnaire. The Interview Schedule for Social Interaction measured social support. Data were analysed with descriptive statistics, repeated-measure ANOVA, and multiple linear regression analyses with robust standard errors. less thanbrgreater than less thanbrgreater thanResults: Social support was generally rated high, although being a man, living alone, perceiving a problematic financial situation, and high disease severity (NYHA) were associated with lower levels of social support. Age was not associated with social support. Social support was generally associated with HRQoL, in particular the emotional dimensions. less thanbrgreater than less thanbrgreater thanConclusion: Taking social support into account when caring for older patients with heart failure can be of importance for improving or maintaining HRQoL.
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