| 1. |
- Sundin, Josefin, et al.
(author)
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Stress hos europeisk ål under sumpning och transport : effekter av fångst and transport
- 2023
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Reports (other academic/artistic)abstract
- Fångst och transport, så kallad ’trap and transport’, används för att transportera fisk förbi hinder som blockerar dess vandringsväg. Metoden kan användas för att transportera fisk både uppströms och nedströms vandringshinder. Fångst och transport används ofta för att bevara fiskpopulationer och ekosystemfunktioner, men kan också användas för att förbättra möjligheterna till fiske i områden uppströms vandringshinder. Den europeiska ålen, Anguilla anguilla, är en art där fångst och transport används som en bevarandeåtgärd. Ålen har minskat kraftigt och är rödlistad som akut hotad av den internationella naturvårdsunionen (IUCN). Genom att samla in vuxen ål, så kallad blankål, i sjöar och andra vattendrag, transportera dem nedströms vattenkraftverk och dammar, och släppa ut dem i havet eller nedströms vandringshinder, är förhoppningen att öka mängden blankål som kan fullborda sin vandring till Sargassohavet där de reproducerar sig. Om metoden verkligen fungerar är i dagsläget okänt eftersom vi inte lyckats följa någon ål på hela dess vandring från Europas kuster till Sargassohavet. Det är däremot känt att passager genom turbiner medför dödlighet för den blankål som vandrar nedströms, varför det kan antas att fångst och transport åtminstone initialt minskar dödligheten. Under fångst och transport hanteras ålen i flera steg då de först fångas in med ett fångstredskap, därefter sumpas de en tid (i vissa fall sker transporten direkt efter insamling), för att sedan flyttas till en transporttank på en bil för att köras till platsen där de släpps ut. Dessa hanteringsmoment innebär en påverkan på ålen som kan leda till direkt dödlighet. Hanteringen kan även öka stress och orsaka skador på ålen, vilket i sin tur kan leda till förhöjd dödlighet senare, vilket har en negativ påverkan på ålens möjlighet att nå Sargassohavet och reproducera sig.I det här projektet har vi undersökt stressnivåer hos ål genom alla steg som ingår i fångst och transport inom ramen för den kompensatoriska åtgärd som finansieras av program Krafttag ål. Genom att kirurgiskt implantera elektroniska loggrar, så kallade biologgers, kunde vi mäta ålarnas hjärtrytm, vilket sedan användes som en indikator för att tolka stressnivå. Detta gjordes på två lokaler där fångst och transport normalt sett utförs, där metoden (utöver implantering av biologgers) efterliknade normal hantering under fångst och transport av ål. Försöken utfördes under vår, sommar och höst år 2023. För att samla in data över kontrollvärden, eller basnivåvärden, på ålens hjärtrytm under relativt ostörda förhållanden förvarades ål med biologgers i en miljö som var gjord för att minska stress så mycket som möjligt. Resultaten visade att överlevanden var hög under fångst och transport då ingen ål dog under hanteringsmomenten. Ålens respons på hantering under fångst och transport var tydligt påverkad av vattentemperatur, ålarnas hjärtfrekvens var generellt högre och ökade mer under hantering vid höga vattentemperaturer. Under tiden som ålen förvarades i sump var stressnivåerna relativt låga, för att sedan öka igen då de hanterades under transporten. Stressnivåerna var höga under hela transporttiden.Vår slutsats är att stressnivåerna under fångst och transport inte var så höga att de orsakade någon dödlighet vid de vattentemperaturer som uppmättes under märkningsförsöken (8–18° C). Vid höga vattentemperaturer var hjärtfrekvensen generellt högre, framför allt under transport. Om fångst och transport sker vid vattentemperaturer under 18–19° C så kan denna åtgärd öka möjligheterna för blankål att vandra mot Sargassohavet. Eftersom ålen utsätts för stress och hantering, samt att metoden kräver mänsklig inverkan, så bör det slutgiltiga målet vara att skapa fria vandringsvägar runt vandringshinder.
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| 2. |
- Axelsson, Lena, et al.
(author)
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End of life of patients treated with haemodialysis as narrated by their close relatives
- 2015
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In: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 29:4, s. 776-784
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Journal article (peer-reviewed)abstract
- AIM: The study aimed to describe end of life for patients treated with maintenance haemodialysis as narrated by their close relatives.INTRODUCTION: Many patients undergoing haemodialysis are older, have several comorbidities and underestimated symptoms and are in their last year of life. To improve care, we need to know more about their end-of-life situation.DESIGN: Qualitative and descriptive.METHODS: Qualitative retrospective interviews were conducted with 14 close relatives of deceased haemodialysis patients (3-13 months after death). Data were analysed using qualitative content analysis. The study is ethically approved.FINDINGS: In the last months, a gradual deterioration in health with acute episodes necessitating hospital admissions was described. This involved diminishing living space and expressions of dejection, but also of joy. Three patterns emerged in the last weeks: uncertain anticipation of death as life fades away; awaiting death after haemodialysis withdrawal; and sudden but not unexpected death following intensive care. Findings show complexities of decisions on haemodialysis withdrawal.CONCLUSIONS: Different end-of-life patterns all involved increasingly complex care needs and existential issues. Findings show a need for earlier care planning. The identification of organisational factors to facilitate continuity and whole person care to meet these patients' specific care needs with their complex symptom burdens and comorbidities is needed. Findings indicate the need for integration of a palliative care approach in the treatment of patients in haemodialysis care.
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| 3. |
- Axelsson, Lena
(author)
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Living with haemodialysis close to death - patients' and close relatives' experiences
- 2013
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Doctoral thesis (other academic/artistic)abstract
- The overall aim of this thesis is to generate understanding and knowledge a bout the experiences of patients living with haemodialysis, and their close relati ves, near the end of life. In studies I and II we conducted a series of 31 qualitative interviews over a period of 12 months with 8 severely ill patients (aged 66–87) treated with haemodialysis. For study I the text of the interviews was analysed using phenomenological hermeneutics to describe and to el ucidate the meanings of being severely ill living with haemodialysis when nearing end of life. For study II the text was analysed using qualitative content analysis to describe inner thoughts and feelings relating to death and dying of these patients. For studies III and IV, we conducted 14 retrospective qualitative interviews with close relatives of deceased patients treated with haemodialysis about th eir experiences during end of the patient’s life. For paper III the interview text was analysed usi ng phenomenological hermeneu tics to describe and elucidate the meanings of being a close relative at the end of life of a severely ill family member treated with maintenance haemodialysis. For paper IV the text was analysed using qualitative content analysis to describe end of life for the patients from the perspective of their close relatives. The findings of study I suggest that being severely i ll and living with haemodialysis near the end of life means living with suffering from a deteriorating body, a high symptom burden, and dependence on advanced medical technology, simultaneously with r econciliation and well-being. The meanings of living with illness and dialysis are intertwined with the meanings of being old. Study II shows that thoughts and feelings about deat h and dying are significant and complex for those living with haemodialysis as they approach the end of life. Patients experience a multifaceted presence of death. Their awareness of approaching death may include their repressing of thoughts of death, not as denial, but to allow them to focus on living as fully as possible the time they have left. Study III shows that close relatives strive to maintain balance and well-being for themselves and for the patient, which we interpreted as their striving to regain balance, and inner equilibrium in their changed and challenged rhythm of life. Study IV shows that after gradual deterioration and increasing care needs, older patients in haemodialysis care with co-morbidities follow three different main paths at the end of life: uncertain anticipation of death; awaiting death after dialysis withdrawal; and sudden but not unexpected death. The ends of their lives are marked by complex symptoms and existential issues related to haemodialysis treatment and withdrawal, and their uncertainty of what to expect at the end of life suggests the need for increased continuity and coordination of whole person care. Both patients and their close relatives are often alone with their existential thoughts. In their complex lifeworlds, intertwined meanings of living with illness and maintenance of life with haemodialysis treatment near the end of life show that patients live in a borderland of living-dying that is shared by the close relative. Patients and close relatives focus on living when death is close but uncertain, with severe illness and the maintenance of life through advanced technology. Integrating the philosophy of palliative care (with a focus on symptom relief, team work, communication, relationships, and support of family members) into dialysis care, may support health care professionals in haemodialysis units and other re nal contexts, to improve the care of severely ill patients, both earlier in their illness and as they approach the end of their lives.
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| 4. |
- Axelsson, Lena, et al.
(author)
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Living with haemodialysis when nearing end of life
- 2012
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In: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 26:1, s. 45-52
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Journal article (peer-reviewed)abstract
- AIMS AND OBJECTIVES: The aim of this study was to describe and to elucidate the meanings of being severely ill living with haemodialysis when nearing end of life.INTRODUCTION: To have end stage renal disease and to be treated with maintenance haemodialysis implies being dependent on lifelong treatment. Several studies have reported that these patients suffer a high symptom burden and an impaired quality of life due to both disease and treatment. In the dialysis unit, where the focus is on handling technology and maintaining life, end of life care may be neglected or overlooked. Nevertheless, mortality rates show that about one-fourth of patients in haemodialysis care are in their last year of life.DESIGN: A qualitative interpretative design was used.METHODS: Serial qualitative interviews over a period of 12 months were conducted with eight patients (aged 66-87). Altogether text of 31 interviews was interpreted using a phenomenological hermeneutical method in three phases. The study is ethically approved.FINDINGS: The structural analysis resulted in 11 subthemes and thereafter the following three themes were formulated; being subordinate to the deteriorating body, changing outlook on life and striving for upheld dignity. The comprehensive interpretation revealed that being severely ill living with haemodialysis near the end of life means living with suffering simultaneously with reconciliation and well-being. Further, the meanings are understood as intertwined with being old.CONCLUSIONS: Findings contribute to an increased awareness of the complexities of these patients' life worlds and their meanings, and thus of the importance to listen to their experiences and their understandings. Findings suggest that to integrate the philosophy of palliative care in haemodialysis units may improve care for patients who are living with haemodialysis and approaching the end of their lives.
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| 5. |
- Axelsson, Lena, et al.
(author)
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Meanings of being a close relative of a family member treated with haemodialysis
- 2015
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In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 24:3/4, s. 447-456
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Journal article (peer-reviewed)abstract
- AIMS AND OBJECTIVES:To describe and elucidate the meanings of being a close relative of a severely ill family member treated with maintenance haemodialysis approaching the end of life.BACKGROUND:End-stage renal disease together with comorbidities, haemodialysis treatment and high mortality rates also affects the lives of close relatives, who report burdens and impaired quality of life. To improve care, more understanding is needed of close relatives' experiences during these patients' end of life.DESIGN:This study has a qualitative interpretative design.METHODS:Fourteen retrospective qualitative interviews were conducted with close relatives (aged 48-93 years) of deceased patients who had been treated with haemodialysis. The interview text was interpreted using a phenomenological hermeneutical method in three phases.RESULTS:The findings of the structural analysis were formulated as six themes: Striving to be supportive and helpful without doing harm to the ill person's self; Needing increasing strength and support; Balancing the will to help with one's own ongoing life; Increasing responsibility involving dilemmas; Striving for a good life together in the present and Living with awareness of death.CONCLUSIONS:Close relatives strive for balance and well-being accompanying their ill family member through the end of life. They are facing moral dilemmas and growing demands as their responsibility increases with the deterioration of their family member. Support from and interaction with the healthcare professionals is then of significance.RELEVANCE TO CLINICAL PRACTICE:Findings challenge healthcare professionals in haemodialysis settings to identify close relatives' individual resources and needs towards the patients' end of life. Healthcare professionals in haemodialysis settings need to offer close relatives opportunities to talk about the future and what may be expected at end of life, with or without haemodialysis. They should also contact the closest relative after the death as they may need confirmation and closure.
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| 6. |
- Axelsson, Lena, et al.
(author)
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Thoughts on death and dying when living with haemodialysis approaching end of life
- 2012
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In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 21:15-16, s. 2149-59
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Journal article (peer-reviewed)abstract
- AIMS AND OBJECTIVES: To describe inner thoughts and feelings relating to death and dying when living with haemodialysis approaching end of life.BACKGROUND: Patients who undergo maintenance haemodialysis suffer a significant symptom burden and an impaired quality of life. The high mortality rate in these patients indicates that about one-fourth of them are in their last year of life, suggesting the presence of death and dying in the haemodialysis unit.DESIGN: A qualitative descriptive design was used. Methods. A total of 31 qualitative interviews were conducted with eight patients (aged 66-87) over a period of 12 months. Qualitative content analysis was used to analyse data.RESULTS: The analysis revealed 10 subthemes that were sorted into three main themes. Being aware that death may be near comprises being reminded of death and dying by the deteriorating body, by the worsening conditions and deaths of fellow patients, and by knowing haemodialysis treatment as a border to death. Adapting to approaching death comprises looking upon death as natural, preparing to face death, hoping for a quick death and repressing thoughts of death and dying. Being alone with existential thoughts comprises a wish to avoid burdening family, lack of communication with healthcare professionals and reflections on haemodialysis withdrawal as an hypothetic option.CONCLUSIONS: Living with haemodialysis approaching, the end of life involves significant and complex existential issues and suffering, and patients are often alone with their existential thoughts.RELEVANCE TO CLINICAL PRACTICE: Nurses and other healthcare professionals in haemodialysis settings need to combine technical and medical abilities with committed listening and communication skills and be open to talking about death and dying, with sensitivity to individual and changeable needs.
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| 7. |
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| 8. |
- Gunnarsson, Iva, et al.
(author)
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Histopathologic and clinical outcome of rituximab treatment in patients with cyclophosphamide-resistant proliferative lupus nephritis
- 2007
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In: Arthritis and Rheumatism. - : John Wiley & Sons. - 0004-3591 .- 1529-0131. ; 56:4, s. 1263-1272
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Rituximab is a monoclonal antibody directed against the CD20 marker of B cells. Because of its ability to deplete B lymphocytes, it has been suggested that the drug could be of benefit in B cell-dependent diseases, including systemic lupus erythematosus (SLE). The purpose of this study was to investigate the histopathologic and clinical effects of combination treatment with rituximab and cyclophosphamide (CYC) in patients with CYC-resistant proliferative lupus nephritis.METHODS: Seven female patients with proliferative lupus nephritis were treated with rituximab in combination with CYC. Renal biopsies were performed before treatment and during followup. SLE activity was evaluated by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and the British Isles Lupus Assessment Group index. In 6 of the 7 patients, immunostaining of lymphocyte subpopulations in the renal tissue was performed before treatment and during followup.RESULTS: At 6 months of followup, significant clinical improvement was noted, with a reduction in SLEDAI scores (from a mean of 15 to 3), anti-double-stranded DNA antibody levels (from a mean of 174 IU/ml to 56 IU/ml), and anti-C1q antibody levels (from a mean of 35 units/ml to 22 units/ml). On repeat renal biopsy, improvement in the histopathologic class of nephritis occurred in a majority of patients, and a decrease in the renal activity index was noted (from 6 to 3). A reduction in the number of CD3, CD4, and CD20 cells in the renal interstitium was noted in 50% of the patients on repeat biopsy.CONCLUSION: At 6 months of followup, all patients had responded both clinically and histopathologically to combination therapy. For patients with proliferative lupus nephritis who fail to respond to conventional immunosuppressive therapy including CYC, combined treatment with rituximab and CYC may constitute a new treatment option.
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| 9. |
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| 10. |
- Herkner, Birgitta, 1951-
(author)
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Läsutveckling i årskurs 2–6 belyst genom standardiserade test och nationella provet i svenska i årskurs 3
- 2011
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Licentiate thesis (other academic/artistic)abstract
- The overall aim of this study is to analyse and describe reading ability from the second to sixth year of schooling in Sweden (ages 8–13). An introductory study presents the pupils’ reading profiles and also the extent to which teaching in reading comprehension is given at their schools. In a second study, the results and effects of the national test in Swedish in grade three (age 9) are studied and compared with other recognised test data on the development of children’s reading. A total of 428 pupils at four schools participated in the study. Each child was tested once a year during two consecutive school years. In addition to collecting results on the national test for all the pupils in their third year, standardised tests of word decoding ability and reading comprehension were administered to all students in the study. A questionnaire dealing with teaching reading and skills development was answered by 23 teachers. The study reveals that there are stronger links between phonological tasks and reading comprehension for pupils in their first three years than for those in years 4–6. The study also shows that the national test identifies some pupils with reading difficulties but not all of them. A number of pupils who have problems with word decoding nevertheless attain the national test threshold for reading comprehension tasks in the third year. There are also pupils who cannot manage the age-adapted reading comprehension tasks but who still pass the national test in their third year. The findings reveal that teachers work with reading comprehension exercises to only a small extent in both the first three years and second three years of schooling. The study indicates the importance of using a diagnostic approach, so that early and effective measures can be adopted to prevent the emergence of reading comprehension problems.
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