7 research outputs found
Att lära av det vackra - om organisation för omvårdnad
No full textDet finns mycket att lära av väl fungerande or ganisationer inom hälso- och sjukvården. Före bilderna från industriell organisation har med verkat till utvecklingen av sjukvård på löpande band men även till gruppvården. I vårdarbetet finns genuina dilemman som måste hanteras så skickligt att det går att leva med dem. Därför är studier av väl fungerande enheter viktiga som inspirationskälla och ett bra medel mot tron att goda organisationslösningar är något vi kan få från någon central standardiseringskommission. Detta är några av utgångspunkterna för ett forskningsprojekt om "vackra kliniker" som presenteras i denna artikel
The Children's Depression Inventory (CDI) as measure of depression in Swedish adolescents. A normative study
No full textWeight concerns, body image, depression and anxiety in Swedish adolescents
No full textOBJECTIVES: To assess weight problems and correlates in respect of body image, depression, anxiety and demographic background factors. METHOD: 405 Swedish adolescents were assessed in respect of Body Mass Index (BMI), biographical data, the Body Esteem Scale for Adolescents and Adults (BESAA), the Multidimensional Anxiety Scale for Children (MASC) and the Children's Depression Inventory (CDI). RESULTS: Boys were in the positive and girls in the negative direction from ideal BMI for age and gender. Girls and boys differed in respect of CDI, MASC and of BESAA where girls generally were shifted in the "pathological" direction. DISCUSSION: The adolescents' own positive attitude to slimness, negative mood (girls), and anxiety symptoms that reflect social fears (boys) and physical aspects of anxiety (girls and boys) were important correlates of lower BMI than ideal. Adolescent cultural norms need to be addressed in preventive work. However, in girls' separation anxiety might be a protective factor against underweight. In girls, overweight seems to be associated with negative self-esteem
Glomerular C3c deposition and intravascular macrophage accumulation in early humoral renal allograft rejection signifies a poor short‐term outcome
No full textC4d deposition in the walls of peritubular capillaries is considered the key phenomenon in the histopathological diagnosis of humoral, i.e. antibody-mediated, allograft rejection. We have earlier proposed that deposition of C3c in glomerular capillaries and simultaneous intravascular accumulation of macrophages in allografts with immediate or early humoral rejection indicates a potentially serious condition with very poor prognosis. The clinical outcome of 45 cadaveric grafts with this phenomenon among 1960 renal allografts transplanted at our centre during 1984-1999, and the recipients of the contralateral kidneys, was retrospectively evaluated. Graft failure occurred in 44/45 grafts within 3 weeks, with graft loss in 33/45 (77%) within 4 months and 37/45 (82%) within 1 year. From the contralateral kidneys, 5/33 (15%) were lost within 1 year. In a recent series of early biopsies, we recognised that of 13 cases showing C4d positivity in peritubular capillaries but lacking C3c in glomeruli, 10/13 (77%) were still functioning after 4 months. The mean number of CD68(+) macrophages per glomerular profile, i.e. the glomerular macrophage index, shows a significant difference between C4d(+)C3c(-) and C4d(+)C3c(+) cases (p<0.001). Our results indicate the existence of a clinically important subgroup of early humoral rejection with particular morphological features
Extracorporeal (“ex vivo”) connection of pig kidneys to humans. I. Clinical data and studies of platelet destruction
No full textThe pioneering experiment by Welsh et al. (Immunological Lett 1991:29:167-170) connecting a pig kidney to the human circulation has been repeated in a modified manner. Two volunteer dialysis patients were pretreated by daily plasmapheresis on days -2,-1, and 0 to remove the naturally occurring anti-pig xenoantibodies. The anti-pig lymphocytotoxic liters were reduced from 1:8 to 1:2 in patient 1 and from 1:8 to 1:1 in patient 2. No steroids or immunosuppressive drugs were administrated before or during the experiments. A sterile pig kidney was extracorporeally ("ex vivo") connected to the patients a/v fistula using an arterial and a venous pump similar to a dialysis. The two experiments gave different results. In the first experiment the perfusion pressure was kept at 100 mmHg for the initial 25 min by reducing the pump speed until the minimum blood flow of 30 ml/min was reached. Thereafter, the pressure rose continuously and the experiment was terminated at 65 min at a perfusion pressure of 200 mmHg. The patient did not feel any discomfort during the perfusion. In the second experiment, a stable blood flow of 200 ml/min was reached at a pressure of 100 mmHg after a few minutes. The perfusion was terminated at 15 min when the patient developed chest and abdominal pain, hypotension, and electrocardiographic signs of myocardial ischemia. The patient recovered quickly. In the first experiment, small volumes of clear urine was produced until the pressure rose above 100 mmHg, which resulted in hematuria. In the second experiment clear urine (4 ml/min) was produced. (51)Chromium clearance values were after 15 min <1 ml/min for kidney 1 and 12 ml/min (8 ml/min/100 g) for kidney 2. A drastic reduction in platelet count (128 to 48 and 64 to 8 × 10(9)/1, respectively) during the passage through the kidney was found in blood samples collected simultaneously before and after the organ. No change in hemoglobin values and leucocyte counts were found. Light- and electron-microscopical analysis of the kidney tissues revealed for kidney 1 focal areas with obliteration of the glomerular and peritubular capillaries by platelets and PMN cells and severe damage of the endothelial cells comparable to a picture of a hyperacute rejection. In kidney 2, all vessels were patent but in the capillaries large amount of membrane fragments were detected by electron microscopy and a discrete damage of the endothelial cells were seen in some segments. No intact platelets were present in the vascular tree. These human experiments support the hypothesis that hyperacute rejection of pig to human xenografts is delayed in time by removal of the preformed anti-pig xenoantibodies. A new finding was a very rapid destruction of platelets occurring in the kidney of patient 2 who had very low liters of xenoantibodies. The humoral immune response is described in detail in an accompanying paper (Rydberg et al., this issue)
"As soon as you trust yourself, you will know how to live" (Goethe). Protective and mediator factors for internalizing disorders in early and mid-adolescence
No full textAdolescence is often considered as a period of changes and challenges, during which youth are at particular risk for developing psychological disorders (Lee & Bukowski, 2012; Verona, Javdani, & Sprague, 2011). Anxiety and depression are two very common disorders in adolescence (Angold & Costello, 2008; Vierhaus, Lohaus, & Shah, 2010). Several authors have focused on the study of the possible risk factors that might interfere or enlarge the chance to develop such maladaptive behaviors. Some empirical studies have reported good quality of attachment relationships and positive evaluation of self as two of the most crucial protective factors for the psychological well-being in adolescence (Lee & Hankin, 2009; Tambelli, Laghi, Odorisio, & Notari, 2012; Wilkinson, 2004). Other studies, have focused on how different trends of psychological disorders and attachment relationships are detachable within the whole adolescence. Thus the central purpose of this study is to examine the relationships of attachment, in particular to mother, father, and peer, and self-esteem to depressive and anxiety symptoms, in early and mid-adolescence respectively. A community based sample of Italian early (n=1078) and mid-adolescents (n=1138) completed self-report measures of attachment (Inventory of Parent and Peer Attachment, IPPA, Armsden & Greenberg, 1987, 1989; Greenberg, Siegel, & Leitch, 1983) self-esteem (Rosenberg Self-Esteem Scale, RSES, Rosenberg, 1965) as well as anxiety (Spence Childrenâs Anxiety Scale, SCAS, Spence 1997) and depressive symptoms (Childrenâs Depression Inventory, CDI, Kovacs, 1992). After the evaluation of the psychometric properties (internal consistency and structural validity) of each selected measure, age and gender-related differences are evaluated. Correlations between the total scores of the measure are reported. Through structural equation modeling it is assessed the direct influence of both maternal and paternal attachment on psychological health, self-esteem and peer attachment. Moreover, the influence of peer attachment on psychological health is totally mediated by self-esteem. Anxiety and depressive symptoms are considered and evaluated separately. The multi-group approach is used to evaluate gender differences in the model. To avoid the artifacts of sampling and to strengthen the obtained results, the cross-validation procedure is adopted. Results indicate good psychometric characteristics for each measure. Additionally, the comparison between the two age-groups show early adolescence report higher levels of attachment (to mother, father and peer), and self-esteem, whereas mid-adolescents report higher levels of depressive symptoms. Furthermore, in general girls score higher on levels of attachment relationships to peer and on anxiety symptoms, while boys report higher levels of self-esteem and paternal attachment. The major finding from the model concerns the crucial role of self-esteem. Maternal, paternal and peer attachment have only a weak effect on anxiety and depressive symptoms respectively, whereas the self-esteem shows a greater effect on both. The only one exception regards the strong direct role of peer attachment on depressive symptoms showed by the mid-adolescents sample. However, the primary effect of the considered attachment relationships is on self-esteem. Symptom and age-related differences are discussed. To conclude, this study suggests that it is the evaluation of the self rather than the quality of attachment relationships that may influence the levels of psychological symptoms reported by early and mid-adolescents. Limits of the study and implications for research are presente
