Korleis kan sjukepleiar bidra til meistring av sjukdommen hos pasientar med Morbus Crohn?

Kvart år blir det diagnostisert 200-300 nye tilfeller av Morbus Crohn i Noreg, ein kronisk sjukdom som har eit forløp karakterisert av periodevis remisjon og periodevis aktiv sjukdom. I den aktive sjukdoms perioden kan pasienten oppleve store påkjenningar, der dei til tider ikkje kan fungere i sine vande roller i kvardagen, der sjukdommen styrer livet og livsutfaldinga til pasienten. Denne oppgåva er ei litteratur studie som omhandlar sjukepleie og pasientars meistring av sjukdommen Morbus Crohn. Problemstillinga i denne oppgåva er korleis ein som sjukepleiar kan bidra til meistring av dei påkjenningane som pasientane møter ved diagnostisering, der eg er ute etter ei sjukepleiar åtferd eller funksjon som kan bidra til dette i relasjon med pasienten. Metoden som er brukt er litteraturstudie, der funna i hovudsak kjem i frå forskingslitteratur. Hovudfunna i denne studia avdekkar at sjukepleiaren kan bidra til Morbus Crohn pasientens meistring ved at dei bidreg med informasjon og kunnskapar til pasienten, samt lyttar, har tillitt til og støttar pasienten i sin situasjon

Microbial challenges in recirculating aquaculture systems (RAS) for Atlantic salmon (Salmo salar) smolt and post-smolt

Aquaculture is one of the fastest growing food producing sectors today. Norway is the world’s largest producer of farmed Atlantic salmon (Salmo salar), and the aquaculture industry is an important contributor to value creation and employment nationally. The land based production phase in Norwegian salmon farming has the past years been extended to include post-smolt for an increasing number of farms. This is a consequence of problems with salmon lice and diseases in open net pens, escapes, pollution, industry public relations and economic aspects of regulations and concessions. Increased production time on land in recirculating aquaculture systems (RAS) with larger fish demand more comprehensive water treatment to maintain good water quality. Higher biomass and feeding generate more intensive organic loads and particles in RAS. Furthermore, prolonging the production on land to include post -smolt may involve introduction of salt water to the systems. Organic matter and salinity will affect the water treatment significantly, in particular nitrification and the microbial water quality. Bacteria are key players in the nutrient fluxes in RAS to maintain high water quality. The motivation for this thesis was to provide more knowledge on operation and rearing regimes in RAS for salmon smolt and post-smolt production, with a special focus on microbial challenges related to organic matter and salinity. Our first experiment evaluated the effects of enhanced particle removal with membrane filtration in RAS on concentrations of organic matter and its consequences for water quality and microbial conditions. This experiment was furthermore used to make a carbon and nitrogen mass balance. We evaluated the dynamics and fate of C and N input to RAS, and removal efficiencies of the water treatment, including a membrane, for C and N compounds. The results showed that the system with membrane filtration had higher microbial diversity, lower and shorter bacterial blooms and generally lower bacterial densities in the water than in the system without membrane filtration. The mass balance showed that membrane filtration reduced the fraction of input C and N ending up as particles in RAS. The membrane directly removed particles, reducing accumulation of C and N compounds which resulted in better water quality. The better physicochemical and microbial water quality in combination with higher temperatures led to better appetite of the fish and as a consequence, this system had less feed waste and better fish growth than the system without membrane filtration. High organic matter loadings did not impact the nitrification efficiency negatively due to total ammonia nitrogen (TAN) limitation. This implies that as long as TAN is limiting and there is sufficient oxygen concentrations in the biofilter, increased loadings of organic matter in post-smolt production with larger fish will not suppress nitrification. Membrane filtration has shown to be a suitable technology for removal of the smallest particles and bacteria in RAS to improve water quality. However, cost-benefit analyses with membrane filtration at different life stages during Atlantic salmon production remains to be done to determine economic feasibility for the fish farmers. Our second experiment studied how two different regimes for salinity increase in RAS affected the RAS microbiota, nitrification capacity and performance of fish. One regime was a gradual increase in salinity in a brackish water RAS with post-smolt, the other was a direct transfer of post-smolts from a low salinity brackish RAS to a high salinity/seawater RAS, both groups with subsequent transfer to sea. The results showed that salinity was a driver for bacterial succession in RAS water. This included a combination of physiological salinity adaptation processes and succession causing change in community structure and introduction of new species. We showed that it was possible to successfully increase the salinity in an operating RAS with fish without exceeding toxic concentrations of TAN and nitrite. We hypothesize this was due to the salinity history of the system and halotolerant nitrifying bacteria embedded in the biofilter biofilm. Whether one salinity adaptation strategy was better than the other in respect to the fish still remains unknown as there were no clear positive indications in either of the fish groups in the two salinity adaptation regimes both on land and at sea. The third experiment investigated the start-up of nitrifying biofilms in freshwater and brackish water MBBR biofilters. The development of the nitrifying community assembly in the biofilm and nitrification capacity were compared in the two reactors. We observed that after 60 days of start-up, the brackish water biofilm had half the nitrification capacity of the freshwater biofilm during stress-tests, with less diverse microbial communities and lower proportion of nitrifiers. However, low ammonia and nitrite concentrations with rapidly increasing nitrate concentrations indicated that complete nitrification was established in both reactors. The results suggest that nitrification developed in comparable time in brackish and freshwater, and brackish start-up can be a strategy for bioreactors with varying salinity, like in post -smolt production

Prospective and Efficient Techniques for Model Reduction in Reliability Calculations

A reliable electric power supply is essential for modern society. Recently, severe blackouts worldwide have attracted attention to reliability studies in power system planning and operation. The relevance of the traditional N-1 criterion has been discussed, and much focus has been directed towards developing satisfactory probability based reliability tools. Goodtech Project & Services has developed a methodology for calculation of online power delivery reliability for use in power system operation and planning. The method, based on Markov models, analyzes the entire network for a large number of fault combinations, a useful approach for relatively small networks. However, the computation time increases polynomial with increasing system size. Because the impact of an outage has a limited geographical extent, it is desirable to reduce the system to be simulated, so that it only includes the affected area. The objective of this project is to develop methods for identifying the components that can be considered influenced by a fault. The focus of the pre-study was to evaluate which post-processing method best suited for developing a reduced network system. In the pre-study, power flow results from the standard DC load flow were used. The main focus of this thesis has been on developing and implementing fast methods for obtaining the necessary power flow data needed in order to use the post-processing methods. Three approaches have been investigated and tested, namely AC load flow based on the fast decoupled load flow with compensation techniques for obtaining the post- contingency power flows, DC load flow with compensation techniques and the efficient bounding method. The key principle of the compensation methods is that the effect of outages can be calculated by introducing simple compensation terms, thus avoiding the need to rebuild and factorize the system matrices for every contingency case. The bounding method is based on the principle of sensitivity factors and the fact that given knowledge about changes inside a boundary certain conclusions can be made regarding the changes outside it, thus eliminating the need for studying the entire system. The method based on the fast decoupled load flow is the only method that gives the possibility to provide an exact solution, and is also the only method that includes reactive power and voltage magnitudes. It is therefore recommended used in cases where a high degree of accuracy is important, or if reactive power and voltages are of interest. Tests show that the DC load flow is fastest. The accuracy is assumed sufficient for most intended purposes, and should therefore the preferred choice in most cases. Bounding methods are especially useful in highly meshed grids, and if only the largest changes are of interest

The Effect of Membrane Filtration on the Microbial Community Dynamics in RAS for Post-Smolt Production

An increased interest for recirculating aquaculture systems (RAS) the past years have led to more research on water treatment processes and how they affect water quality. Most studies have been focusing on the units governing the physicochemical parameters, however the microbial environment is also an important parameter in the cultivation of fish. Bacteria are highly abundant in the rearing water and thus in close contact with the fish. Knowledge on the potential health effects of the microbial environment in the cultivation of salmon fry, smolt and post-smolt are limited and remains to be studied. Accumulation of solids is a known problem in RAS, and could affect the water quality and fish performance. The conventional particle removal systems in use today only manage to remove larger particles, leaving the fine solids in the system water for recirculation. Membrane technology has been proposed as a strategy for removal of the fine solids in the system and could potentially improve the water quality. The scope of this thesis was to evaluate the effect of membrane filtration on the bacterial concentrations and the microbial community structures in the rearing water of post-smolt production in two identical RASs, one control RAS (cRAS) and one RAS modified to include a membrane (mRAS). The community compositions of the gut microbiota from the post-smolts reared in the two systems were also investigated at the end of the experiment. To estimate the bacterial concentrations, flow cytometry analysis was used to count the bacteria in the rearing water. To investigate the microbial community compositions, 16S rRNA PCR/DGGE analysis was conducted. Implementation of a membrane in the water treatment significantly reduced the bacterial concentrations in the rearing water. At the end of the experiment the bacterial concentrations of water in the fish tanks in mRAS were around 6 million/ml, and in cRAS 14 million/ml, respectively. The microbial community compositions in mRAS and cRAS were significantly different from each other, and the community compositions in mRAS were more diverse than those of cRAS. The water microbiota in both systems changed throughout the experiment, however it was observed a more stable microbiota over time in mRAS than cRAS. The microbial community compositions of the gut samples from mRAS and cRAS were significantly different from each other, thus the membrane filtration affected the gut microbiota of the salmon post-smolts

Inflammation and Digestive Cancer

Chronic inflammation is linked to carcinogenesis, particularly in the digestive organs, i.e., the stomach, colon, and liver. The mechanism of this effect has, however, only partly been focused on. In this review, we focus on different forms of chronic hepatitis, chronic inflammatory bowel disease, and chronic gastritis, conditions predisposing individuals to the development of malignancy. Chronic inflammation may cause malignancy because (1) the cause of the chronic inflammation is itself genotoxic, (2) substances released from the inflammatory cells may be genotoxic, (3) the cell death induced by the inflammation induces a compensatory increase in proliferation with an inherent risk of mutation, (4) changes in cell composition due to inflammation may modify function, resulting in hormonal disturbances affecting cellular proliferation. The present review focuses on chronic gastritis (Helicobacter pylori or autoimmune type) since all four mechanisms may be relevant to this condition. Genotoxicity due to the hepatitis B virus is an important factor in hepatocellular cancer and viral infection can similarly be central in the etiology and malignancy of inflammatory bowel diseases. Helicobacter pylori (H. pylori) is the dominating cause of chronic gastritis and has not been shown to be genotoxic, so its carcinogenic effect is most probably due to the induction of atrophic oxyntic gastritis leading to hypergastrinemia.publishedVersio

Seksualitet og fertilitet hos unge kvinner etter kurativ behandling for brystkreft og Hodgkin lymfom, diagnostisert ved UNN i perioden 2010-2019

Bakgrunn - Økt overlevelse blant de som blir diagnostisert med kreft, gir en stadig større gruppe kreftoverlevere. Dette gir en voksende gruppe mennesker som må leve med seneffekter etter sin behandling. Problemer med seksualitet og fertilitet er eksempler på seneffekter som kan ramme kreftoverlevende, og som for unge kreftoverlevere kan oppleves som en alvorlig konsekvens av kreftbehandlingen. Brystkreft og Hodgkin lymfom er krefttyper som rammer unge kvinner. Målet med denne oppgaven var derfor å undersøke hvorvidt kvinner kurativt behandlet for brystkreft eller Hodgkin lymfom, diagnostisert ved UNN i perioden 2010-2019, opplever problemer relatert til seksualitet og fertilitet. Videre ønsket vi å se på mulige faktorer assosiert med dette, samt vurdere kvinnenes tilgang på og ønske om informasjon knyttet til seksuelle problemer. Materiale og metode - Studien inkluderer 37 kvinner, 30 brystkreft-overlevere og syv Hodgkin lymfom-overlevere. Disse ble identifisert ved å søke på prosedyre- og diagnosekoder i elektronisk pasientjournal, blant kvinner ≤40 år diagnostisert i perioden 2010-2019. Et spørreskjema om seksualitet og fertilitet ble utformet basert på validerte spørreskjema, og tilsendt kvinnene elektronisk. Kliniske opplysninger ble hentet fra pasientjournal. Resultater - Blant de 30 brystkreft-overleverne var median alder på tidspunkt for diagnose 37 år. Blant Hodgkin lymfom-overleverne 24 år. Vi fant en høy grad av komorbiditet: Totalt var 62,2% overvektige, 56,8% hadde fatigue, 40,5% muskel-skjelett-lidelser og 37,8% depresjon. Totalt 78,4% var seksuelt aktive og av disse oppga 24,1% at sex var en viktig del av livet og 51,7% hadde glede av seksuell aktivitet, mens 27,6% opplevde ubehag ved inntrenging i skjeden og 51,7% merket tørrhet i skjeden. Mangel på partner var vanligste årsak til seksuell inaktivitet. Totalt 78,4% av kvinnene oppga å ha seksuelle problemer, og 92,6% fikk de i etterkant av kreftbehandlingen. Totalt 14,8%, hadde mottatt hjelp for sine seksuelle problemer. Helsepersonell og internett var kvinnenes foretrukne informasjonskilder om seksuelle problemer. Totalt 76,9% med ønske om barn i etterkant av kreftbehandlingen, hadde lyktes i dette. Totalt 60% av kvinnene var menopausale (alle tilhørende brystkreftgruppen). Konklusjon - I vår studiepopulasjon var det en høy forekomst av komorbide lidelser. Kvinnene er mindre seksuelt aktive, og opplever mindre nytelse og mer ubehag ved seksuell aktivitet enn normalbefolkningen. Av kvinnene med seksuelle problemer, har nesten alle fått de i etterkant av sin kreftbehandling. Helsepersonell og internett er foretrukne informasjonskilder hva gjelder seksuelle problemer. De fleste med ønske om barn i etterkant av sin kreftbehandling, har lyktes i dette. Funnene er i tråd med tidligere forskning, men flere studier trengs

The impact of proton pump inhibitors on the course of ulcerative colitis: a cohort study of over 10,000 newly diagnosed patients in Norway

Background and Aims Proton pump inhibitors (PPI) affect the gastrointestinal microbiota, which is thought to play a role in the pathogenesis of ulcerative colitis (UC). Previous studies suggest an association between PPI use and risk of incident UC as well as disease course. The aim of the study was to examine if PPI exposure is associated with disease course in UC patients. Methods A national cohort consisting of all newly diagnosed UC patients from 2010 to 2020 was defined combining data from Norwegian registries. PPI exposure was included as a time dependent variable with a 30 day time lag from starting the drug. Outcomes were starting advanced therapies including anti-TNF, systemic glucocorticoids, any additional systemic anti-inflammatory medication and undergoing colectomy during follow-up. Time-dependent Cox regressions included the variables PPI use, first systemic glucocorticoid prescription, first UC hospitalization, age-groups and sex. Results The study cohort consisted of 10,149 patients with median age 40 years (IQR 27–56) and 56% males. PPI use independently increased the risk of starting advanced therapies (HR 1.54, 95% CI 1.36–1.73, p < 0.005), starting systemic glucocorticoids (HR 1.20, 95% CI 1.07–1.34, p < 0.005), starting any additional anti-inflammatory treatment (HR 1.18, 95%CI 1.05–1.32, p < 0.01) and undergoing colectomy (HR 1.52, 95%CI 1.17–1.98, p < 0.005). Conclusions PPI use was associated with unfavorable outcomes including advanced therapy initiation, additional anti-inflammatory medications and undergoing colectomy. Although further studies are needed, the evidence suggests that PPIs could affect the course of UC and should be used cautiously in UC patients.publishedVersio

«Mange som ruser seg sier hver dag at i dag slutter jeg, men så fortsetter de selv om de ikke vil» Opplevelse av autonomi i situasjoner med alvorlig rusmiddelavhengighet

Master's thesis in Mental health and addiction issuesSAMMENDRAG Masteroppgaven omhandler opplevelse av autonomi i situasjoner med alvorlig rusmiddelavhengighet. Målet med studien er å utvikle kunnskap om autonomi opp mot forståelsen av avhengighet og se på hvilke måter alvorlig rusmiddelavhengighet påvirker evnen til å ivareta egen autonomi og til å ta adekvate og rasjonelle valg. Alvorlig rusmiddelavhengighet fører ofte til alvorlige negative konsekvenser for den avhengige, allikevel kan det være svært vanskelig å slutte å bruke rusmidler. Studien vil kunne tilføre kunnskap om avhengighet i en stadig aktiv fagpolitisk debatt om rusmiddelavhengiges rettsposisjon og hvordan samfunnet skal respondere på den. For å få kunnskap om dette har jeg valgt kvalitativ metode og semi-strukturerte intervjuer av åtte personer, det vil si fire par fagpersoner/ brukere som har hatt en relasjon i en situasjon hvor spørsmålet om autonomi har blitt satt på spissen ved at bruk av tvang har blitt vurdert. Situasjoner som oppstår mellom fagperson og bruker i forbindelse med vurdering av tvang, er situasjoner som setter søkelys på hvordan autonomi oppleves og forstås, både fra fagpersons og brukers perspektiv. Gjennom at både fagperson og bruker intervjues får vi data fra situasjoner hvor dette ikke bare er opplevd og tenkt på men også italesatt. Resultatene viser at både fagpersoner og brukere beskrev at autonomien var sterkt begrenset på tidspunktet for vurdering av tvang. Det var imidlertid ikke bare rusmiddelavhengigheten som var årsak til den begrensede autonomien, men konsekvensene rusmiddelavhengigheten har for alle levekårsområder. Det er altså den totale livssituasjonen som følge av rusmiddelavhengighet som reduserer autonomien; rusmiddelavhengigheten, fysiske og psykiske helseutfordringer, stigmatisering, marginalisering, bosituasjon, nettverk, økonomi og manglende aktivitet. Særlig ser det ut til at alvorlige psykiske lidelser og plager også bidrar til redusert autonomi i slike situasjoner

Gastric Cancers Missed at Upper Endoscopy in Central Norway 2007 to 2016—a Population-Based Study

Simple summary: Stomach cancer may be missed during upper endoscopy. We have examined how often this occurs and identified factors associated with missed cancers. Among 730 patients with gastric cancer, 67 (9.2%) were missed during endoscopy 6 to 36 months prior to the cancer diagnosis. Missed cancers were more often located in the upper part of the stomach, of Lauren’s diffuse histologic type and more frequent in patients with previous Billroth II operation. The missed cancers were diagnosed at somewhat earlier stages than the non-missed cancers. In missed cancers, an ulceration was more often found in patients with shorter time interval between the first endoscopy and the endoscopy where the cancer was diagnosed. The factors associated with missed stomach cancers should be kept in mind by doctors performing endoscopies as this may lead to an earlier diagnosis of cancer.publishedVersio

A comparison of two seawater adaptation strategies for Atlantic salmon post-smolt (Salmo salar) grown in recirculating aquaculture systems (RAS): Nitrification, water and gut microbiota, and performance of fish

The land-based production phase in Norwegian Atlantic salmon farming has the past years been extended to include post-smolt for an increasing number of farmers. Post-smolt production can involve introduction of brackish/seawater to a recirculating aquaculture system (RAS) that is acclimatized to freshwater for the earlier stages of salmon production. A change from freshwater to seawater shifts the environmental conditions for fish, bacteria and water treatment processes in RAS. Two regimes for salinity increase were studied to evaluate the effects on nitrification functionality, water and gut microbiota and fish performance on land and in the sea cages. A fish group of 200,000 salmon parr were stocked in a brackish water RAS (bRAS) at 3‰ salinity. After the fish had smoltified the group was split in two, one group was kept in bRAS and the other was moved to a RAS operated at 28‰ salinity (sRAS). The bRAS was operated with a gradual increase in salinity from 3 to 26‰ over a period of 28 days, whereafter both groups were moved to two separate sea cages. Bacterial communities of water, biofilter biofilm and fish faeces were characterized by 16S rRNA amplicon sequencing. Nitrification capacity tests at different salinities were performed on biofilter media from bRAS, to evaluate short term robustness to salinity changes. Ordination based on Bray-Curtis similarities showed that in water samples in bRAS, the bacterial communities were stable from 12 to 26‰ salinity increase. The faecal microbiota of the fish showed high inter-individual variation within fish tanks, suggesting stochastic processes/drift to affect the community structures in addition to salinity increase. The same nitrifying bacteria were present in bRAS (throughout the salinity increase) and in sRAS, showing that these nitrifiers could adapt to salinities from 3 to 26‰, and 28‰. After the sea cage phase, fish from the sRAS system had in total 2.9% higher weight than the fish from bRAS, however the mortality was 15% higher in the sRAS group. Salinity was a driver for succession in RAS, and other factors such as organic load in the water and stochastic processes in the host also affected the bacterial community dynamics.publishedVersionAvailable online 30 September 2020 0044-8486/ © 2020 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). DOI:10.1016/j.aquaculture.2020.73597