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Biomedical subjects

J Mårtensson

Publications and source records attributed to J Mårtensson.

At least 19 recordsLinked to original sources
PubMed2006

Heart failure management programmes in Europe.

BACKGROUND: The ESC guidelines recommend that an organised system of specialist heart failure (HF) care should be established to improve outcomes of HF patients. The aim of this study was therefore to identify the number and the content of HF management programmes in Europe. METHOD: A two-phase descriptive study was conducted: an initial screening to identify the existence of HF management programmes; and a survey to describe the content in countries where at least 30% of the hospitals had a programme. RESULTS: Of the 43 European countries approached, 26 (60%) estimated the percentage of HF management programmes. Seven countries reported that they had such programmes in more than 30% of their hospitals. Of the 673 hospitals responding to the questionnaire, 426 (63%) had a HF management programme. Half of the programmes (n = 205) were located in an outpatient clinic. In the UK a combination of hospital and home-based programmes was common (75%). The most programmes included physical examination, telephone consultation, patient education, drug titration and diagnostic testing. Most (89%) programmes involved nurses and physicians. Multi-disciplinary teams were active in 56% of the HF programmes. The most prominent differences between the 7 countries were the degree of collaboration with home care and GP's, the role in palliative care and the funding. CONCLUSION: Only a few European countries have a large number of organised programmes for HF care and follow up. To improve outcomes of HF patients throughout Europe more effort should be taken to increase the number of these programmes in all countries.

Aftercare↗
PubMed2006

Situations influencing habits in diet and exercise among nurses working night shift.

OBJECTIVES: The aim of the investigation was to describe situations with a significant influence on healthy diet and exercise habits among nurses working night shift. METHODS: A qualitative descriptive design with a Critical Incident Technique approach was used. Situations were collected by means of interviews with 27 registered/enrolled community nurses. RESULTS: A total of 143 situations were identified comprising two main areas: coping ability at work and coping ability during leisure hours. Coping ability at work included 81 critical incidents grouped into two categories: the nurses' diet and exercise habits were influenced by social interaction with colleagues at work and by the disruption to their circadian rhythm. Coping ability during leisure hours included 62 critical incidents grouped into two categories: the diet and exercise habits were influenced when the nurses recovered from the disruption to their circadian rhythm and when they took advantage of the freedom of action offered by night work. CONCLUSIONS: By identifying the factors that influence diet and exercise habits among nurses working night shift, strategies can be developed in order to strengthen the factors with a positive influence.

Adaptation, Psychological↗
PubMed2005

Patients with heart failure in primary health care: effects of a nurse-led intervention on health-related quality of life and depression.

AIMS: To determine the effects of a nurse-led intervention designed to improve self-management of patients with heart failure in a primary health care setting regarding health-related quality of life and depression. METHODS: Patients at eight primary health care centres were screened by the Diagnosis Related Groups registry for the diagnosis of heart failure and eligibility for a cluster randomised study. A total of 153 patients were included (n=78 in the intervention group, 54% males, mean age 79 years, 59% in New York Heart Association class III-IV). The intervention involved patient and family education about heart failure and self-management and monthly telephone follow-up during 12 months by a primary health care nurse. RESULTS: The effects of the nurse-led intervention were limited. Significant differences were found in the physical dimension measured by the SF-36 health survey, and in depression measured by the Zung Self-rating Depression Scale. In comparison within groups at the 3 and 12-month follow-up, the intervention group significantly maintained their health-related quality of life measured by the SF-36 health survey, and their experience of depression measured by the Zung Self-rating Depression Scale to a greater extent than in the control group, especially among women. CONCLUSION: A nurse-led intervention directed toward patients with heart failure in a primary health care setting resulted in limited effects between the groups, although the physical and mental status were retained during 12 months of follow-up to a greater extent than in the control group.

Aged↗
PubMed2004

A novel nonsense mutation of the mineralocorticoid receptor gene in a Swedish family with pseudohypoaldosteronism type I (PHA1).

Pseudohypoaldosteronism type I (PHA1) is a condition associated with salt wasting leading to dehydration, hypotension, hyperkalemia, and metabolic acidosis. Sporadic cases and two familial forms, one autosomal dominant and one autosomal recessive form, have been described. The autosomal dominant or sporadic form manifests milder salt wasting that remits with age. Mutations in the gene encoding the mineralocorticoid receptor (MR) have been identified in patients with the autosomal dominant inheritance. However, recent studies suggest that the autosomal dominant and sporadic forms are genetically heterogeneous and that additional genes might be involved. We report on the study of 15 members of a Swedish five-generation family with the autosomal dominant form of PHA1. Interestingly, neuropathy was found in two of five affected individuals. A novel heterozygous nonsense mutation C436X in exon 2 was identified in the index patient by linkage analysis, PCR, and direct sequencing of the MR gene. Analysis of the family demonstrated that the mutation segregated with PHA1 in the family. It is unclear whether the neuropathy is associated with the mutation found. Our results together with previously published data suggest that loss-of-function mutations of the MR gene located at 4q31.1, commonly are associated with the autosomal dominant form of PHA1.

Adult↗
PubMed2003

Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: results from a prospective, randomised trial.

AIM: The aim of this trial was to prospectively evaluate the effect of follow-up at a nurse-led heart failure clinic on mortality, morbidity and self-care behaviour for patients hospitalised due to heart failure for 12 months after discharge. METHODS: A total of 106 patients were randomly assigned to either follow-up at a nurse-led heart failure clinic or to usual care. The nurse-led heart failure clinic was staffed by specially educated and experienced cardiac nurses, delegated the responsibility for making protocol-led changes in medications. The first follow-up visit was 2-3 weeks after discharge. During the visit the nurse evaluated the heart failure status and the treatment, gave education about heart failure and social support to the patient and his family. RESULTS: There were fewer patients with events (death or admission) after 12 months in the intervention group compared to the control group (29 vs 40, p=0.03) and fewer deaths after 12 months (7 vs 20, p=0.005). The intervention group had fewer admissions (33 vs 56, p=0.047) and days in hospital (350 vs 592, p=0.045) during the first 3 months. After 12 months the intervention was associated with a 55% decrease in admissions/patient/month (0.18 vs 0.40, p=0.06) and fewer days in hospital/patient/month (1.4 vs 3.9, p=0.02). The intervention group had significantly higher self-care scores at 3 and 12 months compared to the control group (p=0.02 and p=0.01). CONCLUSIONS: Follow up after hospitalisation at a nurse-led heart failure clinic can improve survival and self-care behaviour in patients with heart failure as well as reduce the number of events, readmissions and days in hospital.

Aged↗
PubMed2003

Development and testing of the European Heart Failure Self-Care Behaviour Scale.

BACKGROUND: Improvement of self-care behaviour is an aim of several non-pharmacological nurse-led management programmes for patients with heart failure. These programmes are often evaluated based on their effects on readmission, costs and quality of life. It is, however, also important to know how patients changed their self-care behaviour as a result of such a programme. Therefore a comprehensive, reliable and valid measure of the self-care behaviour of HF patients is needed. OBJECTIVES: To develop a scale measuring the behaviour that heart failure patients perform to maintain life, healthy functioning, and well-being. METHOD: The European Heart Failure Self-Care Behaviour Scale (EHFScBS) was developed in three phases: (1) concept analysis and first construction; (2) revision of items and response and scoring format; and (3) testing of the new scale for validity and reliability. RESULTS: The European Heart Failure Self-Care Behaviour Scale is a 12-item, self-administered questionnaire that covers items concerning self-care behaviour of patients with heart failure. Face-validity and concurrent validity was established and the internal consistency of the scale was tested using pooled data of 442 patients from two centres in Sweden, three in the Netherlands and one in Italy. Cronbachs's alpha was 0.81. CONCLUSION: The instrument is a valid, reliable and practical scale to measure the self-reported self-care behaviour of heart failure patients. It is ready to use by investigators evaluating the outcome of heart failure management programmes that target changes in patients' self-care practices.

Aged↗
PubMed2001

Control of electron transfer in supramolecular systems.

The fluorescence quantum yield of zinc porphyrin (ZnP) covalently linked to 9,10-bis(phenylethynyl)anthracene (AB) is strongly dependent upon the solvent properties. The bichromophoric system ZnP-AB exhibits 'normal' zinc porphyrin fluorescence in solvents that cannot coordinate to the central zinc atom. In contrast, if a Lewis base, such as pyridine, is added to a sufficiently polar solvent, the fluorescence is significantly quenched. Picosecond transient absorption measurements, in conjunction with fluorescence quenching and cyclic voltammetric measurements, suggest that the quenching mechanism is intramolecular electron transfer from ZnP to AB. The charge separated state. ZnP*+-AB*-, has a lifetime of not more than 220 ps before recombining. If a secondary electron acceptor, iron(III) porphyrin (FeP), is covalently connected to the AB unit, a second electron transfer from AB*- to FeP occurs and the charge separated state, ZnP*+-AB-FeP*-, has a lifetime of at least 5 ns. This demonstrates that electron transfer might be sensitively tuned (switched on) by specific solvent effects.

Absorption↗
PubMed2001

Enhanced intersystem crossing in donor/acceptor systems based on zinc/iron or free-base/iron porphyrins.

The deactivation pathways of the singlet excited state of a series of zinc or free-base donor porphyrins covalently linked by a bridge to a paramagnetic iron(III) chloride porphyrin acceptor have been studied. These donor-bridge-acceptor systems all share a similar geometry (25 A donor-acceptor center-to-center distance), but the bridges vary in electronic structure. In previously reported investigations of zinc/iron porphyrin systems, the fluorescence quenching of the donor has predominantly been assigned to electron transfer. However, for the porphyrin systems studied in this paper, we show that the dominant deactivation channels are enhanced intersystem crossing and singlet energy transfer. In both series, the intersystem crossing rate (S1-->T1) of the donor moiety is almost doubled in the presence of a paramagnetic high-spin metal-porphyrin acceptor. The significant spectral overlap of the donor fluorescence and acceptor absorption in both series allows for efficient singlet energy transfer (Forster mechanism). Furthermore, the bridging chromophores mediate energy transfer and the enhancement is inversely dependent upon the energy gap between the donor and bridge excited states. Although Marcus theory predicts thermodynamically favorable electron transfer to occur in the systems investigated, the quenching rate constants were found to be independent of solvent polarity, and no charge-separated state could be detected, indicating very small electronic coupling for electron transfer.

Journal Article↗
PubMed2001

Bridge-dependent electron transfer in porphyrin-based donor-bridge-acceptor systems.

Photoinduced electron transfer in donor-bridge-acceptor systems with zinc porphyrin (or its pyridine complex) as the donor and gold(III) porphyrin as the acceptor has been studied. The porphyrin moieties were covalently linked with geometrically similar bridging chromophores which vary only in electronic structure. Three of the bridges are fully conjugated pi-systems and in a fourth, the conjugation is broken. For systems with this bridge, the quenching rate of the singlet excited state of the donor was independent of solvent and corresponded to the rate of singlet energy transfer expected for a Förster mechanism. In contrast, systems with a pi-conjugated bridging chromophore show a solvent-dependent quenching rate that suggests electron transfer in the Marcus normal region. This is supported by picosecond transient absorption measurements, which showed formation of the zinc porphyrin radical cation only in systems with pi-conjugated bridging chromophores. On the basis of the Marcus and Rehm-Weller equations, an electronic coupling of 5-20 cm(-)(1) between the donor and acceptor is estimated for these systems. The largest coupling is found for the systems with the smallest energy gap between the donor and bridge singlet excited states. This is in good agreement with the coupling calculated with quantum mechanical methods, as is the prediction of an almost zero coupling in the systems with a nonconjugated bridging chromophore.

Electrochemistry↗
PubMed2001

Nurse-led heart failure clinics in Sweden.

OBJECTIVE: The aim of this study was to describe the nurse-led heart failure care in Sweden. METHODS: A postal questionnaire was sent to all 86 hospitals in Sweden treating heart failure patients. All hospitals completed the questionnaire, which contained 20 questions about heart failure nurses, patient education, heart failure clinics, co-operation with primary healthcare and care programmes. RESULTS: Sixty-nine percent of all hospitals (n=86) had nurses specialised in taking care of heart failure patients, in total 148 heart failure nurses. The nurses were involved in patient education and follow-up. There were nurse-led heart failure clinics in 66% of the hospitals. The clinics provided follow-up after hospitalisation, telephone counselling and drug titration. The majority of the heart failure nurses had been delegated the responsibility for making protocol-led changes in medications. Most clinics registered the number of annual visits to the clinic, and the largest clinic had up to 1000 visits. Approximately half of the hospitals had a special care plan for patients with heart failure and an organised co-operation with primary healthcare. CONCLUSION: The first nurse-led heart failure clinic started in Sweden in 1990 and since then the model has been spread to two-thirds of the Swedish hospitals.

Heart Failure↗
PubMed2000

Towards an artificial model for Photosystem II: a manganese(II,II) dimer covalently linked to ruthenium(II) tris-bipyridine via a tyrosine derivative.

In order to model the individual electron transfer steps from the manganese cluster to the photooxidized sensitizer P680+ in Photosystem II (PS II) in green plants, the supramolecular complex 4 has been synthesized. In this complex, a ruthenium(II) tris-bipyridine type photosensitizer has been linked to a manganese(II) dimer via a substituted L-tyrosine, which bridges the manganese ions. The trinuclear complex 4 was characterized by electron paramagnetic resonance (EPR) and electrospray ionization mass spectrometry (ESI-MS). The excited state lifetime of the ruthenium tris-bipyridine moiety in 4 was found to be about 110 ns in acetonitrile. Using flash photolysis in the presence of an electron acceptor (methylviologen), it was demonstrated that in the supramolecular complex 4 an electron was transferred from the excited state of the ruthenium tris-bipyridine moiety to methylviologen, forming a methylviologen radical and a ruthenium(III) tris-bipyridine moiety. Next, the Ru(III) species retrieved the electron from the manganese(II/II) dimer in an intramolecular electron transfer reaction with a rate constant kET > 1.0 x 10(7) s(-1), generating a manganese(II/III) oxidation state and regenerating the ruthenium(II) photosensitizer. This is the first example of intramolecular electron transfer in a supramolecular complex, in which a manganese dimer is covalently linked to a photosensitizer via a tyrosine unit, in a process which mimics the electron transfer on the donor side of PS II.

2,2'-Dipyridyl↗
PubMed2000

Patients with implantable cardioverter-defibrillators and their conceptions of the life situation: a qualitative analysis.

The implantable cardioverter-defibrillator (ICD) is today widely used for the treatment of sudden cardiac near-death episodes as a result of malignant ventricular dysrhythmia. After examining the literature, only four descriptive studies, all carried out in the USA, with a qualitative analysis based on ICD-patients' own perspectives on their life situation have been found. The aim of this study was to describe how patients living with an ICD-device in south-western Sweden conceive their life situation. As the focus was on patients' conceptions seen from a holistic perspective, an analysis inspired by phenomenography was employed on a strategic sample of 15 ICD-patients. Six categories emerged: a feeling of safety, a feeling of gratitude, a feeling of being, having a network, having a belief in the future, and gaining awareness. Although the findings cannot be generalized because of the descriptive research design, they illuminate the beneficial as well as intrusive effects of such a device, and emphasize the need for support groups for patients and families as well as further education for personnel in hospital and primary health care.

Adaptation, Psychological↗
PubMed1998

Female patients with congestive heart failure: how they conceive their life situation.

Congestive heart failure (CHF) is a significant health problem for women, particularly elderly women. The risk factors for heart failure appear to be different in women than in men, with hypertension and diabetes playing a greater role in women and ischaemic heart disease a greater role in men. The aim of this study was to describe, from a nurse's perspective, how female patients with CHF conceive their life situation. Interview questions were designed with a focus on five dimensions: biophysical, socio-cultural, emotional, intellectual and spiritual-existential. A qualitative method was used with a phenomenographic approach, as this approach examines aspects of the surroundings as they are conceived. Five categories emerged in the results: feeling content, feeling a sense of support, feeling a sense of limitation, feeling anxiety and feeling powerless. A sense of limitation regarding working capacity and being able to support those in their surroundings causes patients with CHF to experience anxiety due to feeling insecure about themselves and in relation to their surroundings. This may result in feelings of worthlessness in women with CHF, both concerning their own capacity and the fact that they feel they are a burden to those around them. Through nursing intervention, these patients can receive help to break this vicious circle of feeling limited and powerless. This can be done by encouraging them to verbalize their feelings and set realistic goals and expectations, and by increasing their knowledge and that of their families concerning CHF and its symptoms, with a focus on self-care and existing possibilities. These measures will make it easier for women with CHF to maintain a hopeful perspective and a sense of control, competence, and self-esteem.

Adaptation, Psychological↗
PubMed1998

Chromium-51-EDTA clearance in adults with a single-plasma sample.

UNLABELLED: In 1996, a committee on renal clearance recommended a mean sojourn time-based methodology for single-sample determination of plasma clearance of 99mTc-diethylenetriamine pentaacetic acid (DTPA) to be used on adults if the patient's glomerular filtration rate (GFR) is suspected to be >30 ml/min. The main purpose of this study was to derive a mean sojourn time-based formula for calculation of 51Cr-ethylenediamine tetraacetic acid (EDTA) clearance in adults. METHODS: Two groups of patients with 51Cr-EDTA clearance (Cl) between 16 and 172 ml/min were studied. In Group I (n = 46), reference Cl was determined as a multiplasma sample, single-injection method (ClSM). Sixteen blood samples were drawn from 0 until 5 hr after a single intravenous injection of 51Cr-EDTA. In Group II (n = 1046), reference Cl was determined by the Brøchner-Mortensen four-sample clearance method (ClBM). The plasma time-activity curves of Group I were used to derive two mean sojourn time-based formulas (Formulas 1 and 2) for calculation of a single-sample clearance. Formula 1 was derived from the entire time-activity curve, whereas the derivation of Formula 2 used only the final slope of the time-activity curve. The accuracy of the two formulas and the Christensen and Groth 99mTc-DTPA formula was tested on Group II. RESULTS: Chromium-51-EDTA Cl calculated by Formula 1 was almost identical to the Cl calculated by the reference Cl method (r = 0.982; SDdiff = 5.82 ml/min). Both 51Cr-EDTA Cl calculated by Formula 2 and by the 99mTc-DTPA formula showed close correlation with the reference method (r = 0.976, r = 0.985, respectively) but systematically overestimated GFR for the whole range of clearance values by 3.5 and 3.2 ml/min (p<0.001), respectively. CONCLUSION: It is possible to get an accurate determination of 51Cr-EDTA Cl from a single-plasma sample in adults by the mean sojourn time methodology. The determination is marginally more accurate (p<0.001) if using a formula derived from the entire plasma time-activity curve than from only the final slope. The single-sample formula derived for determination of 99mTc-DTPA Cl tends slightly to overestimate GFR if used to calculate 51Cr-EDTA Cl.

Adult↗
PubMed1997

Male patients with congestive heart failure and their conception of the life situation.

Patients with congestive heart failure (CHF) are an extensive group in Sweden both with regard to prevalence and number of medical care events. As the age of the population and survival after myocardial infarction are increasing, the incidence of CHF is also on the rise. The aim of this study is to describe, from a nurse's perspective, how male patients with CHF conceive their life situation. Interview questions were designed with a focus on five dimensions: the biophysical, the sociocultural, the emotional, the intellectual, and the spiritual-existential. A qualitative method was used with a phenomenographic approach as it examines aspects of the surroundings as conceived. In the results, six categories emerged: feeling a belief in the future, gaining awareness, feeling support from the environment, feeling limitation, feeling a lack of energy and feeling resignation. The mental and physical lack of energy which patients feel easily leads to limited working capacity and social activities. This limitation may cause patients with CHF to believe that neither they nor their environment can influence their life situation and there is a risk that these patients become resigned. In order to help them get out of this vicious circle of limitation and resignation, it is important that the nurse teaches them self-care and shows them the possibilities that exist in everyday life. With increased awareness of their life situation, patients may adapt to their CHF and see that it is possible to improve their future themselves.

Activities of Daily Living↗
PubMed1995

Glutathione metabolism in newborns: evidence for glutathione deficiency in plasma, bronchoalveolar lavage fluid, and lymphocytes in prematures.

Respiratory distress in premature newborns is associated with deficiency of surfactant in the bronchoalveolar lining fluid; this may be influenced by a local deficiency of antioxidants. Severe L-buthionine-S,R-sulfoximine-induced depletion of glutathione (GSH, a major antioxidant) in rodents is associated with lung type 2 cell lamellar body damage and decreased concentrations in lung and bronchoalveolar lavage fluid (BALF) of phosphatidyl choline (a major component of surfactant). At birth, prematurely born newborns (30-34 weeks) had lower peripheral venous plasma GSH concentrations than term (> 36 weeks) babies; these levels decreased further with increasing prematurity (< 27 weeks, with respiratory distress). On day 2, the peripheral venous plasma GSH concentrations reached a nadir, and the lowest levels were found in the most premature newborns. Lymphocyte GSH concentrations were lowest on day 2 and day 7, and in prematures (< 27 weeks, with respiratory distress) remained below adult lymphocyte GSH levels for at least 4 weeks. At birth, prematures (< 27 weeks, with respiratory distress) had a central plasma arterio-venous (A-V) GSH gradient across the lung (an estimate of lung uptake of GSH) of 0.72 +/- 0.15 (mean +/- SD) mumol/L; on day 2, the A-V gradient did not change significantly (0.49 +/- 0.09 mumol/L). At birth, these prematures had markedly decreased BALF GSH concentrations (compared with adult levels), and they were not significantly changed during the first 4 weeks of life. These results suggest that GSH deficiency is present in prematures and that it increases with the degree of prematurity. At birth, GSH deficiency will compromise the lungs' defense against oxidative stress injury. Oxidative stress is likely to increase if hyperoxic treatment is given for respiratory distress in these infants.

Bronchoalveolar Lavage Fluid↗
PubMed1995

The chemical nature, purity and stability of 99mTc-N-(2,6-Diethyl-3-iodo-phenylcarbamoylmethyl)-iminodiacetic acid.

The chemical purity and stability of a radio pharmaceutical 99mTc-N-(2,6-diethyl-3-iodo-phenylcarbamoylmethyl)-iminodiacetic acid (IODIDA) has been studied using HPLC. The HPLC results indicate that IODIDA decomposed into at least three species after 99mTc labelling, and the amount of these varied with time. Mass spectra obtained by negative ion FABMS of no-carrier-added (NCA) Tc-labelled IODIDA showed, in addition to the molecular ion and the sodium adduct of N-(2,6-diethyl-3-iodo-phenylcarbamoylmethyl)-iminodiacetic acid, peaks corresponding to sodium containing dimers, trimers and tetramers. Several peaks were also found that may be assigned to 99Tc(I) containing dimers, trimers and tetramers.

Chromatography, High Pressure Liquid↗