Læknablaðið : fylgirit - 05.01.2015, Blaðsíða 88

X V I I V Í S I N D A R Á Ð S T E F N A H Í
F Y L G I R I T 8 2
88 LÆKNAblaðið/Fylgirit 82 2015/101
V 98 Alvarleg munnslímhúðarbólga hjá börnum með krabbamein á
Íslandi: Algengi, áhrifaþættir og afleiðingar
Oddný Kristinsdóttir1,2, Ólafur Gísli Jónsson2, Guðrún Kristjánsdóttir1,2
1Hjúkrunarfræðideild, Háskóla Íslands, 2Barnaspítala Hringsins Landspítala
oddnyk@landspitali.is
Inngangur: Alvarleg munnslímhúðarbólga (AM) er algengur og hvim-
leiður fylgikvilli barna í krabbameinslyfjameðferð. Upplýsingar skortir
um algengi og hvernig skuli meta umfang þessa vandamáls. Hér verður
gert grein fyrir algengi, tíðni, áhrifaþáttum og afleiðingum AM hjá börn-
um sem gengust undir krabbameinslyfjameðferð á Íslandi 2002-2011.
Efniviður og aðferðir: Rannsóknin var lýðgrunduð og notast við lýsandi
afturskyggnt rannsóknarsnið. Upplýsingar voru fengnar úr sjúkraskrám
og skráðar á gagnaskráningarblað. Úrtakið voru börn (1-18 ára) sem
gengust undir krabbameinslyfjameðferð á Íslandi á árunum 2002-2011,
alls 64 börn af þeim 120 sem greindust með krabbamein á tímabilinu.
Notast var við munnslímhúðar matsskala WHO og NIC til að greina
börn með AM.
Niðurstöður: Algengi AM var 39% (n=25/64), þar af voru 60% drengir
(n=15). Börn með AM voru marktækt eldri (p=0,008) en þau sem fengu
væga eða enga munnslímhúðarbólgu. Níu börn (36%) fengu AM einu
sinni, en eitt sex sinnum, samtals voru 60 AM tilvik. Hæsta hlutfall AM
var hjá börnum með illkynja beinsarkmein, Burkitt´s eitilfrumukrabba-
mein og bráða mergfrumuhvítblæði. Blóðræktun var gerð í 80% tilvika
og sýklalyf gefin í æð í 77%. Blóðræktun var jákvæð í 21% tilvika, þar af
talið mengun í 50% þeirra. Marktæk jákvæð fylgni reyndist vera á milli
fjölda daga í daufkyrningafæð og fjölda daga með einkenni um alvar-
legrar munnslímhúðarbólgu (r=0,736, p<0,0001).
Ályktanir: Stór hluti barna í krabbameinslyfjameðferð á Íslandi fá AM.
Þetta samræmist erlendum niðurstöðum, sem þó eru misvísandi vegna
mismunandi mæliaðferða. Mikil einkennabyrði hvílir á þessum börn-
um, spítalainnlagnir eru tíðar og þau virðast útsettari fyrir sýkingum.
V 99 A Midwifery Model of Woman Centred Childbirth Care
Ólöf Ásta Ólafsdóttir1, Marie Berg2, Ingela Lundgren2
1Námsbraut í ljósmóðurfræði, Hjúkrunarfræðideild Háskóla Íslands, 2Institute of Health Care
Sciences, University of Gothenburg
olofol@hi.is
Introduction: Theoretical models for health care practice are important
both as tools for guiding daily practice, explaining the philosophical
basis for care and provide critical view to optimise and assess quality
of maternity care.
Methods and data: The aim was to identify and develop an evidence
based midwifery model of childbirth care in the cultural context of
Sweden and Iceland.. With a qualitative hermeneutic approach a woman
centred model of care was developed by a synthesis and meta-inter-
pretation of own published qualitative studies (n=12) about women´s
and midwives´ experiences of childbirth. For purposes of validity and
reliability the model was discussed and assessed for implementation in
six focus group interviews with practising midwives (n=30).
Results: The model includes five main themes. Three central intertwi-
ned themes with sub-themes that involve interactions with each woman
and family are: a reciprocal relationship; a birthing atmosphere; and
grounded knowledge. The remaining two themes around the others,
which likewise influence care, are the cultural context with hindering
and promoting norms of a midwifery approach and the balancing act
in basing work on midwifery philosophies, facilitating woman-centred
care in cooperation between midwives and other health professionals.
Implementation and evaluation of this childbirth model of care is in
progress.
Conclusions: In an era of rising technicality, this salutogenic model
could have positive impact on provision and outcome of care, raise
normality of all birth and promote interdisciplinary care. It could be
a broad theoretical framework in maternity care and applied to other
cultural contexts.
V 100 MITF in the central nervous system: A possible factor in
inflammation
Diahann A.M. Atacho1,2, Anna Þóra Pétursdóttir1, Signe K. Skadborg1,3, Eiríkur
Steingrímsson2, Pétur Henry Petersen1
1Department of Anatomy, Biomedical Center, Faculty of Medicine, University of Iceland,
2Department of Biochemistry and Molecular Biology, Biomedical Center, Faculty of Medicine,
University of Iceland, 3Department of Biology, Faculty of Science, University of Copenhagen
phenry@hi.is
Introduction: MITF is a basic helix-loop-helix leucine zipper transc-
ription factor known for its role in melanocytes. It is also expressed in
the glutamatergic neurons in the mouse olfactory bulb (OB) and mast
cells and melanocytes of the brain meninges. Mice carrying the Mitfmi-
vga9/mi-vga9 mutation do not express MITF and exhibit microphthalmia, a
white coat and become deaf at two months of age. In order to determine
the functional role of MITF in neurons, a gene expression analysis was
performed in order to characterize potential target genes. As many of
the genes upregulated in the mutant OB are involved in inflammation,
inflammation in the olfactory bulb and cortex of the Mitf mi-vga9/mi-vga9 mice
was examined.
Methods and data: Mitfmi-vga9/mi-vga9 and C57Bl/6J mice were used. Toludine
blue staining was performed on the meninges to stain for mature mast
cells, brain tissue was homogenized and used for rtPCR, Microarray or
Western Blots.
Results: MITF isoforms show a spatial expression patterns in different
regions of the brain. Analysis of the meninges shows complete loss of
mature mast cells in the Mitf mi-vga9/mi-vga9. No evidence of inflammation
was detected.
Conclusions: Mitf mi-vga9/mi-vga9 mice, though lacking mature mast cells
and showing a possible increase in inflammatory markers at the gene
level, do not show evidence of inflammation at the protein level. While
the mutant mice might be more sensitive towards CNS inflammation
and infection, it is unlikely that inflammation of the OB will complicate
studies of Mitf function in OB neurons.
V 101 Staða lyfjagjafa á hjúkrunarheimilum
Pétur S. Gunnarsson1,3, Hlynur Torfi Traustason1, Ólafur Samúelsson2,4, Jón Eyjólfur
Jónsson2,4, Aðalsteinn Guðmundsson2,4
1Lyfjafræðideild Háskóla Íslands, 2læknadeild Háskóla Íslands, 3vísinda- og þróunarsviði,
4öldrunarlækningadeild Landspítala
psg@hi.is
Inngangur: Lyfjanotkun íbúa hjúkrunarheimila er mikil og algengt að
kyngingarörðugleikar eða aðrar færniskerðingar hamli notkun og gjöf
hefðbundinna lyfjaforma. Markmið rannsóknarinnar var að kanna stöðu
lyfjagjafa á hjúkrunarheimilum. Skoðað var hvaða lyf var verið að gefa
og fylgst með því hvort þau væru meðhöndluð og gefin í samræmi við
fylgiseðil.
Efniviður og aðferðir: Rannsóknin fór fram á tveimur hjúkrunar-