Background: Culture is a concept that is individual and is also constantly changing. Transcultural nursing is however complex and includes several concepts. A multicultural society require high demands on nurses to be flexible in transcultural care. The goal is that the nurse and the patient must create a relationship that contributes to the existence where the patient can feel safe and have confidence in the Swedish health care system. Aim: The aim is to describe nurses' experiences of transcultural nursing in Sweden. Method: A literature review based on 11 scientific articles with qualitative approach that emerged in two different databases. Existing articles have undergone a thematic analysis. Results: After analyzing all the articles six different themes appeared that consisted communication barriers, education, person-centered care, gender roles and relatives. In addition, a number of categories emerged within each theme. Conclusion: It is important that the nurse sees the patient's culture from an individual context when one encounters patients of different nationalities, sexualities, social classes and cultures. The nurse should be sensitive and receptive to patient's different needs to build a trustful relationship.

Starting in the early 1980s, media coverage of customary African genital surgeries for females has been problematic and overly reliant on sources from within a global activist and advocacy movement opposed to the practice, variously described as female genital mutilation, female genital cutting, or female circumcision. Here, we use the more neutral expression female genital surgery. In their passion to end the practice, anti-mutilation advocacy organizations often make claims about female genital surgeries in Africa that are inaccurate or overgeneralized or that don't apply to most cases. The aim of this article—which we offer as a public policy advisory statement from a group of concerned research scholars, physicians, and policy experts—is not to take a collective stance on the practice of genital surgeries for either females or males. Our main aim is to express our concern about the media coverage of female genital surgeries in Africa, to call for greater accuracy in cultural representations of little-known others, and to strive for evenhandedness and high standards of reason and evidence in any future public policy debates. In effect, the statement is an invitation to actually have that debate, with all sides of the story fairly represented.

There are an increasing number of unaccompanied children coming to Sweden. Sweden is one of the countries in the world that receive many of them. This awoke my interest to investigate the assessment of financial assistance and “other living expenses” considering unaccompanied children. My approach was a qualitative study including interviewing five social secretaries working in five different districts in Malmö. Theories used to analyze collected data were: organization theory, bureaucracy school, decision making and cognition and Sence of Coherence. Eight themes were identified: briefing profession, knowledge, values, the individual needs in centrum, assessment of "other living expenses", Malmö City Guidelines, Framework as working tool and finally labour division. These together increase our understanding of the assessment of financial assistance. The result of my study shows that three factors contribute to the assessment of financial support. 1) Social Service law which is a frame law. 2) The national and local rule tools that complement the law. 3) The social secretaries personal view of the law, frameworks and unaccompanied children. The social workers did not have an internal or external education about the unaccompanied children’s situation or the child perspective. They rather took personal responsibility to help them.

Background: The transition from student to nurse has proven to be problematic. This is partly because there is a gap between theory and practice, and that there are differences in the social culture between university and professional life. A study by the National Board of Health has shown that newly qualified nurses have shortcomings in the care of critically ill patients, operate technical equipment, education and support for patients and the role of supervisor. The first three months of work is the most stressful and 30-65 percent of newly graduated nurses change jobs during the first year and this affect the health service. Therefore, there is introductory programs. There is often a socialization process that allows graduated nurses to become a part of a culture within the profession. Aim: To enlighten the transition from student to (registered) nurse. Method: A literature review that includes ten qualitative studies. The articles have been read, reviewed and analyzed to then be compiled. Database searches were made in PubMed and Cinahl. Result: Newly graduated nurses felt that the transition from study to the professional life was diffucult. They said that they lacked knowledge in key areas and that they could not live up to what was expected of them. Introduction was seen as an important part and affected the ability to evolve. Socialization occurs through different phases. Conclusion: Support and assistance proved to be a big part to feel welcome at the workplace. However, there were expectations that newly qualified nurses could not live up to and this could lead to uncertainty. The experience of the profession can also be influenced by society’s image.

Background: In most countries of the Western world there have been positive reductions in incidence of cardiovascular diseases in the past decades, among both men and women, but still mortality due to these disease groups are very high. Many studies about myocardial infarction have shown that depression after an event is related to poor medical outcomes from the disease. This means prolonged disability events of angina, arrhythmias, re-hospitalization and increased rate of mortality. In post myocardial infarction patients, depression is a major cause of both short and long term mortality. Aim: The aim of this study was to examine the scientific literature by a systematic review in order to find evidence based knowledge about the benefit of physical activity as a tool to reduce depression in patients with coronary artery event. Method: Three databases were searched (Pubmed, CINHAL, Cochrane) systematically and all articles that met inclusion criteria were examined and graded according to the criteria “Grading quality of evidence and strength of recommendations” by Atkins. A special protocol was designed further from AMSTAR by Beverley, for systematic review with and without the meta-analysis study. Results: It was evident that scientific reports fitting to the area was scarce showing that the area of interest was fairly new. Finally ten studies were included in this study, one meta-analysis, five randomized controlled trail and four clinical trials. The results showed low to moderate evidence for the use of high, moderate and low level of exercise as a tool to reduce depression in post coronary artery event patients. Conclusion: The following study concluded that, exercise shows positive effects to reduce the level of depression among coronary artery event patients.

Syftet med denna litteraturstudie är att beskriva patienters upplevelse av att leva som HIV-positiva eller AIDS sjuka samt de förväntningar patienterna har på vårdpersonal i samband med vård/omvårdnad. Som teoretisk ram har Antonovsky, A (1991) salutogena begrepp KASAM använts. Efter innehållsanalys framkom det 5 kategorier av upplevelser och 3 kategorier rörande förväntningar. De kategorier som rör upplevelser är, att känna frustration och beroende, att pendla mellan hopp och hopplöshet samt självmordstankar, att kunna hantera sitt föränderliga jag och att känna socialt stöd. De kategorier som rör förväntningar är, att känna professionalism/kompetens, att få omsorgsfull behandling och trygghet och att känna delaktighet/individuell omvårdnad. Resultatet som framkom visar på brister i omvårdnad när det gäller att kunna tillgodose patienternas behov och förväntningar.

Sysmex XE-5000 is an automated cell counter that performs measurements with different principles. The two applied in this project are RF/DC (Radio Frequency/Direct Current) and Flow cytometry with semiconductor laser. RF/DC is based on changes in radio frequency resistance and direct current voltage. Changes in RF provide information about the density of the cell’s internal structure (e.g. the nucleus) and changes in DC provide information about the size of the blood cells. Flow Cytometry define as physiological and chemical properties of the cell. Detection of cells is achieved by the irradiation with a laser beam while passing through one by one. The information obtained from flow cytometry includes scattered light and fluorescence. Sysmex XE-5000 works with several different error messages, so-called alarm. One or more alarm indicates that there is an increased risk for the presence of abnormal cells and this can only be ruled out by a manual differential count. In this study three alarms, which indicate the presence of abnormal white blood cells, were analyzed: “Blasts?”, Atypical Lympho?” and “Abn Lympho/L_Blasts?”. The project aims to compare the current calculations with the new software (eMM) for the alarms and evaluate if they provide a smaller number of false positive alarms from the hematology instrument Sysmex XE-5000. Samples with one or two of the alarms were selected and analyzed with the current settings and then with the new settings for eMM. The result showed that the number of false-positive samples was reduced and that the number of duplicate alarms decreased.

In a oncology clinic, the staff feel that the patients are treated with antineoplastic agents to close to ad mortem. Our aim is in a descriptive way examine how close in time the patients last antineoplastic agents treatment is to ad mortem, the study further aims to illustrate the difference ratio related to diagnosis, age and sex during calendar year 2004. Data were collected from the patients medical records with help of datacollectionform. The study comprise 65 journals. The results show that among other things there is a connection between patients difference and age.

HIV, Hepatitis B and C exist around the world. Globally there are approximately 40 million people infected with HIV, 350 million are living with chronic Hepatitis B and 170 million are infected with Hepatitis C. The purpose of this literature review is to investigate if knowledge affects health care workers’ attitudes towards patients with chronic blood-borne infection. This review is based on 10 scientific articles of quantitative and qualitative design. The result of the selected articles lead to four themes: knowledge and attitude, knowledge and fear, knowledge and the willingness to care and knowledge and standard precautions. This literature review proves that knowledge does change health care workers’ attitudes, reduces fear and improves the willingness to care. The results show that education on blood-borne infections and standard precautions increases the knowledge and creates a safety for health care workers to provide the best possible nursing care.

Objectives: This is to identify factors affecting the prevalence of Lactobacillus reuteri in maternal faeces and breast milk and infant faeces after oral supplementation with L. reuteri and to assess the influence on microbial ecology, particularly Clostridium difficile and Bifidobacterium colonization. Materials and Methods: In this double-blind trial, 232 mothers with a family history of atopic disease were randomized to a daily intake of either L. reuteri American-type culture collection (ATCC) 55730 (1 x 108 colony forming units (CFU)) or placebo for the last 4 weeks of pregnancy. Their babies then continued with tha same study product daily from birth until 12 months of age. Bacterial counts and prevalence were assessed in maternal breast milk and faeces and infant faeces, using conventional cultivation methods. Results: The prevalence of L. reuteri was higher during the first year of life in the stool samples from infants in the active as compared with the placebo-treated group. The highest prevalence was recorded at 5 to 6 days of age (82% in the treated vs 20% in the placebo group, P < 0.001). Lactobacillus reuteri was isolated from 12% and 2%, respectively, in the colostrum samples (P < 0.05). Breast-feeding seemed to reduce faecal L. reuteri counts, although antibiotics did not influence the levels of L. reuteri. The administration of L. reuteri did not affect bifidobacteria or C. difficile colonization. Conclusion: Lactobacillus reuteri may be detected in breats milk after oral supplementation to the mother and in almost all infants after oral supplementation during the first year of life, as well as occasionally in many untreated infants.

Tanken med denna studie var att kritiskt granska och redovisa resultatet från vetenskapliga artiklar. Litteraturstudien syftade till att ta reda på hur man bör bemöta en närstående i kris, när den närstående har förlorat någon eller löper risk att förlora någon. Dessutom besvaras om vårdpersonalen uppfyller de närståendes behov. Denna litteraturstudie riktar sig främst till sjuksköterskor. Vår förhoppning var att ge ett redskap för att kunna förbättra omvårdnaden av de närstående. I resultatet påvisades fyra teman som var viktiga i bemötandet. Dessa var: information, närhet, enskildhet och utbildning. I slutet av arbetet ges rekommendationer för sjuksköterskan att använda i mötet med närstående. Rekommendationerna utgick från de vetenskapliga artiklarna.

The design of the coordination shell of an Os-complex and its integration within an electrodeposition polymer enables fast electron transfer between an electrode and a polymer entrapped high-potential laccase from the basidiomycete Trametes hirsuta. The redox potential of the Os3+/2+-centre tethered to the polymer backbone (+720 mV vs. NHE) is perfectly matching the potential of the enzyme (+780 mV vs. NHE at pH 6.5). The laccase and the Os-complex modified anodic electrodeposition polymer were simultaneously precipitated on the surface of a glassy carbon electrode by means of a pH-shift to 2.5. The modified electrode was investigated with respect to biocatalytic oxygen reduction to water. The proposed modified electrode has potential applications as biofuel cell cathode.

Abstract Khat is a plant that grows in East Africa and Yemen which has been used as a stimulant for a long time. To achieve its optimum effect users chew its leaves and stems, and then swallow them. A Khat chewing session can approximately last for several hours. Khat causes amongst other things insomnia, euphoric feeling, delusion and hyperactivity. Historically, Khat has been used by some religious groups especially those called Sufis in order to meditate and stay awake during their rituals at night. As Khat use became more common in the Somali communities in recent times its economic and social problems has also become evident. This has led to many expressing their concerns over Khat consumption. In Sweden, Khat has been classified as a drug since 1989. Its possession can lead to imprisonment, fine or both. Nonetheless it is used by many Somalis who live in Sweden, especially males, on a daily basis. Among these are young people under the age of 26 who also use and has been using it for several years. The purpose of my study was through a qualitative approach examine how it was that these young people were attracted by Khat, and if so, what are the underlying reasons that can be the basis for why they have started chewing Khat at an early age. The study contains interviews with four male youth, where they told amongst other things their own life history, family background and education. The result of the study shows that it is the parents' inability and the authorities that have not made enough to pay attention to Khat problems that have led to these young people becoming victims of Khat consumption. The parents have failed in their parental role by not discovering their teenagers´ Khat consumption at an appropriate time. In addition, they knew little of their whereabouts and with whom they were associated with. The authorities have on their side failed in their responsibility by underestimating the use of Khat among Somali youth living in Malmö and the extent of its social, economical and clinical implications.

The purpose of this literature review was to compile research evidence on patients’ quality of life and nurse’s interventions with regard to oral complications which are problems seen frequently in patients within palliative care. Our questions were: How do oral complications influence quality of life in patients within palliative care? What kind of interventions can a nurse do on the one hand to help patients maintain good oral status, and on the other hand to help patients strengthen their resources to maintain the balance between demands in daily life and resources, internal as well as external? Method: A literature review based on eleven research articles. The authors chose as theoretical reference Carnevali’s balance model, Daily life - Functional state of health. The results showed that physical labour and psychosocial suffering in consequence of oral complications affected patients’ quality of life to a great extent. This resulted in imbalance between the daily life demand and the patients’ resources. The interventions that nurses can use are prevention, patient education, documentation, reports and treating of oral complications. Results from this review can be used in care of patients within palliative care who experience oral complications.

In The Democratic Contradictions of Multiculturalism, Jens-Martin Eriksen and Frederik Stjernfelt elaborate on the concept of “culturalism.” In Telos 163 (Summer 2013), Eriksen continues to analyze its intricacies under the heading “Culturalism: When the Culture becomes Political Ideology.”2 Horizontal class divisions are out, vertical cultural barriers are in. Seemingly, culture has squeezed out all other concepts. The present essay shall broaden this discussion by asking the question: What is the relation between the Counter-Enlightenment of the early nineteenth century and today's culturalism?

The purpose of this paper is to examine the constructions of sexuality, which are produced when judgments concerning asylum are made, based on an asylum seeker’s sexual orientation. The question formulations are the following: Which constructions of sexuality are produced when necessary condition, fear of persecution due to sexual orientation, is applied in judgments regarding refugee status? Furthermore, how constructions of sexuality differ in the judgments where the asylum seeker has been consented and rejected is investigated. The empirical material consists of 13 judgments, which were announced between the years 2009-2013 by the Migration court. A critical discourse analysis is applied in order to answer the question formulations. By examining the linguistic representations in these judgments, the aim is to visualize the statements and positions that are made possible within the discourse. The discourse analysis is mainly based on a queer theoretical perspective with selected concepts from Foucault. The concepts that the analysis is based on are the following; object and subject positions, heteronormativity, performativity and the heterosexual matrix. The results show that constructions of sexuality within the legal discourse, are based on heteronormative perceptions around sexuality. In 8 of 13 judgments, the asylum applicant’s sexual orientation is questioned and they are made to prove their homosexuality. Homosexuality is not given legitimacy within the discourse when the asylum seeker has given descriptions of a heterosexual life according to the judge definition, such as when the person has been in relationships with the opposite sex and have children. A bisexual practice is therefore, not given any legitimacy. Homosexuality is given legitimacy only when the asylum seeker is living in a homosexual relationship. In addition, homosexuality is given credibility when the narrative includes descriptions of homosexuality as an insight involving strong emotions. The result also shows how the asylum seeker is requested to hide their homosexuality in cases where the sexual orientation is criminalized in the person’s home country. In the judgments where the asylum seeker has been rejected, there are constructions of sexuality, which accept the prevailing heteronormativity as well as conceal resistance against oppression. In the judgments in which the asylum seeker has been given refugee status, the definition of sexuality is set in a larger context focusing on the social structures prevalent in the asylum seeker’s home country.

Pain is something subjective and it is only the patient who knows how much pain he has. Pain measurement gives the nurse a perception of the patients’ experience of pain. Nurses often come in contact with patients with pain and that is why it is important to assess the patients’ pain adequately. Different instruments for pain assessment have been developed and are a complement to the nurse in pain measurement. The aim of this study is to get better knowledge and insight into pain measurement from a nurse’s perspective. The study also examines which methods are used in pain measurement, how assessments function in every day medical practise and nurses’ attitudes towards pain measurement. The method of data collection was to interview 9 nurses at two orthopaedic wards. The analysis was done by modified manifest content analysis where four main categories were compiled. Nurse’s pain measurement is individual. If the patient is oriented to time and room the nurse uses visual analoge scale (VAS). If the patient suffers from cognitively dysfunction the nurse looks at the movement pattern or asks about pain. VAS is the tool that is most common. The advantage by using VAS is easy to document. The disadvantage is that some patients learn what to say to get painrelieving.

Background: Here we present the influence of smoking as well as general knowledge of tobacco, which risks occur prior to surgery and surgical wounds. How patient should take care of their surgical wounds to prevent the occurrence of infections. Wound healing process is described and is an important point for the patient's health condition. Nurses role set out, the problems raised about how the literature chosen topic. Aim: The aim of this review was to describe the influence of tobacco smoking on wound healing of surgical wounds. Method: A literature review where ten articles were analysed and reviewed with SBU audit template. Results: Smoking associated with surgery has proven to be one of the causes of impaired operation wound healing. Patients experiencing health problems related to complications. Surgical wound infection is the most common complication associated with smoking and surgical wounds. This is a dilemma that still requires more studies to find a better solution to reduce these complications. However, hospitals are spending enormous amounts of money and resources due to prolonged hospital stays and surgical wound care. Final words: Information about the consequences of smoking at the surgical site must be strengthened so that patients know that smoking can prolong hospital stay and wound healing process, increase the risk of infections and other complications. The relationship between care and the patient needs to be strengthened so finally the patient may experience health associated with surgery. The nurse's role continues by teaching and informing patients about their health.

As our society becomes increasingly multicultural we meet a bigger proportion of people from different cultural backgrounds and with a lack of language proficiency. The aim of this literature review was to illuminate communication problems that arise due to lack of language proficiency and cultural differences in the encounter between patients and health care personnel. The method consisted of database searches in PubMed and Cinahl, 10 articles were chosen and reviewed. From these articles the literature review’s results arose and illuminate aspects such as interpretation problems, the use of bilingual health care personnel, the health care relationship and the educational needs of health care personnel. The authors found there are a limited interpreter access and an uncertainty regarding the accuracy of the interpreted. Bilingual health care personnel are used and are considered giving patient-centered information but involve a heavier workload for the personnel. Within the health care relationship there are both positive and negative attitudes and a shared tension between patient and health care personnel.

The purpose of this study is to research different methods that can be used to prevent osteoporosis and review the nurses` teaching roll in connection with prevention. Method is a literature review. Ten scientific articles were reviewed and analyzed which resulted in the following themes: the importance of food, exercise’s effect to prevent osteoporosis, prevention program and the nurses´ teaching roll. The results demonstrate that the prevention of osteoporosis is effective but it is often difficult to convey the information to the desired target group. In conclusion nurses are in a good position to inform patients regarding the meaning of prevention methods and its procedure.

Background: Patients in palliative care are in need of hope to be able to live during the time left for them. The nursing care of patients in palliative care is connected to the patient’s experience of hope. In a Swedish context it has not been published any study since 1998, concerning how nurses do to mediate hope to patients in palliative care. Aim: The aim of this study was to elucidate how nurses in Sweden mediate hope to patients in palliative care. Method: A qualitative empirical inductive study was conducted. Eight nurses working in a palliative care-unit or a palliative home care-unit (ASIH) were interviewed. The interviews were analyzed with inspiration of Graneheim & Lundman´s qualitative content analysis (2004). Results: The study shows that nurses redirect the hope, permit the incredible hope, build relationships, help with practicalities, handle symptoms medically, touch physically and involve others to mediate hope to patients in palliative care. The result is presented in categories and subcategories, where the categories constitute above-mentioned concepts. Conclusion: The study especially shows that nurses redirect the hope and permit the incredible hope to mediate hope to patients in palliative care. The study also shows a tension between these two categories.

The aim of this empirical study was to investigate how nurses on a ward within the emergency clinic deal with analgesia prescriptions and the pain management documentation. The used method was divided into chart reviews and qualitative interviews with nurses in clinical practice at the ward. This means that both a qualitative and quantitative approach was desired. The results incline that nurses generally apply to the laws and restrictions surrounding the nursing discipline, as used in pain treatment. Thus they generally fulfill the obligations accounting to documentation. The questions concerning how nurses handle temporary and general prescriptions imply that they are used with great caution.

The following report is a constructive responsive evaluation of Svalövs communes unit for newly arrived refugees based on a qualitative user- and stakeholder model. The main purpose is to evaluate the units’ quality from a user and stakeholder perspective. The main findings are that the users and stakeholders are satisfied with the quality of the units’ services but request further social and structural participation. The evaluation provides new organizational understanding and constructive feedback from a systems theory perspective. The conclusion is that further insight in systemic analysis of the intervention is of importance to further develop the units’ perceived success.

Amino-terminated mesoporous silica nanoparticles embedding carbon dots (MSCD) formed by calcination were functionalized with a nitric oxide (NO) photodonor (1) to give a robust MSCD-1 conjugate. The intense fluorescence of MSCDs was strongly quenched in MSCD-1 by effective energy transfer. Visible light excitation of MSCD-1 liberates NO, suppresses the energy transfer mechanism and leads to concomitant fluorescence restoration of the MSCD scaffold, which acts as an optical reporter for the released NO. The MSCD-1 hybrid is also able to encapsulate the highly hydrophobic photosensitizer temoporfin, preserving the fluorescence reporting function.

Children living with a parent with a mental illness can face difficulties. Parentalmental illness may influence the parents’ ability to cope with family life, where theparents’ awareness of their illness plays an important role. Family interventionsprovided by psychiatric and children’s social care services can be a way to supportthese children, making them feel less burdened, and improving the relationshipswithin the family. The aim of this thesis was to illuminate how children infamilies with a parent with a mental illness are supported in psychiatric and socialservices, especially by means of family interventions, and how families experiencethe support. Study I explored how professionals in adult psychiatric outpatient servicesdeal with children and families when a parent has a mental illness. The findingsshowed that professionals balanced between establishing, and maintaining,a relationship with the patient and fulfilling the legal obligations towards thepatient’s children. Asking the patient about their children could be experiencedas intrusive, and involving the patient’s family in the treatment could be seen asa dilemma, in relation to the patient. Efforts were made to enhance the familyperspective, and when the patient’s family and children joined the treatment thisrequired flexibility from the professional. Study II examined how professionals in children’s social care services experienceworking with children and families when a parent has a mental illness. The socialworkers’ objective was to identify the needs of the children. No specific attentionwas paid to families with parental mental illness; they were supported in thesame way as other families. When the parental mental illness became difficult tohandle both for the parent and the social worker, the latter had to set the child’sneeds aside in order to support the parent. Interagency collaboration seemed likea successful way to support these families, but difficult to achieve. Study III investigated if patients in psychiatric services that are also parentsof underage children, are provided with child-focused interventions or involvedin interagency collaboration between psychiatric and social services and childand adolescent psychiatry. The findings showed that only 12.9% of the patientsregistered as parents in Psykiatri Skåne had registered children under the ageof 18 years. One fourth of these patients had been provided with child-focusedinterventions in psychiatric service, and 13% of them were involved in interagencycollaboration. If a patient received child-focused interventions from the psychiatricservices, the likelihood of being involved in interagency collaboration was fivetimes greater as compared to patients receiving no child-focused intervention.Study IV explored how parents and their underage children who were supportedwith family interventions experienced these interventions. The results showedthat parents experiencing mental illness were eager to find support in explainingto and talking with their children about their mental illness, although the supportfrom the psychiatric service varied. Both children and other family membersappreciated being invited to family interventions. After such an intervention, theyexperienced the atmosphere in the family as less strained and found it easier tocommunicate with each other about difficulties. Unfortunately, the participatingpartners felt that they were left without support specifically targeted at them. The thesis showed that there is a gap between how professionals deal withquestions concerning these families and their support, and the parents’ and thefamilies’ needs to receive support in handling the parental mental illness in thefamily. The psychiatric and social services need to expand their approach andwork with the whole family, in order to meet the needs of the child and otherfamily members involved.

The aim of this study is to describe the experiences of children’s social workers in Sweden who work with families in which a parent suffers from serious mental illness, and how a child in such a family receives support. Data were collected through individual interviews and focus groups discussions with 13 professionals in 2 minor municipalities in southern Sweden. Interviewees stated that parental serious mental illness was not a main focus for children’s social workers. When parental serious mental illness became a barrier to caring for their children, the children’s social workers sought to collaborate with psychiatric services, but in many cases it did not turn out well. Providing support to the parent was one way of aiding the family, although at the price of setting the child’s perspective aside. Being faced with responsibility for the parent and the child left children’s social workers feeling they were the last outpost for the families. Children’s social workers require greater knowledge of how to handle parental serious mental illness, and more interagency collaboration with psychiatric services is needed to adequately support children of parents with a serious mental illness. Keywords: children of parents with serious mental illness; parental serious mental illness; children’s social workers; psychiatric services

Abstract Background: Children of parents with a mental illness need support from adult psychiatric services. Efforts have been made to enhance the knowledge of practitioners in this field so that they may work in a more family- oriented manner and to include children in the therapeutic services they provide. Aim: This study investigates how adult psychiatry services works with families and children when a parent has a mental illness. Method: Twenty-four Swedish professional care providers were interviewed individually or in focus groups. Data was analyzed using an inductive content method. Results: Although the professionals knew that their patients had minor children, they still prioritized the individual relationship they had with the parent. Few efforts were made to include both children and families in the treatment offered, and when this happened it was done at the professional’s own discretion. Conclusion: Despite the mandatory Swedish obligation to pay attention to a patient’s children, our study showed that professionals tend to fall short in this regard. Adult psychiatry services needs to strengthen family -oriented work in order to provide support to such children. Keywords: Minor children; Parents with mental illness; Adult psychiatric services; Family therapy

Widespread discrimination across much of sub-Saharan Africa against persons with same-sex sexuality, including recent attempts in Uganda to extend criminal sanctions against same-sex behavior, are likely to have profound effects on this group's health, health care access, and well-being. Yet knowledge of the prevalence of same-sex sexuality in this region is scarce. This study aimed to systematically examine prevalence of same-sex sexuality and related health risks in young Ugandan adults. We conducted two cross-sectional survey studies in south-western Uganda targeting student samples (n = 980, n = 1954) representing 80% and 72% of the entire undergraduate classes attending a university in 2005 and 2010, respectively. A questionnaire assessed items concerning same-sex sexuality (same-sex attraction/fantasies, same-sex sexual relations), mental health, substance use, experience of violence, risky sexual behavior, and sexual health counseling needs. Our findings showed that same-sex sexual attraction/fantasies and behavior were common among male and female students, with 10-25% reporting having sexual attraction/fantasies regarding persons of the same-sex, and 6-16% reporting same-sex sexual relations. Experiences of same-sex sexuality were associated with health risks, e.g. poor mental health (2010, AOR = 1.5; 95% CI: 1.0-2.3), sexual coercion (2010, AOR 2.9; CI: 1.9-4.6), and unmet sexual health counseling needs (2010, AOR 2.2; CI: 1.4-3.3). This first study of young adults in Uganda with same-sex sexuality found high levels of health needs but poor access to health care. Effective response is likely to require major shifts in current policy, efforts to reduce stigmatization, and reorientation of health services to better meet the needs of this vulnerable group of young people.

Each year, hundreds of children in Sweden get evicted. This despite the fact that the Swedish government 25 years ago confirmed the Convention on the Rights of the Child, the “best interest of the child” is implemented in Swedish law, and that the Health and Human Services Department since 2002 has been given the assignment to prevent evictions and to completely eliminate evictions of children. The purpose of this study is to examine how the best interest of the child are taken into account in judicial decision concerning children who are evicted and the executions of these decisions. 34 judicial decisions have been studied and one interview with representatives of the Swedish Enforcement Authority in a city in Skåne has been carried out. The result of this paper shows that children are mentioned in judicial decisions concerning evictions, however this is stated in only a few of them. In just one of the studied judicial decisions the best interest of the child is mentioned and this has influenced the outcome of the case. Furthermore, it appears that the Senior Enforcement Officer doesn’t take in consideration whether a child is likely to be evicted or not. The center of interest is on good treatment against the child and a specific contingence with social services is seen as necessary.

NURSE´S ATTITUDE AND APPROACH TO POSTOPERATIVE PAIN AND ITS EFFECT ON PAIN TREATMENT A SYSTEMATIC REVIEW HANNA OTTOSSON BURGE RANNA AGHA Ottosson Burge, H & Agha, R. Nurse´s attitude and approach to postoperative pain and its effect on pain treatment – a systematic review Degree Project, 15 Credit Points. Nursing Programme, Malmö University: Faculty of Health and Society, Department of Health Care, 2012. Abstract. Several studies have shown and show that postoperative pain is underestimated and under treated. The purpose of this systematic literature review was to examine nurses' attitudes and approaches to postoperative pain and pain treatment. A modified version of Goodman's seven steps was used as method. Eleven scientific, qualitative articles were used. The analysis revealed four categories: 1) Concerns about side effects 2) Views on commitment and influence 3) Subjective view on pain 4) Nurses ´confidence in experience and objective signs of pain. This study shows that the nurses who participated in the eleven selected studies consider pain to be a subjective experience. Despite this, it appears that most nurses, when assessing pain, mainly focuses on objective signs of pain. They act from the perspective that pain is an objective phenomenon. Lack of objective, physiological signs of pain caused the nurses to believe that the pain was not so severe, and treated the patient with pain accordingly. Keywords: nurses´attitude, nurses´approach, pain assessment, postoperative pain, pain relief, pain treatment, systematic review

Syftet med denna litteraturstudie är att undersöka och synliggöra olika aspekter på hur kvinnor efter en hjärtinfarkt upplever sin psykiska och emotionella hälsa.

The purpose of this review was from nurse´s perception to investigate in scientific literature nurse´s attitude to opioidtreatmentin palliative care. After inspiration from the model of Goodman the working process was formed in six steps and the review is based on systematic scruntiny and analysis from eight scientific articles. The results shows that knowledge and experience has got positive impact on nurse´s attitude to opioidtreatment in palliative care.The results produced as well that nurses with short experience of working, nurses inexperience in caring of serious disease and dying patients, plus nurses who dont show confidence to opioids as a treatment are averse against opioidadministration.

Background: Approximately 31.4 million people worldwide develop sepsis annually with mortality rates around 5.3 million. Early identification of the symptoms of sepsis is essential for the patient’s chances of recovery. The nurse works closely with the patient and is therefore best equipped to identify sepsis at an early stage. There are different tools available to assist the nurse in identifying sepsis. Aim: The aim of this study was to investigate which tools the general nurse can use to identify sepsis and what evidence support them. Method: A quantitative literature review of ten scientific studies published 2012- 2017 were reviewed, compiled and graded for evidence. Result: Four tools were identified: SIRS (systemic inflammatory response syndrome), Electronic Medical Record alert system, qSOFA (quick sequential organ failure assessment) and PRESS (prehospital recognition of severe sepsis) score. The evidence review indicated very low evidence for all tools, largely due to limited sample size. Conclusion: The study showed that there are different tools that may be useful to identify sepsis but not to give a definitive diagnosis. The tools can be used to identify the symptoms typically exhibited in a systemic response to infection. However a holistic stance that takes into consideration all of the symptoms presented by the patient is needed to identify actual sepsis. The international guidelines recommend using qSOFA outside of intensive care but SFAI (swe. Svensk förening för anestesi och intensivvård) recommend adhering to NEWS (national early warning score) and MEWS (modified early warning score) in Sweden as these are already established tools.

It is estimated that around 200 000 people in Sweden suffer from heart failure. It is of the utmost importance to gain an understanding of heart failure from an overall perspective as the illness affects each individual in many different ways. The purpose of the study was to examine how living with heart failure affects the daily life of the patients. The focus was also laid on how nurses performed their care based on these experiences. The research process was inspired by Goodman’s seven steps. The literature study is based on 14 scientific articles. We have used, as a theoretical frame of reference Carnevalis Daily life Functional health condition – model. The result shows that patients with heart failure experience physical limitations due to fatigue, lack of energy, dyspné and sleep deficiency. The illness also affects nutrition and the psychosocial state of the patients. The result of the study also shows a lack of knowledge amongst some patients with heart failure exists. An important task for nurses was to assess and observe physical and psychosocial factors amongst patients. Relieving symptoms and informing patients about heart failure was also included in nurses´ care.

Aim of study - The aim of the present work was to compare patients with advancedcancer receiving specialized palliative home care with those receiving conventional carewith regard to time spent at home and place of death (Paper I), factors associated with thepatients’ choice of palliative care (Paper II), and to describe the health-related quality oflife (HRQL) and the occurrence and changes in symptoms over the last three months ofthe patients’ lives (Paper III). In addition, sociodemographic and clinical differencesbetween participants and dropouts were explored in order to establish whether themissing data could be regarded as missing at random (Paper IV).Background - A hospital-based advanced home care programme was initiated in Malmö,Sweden in December1995, in order to enable patients to remain at home for a longerperiod and to choose to die at home. The allocation to advanced home care (AHC) orconventional care (CC) was performed according to the patients’ preferences. Thisintervention offered an opportunity to investigate the effect of AHC and to describe theHRQL of patients with a progressive, life-threatening disease.Methods - A prospective longitudinal comparative study was performed including 297patients consecutively recruited over 2½ years. The two groups of patients (AHC andCC) were compared and the main outcome variables were place of death, time spent ininstitution or at home, and the patients’ HRQL. The latter was assessed monthly by usingself-reported questionnaires, including the European Organisation for Research andTreatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30), the Impactof Event Scale (IES), five questions about social support (MA) and two items concerninggeneral well-being (NT). At the same time, in Trondheim, Norway, a similar palliativecare intervention programme was started. The design of the study was slightly different,but patients were evaluated using the same sociodemographic and clinical variables, andquestionnaire data were collected in the same way as in the Swedish study.Results - The AHC patients spent more time outside the hospital and more patients diedat home compared with patients in the CC group (Paper I). However, there was adifference between patients in the two interventions. Compared with the CC patients,patients who chose the AHC programme had lived longer with their cancer diagnosis,had a shorter survival period after study enrolment, and had poorer performance status. Inaddition, although all patients had reduced HRQL at inclusion, the AHC patients reportedpoorer functioning and more symptoms than the CC patients (Paper II). Results from theHRQL questionnaires returned during the last three months of the patients’ lives wereanalysed in order to describe the symptom burden of dying patients. Due to considerableattrition over the study period, data from the Norwegian study were included in order toincrease the study sample to 116 patients. Generally, a marked, but gradual deteriorationwas seen during the patients’ last three months of life. A more rapid increase in problemswas observed between two and one month before death regarding Physical, Cognitiveand Social function, as well as Fatigue. The mean scores for Pain, Nausea/Vomiting,Sleeping problems, Diarrhoea and Financial impact were stable over time (Paper III).Analyses of the characteristics of patients who dropped out of the study after filling in thefirst questionnaire after inclusion confirmed that they had a less favourable prognosis,with regard to both clinical variables and HRQL data. This pattern was not found whenanalysing data from patients dropping out of the study during the last two months beforedeath (Paper IV).Conclusions -The results obtained in this work add knowledge about patients’preferences regarding care at the end of life, and changes in their HRQL during the lastfew months of life. The palliative intervention with AHC proved successful, and enabledmore patients to stay at home for a longer period, and to die at home. Dying at home isstrongly associated with the patients’ preference to do so. Due to the design of the study,the impact of such preferences cannot be separated from the impact of the AHC. Theresults indicate that patients are reluctant to accept home care until necessary due to theseverity of functioning impairments and symptom burden. It is important to be aware ofthe high level of symptoms in the patients’ last three months of life. Symptom assessmentusing standardised questionnaires may enhance the focus on symptom management.Results from HRQL studies must be interpreted with care due to non-random attrition.This is less evident close to death.

In a longitudinal study of 297 palliative care patients, 280 patients were followed from inclusion to death. Characteristics and health-related quality of life (HRQL) of the participants and those who later dropped out were compared at inclusion, and 3 and 2 months before their death. At inclusion, the dropouts were older (P = 0.001), had reduced Karnofsky performance score (P < 0.001), received more help from the local authority (P = 0.004) and had reduced HRQL compared with patients who continued in the study and completed the next questionnaire. There were no differences in any of the HRQL parameters between participants and dropouts 3 months before death. Two months before death, differences in HRQL were found, but in favour of the dropouts. Data from patients close to death may be representative of a larger group of patients, whereas initial dropouts may lead to a positive bias of reported HRQL.

Cancer patients with advanced disease and short-survival expectancy were given hospitalbased advanced home care (AHC) or conventional care (CC), according to their preference. The two groups were compared at baseline to investigate whether there were differences between the AHC and the CC patients that may help explain their choice of care. The patients were consecutively recruited over 2½ years. Sociodemographic and medical data, and the health-related quality of life (HRQL) of the two groups were compared. HRQL was assessed using a self-reporting questionnaire, including the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQC30), the Impact of Event Scale (IES), five questions about social support, and two items concerning general well-being. The AHC group showed significantly poorer functioning on all the EORTC QLQ-C30 scales and an overall higher symptom burden than the CC patients. Fewer of the AHC patients were receiving cancer treatment. The AHC patients had lived longer with their cancer diagnosis, had a significantly shorter survival after study enrollment, and a significantly poorer performance status. The major differences between the two groups seemed to be related to being at different stages in their disease. The results indicate that patients are reluctant to accept home care until absolutely necessary due to severity of functioning impairments and symptom burden. These findings should be taken into consideration in planning palliative care services. J Pain Symptom Manage 2008;36:217e227. 2008 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Goals of work The aim of the study was to explore the development of functioning impairments and symptom occurrence during the last months of life of advanced cancer patients. Materials and methods Self-reported data from 116 patients who all completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire—Core 30 (EORTC QLQ-C30) at 3, 2 and 1 month before death were analysed. Main results All functioning aspects deteriorated. For physical, cognitive and social function, the most marked changes occurred between 2 and 1 month before death. The proportion reporting serious difficulties with self-care activities increased from 14% to 43%. The most seriously affected activity could not be distinguished from the EORTC QLQ-C30 scores. Levels of fatigue, dyspnoea and appetite loss increased significantly. More than 50% of the patients had severe pain at all assessments, and only a minor number (8%) reported any improvement. Conclusions The findings have implications for the planning of care and indicate that further research is required to improve assessment, treatment and follow-up procedures. Adequate pain treatment seems still to be a challenge. Anorexia, fatigue as well as dyspnoea are all symptoms that need further focus.

Background: Stroke strikes about 30 000 persons/year in Sweden and is the third largest cause of death. When a person get struck by a stroke it doesn’t only affect the patient, it affects the relative as well, they are been put in a hole new role. That’s why it is very important that the staffs are sensitive for the relative’s needs of information and support so that the relatives can put themselves in their new role as carers. The purpose of this literature review was to investigate relative’s needs for information and support when a family member gets struck by a stroke from the relatives point of view. Method: The study has been done as a literature review. The ten scientific articles that have been examined have been both qualitative and quantitative. The results showed that relatives have a need for more information and support from the hospital staff than they get. They expressed that these needs not have been met. It also showed that the lack of accessibility from the hospital staff signify that the relatives must find their information from other sources by themselves. The nurses are the professionals whom have the responsibility that the nursing care, the support and information is given in the best way. The results are shown from the following head categories; information from hospital staff and support from hospital staff with following sub categories; medical information, information before going home, accessibility and teaching. Conclusion: To establish a clear strategy for all hospital staff to follow so that no lack will appear would be something to struggle after.

HOW DO SOCIAL WORKERS WORK WITH PROSTITUTION? A case study on social work in the work with prostitution and perspectives on the sex purchase law from social workers. PERNILLA ELOFSSON MARIA AHLQVIST Elofsson, P. & Ahlqvist, M. How do social workers work with prostitution? A case study on social work in the work with prostitution and perspectives on the sex purchase law from social workers. A thesis in social work, 15 points. Malmö College of higher learning: Health and Society, The Unit of social work, 2009. Our purpose with this study is to examine how social workers describe the purpose and the ambition with social work targeting prostitution and how they see the opportunities to meet this ambition. We also want to examine what they think about the sex purchase law and the debate that have arisen around it in the recent years. Our issues are: What’s the goal and purpose of the work with prostitution and how are the social workers working to achieve it? How do social workers that work with prostitution reason about the sex purchase law and the debate about it that has been and is still going on? In order to answer our issues we have done qualitative interviews with social workers. One of them was a group interview with two social workers and the other was a case study with four social workers. The social workers in the group interview works with prostitution on the street. The social workers in the case study works with prostitution on the Internet and with the persons who buy sex. The interviews have focused on the social workers perspectives, thoughts and the reasoning about their work with prostitution and the sex purchase law. We’ve tried to create an understanding for what the sex purchase law has and the experiences from it have meant for their work. The theories we have used are social constructivism and queer theory. We’ve briefly come to the conclusion that it is clear what the social workers are supposed to do in their work with prostitution but not how there are supposed to do it. This creates an uncertainty in what direction they're working in. The social workers think that the debate about the sex purchase law isn’t leading anywhere and that the law has done both good and bad for the women that sell sex. They also think that the law is an attitude law that let’s the society know the difference between right and wrong but it creates categories of people, victim and offender.

Ahlqvist, P & Fondelius, F. Dialysis on the patients´own terms. A questionnaire. De-gree project, 15 Credit Points. Malmö University: Health and Society, Department of nursing, 2009. To be a dialysis patient means to be dependent on a life-sustaining and time-consuming treatment. The patients learn to live with the restrictions which are placed on them. By being more involved in their care they could experience the satisfaction of becoming more independent. The aim of the study was to describe haemodialysis patients’ experiences of being able to influence specific aspects of the dialysis treat-ment. A quantitative study using data obtained from a semi-structured questionnaire that was distributed among 30 dialysis patients at a haemodialysis unit was per-formed. The results showed that the dialysis patients were satisfied/very satisfied with their dialysis days and schedules and did not wish to make any changes. Patients seemed to prefer a fixed schedule which they can plan their lives around. Such a schedule provides them with a feeling of security, developed by their coping. Several patients requested to have their dialysis treatments in a single-room.

Background: It occurs about 18 000 hip fractures in Sweden each year and that number is rising with the aging population. A good pain relief after surgery leads to decreased pain and shorter hospitalization. Aim: To explore how nurses can assess postoperative pain in patients with hip fracture. Method: A literature review in which ten articles have been reviewed and put together. Results: There are many different tools for pain assessment. It is important to adapt the instrument to the patient's resources when the risk of error decreases. Age and cognitive ability are two factors that affect the assessment of pain. The communication between the nurse and the patient also influences pain assessment. It can be facilitated by a patient appropriate language, which also gives the patient the opportunity to communicate their pain to the nurse.

The interest for complementary medicine treatment is increasing among patients as well as health care professionals. The aim of this literature review was to examine the effect of three complementary therapies on postoperative pain. Central questions were if transcutaneous electrical nerve stimulation, massage and music have a pain-relieving effect on postoperative pain. The seven steps of Goodman (Willman et al, 2006) were used through the process of this literature review. A total of 11 articles were included after searches in the databases PubMed and CINAHL. The scrutiny and the judge of quality were made indi-vidually, using guidelines of Polit & Beck (2006) and a protocol by Willman, et al (2006). Results of the included articles showed that transcutaneous electrical nerve stimulation can relieve postoperative pain and decrease the use of anal-gesics. Results also showed that massage can reduce both the intensity and the unpleasantness of postoperative pain. It also appeared that music can both reduce postoperative pain and the use of analgesics. Further studies are required to additionally be able to establish the effect and evidence of the three comple-mentary therapies in postoperative pain.

” THE REALITY CHOCK” A QUALITATIVE STUDY ABOUT BURNOUT AND ITS IMPACT ON THE WORKPLACE ISRAA AHMAD AJIN YASSIN Ahmad, I & Yassin, A.” The reality chock”. A qualitative study about burnout and its impact on the workplace. Degree project in Social Work 15 credits. Malmö. University: Faculty of health and society. Department of Social Work, 2016. Social workers are among the professions who suffer the most due burnout. The phenomenon is becoming increasingly frequent recent decades. This aroused interest to explore the subject further. The aim of this study was therefore to examine work related factors that contribute to burnout and how it affects the workplace based on social workers’ perspective. Six semi-structured interviews were made with social workers in Malmo cities social services to answer the aim of the study. The result indicates that there is a complex interaction of contributing factors on three levels. The first is on an individual plan illustrating the factor age and level of ambition as contributing to burnout. The problem that they drew attention to is that during the studies the students create expectations that collide with the reality when they meet the work life. This happens especially when the workplace has bad conditions. Thereby we land on the organizational level where social workers are experiencing high demands, low control and lack of social support. Bad conditions are due the interviewed social workers mainly a workplace with lack of support from manager, bad psychosocial working environment and high workload. This conditions characteristics as unhealthy and organizational factors contributing to burnout. Third level is the gender dimension where double work and the fact that women dominate social work mean worse working conditions and higher workload. The result also showed that the workplace affects when social workers suffer by burnout because it spreads concern through the colleagues, which creates a vicious circle. Colleagues have to cover the work tasks when the social worker suffers due burnout and stays at home on sick leave, which increase the burden on them. Inferior quality, client suffering and economic consequences was also an influence that social workers experienced because of burnout. Thereby we consider that it is of essential importance to increase awareness about the phenomenon because of the risk that next students or we encounter this problem in future profession and workplace. Keywords: Burnout, high demands, social worker, system theory, workplace.

An amputation of a leg is a heavy loss to the patient. The aim was to investigate how it was to live and adjust to a leg amputation. This literature review is based on eleven scientific articles. The findings show that the patients experienced a loss of their physical functionality which made them stop working. The change of their appearance contributed to isolation and they withdrew from many of their former activities in spare time. Their self-confidence became worse. Positive and negative coping strategies were used to adjust to the amputation. The factors with an impact on the adjustment were both of physical, social and psychological character. The conclusion is that the condition of those with a leg amputation can be very delicate both in the short and in the long term and their quality of life and their experience of health can be detoriated. This is something a nurse perhaps ought to have in mind when meeting this group of patients so she can be able to provide a good individually based nursing care.

Tax evasion is a major microeconomic problem affecting society. Untaxed money, known as black money, reduces the government’s revenue and leads to higher tax rates for honest taxpayers. This financial crime has profound social consequences, and although a cashless society can reduce tax evasion through better traceability of financial transactions, it does not eliminate it. Loopholes in the tax system still allow individuals to manipulate data and hide their activities.

In Sweden, undeclared work payment is not widespread because of its strict rules for Tax compliance. But some sectors still practice undeclared work payment. Studies have shown that cost-saving benefits and the social security system are the main reasons for misrepresenting wage levels. This paper also explores the socio-economic, cultural, and psychological aspects of the motivation behind undeclared work payment. 

Based on thematic analysis and insights from gatekeepers, the finding provides comprehensive insight into tax evasion strategies in the Swedish labor market. In particular, the research highlighted tax evasion techniques are possible in different types of job categories and the payment methods they use. 

In the year of 2005 and 2007, the Intensive care - and Anaesthetic clinic at a hospital in the southern part of Sweden introduced a project, Tool for interactive learning and daily assistance (TILDA), within the frame of web based learning. The staff members can receive competence cards through TILDA for biomedical equipment. The purpose of the current study was to survey different factors that influence why nurses take respectively not take biomedical competence cards through TILDA and to investigate the nurses’ attitudes towards working with biomedical competence cards through TILDA. The study was a descriptive cross sectional designed study using questionnaires. Data analyses were performed by using the statistic program SPSS and qualitative content analyses. The result showed that nurses who stated that TILDA as a learning method suited them and who have taken biomedical competence cards were significant more positive to TILDA as a learning method compared to the nurses who experienced that TILDA as a learning method didn’t suit them and who hadn’t taken any biomedical competence card (p=0.006). The majority of the nurses (53 %) considered that working with biomedical competence cards are meaningfully. The premier reasons why nurses did not take biomedical competence cards through TILDA were lack of time and giving priority to other work duties. The nurses considered that working with TILDA took time and demanded peace and tranquillity. As a learning method TILDA was excellent but practical management of equipment was lacking. It was also important for the nurses that the content in TILDA is relevant and not too extensive.

The fast development of knowledge within the healthcare section demands that the nurse continuously develop their competence in order to provide the patient’s safety. The nurse’s competence development is more and more done through e-learning, electronic learning, which is a relatively new form of learning. E-learning means that learning is done with the help of computers through networks. The purpose of the study was to investigate the nurse’s attitude to and experience of e-learning connected to competence development, by summarizing current scientific literature. Searching in four databases, Cinahl, ERIC, PubMed and The Cochrane Library resulted in ten scientific articles which were critically examined and analyzed. The result of the summarizing and examining of the articles show that nurses with weak computer skills found it difficult to adjust to e-learning. Support from classmates and teachers were experienced to be very important, but many missed the face-to-face contact. E-learning was experienced to be a flexible way of learning, which demanded self-discipline. In order to utilize education through e-learning basic computer skills and resources as time, computer access and human and technical support are needed.