The Copernicus Marine Environment Monitoring Service Ocean State Report

The Copernicus Marine Environment Monitoring Service (CMEMS) Ocean State Report (OSR) provides an annual report of the state of the global ocean and European regional seas for policy and decision-makers with the additional aim of increasing general public awareness about the status of, and changes in, the marine environment. The CMEMS OSR draws on expert analysis and provides a 3-D view (through reanalysis systems), a view from above (through remote-sensing data) and a direct view of the interior (through in situ measurements) of the global ocean and the European regional seas. The report is based on the unique CMEMS monitoring capabilities of the blue (hydrography, currents), white (sea ice) and green (e.g. Chlorophyll) marine environment. This first issue of the CMEMS OSR provides guidance on Essential Variables, large-scale changes and specific events related to the physical ocean state over the period 1993–2015. Principal findings of this first CMEMS OSR show a significant increase in global and regional sea levels, thermosteric expansion, ocean heat content, sea surface temperature and Antarctic sea ice extent and conversely a decrease in Arctic sea ice extent during the 1993–2015 period. During the year 2015 exceptionally strong large-scale changes were monitored such as, for example, a strong El Niño Southern Oscillation, a high frequency of extreme storms and sea level events in specific regions in addition to areas of high sea level and harmful algae blooms. At the same time, some areas in the Arctic Ocean experienced exceptionally low sea ice extent and temperatures below average were observed in the North Atlantic Ocean

Genital mutilation of girls in Sudan : Community- and hospital-based studies on female genital cutting and its sequelae

Background: In spite of many decades of campaigns, female genital mutilation (FGM) is still highly prevalent in Sudan. One reason for this might be that campaigns have failed to approach fundamental values of FGM. In the absence of previous paediatric research on FGM, immediate and long-term complications for girls are basically unknown, as is their clinical picture. Methods: Interviews were carried out according to questionnaires with open answers with 119 randomly selected respondents (30 young mothers, 29 young fathers, 30 grandmothers and 30 grandfathers) in a village in the Gezira in Sudan. To investigate adverse health effects on the child, 255 consecutive girls aged 4-9 years presenting to the Children's Emergency Hospital, Khartoum, were recruited. A detailed history was obtained and full examination, including inspection of genitalia, and investigations were performed to diagnose urinary tract infection (UTI). To investigate the association between FGM and primary infertility we performed a casereferent study. Cases were 99 women with primary infertility, among whom hormonal and iatrogenic causes, as well as male factor infertility were excluded. Cases underwent diagnostic laparoscopy. Referents were 180 primigravidae women recruited from antenatal care. Results: While all female respondents in the village had undergone FGM, 44% of the young respondents had decided not to let their daughters undergo it. This change of practice was confirmed by the clinical study where 22% of the girls had undergone FGM, but a large share of the rest would have FGM later, leaving 26% of the girls allegedly without FGM in the future. The form of FGM was under-reported in an anatomical sense, 39% of forms being reported as "Sunna", extending to the labia majora. For girls under the age of 7 there was a significant association between FGM and suspected UTI. Symptoms from the urogenital tract in girls were heavily under-reported. Tradition and social pressure were the main motives for performing FGM. Religious belief, education level and socio-economic status significantly affected to what extent FGM was practised. Sexuality was an important aspect, mentioned as a motive both for and against FGM. Reinfibulation was widely practised in this area, with the main motive being sexual satisfaction of the husband. This was contradicted by the fact that male complications resulting from FGM, such as difficulty in penetration, wounds/infections on the penis and psychological problems were described by a majority of the men. Most of the young men would have preferred to marry a woman without FGM. Consequently, young fathers were more involved in the decision process when decisions were taken not to perform FGM. After controlling for age, education, socio-economy, and sexually transmitted infections, cases with primary infertility had a significantly higher risk than referents of having undergone the most extensive form of FGM involving labia majora (OR 4.69; 95% CI 1.49, 19.7). The anatomical extent of FGM, rather than whether or not the vulva had been sutured/closed, was associated with primary infertility. Interpretation: There seems to be a trend towards abandonment and/or milder forms of FGM in Sudan, but a majority of girls still undergo severe forms of the practice. The validity of reported form of FGM is low. Genital mutilation contributes significantly to morbidity already in childhood, but a large share of this does not come to medical attention. By exposing male complications of FGM, showing male negative attitudes towards the practice, male and female sexual problems related to FGM and that FGM is a likely cause of infertility, the results challenge the most important marriage-related traditional motives for FGM. Traditionally FGM was performed to increase the chances of future marriage. Our findings, on the contrary, indicate that genital mutilation of girls might have an opposite effect by destabilising marriages through its effect on sexual and reproductive health

Modelling the dynamics of harmful blooms of Chattonella sp. in the Skagerrak and the Kattegat

The presentation shows observations, satellite images and model results describing the growth and spreading of Chattonella sp. flagellates in the Skagerrak and the Kattegat. Chattonella sp. is a harmful alga that may cause fish kills due to damage of the gills. Calm weather, stable water column stratification, and low turbulence may facilitate the onset of a Chattonella bloom. Results from the three-dimensional hydrodynamical model HIROMB (High Resolution Operational Model for the Baltic Sea) are used as forcing of a transport model that computes vertical and horizontal transports of chemical and biological compounds. A modified version of the Swedish Coastal and Ocean Biogeochemical model (SCOBI) is used to describe the temporal evolution of the phytoplankton spring blooms in the year 2001 when Chattonella was abundant and 2002 when only small amounts of Chattonella were observed. A comparison with satellite images and cell counts indicates that the model captures the main transport patterns of phytoplankton in the surface layers of the offshore areas. The Chattonella bloom of the model starts in the quite shallow parts of the western Kattegat and in the stratified coastal areas of the northern Skagerrak. The coastal waters near the river Göta Älv of Sweden also indicate a tendency of an increased occurrence of Chattonella. Chattonella is observed in the model during both years but the occurrence of Chattonella is more significant in the year 2001 than in 2002. Keywords: Algal blooms; Chattonella sp.; Diatoms; HAB; Marine ecology; Modelling; North Sea; Skagerrak; Kattega

Reliability of self reported form of female genital mutilation and WHO classification: cross sectional study

Objective To assess the reliability of self reported form of female genital mutilation (FGM) and to compare the extent of cutting verified by clinical examination with the corresponding World Health Organization classification. Design Cross sectional study. Settings One paediatric hospital and one gynaecological outpatient clinic in Khartoum, Sudan, 2003-4. Participants 255 girls aged 4-9 and 282 women aged 17-35. Main outcome measures The women's reports of FGMthe actual anatomical extent of the mutilation, and the corresponding types according to the WHO classification. Results All girls and women reported to have undergone FGM had this verified by genital inspection. None of those who said they had not undergone FGM were found to have it. Many said to have undergone “sunna circumcision” (excision of prepuce and part or all of clitoris, equivalent to WHO type I) had a form of FGM extending beyond the clitoris (10/23 (43%) girls and 20/35 (57%) women). Of those who said they had undergone this form, nine girls (39%) and 19 women (54%) actually had WHO type III (infibulation and excision of part or all of external genitalia). The anatomical extent of forms classified as WHO type III varies widely. In 12/32 girls (38%) and 27/245 women (11%) classified as having WHO type III, the labia majora were not involved. Thus there is a substantial overlap, in an anatomical sense, between WHO types II and III. Conclusion The reliability of reported form of FGM is low. There is considerable under-reporting of the extent. The WHO classification fails to relate the defined forms to the severity of the operation. It is important to be aware of these aspects in the conduct and interpretation of epidemiological and clinical studies. WHO should revise its classification

An antithrombin III product containing biologically active hepatocyte growth factor may be beneficial in depp ulcer infections

BACKGROUND: Widely studied for the past 20 years, hepatocyte growth factor (HGF) has been identified as a regenerative marker and an important factor in the development and healing of injuries. Antithrombin III (AT III) is a protein in the blood stream with anti-thrombotic and anti-inflammatory properties and has been used as an adjuvant treatment along with antibiotics in severe sepsis. OBJECTIVE: To study the content and properties of HGF in plasma-derived AT III products, and the regenerative effect in severe deep ulcer infections. METHODS: Commercial AT III products were analyzed for the presence and biological activity of HGF. One AT III product containing biologically active HGF was used to treat 18 cases of critical, deep ulcer infections scheduled for major invasive intervention. The patients were followed up for 6-60 months. RESULTS: The AT III products contained HGF with different biological activity. No adverse reactions were observed after local administration of AT III during the study or follow-up period. In 16 of 18 cases no surgical intervention was needed within the first 6 month of inclusion. CONCLUSION: AT III products containing biologically active HGF may contribute to regeneration and healing in severe deep ulcer infections which do not respond adequately to different combinations of antibiotics alone

An antithrombin III product containing biologically active hepatocyte growth factor may be beneficial in depp ulcer infections

BACKGROUND: Widely studied for the past 20 years, hepatocyte growth factor (HGF) has been identified as a regenerative marker and an important factor in the development and healing of injuries. Antithrombin III (AT III) is a protein in the blood stream with anti-thrombotic and anti-inflammatory properties and has been used as an adjuvant treatment along with antibiotics in severe sepsis. OBJECTIVE: To study the content and properties of HGF in plasma-derived AT III products, and the regenerative effect in severe deep ulcer infections. METHODS: Commercial AT III products were analyzed for the presence and biological activity of HGF. One AT III product containing biologically active HGF was used to treat 18 cases of critical, deep ulcer infections scheduled for major invasive intervention. The patients were followed up for 6-60 months. RESULTS: The AT III products contained HGF with different biological activity. No adverse reactions were observed after local administration of AT III during the study or follow-up period. In 16 of 18 cases no surgical intervention was needed within the first 6 month of inclusion. CONCLUSION: AT III products containing biologically active HGF may contribute to regeneration and healing in severe deep ulcer infections which do not respond adequately to different combinations of antibiotics alone

Female Genital Mutilation in Sierra Leone: who are the decision makers?

The objectives of this study were to identify decision makers for FGM and determine whether medicalization takes place in Sierra Leone. Structured interviews were conducted with 310 randomly selected girls between 10 and 20 years in Bombali and Port Loko Districts in Northern Sierra Leone. The average age of the girls in this sample was 14 years, 61% had undergone FGM at an average age of 7.7 years (range 1-18). Generally, decisions to perform FGM were made by women, but father was mentioned as the one who decided by 28% of the respondents. The traditional excisors (Soweis) performed 80% of all operations, health professionals 13%, and traditional birth attendants 6%. Men may play a more important role in the decision making process in relation to FGM than previously known. Authorities and health professionals’ associations need to consider how to prevent further medicalization of the practice.Les objectifs de cette étude étaient d'identifier les décideurs à l’égard des mutilations génitales féminines et de déterminer si la médicalisation a lieu en Sierra Leone. Des entretiens structurés ont été menés avec 310 filles choisies au hasard entre 10 et 20 ans dans les Districts de Bombali et de Port Loko au nord de la Sierra Leone. L'âge moyen des filles dans cet échantillon était de 14 ans, 61% avaient subi des MGF à un âge moyen de 7,7 ans (entre 1-18ans). En règle générale, les décisions sur les mutilations sexuelles féminines ont été prises par les femmes, mais 28% des interviewés ont mentionné le père comme étant celui qui a décidé. Les exciseuses traditionnelles (Soweis) ont effectué 80% de toutes les opérations, les professionnels de santé 13%, et les accoucheuses traditionnelles 6%. Les hommes peuvent jouer un rôle plus important dans le processus de décision en ce qui concerne les mutilations génitales féminines que précédemment connu. Les autorités et les associations de professionnels de santé doivent tenir compte de la manière de prévenir la médicalisation de cette pratiqu