Sustainable Grazing by Cattle and Sheep for Semi-Natural Grasslands in Sweden

Despite their importance for biodiversity and other ecosystem services, many semi-natural grasslands deteriorate or have even disappeared due to insufficient grazing and neglect. Preservation of grassland habitats depends on a good understanding of sustainable grazing management as well as effective agricultural policy measures that ensure long-term economic sustainability for the farmer. Through meta-evaluation and synthesis of previous investigations and discussion of scientific literature, we aimed to evaluate factors that determine the extent to which cattle and sheep in Sweden graze semi-natural grasslands instead of more productive land and what this means for biodiversity and sustainability. We also aimed to propose which practises and policy measures may be the most cost-effective to promote habitat quality and the sustainable use of grasslands. Results from a nationwide survey of Swedish farmers' attitudes towards agri-environmental payment schemes are discussed in relation to farm characteristics and other factors influencing the use of cattle and sheep for sustainable grazing. This study supports recommendations by environmental economists that payments should be targeted more strongly at the most valuable grasslands, emphasising the need for a more detailed and nuanced framework for classifying grasslands in Europe. A comparison with independent estimates of the area of agricultural land from nation-wide, sample-based monitoring shows that the data from official statistics normally used for nationwide evaluations are partly biased and of insufficient quality, underscoring the need for more sophisticated and precise methods for monitoring both overall trends and detailed environmental effects related to the preservation of semi-natural grasslands

Excess Mortality for Abdominal Aortic Aneurysms and the Potential of Strict Implementation of Cardiovascular Risk Management: A Multifaceted Study Integrating Meta-Analysis, National Registry, and PHAST and TEDY Trial Data

Objective: Previous studies imply a profound residual mortality risk following successful abdominal aorta aneurysm (AAA) repair. This excess mortality is generally attributed to increased cardiovascular risk. The aim of this study was (1) to quantify the excess residual mortality for patients with AAA, (2) to evaluate the cross sectional level of cardiovascular risk management, and (3) to estimate the potential of optimised cardiovascular risk management to reduce the excess mortality in these patients. Methods: Excess mortality was estimated through a systematic review and meta-analysis, and through data from the Swedish National Health Registry. Cardiovascular risk profiles were individually assessed during eligibility screening of patients with AAA for two multicentre pharmaceutical AAA stabilisation trials. The potential of full implementation of cardiovascular risk management was estimated through the validated Second Manifestations of ARTerial disease (SMART) risk scores algorithm. Results: The meta-analysis showed a similarly impaired survival for patients who received early repair (small AAA) or regular repair (≥ 55 mm), and a further impaired survival for patients under surveillance for a small AAA. Excess mortality was further quantified using Swedish population data. The data revealed a more than quadrupled and doubled five year mortality rate for women and men who had their AAA repaired, respectively. Evaluation of the level of risk management of 358 patients under surveillance in 16 Dutch hospitals showed that the majority of patients with AAA did not meet therapeutic targets set for risk management in high risk populations, and indicated a more pronounced prevention gap in women. Application of the SMART risk score algorithm predicted that optimal implementation of risk management guidelines would reduce the 10 year risk of major adverse cardiovascular events from 43% to 14%. Conclusion: Independent of the rupture risk, AAA is associated with a worryingly compromised life expectancy with a particularly poor prognosis for women. Optimal implementation of cardiovascular risk prevention guidelines is predicted to profoundly reduce cardiovascular risk

Hållande av sugga och smågrisar i grisningsbox

SLU:s Vetenskapliga råd för djurskydd har fått i uppdrag från Jordbruksverket att utifrån specificerade frågeställningar beskriva det vetenskapliga kunskapsläget beträffande hållande av sugga och smågrisar i grisningsbox. Den svenska lagstiftningens krav skiljer sig i flera avseenden från de krav som ställs i andra länder, varför det har varit svårt att finna vetenskapligt publicerad litteratur som äger direkt tillämpbar giltighet i svenska besättningar. I dagsläget sker heller ingen konstruktion eller tillverkning av grisningsboxar i Sverige. Rapporten har därför även inkluderat studentarbeten vid SLU, liksom arbeten publicerade i olika rapportserier. Där källan inte utgörs av vetenskapligt granskad litteratur har detta tydligt angivits. Domesticerade grisar har i stor utsträckning samma beteendebehov som vildsvin. Moderna grishållningssystem kan tillgodose flera av de beteendebehov som domesticerade grisar har, medan vissa beteendebehov är svårare att tillgodose, och det faktum att grisen hålls i en box utgör alltid en begränsande faktor. En grisningsbox utgör en kompromiss mellan bland annat suggans och smågrisarnas behov. Suggans modersegenskaper och djurskötarens skicklighet anses ha större betydelse för smågrisöverlevnaden än boxens utformning, under förutsättning att utformningen håller rimlig standard. Under perioden närmast grisning har suggan stort behov av att få röra sig och bygga bo. Boxen bör vara stor nog för att möjliggöra detta beteende, och vara konstruerad på så vis att suggan kan få tillräckligt med halm eller annat bomaterial för att kunna utföra sitt bobyggnadsbeteende. En vanlig uppfattning är att suggorna har ökat i storlek under de senaste decennierna men vetenskapligt underlag som stödjer denna uppfattning saknas. Antalet smågrisar per kull har ökat, vilket betyder att boxens storlek kan behöva utökas och att boxens funktionella delar kan behöva anpassas så att de möjliggör tillräckligt stora ytor för att tillfredsställa grisarnas olika behov av att vila, äta, gödsla, ge di etc. Smågrisarna har under tidig digivning behov av att lätt förflytta sig mellan suggans juver, smågrishörnan och gödselytan. Smågrishörnan, d.v.s. det utrymme där smågrisarna kan vistas skyddade från suggan och med extra tillskottsvärme, är en viktig del av grisningsboxen. Den ska vara tillräckligt stor för att hela kullen ska kunna ligga där samtidigt, och bör vara täckt av ett tak som har en front som är utformad så att den minskar luftrörelser och håller värmen kvar. Smågrishörnan ska vara försedd med tillskottsvärme eller en tillräcklig mängd strö för att tillgodose smågrisarnas värmebehov. Här ska också finnas möjlighet att ge tillskottsfoder till smågrisarna. Boxens utformning bör underlätta för suggan att lägga sig så att smågrisarna lätt kommer åt smågrishörnan, vilken ska vara belägen och konstruerad så att god tillsyn blir möjlig. Flera faktorer måste vägas samman vad gäller boxens placering i förhållande till inspektionsgången i syfte att erhålla god tillsyn utan att störa suggan i onödan. Vid hantering av smågrisarna är ofta den s.k. framåtvända boxen att föredra, där smågrishörnan är placerad vid inspektionsgången. Golvets konstruktion är en viktig del av boxens utformning. Den fasta golvytan består vanligen av betong. Alternativa material finns, men få har utvärderats och tillräcklig erfarenhet av dessa saknas. Golvet ska utgöras av ett jämnt och halkfritt underlag för suggan, samtidigt som underlaget inte ska medföra en skaderisk för smågrisarna. Golvet och strömedlet ska erbjuda en mjuk liggyta och samtidigt möjliggöra en god hygien. För att tillgodose smågrisarnas behov av värme kan den fasta golvytan vara 6 försedd med golvvärme, alternativt förses med extra mycket strö i samband med grisningen. Totalarean spalt, dess material och spaltöppningens bredd har betydelse för hygienen. Strömedel och bomaterial är viktigt för att tillfredsställa grisarnas behov av berikning och kan även ha betydelse för produktionsresultaten. Strömedel är vidare ett krav enligt lagstiftningen. Spalten, liggytan och boxens utgödslingssystem ska därför vara utformade för att möjliggöra användning av funktionella mängder strömaterial så att grisarnas beteendebehov tillfredsställs. Svensk smågrisproduktion har under de senaste årtiondena genomgått betydande strukturella förändringar. Besättningsstorleken har ökat och arbetet i stallarna har därmed blivit mer fysiskt krävande. Arbetsuppgifterna har blivit allt mer specialiserade och monotona. Olika boxtyper kräver olika arbetsinsats och belastningsskador p.g.a. dålig ergonomi kan vara ett problem. Så kallade framåtvända boxar minskar tidsåtgången för gödselskrapning. Den totala yta som utgörs av spaltgolv har också betydelse för den arbetsinsats som krävs. Det är även viktigt att det finns möjlighet att skydda djurskötare från aggressiva suggor vid arbete inne i boxen

Lower limb ischemia in women

Arteriosclerosis is a general disease affecting different parts of the arterial system. In coronary heart disease (CHD) women have different risk factors, symptoms, indication for treatment, interpretation of diagnostic data and outcome than men. The overall aim of this thesis was to test the hypothesis that similar gender differences exist in patients with symptomatic arteriosclerosis in the arteries of the lower limb (LLI) and to investigate the magnitude of the problem. The Stockholm Study. The number of procedures performed, development over time, survival and amputation rates in women and men were investigated in a large epidemiological study of all patients treated with vascular interventions for lower limb ischemia (LLI) in the county of Stockholm in 1970-1994 (8660 patients, 12200 interventions). An increase from 18 vascular interventions to 786 / million inhabitants and in the proportion of women from 34% in 1970 to 48% in 1994 was shown. Mean age increased from 63 to 71 years. Women were older than men (71 years vs 66, p<0.001). The localisation of lesions treated for chronic LLI was similarly distributed between women and men. Women had poorer survival than men. In a Cox regression model, increasing age, later calendar years and being a man were risk factors for poorer survival. In a multivariate analysis of the risk for amputation, age and calendar year were important risk factors, not gender. Our results confirmed the clinical observation of an increasing proportion of women and elderly, possibly related to an increasing prevalence, better knowledge about LLI among referring doctors, improved technique and wider indication for treatment, especially in elderly. The similar or better results after intervention in women could be explained by the generally better survival in women in the population as well as a restrictive attitude towards treating women compared to men. Women treated for critical ischemia. Specific gender differences in preoperative conditions, localisation of treated lesions, complications and long-term outcome was retrospectively investigated in patients treated for chronic critical limb ischemia at the Karolinska Hospital (KH) in 1993-1994 (n=234 patients). Women were older than men (74 vs 68 years), smoking and diabetes was less frequent among women (smokers: 63 % vs 82%, p=0.005; diabetes: 22% vs 43%, p=0.0004). Other preoperative conditions were not worse in women. Women were more commonly treated with suprainguinal interventions than men (44% versus 19%). Outcome was similar for women and men. The greatest disadvantage for women is their high mean age. The later onset for women could depend on biological differences combined with a different distribution of risk factors than in men. The different localisation of treated lesions can be related to age and anatomical differences. The similarities in outcome despite different preoperative conditions indicate that diabetic women with severe LLI are less frequently treated, alternatively men with high risk are offered interventions more generously. Reproductive History. In order to evaluate the reproductive history in women with LLI compared with women in the population, 173 women treated for LLI in 1994-1996 at KH and 348 women living in the hospital catchment area were sent a validated questionnaire. Age at menopause and menarche, pregnancies, hysterectomy and hormone replacement therapy were similar between women treated for LLI and women in the population. More references had used oral contraceptives than patients (53% vs 16%, p<0.001). Women with LLI do not have a different reproductive history than women in the population, contradictory to women with CHD. The influence on the development of arteriosclerotic disease by other risk factors could be more important in LLI patients. Maybe oestrogen levels are less important for the progression of arteriosclerotic disease in other peripheral arteries compared to coronary and carotid arteries. Conclusion The number of vascular interventions, especially in women, have probably increased further after the observed period, and the increase can be expected to continue. Biological and anatomical differences can probably explain several of the found differences between the sexes, such as localisation of treated lesions and age. The similar outcome between women and men indicates that we should continue to focus on established risk factors in our preoperative evaluation, rather than gender or reproductive history in women

The prognostic impact of depressive symptoms on all-cause mortality in individuals with abdominal aortic aneurysm and in the general population. A population-based prospective HUNT study in Norway

Background Abdominal aortic aneurysm (AAA) is a potentially life-threatening disease but the high mortality rate is linked to high age and comorbidity pattern. Depression is associated with increased mortality in the general population and individuals with cardiovascular diseases, but this is sparsely studied for AAA. The aim was to examine the prognostic impact of depressive symptoms on all-cause mortality in individuals with AAA and compare with findings in a general population of the same age and risk profile. Methods Population-based prospective study including 36 616 participants (52.1% women) from the Trøndelag Health Study in Norway. A total of 9428 individuals died during a median follow-up of 10 years at ages 60–90 years. Depressive symptoms were defined by a Hospital Anxiety and Depression Scale-Depression score ≥8. Data on AAA diagnoses and death were obtained from medical records and national registers. HRs from Cox proportional hazard regression models are reported. Results A total of 4832 (13.2%) individuals reported depressive symptoms, whereas 583 (1.6%) AAAs were identified. The adjusted hazard of death was 2.66 times higher in persons with AAA compared with the general population (95% CI 2.39 to 2.97). Overall, there was no significant adverse effect of depressive symptoms in individuals with AAA (HR 1.15;95% CI 0.88 to 1.51), whereas an increased risk was seen in the general population (HR 1.23;95% CI 1.17 to 1.30). Conclusion The overall risk of death was considerably higher in individuals with AAA compared with a general population of the same age and risk profile. Depressive symptoms did not significantly influence the risk of death in the AAA group

Prevalence and Risk Factors of Abdominal Aortic Aneurysms Detected with Ultrasound in Korea and Belgium

The objective was to investigate the prevalence of abdominal aortic aneurysms (AAAs) and the diameters of the aorta and common iliac arteries (CIAs) in a Korean cohort and secondly to analyze the differences in aortic diameter by comparison with a European cohort. The Korean cohort included participants ≥ 50 years who consented to AAA screening and data were analysed retrospectively. Aortic and common iliac diameters were measured using the outer-to-outer diameter method and prevalence rates were calculated. Common risk factors such as smoking, body mass index, pulmonary disease, hypertension, diabetes, hyperlipidaemia, ischaemic heart disease, and cerebrovascular disease were reported in association with AAA occurrence and AAA development. The aortic diameters were then compared with those in a Belgian cohort of 2487 participants identified in the Liège AAA Screening Program. An aortic size index (ASI) was also calculated to account for the potential size differences in the Belgian and Korean populations. A total of 3124 Korean participants were examined using ultrasound. The prevalence of AAAs in this cohort was 0.7%. The combined prevalence of subaneurysmal dilatation and AAA was 1.5%. The prevalence in male smokers older than 65 years was 2.7% (19/715). The mean infrarenal aortic diameter was 17.3 ± 3.1 mm in men and 15.7 ± 2.7 mm in women; the corresponding values in Belgian participants were 19.4 ± 3.0 mm in men and 17.9 ± 2.4 mm in women. The median aortic size index was 0.99 (interquartile range 0.88–1.12). The mean infrarenal aortic diameter was significantly smaller in the Korean cohort than in the Belgian cohort. Considering the observed prevalence of AAAs in different age groups, the age groups which would contribute to most cases was male persons above 66 years in both cohorts

Results After Open and Endovascular Repair of Popliteal Aneurysm : A Matched Comparison Within a Population Based Cohort

Objective To identify factors affecting the outcome after open surgical (OSR) and endovascular (ER) repair of popliteal artery aneurysm (PA) in comparable cohorts. Methods A matched comparison in a national, population based cohort of 592 legs treated for PA (2008 – 2012), with long term follow up. Registry data from 899 PA patients treated in 2014 – 2018 were analysed for time trends. The 77 legs treated by ER were matched, by indication, with 154 legs treated with OSR. Medical records and imaging were collected. Analysed risk factors were anatomy, comorbidities, and medication. Elongation and angulations were examined in a core lab. The main outcome was occlusion. Results Patients in the ER group were older (73 vs. 68 years, p = .001), had more lung disease (p = .012), and were treated with dual antiplatelet therapy or anticoagulants more often (p &lt; .001). The hazard ratio (HR with 95% confidence intervals) for occlusion was 2.69 (1.60 – 4.55, p &lt; .001) for ER, but 3.03 (1.26 – 7.27, p = .013) for poor outflow. For permanent occlusion, the HR after ER was 2.47 (1.35 – 4.50, p = .003), but 4.68 (1.89 – 11.62, p &lt; .001) for poor outflow. In the ER subgroup, occlusion was more common after acute ischaemia (HR 2.94 [1.45 – 5.97], p = .003; and poor outflow HR 14.39 [3.46 – 59.92], p &lt; .001). Larger stent graft diameter reduced the risk (HR 0.71 [0.54 – 0.93], p = .014). In Cox regression analysis adjusted for indication and stent graft diameter, elongation increased the risk (HR 1.020 per degree [1.002 – 1.033], p = .030). PAs treated for acute ischaemia had a median stent graft diameter of 6.5 mm, with those for elective procedures being 8 mm (p &lt; .001). Indications and outcomes were similar during both time periods (2008 – 2012 and 2014 – 2018). Conclusion In comparable groups, ER had a 2.7 fold increased risk of any occlusion, and 2.4 fold increased risk of permanent occlusion, despite more aggressive medical therapy. Risk factors associated with occlusion in ER were poor outflow, smaller stent graft diameter, acute ischaemia, and angulation/elongation. An association between indication, acute ischaemia, and small stent graft diameter was identified.De två sista författarna delar sistaförfattarskapet</p