Pelvic pain due to endometriosis and dysmenorrhea

Background Approximately 70% of women in reproductive age suffer from dysmenorrhea around the world but no prevalence study has been made in Sweden for 35 years. Dysmenorrhea, painful menstruation, can be a sign of endometriosis which for many is a disabling disease due to pelvic pain but also symptoms from the gastrointestinal tract, the bladder, fatigue and infertility. Treatment options for this chronic inflammatory disease as well as for dysmenorrhea are pain killers and hormonal therapy to suppress the menstrual cycle, and for endometriosis sometimes surgery. But these treatment options are not suited for everybody and are often associated with adverse effects. Preclinical trials have shown that melatonin has analgesic and anti-oxidative properties. Melatonin has shown to reduce the size of endometriotic implants in rodents. A clinical trial has showed melatonin to reduce endometriosis-associated pain more effectively than placebo. Aim To investigate the prevalence of dysmenorrhea and its impact on the life of young women in Stockholm. To investigate the analgesic effect of melatonin on severe dysmenorrhea and endometriosis-associated pain respectively, compared to placebo. A significant clinical effect was set to a reduction of 1.3 units on the numeric rating scale. Materials, methods and results Three studies were conducted during 2017-2021. Study I is a cross-sectional study. A questionnaire was sent out to all women born in the year 2000 and residing in Stockholm (n= 3998). With a response rate of 45%, the prevalence of dysmenorrhea was 89% (1580 of 1785, 95% CI 87‐90), out of which 36% (574 of 1580, 95% CI 34‐39) reported severe dysmenorrhea. High rates of fatigue (83%) and headache (82%) were observed, 14% reported monthly absenteeism and the tendency to seek medical care was low as only 7% had seen a doctor. Studies II and III are placebo-controlled, randomized trials with 40 women in each trial, 20 were allocated to placebo and 20 to melatonin. In Study II women with severe dysmenorrhea received 10 mg melatonin or placebo at bedtime for the week of menstruation during two menstrual cycles. No superior analgesic effect was seen with melatonin compared with placebo. In study III women with endometriosis-associated pain received 20 mg melatonin or placebo at bedtime for two consecutive menstrual cycles or months. No superior analgesic effect was seen with melatonin compared with placebo. Conclusions The prevalence of dysmenorrhea in Stockholm is high with substantial implications on the daily lives of young women. The low tendency to seek medical care suggests a normalization. Our chosen dose and regime could not show any analgesic effect superior to placebo, future studies are needed to investigate other doses and regimes that could be of use as adjuvant treatment of dysmenorrhea and endometriosis-associated pain

Biodiversity and ecosystem services in impact assessment : from components to services

Ecological impact assessment focuses both on spatially bound biophysical environment and biodiversity as composition, structure, and key processes and on benefits of biodiversity gained through ecosystem services. It deals with allocation of space in complex situations characterised by uncertainty and conflicting values of actors. In the process of ecological impact assessment that forms part of environmental impact assessment (EIA) and strategic environmental assessment (SEA), the whole proposal of a project, plan, or programme; its targets; alternative options and their acceptability from a biodiversity standpoint; and knowledge of the biodiversity and ecosystem services it provides are shaped. The analyses in this thesis examine the current practices of Finnish ecological impact assessment with respect to its substantive and procedural features and the roles of actors. The analyses utilise qualitative and semi-quantitative data from EIA and Natura 2000 appropriate assessment reports, statements of environmental authorities, other data produced via assessment processes, and actors views related to ecological impact assessment. After analysis of the present shortcomings, constraints, and development needs, a tool taking into account fully current understanding and ecosystem services is developed to improve prevailing impact assessment practices. The results of the analyses demonstrate that the knowledge base for the comprehensive ecological impact assessment in EIA, Natura 2000 appropriate assessment, and municipal land-use planning SEA is far from adequate. Impact assessments fail to identify the biodiversity at stake, what is affected, and how, and, as a consequence, the selection of biodiversity elements for assessment is unsystematic, superficial, or focused on the most obvious strictly protected species. The connection between baseline studies and impact prediction is loose; consequently, the predictive value of baseline studies is low, preventing effective mitigation and monitoring. There is also a tendency toward unnecessary detail at the expense of a broader treatment of biodiversity that would address ecosystem processes, interactions, and trends. Substantive treatment of biodiversity is often restricted to compositional diversity and at the species and habitat type level. Finnish ecological impact assessment does not take into account the value-laden nature of impact assessment. It is baseline-oriented and often seen as external and parallel to the actual planning and decision-making. Scoping practices reflect this separateness by outsourcing important value-bound significance determinations to individual ecology consultants instead of considering them an integral part of the planning process. Cumulative effects are hardly ever considered in Finnish ecological impact assessment practices. The use of more sophisticated methods and tools than expert judgements and matrices is almost non-existent in Finnish ecological impact assessment practices, because of the planning environment lacking the time, resources, and skills for it. In addition, often a highly detailed treatment of biodiversity elements with complex tools is not necessary for achieving a holistic picture of the targets and impacts of an initiative. Therefore, an objective set for improvement in the knowledge grounding of ecological impact assessment has been the development of a relatively simple tool utilising already available data. Ecosystem services criteria and indicators were developed for target-setting, impact prediction, and monitoring, and these were tested in three processes of local master planning and regional planning. Timing constraints of data delivery; obstacles in data availability, quality, and consistency; and relative closeness of planning processes hampered the use of indicators, but the tool nonetheless was experienced as beneficial by the testing teams overall. The future challenges facing use of the tool involve its independent utilisation by planners without support from researchers on different planning scales, collaboration and commitment of actors in setting targets for ecosystem services, and versatile use of data. The other challenges in improvement of today s ecological impact assessment practices comprise finding a balance between broad-brush and detailed information individually for each planning situation; utilising, sharing, and mediating both knowledge within ecosystem-service-generating units and users and beneficiaries views of valued and prioritised ecosystem services; shifting from parallel linkage of impact assessment and planning towards planning- and decision-making-centred environmental assessment; supplying the necessary substantive and procedural requirements for ecological impact assessment in the EIA, nature conservation, and land-use and building legislation; placing stronger emphasis on scoping by strengthening the guiding role of authorities and reserving more time and resources for scoping by proponents and planners; generating specific cumulative impact assessment in EIA and SEA and improving that employed in Natura 2000 appropriate assessment by creating an iterative link; and fostering work-sharing between project- and plan/programme-level actors in identification of cumulative impacts.Luontovaikutusten arviointi paneutuu sekä paikkasidonnaiseen biofyysiseen ympäristöön ja luonnon monimuotoisuuden koostumukseen, rakenteeseen ja prosesseihin että ekosysteemipalvelujen kautta määrittyviin biodiversiteetin hyötyihin. Se käsittelee maankäytön ratkaisuja monimutkaisissa tilanteissa, joita luonnehtivat epävarmuus ja toimijoiden ristiriitaiset arvot. Ympäristövaikutusten arviointimenettelyn (YVA) ja suunnitelmien ja ohjelmien vaikutusten arvioinnissa (SOVA) luontovaikutusten arviointiprosessissa muokkautuvat koko hankkeen, suunnitelman tai ohjelman tavoitteet, vaihtoehdot ja niiden hyväksyttävyys luonnon monimuotoisuuden ylläpidon näkökulmasta. Niin ikään tieto luonnon monimuotoisuudesta ja sen tarjoamista ekosysteemipalveluista määrittyy. Tämä väitöskirja tarkastelee suomalaisen luontovaikutusten arvioinnin sisältöä, prosessia ja toimijoiden rooleja. Tutkimuksen laadullisten ja määrällisten analyysien aineistona on käytetty YVA- ja Natura-arviointiraportteja, viranomaisten lausuntoja arvioinneista, muuta arviointiaineistoa ja luontovaikutusten arvioinnin toimijoiden haastatteluaineistoja. Arviointikäytännön nykyisten puutteiden, rajoitteiden ja kehittämistarpeiden käsittelyn jälkeen kehitettiin ajantasaiseen tieteelliseen ekosysteemipalvelutietoon perustuva ekosysteemipalvelukriteeristö ja -indikaattorit. Tutkimuksen mukaan luontovaikutusten arvioinnin tietopohja YVAssa, Natura-arvioinnissa ja yleiskaavoituksen luontovaikutusten arvioinnissa on kaukana kattavasta. Arvioinnit eivät onnistu tunnistamaan vaikutusten arvioinnin kannalta oleellisia biodiversiteetin piirteitä eli sitä, mihin ja miten vaikutukset kohdistuvat. Tämän vuoksi tarkasteltavien kohteiden tai ilmiöiden valinta on epäsystemaattista ja pintapuolista tai tarkastavaksi valikoituvat ilmeisimmät, tiukasti suojellut lajit. Luontoselvitysten ja vaikutusarvioinnin yhteys on heikko. Siten myös luontoselvitysten ennustearvo on heikko, mikä puolestaan estää tehokkaan vaikutusten lieventämisen ja seurannan. Arviointikäytännössä on myös pyrkimys tarpeettomaan yksityiskohtaisuuteen holistisen, ekosysteemiprosesseihin, vuorovaikutussuhteisiin ja kehityssuuntia tunnistavan luonnon monimuotoisuuteen keskittyvän tarkastelun kustannuksella. Sisällöllisesti arviointi on usein keskittynyt vain biodiversiteetin koostumukseen kuvaten pääosin lajistoa ja luontotyyppejä. Suomalainen luontovaikutusten arviointi ei huomioi vaikutusten arvioinnin arvosidonnaista luonnetta ja on hyvin perusselvitysorientoitunut. Lisäksi arviointi nähdään usein suunnitteluprosessille erillisenä ja rinnakkaisena toimintona. Tätä erillisyyttä kuvastavaa arvioinnin kohdentamiskäytäntö, jossa arvosidonnaiset päätökset siitä, mitä ja miten selvitetään ja arvioidaan, ulkoistetaan yksittäisille luontokonsulteille sen sijaan, että arvioinnin kohdentamista käsiteltäisiin osana suunnitteluprosessia. Kasautuvien vaikutusten arviointi on hyvin niukkaa. Asiantuntija-arvioita ja arviointimatriiseja monimutkaisempien menetelmien käyttö luontovaikutusten arvioinnissa on lähes olematonta, koska arvioinneissa ei ole aikaa, resursseja eikä asiantuntemusta tähän. Sitä paitsi hyvin yksityiskohtainen biodiversiteetin käsittely monimutkaisin menetelmin on usein tarpeetonta holistisen näkemyksen saavuttamiseksi hankkeen, suunnitelman tai ohjelman tavoitteista ja vaikutuksista. Tutkimuksen tavoitteena luontovaikutusten arvioinnin tietopohjan parantamiseksi olikin suhteellisen yksinkertaisen, olemassa olevien tietoja hyödyntävän työkalun kehittäminen. Ekosysteemipalvelukriteeristö- ja indikaattorit kehitettiin tavoitteenasettelua, vaikutusten arviointia ja seurantaa varten ja niitä testattiin kolmessa yleiskaavoitusta ja maakuntasuunnittelua koskevassa suunnitteluprosessissa. Tiedon toimittamisen ajoitukseen, tiedon saatavuuteen, laatuun ja yhdenmukaisuuteen liittyvät ongelmat ja suunnitteluprosessien avoimuuden puute haittasivat kriteeristön ja indikaattorien käyttöä, mutta kokonaisuudessaan työkalu koettiin hyödylliseksi testauksessa. Kriteeristön ja indikaattorien käytön tulevaisuuden haasteet koskevat monipuolista tiedon käyttöä, työkalun itsenäistä käyttöä eri suunnittelutasoilla ilman tutkijoiden tukea ja suunnittelun ja arvioinnin toimijoiden sitoutumista ekosysteemipalvelutavoitteiden määrittelyyn. Muita luontovaikutusten arvioinnin kehittämisen haasteita ovat tasapainon löytäminen yleispiirteisen ja yksityiskohtaisen tiedon välillä kussakin yksittäisessä suunnittelu- ja arviointitilanteessa; ekosysteemipalveluita tuottavien biodiversiteetin piirteiden ja palveluita hyödyntävien tai niistä hyötyvien toimijoiden näkemysten ja priorisointien hyödyntäminen, jakaminen ja yhteensovittaminen; siirtyminen vaikutusarvioinnin ja suunnittelun erillisyydestä kohti suunnittelu- ja päätöksentekokeskeistä vaikutusten arviointia; luontovaikutusten arvioinnin sisällön ja esittämisen tarkempi määrittäminen YVA-, luonnonsuojelu- ja maankäyttö- ja rakennuslainsäädännössä; arvioinnin kohdentamisen painotus vahvistamalla ohjaavien viranomaisten roolia sekä lisäämällä hankkeista ja suunnitelmista ja ohjelmista vastaavien panostusta kohdentamiseen; kasautuvien vaikutusten arvioinnin edistäminen YVAssa ja maankäytön suunnittelun vaikutusten arvioinnissa ja sen parantaminen Natura-arvioinneissa luomalla iteratiivinen yhteys ja työnjako eri suunnittelutasojen toimijoiden välille kasautuvien luontovaikutusten arvioinnissa

El Ombdusman en Finlandia

La Constitución finlandesa fue aprobada en el año 1919, después de la cruenta guerra civil que siguió a la declaración de independencia de 1917. La Constitución incorporó el cargo de Ombudsman siguiendo el modelo sueco. Su primera regla directiva dispone la adopción de las medidas necesarias siempre que un juez u otro funcionario se haya hecho culpable de alguna práctica defectuosa por parcialidad o negligencia grave, haya infringido los derechos legales de los ciudadanos o se haya excedido de su autoridad en el desempeño de sus funciones. La independencia del Ombudsman finlandés radica en que lo elige el Parlamento (cada cuatro años) y que éste delega sus facultades para supervisar la observancia de las leyes por parte del Gobierno, el poder judicial y los funcionarios públicos, y que en esta gestión actúa según sus propias consideraciones. Su tarea principal es atender quejas de los ciudadanos y efectuar inspecciones necesarias: en prisiones, instituciones cerradas y unidades de las fuerzas armadas. El sistema del Ombudsman ha probado ser útil. Las transformaciones de la sociedad y el aumento de las demandas de la ciudadanía presuponen el mejoramiento permanente del sistema. Sin dudas, es positivo que la judicatura ejerza alguna supervisión e instrucción interna. No obstante, esta función se suplementa debidamente a través del Canciller de Justicia del Consejo de Estado y el Ombudsman Parlamentario. Naturalmente, lo más importante es que el control se ejecute con suficiente preparación y un alto grado de profesionalismo, especialmente ahora que los derechos humanos devienen una nueva dimensión natural y pertinente de la gestión del Ombudsman en Europa y el resto del mundo.Finlandiako Konstituzioa 1919. urtean onartu zen, 1917ko askatasun aldarrikapenari jarraitu zitzaion gerra zibil odoltsua amaitu eta gero. Konstituzioak Ombudsman kargua hartu zuen bere baitan, eredu suediarraren arabera. Horrenbestez, epaile bat edo beste ezein funtzionari, negligentziaz edo partzialtasunez, akats baten errudun denean, hiritarren legezko eskubideak zapaltzen dituenean edo dagozkion funtzioa betzerakoan bere aginteaz gain jokatzen duenean hartu beharreko neurriak xedaturik ageri dira Ombudsmanari buruzko lehen arau nagusian. Finlandiako Ombudsmanaren independentzia Parlamentuak hautatua izatean datza (la urte oroz). Izan ere, Gobernuak, botere judizialak, eta funtzionari publikoek legeak betetzen ote dituzten begiratzeko Parlamentuak duen ahalmena Ombudsmanaren gain uzten du, berau gestio horretan bere eskuko delarik. Haren eginbide nagusia hiritarren kexei harrera egitea da, bai eta kartzela, instituzio itxi eta indar armatuetako unitateetan premiazkoak diren ikerketak burutzea. Ombudsman-sistemak onuragarria dela frogatu du. Gizartearen aldaketak eta hiritarren eskarien emendioak sistemaren etengabeko hobekuntza dakarte. Ezbairik gabe, halako barne ikuskatze bat burutzea positiboa da. Dena den, funtzio horren osagai egokia Estatu Kontseiluko Justizia Kantzelariaren eta Parlamentuko Ombudsmanaren bidez ematen da. Jakina, garrantzitsuena zera da, kontrol hori prestakuntza egokiz eta profesionalismo maila altuz gauzatzea, batez ere gure egunotan, giza eskubideak Ombudsmanaren gestioaren berezko dimentsio berri eta egoki bihurtu direnean, hala Europan nola munduko osoan.Finnish Constitution was approved in 1919, after the bloody civil war subsequent to the declaration of independence in 1917. That Constitution included the figure of the Ombudsman, following the example of the Swedish model. Its first guiding rule is the adoption of the necessary measures if a judge or another official is founded guilty practice, through partiality or negligence, has contravened the legal rights of te citizens, or has abused of authority in the performance of his duties. The independence of Finnish Ombudsman is based on the fact that he is elected by the Parliament (every four years) and the latter delgates to him its power to supervise the observance of laws by the Goverment, the judicial power and the public officials, and for this control, he acts according to his reflections.His main task is to satisfy from citizens and to perform the necessary imspections in prisons, closed institutions and army units. The Ombudsman system has proved to be useful. The changes in society an the increasing complaints of citizens presuppose the constant improement of the system. Certainly, it is positive that judicature exerte en internal supervision and instruction Nevertheless, this task is suitably supplemented through the Chacellor of Justice of the Council of State and the Parliament Ombudsman. Of course, the most important thing is that control must be performed on the ground of a suitable qualification and a high degres of professionalism, particularly nowadays, when human rights become again a new natural and revelant dimension of the task of Ombudsman in Europe an in the rest of the world

O lägg din kind intill min kind (1856)

August Söderman O lägg din kind intill min kind (1856) text by Heinrich Heine, Poem 6 of Lyrisches Intermezzo (Buch der Lieder

Healthcare professionals’ work with sickness absence : with focus on oncology

Background: Physicians have an important role in patients’ sickness absence (SA) process, and many initiatives have been taken to influence their sickness certification practice. Many physicians experience sickness certification as a problematic task. This also applies to oncologists, a group in which a larger proportion has sickness certification tasks more often compared to physicians with other specialties. Experiences of encounters with healthcare professionals is one factor that has been shown to be of importance regarding SA and ability to return to work (RTW) among sickness absentees in general. Breast cancer (BC) is the most common cancer among women of working age, however, knowledge about their experiences of encounters with healthcare professionals regarding SA and work is scarce. Aim: To increase the knowledge about healthcare professionals’ work with SA, how women with BC experience encounters with healthcare professionals, and possible associations with SA and RTW. Method: In study I-III, data from three different Swedish surveys were analyzed. Study I: 342 oncologists who had sickness certification consultations were included. Study II: A cohort of 690 women in Stockholm, who had had surgery for primary BC, and were aged 24-63 years were included. Study III: A random sample of 6197 women in Sweden, aged 19-65 years, and on SA since 4-8 months were included. Of those, 187 were on SA due to BC. In study I-III, descriptive statistics were calculated, and logistic regression with odds ratios (OR) with 95% confidence intervals (CI) were used for analyses of associations. Study IV: A systematic literature review of interventions regarding physicians’ sickness certification practices. Metaanalyses were performed to produce summarized relative risk estimates with 95% CI from the data pooled using random effect models. Results: Study I: A majority of the oncologists had consultations involving sickness certification weekly and one fifth experienced such consultations as problematic at least once a week. Associations were found between oncologists stating not having enough organizational resources for work with such tasks and experiencing different aspects of sickness certification as problematic. Study II: A majority of the women with BC had experienced encounters regarding work with healthcare. An association was found both between women having experienced advice and support regarding work and having been encouraged to work and having less SA, as well as between to have been encouraged to be on SA and having more SA. The latter was partly explained by disease and treatment factors. Study III: Positive encounters with healthcare professionals in connection to SA were experienced by almost all the women on SA, both women with BC and with other SA diagnoses. About half of the women stated that positive encounters promoted their ability to RTW, slightly fewer among women with BC. Four specific types of encounters; “allowed me to take own responsibility”, “encouraged me to carry through my own solutions”, “made reasonably high demands”, and “sided with me/stood on my side” were also experienced to a lesser extent by women with BC. Study IV: Nine intervention studies were included. The effect measures varied considerably. Significant intervention effects in intended direction were found in four of the nine interventions, in two interventions unintended effects were found. The meta-analyses indicated a summarized effect on any RTW (first, partial or full) among the patients. Conclusion: Although oncologists often had sickness certification tasks, such tasks were seldom experienced as problematic. However, lack of resources for sickness certification tasks was associated with experiencing such tasks as problematic. Most of the women with BC had experienced encounters from healthcare professionals regarding work and SA the year after the surgery. Most of the women, both on SA due to BC or due to other diagnoses, had experienced positive encounters, and that such encounters promoted being able to RTW. The results indicate that physicians’ sickness certification practice can be influenced by interventions

Review: The Danish Miridae

Lars Skipper 2013: Danmarks blomstertæger. [The Danish Miridae.] 407 pp. ISBN 978-87- 92832-03-0. Apollo Booksellers, Denmark; [email protected], www.apollobooks.dk. Price 420 DKK, 62 EUR, not including shipping

Influencing political business environment in the trade policy field of the European Union - Finnish paper industry and the Council Regulation 1031/2002 ("Steel case")

Siirretty Doriast

Medieval Buddhist Textuality : "Kyōgyōshinshō" as Literature

「日本研究」再考 : 北欧の実践からRethinking "Japanese Studies" from Practices in the Nordic Region, コペンハーゲン大学, 2012年8月22日-24

Review: Danish Pentatomoidea, Coreoidea and Pyrrhocoroidea

Ole Fogh Nielsen & Lars Skipper 2015: Danmarks bredtaeger, randtaeger og ildtaeger [Danish Pentatomoidea, Coreoidea and Pyrrhocoroidea.] 202 pp. ISBN 978-87-92832-04-7. Apollo Booksellers, Denmark; info@apollobooks. dk, www.apollobooks.com. Price 300 DKK, 43 EUR, excluding shipping

Auchenorrhyncha captured at light in Finland: (Hemiptera, Fulgoromorpha et Cicadomorpha)

A considerable proportion of Finnish species of Auchenorrhyncha was found to be nocturnally active based on samples from extensive light-trapping in the years 2002 and 2003. Altogether 214 species and more than 147,000 specimens were recorded from 148 annual light trap samples in 76 sites. The samples revealed 14 species new to the country and more than 500 new provincial records. A periodical test showed that the nocturnal activity has two activity peaks with differring sex ratios