Mapping and Evaluating Marine Protected Areas and Ecosystem Services: A Transdisciplinary Delphi Forecasting Process Framework

Marine Protected Areas (MPAs) are an important tool for management and conservation and play an increasingly recognised role in societal and human well-being. However, the assessment of MPAs often lacks a simultaneous consideration of ecological and socio-economic outcomes, and this can lead to misconceptions on the effectiveness of MPAs. In this perspective, we present a transdisciplinary approach based on the Delphi method for mapping and evaluating Marine Protected Areas for their ability to protect biodiversity while providing Ecosystem Services (ES) and related human well-being benefits - i.e., the ecosystem outputs from which people benefit. We highlight the need to include the human dimensions of marine protection in such assessments, given that the effectiveness of MPAs over time is conditional on the social, cultural and institutional contexts in which MPAs evolve. Our approach supports Ecosystem-Based Management and highlights the importance of MPAs in achieving restoration, conservation, and sustainable development objectives in relation to EU Directives such as the Marine Strategy Framework Directive (MSFD), the Maritime Spatial Planning Directive (MSPD), and the Common Fisheries Policy (CFP)

”Monstret säger Aaaaa” en undersökning om surfplattan i förskolan

Syfte: Studiens syfte var att undersöka två olika förfaranden att introducera en ny ABC-app för barnen. Då de förfaranden var något vi observerat i verksamheten ville vi även undersöka om pedagogerna använder dessa som ett medvetet sätt att arbeta. Metod: Vi har använt oss av en kvalitativ metod i form av observationer, där vi observeradebarn, vi har även intervjuat pedagoger på tre förskoleavdelningar. Vår dokumentation har skett med löpande anteckningar och ljudinspelning. Resultat: Resultaten i vår undersökning visar att surfplattan är ett användbart verktyg i arbetet med barns tidiga språk, läs och skrivutveckling. Resultatet visar att barnen interagerade på liknande sätt i båda förfaranden men att pedagogen har stora möjligheter till att påverka situationen. I undersökningen framgår vikten av att pedagogen tar en aktiv roll i arbetet med surfplattan. Det framgår även att pedagogerna reflekterar och diskuterar kring arbetet med surfplattor men det är en del av verksamheten som fortfarande är under utveckling

Impact of pregnancies on ovarian cancer : Risk, prognosis and tumor biology

Ovarian cancer is the most lethal gynecological malignancy. The etiology is complex and not fully understood, partly since ovarian cancer is not one distinct disease, but rather several histologically and clinically different subtypes. The two main groups are epithelial (90%) and non-epithelial (10%) cancers, further divided into five epithelial and two main non-epithelial subtypes. Women who have given birth have a lower risk of developing epithelial ovarian cancer, and the risk is further reduced with each additional childbirth. However, the association between several pregnancy-related factors, such as pregnancy length, maternal age at birth, offspring size, and subsequent risk of ovarian cancer has been unclear. In addition, the impact of pregnancy-related risk factors on non-epithelial ovarian cancer is unknown. Further, the underlying mechanism behind the protection of childbirth has not been revealed and the prognostic impact of pregnancies is not established. In my first two studies, I evaluated associations between pregnancy-related factors and risk of epithelial ovarian cancer and its different subtypes [Study I] and non-epithelial ovarian cancer [Study II]. These case-control studies were based on linked data from the population-based medical birth registers and cancer registers in Denmark, Finland, Norway and Sweden. In Study I, preterm birth was associated with an increased risk of epithelial ovarian cancer among parous women, whereas increased number of births and pregnancies at older age were associated with decreased risk. In Study II, increasing age at last birth was associated with lower risk of sex cord-stroma cell tumors (SCSTs), as was shorter time since last birth. In Study III, the prognostic impact of parity on both epithelial and non-epithelial ovarian cancer by subtype was investigated by linkage of data from the Swedish medical birth register, the cancer register and the cause of death register. Parity was associated with reduced cancer-specific mortality in ovarian germ cell tumors. We found no prognostic impact of parity in patients with SCSTs or epithelial ovarian cancer. In Study IV, we investigated whether hormones and proteins involved in pregnancy and tumor development differed according to the woman’s parity status in patients with high-grade serous ovarian cancer. Parous women more often had progesterone receptor (PR) positive tumors, in comparison with nulliparous women, and increased number of children was associated with PR positive tumors. In summary, a woman’s reproductive history will not only impact on the risk of developing ovarian cancer, but also have a long-lasting influence on the tumor biology

Impact of pregnancies on ovarian cancer : Risk, prognosis and tumor biology

Ovarian cancer is the most lethal gynecological malignancy. The etiology is complex and not fully understood, partly since ovarian cancer is not one distinct disease, but rather several histologically and clinically different subtypes. The two main groups are epithelial (90%) and non-epithelial (10%) cancers, further divided into five epithelial and two main non-epithelial subtypes. Women who have given birth have a lower risk of developing epithelial ovarian cancer, and the risk is further reduced with each additional childbirth. However, the association between several pregnancy-related factors, such as pregnancy length, maternal age at birth, offspring size, and subsequent risk of ovarian cancer has been unclear. In addition, the impact of pregnancy-related risk factors on non-epithelial ovarian cancer is unknown. Further, the underlying mechanism behind the protection of childbirth has not been revealed and the prognostic impact of pregnancies is not established. In my first two studies, I evaluated associations between pregnancy-related factors and risk of epithelial ovarian cancer and its different subtypes [Study I] and non-epithelial ovarian cancer [Study II]. These case-control studies were based on linked data from the population-based medical birth registers and cancer registers in Denmark, Finland, Norway and Sweden. In Study I, preterm birth was associated with an increased risk of epithelial ovarian cancer among parous women, whereas increased number of births and pregnancies at older age were associated with decreased risk. In Study II, increasing age at last birth was associated with lower risk of sex cord-stroma cell tumors (SCSTs), as was shorter time since last birth. In Study III, the prognostic impact of parity on both epithelial and non-epithelial ovarian cancer by subtype was investigated by linkage of data from the Swedish medical birth register, the cancer register and the cause of death register. Parity was associated with reduced cancer-specific mortality in ovarian germ cell tumors. We found no prognostic impact of parity in patients with SCSTs or epithelial ovarian cancer. In Study IV, we investigated whether hormones and proteins involved in pregnancy and tumor development differed according to the woman’s parity status in patients with high-grade serous ovarian cancer. Parous women more often had progesterone receptor (PR) positive tumors, in comparison with nulliparous women, and increased number of children was associated with PR positive tumors. In summary, a woman’s reproductive history will not only impact on the risk of developing ovarian cancer, but also have a long-lasting influence on the tumor biology

Spasticity : an elusive problem after spinal cord injury

The aim of this thesis was to characterize spasticity in individuals and in a near total prevalence population with traumatic spinal cord (SCI) injury by assessment of: Article I Relation between Self-reporting of symptoms, neurologic examination (ASIA), physical therapy examination, ROM and complications Article II Repeated self-rating (VAS), and the relation between movement- provoked MAS rating and self-rating after a repetitive passive movement intervention Article III Correlation between movement-provoked MAS rating during simultaneous recording of EMG thigh muscle activity Article IV Correlation between Isokinetic movement-provoked resistive torque measurements during recording of EMG thigh muscle activity Article V FES induced changes in body composition evaluated by CT and in spasticity by using the methods from articles II-IV Article I comprised the near-total prevalence population (n=354) of individuals with traumatic SCI in Stockholm. Article II comprised 45 individuals with various levels and degrees of injury. Articles III- V comprised 15 male individuals with a cervical motor complete SCI. Problematic spasticity was significantly more common in individuals with a cervical incomplete (ASIA B-D) injury. Reports of beneficial effects of spasticity were significantly less common in females and in subgroups with duration of injury less than 4 years. Spasticity was elicitable by movement provocation in only 60% of the individuals reporting spasticity. Spasticity of SCI subjects with a cervical injury fluctuated significantly (p<0.05) during time of the day, unlike spasticity of SCI subjects with thoracic injury. Immediately after intervention with passive movements, spasticity ratings (VAS) in SCI patients with a thoracic motor complete injury decreased by 11-14 mm (90%, p<0.001) as self-rated on VAS and by 1-2 grades (50%, p<0.001) as measured with MAS. Spasticity was provoked in 50% of the subjects. while correlations between MAS grades and EMG values were calculated both including and excluding the MAS 0-grade ratings. 80% of spasticity MAS ratings (0-grades included) correlated significantly (p<0.05) with simultaneous EMG values. The flexion movement correlated significantly (p<0.05) irrespective of side and regardless whether O-grades were included or excluded as opposed to extension movement. Significantly higher isokinetic resistance (p=0.049) was provoked for extension movement compared to that of flexion. Contrary, the maximum EMG thigh muscle activity was significantly higher (p=0.009) during flexion provocation compared to that during extension. No change in FES induced spasticity (evaluated as in studies II-IV) was seen in the training group when compared with the control group. The training group increased their leg muscle volume by an average of 1300 cm3 (p<0.001) as compared to the control group who experienced no change. No significant changes were found in the subject's lower extremity or abdomen with regard to subcutaneous and visceral adipose tissue (AT). This thesis has highlighted in subjective and objective data sets of spasticity in SCI man, the elusive nature of this prevalent symptom. Careful comparisons of self-assessments, clinical assessments, and in occasional systematic studies objective measures are recommended

Hälso- och sjukvårdspersonals uppfattningar av att genomföra en orosanmälan vid misstanke om barn som far illa

Sammanfattning Bakgrund: Många barn i världen far illa. Barnkonventionen arbetar för att världens barn ska få en trygg uppväxt och lagar finns som förbjuder barnaga. Av världens 195 länder har 62 infört förbud mot barnaga. Barnmisshandel är både fysisk och psykisk och barnen utsätts oftast av den person som barnet litar mest på, den som tar hand om barnet i vardagen. Syfte: Syftet med denna litteraturstudie var att undersöka hälso- och sjukvårdspersonals uppfattningar av att göra eller inte göra en orosanmälan vid misstanke om barn som far illa i primärvården och skolan. Metod: En systematisk litteraturstudie genomfördes med databassökningar i Medline via PubMed med söktermerna barnmisshandel och obligatorisk rapportering. Tio vetenskapliga artiklar av kvantitativ (n=4), kvalitativ (n=4) och mixad ansats (n=2) ingick i litteraturstudiens resultat. Huvudresultat: Det framkom att hälso- och sjukvårdspersonal önskade mera utbildning och kunskap om barnmisshandel. Bristande information om hur rapporteringen gick till gjorde att hälso- och sjukvårdspersonalen inte orosanmälde och många uttryckte att ett färdigt rapporteringsformulär skulle öka rapporteringsfrekvensen. Slutsats: Utbildning inom barnmisshandel och rapportering av orosanmälan var det som deltagarna i många studier efterfrågade. Om hälso- och sjukvårdspersonalen skulle få utbildning kontinuerligt så kanske rapporteringen av orosanmälningarna ökade och barnen få en bättre vardag. Nyckelord: Barnmisshandel, hälso- och sjukvårdspersonal och obligatorisk rapportering

Kvinnors och mäns motiv och ambivalens till att donera ägg och spermier i Sverige

Involuntary childlessness is a big problem around the world. One way to solve the problem is to receive oocytes or semen from a donor. In Sweden, semen donation has been regulated by law since 1985 and oocyte donation since 2003. The aim of this study was to investigate what motivations women and men in Sweden have to donate gametes, if they feel any ambivalence to donate, and to compare if there is any difference in motivation and ambivalence between women and men. Motivation was measured with eight statements based on previous results and clinical experience. Ambivalence was measured with a scale consisting of seven statements that addressed thoughts and feelings about the donation. The participants in the study were donors at some of the seven infertility clinics in Sweden. The dropout rate for the sperm donors was 19 %. For the egg donors the dropout rate was 17 %.. The main result showed that the main motivation for donating oocytes or semen was helping childless couples. The significant differences between women’s and men’s motivations for donating oocytes or semen were that the women were keener to helping others, while the men to a higher extent wanted to do something important, spread their genes and find out about their own fertility. The oocyte and semen donors did not feel any particular ambivalence about the decision to donate, most of them did not find it difficult to make the decision, and they would have been disappointed if they had not been allowed to donate for some reason. The conclusions to be drawn from this study are that once the donors have decided to donate, they don’t feel any particular ambivalence about the donation, and women and men have different motivations to why they are donating, even if the main motivation is the same.Ofrivillig barnlöshet är ett stort problem världen över. Ett sätt att lösa problemet är att ta emot ägg eller spermier ifrån en donator. I Sverige har spermiedonation varit reglerat i lag sedan 1985 och äggdonation sedan 2003. Syftet med denna studie var att undersöka vilka motiv kvinnor och män i Sverige har till att donera ägg respektive spermier, om de känner någon ambivalens till att donera, samt att jämföra om det är någon skillnad i motiv och ambivalens mellan kvinnor och män. Motiv mättes med åtta påståenden konstruerade utifrån tidigare resultat och klinisk erfarenhet. Ambivalens mättes med en skala som bestod av sju påståenden som behandlade tankar och känslor kring donationen, Deltagarna i studien var donatorer vid någon av de sju infertilitetscentra i Sverige. Bortfallet för spermiedonatorerna var 19 %. För äggdonatorerna var bortfallet 17 %. Huvudresultatet visade att det främsta motivet hos kvinnor och män till att donera ägg respektive spermier i Sverige var att hjälpa barnlösa par. De signifikanta skillnaderna mellan kvinnors och mäns motiv till att donera ägg respektive spermier var att kvinnor var mer måna om att hjälpa andra, medan männen i högre grad ville göra något betydelsefullt, sprida sina gener och få reda på hur det stod till med den egna fertiliteteten. Ägg- och spermiedonatorerna kände ingen större ambivalens inför beslutet om att donera, de flesta tyckte inte att beslutet var svårt att ta, och de skulle ha blivit besvikna om de inte fick donera av någon anledning. Slutsatser som har dragits är att när ägg- respektive spermiedonatorer väl har bestämt sig för att donera känner de ingen större ambivalens inför donationen, och män och kvinnor har skilda motiv till varför de donerar även om huvudmotivet är detsamma

Hälso- och sjukvårdspersonals uppfattningar av att genomföra en orosanmälan vid misstanke om barn som far illa

Sammanfattning Bakgrund: Många barn i världen far illa. Barnkonventionen arbetar för att världens barn ska få en trygg uppväxt och lagar finns som förbjuder barnaga. Av världens 195 länder har 62 infört förbud mot barnaga. Barnmisshandel är både fysisk och psykisk och barnen utsätts oftast av den person som barnet litar mest på, den som tar hand om barnet i vardagen. Syfte: Syftet med denna litteraturstudie var att undersöka hälso- och sjukvårdspersonals uppfattningar av att göra eller inte göra en orosanmälan vid misstanke om barn som far illa i primärvården och skolan. Metod: En systematisk litteraturstudie genomfördes med databassökningar i Medline via PubMed med söktermerna barnmisshandel och obligatorisk rapportering. Tio vetenskapliga artiklar av kvantitativ (n=4), kvalitativ (n=4) och mixad ansats (n=2) ingick i litteraturstudiens resultat. Huvudresultat: Det framkom att hälso- och sjukvårdspersonal önskade mera utbildning och kunskap om barnmisshandel. Bristande information om hur rapporteringen gick till gjorde att hälso- och sjukvårdspersonalen inte orosanmälde och många uttryckte att ett färdigt rapporteringsformulär skulle öka rapporteringsfrekvensen. Slutsats: Utbildning inom barnmisshandel och rapportering av orosanmälan var det som deltagarna i många studier efterfrågade. Om hälso- och sjukvårdspersonalen skulle få utbildning kontinuerligt så kanske rapporteringen av orosanmälningarna ökade och barnen få en bättre vardag. Nyckelord: Barnmisshandel, hälso- och sjukvårdspersonal och obligatorisk rapportering

Parity is associated with better prognosis in ovarian germ cell tumors, but not in other ovarian cancer subtypes

Ovarian cancer is influenced by reproductive factors, with a reduced risk of epithelial ovarian cancer in parous women. Nonepithelial ovarian cancer frequently affects young women and often precedes or occurs during the childbearing years. However, the impact of reproductive factors on ovarian cancer survival remains unclear: in epithelial ovarian cancer, data are conflicting, and subtype-specific associations have not been examined, and in nonepithelial ovarian cancer, it has not been studied. Using Swedish registers, we evaluated associations between women's reproductive history and cancer-specific mortality by subtype of epithelial and nonepithelial ovarian cancer in 3791 women born 1953 and later, diagnosed from 1990 to 2018. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated using Cox-proportional hazard models. Parity was associated with a 78% decreased risk of cause-specific mortality in 243 women with germ cell tumors (GCTs) (parous vs nulliparous, adjusted for age at diagnosis: HR: 0.22 [95% CI 0.07-0.62]), with a decreased risk with increasing number of births (per birth: HR: 0.60 [95% CI 0.38-0.95]). We found no evidence of associations between parity and cause-specific mortality among the 334 patients with sex-cord stromal tumors, nor among the 3214 patients with epithelial ovarian cancer; neither overall, nor by subtype. In conclusion, in our large, population-based study, parity was associated with a clearly better prognosis in GCTs but not in the other ovarian cancer subtypes. Future research on how hormone exposure impacts GCT development may lead to a better understanding of mechanisms affecting survival. What's new? While risk of epithelial ovarian cancer is known to be influenced by pregnancy, the mechanisms underlying this association remain unclear. In this population-based study, the impact of reproductive history on ovarian cancer prognosis was evaluated by ovarian cancer subtype. Among women with germ cell tumors, parity was associated with 78 percent reduction in risk of cause-specific mortality. No associations were detected between parity and prognosis among women with sex-cord stromal tumors or epithelial ovarian cancer. These observations raise new questions about relationships between ovarian cancer prognosis and reproductive factors, including possible impacts of hormone exposure in pregnancy