Handbok för bekämpning av vresros i Sverige och Finland

Denna handbok har tagits fram inom Interreg Botnia-Atlanticaprojektet INSPECT, Invasive species eradication and control. Projektet är ett samarbete mellan Sverige och Finland. Handboken innehåller därför information som gäller för båda länderna och finns också tillgänglig på finska. Invasiva främmande arter är sådana arter som människan, avsiktligt eller av misstag, tagit in till ett nytt område där de sedan sprids kraftigt och orsakar ekologisk, ekonomisk eller social skada eller skada mot hälsa. Invasiva arter anses idag vara ett av de största hoten mot biologisk mångfald. Problemet är mycket utbrett och därför är engagemang på såväl myndighets- som individnivå viktigt och kräver samarbete mellan grannar, grannkommuner och till och med mellan grannländer. Vresrosen är en invasiv art som är robust och har en god spridningsförmåga. Det har lett till att den blivit ett problem i områden där den inte hör hemma. Handboken ger stöd till alla som planerar att genomföra en bekämpningsinsats mot vresros; privatpersoner, föreningar, företag, kommuner eller myndigheter. Några kapitel riktar sig främst till större insatser, men i de fall där informationen delvis är relevant också för mindre insatser har vi sammanfattat det väsentliga i början av kapitlen. Handboken behandlar såväl bekämpningsmetoder som arbetskraft och kommunikation. Det finns också ett digitalt verktyg (hyperlänk) som föreslår lämpliga metoder utifrån angivna förutsättningar. Förutsättningar för bekämpningsinsatser bedöms subjektivt, därmed kan inte universella rekommendationer ges utan flera alternativ presenteras

Opas kurtturuusun torjuntaan Suomessa ja Ruotsissa

Tämä opas on laadittu Interreg Botnia-Atlantica -hankkeessa INSPECT, Invasive species eradication and control. Hanke toteutetaan Ruotsin ja Suomen välisenä yhteistyönä. Opas sisältää siksi molempia maita koskevaa tietoa ja on saatavilla myös ruotsiksi. Haitalliset vieraslajit ovat lajeja, jotka ihminen on tuonut tarkoituksella tai vahingossa uudelle alueelle, niiden luontaisen levinneisyysalueen ulkopuolelle, missä ne leviävät voimakkaasti ja aiheuttavat ekologista, taloudellista, terveydellistä tai sosiaalista vahinkoa. Haitallisia vieraslajeja pidetään nykyään yhtenä suurimmista luonnon monimuotoisuuteen kohdistuvista uhkista. Ongelma on hyvin laaja, ja siksi sitoutuminen torjuntaan on tärkeää sekä viranomais- että yksilötasolla, ja vaatii yhteistyötä naapurien ja naapurikuntien – jopa naapurimaiden välillä. Kurtturuusu on haitallinen vieraslaji, jota voi olla vaikea poistaa, kun se on kerran saanut jalansijan. Kurtturuusun vahvuus ja hyvä leviämiskyky ovat johtaneet siihen, että siitä on tullut ongelma alueilla, joille se ei kuulu. Opas tarjoaa tukea kaikille kurtturuusun torjuntaa suunnitteleville, olipa kyse yksityishenkilöistä, yhdistyksistä, yrityksistä, kunnista tai viranomaisista. Joissakin luvuissa keskitytään lähinnä suurempiin torjuntatoimiin, mutta niissä tapauksissa, joissa tiedot ovat osittain merkityksellisiä myös pienempien toimien kannalta, olemme tiivistäneet olennaiset tiedot luvun alkuun. Oppaassa käsitellään niin torjuntamenetelmiä kuin työvoimaa ja viestintääkin. Käytössä on myös digitaalinen työkalu, joka ehdottaa sopivia menetelmiä annettujen edellytysten pohjalta. Torjuntatoimien edellytykset arvioidaan subjektiivisesti, joten yleispäteviä suosituksia ei voida antaa vaan oppaassa esitellään useita vaihtoehtoja

PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis

Background & Aims: Acute decompensation (AD) of cirrhosis may present without acute-on-chronic liver failure (ACLF) (ADNo ACLF), or with ACLF (AD-ACLF), defined by organ failure(s). Herein, we aimed to analyze and characterize the precipitants leading to both of these AD phenotypes. Methods: The multicenter, prospective, observational PREDICT study (NCT03056612) included 1,273 non-electively hospitalized patients with AD (No ACLF = 1,071; ACLF = 202). Medical history, clinical data and laboratory data were collected at enrolment and during 90-day follow-up, with particular attention given to the following characteristics of precipitants: induction of organ dysfunction or failure, systemic inflammation, chronology, intensity, and relationship to outcome. Results: Among various clinical events, 4 distinct events were precipitants consistently related to AD: proven bacterial infections, severe alcoholic hepatitis, gastrointestinal bleeding with shock and toxic encephalopathy. Among patients with precipitants in the AD-No ACLF cohort and the AD-ACLF cohort (38% and 71%, respectively), almost all (96% and 97%, respectively) showed proven bacterial infection and severe alcoholic hepatitis, either alone or in combination with other events. Survival was similar in patients with proven bacterial infections or severe alcoholic hepatitis in both AD phenotypes. The number of precipitants was associated with significantly increased 90day mortality and was paralleled by increasing levels of surrogates for systemic inflammation. Importantly, adequate first-line antibiotic treatment of proven bacterial infections was associated with a lower ACLF development rate and lower 90-day mortality. Conclusions: This study identified precipitants that are significantly associated with a distinct clinical course and prognosis in patients with AD. Specific preventive and therapeutic strategies targeting these events may improve outcomes in patients with decompensated cirrhosis. Lay summary: Acute decompensation (AD) of cirrhosis is characterized by a rapid deterioration in patient health. Herein, we aimed to analyze the precipitating events that cause AD in patients with cirrhosis. Proven bacterial infections and severe alcoholic hepatitis, either alone or in combination, accounted for almost all (96-97%) cases of AD and acute-on-chronic liver failure. Whilst the type of precipitant was not associated with mortality, the number of precipitant(s) was. This study identified precipitants that are significantly associated with a distinct clinical course and prognosis of patients with AD. Specific preventive and therapeutic strategies targeting these events may improve patient outcomes. (c) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

The PREDICT study uncovers three clinical courses of acutely decompensated cirrhosis that have distinct pathophysiology

Acute decompensation (AD) of cirrhosis is defined as the acute development of ascites, gastrointestinal hemorrhage, hepatic encephalopathy, infection or any combination thereof, requiring hospitalization. The presence of organ failure(s) in patients with AD defines acute-on-chronic liver failure (ACLF). The PREDICT study is a European, prospective, observational study, designed to characterize the clinical course of AD and to identify predictors of ACLF. A total of 1,071 patients with AD were enrolled. We collected detailed pre-specified information on the 3-month period prior to enrollment, and clinical and laboratory data at enrollment. Patients were then closely followed up for 3 months. Outcomes (liver transplantation and death) at 1 year were also recorded. Three groups of patients were identified. Pre-ACLF patients (n = 218) developed ACLF and had 3-month and 1-year mortality rates of 53.7% and 67.4%, respectively. Unstable decompensated cirrhosis (UDC) patients (n = 233) required ≥1 readmission but did not develop ACLF and had mortality rates of 21.0% and 35.6%, respectively. Stable decompensated cirrhosis (SDC) patients (n = 620) were not readmitted, did not develop ACLF and had a 1-year mortality rate of only 9.5%. The 3 groups differed significantly regarding the grade and course of systemic inflammation (high-grade at enrollment with aggravation during follow-up in pre-ACLF; low-grade at enrollment with subsequent steady-course in UDC; and low-grade at enrollment with subsequent improvement in SDC) and the prevalence of surrogates of severe portal hypertension throughout the study (high in UDC vs. low in pre-ACLF and SDC). Acute decompensation without ACLF is a heterogeneous condition with 3 different clinical courses and 2 major pathophysiological mechanisms: systemic inflammation and portal hypertension. Predicting the development of ACLF remains a major future challenge. ClinicalTrials.gov number: NCT03056612. Lay summary: Herein, we describe, for the first time, 3 different clinical courses of acute decompensation (AD) of cirrhosis after hospital admission. The first clinical course includes patients who develop acute-on-chronic liver failure (ACLF) and have a high short-term risk of death - termed pre-ACLF. The second clinical course (unstable decompensated cirrhosis) includes patients requiring frequent hospitalizations unrelated to ACLF and is associated with a lower mortality risk than pre-ACLF. Finally, the third clinical course (stable decompensated cirrhosis), includes two-thirds of all patients admitted to hospital with AD - patients in this group rarely require hospital admission and have a much lower 1-year mortality risk

Översiktsplan för våtmarker, skyddszoner och naturlig mångfald i jordbruksområden : Vörå

Maaseudun perinteinen maisema ja luonto ovat muotoutuneet vuosisatojen aikana erilaisten maankäyttötapojen tuloksena. Perinteiset maankäyttömuodot, kuten laidunnus ja niitto, ovat luoneet näille alueille tunnusomaisen kasvi- ja eläinlajiston. Maatalouden tarjoamissa elinympäristöissä elää noin neljäsosa Suomen luonnonvaraisista eliölajeista. Viime vuosikymmenten aikana maisema on kuitenkin muuttunut yksipuolisemmaksi ja luonnon monimuotoisuus vähentynyt maatalousympäristössä. Kuivatus on vähentänyt vesistöihin ja luonnon uomiin kuuluneita kosteikkoja ja tulva-alueita. Samalla maatalousalueilta huuhtoutuvat ravinteet ja kiintoaineet kuormittavat vesistöjä. Maatalousympäristöä hoitamalla voidaan vähentää tuotantotoiminnan haitallisia vesistövaikutuksia sekä palauttaa luonnon monimuotoisuutta ja maisemallisia arvoja. Luonnon monimuotoisuudella tarkoitetaan kaikkien eliölajien sekä niiden elinympäristöjen ja elottoman luonnon moninaisuutta. Vöyri on perinteikästä maatalousaluetta. Vöyrille laadittiin vuosien 2012–2013 aikana MMM:n määrärahalla maatalousalueiden monivaikutteisten kosteikkojen, luonnon monimuotoisuuden ja suojavyöhykkeiden yleissuunnitelma. Suunnittelualue, jolle kartoitus keskittyi, sijoittui Vöyrin valtakunnallisesti arvokkaalle maisema-alueelle. Hankkeessa Vöyrillä kartoitettiin 57 luonnon monimuotoisuuskohdetta ja kaksi mahdollista monivaikutteisen kosteikon paikkaa. Suojavyöhykkeiden tarvetta kartoitettiin Vöyrinjoen rannoilla. Maanomistajien yhteydenottojen perusteella kohteita kartoitettiin koko Vöyrin kunnan alueella. Kohteille annettiin toimenpidesuosituksia, joita maanomistajat voivat halutessaan toteuttaa. Hoidon rahoittamiseksi ehdotettiin kohteille sopivaa maatalouden erityistukimuotoa.Landsbygdens traditionella landskap och natur har formats under århundraden av olika typer av markanvändning. Traditionell markanvändning, såsom bete och slåtter, har skapat en karakteristisk flora och fauna. Ungefär en fjärdedel av alla våra vilda djur och växter lever i livsmiljöer i som finns i jordbruksområden. Under de senaste årtiondena har jordbruksmiljön dock blivit ensidigare och den naturliga mångfalden har minskat. Våtmarker och översvämningsområden har torrlagts, samtidigt som näringsämnen och partiklar från åkermark sköljs ut i vattendragen. Genom att sköta om jordbruksmiljön kan man minska de skadliga verkningarna på vattendragen som produktionsverksamheten medför och få tillbaka naturlig mångfald och landskapsmässiga värden. Med naturlig mångfald menas en rikedom på arter och livsmiljöer. Vörå är ett område med långa jordbrukstraditioner. År 2012-2013 har en översiktsplan för våtmarker, skyddszoner och naturlig mångfald gjorts för Vörå. Karteringen koncentrerade sig till Vörås nationellt värdefulla landskapsområde. På markägares önskemål karterades objekt i hela kommunen. Sammanlagt karterades 57 mångfaldsobjekt och två våtmarker. Behovet av skyddszoner granskades längs Vörå å. För varje objekt ges skötselrekommendationer, som markägaren kan genomföra om han/hon vill. Dessutom föreslås lämpliga miljöspecialstödsformer för finansiering av åtgärderna

Carvedilol versus traditional, non-selective beta-blockers for adults with cirrhosis and gastroesophageal varices

BACKGROUND: Non-selective beta-blockers are recommended for the prevention of bleeding in people with cirrhosis, portal hypertension and gastroesophageal varices. Carvedilol is a non-selective beta-blocker with additional intrinsic alpha1-blocking effects, which may be superior to traditional, non-selective beta-blockers in reducing portal pressure and, therefore, in reducing the risk of upper gastrointestinal bleeding. OBJECTIVES: To assess the beneficial and harmful effects of carvedilol compared with traditional, non-selective beta-blockers for adults with cirrhosis and gastroesophageal varices. SEARCH METHODS: We combined searches in the Cochrane Hepato-Biliary's Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS, and Science Citation Index with manual searches. The last search update was 08 May 2018. SELECTION CRITERIA: We included randomised clinical trials comparing carvedilol versus traditional, non-selective beta-blockers, irrespective of publication status, blinding, or language. We included trials evaluating both primary and secondary prevention of upper gastrointestinal bleeding in adults with cirrhosis and verified gastroesophageal varices. DATA COLLECTION AND ANALYSIS: Three review authors (AZ, RJ and LH), independently extracted data. The primary outcome measures were mortality, upper gastrointestinal bleeding and serious adverse events. We undertook meta-analyses and presented results using risk ratios (RR) or mean differences (MD), both with 95% confidence intervals (CIs), and I2 values as a marker of heterogeneity. We assessed bias control using the Cochrane Hepato-Biliary domains and the quality of the evidence with GRADE. MAIN RESULTS: Eleven trials fulfilled our inclusion criteria. One trial did not report clinical outcomes. We included the remaining 10 randomised clinical trials, involving 810 participants with cirrhosis and oesophageal varices, in our analyses. The intervention comparisons were carvedilol versus propranolol (nine trials), or nadolol (one trial). Six trials were of short duration (mean 6 (range 1 to 12) weeks), while four were of longer duration (13.5 (6 to 30) months). Three trials evaluated primary prevention; three evaluated secondary prevention; while four evaluated both primary and secondary prevention. We classified all trials as at 'high risk of bias'. We gathered mortality data from seven trials involving 507 participants; no events occurred in four of these. Sixteen of 254 participants receiving carvedilol and 19 of 253 participants receiving propranolol or nadolol died (RR 0.86, 95% CI 0.48 to 1.53; I2 = 0%, low-quality evidence). There appeared to be no differences between carvedilol versus traditional, non-selective beta-blockers and the risks of upper gastrointestinal bleeding (RR 0.77, 95% CI 0.43 to 1.37; 810 participants; 10 trials; I2 = 45%, very low-quality evidence) and serious adverse events (RR 0.97, 95% CI 0.67 to 1.42; 810 participants; 10 trials; I2 = 14%, low-quality evidence). Significantly more deaths, episodes of upper gastrointestinal bleeding and serious adverse events occurred in the long-term trials but there was not enough information to determine whether there were differences between carvedilol and traditional, non-selective beta-blockers, by trial duration. There was also insufficient information to detect differences in the effects of these interventions in trials evaluating primary or secondary prevention. There appeared to be no differences in the risk of non-serious adverse events between carvedilol versus its comparators (RR 0.55, 95% CI 0.23 to 1.29; 596 participants; 6 trials; I2 = 88%; very low-quality evidence). Use of carvedilol was associated with a greater reduction in hepatic venous pressure gradient than traditional, non-selective beta-blockers both in absolute (MD -1.75 mmHg, 95% CI -2.60 to -0.89; 368 participants; 6 trials; I2 = 0%; low-quality evidence) and percentage terms (MD -8.02%, 95% CI -11.49% to -4.55%; 368 participants; 6 trials; I2 = 0%; low-quality evidence). However, we did not observe a concomitant reduction in the number of participants who failed to achieve a sufficient haemodynamic response (RR 0.76, 95% CI 0.57 to 1.02; 368 participants; 6 trials; I2 = 42%; very low-quality evidence) or in clinical outcomes. AUTHORS' CONCLUSIONS: We found no clear beneficial or harmful effects of carvedilol versus traditional, non-selective beta-blockers on mortality, upper gastrointestinal bleeding, serious or non-serious adverse events despite the fact that carvedilol was more effective at reducing the hepatic venous pressure gradient. However, the evidence was of low or very low quality, and hence the findings are uncertain. Additional evidence is required from adequately powered, long-term, double-blind, randomised clinical trials, which evaluate both clinical and haemodynamic outcomes