Mortalidade materna: 75 anos de observações em uma Maternidade Escola

OBJETIVO: avaliar as causas de todas as mortes maternas ocorridas no período de 1927 a 2001 entre 164.161 pacientes, internadas no Serviço de Obstetrícia da Universidade Federal de Juiz de Fora. MG. MÉTODOS: estudo retrospectivo das 144 mortes maternas que ocorreram na maternidade em 75 anos, com um total de 131.048 nascidos vivos, utilizando todos os prontuários de pacientes, avaliados pela história clínica e dados da certidão de óbito (não foram realizadas necropsias). Foram registrados a idade, paridade, tempo de gestação, complicações, momento e causas de morte, estabelecendo-se o índice de mortalidade materna (IMM) hospitalar por cem mil nascidos vivos. Análise estatística pelo teste do chi2 e pela técnica de amortecimento exponencial (alfa =0,05). RESULTADOS: de 1927 a 1941 o IMM foi de 1544, entre 1942 e 1956 houve redução para 314 (p<0,001) e de 1957 a 1971 decresceu para 76,4 por cem mil nascidos vivos (p<0,001). No entanto, desde 1972 tem se mantido estável (IMM=46 nos últimos 15 anos, p=0,139). As mortes maternas mais freqüentes ocorreram entre 15 e 39 anos, em nulíparas com gestação a termo, e no puerpério imediato (53%). Causas obstétricas diretas foram responsáveis por 79,3% dos casos e indiretas em 20,7%. Analisando as causas de mortes, verificou-se que no primeiro período as causas obstétricas diretas mais freqüentes em ordem decrescente, foram a infecção puerperal, eclampsia e ruptura uterina intraparto; no segundo período, foram a hemorragia pré-parto e eclampsia, e entre 1977 e 2001, as hemorragias, abortos e pré-eclampsia. A análise dos últimos 15 anos mostrou que não houve morte por pré-eclampsia/eclampsia nem infecção puerperal e as principais causas foram hemorragia periparto, aborto e obstétricas indiretas. Relacionando a mortalidade materna por tipo de parto pelo risco relativo associado à cesárea e/ou parto vaginal, verificou-se que, quando a cesárea é indicação inevitável, o risco a ela associado é menor (risco relativo = 0,6) que o de parto por via vaginal. CONCLUSÕES: apesar da redução ao longo dos 75 anos, a mortalidade materna, de 46 por 100 mil nascidos vivos, ainda é muito elevada, não havendo decréscimo significativo desde 1972, e muitas mortes são evitáveis. Hemorragias são atualmente as causas mais freqüentes de morte materna. A mortalidade materna por aborto tem aumentado de maneira alarmante e o planejamento familiar efetivo é indispensável.

Biodiversity and ecosystem functioning in angiosperm communities in the Baltic Sea

The biological variation in nature is called biodiversity. Anthropogenic pressures have led to a loss of biodiversity, alarming scientists as to what consequences declining diversity has for ecosystem functioning. The general consensus is that diversity (e.g. species richness or identity) affects functioning and provides services from which humans benefit. The aim of this thesis was to investigate how aquatic plant species richness and identity affect ecosystem functioning in terms of processes such as primary production, nutrient availability, epifaunal colonization and properties e.g. stability of Zostera marina subjected to shading. The main work was carried out in the field and ranged temporally from weeklong to 3.5 months-long experiments. The experimental plants used frequently co-occur in submerged meadows in the northern Baltic Sea and consist of eelgrass (Z. marina), perfoliate pondweed (Potamogeton perfoliatus), sago pondweed (P. pectinatus), slender-leaved pondweed (P. filiformis) and horned pondweed (Zannichellia palustris). The results showed that plant richness affected epifaunal community variables weakly, but had a strong positive effect on infaunal species number and functional diversity, while plant identity had strong effects on amphipods (Gammarus spp.), of which abundances were higher in plant assemblages consisting of P. perfoliatus. Depending on the starting standardizing unit, plant richness showed varying effects on primary production. In shoot density-standardized plots, plant richness increased the shoot densities of three out of four species and enhanced the plant biomass production. Both positive complementarity and selection effects were found to underpin the positive biodiversity effects. In shoot biomass-standardized plots, richness effects only affected biomass production of one species. Negative selection was prevalent, counteracting positive complementarity, which resulted in no significant biodiversity effect. The stability of Z. marina was affected by plant richness in such that Z. marina growing in polycultures lost proportionally less biomass than Z. marina in monocultures and thus had a higher resistance to shading. Monoculture plants in turn gained biomass faster, and thereby had a faster recovery than Z. marina growing in polycultures. These results indicate that positive interspecific interactions occurred during shading, while the faster recovery of monocultures suggests that the change from shading stress to recovery resulted in a shift from positive interactions to resource competition between species. The results derived from this thesis show that plant diversity affects ecosystem functioning and contribute to the growing knowledge of plant diversity being an important component of aquatic ecosystems. Diverse plant communities sustain higher primary productivity than comparable monocultures, affect faunal communities positively and enhance stability. Richness and identity effects vary, and identity has generally stronger effects on more variables than richness. However, species-rich communities are likely to contain several species with differing effects on functions, which renders species richness important for functioning. Mixed meadows add to coastal ecosystem functioning in the northern Baltic Sea and may provide with services essential for human well-being.

Deregulation’s Impact on the Railway Freight Transport Sector’s Future in the Baltic Sea Region

The European transport market has confronted several changes during the last decade. Due to European Union legislative mandates, the railway freight market was deregulated in 2007. The market followed the trend started by other transport modes as well as other previously regulated industries such as banking, telecommunications and energy. Globally, the first country to deregulate the railway freight market was the United States, with the introduction of the Staggers Rail Act in 1980. Some European countries decided to follow suit already before regulation was mandated; among the forerunners were the United Kingdom, Sweden and Germany. The previous research has concentrated only on these countries, which has provided an interesting research gap for this thesis. The Baltic Sea Region consists of countries with different kinds of liberalization paths, including Sweden and Germany, which have been on the frontline, whereas Lithuania and Finland have only one active railway undertaking, the incumbent. The transport market of the European Union is facing further challenges in the near future, due to the Sulphur Directive, oil dependency and the changing structure of European rail networks. In order to improve the accessibility of this peripheral area, further action is required. This research focuses on topics such as the progression of deregulation, barriers to entry, country-specific features, cooperation and internationalization. Based on the research results, it can be stated that the Baltic Sea Region’s railway freight market is expected to change in the future. Further private railway undertakings are anticipated, and these would change the market structure. The realization of European Union’s plans to increase the improved rail network to cover the Baltic States is strongly hoped for, and railway freight market counterparts inside and among countries are starting to enhance their level of cooperation. The Baltic Sea Region countries have several special national characteristics which influence the market and should be taken into account when companies evaluate possible market entry actions. According to thesis interviews, the Swedish market has a strong level of cooperation in the form of an old-boy network, and is supported by a positive attitude of the incumbent towards the private railway undertakings. This has facilitated the entry process of newcomers, and currently the market has numerous operating railway undertakings. A contrary example was found from Poland, where the incumbent sent old rolling stock to the scrap yard rather than sell it to private railway undertakings. The importance of personal relations is highlighted in Russia, followed by the railway market’s strong political bond with politics. Nonetheless, some barriers to entry are shared by the Baltic Sea Region, the main ones being acquisition of rolling stock, bureaucracy and needed investments. The railway freight market is internationalizing, which is perceived via several alliances as well as the increased number of mergers and acquisitions. After deregulation, markets seem to increase the number of railway undertakings at a rather fast pace, but with the passage of time, the larger operators tend to acquire smaller ones. Therefore, it is expected that in a decade’s time, the number of railway undertakings will start to decrease in the deregulation pioneer countries, while the ones coming from behind might still experience an increase. The Russian market is expected to be totally liberalized, and further alliances between the Russian Railways and European railway undertakings are expected to occur. The Baltic Sea Region’s railway freight market is anticipated to improve, and, based on the interviewees’ comments, attract more cargoes from road to rail.

Corporate Social Responsibility and Shipping Views of Baltic Sea Shipping Companies on the Benefits of Responsibility

The safety of shipping operations in the Baltic Sea is an extensively studied issue due to the density of traffic and the ecological sensitivity of the area. The focus has, however, mainly been on ship technology or on traffic control measures and the operative safety aspect of shipping is in a minor position in maritime safety studies and is lacking in terms of solutions. Self-regulatory and voluntary measures could be effective ways to improve the operational safety of shipping. Corporate social responsibility, or CSR, is one example of a voluntary measure that the shipping companies can take. CSR can enhance maritime safety and improve the shipping companies’ competitiveness. The aim of this study is to increase the knowledge of CSR in the maritime sector and study its applicability and benefits to the shipping companies. The research comprises of a theory part and a questionnaire study, which examine the significance of corporate social responsibility in shipping companies’ maritime safety and competitiveness. The aim of the questionnaire study is to find out how corporate social responsibility is implemented in the shipping companies. According to the literature review, responsible actions can produce financial and time costs, but due to these actions cost savings in the form of learning and increased efficiency can be achieved. Responsible actions can also produce concrete improvements and a reputation of responsibility that can lead to both cost savings and increase in the company’s income. CSR is recognised as having real business benefits in terms of attracting customers and high-quality employees. In shipping, CSR usually focuses on environmental issues. Environmental social responsibility in shipping is mainly motivated by the need to comply with existing and forthcoming regulation. Shipping companies engage in CSR to gain competitive advantage and to increase maritime safety. The social aspects of CSR take into account the well-being and skills of the employees, corporation and other stakeholders of the company. The questionnaire study revealed that the most common CSR measures in shipping companies are environmental measures, and that environmental concerns are considered to be the most important reason to engage in CSR. From the preliminary question about the concept of CSR it can also be seen that safety issues are commonly considered to be a part of CSR and safety gains are the second most important reason to engage in CSR. From the questionnaire, it can also be extrapolated that gaining a better reputation is one of the most important reasons to engage in CSR in the first place. For example, the main economic benefit was seen to be the increase of customer numbers as a result of a better reputation. Based on the study, it would seem that companies are starting to realise that they might gain competitive advantage and be favoured as shippers if they engage in sustainable, responsible operations and present themselves as “green”.

Five Baltic Ports Togehter: Forecasts, Trends and Recommendations

The ports of Stockholm, Tallinn, Helsinki, Naantali and Turku play key roles in making the Central Baltic region accessible. Effective, competitive, eco-friendly and safe port procedures and solutions for the transportation of goods are of major importance for trade in the Baltic Sea region. This report presents the most essential results and recommendations of the PENTA project, which focused on how ports could better comprehend and face current and future challenges facing carriage of goods by sea. Each of the four work packages (WPs) of the PENTA project analysed the changes from a different perspective. WP2 focused on traffic flows between the PENTA ports. Its main emphasis was on the ports, shipowners, and logistics companies that are the key parties in freight transport and on the changes affecting the economy of those ports. In WP3 noise as an environmental challenge for ports was investigated and the analysis also shed light on the relationship between the port and the city. In WP4 procedures related to safety, security and administrative procedures were researched. The main emphasis was on identifying the requirements for the harmonisation of those procedures. Collaboration is highlighted throughout this report. In order to prepare for the future, it was found that ports need to respond to growing competition, increasing costs and shifts in customer demand by strengthening their existing partnerships with other actors in the maritime cluster. Cargo and passenger transport are the main sources of income for most ports. Cargo traffic between the PENTA ports is expected to grow steadily in the future and the outlook for passenger traffic is positive. However, to prepare for the future, ports should not only secure the core activities which generate revenue but also seek alternative ways to make profit. In order to gain more transit traffic, it is suggested that ports conduct a more thorough study of the future requirements for doing business with Russia. The investigation of noise at ports revealed two specific dilemmas that ports cannot solve alone. Firstly, the noise made by vessels and, secondly, the relationship between the port and the surrounding city. Vessels are the most important single noise source in the PENTA ports and also one of the hardest noise sources to handle. Nevertheless, port authorities in Finland and Sweden are held responsible for all noise in the port area, including noise produced by vessels, which is noise the port authority can only influence indirectly. Building housing by waterfront areas close to ports may also initiate disagreements because inhabitants may want quiet areas, whereas port activities always produce some noise from their traffic. The qualitative aspects of the noise question, cooperating with the stakeholders and the communicating of issues related to noise are just as important. We propose that ports should follow the logic of continuous improvement in their noise management. The administrative barriers discussed in this report are mainly caused by differences in international and national legislation, variations in the customs procedures of each country, the incompatibility of the IT systems used in maritime transport, noncompliance with regulations regarding dangerous goods, and difficulties in applying Schengen regulations to vessels from non-EU countries. Improving the situation is out of the hands of the ports to do alone and requires joint action on a variety of levels, including the EU, national authorities and across administrative borders.

State of logistics and transport in the Baltic Sea region in 2025

The world’s pace of change is accelerating and new innovations, inventions and technologies come about every day. Change is unavoidable. It is difficult to keep up and even more difficult to prepare for the future. Even though it is not possible to know exactly what will happen in the future, by studying futures people can better anticipate what might lie ahead. By making decisions and realizing the consequences of their choices today, people and governments are able to actively decide how they will act in the future. Both opportunities and pitfalls lie ahead, which encourages actors to make more farsighted decisions. The Baltic Sea region is an interesting area for futures studies. It comprises 11 nations and more than 100 million inhabitants and entails countries with advanced, high-income economies, like Finland, Germany and Denmark, and developing economies, like Russia, Latvia and Lithuania. The western, eastern, northern and southern parts of the region are separated by the Baltic Sea, which at the same time represents a barrier and a facility for trade and travel between the countries belonging to the region The purpose of this study was to uncover the most probable future of transport and logistics in the Baltic Sea region in 2025 by using the Delphi method. Altogether 109 responses were collected in two separate instances from experts in all the Baltic Sea region countries, 56 of whom were defined as academic respondents and 53 of whom business respondents. Only minor differences in the opinions of academic and business experts were discovered, and the larger differences lie between eastern and western response groups. The Baltic Sea region is a very heterogeneous region and the division is clearest between East and West, which differ in political, economic, social, technological and environmental aspects. The probable future of the Baltic Sea region presented in this study is coherent with previous studies on the same subject. The future of the Baltic Sea region in terms of logistics and transport looks quite bright according to the experts who participated in the study. Trade volumes will grow and the importance of logistics and transport to the competitiveness of the region will increase. Respondents from eastern countries seemed to be more optimistic about the future in general. Most differences between opinions could be explained by the gap in technological and infrastructural development between the East and West. As eastern countries are less-developed in some parts of their economies, it is easier for them to improve the technical condition of infrastructure by merely catching up with the western countries.

Macroalgae across environmental gradients : tools for managing rocky coastal areas of the northern Baltic Sea

Macroalgae are the main primary producers of the temperate rocky shores providing a three-dimensional habitat, food and nursery grounds for many other species. During the past decades, the state of the coastal waters has deteriorated due to increasing human pressures, resulting in dramatic changes in coastal ecosystems, including macroalgal communities. To reverse the deterioration of the European seas, the EU has adopted the Water Framework Directive (WFD) and the Marine Strategy Framework Directive (MSFD), aiming at improved status of the coastal waters and the marine environment. Further, the Habitats Directive (HD) calls for the protection of important habitats and species (many of which are marine) and the Maritime Spatial Planning Directive for sustainability in the use of resources and human activities at sea and by the coasts. To efficiently protect important marine habitats and communities, we need knowledge on their spatial distribution. Ecological knowledge is also needed to assess the status of the marine areas by involving biological indicators, as required by the WFD and the MSFD; knowledge on how biota changes with human-induced pressures is essential, but to reliably assess change, we need also to know how biotic communities vary over natural environmental gradients. This is especially important in sea areas such as the Baltic Sea, where the natural environmental gradients create substantial differences in biota between areas. In this thesis, I studied the variation occurring in macroalgal communities across the environmental gradients of the northern Baltic Sea, including eutrophication induced changes. The aim was to produce knowledge to support the reliable use of macroalgae as indicators of ecological status of the marine areas and to test practical metrics that could potentially be used in status assessments. Further, the aim was to develop a methodology for mapping the HD Annex I habitat reefs, using the best available data on geology and bathymetry. The results showed that the large-scale variation in the macroalgal community composition of the northern Baltic Sea is largely driven by salinity and exposure. Exposure is important also on smaller spatial scales, affecting species occurrence, community structure and depth penetration of algae. Consequently, the natural variability complicates the use of macroalgae as indicators of human-induced changes. Of the studied indicators, the number of perennial algal species, the perennial cover, the fraction of annual algae, and the lower limit of occurrence of red and brown perennial algae showed potential as usable indicators of ecological status. However, the cumulated cover of algae, commonly used as an indicator in the fully marine environments, showed low responses to eutrophication in the area. Although the mere occurrence of perennial algae did not show clear indicator potential, a distinct discrepancy in the occurrence of bladderwrack, Fucus vesiculosus, was found between two areas with differing eutrophication history, the Bothnian Sea and the Archipelago Sea. The absence of Fucus from many potential sites in the outer Archipelago Sea is likely due to its inability to recover from its disappearance from the area 30-40 years ago, highlighting the importance of past events in macroalgal occurrence. The methodology presented for mapping the potential distribution and the ecological value of reefs showed, that relatively high accuracy in mapping can be achieved by combining existing available data, and the maps produced serve as valuable background information for more detailed surveys. Taken together, the results of the theses contribute significantly to the knowledge on macroalgal communities of the northern Baltic Sea that can be directly applied in various management contexts.