| 1. |
- Anskär, Eva, 1957-
(författare)
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Time flies in primary care : a study on time utilisation and perceived psychosocial work environment
- 2019
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Time utilisation among primary care professionals has been affected by structural changes and reorganisation performed in Swedish primary care over several decades. The work situation is complex with a heavy administrative work load. The overall aim with this thesis was to describe time utilisation among staff in Swedish primary care and to investigate associations with perceived psychosocial work environment and legitimacy of work tasks.Methods: A multicentre, descriptive, cross-sectional study design was used including all staff categories in primary care i.e. registered nurses, primary care physicians, care administrators, nurse assistants and allied professionals (physiotherapists, occupational therapists, psychologists, counsellors, dieticians and chiropodists) at eleven primary care centres located in southeast Sweden. The data collection consisted of a questionnaire including a subjective estimate of workload, the Bern Illegitimate Tasks Scale (BITS) and the Copenhagen Psychosocial Questionnaire (COPSOQ). Also, a time study was performed, where the participants reported their work time based on three main categories; direct patient work tasks, indirect patient work tasks and other work tasks, each with a number of subcategories. The participants reported time spent on different work tasks, day by day during two separate weeks. Response rates were 75% for the questionnaire and 79% for the time study.Results: In paper I the time study revealed that health professionals at the primary care centres spent 37% of their work time with direct patient work tasks. All professions estimated a higher proportion of time spent directly with patients than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress and role conflicts. The proportion of administrative work tasks was associated with role conflicts, the more administration the more role conflicts. Findings in paper II were that more than a quarter of physicians scored above the cut-off value for BITS regarding unnecessary work tasks, which was significantly more than the proportion observed in all other professions in the survey. Across all staff groups, a perception of having to perform illegitimate work tasks was associated with experiencing negative psychosocial work environment and with high proportion of administrative-related work tasks.Conclusions: Swedish primary care staff spend a limited proportion of their work time directly with patients and primary care physicians perceive the psychosocial work environment in negative terms to a greater extent than all other staff members. Allocation of work tasks has an influence on the perceived psychosocial work environment. The perception of having a large number of illegitimate work tasks affects the psychosocial work environment negatively, which might influence the perception the staff have of their professional roles. Perception of high proportion of unreasonable work tasks is associated with a high proportion of non-patient-related administration.This thesis illuminates the importance of decision makers thoroughly considering the distribution and allocation of non-patient related work tasks among staff in primary care, in order to achieve efficient use of personnel resources and favourable working conditions. Hopefully, the results of this study will contribute to further development of primary care so that medical competence will benefit patients as much as possible.
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| 2. |
- Lefébure, Robert, 1980-
(författare)
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Effects of temperature and terrestrial carbon on fish growth and pelagic food web efficiency
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Both temperature and terrestrial dissolved organic carbon (TDOC) have strong impacts on aquatic food web dynamics and production. Temperature affects vital rates of all organisms and terrestrial carbon has been shown to alter the dynamics of phytoplankton and bacterial production and affect the trophic structure of planktonic food webs. As climate change predictions for the Baltic Sea suggests future increases in both terrestrial carbon run-off and increases in temperature, the aim of thesis was to adopt a system-ecological approach and study effects of these abiotic variables, not only on interactions within planktonic food webs, but also on the growth and consumption rates of one of the most common zooplanktivorous fish in the Baltic Sea, the three-spined stickleback Gasterosteus aculeatus. Results showed that three-spined sticklebacks display a high degree of resilience against increasing temperatures, as both growth rates as well as consumption rates on zooplankton were high at temperatures well over 20 °C. Furthermore, it was shown that the minimal resource densities required to sustain individual and population growth, actually decreased with increasing temperatures, implying that sticklebacks around their optimum temperature for growth at 21 °C will actually have an increased scope for growth. As stickleback population densities have increased over the last decade in the Baltic Sea and are now suggested to out-compete other coastal fish species for shared zooplankton resources, the results presented in this thesis suggest that increased water temperatures would only serve to increase sticklebacks competitive advantage. As the structuring role of this small zooplanktivore on pelagic communities might be considerable, further studies investigating competitive interactions as well as patterns of population abundances are definitely warranted. TDOC was overall shown to stimulate bacterial production and the microbial food web. Because of the longer trophic pathways required to transport carbon from bacterial production to higher trophic levels, the addition of TDOC always reduced food web transfer efficiency. However, it became apparent that the full effect of TDOC additions on pelagic food webs was complex and depended heavily not only on the existing trophic structure to which the carbon was introduced, but also on ambient temperature levels. When three-spined sticklebacks were part of food webs with significant TDOC inputs, the presence of fish, indirectly, through predator release of lower trophic levels, amplified the magnitude of the effects of carbon addition on bacterial production, turning the base of the system significantly more heterotrophic, which ultimately, impacted negatively on their own production. However, when a pelagic food web containing sticklebacks was simultaneously subjected to realistic increases in temperature and TDOC concentrations, food web efficiency and fish production increased compared to present day conditions. These results were explained by a temperature dependent increased production potential of zooplankton, sustained by an increased production of heterotropic microzooplankton via TDOC additions, which lead to higher fish production. Although the increased number of trophic linkages in heterotrophic food webs should have reduced energy transfer efficiency, these negative effects seem here to have been overridden by the positive increases in zooplankton production as a result of increased temperature. These results show that heterotrophic carbon transfer can be a viable pathway to top-consumers, but also indicates that in order to understand the full effects of climate change on trophic dynamics and fish production, abiotic variables cannot be studied in isolation.
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| 3. |
- Liljeberg, Evelina, 1985-
(författare)
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Oral nutritional supplements within the nutrition therapy : Prescription and adherence from a dietetic practice perspective
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to increase knowledge and deepen understanding on prescription of and adherence to oral nutritional supplements (ONS). In Paper I, the reporting quality of interventions with ONS in publications of randomised controlled trials was explored. In Paper II, adherence to ONS prescriptions from dietitians to hospital outpatients in clinical practice was assessed. Further, an evaluation of the population characteristics and ONS prescription characteristics was performed. In Papers III and IV, dietitian and patient experiences of prescribing or being prescribed and using ONS were explored through qualitative interviews.The reporting quality of ONS interventions was found to be incomplete, making it hard to interpret trial findings and replicate them in clinical practice. The articles mainly lacked a description of intervention procedures, provider and location(s), but an improvement was observed in articles published after 2011. Adherence to ONS was found to be high (> 75%) among hospital outpatients prescribed ONS in clinical practice. The population was relatively young (mean age 67 years), and the two most common medical diagnoses were cancer and gastrointestinal disease. The prescriptions were individually tailored by dietitians, usually encompassing several flavours (mean 4.2) and 1–3 bottles/day. In the dietitian interview study, shared tailoring of the ONS prescription and provision of behaviour change support were identified as important aspects when dietitians prescribe ONS. In the patient interview study, ONS were described as a one-dimensional remedy: contributing with nutrients, but unable to resolve the situation of altered eating. Additionally, ONS usage was described as regulated autonomously based on the priority given to nutrition in everyday life.In conclusion, this thesis shows that prescription of and adherence to ONS are complex processes, which tend to be underestimated in the ONS literature. Adherence to ONS was high, which might be explained by population characteristics and the dietitian-tailored prescriptions fulfilling criteria for appropriate ONS prescriptions. The interview studies provided insights into nutrition therapy with ONS from both the dietitian and the patient perspective. The findings indicated that ONS should be prescribed using a person-centred care approach, with patients viewed as an active part in nutrition therapy.
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| 4. |
- Mathisen, Peter
(författare)
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Environmental factors selecting for predation resistant and potentially pathogenic bacteria in aquatic environments
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The long history of co-existence of bacteria and their protozoan predators in aquatic environments has led to evolution of protozoa resistant bacteria (PRB). Many of these bacteria are also pathogenic to humans. However, the ecological drivers determining the occurrence of different types of PRB in aquatic environments, and the eco-evolutionary link between bacterial adaptation and the resulting implications for mammalian hosts are poorly known. This thesis examines the impact of nutrients and predation on PRB, as well as the ecological and evolutionary connection between their life in aquatic environments and mammalian hosts. In the first study seven bacterial isolates from the Baltic Sea were investigated for their plasticity of adaptation to predation. The response to predation showed large variation where some bacteria rapidly developed a degree of grazing resistance when exposed to predators. The rapid adaptation observed may result in bacterial communities being resilient or resistant to predation, and thus rapid adaptation may be a structuring force in the food web. With the aim to elucidate the link between occurrence of PRB and environmental conditions, a field study and a laboratory experiment were performed. In both studies three PRB genera were found: Mycobacterium, Pseudomonas and Rickettsia. PRB were found both in oligotrophic and eutrophic waters, indicating that waters of all nutrient states can harbor pathogenic bacteria. However, the ecological strategy of the PRB varied depending on environmental nutrient level and disturbance. Using an advanced bioinformatic analysis, it was shown that ecotypes within the same PRB genus can be linked to specific environmental conditions or the presence of specific protozoa, cyanobacteria or phytoplankton taxa. These environmental conditions or specific plankton taxa could potentially act as indicators for occurrence of PRB. Finally, using four mutants (with specific protein deletions) of the pathogenic and predation resistant Francisella tularensis ssp. holarctica, I found evidence of an eco-evolutionary connection between the bacterium´s life in aquatic and mammalian hosts (aquatic amoeba Acanthamoeba castellanii and a murine macrophage). To a large extent F. t. holarctica use similar mechanisms to persist predation by protozoa and to resist degradation by mammal macrophages. To summarize I found a link between predation resistant bacteria in aquatic environments and bacteria that are pathogenic to mammals. Further, I showed that different environmental conditions rapidly selects for PRB with either intracellular or extracellular lifestyles. This thesis provides insights regarding environmental conditions and biomarkers that can be used for assessment of aquatic environments at risk for spreading pathogenic bacteria.
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| 5. |
- Skrobonja, Aleksandra, 1990-
(författare)
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Formation, uptake and bioaccumulation of methylmercury in coastal seas : a baltic sea case study
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Methylmercury (MeHg) is a potent neurotoxin which can bioaccumulate to harmful levels in aquatic food webs. Methylmercury formation is a predominantly biotic process which involves phylogenically diverse microorganisms (e.g. iron- or sulfate-reducing bacteria). The formation of MeHg is related to the presence of organic matter (OM) which contains substrates essential for methylating microbes and reduced sulfur ligands (thiols, RSH) that form strong bonds with inorganic mercury (HgII) and affect its bioavailability. In aquatic systems, MeHg is bio-concentrated from the water column to the base of the food web and this step is crucial for MeHg levels found at higher trophic levels. Trophic transfer processes of MeHg in the food web are also of great importance. Discharge of OM in coastal areas affects light conditions needed for phytoplankton growth, and promotes heterotrophy, i.e. bacteria production. This may lead to a shift from the phytoplankton-based to the longer bacteria-based (microbial loop) food web and influence the amount of bioaccumulated MeHg in higher trophic levels. Methylmercury levels in predatory biota is thus affected by the bioavailability of HgII for methylation (studied in Paper I & II), MeHg speciation in the water column, crucial for MeHg incorporation at the base of the food web (Paper III), and the structure of the pelagic food web (Paper IV).In this thesis, it is shown that OM can act as a predictor of dissolved MeHg levels in estuarine and coastal systems. It impacts MeHg levels both by affecting HgII bioavailability (through Hg complexation with humic matter) and the activity of methylating microbes (providing metabolic electron donors) (Paper I). Moreover, elevated concentrations of particulate and dissolved HgII and MeHg, are associated with the presence of pelagic redoxclines in coastal seas. The redoxcline affects HgII speciation in the water column and its bioavailability for methylation (Paper II). It is further shown that the molecular structure of ligands in MeHg complexes affects the kinetics of MeHg uptake in phytoplankton. Rate constants for association of MeHg to the cell surface of a green algae were higher in treatments containing smaller thiol ligands of simpler structure than in treatments with larger thiols and more “branched” structure (Paper III). Finally, it is demonstrated that MeHg bioaccumulation in zooplankton can increase in systems with highly heterotrophic food webs and enhanced loadings of terrestrial OM (Paper IV). Such conditions are expected to occur in northern latitude coastal systems following climate changes.
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| 6. |
- Zhao, Li, 1988-
(författare)
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Microbial communities : descriptors of environmental change in marine ecosystems
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In northern marginal seas, like the northern Baltic Sea, climate change will lead to many alterations, for example increased inflows of nutrients and dissolved organic matter (DOM). Nutrients and DOM are fundamental drivers shaping marine microbial communities, including both bacterial and phytoplankton populations. Potentially microbial communities and their functions can be used as descriptors of environmental change in marine systems. Changed nutrient availability will affect the phytoplankton communities, which is widely used as descriptor of environmental state in aquatic systems. Traditionally phytoplankton is analyzed using microscopy in monitoring, while molecular methods holds a great potential for future development. I performed a comparative study between metabarcoding and microscopy. Metabarcoding and microscopy displayed relatively similar distribution pattern at the group level. The results showed that the relative abundances of the 18S rRNA amplicon at the group level best fitted the microscopy carbon biomass metric. The results are promising for implementing DNA metabarcoding as a complement to microscopy in phytoplankton monitoring, especially if databases would be improved and group level indexes could be applied to classify environmental state of water bodies.Bacterioplankton are the main DOM processors in the marine food web. A shift in the quality and quantity of the DOM pool could affect the microbial community structure and alter their functioning. Presently it is poorly known how coastal bacteria respond compositionally and functionally to quality and quantity changes in DOM supply. To comprehensively address this question, there is a critical need for microcosm experimental studies as well as field studies. Thus, I used approaches from single species laboratory experiment to community levels in situ incubation experiments and community levels spatiotemporal field surveys to evaluate the impacts of climate shifts on microbial community. Intricate relationships between environmental factors and microbial communities, for example, links between key microbial functional genes and DOM conditions were identified. Results showed that bacteria isolated from coastal area harbor genes for the sequestration of autochthonously produced carbon substrates, while bacteria isolated from a river contained genes for the degradation of relatively refractive terrestrial organic matter. A field experiment showed that Gammaproteobacteria was promoted by plankton extract addition and the genes for chitin and cellulose catabolism are enriched by addition of autochthonous carbon sources. The field survey with comprehensive metagenomic investigation of microbial community composition indicated that the temporal variation is larger compare to spatial changes. Bacteroidia, Actinomycetia, Gammaproteobacteria, Acidimicrobiia, and Alphaproteobacteria were the dominant bacterial classes, with Bacteroidia being more abundant in inshore stations compared to offshore locations. The seasonal shift in the relative abundance of these bacterial classes suggests that environmental factors and ecological processes drive changes in the abundance of different bacterial classes over time. Overall, these studies strengthen our understanding of the relationships between microbial composition and biogeochemical processes in coastal areas.
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| 7. |
- Andersson, Therése, 1978-
(författare)
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Estrogen and Glucocorticoid Metabolism
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Cardiovascular disease (CVD) is the leading cause of death among women in Sweden. The risk of CVD increases rapidly after the menopause. A major contributing factor may be the redistribution of adipose tissue, from the peripheral to central depots, associated with menopause. This change in body composition is commonly attributed to declining estrogen levels but may also be affected by tissue-specific alterations in exposure to other steroid hormones, notably glucocorticoids – mainly cortisol in humans. Indeed, adipose tissue-specific overexpression of the glucocorticoid-activating enzyme 11β-hydroxysteroid dehydrogenase type 1 (11βHSD1) induces central obesity, insulin resistance and hypertension in mice. Interestingly, estrogen may regulate this enzyme. The aim of this thesis was to investigate putative links between estrogen and glucocorticoid activation by 11βHSD1. Materials and Methods: 11βHSD1 expression and/or activity in adipose tissue and liver, and adipose estrogen receptor α and β (ERα and ERβ) gene expression, were investigated in lean pre- and postmenopausal women and ovariectomized rodents with and without estrogen supplementation. In lean women measures of 11βHSD1 were correlated to risk markers for CVD. The association between adipose 11βHSD1 and ER mRNA expression was investigated in both lean women and rats and in an additional cohort of obese premenopausal women. In vitro experiments with adipocyte cell lines were used to explore possible pathways for estrogen regulation of 11βHSD1. Results: Subcutaneous adipose tissue transcript levels and hepatic activity of 11βHSD1 were higher in postmenopausal vs. premenopausal women. In rodents, estrogen treatment to ovariectomized rats decreased visceral adipose tissue 11βHSD1, resulting in a shift towards higher subcutaneous (vs. visceral) 11βHSD1 mRNA expression/activity. Increased adipose and hepatic 11βHSD1 were associated with increased blood pressure and a disadvantageous blood lipid profile in humans. We found significant positive associations between 11βHSD1 and ERβ transcript levels in adipose tissue. The in vitro experiments showed upregulation of 11βHSD1 mRNA expression and activity with estrogen or ERβ-agonist treatment at low (corresponding to physiological) concentrations. Conclusions: Our studies show for the first time increased local tissue glucocorticoid activation with menopause/age in women. This may contribute to an increased risk of CVD. Estrogen treatment in rodents induces a shift in 11βHSD1 activity towards the subcutaneous adipose tissue depots, which may direct fat accumulation to this metabolically “safer” depot. The in vitro studies suggest that low-dose estrogen treatment upregulates 11βHSD1 via ERβ. In summary, estrogen - glucocorticoid metabolism interactions may be key in the development of menopause-related metabolic dysfunction and in part mediate the beneficial effects of postmenopausal estrogen treatment on body fat distribution.
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| 8. |
- Carlfjord, Siw, 1959-
(författare)
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The Challenge of Changing Practice : Applying Theory in the Implementation of an Innovation in Swedish Primary Health Care
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The translation of new knowledge, such as research findings, new tools or methods into health care practice has gained increased interest in recent years. Important factors that determine implementation outcome have been identified, and models and checklists to be followed in planning as well as in carrying out an implementation process have been produced. However, there are still knowledge gaps regarding what approach should be used in which setting and for which problems. Primary health care (PHC) in Sweden is an area where there is a paucity of research regarding implementation of new methods into practice. The aim of the thesis was to apply theory in the study of the implementation of an innovation in Swedish PHC, and identify factors that influenced outcome.Methods: The study was performed using a quasi-experimental design, and included six PHC units, two from each one of three county councils in the southeast part of Sweden. A computer-based lifestyle intervention tool (CLT) developed to facilitate addressing lifestyle issues, was introduced at the units. Two different strategies were used for the introduction, both aiming to facilitate the process: a theory-based explicit strategy and an implicit strategy requiring a minimum of effort. Data collection was performed at baseline, and after six, nine and 24 months. Questionnaires were distributed to staff and managers, and data was also collected from the CLT database and county council registers. Implementation outcome was defined as the proportion of eligible patients being referred to the CLT, and was also measured in terms of Reach, Effectiveness, Adoption, Implementation and Maintenance according to the RE-AIM framework. Interviews were performed in order to explore experiences of the implementation process as perceived by staff and managers.Results: A positive organizational climate seemed to promote implementation. Organizational changes or staff shortages coinciding with the implementation process had a negative influence on outcome. The explicit implementation strategy seemed to be more effective than the implicit strategy in the short term, but the differences levelled out over time. The adopters’ perceptions of the implementation seemed to be influenced by the existing professional sub-cultures. Successful implementation was associated with positive expectations, perceptions of the innovation being compatible with existing routines and perceptions of relative advantage.Conclusions: The general conclusion is that when theory was applied in the implementation of a lifestyle intervention tool in Swedish PHC, factors related to the adopters and to the innovation seemed to be more important over time than the strategy used. Staff expectations, perceptions of the innovation’s relative advantage and potential compatibility with existing routines were found to be positively associated with implementation outcome, and other major organizational changes concurrent with implementation seemed to affect the outcome in a negative way. Values, beliefs and behaviour associated with the existing sub-cultures in PHC appeared to influence how the implementation of an innovation was perceived by managers and the different professionals.
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| 9. |
- Dahlgren, Kristin, 1979-
(författare)
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Food web structures and carbon transfer efficiencies in a brackish water ecosystem
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Two differently structured food webs can be distinguished in the pelagic habitat of aquatic systems; the classical one (autotrophic) with phytoplankton as a base and the microbial food web (heterotrophic) with bacteria as a base. Energy (produced at the basal trophic level) reaches higher trophic levels, i.e. zooplankton, directly in the classical food web in contrast to the microbial food web where it passes through additional trophic levels before reaching zooplankton. Energy is lost between each trophic level and therefore less energy should reach higher trophic levels in the microbial food web than in the classical food web. However, factors such as edibility of prey, temperature and properties of the predator, might also influence the food web structures and functions.In this thesis I studied which factors are important for an efficient carbon transfer and how a potential climate change might alter the food web efficiency in pelagic and pelagic-benthic food webs in the Baltic Sea. Furthermore, one of the most dominant zooplankton in the northern Baltic Sea, Limnocalanus macrurus, was studied in order to establish the seasonal pattern of lipid reserves in relation to food consumption.My studies showed that the carbon transfer efficiency during summer was not directly connected to the basal production, but factors such as the ratio between heterotrophs and autotrophs, the relationship between cladocerans and calanoid copepods and the size and community structure of both phytoplankton and zooplankton were important for the carbon transfer efficiency. In a climate change perspective, the temperature as well as the relative importance of the microbial food web is likely to increase. A temperature increase may have a positive effect on the pelagic food web efficiency, whereas increasing heterotrophy will have a negative effect on the pelagic and pelagic-benthic food web efficiency, reduce the fatty acid content of zooplankton and reduce the individual weight of both zooplankton and the benthic amphipod Monoporeia affinis. During the seasonal study on the calanoid copepod L. macrurus, I found that this species is mainly a carnivore, feeding on mesozooplankton during most of the year but switches to feeding on phytoplankton when these are abundant. Furthermore, when food is scarce, it utilizes lipids that are built up during the course of the year.From these studies I can draw some major conclusions; there are many factors that influence how efficient carbon is transferred in the food web and different factors are probably of various importance in different areas. In order to determine the carbon transfer efficiency, the various strategies exerted by different organism groups have to be considered, as for example that some zooplankton utilize lipid reserves instead of feeding all year around. Also, in a climate change perspective, the pelagic-benthic food web efficiency will decrease, as will the quality of zooplankton and M. affinis, possibly having implications for higher trophic levels such as fish.
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| 10. |
- Eriksson, Karolina I. A., 1991-
(författare)
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Bacteria that escape predation : waterborne pathogens and their relatives
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The hidden presence of opportunistic bacterial pathogens in the environment evokes concerns about emerging diseases, especially in the light of climate change. The co-evolution of bacteria and their predators (protozoa) has led to bacterial defence strategies of which some contribute to the ability of bacteria to cause disease. To increase our understanding of the interplay between bacteria, protozoa, land use, and climate scenarios in Nordic brackish and freshwater, four studies were designed. The first study explored the co-occurrence patterns between predation resistant bacteria (PRB) and bacterivorous protozoa in a coastal area in the northern Baltic Sea. The results showed higher PRB diversity in the bays and freshwater inlets, than in the offshore waters. Further, genotype specific interactions between protozoa and bacteria were identified. The second study focused on Legionella species diversity and their association with humic substances and low salinity, potentially facilitated through the promotion of the heterotrophic microbial food web or by iron availability. The third study examined the impact of intensified land use on bacterial taxa abundance and community composition in lake inflows, demonstrating indirect downstream effects on water quality. Factors such as pastures, fields, farms, aluminium, iron, and humic substances were linked to increased Legionella abundance. The fourth study exposed aquatic organisms to climate change scenarios, causing eutrophication or brownification with elevated iron levels. Pseudomonas aeruginosa were found to be especially persistent to iron, likely linked to the same mechanism that enables survival in protozoan cells. This trait was shared with other observed intracellular pathogens and uncultured species, who showed elevated resilience to brownification and ability to survive outside host cells. These findings identified complex relationships, which improve our understanding of the intricate dynamics that shape aquatic ecosystems, and highlight the importance of considering multiple factors in managing water resources and maintaining ecosystem health. Human activities including intensified land use can have far-reaching consequences, jeopardizing the pristine nature of water bodies and escalate the presence of environmental and opportunistic bacterial pathogens.
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