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- Jansson, Markus, 1982-
(author)
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Pelvic Floor Dysfunction and Perineal and Vaginal Tears in Primiparous Women
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Pelvic floor dysfunction (PFD), including urinary incontinence, faecal incontinence (FI), and pelvic organ prolapse, is highly prevalent among parous women. There is evidence that pregnancy, vaginal delivery, and obstetric perineal tears increase the risk of pelvic floor dysfunction, but many of the studies in this field are retrospective. The overall aim of this thesis was to prospectively examine risk factors for perineal and vaginal tears and postpartum PFD in primiparous women.Study I was a validation study of a protocol for documentation of perineal tears, including 187 primiparous women in 2015–2016. The coverage of documentation was higher in the protocol compared to the obstetric record system (ObstetriX). Incidence of second degree perineal tears was 26% according to the protocol and 11% according to ObstetriX.Studies II–IV utilized a cohort of initially nulliparous women (n=1049) prospectively included in early pregnancy in 2014–2017. Women completed questionnaires on PFD in early and late pregnancy and at 8 weeks and 1 year postpartum.Study II (n=644) showed that high foetal weight and vacuum extraction were risk factors for both second degree tears and OASI, suggesting that these tears should be viewed as a continuum rather than different entities. Risk factors for high vaginal tears were large foetal head circumference, vacuum extraction, and heredity of PFD/connective tissue deficiency. Study III (n=670) found that vaginal delivery increased the risk of stress urinary incontinence (SUI) but not urgency urinary incontinence (UUI) 1 year postpartum. No single characteristic of the vaginal delivery was associated with SUI. SUI during pregnancy increased the risk of SUI postpartum, and UUI during pregnancy increased the risk of UUI postpartum.Study IV (n=898) showed that FI increased by late pregnancy, and that this increase persisted 1 year postpartum. Obstructed defecation was associated with increased FI postpartum, suggesting that post-defecatory faecal loss may be an underlying mechanism of FI. Overall conclusion: The extent to which pregnancy, vaginal delivery, and their respective characteristics contributed to the development of PFD differed between the pelvic floor disorders studied. For SUI, both the pregnancy and the vaginal delivery increased the risk, whereas for FI it was the pregnancy itself rather than the vaginal delivery that was demonstrated to increase the risk.
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| 2. |
- Mispelaere, Jan, 1965-
(author)
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Guldmynt eller äpple : Straffrättsligt ansvar för barn och ungdomar i Sverige och Nederländerna 1590-1800
- 2009
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Doctoral thesis (other academic/artistic)abstract
- The principal aim of this dissertation was to examine the character in praxis of children's and youth's criminal responsibility in two particular European regions during the early modern period that, in comparison with each other, were marked by a number of substantial societal differences. The regions selected were the densely populated, market-oriented coastal district of the Netherlands and the sparsely populated agricultural society in Sweden during the period 1590-1800.Since there were substantial economic and social differences between the Netherlands and Sweden during the 1600s in such areas as the development of salaried work, urbanization, and the structure and character of the household, it was reasonable to imagine that the present investigation would reveal, among other things, that there were marked differences in views concerning children and youth as well. Upon the basis of what was written concerning the application of extenuating circumstances in respect to children, along with what was known about views concerning children in older legislation, previous research has emphasized that there were a considerable number of similarities within European legal praxis during the early modern period.In conclusion, one can state that early modern judges from the Netherlands and Sweden assigned criminal responsibility to children under twelve in quite similar ways, while the differences between them in this regard primarily concerned how youths were treated. There was roughly the same attitude concerning children throughout the period 1590-1799 in both regions, but the view concerning the criminal responsibility of teenagers was different in the Netherlands until the first half of the 1700s. Views concerning their criminal responsibility were quite clearly influenced by such factors as gender, competence, and age, but the effect of social changes was to a much greater degree visible in praxis for them than it was in respect to children under twelve. Different societies placed different demands on youths, and this was expressed above all in the age level for full responsibility and the application of adult punishment.The most striking differences between the Netherlands and Sweden concerned the application of age limits for full responsibility, the responsibility borne by youths who had been enticed into committing crimes, and the manner in which the law viewed the responsibility of boys and girls when the offenders were between twelve and eighteen years of age. All three of the most substantial differences thus involved the level of criminal responsibility that youths bore.
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