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The motivational value of food is lower during satiety compared to fasting. Dynamic changes in motivational value promote food seeking or meal cessation. In obesity this mechanism might be compromised since obese subjects ingest energy beyond homeostatic needs. Thus, lower adaptation of eating behaviour with respect to changes in motivational value might cause food overconsumption in obesity. To test this hypothesis, we implemented a selective satiation procedure to investigate the relationship between obesity and the size of the behavioural devaluation effect in humans. Lean to obese men (mean age 25.9, range 19–30 years; mean BMI 29.1, range 19.2–45.1 kg/m2) were trained on a free operant paradigm and learned to associate cues with the possibility to win different food rewards by pressing a button. After the initial training phase, one of the rewards was devalued by consumption. Response rates for and wanting of the different rewards were measured pre and post devaluation. Behavioural sensitivity to reward devaluation, measured as the magnitude of difference between pre and post responses, was regressed against BMI. Results indicate that (1) higher BMI compared to lower BMI in men led to an attenuated behavioural adjustment to reward devaluation, and (2) the decrease in motivational value was associated with the decrease in response rate between pre and post. Change in explicitly reported motivational value, however, was not affected by BMI. Thus, we conclude that high BMI in men is associated with lower behavioural adaptation with respect to changes in motivational value of food, possibly resulting in automatic overeating patterns that are hard to control in daily life.

Síndrome dos Ovários Policísticos (PCOS), caracterizada por disfunção ovulatória e hiperandrogenismo, é a endocrinopatia mais frequente entre mulheres em idade reprodutiva, afetando aproximadamente de 6 a 19% desta população, conforme o critério diagnóstico empregado. Além dos distúrbios reprodutivos, as mulheres com PCOS frequentemente apresentam maior prevalência de fatores de risco cardiometabólico como obesidade abdominal, dislipidemia, hipertensão, tolerância diminuída à glicose e diabetes mellitus tipo 2. A resistência insulínica e a hiperinsulinemia compensatória são consideradas como o ponto central destas alterações metabólicas. Os critérios atuais para diagnóstico de PCOS, a partir do Consenso de Rotterdam, indroduziram diferentes fenótipos. Os mais frequentes são o fenótipo “clássico” (hiperandrogenismo e anovulução, com ou sem a aparência policística do ovário), e o fenótipo “ovulatório” (hiperandrogenismo e aparência policística do ovário). Evidências sugerem que as mulheres com PCOS fenótipo “clássico” tenham alterações metabólicas mais severas comparadas às mulheres com o fenótipo ovulatório. Em razão disto, o objetivo do primeiro artigo original foi avaliar o desempenho da circunferência abdominal, da razão cintura-estatura, do índice de conicidade, do produto da acumulação lipídica (LAP) e do índice de adiposidade visceral (VAI) com base no modelo de homeostasia de à insulina (HOMA-IR)≥ 3,8 como padrão de referência para rastreamento de alterações Este estudo mostrou que, dentre os índices de adiposidade avaliados, os que apresentaram maior acurácia foram o LAP entre as mulheres com PCOS fenótipo “clássico” e o VAI entre as com fenótipo “ovulatório”. Aplicando o ponto de corte do LAP< 34, identificamos um subgrupo de pacientes sem alterações cardiometabólicas no grupo de mulheres com PCOS com fenótipo “clássico”, população com maior risco de hipertensão, de dislipidemia e de tolerância diminuída à glicose. Dentre as mulheres com PCOS classificadas com o fenótipo “ovulatório”, VAI≥ 1,32 foi capaz de detectar mulheres com pressão arterial significativamente mais alta e variáveis glicêmicas e lipídicas menos favoráveis em relação às mulheres com PCOS com fenótipo “ovulatório” com VAI abaixo deste ponto de corte. Atualmente, mudanças de estilo de vida (dieta e/ou exercício físico) são consideradas como primeira opção de tratamento não farmacológico nas mulheres com PCOS. Embora a prática de, pelo menos, 30 minutos por dia de exercício físico estruturado seja recomendada e tenha mostrado um potencial efeito na melhora da resistência insulínica e das variáveis antropométricas e hormonais, a manutenção deste hábito a longo prazo permanece como um ponto crítico. Neste sentido, o objetivo do segundo artigo foi avaliar o efeito da atividade física habitual (AFH) nos perfis metabólico e hormonal de mulheres com PCOS e controles pareadas por idade e índice de massa corporal (IMC). A AFH das participantes foi avaliada por meio de pedômetro digital e, conforme o número de passos diário, a participante foi classificada como ativa (≥ 7500 passos/dia) ou sedentária (< 7500 passos/dia). Mulheres ativas, em ambos os diagnósticos, apresentaram menor IMC, circunferência abdominal e LAP. No grupo PCOS, as mulheres ativas apresentaram menores valores de testosterona total, androstenediona e índice de androgênios livres (IAL) em comparação às sedentárias. Além disto, o aumento de 2000 passos foi um preditor independente de redução do IAL nas mulheres com a síndrome. Este estudo mostrou que ser mais ativa foi associado a um perfil antropométrico e metabólico mais saudável, portanto encorajar um estilo de vida mais ativo pode ser benéfico para mulheres com PCOS, especialmente para as obesas e sedentárias. / Polycystic Ovary Syndrome (PCOS) is characterized by ovulatory dysfunction a hyperandrogenism. The prevalence of PCOS in women of reproductive age range from 6- 19%. Women with PCOS present higher prevalence of cardiometabolic risk factors as abdominal obesity, dyslipidemia, hypertension, impaired glucose tolerance and diabetes mellitus type 2. These metabolic abnormalities have been primarily linked to insulin resistance. Currently, the diagnosis of PCOS is confirmed according the Rotterdam Consensus. The more frequent phenotypes are the classic phenotype (hyperandrogenism and anovulation with or without polycystic ovary appearance), and the ovulatory phenotype (hyperandrogenism and polycystic ovary appearance). Evidence suggests that women with classic PCOS phenotype present more severe metabolic alterations compared to women with ovulatory PCOS phenotype. The aim of the first study was to evaluate the performance of the waist circumference (WC), waist-to-height ratio, conicity index, lipid accumulation product (LAP), and visceral adiposity index (VAI) based on homeostasis model assessment of insulin resistance (HOMA- IR)≥ 3.8 as standard reference for screening preclinical metabolic alterations and cardiovascular risk factors in classic PCOS and ovulatory PCOS phenotypes. Among these indexes, LAP had the best accuracy for screening metabolic alterations in classic PCOS phenotype, while VAI had the best accuracy for ovulatory PCOS phenotype. cardiometabolic alterations in the group with classic PCOS, a phenotype which is characterized by higher risk for hypertension, dyslipidemia, and impaired glucose tolerance. In ovulatory PCOS, VAI≥ 1.32 was useful to detect women with significantly higher blood pressure and less favorable glycemic and lipid variables as compared to ovulatory PCOS with lower VAI. In addition, lifestyle intervention (diet and/or exercise) is the first-line treatment for PCOS. Although structured exercise (at least 30 minutes daily) has been recommended and has shown a potential effect on improving insulin resistance, anthropometric, and hormonal variables, the long-term maintenance of exercise remains a critical point. Therefore, the aim of the second study was to objectively examine the effect of habitual PA on metabolic, hormonal, BMI, and anthropometric variables of women with PCOS and a control group, matched by age and BMI. The PA was assessed by digital pedometer, and according to the number of steps/day, participants were classified as active (≥ 7500 steps) or sedentary (< 7500 steps). This study showed that BMI, WC, and LAP were lower in active women in both groups. In the PCOS group, total testosterone, free androgen index (FAI), and androstenedione levels were lower in active when compared to sedentary women. Besides that, a 2,000 daily step increment was an independent predictor of the FAI reduction in PCOS group. The present study showed that a more active lifestyle is associated with healthier anthropometric and metabolic profile, and may be beneficial to women with PCOS, especially for those which are obese and sedentary.

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Bakgrund: I Sverige definieras begreppet upprepade missfall som att en kvinna har fått tre eller flera missfall i följd och det uppskattas drabba ca en procent av världens alla par i fertil ålder. Då detta är en liten grupp kvinnor kan det vara svårt för den drabbade kvinnan att veta var hon kan vända sig med sina funderingar och vad hon har rätt till för vidare hjälp. Vid flera upprepade missfall växer behovet av att få svar på vad som sker och varför samtidigt som behovet av stöd och förståelse från sina närstående blir större. Tillgången till utredning och behandling ser olika ut men med hjälp från barnmorskans och vårdens sida kan lämplig planering utifrån kvinnan situation utvecklas. Syfte: Syftet med denna studie är att undersöka kvinnans upplevelse av upprepade missfall och belysa hennes behov under och tiden efter missfallet. Metod: Metoden för denna uppsats var en kvalitativ metasyntes med metaetnografisk analysmetod. Totalt kvalitetsgranskades 29 artiklar varav 16 gick igenom kvalitetsgranskningen och sammanställdes till ett resultat. Resultat: Sju kategorier med nyckelbegrepp bildades. Kategorierna som identifierades var missfallsprocessen, utrymme för sorg, undvikande beteende, partnerrollen, socialt stöd, förväntningar på vården och att bli gravid igen. Slutsats: Då alla kvinnor är olika varierar upplevelsen och behoven vid en missfallsprocess. Genom att ha kunskap om vad kvinnan går igenom både fysiskt- och psykiskt vid upprepade missfall bidrar det till en ökad förståelse för vad kvinnan behöver, både från sin omgivning men även från vårdens sida. Klinisk tillämpbarhet: Studien skulle kunna bidra till att utforska möjligheten att ändra på kriterierna för utredning vid upprepade missfall. Studien skulle även kunna leda till en förbättring av kunskapsläget både för individen, samhället och vården gällande hur bemötandet av denna grupp av kvinnor ser ut. Barnmorskor kan som yrkesgrupp stödja och hjälpa denna grupp kvinnor genom uppföljning i samband med att de kommer i kontakt med barnmorskemottagningen för att meddela att graviditeten har slutat i ännu ett missfall. Vidare kan etableringen av stödgrupper inom vården vara ett bra stöd för kvinnor som är med om upprepade missfall och dessa grupper skulle potentiellt ledas och samordnas av en barnmorska som innehar kompetens inom området upprepade missfall. / Background: In Sweden, the concept of recurrent miscarriage is defined as a woman having three or more miscarriages in succession and it is estimated to affect about one percent of all couples of childbearing age worldwide. Since this is a small group of women, it can be difficult for the effected woman to know where she can turn with her thoughts and what she is entitled to regarding further help. After enduring multiple recurrent miscarriages, the need to get some answers and at the same time the need to receive support and understanding from their close surroundings increases. The access to further investigation and treatment is different depending on where you are but with some help from a midwife and other healthcare providers, an appropriate plan based on the woman's situation can be developed. Purpose: The aim of this essay was to investigate the experiences of women who have endured recurrent miscarriages and their further needs that occurred during and the time after the miscarriage. Methods: The method used in this essay was a qualitative metasynthesis with metaethnographic analysis method. In total, 29 articles were collected of which 16 of them went through the quality review and were compiled to a result. Results: seven categories containing of key concepts were formed. The categories identified were the process of miscarrying, room for griefing, avoiding behavior, the partners role, social support, expectations of the healthcare and becoming pregnant again. Conclusion: Due to the fact that all women are different, the experiences and needs during a miscarrying process varies. By having the knowledge of what the woman goes through both physically and mentally during recurrent miscarriages, it contributes to a greater understanding of what the woman needs, both from her surroundings but also from the healthcare. Clinical applicability: This essay could help to explore the possibilities of modifying the criteria for an investigation of recurrent miscarriages. The essay could also lead to improvement of the knowledge situation for the individual, the society and the care providers regarding how this group of women wants to be treated. Midwives as a profession could help to support this group of women by initiating contact with the women when or after she has contacted the midwife clinic to announce another pregnancy loss. Furthermore, the establishment of support groups for women with recurrent miscarriages could be helpful and supportive for these women. The support groups could potentially be coordinated by a midwife with specific knowledge about recurrent miscarriage.

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Abstract ¡§Taiwan Domestic Shipbuilding Industries and Warship Commercial Maintenance¡¨ is the long-term policy of defense independent industries pushed by the Taiwan government. Domestic shipbuilding, ship maintenance, and national integrated resources can be used to support naval ships logistic maintenance. But there are some differences in technology and concept between ¡§merchant ship¡¨ and ¡§warship¡¨. The complexity, mobility, and specialization of warship systems are higher than merchant ships. Every type of operating system now utilized by commercial shipyards must be modified if they want to receive and carry on warship commercial maintenance activity. Building desirable systems to conduct warship maintenance project management effectively is the key factor if commercial shipyards wish to carry on warship commercial maintenance activity. How to evaluate a warship commercial maintenance system and provide improved solutions for commercial shipyards is the main purpose of this research. This paper start from warship maintenance project management and focuses on warship commercial maintenance peculiarities to correct domestic public projects and shipbuilding related references. We use the Habitual Domains (HD) method to search Key Success Factors (KSF) for warships commercial maintenance system applied to commercial shipyards and to adopt Analytic Hierarchy Process (AHP) to exploit a multi-estimate criteria model to enhance effectiveness and reliability for evaluating a warship commercial maintenance system. The present study uses theoretical and actual experiences to develop a warship commercial maintenance system. Several recommendations are made in order to improve overall performance of a warship commercial maintenance system. We hope that domestic commercial shipyards can do the long-term planning and investment on conducting warship commercial maintenance activity. The navy also can perform warship maintenance frugally and diversely. In this way, navy and commercial shipyards can cooperate and realize the optimal benefit from both sides. ¡iKey Words¡j Taiwan Domestic Shipbuilding Industries, Warship Commercial Maintenance, warship maintenance project management, Habitual Domains (HD), Key Success Factor (KSF), Analytic Hierarchy Process (AHP)

The influence of the cross-strait matrimony is not only to the parties theirselves, but also to the problems of complexsive population policy, the allocation of internal social resources, safeguard against noational interests, the consideration of the safety of national defense and foreigners treatment. If the cross-strait matrimony asise disputes and gets into the litigation procedure, the court do not deal with it appropriately, it will cause the damage of parties¡¦ rights and interests, the influence of the mutually preferential relationship of cross-strait judicial systems and deteriorate relationship of Cross-Strait. For this reason, it is very important to solve the cross-strait matrimony cases properly. The law of the cross-strait matrimony cases is not complete, the court is not clearly how to probe into and solve problems in the cross-strait matrimony cases. By the viewpoints of trail practice and conflict of laws, the nature of the cross-strait matrimony cases is equivalent to the generally foreign matrimony cases what is called international identity disputes, and the court confronts the problems of the cross-strait matrimony cases similarly to international identity disputes. The theories, legislative and precendent of conflict of laws of international identity disputes is also applicable to the cross-strait matrimony cases, therefore, it will contribute to solve the problems. This article introduces legislatives of every nation, international convention and judicial practice, from the viewpoints of legislative policy and trial practice to analyze the court in Taiwan district how to decide the problems of the delimintation of jurisdiction and the conflict of laws of the cross-strait matrimony cases.

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Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 4 uppsatser.