Urininkontinens är ett problem alla kan drabbas av. Det innebär att personen läcker urin eller kissar på sig. Det ses som ett vanligt folkhälsoproblem i hela världen och det förekommer mest hos kvinnor. Det påverkar kvinnorna och hämmar dem i det dagliga livet. Hämningen grundar sig i rädsla och oro för att läcka samt lukta urin. Kvinnorna med urininkontinens upplever att ämnet är tabubelagt samt nedtystat och associeras med skamkänslor. De känner en daglig påverkan av urininkontinensen och den planerade livsplanen spricker med en överhängande känsla av maktlöshet samt frustration. De försöker hitta olika sätt att acceptera sina symtom men flertalet av kvinnorna ser symtomen som en oundviklig del av livet. Ett problem som kommer med stigande ålder eller en åkomma efter förlossning. Kvinnor som är äldre än femtio år har lättare att acceptera sin urininkontinens än de som är trettio år. De okontrollerade symtomen ger kvinnorna en känsla av förlorad kroppskontroll och sårbarhet. Detta kan leda till dåligt självförtroende och depression. Kvinnorna begränsas i sociala sammanhang och de hindras att utföra fysiska aktiviteter till följd av nervositet att läcka samt lukta urin. Detta upplevs som en förlust i vardagen. Kvinnorna uttrycker även en försämring i deras sexuella relationer och de känner en svårighet att vara spontana i sexuella aktiviteter. Mindre feminitet och en känsla av att inte vara fräsch uttrycks också av kvinnorna. Till följd av detta känner de en sämre självkänsla. Olika strategier används för att fungera i det dagliga livet. Vilket kan innebära att de anpassar sin klädsel och förbereder sig med extra inkontinensskydd för att dölja fläckar från läckage. De tar även alltid reda på tillgång till toaletter i offentliga miljöer. Ett annat problem dessa kvinnor upplever är ett ignorant bemötande av vårdpersonal och brist på kunskap om urininkontinens. Kvinnorna önskar en mer förstående attityd och bättre kommunikation i vården för att få möjlighet till rätt behandling. Vården har mycket att förbättra i mötet med dessa kvinnor både professionellt samt kunskapsmässigt och i öppenheten till ämnet. Det går inte att förvänta sig att kvinnorna tar sina egna besvär på allvar när inte vårdpersonalen gör det. / Background: Urinary incontinence denotes an involuntary leakage from the bladder which can affect women of all ages, but leakage problems are often more common with rising age. It is a common issue, however there is a large unrecorded number of women who do not seek medical attention for their urinary incontinence. Urinary incontinence is very costly for the society because of the medical and social disability it causes the affected. Aim: To illuminate the experiences of women living with urinary incontinence Method: A literary study was done where nine scientific articles were examined and analyzed according to a five step model. Results: The women experienced their urinary incontinence as taboo and shameful. The issue was too intimate and private and therefore unnatural to talk about. Their leakage lead to fear and nervousness which made them end up in a vulnerable situation. This affected them on several emotional levels both psychosocial, psychological and physical. The women experienced an ignorance and a nonchalant attitude from their care providers which caused an hesitancy in their search of healthcare. They experienced that their bodies were unreliable which lead to a reduced spontaneity and restrictions in life. Conclusion: Urinary incontinence is not solely an issue with leaking urine, it is affecting the women's lives as a whole on many levels. The hindrance that the urinary incontinence caused the women on a daily basis made them feel a sense of loss and affected their joy and zest of life. It requires an improvement of healthcare praxis in order to meet these women in a professional and trustworthy manner.

This study aims to understand the influence of external forcing (i.e. climate, human influences) changes on the inputs of terrigenous materials from the Kaoping River as well as the biogeochemical responses of carbon and nutrients to riverine fluxes in the Kaoping coastal zone. The Kaoping River exhibits contrasting patterns in water discharge and material fluxes between wet and dry seasons. In general, river discharge is about 12 times higher in the wet season than in the dry season. Riverine fluxes of terrigenous materials (DOC¡BPOC¡BDSi¡BDIN¡BDIP¡BTDN and TDP) are about 3 to 10 times higher in the wet season than in the dry season. Consequently, distribution patterns of carbon, nutrients and hydrochemical parameters are significant difference among four seasons in the Kaoping coastal zone. Distributions of DOM (dissolved organic matter), POM (particulate organic matter) and nutrients in the Kaoping coastal zone show that the highest concentration is generally found in the area close to the Kaoping estuary, and the concentration decreases with the distance away from the land. The riverine fluxes also affect the ratios of DOC/TOC and £GPOC/£GPN in the coastal zone. The characteristics of DIN and DIP distributions and their ratios imply that the primary productivity may be largely limited by nitrogen (DIN < 1£gM¡AN/P < 10) rather than phosphorus (DIP < 0.2£gM¡AN/P < 30) in the Kaoping coastal zone. The occurring probability of nitrogen limitation varies from season to season during the study period, roughly ranging from 4% to 42% (winter, summer > spring, autumn). The GP (gross production) ranges from 708-19819 mg C m-2 d-1 in spring, from 2451-16230 mg C m-2 d-1 in summer, and from 844-5549 mg C m-2 d-1 in winter. The DCR (dark community respiration) ranges from 970-6284 mg C m-2 d-1 in spring, from 861-12418 mg C m-2 d-1 in summer, and from 997-5781 mg C m-2 d-1 in winter. Both GP and DCR display the highest value in summer, indicating the significant influence of terrigenous fluxes on biological production and respiration during summer. Meanwhile, correlations are significantly positive between GP (DCR) and temperature and nutrients, but significantly negative between GP (DCR) and salinity, also indicating the impacts of terrigenous inputs on GP and DCR. In the Kaoping coastal zone, the BCD (bacterial carbon demand) is about 15% GP and 64% GP, respectively, in winter and summer, inplying that the contribution of GP to BCD is more important in winter than in summer. Judging from the ratio of GP/DCR in different seasons and sampling stations, we conclude that the study area near the Kaoping estuary is likely to be autotrophic throughout the study period, the other stations are also likely to be autotrophic during summer. Nevertheless, the offshore stations appear to be heterotrophic during the winter season.

This thesis addresses Art. 4 ATAD and looks at it from two different angles. Firstly, Art. 4 ATAD will be examined in the light of the TFEU freedoms. Special regard will be had to the principle of proportionality. Secondly, it will be evaluated how Art. 4 ATAD, or rather its domestic implementation, aligns with the constitutions of the Member States. For the first part, Art. 4 ATAD has to be measured against the case law the ECJ has developed regarding testing anti-avoidance rules against the TFEU freedoms. An interest limitation rule like Art. 4 ATAD falls under the scope either of the freedom of establishment or the free movement of capital. However, since Art. 4 ATAD applies to cross-border interest payments in the same way as it applies to such payments on a purely national level, it does not impose a restriction on any of the freedoms. Since Art. 4 ATAD is not a domestic rule, which is tested against the TFEU freedoms, but EU law, it still has to follow the proportionality principle according to Art. 5 (1) TEU. For this reason, the proportionality test, which usually forms part of the justification test, still has to be conducted on its own. Art. 4 ATAD has to be suitable for securing the attainment of the objective which it pursues without going beyond what is necessary to attain it. As the name of the ATAD implies, its main objective is preventing tax avoidance. Regarding this justification ground, the ECJ has developed two different lines of judicature. The first line involves the anti-avoidance purpose on its own. Then, the given measure has to target wholly artificial arrangements, which do not reflect a real economic activity. Moreover, the taxpayer needs to be given the chance to prove such an economic reality. Art. 4 ATAD does not meet these requirements, because it covers all sorts of interest payments and does not provide for an exception in case of a proven sound business reason. The second line considers the anti-avoidance purpose combined with another justification ground. Then, the provision does not have to target only wholly artificial arrangements. Here, the balanced allocation of taxing rights is suitable for this purpose. Nevertheless, the problem still remains that Art. 4 ATAD is not limited to cross-border interest payments, but covers all kinds of interest payments and therefore overshoots its aim of securing the balanced allocation of taxing rights. This is why this justification ground is not able to render Art. 4 ATAD proportionate either, neither combined with the anti-avoidance purpose nor taken on its own. Art. 4 ATAD in not in line with the TFEU freedoms, because it violates the principle of proportionality, which is part of the justification test. For the second part, Art. 4 ATAD has to be measured against national constitutions. As an example serves the German interest barrier rule. This is, because it served as a blueprint for Art. 4 ATAD, so it can be seen as already implementing Art. 4 ATAD. Furthermore, the German interest barrier rule is currently under review by the German Constitutional Court, because its constitutionality is being questioned. The reason for this is that by limiting the deduction of interest expenses, the German interest barrier rule interferes with the objective net principle. In German tax law, the objective net principle is deduced from the ability-to-pay principle, which again is deduced from the principle of equality. The principle of equality is laid down in Art. 3 (1) of the German Constitution. Through the connection to the principle of equality, the objective net principle itself is covered by the German Constitution. This derogation from the objective net principle is not justified, because the German interest barrier rule - like Art. 4 ATAD - is not proportionate in relation to its objectives, i.e. the control of economic policy, the state's financing needs and the need to prevent abusive structures. The same problem would occur with an actual domestic implementation of Art. 4 ATAD. In case, the objective net principle is also covered by the constitutions of other EU Member States, they will face the same difficulties. Even if the objective net principle is not covered by the constitution of a Member State, it still is a fundamental principle of tax law. It is true, that EU law prevails over domestic laws and even national constitutions. However, according to Art. 4 (2) and (3) TEU, the EU also has to respect the national fundamentals and follow the principle of sincere cooperation. This means, that the EU should not counteract such fundamental principles of the Member States as the objective net principle and the ability-to-pay principle. By adapting Art. 4 ATAD, the EU does not meet these requirements. It can be concluded that Art. 4 ATAD results in difficulties both with primary EU law and with national constitutional law or at least fundamental principles. Although these concerns are rather of a theoretical nature, they still lead to the legitimate question if the EU legislators have made the right choice in phrasing Art. 4 ATAD as they did.

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / O estudo teve como objetivo construir e validar as definiÃÃes constitutivas e operacionais do resultado Mobilidade e dos seus indicadores presentes na ClassificaÃÃo dos Resultados de Enfermagem (NOC, 2010). Estudo do tipo metodolÃgico, realizado em trÃs etapas: anÃlise de conceito, validaÃÃo por especialistas e validaÃÃo clÃnica do instrumento. Para a seleÃÃo das produÃÃes utilizou-se o acesso on-line a cinco bases de dados: Scopus, Pubmed, Cinahl, Cochrane e Lilacs, com os descritores: Mobility, Stroke, nursing e suas sinonÃmias nas lÃnguas portuguesa e espanhola. Identificaram-se 1.521 artigos e apÃs seleÃÃo criteriosa resultaram 49 artigos. Entre os diferentes paÃses, destacam-se os artigos publicados no Canadà (26,7%), sobretudo das produÃÃes a partir de 2001 (95,9%) por fisioterapeutas (34,6%), em unidades de reabilitaÃÃo (61,5%). Os atributos identificados para Mobilidade foram: andar, ficar em pÃ, sentar, colocar a perna de um lado para outro, virar-se, iniciar e parar a locomoÃÃo, subir escadas, funÃÃo motora, transferÃncia e habilidade motora. Para LimitaÃÃo da mobilidade: hemiplegia, hemiparesia, dÃficit na marcha e habilidade motora diminuÃda. TambÃm foi construÃdo um caso modelo e um caso contrÃrio e identificados antecedentes e consequentes para Mobilidade e LimitaÃÃo da mobilidade. ApÃs a anÃlise de conceito nesta etapa foi possÃvel propor um instrumento com as definiÃÃes constitutivas e operacionais para os indicadores do resultado Mobilidade empregando alguns princÃpios da psicometria. Este foi submetido à avaliaÃÃo de 23 enfermeiros especialistas que atenderam aos critÃrios adaptados de Fehring (1994). Os dados foram compilados no programa Microsoft Office Excel 2007 e analisados pelo SPSS versÃo 19.0. A maioria dos especialistas era do sexo feminino (95,7%), trabalhava no Estado do Cearà (76,0%) em instituiÃÃo de ensino superior e em hospitais (56,5%), era mestre (78,3%) e tinha experiÃncia de trabalhos com mobilidade e/ou AVC. Observou-se que os indicadores Correr, Saltar, Rastejar e Movimentos realizados com facilidade apresentaram para a maioria dos critÃrios da psicometria proporÃÃes estatisticamente inferiores a 85%. AlÃm disso, a maior parte dos enfermeiros sugeriu a retirada destes indicadores por julgÃ-los nÃo representativos para pacientes que tiveram AVC. Assim, estes indicadores foram excluÃdos ao se construir o instrumento para ser aplicado na etapa de validaÃÃo clÃnica do instrumento. A coleta de dados da terceira etapa ocorreu no ambulatÃrio de neurologia de um hospital de referÃncia para tratamento de pacientes com AVC no Cearà e todos os aspectos Ãticos foram respeitados em todas as etapas do estudo. ApÃs a confirmaÃÃo da presenÃa do diagnÃstico de enfermagem Mobilidade fÃsica prejudicada em pacientes que tiveram AVC pela pesquisadora do estudo, uma dupla de enfermeiras aplicou o instrumento com as definiÃÃes constitutivas e operacionais construÃdas e validadas nas duas primeiras etapas do estudo enquanto a outra dupla aplicou o mesmo instrumento sem as definiÃÃes. Ao analisar as avaliaÃÃes entre as enfermeiras, houve similaridade entre a dupla de avaliadores que utilizou o instrumento com as definiÃÃes constitutivas e operacionais para todos os indicadores e entre a dupla que utilizou o instrumento sem estas definiÃÃes ao aplicar os testes estatÃsticos de Friedman e o Coeficiente de CorrelaÃÃo Intraclasse. Ao aplicar este coeficiente para os indicadores EquilÃbrio, Andar, Movimento das articulaÃÃes e Desempenho no posicionamento do corpo identificou-se maior correlaÃÃo entre as avaliadoras que empregaram as definiÃÃes quando comparadas com as que nÃo utilizaram. Jà para os indicadores Marcha, Movimento dos mÃsculos, Desempenho na transferÃncia e CoordenaÃÃo, foi maior a concordÃncia entre as enfermeiras que nÃo adotaram as definiÃÃes. Mas, de forma geral, observou-se que para a maioria dos indicadores houve maior concordÃncia entre a dupla que usou o instrumento com as definiÃÃes constitutivas e operacionais. No entanto, recomenda-se a realizaÃÃo de outras pesquisas de validaÃÃo com o resultado de enfermagem Mobilidade tanto em paciente com AVC como em diversas outras situaÃÃes clÃnicas. Esta pesquisa poderà contribuir para o aperfeiÃoamento da taxonomia da NOC. / The study aimed at identifying and validating the constitutive and operational definitions of the mobility outcome and its indicators present in the Nursing Outcomes Classification (NOC 2010). The study was of methodology type and was performed in three stages: concept analysis, validation by specialists and clinical validation of the instrument. For the selection of productions it was used the online access to five databases: Scopus, PubMed, Cinahl, Lilacs and Cochrane, with the descriptors: mobility, stroke, nursing and their synonyms in both Portuguese and Spanish languages. 1521 articles were identified in all the databases searched and a careful selection resulted in 49 articles. Amongst the fifteen different countries, we highlight the articles published in Canada (26.7%), especially works from 2001 (95.9%) by physiotherapists (34.6%) in rehabilitation units (61.5 %). The attributes identified for Mobility were: walking, standing, sitting, placing the leg side to side, turning around, start and stop walking, climbing stairs, motor function, transfer and motor skill. For Mobility limitation: hemiplegia, hemiparesis, gait deficit and decreased motor skills. It was also created a sample case and an opposite case and were identified antecedents and consequences for both terms Mobility and Mobility limitation. After the concept analysis stage, it was brought forward an instrument with the constitutive and operational definitions for the indicators of the Mobility outcome by using the principles of psychometrics. This instrument was assessed by 23 specialist nurses who met the criteria adapted from Fehring (1994). The data were compiled into a spreadsheet program Microsoft Office Excel 2007 and analyzed by SPSS version 16.0. Most specialists was female (95.7%), worked in the State of Cearà (76.0%) in institution of higher education and hospitals (56.5%), was a master (78.3%) and had experience working with mobility and / or stroke. It was noted that the following indicators: Run, Jump, Crawl and Movements performed with ease showed ratios statistically less than 85% for most of the psychometrics criteria. Moreover, most of the nurses suggested the removal of these indicators by judging they were not representative for patients who had strokes. Thus, these indicators were excluded when defining the instrument to be applied in the clinical validation of the instrument stage. The data collection for the third stage took place in the neurology first-aid room of a referral hospital for treatment of patients with stroke in Cearà State and all ethical aspects have been followed at all stages of the study. After the researcher of the study confirmed the existence of the Impaired physical mobility nursing diagnosis in patients who had stroke, a pair of nurses applied the instrument with the constitutive and operational definitions identified and validated in the first two stages of the study while another pair used the same instrument without the definitions. As for the analysis of the nurses evaluations, there was similarity amongst the pair of evaluators who used the instrument with the constitutive and operational definitions for all indicators and amongst the pair who used the instrument without these definitions in applying the statistical tests from Fridman and the Intraclass Correlation Coefficient. With the use of this coefficient to such indicators: Balance, Walking, Joint movement and Body positioning performance, it was found a higher correlation between the evaluators who used the definitions as compared to those who did not. As for the following indicators: Gait, Muscle movement, Performance in the transfer and coordination, the agreement was higher amongst the nurses who did not adopt the definitions. But overall, it was observed that for most indicators there was greater agreement amongst the pair who used the instrument with the constitutive and operational definitions. However, it is recommended to execute other validation researches with the Mobility nursing outcome in patients with stroke and in several other clinical situations as well. This research may contribute to the improvement of the NOC taxonomy.

Consumer-driven nutrient cycling has been shown to be an important process in supplying inorganic nutrients to autotrophic and heterotrophic organisms in aquatic ecosystems. Theory indicates that consumer nutrient excretion is influenced primarily by an organism's nutrient composition; however, an organism's diet should also play an important role in nutrient excretion, especially if the consumer is nutrient limited. This study asks the question, how does diet influence nutrient excretion of consumers at different trophic levels? Macroinvertebrates and fish were collected from six streams and nitrogen (N) and phosphorus (P) excretion were quantified. Epilithon, leaf detritus, and seston (fine particulate organic matter in transport) were collected and analyzed for carbon (C), nitrogen (N), and phosphorus (P) content in an attempt to qualitatively assess the nutritional status of the diet of primary consumers. Macroinvertebrates were also analyzed for C, N, and P content to assess their nutritional composition in relation to their excretion and also to assess the nutritional composition of the diet of predatory insects and fish. Fish were also analyzed for C, N, and P. Similar to theoretical predictions, fish and macroinvertebrate P excretion was negatively related to P content and the N:P excretion ratio was negatively related to the body N:P ratio. However, this relationship was driven primarily by two phosphorus rich species, mottled sculpin in the fish and crayfish in the macroinvertebrates. Some relationships did emerge between consumer excretion and diet. For example, hydropsychid caddisflies had the highest macroinvertebrate P excretion, possibly explained by the low N:P of seston. However, shredders, eating on a very low N and P diet of leaf detritus, had very low N and P excretion. The relationship between consumers, their food, and nutrient excretion is a matter of mass balance. If the food N:P ratio is higher than that of the consumer, then the N:P excretion should be higher than the consumer N:P and the food N:P, especially if organisms are P-limited. However, N:P excretion by macroinvertebrates and fish were very similar despite large differences in diet. The majority of macroinvertebrates and fish had a lower N:P excretion ratio than the predicted N:P of their food, possibly indicating that 1) consumers were either selectively consuming more P-rich foods than the diets that I assigned them or 2) consumers are generally not N or P limited or influenced by the N or P in their diet. Mottled sculpin and crayfish were the only organisms with a higher N:P excretion than their resources and both had a higher %P than the other fish and macroinvertebrates, respectively. High N:P excretion along with high phosphorus content is indicative of P-limitation. Macroinvertebrates and fish, excluding mottled sculpin and crayfish, had a lower N:P excretion and the N:P ratio of the water column. If consumers do play a role in nutrient dynamics, then consumers could alter the relative abundance of nitrogen and phosphorus by supplying more phosphorus. However, the presence of a P-limited organism, such as mottled sclupin or crayfish, could alter the relative abundance of nitrogen and phosphorus by supplying less phosphorus. / Master of Science

La présente étude examine les causes de déchéance du droit à limitation de responsabilité du transporteur maritime de marchandises. En règle générale, les plafonds d’indemnisation fixés par les conventions internationales écartent la réparation intégrale du préjudice causé par le transporteur maritime de marchandises. Cependant, il est également prévu un certain nombre de causes de déchéance de ce droit à limitation, pour lesquelles les conditions d’application diffèrent d’une convention internationale à l’autre (Règles de La Haye, Règles de La Haye-Visby, Règles de Hambourg et Règles de Rotterdam). Parallèlement, les tribunaux nationaux, par le recours à des notions propres de leurs systèmes juridiques, modifient l’étendue des causes de déchéance de ce droit. En somme, la déchéance du droit à limitation de responsabilité variera selon la convention internationale appliquée et selon la juridiction compétente. Ce qui, en définitive, porte atteinte à la structuration rationnelle du régime de responsabilité du transporteur maritime dans sa globalité et à l’objectif d’uniformisation poursuivi jusqu’ici. / This study examines the institutions capable to deprive the sea carriers from the benefit of limitation of liability. In general, the package limitation provisions settled by international maritime conventions reject the full compensation of damages caused by the shipowning companies. However, this rule can be mitigated. Some specific conducts can bar the carrier from the benefit of limitation of liability. The conventions on international transport of goods (the Hague Rules, the Hague-Visby Rules, the Hamburg Rules and the Rotterdam Rules) have set out differently the conditions required to deprive the carrier of the right to limit responsibility. Concurrently, national courts, through the use of specific concepts, have modified the scope of the right of such limitation. In sum, the conducts barring limitation of liability will vary according to the International Convention applied and according to the relevant competent court. This, ultimately, undermines the rational organization of the maritime liability system and adversely affects the objective of uniformity in this matter.

A virulent strain of Legionella pneumophila serogroup 1 was established in continuous culture under defined iron-replete conditions at pH 6.9. Iron-limitation and extremes of pH (6.0 and 7.8) influenced the growth and metabolism of L. pneumophila, as manifested by increased metabolic activity, impaired energy coupling, and altered metabolic fluxes. In particular, the physiological versatility of L. pneumophila was demonstrated by a significant decrease in the iron content of biomass (6-fold increase in Yiron), coupled with reduced metabolic efficiency (Y, on), in response to iron-limited growth. Iron limitation promoted the accumulation of significant intracellular reserves of poly- ß-hydroxybutyrate (16 % cell dry wt.), which supported long-term survival of L. pneumophila under starvation conditions. Expression of the important pathogenicity factor, the zinc metalloprotease, was regulated by iron availability. Common iron acquisition mechanisms, such as siderophores and transferrin receptors, were not elaborated by iron-limited cells. However, human transferrin was identified as a potential iron source for L. pneumophila, with the zinc metalloprotease mediating transferrin digestion and possibly iron acquisition. Iron-limitation and extremes of pH also influenced cellular morphology and the surface properties of L. pneumophila, promoting the formation of uniform cultures of short rod-shaped bacteria, with altered fatty acid, phospholipid and protein composition. In addition to morphological and physiological adaptation, iron limitation had a significant effect on the virulence of L. pneumophila. Iron-replete cells grown at pH 6.9 and 6.0 were highly virulent in a guinea pig model. However, the virulence of L. pneumophila was significantly attenuated (P < 0.05) in response to iron-limited growth. This phenomenon was reversible, and correlated with reduced phagocytosis and / or reduced intracellular survival following infection. Decreasing the pH of iron-limited cultures to 6.0 did not stimulate recovery of culture virulence. Therefore, this study clearly demonstrates that environmental stresses, including iron limitation and extremes of pH, play an important role in modulating the physiology and virulence of L. pneumophila, inducing the expression of distinct phenotypes differing in their ability to persist in nature and cause infection.

Background: Endometriosis is a disease which, though it impacts one of ten women, has a lack of knowledge in the society and among healthcare professionals. The lack of knowledge causes delays in diagnosis and a lack of comprehension for the women. Aim: The aim of this study was to describe women's experiences of living with endometriosis. Method: The method used in this study was a method to contribute to evidence-based nursing with ground in analysis of qualitative research. Through the similarities and contradictions in the analyzed studies, themes and under-themes were created. Result: Findings showed that the women's experiences often were negative. Friends, family and healthcare professionals normalized the pain and the women often endured the pain in belief that it was normal. The lack of knowledge in endometriosis caused misdiagnosis and diagnostic delays. The endometriosis limited the women's daily living, work and social life by decreasing their activity because of symptoms as pain, nausea, fatigue, heavy bleeding and diarrhea. The disease also affected the women's relationships and the feeling of being a woman. Conclusion: The lack of knowledge in endometriosis caused an unnecessarily suffering among the women with the disease. If the awareness of endometriosis would increase in the society and among healthcare professionals the time for diagnosis and the encounters with patients suffering from endometriosis could improve.

Earlier studies indicate that the interaction between heterotrophic bacteria and dissolved organic matter is rather different in rivers and estuaries. The aim of my thesis was to elucidate if bacteria are regulated differently in the Råne river and estuary during a spring situation. Surface water was collected at both locations and a bioassay performed to study limiting substances for bacterial production, proportion bio-available dissolved organic carbon (DOC) in the water and bacterial growth efficiencies (BGE). The Carbon, Nitrogen and Phosperous concentrations were all higher in the estuary than in the river. The bioassay showed that nitrogen-phosphorus limited the bacterial production at both locations, while DOC occurred in excess. The bio-available part of the DOC pool was larger in the estuary (~6%) than in the river (~3%). However, the BGE was much higher in the river (~40%) than in the estuary (~5%), indicating that a larger proportion of the consumed DOC was used for respiration in the estuary. I conclude that heterotrophic bacteria are limited by the same substance, but that the bacterial metabolism is quite differently regulated in the river and in the estuary.

La présente étude examine les causes de déchéance du droit à limitation de responsabilité du transporteur maritime de marchandises. En règle générale, les plafonds d’indemnisation fixés par les conventions internationales écartent la réparation intégrale du préjudice causé par le transporteur maritime de marchandises. Cependant, il est également prévu un certain nombre de causes de déchéance de ce droit à limitation, pour lesquelles les conditions d’application diffèrent d’une convention internationale à l’autre (Règles de La Haye, Règles de La Haye-Visby, Règles de Hambourg et Règles de Rotterdam). Parallèlement, les tribunaux nationaux, par le recours à des notions propres de leurs systèmes juridiques, modifient l’étendue des causes de déchéance de ce droit. En somme, la déchéance du droit à limitation de responsabilité variera selon la convention internationale appliquée et selon la juridiction compétente. Ce qui, en définitive, porte atteinte à la structuration rationnelle du régime de responsabilité du transporteur maritime dans sa globalité et à l’objectif d’uniformisation poursuivi jusqu’ici. / This study examines the institutions capable to deprive the sea carriers from the benefit of limitation of liability. In general, the package limitation provisions settled by international maritime conventions reject the full compensation of damages caused by the shipowning companies. However, this rule can be mitigated. Some specific conducts can bar the carrier from the benefit of limitation of liability. The conventions on international transport of goods (the Hague Rules, the Hague-Visby Rules, the Hamburg Rules and the Rotterdam Rules) have set out differently the conditions required to deprive the carrier of the right to limit responsibility. Concurrently, national courts, through the use of specific concepts, have modified the scope of the right of such limitation. In sum, the conducts barring limitation of liability will vary according to the International Convention applied and according to the relevant competent court. This, ultimately, undermines the rational organization of the maritime liability system and adversely affects the objective of uniformity in this matter.