Nya perspektiv på robusthet

Den här uppsatsen handlar just om robusthet. Nu påbjuder traditionen att man delar upp beslutsunderlag i två sorters komponenter: en som har med hur världen (sannolikt) ser ut och en som har med värdet av detta att göra. Moralen har mest att göra med värdekomponenten. Frågan om moralisk robusthet kommer upp just när man försöker analysera ett visst ställningstagande med avseende på värdefrågor. Kunskapskomponenten, som har med hur världen (sannolikt) ser ut att göra, är förstås också intressant att analysera ur robusthetshänseende. Vi talar då om epistemisk robusthet. Längre fram i uppsatsen ser vi närmare på hur man brukar karakterisera den. Men låt oss först säga något om målet med denna övning. Vi är intresserade av att leta efter likheter mellan och konsekvenser av de här två sorternas robusthet för att vi anser att de är viktiga för att förklara varför vi handlar som vi gör. Speciellt tror vi att frågor som rör samhällets riskhantering har mycket att vinna på en genomlysning av problematiken. Vi använder oss av robusthet i juridiken som en brygga mellan de två sorternas robusthet för vi tror att den utgör en sådan mellanform som ställer några frågor på sin spets och underlättar vår studie också genom att bidra med empiriskt innehåll. Det kan redan nu vara av intresse att studera hur robusthet i juridiken förhåller sig till moralisk robusthet

Hands-on approach during breastfeeding support in a neonatal intensive care unit: a qualitative study of Swedish mothers' experiences

BACKGROUND: Assisting mothers to breastfeed is not easy when babies experience difficulties. In a neonatal intensive care unit (NICU), nurses often help mothers by using hands-on-breast without their permission. Little is known about how mothers feel about this unusual body touching. To gain more knowledge from mothers who lived through this experience, this hands-on practice was studied in a NICU in Sweden. METHODS: Between January and June 2001, in-depth interviews were conducted with ten mothers of preterm or sick term infants and all of them experienced the hands-on approach. In this research, Radnitzky's seven principles of hermeneutic interpretation were applied in order to interpret the meaning of mothers' responses. This article presents results related to the period of initiation of breastfeeding. This qualitative study was based on a combination of the models of Gustafsson, Orem, and Aarts' Marte Meo. RESULTS: Five main themes were identified: Insult to integrity, Manipulating the baby, Understanding and adjustment, Breasts as objects, Alternatives to this practice. Hands-on help in the breastfeeding situation was experienced as unpleasant and the women experienced their breasts as objectified. The mothers accepted the hands-on help given by nursing staff, even though they considered it unpleasant. Most mothers expressed a need for assistance when starting breastfeeding, but could not suggest any alternative to hands-on help such as demonstrating with an artificial breast and a doll. CONCLUSION: The study provides information about how mothers experience unexpected hands-on help with breastfeeding in a NICU, which has not been described previously. Since most mothers in this study regarded this behavior as unpleasant and not helpful mostly because it was unexpected and unexplained, it would be important to either explain beforehand to mothers what type of physical approach could be attempted on their body or better, to avoid this type of approach completely

Undantag från kravet på etikprövning av humanistisk och samhällsvetenskaplig forskning. En internationell utblick

The Swedish ethical review system has recently come under heavy criticism - criticism that has largely centered on the system’s negative impact on research in the humanities and social sciences. Among other things, it has been claimed that the requirement for ethical review is unnecessarily comprehensive. One way of exploring the reasonableness of the Swedish system is to compare it with the rules and considerations found in other jurisdictions regarding the type of research project that needs to undergo ethical review. This study compares the Swedish system with a sample of systems found in Europe, the USA, Canada, and Australia. A number of exemptions from the requirements of ethical review are identified and discussed. These exemptions that can serve as a starting point for further analyses and changes to the Swedish system

Effects of offshore wind farms on marine wildlife

Marine management plans over the world express high expectations to the development of offshore wind energy. This would obviously contribute to renewable energy production, but potential conflicts with other usages of the marine landscape, as well as conservation interests, are evident. The present study synthesizes the current state of understanding on the effects of offshore wind farms on marine wildlife, in order to identify general versus local conclusions in published studies. The results were translated into a generalized impact assessment for coastal waters in Sweden, which covers a range of salinity conditions from marine to nearly fresh waters. Hence, the conclusions are potentially applicable to marine planning situations in various aquatic ecosystems. The assessment considered impact with respect to temporal and spatial extent of the pressure, effect within each ecosystem component, and level of certainty. Research on the environmental effects of offshore wind farms has gone through a rapid maturation and learning process, with the bulk of knowledge being developed within the past ten years. The studies showed a high level of consensus with respect to the construction phase, indicating that potential impacts on marine life should be carefully considered in marine spatial planning. Potential impacts during the operational phase were more locally variable, and could be either negative or positive depending on biological conditions as well as prevailing management goals. There was paucity in studies on cumulative impacts and long-term effects on the food web, as well as on combined effects with other human activities, such as the fisheries. These aspects remain key open issues for a sustainable marine spatial planning

Science and proven experience: a Swedish variety of evidence-based medicine?

A key question for evidence-based medicine (EBM) is how best to model the way in which EBM should “[integrate] individual clinical expertise and the best external evidence” (Sackett et al. 1996). We argue that the formulations and models available in the literature today are modest variations on a common theme and face very similar problems. For example, both the early and updated models of evidence-based clinical decisions presented in Haynes, Devereaux and Guyatt (2002) assume (with Sackett, et. al., 1996) that EBM consists of, among other things, evidence from clinical research and clinical expertise. On this A-view, EBM describes all that goes on in a specific justifiable medical decision. There is, however, an alternative interpretation of EBM, the B-view, in which EBM describes just one component of the decision situation (a component usually based on evidence from clinical research) and in which, together with other types of evidence, EBM leads to a justifiable clincial decision but does not describe the decision itself. This B-view is inspired by a 100-years older version of EBM, a Swedish standard requiring medical decision-making and practice to be in accordance with ‘science and proven experience’. In the paper we outline how the Swedish concept leads to an improved understanding of the way in which scientific evidence and clinical experience can and cannot be integrated in light of EBM. In addition the paper sketches the as yet unexplored historical background to EBM