| 1. |
- Munthe, Christian, 1962, et al.
(författare)
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The Return of Lombroso? Ethical Aspects of (Visions of) Preventive Forensic Screening
- 2015
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Ingår i: Public Health Ethics. - : Oxford University Press (OUP). - 1754-9973 .- 1754-9981. ; 8:3, s. 270-283
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Tidskriftsartikel (refereegranskat)abstract
- The vision of legendary criminologist Cesare Lombroso to use scientific theories of individual causes of crime as a basis for screening and prevention programmes targeting individuals at risk for future criminal behaviour has resurfaced, following advances in genetics, neuroscience and psychiatric epidemiology. This article analyses this idea and maps its ethical implications from a public health ethical standpoint. Twenty-seven variants of the new Lombrosian vision of forensic screening and prevention are distinguished, and some scientific and technical limitations are noted. Some lures, biases and structural factors, making the application of the Lombrosian idea likely in spite of weak evidence are pointed out and noted as a specific type of ethical aspect. Many classic and complex ethical challenges for health screening programmes are shown to apply to the identified variants and the choice between them, albeit with peculiar and often provoking variations. These variations are shown to actualize an underlying theoretical conundrum in need of further study, pertaining to the relationship between public health ethics and the ethics and values of criminal law policy.
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| 2. |
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| 3. |
- Nilsson, Thomas, 1954, et al.
(författare)
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The precarious practice of forensic psychiatric risk assessments
- 2009
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 32:6, s. 400-407
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Tidskriftsartikel (refereegranskat)abstract
- The development of forensic psychiatric risk assessments is discussed from a clinical point of view using the example of Sweden. A central task in forensic psychiatry has traditionally been to identify dangerous, mentally disordered subjects considered to be prone to commit violent acts. Over time, “dangerousness” has been reworded into “risk”. Nevertheless, such assessments have generally been based on the psychiatric factors characterising the individual patient, while group interaction, situational factors, or social and cultural circumstances, such as the availability of alcohol and drugs, have been largely overlooked. That risk assessments have a focused on people with a diagnosis of “mental disorder” and been used as grounds for coercive measures and integrity violations has somehow been accepted as a matter of course in the public and political debate. Even the basic question whether offenders with a mental disorder are really more prone to criminal recidivism than other offenders seems to have been treated light-handedly and dealt with merely by epidemiological comparisons between groups of persons with broad ranges of psychosocial vulnerability and the general population. Legal texts, instructions and guidelines from the authorities in charge are often vague and general, while actors in the judicial system seem to put their trust in psychiatric opinions. The exchange of professional opinions, general public expectations, and judicial decision processes poses a huge risk for misunderstandings based on divergent expectations and uses of terminology.
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| 4. |
- Trägårdh, Karin, et al.
(författare)
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Risk Profiles of Female Perpetrators of Severe Violence
- 2019
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Ingår i: 13th Nordic Symposium on Forensic Psychiatry. August 20-22, Gothenburg, Sweden.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Female offenders without a severe mental disorder show more criminogenic factors than those with. Both groups are characterized by mental health problems. We need to further characterize female offenders. Background Offenders of lethal/severe violence are in a majority of cases male, about 90% (Falk et al., 2014), and research has to a considerable extent focused on male violent offenders. Although less is known about female violent offenders than male offenders, previous research has indicated significant differences between male and female offenders of lethal/severe violence (Trägårdh et al., 2016; Yourstone et al., 2008). Since a majority of female perpetrators of lethal violence undergo a forensic psychiatric investigation (RPU/FPI), these documents contains important information about this group. Purpose The aim of this ongoing study is to characterize female perpetrators of severe violent crimes, and to compare female perpetrators sentenced to forensic psychiatric compulsory care with those sentenced to correctional treatment. Method This is an exploratory and descriptive study with a cross-sectional design. All forensic evaluations (FPI) made in Sweden between 2000-2014 (from The National Board of Forensic Medicine/RMV), and the subsequent court verdicts, in cases where women had used lethal/severe violence (n≈180) where used as the basis for data collection in this study. The present preliminary analyses (2-tests and ANOVA) contains approx. 26% (n=47) of the total group. Group differences were investigated regarding: Mental health (FPI) Risk factors (HCR-20 and PCL-R) Victim relation (FPI) Criminal behavior (FPI) Results Female offenders with and without a Severe mental disorder (SMD) seems to differ in some respects. For female offenders with a SMD, the crime was more likely to have been conducted in a less criminal context (see Table). For female offenders without a SMD, the following characteristics were more frequently present: Victim gender – male Substance abuse + Under the influence of substance (offender and victim) Previous violence between victim and offender Previous registered criminality Also, several common features between the SMD and non-SMD group of female offenders were found. The majority of all female offenders had: Previous psychiatric contact and diagnoses Previously attempted suicide No previously registered criminality Conclusions Preliminary results of the female perpetrators who had underwent a FPI seems to identify both substantial differences and similarities between those with versus without a SMD, where those without show more criminogenic factors. Both groups were also characterized by a high amount of mental illness. Also, these results supports previous research that female and male offenders of severe violence differ in important ways. Since a majority of female perpetrators of lethal violence undergo a forensic psychiatric investigation, these results should be generalizable to this group as a whole in Sweden. Based on these results, a great need to further characterize female offenders of severe/lethal violence remain.
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| 5. |
- Lindhe, Andreas, 1981, et al.
(författare)
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Användningen av MACRO-DB i tillståndsärenden och effekter av ny modellversion: Enkätstudie och samhällsekonomisk analys av arbetet med MACRO-DB
- 2022
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I syfte att skydda dricksvattentäkter, dvs. yt- och grundvattenresurser, kan användningen av växtskyddsmedel regleras genom att exempelvis ställa krav på tillstånd för yrkesmässig användning inom vattenskyddsområden. Att bedöma när, hur och vilka växtskyddsmedel som kan spridas kan vara komplicerat. För att underlätta arbetet med att både ta fram och handlägga tillståndsärenden finns därför modellverktyget MACRO-DB. Verktyget har utvecklats av SLU Centrum för kemiska bekämpningsmedel i miljön (CKB) och används för att simulera bekämpningsmedelsläckage till yt- och grundvatten och bedöma om risken är acceptabelt låg eller inte. År 2018 gjordes en satsning där både Havs- och vattenmyndigheten (HaV) och CKB gjorde investeringar för att vidareutveckla MACRO-DB. Syftet med analysen som presenteras i denna rapport har varit att utvärdera om satsningen varit samhällsekonomiskt motiverad med hjälp av en kostnads-nyttoanalys (KNA). För att ta fram nödvändigt underlag och ge en bild av dagens arbete med tillståndsärenden för yrkesmässig användning av växtskyddsmedel på jordbruksmark inom vattenskyddsområden har en enkätundersökning genomförts. Enkäten skickades till samtliga svenska kommuner och syftade specifikt till att kartlägga användningen av MACRO-DB. Den genomförda enkätstudien besvarades av 58 % av Sveriges kommuner och bedöms baserat på detta och den geografiska spridningen ge en bra bild av dagens arbete med tillståndsärenden för användning av växtskyddsmedel på jordbruksmark inom vattenskyddsområden och specifikt användningen av MACRO-DB. Av de kommuner som besvarat enkäten är det 71 % som handlägger den aktuella typen av ärenden och av dessa är det 61 % som använder MACRO-DB som del av beslutsunderlaget. En majoritet av kommunerna använder såldes MACRO-DB. Bland de som inte använder MACRO-DB beror det framför allt på att man inte känner verktyget. Endast en mindre andel anser att det är inte rimligt att ställa krav på användning av MACRO-DB i den typ av ärenden de hanterar. Av de kommuner som använder MACRO-DB gör 55 % egna körningar för att kontrollera resultaten som lämnas in med tillståndsansökningarna. En stor andel (44 %) gör i stället granskningar av underlagsmaterial och antaganden. Enligt drygt hälften (53 %) av kommunerna tar dricksvattenproducenten del av uppgifter om vilka växtskyddsmedel som används inom vattenskyddsområden, i syfte att anpassa kontrollen av förekomst av växtskyddsmedelsrester i rå- och dricksvatten. Resultaten från enkäten visar också att majoriteten av kommunerna som använder MACRO-DB (93 %) anser att verktyget fungerar bra (61 %) eller mycket bra (32 %) som hjälpmedel. De förslag som lämnats på hur användningen skulle kunna förbättras innefattar bland annat behov av utbildning och annan stöttning men även behovet av mindre tidskrävande simuleringar. Att reducera simuleringstiden har varit ett av syftena med den uppdatering av MACRO-DB som gjorts och är en av de nyttor som ingår i den genomförda KNA:n. I analysen har fokus varit på följande kostnader och nyttor: (i) investeringarna som HaV och CKB gjort, (ii) tidsvinster som den nya modellversionen ger för kommuner, rådgivare och andra aktörer, (iii) möjliga effekter av en ökad livsmedelproduktion om det blir möjligt att söka tillstånd för spridning av växtskyddsmedel på odlingsmark där det idag råder förbud, och (iv) förlust av miljönyttor som en ökad spridning av växtskyddsmedel kan ge upphov till. Utifrån de antaganden som scenarierna i KNA:n bygger på bedöms nyttorna kunna överstiga kostnaderna, vilket alltså indikerar att satsningen på nya MACRO-DB kan vara samhällsekonomiskt motiverad. Skillnaden mellan nyttor och kostnader är samtidigt inte så betydande att ett annat resultat helt kan uteslutas, det vill säga att kostnaderna skulle kunna överstiga nyttorna. Scenarierna bygger på flera antaganden som är osäkra och de presenterade resultaten över samhällsekonomisk lönsamhet bör därför tolkas med viss försiktighet. Det kan dock konstateras att nyttorna till följd av tidsbesparingar är i samma storleksordning som investeringskostnaderna, vilket innebär att satsningen kan vara samhällsekonomiskt även om endast dessa aspekter beaktas. Osäkerheterna bedöms vara störst i de uppskattade nyttorna av ökad livsmedelsproduktion samt de minskade miljönyttorna. Dessa poster i KNA:n beskriver för- respektive nackdelarna som uppstår om det blir möjligt att söka tillstånd för spridning av växtskyddsmedel på odlingsmark där det idag rådet förbud. Resultaten visar att även dessa nyttor och kostnader är i samma storleksordning. Det kan därför konstateras att såväl möjligheten att bruka marken för livsmedelproduktion som skyddet av yt- och grundvattenresurser är förknippade med stora nyttor. Skyddet av yt- och grundvattenresurserna behöver därför säkerställas samtidigt som åtgärderna inte ska vara onödigt långtgående så att de ger orimliga restriktioner i markanvändningen och i detta fall effekter på livsmedelproduktionen. Verktyg och hjälpmedel som MACRO-DB är därför viktiga för att möjliggöra en rimlig avvägning när risken spridning av växtskyddsmedel kan tillåtas och när det inte är rimligt. I handläggningen av tillståndsärenden och avvägningar om det ska råda förbud eller krav på tillstånd är den inte bara spridningen av växtskyddsmedel som behöver beaktas utan även övriga förutsättningar och risker som hanteringen av växtskyddsmedel är förknippad med.
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| 6. |
- Munthe, Christian, 1962
(författare)
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Patient Collaboration and Person Centeredness in Forensic Psychiatric Care: An Ethical Map
- 2017
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Ingår i: 35th International Congress on Law and Mental Health, July 9-14, 2017, Prague. Abstracts of the XXX Vth International Congress on Law and Mental Health / David N. Weisstub Editor.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- There is increasing interest in applying ideas from person centred care (PCC) in forensic psychiatry, including increased room for patients to collaborate in the care design. However, standard ethical assumptions in PCC about capacities of patients, as well as a traditional health care ethical context, departs significantly from the forensic psychiatric situation. Forensic psychiatric care is beset with restrictions of personal freedom and motivated partly by patients' incapacity to take responsibility brought by mental ill-health, usually within limits from criminal law, public safety and court orders. The care is supposed to change patients to become more autonomous and responsible in order for the restrictions on freedom to be justifiably relaxed or removed. Doing so may involve some room for independent decision-making by patients, using their responsibility capacities, but PCC opens up for much more far-reaching empowerment of patients, e.g., regarding the goals of care and the acceptance of applied methods. Therefore, there is a manifold increase of the ethical complexity creating tensions for PCC already in standard health care. This presentation provides a map of these ethical complexities, focusing especially on the issue of how the central notions of patient empowerment and shared decision-making should imply within forensic psychiatric care.
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| 7. |
- Ahlm, Kristin, et al.
(författare)
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Suicidal drowning deaths in northern Sweden 1992-2009 : the role of mental disorder and intoxication
- 2015
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Ingår i: Journal of Forensic and Legal Medicine. - : Elsevier. - 1752-928X .- 1878-7487. ; 34, s. 168-172
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Tidskriftsartikel (refereegranskat)abstract
- Suicides by drowning have received limited attention by researchers. A recent finding that almost onethird of all drowning deaths in Sweden were classified as suicide instigated this study. We identified 129 cases of suicide by drowning in Northern Sweden and analyzed the circumstances and the psychiatric history prior to the suicide. Information was obtained from autopsy, police and medical records, as well as from the National Inpatient Register. One-third of the suicide victims had previously attempted suicide and half of the victims had been hospitalized due to mental health problems. One-third of these had left the hospital less than one week before the suicide. Alcohol and psychoactive drugs were present in 16% and 62% of the cases, respectively. A history of mental disorder and previous suicide attempt (s), especially by drowning, is an ominous combination necessitating efficient clinical identification, treatment and follow-up if a complete suicide is to be prevented.
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| 8. |
- Kronstrand, Robert, et al.
(författare)
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Unintentional fatal intoxications with mitragynine and O-Desmethyltramadol from the herbal blend krypton
- 2011
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Ingår i: Journal of Analytical Toxicology. - 0146-4760 .- 1945-2403. ; 35:4, s. 242-247
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Tidskriftsartikel (refereegranskat)abstract
- The leaves of Kratom, a medicinal plant in Southeast Asia, have been used as an herbal drug for a long time. At least one of the alkaloids present in Kratom, mitraynine, is a mu-receptor agonist. Both Kratom and an additional preparation called Krypton are available via the internet. It seems to consist of powdered Kratom leaves with another mu-receptor agonist, O-desmethyltramadol added. O-desmethyltramadol is an acitve metabolite of tramadol, a commonly prescribed analgesic. We present nine cases of intoxication, occurring in a period of less than one year, where both mitragynine and O-desmethyltramadol were detected in the postmortem blood samples. neither tramadol nor N-desmethyltramadol was present in these samples, which implies that the ingested drug was O-desmethyltramadol. The blood concentrations of mitragynine, determined by ultra-performance liquid chromatography-tandem mass spectrometry, ranged from 0.02 to 0.18 μg/g, and O-desmethyltramadol concentrations, determined by gas chromatogtraphy with nitrogen-specific detection, ranged from 0.4 to 4.3 μg/g. We believe that the addition of the potent mu-receptor agonist O-desmethyltramadol to powdered leaves from Kratom contributed to the unintentional death of the nine cases presented and conclude that intake of Krypton is not as harmless as it often is described on internet websites.
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| 9. |
- Rizzi, Maria C, et al.
(författare)
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The potential of different countermeasures to prevent injuries with high risk of health loss among bicyclists in Sweden
- 2020
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Ingår i: Traffic Injury Prevention. - : Informa UK Limited. - 1538-9588 .- 1538-957X. ; 21:3, s. 215-221
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Tidskriftsartikel (refereegranskat)abstract
- Objective: As bicyclists account for the largest share of serious injuries in Sweden, focus to improve safety for bicyclists is needed. While knowledge about fatal bicycle crashes is rather extensive, the number of studies that have investigated non-fatal injuries is still rather limited. The aim of this study was to estimate the potential of different countermeasures to reduce crashes resulting in injuries with high risk of health-loss among cyclists in Sweden. A further aim was to describe the residual—that is, crashes that were not considered to be addressed by the analyzed countermeasures. Methods: A sample of individuals with specific injury diagnoses was drawn from the Swedish national crash database Strada. A survey form was used to collect additional information about the crash and the health-related outcomes. The potential of countermeasures currently included in the Swedish Safety Performance Indicators, as well as of countermeasures that could be described as “existing but not fully implemented” was assessed. The overall potential of all countermeasures assessed was calculated, giving a grand total without double counting. Cases that were considered not to be addressed by any of the countermeasures included (i.e., the residual crashes) were described in more detail. Results: The current Swedish Safety Performance Indicators that relate to safe cycling addressed 22% of crashes. Improved maintenance by deicing and removal of snow from bicycle infrastructure was found to have the highest potential (8%), followed by improved crashworthiness of passenger cars (5%) and safer bicycle crossings (4%). The potential for existing but not fully implemented safety improvements was 56%. The greatest potential was found for Autonomous Emergency Braking with cyclist detection for passenger cars (12%), followed by studded winter tyres for bicycles (12%), and improved maintenance on non-bicycle infrastructure (11%). In total, taking double counting into consideration, all safety improvements could address 64% of all crashes. Among the residual crashes, the majority (69%) were single bicycle crashes of which most were related to wheel locking during braking and losing balance at low speed or stationary. Conclusions: Compared with fatal crashes that involve a majority of bicycle-car crashes, the crashes leading to health-loss are mostly single bicycle crashes. Therefore, innovation and development of additional countermeasures to improve safety for bicyclists should focus on single bicycle crashes.
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| 10. |
- Timpka, Toomas, 1957-, et al.
(författare)
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Community-level football injury epidemiology : traumatic injuries treated at Swedish emergency medical facilities
- 2018
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Ingår i: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 28:1, s. 94-99
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite the popularity of the sport, few studies have investigated community-level football injury patterns. This study examines football injuries treated at emergency medical facilities using data from three Swedish counties.Methods: An open-cohort design was used based on residents aged 0-59 years in three Swedish counties (pop. 645 520). Data were collected from emergency medical facilities in the study counties between 1 January 2007 and 31 December 2010. Injury frequencies and proportions for age groups stratified by sex were calculated with 95% confidence intervals (95% CIs) and displayed per diagnostic group and body location.Results: Each year, more than 1/200 person aged 0-59 years sustained at least one injury during football play that required emergency medical care. The highest injury incidence was observed among adolescent boys [2009 injuries per 100 000 population years (95% CI 1914-2108)] and adolescent girls [1413 injuries per 100 000 population years (95% CI 1333-1498)]. For female adolescents and adults, knee joint/ligament injury was the outstanding injury type (20% in ages 13-17 years and 34% in ages 18-29 years). For children aged 7-12 years, more than half of the treated injuries involved the upper extremity; fractures constituted about one-third of these injuries.Conclusions: One of every 200 residents aged 0-59 years in typical Swedish counties each year sustained a traumatic football injury that required treatment in emergency healthcare. Further research on community-level patterns of overuse syndromes sustained by participation in football play is warranted.
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