1.
Munthe, Christian, 1962
(författare)
Pure Selection. The Ethics of Preimplantation Genetic Diagnosis and Choosing Children without Abortion
1999
Bok (övrigt vetenskapligt/konstnärligt) abstract
Preimplantation ge¬netic diagnosis (PGD) is taken to mark the starting-point of a new phase in human reproduction, where the possibility of choosing children on genetic grounds without having to resort to ethi¬cally controversial procedures (such as abortion) will grad¬ually increase. Ethical and political issues actu¬alised by this develop¬ment are addressed. The discussion touches upon issues regarding the moral status of em¬bryos and gametes, the moral import of respecting individual auton¬omy and its implications for the requirement of informed consent in health-care, the connec¬tion between sickness, dis¬ability and the value of life, the moral status of possible future people, and the connection between choosing children and eugenic policies of the past. Practical policy issues are adressed on the basis of this, as well as an empirical case-study of the intro¬duction of PGD in Sweden. The book ends up in a set of recommendations regarding the management of re¬search on, introduction and routine use of procedures for pure se¬lection, both within health care and from the point of view of society as a whole. It is argued that research on such procedures should be allowed and supported by society. However, tight restrictions regarding the clinical introduction of new procedures in this area is highly desirable. A rough model for implementing such re¬strictions is also pre¬sented. It is further asserted that, although reasons of economy and safety should limit the access to pure se¬lection, society should not apply any explicit restrictions based on ideasregarding how different traits affect a person’s quality of life. It is stressed that, in order to to avoid a re¬sur¬rection of eugenic policies of the past, the development in this field un¬der¬lines the need for continued and strengthen public support to the sick, dis¬abled and mentally retarded.
2.
Ahlborg, Gunnar, 1948, et al.
(författare)
Reproductive effects of chemical exposures in health professions
1995
Ingår i: Journal of Occupational and Environmental Medicine. - 1076-2752. ; 37:8, s. 957-61
Forskningsöversikt (refereegranskat) abstract
Numerous chemical substances are handled by persons working in the health care sector. At exposure levels that may occur in the occupational setting, some of these substances are potentially harmful to the reproductive processes. Among the potentially harmful substances are anesthetic gases, antineoplastic agents, and sterilants. The epidemiological evidence of increased risks for adverse reproductive effects (eg, subfertility, spontaneous abortions, congenital defects) from such exposure is not unequivocal. However, due to the toxic potential, exposures should be kept at a minimum, and this may be especially important for workers who are pregnant or are planning to achieve pregnancy.
3.
4.
Follér, Maj-Lis, 1946
(författare)
Future health of indigenous people: A human ecology view and the case of the Amazonian Shipibo-Conibo
1995
Ingår i: Futures (special double issue on health futures). - 0016-3287. ; 27:9/10, s. 1005-1023
Tidskriftsartikel (refereegranskat) abstract
Health has its basis in the relationships between human societies and cultures and the environment. The health of indigenous peoples living in traditional territories is threatened today by the destruction of this environment and the introduction of new contagious diseases; those who move to urban areas suffer even worse health because of ‘civilization’ diseases and the loss of the social networks that provide personal support and health care. Contrary to expectations, an epidemiological transition has not occurred in developing countries where many of these groups live. Two apparent underlying causes—persistent poverty and political inequality—are among the factors that will affect the future health of indigenous groups, together with trends in population, urbanization, and the environment. Indigenous groups can play a major role in determining that future and are already doing so through territorial-control projects aimed at protecting the environment on which their health and well-being depend.
5.
Wassenius, Ola, et al.
(författare)
Variability in Skin Exposure in Machine Operators Exposed to Cutting Fluids
1998
Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 24:2, s. 125 - 129
Tidskriftsartikel (refereegranskat) abstract
Objective. This study describes a new technique for measuring skin exposure to cutting fluids and evaluates the variability of skin exposure among machine operators performing cyclic (repetitive) work. Methods. The technique is based on video recording and subsequent analysis of the videotape by means of computer-synchronized video equipment. The time intervals at which the machine operator's hand was exposed to fluid were registered, and the total wet time of the skin was calculated by assuming different evaporation times for the fluid. The exposure of twelve operators with different work methods was analyzed in six different workshops, which included a range of machine types, from highly automated metal cutting machines (ie, actual cutting and chip removal machines) requiring operator supervision to conventional metal cutting machines, where the operator was required to maneuver the machine and manually exchange products. Results; the relative wet time varied between 0% and 100%. A significant association between short cycle time and high relative wet time was noted. However, there was no relationship between the degree of automatization of the metal cutting machines and wet time. Conclusions. The study shows that skin exposure to cutting fluids can vary considerably between machine operators involved in manufacturing processes using different types of metal cutting machines. The machine type was not associated with dermal wetness. The technique appears to give objective information about dermal wetness. A comment: This publication is a result of a cooperation between the authors at Chalmers University of Technology and Gothenburg University, i.e. between the Department of Transportation and the Department of Occupational Health and the Department of Sociology.
6.
Munthe, Christian, 1962
(författare)
Informed Consent and Quality of Available Information
1998
Ingår i: Fourth World Congress of the International Association of Bioethics, Tokyo, November 4-7, 1998.
Konferensbidrag (övrigt vetenskapligt/konstnärligt) abstract
Standard versions of the requirement of informed consent state that patients who are offered to enter a clinical trial of a medical procedure should be informed about risks and possible benefits of this procedure (compared to available alternatives) in order to facilitate a rational decision whether or not to participate. However, in many real cases where new medical procedures are to be clinically tested for the first time the information available for such communication to prospective patients is very scarce, vague and/or uncertain. This phenomenon is illustrated by the clinical introduction of new procedures in reproductive medicine, such as preimplantation genetic diagnosis (PGD). Regarding such procedures, it has ben argued that, in such cases, the quality of the available information may be too low for the obtaining of informed consent to be possible, even if it is successfully communicated. Others, instead, holds that informed consent may always be obtained regardless of the quality of the available information. Unfortunately, the standard litterature on informed consent give no clue as to which of these interpretations is correct. This issue is explored by connecting the concept of informed consent to ethical ideas of respect for autonomy and ideas of rational decision making. It is argued, first, that low quality of available information regarding the risks and possible benefits of a medical procedure may indeed make the obtaining of informed consent from patients to undergo this procedure impossible even in theory. However, it is also argued that whether or not this is the case must be relativized to the actual needs and desires of individual patients. Thus, regarding one and the same procedure, informed consent may be impossible to obtain from some patients due to the low quality of the available information regarding this procedure, but still be possible to obtain from other patients.
7.
8.
Ahlborg, Gunnar, 1948, et al.
(författare)
Shift work, nitrous oxide exposure and subfertility among Swedish midwives
1996
Ingår i: International Journal of Epidemiology. - 0300-5771. ; 25:4, s. 783-90
Tidskriftsartikel (refereegranskat) abstract
BACKGROUND: Shift work and nitrous oxide exposure have both been suspected of having adverse influence on the reproductive performance of health workers. Time to pregnancy has been suggested as a sensitive measure of fecundity in occupationally exposed groups. We investigated the effects of shift work and nitrous oxide exposure on the fertility of Swedish midwives. METHODS: A questionnaire was mailed to all members of the Swedish Midwives Association who were born 1940 or thereafter, 3985 in all. Eighty-four per cent responded. Detailed information on the number of menstrual cycles required to achieve pregnancy and the working conditions during that period were obtained concerning the most recent, planned pregnancy occurring after 1983. The per cycle probability of becoming pregnant was calculated for each exposure category, and the relation to the unexposed was expressed as fecundability ratios. RESULTS: Midwives who worked two-shift, three-shift rotas, or only nights had reduced fertility compared to those working in the day time. The fecundability ratios were 0.78 (95% confidence interval [CI]: 0.65-0.94), 0.77 (95% CI: 0.60-0.98), and 0.82 (95% CI: 0.64-1.03), respectively, after adjustment for covariates. No effect of nitrous oxide exposure was noted except in the small group reporting that they assisted at more than 30 deliveries per month when nitrous oxide was used (fecundability ratio = 0.64; 95% CI: 0.44-0.95). CONCLUSION: Shift work and frequent, high occupational exposure to nitrous oxide may have a negative influence on the ability of women to become pregnant.
9.
Bodin, L., et al.
(författare)
The association of shift work and nitrous oxide exposure in pregnancy with birth weight and gestational age
1999
Ingår i: Epidemiology. - 1044-3983. ; 10:4, s. 429-36
Tidskriftsartikel (refereegranskat) abstract
We examined the relation between shift work and occupational nitrous oxide exposure in the second trimester of pregnancy and birth weight and gestational age at delivery among the members of the Swedish Midwives Association. Eighty-four per cent of members who were registered in 1989 responded to a postal questionnaire concerning occupational exposures, including work schedule and the use of nitrous oxide, in relation to each of their pregnancies. We obtained information on births from the Swedish Medical Birth Register. We used models with allowance for dependence between births for the same woman and found that night work was associated with preterm birth (<37 weeks) [odds ratio (OR) = 5.6; 95% confidence limits (CL) = 1.9, 16.4] and to a lesser extent with low birth weight [OR = 1.9 (95% CL = 0.6, 5.8)]. Three-shift work schedule (day, evening, and night rotation) showed a possible association with preterm birth [OR = 2.3 (95% CL = 0.7, 7.3)]. Exposure to nitrous oxide use was associated with reduced birth weight (-77 gm; 95% CL = -129, -24) and an increase in the odds of infants being small for gestational age (< or = 10th percentile of weight for gestational week) (OR = 1.8; 95% CL = 1.1, 2.8).
10.
