The menopausal transition inngår i serien Key issues in mental health og omhandler samspillet mellom hormoner, helse og atferd gjennom kvinnens livssyklus, isaer konsentrert om overgangsalderen. Temaer om hva som venter i den perioden når det gjelder seksualitet, sosiokulturelle endringer og stress som utløsende faktor for depresjon, blir grundig omtalt og diskutert. Fysiologien bak termoregulering og årsaken til hetetokter blir beskrevet, for å øke forståelsen av vasomotoriske plager.Teksten er basert på resultater fra en rekke epidemiologiske studier, bl.a. WHIstudien (Women's Health Initiative) og NHS-studien (Nurses' Health Study), og studier om kvinners seksualitet, men også på kliniske erfaringer fra en rekke gynekologer og psykiatere.Det er interessant at det nå kommer en etterlengtet utgivelse om psykiske plager hos kvinner i overgangsalderen. Nyere epidemiologiske studier viser at det er sammenheng mellom perimenopause og depresjon. Jo lenger perimenopausen varer, desto større er risikoen for utvikling av depresjon. Risikoen øker ytterligere dersom man også har vasomotoriske plager. Insidensen av psykiske plager hos kvinner i overgangsalderen er økt, det samme gjelder insidensen av psykoser og schizofreni.17-β-østradiol modulerer serotonin-og noradrenalinnevrotransmittere, en prosess som kan tenkes å utløse depressive symptomer og/eller angstsymptomer hos biologisk predisponerte i perioden hvor kjønnshor-monnivåene fluktuerer, som i overgangsalderen. Det er vist at østrogensubstitu-sjonsbehandling og SSRI/SNRI-behandling er effektivt i håndteringen av depresjon og vasomotoriske plager hos symptomatiske kvinner i overgangsalderen. Det er derfor tankevekkende at disse i langt mindre grad enn friske kvinner får tilbud om hormonsubstitusjonsbehandling. De ville hatt god effekt av slik behandling, ettersom 17-β-østradiol har liknende effekt som nevrotransmittere.I et interessant kapittel, Psychotic disorders and menopause: the untold story, vises det til at 17-β-østradiol har en beskyttende effekt når det gjelder sent debuterende schizofreni. Intervensjon med østrogen har vaert kjent siden 1940-årene, og østrogensubsti-tusjonsbehandling har vaert forsøkt med god effekt ved postpartumpsykoser.I siste kapittel, Hormone therapies and menopause: where do we stand in the post-WHI era?, tar forfatterne et oppgjør med WHI-studien og den usikkerheten som ble skapt i kjølvannet av de publiserte resultatene som vi nå kjenner så godt. Bruken av hormonsubstitusjonsbehandling er drastisk redusert -dette rammer isaer dem som ville ha hatt nytte av en slik behandling.The menopausal transition inneholder mange interessante og informative kapitler. Det er en nyttig utgivelse både for gynekologer, psykiatere og allmennleger, saerlig informasjonen om viktigheten av å ta kvinner med nedstemthet/depresjon på alvor og raskt starte behandling med bl.a. østrogen. Det er en kortfattet utgivelse med mange interessante referanser. Den er egnet som innføring i et kontroversielt tema, men også som referanse for lesere med vidt forskjell...

Informed consent represents a cornerstone of the endeavours to make health care research ethically acceptable. Based on experience of qualitative research on power dynamics in nursing care in acute psychiatry, we show that the requirement for informed consent may be practised in formalistic ways that legitimize the researcher's activities without taking the patient's changing perception of the situation sufficiently into account. The presentation of three patient case studies illustrates a diversity of issues that the researcher must consider in each situation. We argue for the necessity of researchers to base their judgement on a complex set of competencies. Consciousness of research ethics must be combined with knowledge of the challenges involved in research methodology in qualitative research and familiarity with the therapeutic arena in which the research is being conducted. The article shows that the alternative solution is not simple but must emphasize the researcher's ability to doubt and be based on an awareness of the researcher's fallibility.

The Data Protection Directive (95/46/EC) allows Member States the option of implementing (with adequate safeguards) what might be described as 'Research Exemptions'. This allows for specific, limited derogations from the ordinary operation of the rights and duties of the Directive in the specific circumstances of scientific, historical and statistical purposes. This article argues that this option should be considered not as an 'exemption' (implying an 'abnormal' route), but as an equally acceptable route to achieve protection when secondary-processing data in large biobanks and data sets, operating without attending to any kind of consent. This can be done without reducing data subjects' privacy and related interests, through appropriate safeguards. We have suggested that such appropriate safeguards require research organisations to implement stringent security for the processing of data, robust assessment of proportionality, the possibility of opt-out for individuals, and introducing various forms of public participation.

The ideal of trust pervades nursing. This article uses empirical material from acute psychiatry that reveals that it is distrust rather than trust that is prevalent in this field. Our data analyses show how distrust is expressed in the therapeutic environment and in the relationship between nurse and patient. We point out how trust can nonetheless be created in an environment that is characterized by distrust. Both trust and distrust are exposed as ;fragile' phenomena that can easily ;tip over' towards their opposites. Trust is not something that nurses possess or are given; it is rather something that they earn and have to work hard to achieve. Regarding themselves as potential causes of distrust and active wielders of power can contribute to nurses developing a more realistic view of their practice. Assuming a realistic middle-way perspective can help to manoeuvre between the extremities of excellence and resignation, which in turn can lead to processes that create trust between psychotic patients and nurses.

This work is licensed under the Creative Commons Attribution 4.0 International (CC-BY 4.0).To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. SAMMENDRAG Stadig flere reguleringer bidrar til å minske rommet for skjønn i forskningsetikken. Det kan vaere behagelig for forskeren å forholde seg til gitte krav og etablere strategier for å unngå å utøve skjønn. Denne artikkelen fremhever at skjønn like fullt er en avgjørende egenskap for at forskere skal kunne utføre forskning på mennesker på en forsvarlig måte. Samtidig vektlegges at det er viktige grenser for skjønnsutøvelse og at skjønnet kan ta feil.NØKKELORD forskningsetikk, samtykke, skjønn, forsvarlighet, tillit ABSTRACT An increasing number of regulations are diminishing the space for discretionary judgement in research ethics. Following requirements thus set out and establishing strategies for avoiding the exercise of discretionary judgement can also be temptingly convenient for the researcher. This article highlights the fact that discretionary judgement is nonetheless an essential quality for researchers, enabling them to conduct research on humans in an appropriate manner. At the same time, the article emphasises that the exercise of discretionary judgement has important boundaries, and such judgement can sometimes be wrong.

This article is an attempt to evaluate the Oregon plan from the perspective of a Scandinavian national health care system. The Nordic welfare states are marked by a strong emphasis on equality. As an example of an egalitarian system we present the Norwegian health care model in part one. In part two, the arguments in favor of a one tier system in Norway are presented and compared to Oregon's two tier system. Although we argue, in part three, that a comparison of the degree of explicitness in the prioritization process shows that Norway has much to learn from Oregon, we do believe that the Norwegian system has some attractive elements that may function as an important corrective. In part four we present the Norwegian Guidelines for priority-setting and discuss the weight assigned to the severity of disease criterion. It is argued that the exclusion of information about the severity of disease partly explains the counterintuitive ranking of treatment-condition pairs in Oregon's initial method based on the principle of health maximization. A normative analysis of the conflicting norms of efficiency and equality of results is called for. The final part of the paper is devoted to the problem of rigidity. Henry J. Aaron has argued that the Oregon system is insensitive to inter-individual variations within each diagnosis-treatment pair. This objection is a severe one, since the system might end up treating patients unfairly on the individual level. To overcome this problem, we suggest a selection rule that should be more capable of dealing with the problem of rigidity.

Unsolved financial issues were the key reason why this process was so prolonged. The organisational model proposed by the Norwegian Medical Association in 1977 is fairly similar to the one that the Health Research Act brought into place in 2009.

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