Humana Assistans

Humana: "Enormt stor negativ effekt på bolaget"

Omsorgsbolaget Humana har ansökt om miljonskadestånd efter att IVO drog in bolagets tillstånd att bedriva assistans i fjol, ett beslut som senare upphävdes. Enligt bolaget går det att bevisa att de förlorade 239 miljoner kronor på IVO:s felbedömning. ”Det hade en enormt stor negativ effekt på bolaget”, säger den avgående vd:n Johanna Rastad.

Större hjärnor bakom riskfyllda förlossningar – nu ifrågasätts teorin

Det kallas det obstetriska dilemmat – teorin om varför människan ofta behöver assistans för att klara av en förlossning medan de flesta andra djur för det mesta klarar sig utan komplikationer på egen hand. Hypotesen, från 1960, har varit att människan utvecklade ett smalare bäckenben i samband med att våra förfäder började gå upprätt. Det samtidigt som våra hjärnor och huvuden blev större. Kombinationen innebar mer riskfyllda förlossningar. Förklaringen fick snabbt fäste – men stämmer den? En del forskare är inte så säkra längre, skriver The New York Times. Scientists are revisiting an influential theory that the evolution of big brains made human childbirth risky. By Carl Zimmer July 30, 2023 It’s a question on every new parent’s exhausted mind: Why are babies born so helpless? In 1960, an American anthropologist laid out an influential explanation rooted in human evolution. As our early ancestors began walking upright, Sherwood Washburn argued in 1960, they evolved a narrower pelvis to make walking long distances more efficient. At the same time, those hominins were evolving larger brains. And babies with big heads could get stuck in a tight birth canal during delivery, threatening the lives of mothers and babies alike. According to Washburn, evolution dealt with this “obstetrical dilemma,” as he called it, by shortening pregnancies, so that women delivered babies before the infant brain was done growing. Washburn’s theory was hugely influential and became a common lesson in biology classes. “Sapiens: A Brief History of Humankind,” a 2011 bestselling book, presented the obstetrical dilemma as fact. Many researchers still embrace it. But a detailed review of the evidence, slated to be published soon in the journal Evolutionary Anthropology, threw cold water on the idea. In the review, Anna Warrener, a biological anthropologist at the University of Colorado, Denver, argued that evidence to date did not offer strong support for the obstetrical dilemma, and that scientists had not paid enough attention to possible alternatives. What’s more, the scientist said, the idea sends a pernicious message to women that pregnancy is inherently dangerous. “It perpetuates a narrative of bodily incompetence,” Warrener said. In graduate school, Warrener did not see any reason to doubt the obstetrical dilemma. For her dissertation, she investigated one of Washburn’s key assumptions — that women walk less efficiently than men do because their pelvis is wider for childbirth. But in 2015, after studying volunteers walking on treadmills, Warrener found that having a wider pelvis did not create a bigger demand for oxygen. “The data came in, and I was like, ‘Wait a minute — I may have gotten some of the story wrong,’” she recalled. Holly Dunsworth, a biological anthropologist now at the University of Rhode Island, also became disenchanted with the obstetrical dilemma when she took a close look at the evidence. “I was scandalized,” she said. In 2012, she and her colleagues published a study on the length of pregnancies in humans and other primates. They found that, in general, bigger primates tended to have longer pregnancies than smaller ones. For their size, humans don’t have shortened pregnancies. If anything, human pregnancies are longer than one would predict for primates of their size. Since then, Dunsworth has become a strong critic of the obstetrical dilemma, arguing that the timing of childbirth is determined by the size of babies’ bodies, not their heads. The birthing process begins when a fetus demands more energy than a mother’s body can provide, she proposes. “We’re giving birth to massive babies,” she said. Other scientists, however, have come to the theory’s defense, while admitting that its original conception was overly simplistic. In a study published last month, a team of researchers argued that the difference between the male and female pelvis shows signs of natural selection acting in different directions. While human males are bigger and taller on average than human females, certain parts of their pelvises are relatively smaller. The biggest differences are in the bones that surround the birth canals in human females. Despite these differences, the female pelvis still creates a tight fit between a baby’s head and the birth canal, sometimes putting both the baby and mother in peril. “So why did natural selection not manage to kind of resolve this situation and make birth a little less risky?” asked Nicole Grunstra, an evolutionary anthropologist at the University of Vienna and one of the study’s authors. “It has evolved to be an evolutionary compromise between competing demands,” she said — in other words, to solve an obstetrical dilemma. But Grunstra acknowledged flaws in Washburn’s original version of the theory. She suspected that walking may not have been the most important factor in the evolution of the pelvis. Merely standing upright, she said, might have put pressure on the pelvic floor, preventing the evolution of a more spacious birth canal. Skeptics aren’t convinced by these arguments. In her new review, Warrener questioned whether babies getting stuck in birth canals have posed a major threat to women’s lives. It is far more common, she noted, for new mothers to die from blood loss or infections. She also criticized the way in which Grunstra and other defenders of the obstetrical dilemma make the case for their hypothesis. In her view, they assume that every piece of human anatomy has been fine-tuned by natural selection for a specific job. Sometimes, Warrener said, adaptations are flukes. For example, some of the genes that build the pelvis are also active in the development of other parts of the skeleton. If another bone in our body were to evolve into a new shape, the pelvis might change simply as a byproduct — not because it was evolving for walking or childbirth. “I think sex differences in the pelvis have been somewhat of a red herring,” Dunsworth said. Like other bones, the pelvis does not have a fixed shape encoded in a genetic blueprint. Its development is influenced by the tissues around it, including the uterus, the ovaries and other organs. The proportions of the female pelvis may result in part from all the organs that grow inside it. Dunsworth and Warrener worry that the obstetrical dilemma leads to a widespread notion of the female body as inescapably defective. “That just makes us feel like problems that need to be solved by medicine,” Dunsworth said. That narrative may play a part in the medicalization of childbirth in recent decades, she added. The World Health Organization has warned that doctors are increasingly performing unnecessary medical intervention on mothers, while chronic disorders that can threaten maternal health — such as high blood pressure, obesity and diabetes — get little attention. “The way we live now probably doesn’t lead us to meet the challenge of childbirth as well as our bodies did when they developed differently in the past,” Dunsworth said. But recognizing the over-medicalization of modern pregnancy doesn’t end the debate about its origins, Grunstra said. “That does not in itself mean that evolutionary explanations are wrong,” she said. © 2023 The New York Times Company. Read the original article at The New York Times.

Självklart ska Humana få ge assistans

Rullstolsbundna människor med stort assistansbehov som själva går (observera går) och handlar. Assistenter som säger sig jobba men i själva verket är utomlands. Att det finns stora problem med assistansersättning och assistansbranschen är klarlagt. De felaktigt utbetalade ersättningarna beräknas till flera miljarder varje år. Pengarna finansierar såväl organiserad brottslighet som våldsbejakande extremism.

Humana får fortsätta sin verksamhet

Enligt förvaltningsrätten ligger de fel och brister som Ivo pekat på långt tillbaka i tiden, och är dessutom inte tillräckligt utredda. — Domstolen anser att Humana i vissa fall har brustit, bland annat i sin insyn i anordnad assistans. De klarlagda bristerna är dock förhållandevis få och inte tillräckligt allvarliga för att motivera att bolaget och dess företrädare ska anses olämpliga. Domstolen bedömer också att Humana har vidtagit rimliga åtgärder för att följa IVO:s tillsynsbeslut och säkra kvalitet i verksamheten, skriver lagmannen Eva-Lotta Hedin i ett pressmeddelande. Nu upphäver domstolen Ivo:s beslut, vilket innebär att Humana får fortsätta sin verksamhet.

Humana vinner i domstol – får fortsätta bedriva verksamheten

Enligt förvaltningsrätten ligger de fel och brister som Ivo pekat på långt tillbaka i tiden, och är dessutom inte tillräckligt utredda. Domstolen: "Brustit i vissa fall"

"Domstolen anser att Humana i vissa fall har brustit, bland annat i sin insyn i anordnad assistans. De klarlagda bristerna är dock förhållandevis få och inte tillräckligt allvarliga för att motivera att bolaget och dess företrädare ska anses olämpliga. Domstolen bedömer också att Humana har vidtagit rimliga åtgärder för att följa IVO:s tillsynsbeslut och säkra kvalitet i verksamheten", skriver lagmannen Eva-Lotta Hedin i ett pressmeddelande. Ivo:s beslut upphävs

Ivo har hävdat att Humana och bolagets företrädare inte är lämpliga, men det tillbakavisas av domstolen. Nu upphäver förvaltningsrätten Ivo:s beslut, vilket innebär att Humana får fortsätta sin verksamhet.

"Vi är väldigt glada över att förvaltningsrätten har lyssnat på oss och kunnat landa i slutsatsen att processen för Ivo:s tillståndsprövning inte varit tillräckligt genomarbetad. Det är en lättnad för våra fantastiska medarbetare och alla våra kunder. Nu ska vi fortsätta med vårt systematiska kvalitetsarbete för att kunna erbjuda bästa möjliga omsorg för våra assistansberättigade", säger Johanna Rastad, vd och koncernchef på Humana.

Aktien i Humana handelsstoppades av Stockholmsbörsen minuterna före domen. Aktien hade då rusat uppåt med 18,4 procent.