'In the hospital all is taken care of': a practice-theoretical approach to understand patients' medication use.

Drawing from case examples of medication review implementation in three hospital settings in Sweden, this article examines patients' medication use. Based on a practice theory approach and utilising data from interviews with patients and participant observation, we reconstruct three practices of everyday medication use centring on accepting, challenging or appropriating medication orders. This article argues that patients' medication practices are embedded in wider practice arrangements that afford different modes of agency. Reconceptualising patients' medication use from a practice-based perspective revealed the meaning-making, order-producing and identity-forming features of these practices. Also, we illustrated how different modes of agency were achieved in patients' medication practices, suggesting a fluidity of both the meanings attached to and the identities related to medication use. Our findings have practical implications as these practices of medication use can be transformed when altering the arrangements they are embedded in, thus going beyond the clinical encounter.

Embedding hospital-based medication review.

PURPOSE: The purpose of this paper is to explore the embedding of hospital-based medication review attending to the conflictual and developmental nature of practice. Specifically, this paper examines manifestations of contradictions and how they play out in professional practices and local embedding processes. DESIGN/METHODOLOGY/APPROACH: Using ethnographic methods, this paper employs the activity-theoretic notion of contradictions for analyzing the embedding of medication review. Data from participant observation (in total 290 h over 48 different workdays) and 31 semi-structured interviews with different healthcare professionals in two Swedish hospital-based settings (emergency department, department of surgery) are utilized. FINDINGS: The conflictual and developmental potential related to three interrelated characteristics (contested, fragmented and distributed) of the activity object is shown. The contested nature is illustrated showing different conceptualizations, interests and positions both within and across different professional groups. The fragmented character of medication review is shown by tensions related to the appraisal of the utility of the newly introduced practice. Finally, the distributed character is exemplified through tensions between individual and collective responsibility when engaging in multi-site work. Overall, the need for ongoing "repair" work is demonstrated. ORIGINALITY/VALUE: By using a practice-theoretical approach and ethnographic methods, this paper presents a novel perspective for studying local embedding processes. Following the day-to-day work of frontline clinicians captures the ongoing processes of embedding medication review and highlights the opportunities to learn from contradictions inherent in routine work practices.

Schoolgirls' health agency: silence, upset and cooperation in a psycho-educational assemblage.

PURPOSE: Since the millennium, manual-based preventive health programmes, drawing on psychological models of behaviour management, have dominated psycho-educational practices in school. The aim of this article is to study the health agency of 13-year-old schoolgirls participating in a programme for improving schoolchildren's psychological health in Sweden. METHOD: Drawing on Deleuze and Guattari's theories of assemblages, the interaction between schoolchildren, teachers, the manual and psycho-educational techniques is scrutinized. The methodology of assemblage ethnography is used in the analysis of video observations of 13 course meetings. RESULTS: Three salient attitudes in relation to the possibilities built up for the schoolgirls are identified-silence, upset and cooperation. The girls' acts and stories question the psycho-centric, individualized and gender-normative approach used in psycho-educational programmes and make visible the relational and contextual aspects of schoolchildren's psychological health. CONCLUSION: Children depend on multiple factors for their agency; the institutional networks they are involved in both allow and restrict their actions. The study demonstrates that focusing on children as health actors, in the sense that agency develops in the assemblages children take part in, can complement the knowledge base and question the predominant framing of psychological health.

Amelogenesis Imperfecta and Early Restorative Crown Therapy: An Interview Study with Adolescents and Young Adults on Their Experiences.

Patients with Amelogenesis imperfecta (AI) can present with rapid tooth loss or fractures of enamel as well as alterations in enamel thickness, color, and shape; factors that may compromise aesthetic appearance and masticatory function. The aim was to explore the experiences and perceptions of adolescents and young adults living with AI and receiving early prosthetic therapy. Seven patients with severe AI aged 16 to 23 years who underwent porcelain crown therapy participated in one-to-one individual interviews. The interviews followed a topic guide consisting of open-ended questions related to experiences of having AI. Transcripts from the interviews were analyzed using thematic analysis. The analysis process identified three main themes: Disturbances in daily life, Managing disturbances, and Normalization of daily life. These themes explain the experiences of patients living with enamel disturbances caused by AI and receiving early crown therapy. Experiences include severe pain and sensitivity problems, feelings of embarrassment, and dealing with dental staff that lack knowledge and understanding of their condition. The patients described ways to manage their disturbances and to reduce pain when eating or drinking, and strategies for meeting other people. After definitive treatment with porcelain crown therapy, they described feeling like a normal patient. In conclusion the results showed that adolescents and young adults describe a profound effect of AI on several aspects of their daily life.

"I Hope I Get Movie-star Teeth": Doing the Exceptional Normal in Orthodontic Practice for Young People.

Orthodontics offer young people the chance to improve their bite and adjust their appearances. The most common reasons for orthodontic treatment concern general dentists', parents' or children's dissatisfaction with the esthetics of the bite. My aim is to analyze how esthetic norms are used during three activities preceding possible treatment with fixed appliances. The evaluation indexes signal definitiveness and are the essential grounds for decision-making. In parallel, practitioners and patients refer to self-perceived satisfaction with appearances. Visualizations of divergences and the improved future bite become part of an interactive process that upholds what I conceptualize as "the exceptional normal." Insights into this process contribute to a better understanding of how medical practices intended to measure and safeguard children's and young people's health at the same time mobilize patients to look and feel better. The article is based on an ethnographic study at two orthodontic clinics.

"I hope I Get Movie-Star Teeth" - Doing the Exceptional Normal in Orthodontic Practice for Young People.

Orthodontics offer young people the chance to improve their bite and adjust their appearances. The most common reasons for orthodontic treatment concern general dentists', parents' or children's dissatisfaction with the esthetics of the bite. My aim is to analyze how esthetic norms are 'done' during three activities preceding possible treatment with fixed appliances. The evaluation indexes signal definitiveness and are the essential grounds for decision-making. In parallel, practitioners and patients refer to self-perceived satisfaction with appearances. Visualizations of divergences and the improved future bite become part of an interactive process that upholds what I conceptualize as 'the exceptional normal.' Insights into this process contribute to a better understanding of how medical practices intended to measure and safeguard children's and young people's health at the same time mobilize patients to look and feel better. The article is based on an ethnographic study at two orthodontic clinics. This article is protected by copyright. All rights reserved.

The dilemma of reporting suspicions of child maltreatment in pediatric dentistry.

This study examined the factors that lead specialists in pediatric dentistry to suspect child abuse or neglect and the considerations that influence the decision to report these suspicions to social services. Focus group discussions were used to identify new aspects of child maltreatment suspicion and reporting. Such discussions illuminate the diversity of informants' experiences, opinions, and reflections. Focus groups included 19 specialists and postgraduate students in pediatric dentistry. We conducted video-recorded focus group discussions at the informants' dental clinics. All sessions lasted approximately 1.5 h. We transcribed the discussions verbatim and studied the transcripts using thematic analysis, a method well-suited to evaluating the experiences discussed and how the informants understand them. The analysis process elicited key concepts and identified one main theme, which we labeled 'the dilemma of reporting child maltreatment'. We found this dilemma to pervade a variety of situations and divided it into three sub-themes: to support or report; differentiating concern for well-being from maltreatment; and the supportive or unhelpful consultation. Reporting a suspicion about child maltreatment seems to be a clinical and ethical dilemma arising from concerns of having contradicting professional roles, difficulties confirming suspicions of maltreatment, and perceived shortcomings in the child-protection system.

"Lungisa"-weaving relationships and social space to restore health in rural KwaZulu Natal.

Many Zulu people who live in big cities in South Africa return to their rural homestead when they fall ill. Although the health care offered in rural areas is not efficient, people wish to connect to their family and ancestors. My aim is to explore acts of lungisa ("to put in order") and what they say about health, agency, and the circumstances under which people live. Returning home means weaving oneself firmly within a web of relationships that are located in material things and places. Healing involves imperfect strategies used to better connect bodies, relationships, and places. I theorize the acts of returning using Adriana Cavarero's concept of weaving together and argue that people produce space and relationships over time to exert some control over a life lived under political and economic circumstances that have created separation. Six months of ethnographic fieldwork make up the material for my analysis.