bluuebunny/crossref_metadata_2025 huggingface dataset:
Cultivating a Healthy Second Nature - Nature, Culture, and Morality in Danish Parents’ Narratives about their Children’s Overweight and Weight Loss
Authors: Andreassen Pernille , Grøn Lone , Roessler Kirsten Kaya
Published: September 2016

Professional explanations for the causes of childhood overweight vary greatly and no particular weight loss methods have proved successful. Nevertheless, parents are generally regarded as primarily to blame for overweight children and also perceived as key to successful weight loss. Based on semi-structured interviews with twelve mothers and two fathers of overweight preschool children, we use a narrative approach to focus on parents’ own aetiological explanations as well as their hopes for a resolution. In their stories of how their children became overweight, parents draw on a number of explanations that refer to both natural and cultural causes which to a large extent mirror the available professional explanations, and in their stories of future possibilities, parents hope to develop a healthy second nature in their children. We argue that the parents employ these hopes and explanations as narrative devices to position themselves as moral actors in relation to the prevalent and widespread idea of childhood overweight as caused by parental failure. The parents’ narratives offer valuable insight into the exceptionally morally charged position of parenting within the social and cultural context of childhood overweight and weight loss.
Dekonstruktion af Placebo Effekten og fundet af Betydningsrespons
Authors: Jonas Wayne B. , Moerman Daniel
Published: September 2016

We provide a new perspect ve with which to understand what for a half century has been known as the »placebo effect.« We argue that, as currently used, the concept includes much that has nothing to do with placebos, confusirig the most interesting and important aspects of the phenomenon. We propose a new way to understand those aspects of medical care, plus a broad range of additional human experiences, by focusing on the idea of »meaning,« to which people, when they are sick, often respond. We review several of the many areas in medicine in which meaning affects illness or healing and introduce the idea of the »meaning response.« We suggest that use of this formulation, rather than the fixation on inert placebos, will probably lead to far greater insight into how treatment works and perhaps to real improvements in human well-being.
Before the placebo effect Discussions on the power of the imagination in 19th century medicine - with perspectives to present discussions on the mind’s influence upon the body
Authors: Andersen Lars Ole
Published: September 2016

The use of the placebo and discussions on the power of the imagination in 19th century medicine will be investigated in this article. The 19th century is interesting since early discussions can be found on whether the power of the imagination and the mind’s influence upon the body should be used in medicine or if it should be avoided. Placeboes could already from the 18th century be used both to help but also to deceive the patient. Use of placeboes could initiate discussions on the power of the imagination and discussions on the power of the imagination could initiate use of placeboes. There were attempts to “professionalize” the use of the power of the imagination, but many found it difficult to control and it was feared it could induce diseases. In the article examples will be given of discussions about the maternal imagination, the effect of mesmerism, Perkins’ tractors, and homoeopathy. Perspectives from these discussions to modern discussions on the placebo effect and the mind’s influence upon the body will be described.
Placebo effects in chronic pain conditions. Can placebo components enhance the efficacy of active treatments?
Authors: Skyt Ina , Vase Lene
Published: September 2016

The conceptualization of the placebo phenomenon has changed. Previously placebo was seen as an inactive agent, but today placebo effects are viewed as related to patients’ perception of a treatment. During the last decades, the mechanisms underlying placebo analgesia effects have been specified and it has been shown that patients’ perception of a treatment is influenced by previous experiences, the patient-practitioner relationship as well as expectations and emotions. These factors are, in turn, associated with altered brain activation and release of endogenous opioids, thereby demonstrating that placebo analgesia has a psycho-neurobiological basis. The placebo effect has primarily been investigated in relation to healthy volunteers, but here we review literature on placebo mechanisms in relation to chronic pain states as this is important for an understanding of how placebo factors can be optimized in clinical practice. We outline some of the ethical discussions concerning the use of placebo in clinical practice and we illustrate how patients perception of a treatment contribute to the efficacy of active treatments, thereby showing how focus on patients perception of a treatment may help optimize the outcome of standard active pain treatments in ethically appropriate ways.
Angst og depression: Emotionsregulering i psykoterapi
Authors: O'Toole Mia Skytte , Hougaard Esben
Published: September 2016

Emotioner er kommet i fokus inden for en række videnskaber de sidste årtier, hvor man er begyndt at tale om affektive videnskaber, der bl.a. omfatter psykologi, neurovidenskab, medicin og sociologi. I denne artikel hævder vi, at emotioner er en funktionel størrelse, og at uhensigtsmæssig regulering af emotioner spiller en vigtig rolle ved psykisk lidelse. Vi fremhæver herefter nogle centrale emotionsreguleringsstrategier ved angstlidelser og depression og præsenterer på denne baggrund emotionsreguleringsterapi som et bud på en psykologisk behandling, der direkte retter sig mod emotionsregulering i angst og depression. Anxiety and depression: Emotion regulation in psychotherapy. There has been an increasing interest in emotions during the past couple of decades, reflected in a rapid growth of the affective sciences. In this article we argue that emotions serve important functions in human life and that adaptive emotion regulation is crucial for mental health. We review some of the central emotion regulation strategies in anxiety disorders and depression and describe how Emotion Regulation Therapy is aimed at targeting emotion dysfunction in so-called distress disorders.
Evaluering når behandling er kompleks - om placebo og forskning i alternativ behandling
Authors: Barfod Toke
Published: September 2016

Hvordan bør man evaluere komplekse behandlinger og behandlinger, der i en vis forstand primært virker gennem placeboeffekten? I denne artikel argumenteres for, at placebobegrebets flertydighed kan vanskeliggøre forskning i alternative behandlinger, og kan være forstyrrende for tolkningen af forskningens resultater. Der argumenteres for, at alternativ behandling udmærket kan undersøges i randomiserede undersøgelser, men at metoden ikke bør stå alene, og at den skal tilpasses behandlingens kompleksitet og at effektmålingerne bør nuanceres. Artiklen indledes med en begrebsafklaring. Herefter følger en vurdering af placeboeffektens størrelse ved lægelig og alternativ behandling, og efter en diskussion af det randomiserede forsøgs problemer konkluderes der vedrørende metoder til forskning i alternativ behandling.
Medicinsk teknologi: Et tveægget sværd
Authors: Tjørnhøj Tine
Published: September 2016

Introduktion
Regulering af transplantation: Overvejelser om en teknologis moralske, politiske og økonomiske aspekter
Authors: Høyer Klaus Lindgaard
Published: September 2016

Denne artikel undersøger moralske, politiske og økonomiske aspekter af reguleringen af knogletransplantation. Der argumenteres for, at EU og den danske lovgivning søger at regulere gennem en relativt snæver, sundhedsfaglig forståelse af hvilken type viden, der er relevant for teknologiens praksis. Derved ignoreres en række faktorer, der har afgørende betydning for, hvad man gør i praksis. Desuden forbigås en række moralske implikationer af teknologien og dens regulering. En større forståelse for, hvad der er på spil for sundheds­professionelle og patienter kan måske skabe bedre sammenhæng mellem den regulering, der foregår på papiret, og det man i praksis foretager sig.
Tæt på døden
Authors: Neergaard Mette Asbjørn , Rosendal Marianne
Published: September 2016

I den vestlige verden har der i mange år været en higen efter »det evige liv« og en stræben efter at forlænge livet så meget som muligt. En af konsekvenserne heraf er at en stillingtagen til dødens komme - også hos de uhelbredeligt syge mennesker selv - til tider udskydes uhensigtsmæssigt længe, og at aktiv biomedicinsk behandling fortsættes helt frem til dødstidspunktet. Det er svært at acceptere både for de professionelle behandlere, for patienter og for deres pårørende, når der ikke er flere muligheder for helbredelse for en given sygdom. Dette til trods for, at der f.eks. er næsten 16.000 danskere, der dør af kræft hvert år. I mange menneskers liv bliver det på et tidspunkt nødvendigt at dreje tankegangen væk fra at kæmpe forat undgå sygdom og død, til at se døden i øjnene. Døden i den vestlige verden er i høj grad blevet et professionelt anliggende hvor fokus på udbygningen af en specialiseret tværfaglig indsats har været dominerende, og der er et stigende behov for at fokusere på denne professionelle indsats. Når man i den sundhedsfaglige verden bevæger sig væk fra helbredelse og i stedet fokuserer på at lindre og trøste, anvendes betegnelsen palliation (fra latin: Palliatus: dækket med kappe/tilsløret). WHO har defineret den palliativeindsats som det at fremme livskvaliteten hos patienter og familier, som står over for de problemer der er forbundet med livstruende sygdom, ved at forebygge og lindre lidelse gennem tidlig diagnosticering og umiddelbar vurdering og behandling af smerter og andre problemer af både fysisk, psykisk, psykosocial og åndelig art i perioden op til døden og i efterforløbet hos de efterladte (WHO, 1990). Der er således udover fysiske symptomer også et vigtigt fokus på fx angst, depression, eksistentielle og sociale problemstillinger, samt åndelige og religiøse aspekter af livet før døden og hos de efterladte pårørende. Palliation tager udgangspunkt i et holistisk livssyn hvor det enkelte individ, og den kontekst individet er i, er unik.
Thanatosociologi– træk af en udviklingshistorik og tilstandsrapport
Authors: Jacobsen Michael Hviid
Published: September 2016

Denne artikel introducerer til den ofte oversete sociologiske subdisciplin, der bærer titlen ‘thanatosociologi’, og som er optaget af at beskrive og analysere menneskers forhold til døden samt at belyse de historiske, kulturelle og sociale omstændigheder, hvorunder døden udspiller sig. Artiklens hensigt er for det første at præsentere læseren for formålet med og indholdet af thanatosociologiens blik på døden med særligt fokus på, hvordan thanatosociologiens udvikling afspejler forandringer i samfundets forhold til døden og vice versa. Thanatosociologien er således i vid udstrækning opstået som en reaktion på den måde, døden opfattes og håndteres på i det moderne vestlige samfund, samtidig med at thanatosociologien selv har påvirket denne udvikling. For det andet er det hensigten kronologisk at dokumentere fremvæksten af thanatosociologien gennem det 20. århundrede og vise dens variationer og forandringer. Slutteligt diskuteres det, hvilke faglige udfordringer der lurer for en fortsat udvikling af thanatosociologien.
Det gode liv før døden
Authors: Nielsen Marie Konge
Published: September 2016

Hvilke holdninger til at blive ældre og til at blive gammel er repræsenteret i en dansk sammenhæng? Hvilke forventninger og ønsker eksisterer til »det gode liv« som gammel? Og hvad siger disse forestillinger om »det gode liv« som gammel om forestillinger om livet lige før døden og om selve døden? Baseret på etnografisk materiale fra en dansk sammenhæng præsenterer artiklen konklusioner om en ideal forestilling om “et godt liv« som gammel. Til denne ideal forestilling hører værdierne aktivitet, uafhængighed, autonomi, værdighed, familiesamvær og frihed. Med inspiration fra et livsløbsperspektiv argumenteres der for, at alderdommen ikke kan ses løsrevet fra vores tidligere liv. I stedet afspejler den det levede liv og de sociale og kulturelle forhold som vi har været en del af. Når vi taler om »det gode liv« i alderdommen, kan det udledes, at forestillinger om døden også er rodfæstet i den enkeltes livsløb.
At tale om døden - forskelle og ligheder mellem konteksten plejehjem og eget hjem
Authors: Raunkiær Mette
Published: September 2016

Artiklen er baseret på to empiriske undersøgelser af hverdagslivet tæt på døden. Den ene er foretaget i forbindelse med et forsknings- og udviklingsprojekt om døden på plejehjem. Den anden omhandler døden i eget hjem og er en del af et ph.d. projekt. Formålet med artiklen er at undersøge forskelle og ligheder mellem hvordan døende i eget hjem, plejehjemsbeboere, pårørende og professionelle oplever at skulle tale om døden og diskutere hvordan den kan forstås. Empirien fra de to undersøgelser består af observationer og interviews med beboere på plejehjem, deres pårørende og plejehjemspersonale samt uhelbredeligt syge døende i eget hjem, deres pårørende og hjemmesygeplejersker. Datamaterialet er analyseret ud fra en hverdagslivsteoretisk ramme. Døende derhjemme og plejehjemsbeboere forholder sig fortrinsvis til nutiden og fortiden - helst ikke til fremtiden. Det betyder at de undgår at forhold sig til og tale om døden, idet den repræsenterer fremtiden, det usikre og det ultimative brud. Når døden berøres, sker det oftest tilfældigt når hverdagen alligevel brydes. Det indebærer bl.a. at aktørerne kan være i tvivl om indholdet i samtalen eller, hvorvidt samtalen har fundet sted. I følge døende hjemme, plejehjemsbeboere og pårørende er en sådan samtale forbeholdt familien - ikke de professionelle. Indholdet i en samtale om døden er yderligere afhængig af aktørpositionen. Hvor plejehjemspersonale, pårørende, plejehjemsbeboere og døende hjemme især forbinder samtale om døden med praktiske forhold, så forbinder hjemmesygeplejersker dette med psykiske reaktioner indenfor en kriseteoretisk ramme. Disse forskelle kan hænge sammen med forskellig faglig praksis og uddannelsestraditioner
The role of chronic pain and suffering in contemporary society
Authors: Møller Marie Østergaard , Gormsen Lise Kirstine
Published: September 2016

The structure and organization of health care is a salient political issue across nations and welfare states. It is important not only from an economic perspective, but also from a social and political perspective regarding the possibility of maintaininga proper qualitative level of health care as well as a system that is broadly accessible to the citizenry. Equal access to health care and social care is thus a key factor when the general quality of public life is discussed, not only in Denmark but also in many other welfare states. A common prerequisite for the existence of such a system is a strong general norm of reciprocity in social and political contexts. The norm states that everybody should contribute to our common welfare by working, paying taxes and participating in political institutions and in return be treated as equal members (citizens) of the state. However, not all citizens are capable of working, and far from everybody has equal access to health care and social care. In theory everybody should enjoy the same rights and access to common services, but in reality the boundary between being considered entitled to and deserving of public assistance and being perceived as responsible for one’s condition is more a political than an objective measure (Stone, 1984: 26; Møller, 2009b: 235). In practice, the principle of equal access is interpreted and implemented by doctors who treat patients, health care professionals promoting health strategies, caseworkers who manage clients and schoolteachers teaching children and at the end of the day it is professionals like them who decide who is given access to services, transactions, preventive interventions and treatments.In health care the diagnostic system works as a platform for deciding who should treat which citizens with what, but in social care such a system is more invisible. Instead the main criterion for access to services and transactions is a systemdesigned to detect and measure the workability of every assistance-seeking citizen. The method of evaluating assistance-seeking citizens’ workability seeks to differentiate between needs and claims because an absolute main reason why citizens cannot maintain a job and need to apply for public support is health problems such as chronic pain, for which they seek medical, psychological or therapeutic help. On an economic level this demand of public support is often seen as creating incentives to exploit the social sector to reduce labor costs; on a practical level it constitutes a difficult and paradoxical interplay between the role of the doctor, the social worker and the idea of the independent citizen, in theory, the equal member of the state. This volume focuses explicitly on the case of chronic pain in such different social and political contexts.
Pain as an object of research, treatment, and decision-making
Authors: Gormsen Lise Kirstine
Published: September 2016

This essay is a reflection on my professional norms when I do pain research, treat pain patients, and communicate with the social system. Being both a medical doctor and a clinical researcher, I daily have to combine what I see as arbitrary rationalities in my approach to pain. The reason is that pain research is often conducted within a theoretical framework that mainly understands pain as a physical or biomedical phenomenon even though a broader and more precise perspective on pain exists - and is often used when physicians treat patients. It is of interest to see how easily doctors use different concepts of pain when they conduct biomedical research with advanced equipment and standardized tools with one hand, and with the other hand talk to patients, trying to focus on their needs and helping them cope with their pain using a very broad perceptive of pain. This dilemma of acting both as a researcher and a clinical doctor is not often discussed or reflected upon by doctors. An explanation could be the focus on productivity and efficiency that rules the everyday life of most doctors as opposed to a focus on reflection, concepts, and values in pain medicine. The focus of this essay is therefore to describe,reflect, and elaborate on the differences of pain as an object of research, treatment, and decision-making. In other words, to reflect upon the ambiguous practice doctors engage in when doing pain research and treating chronic pain patients. Furthermore, this essay may contribute to our understanding of why decisions on eligibility in the social system are made without adequate documentation of patients’ chronic pain conditions.
‘Making a virtue’ of going ill to work – reflections on the necessity of everyday workplace ‘suffering’
Authors: Hansen Claus D.
Published: September 2016

How much pain should an employee be prepared to accept when carrying out her job? Are symptoms of illness at work sufficient reason to take sick leave, or simply a normal condition of everyday life that you have to put up with (even if this means suffering pain or discomfort while carrying out your job)? The answer, this paper argues, depends among other things on social class, and more specifically on the extent to which members of differentclasses feel it ‘necessary’ to turn up for work even when ill. For some, going ill to work is preferable to taking sick leave because the consequences of doing the latter will be severe. Bourdieu’s notion of ‘making a virtue of necessity’ helps explain why manual workers take a more restrictive view of when it is legitimate to take sick leave than professionals, who are more liable to look at the question purely theoretically.
Being stout: on health and lifestyle-change
Authors: Wathne Kjetil
Published: September 2016

I vestlig diskurs, er god helse blitt individets egen moralske plikt. Ettersom overvekt må stamme enten fra uvitenhet eller manglende viljestyrke, kan det sies at fedme peker til motsatsen til Det moralske individ. Anlegger man et sådan moralsk perspektiv vil man imidlertid stå i fare for å misforstå hva massive kropper kan bety for den enkelte, ettersom viljestyrke ikke nødvendigvis er i kjernen av egen forståelse av det å være stor. Basert på casestudie av en ung, norsk overvektspasient, ”Ulrik” – undersøker denne artikkelen hvordan en selverklært ”tjukkas” forholder seg til samfunnets forståelse av hans type kropp. Skjønt han aldri kan frigi seg fullstendig fra tanken om at ”fett er farlig”, innebærer for Ulrik det å være stor samtidig det å være fysisk sterk. Det å fremstå som ”tøff” er med andre ord til hindring for hans genuine deltagelse i vervektsbehandlingen og kompliserer mulighetene for vekttap gjennom livsstilsendring. Man bør innen overvektproblematikk, streve etter å forstå enkeltindividet. Debatten er først og fremst myntet på fagfolk opptatt av hvordan konseptet helse gjennom rett livsførsel gjør seg gjeldende i moderne samfunn.
At spise – ikke kun et spørgsmål om mad
Authors: Risør Torsten , Guassora Ann Dorrit , Petersson Birhit H.
Published: September 2016

Forholdet mellem kost og sundhed er emne for debat, forskning og praksis i og udenfor sundhedsvæsenet. Men det at spise – ikke blot kostens indhold, men den faktiske praksis hvor mad indtages som en integreret del af vores daglige liv – diskuteres mindre. Ikke desto mindre udgør denne aktivitet på forskellige måder en kontaktflade mellem menneskers sociale liv og deres helbred. Det er denne kontaktflade vi ønsker at sætte fokus på med dette temanummer.
Velbekomme: familien i madkassen – om madpakker, kultur, historie og forbundethed
Authors: Elverdam Beth
Published: September 2016

I artiklen inddrages forskellige materialer og teorier til at belyse det specielle ved ”madpakken”. Madpakken og dens format har været næsten uændret fra den blev etableret og til nu, hvilket siger noget om dens funktionalitet. Madpakken er en integreret del af familiens dagligliv og belyser madklassifikation og måltidskultur. Samtidig er madpakken symbol på den enkelte families kultur, idet madpakken tilpasses og tilberedes i den enkelte familie. I madpakken udtrykkes smagspræferencer og identitet. Samtidig er madpakken speciel, fordi den spises et andet sted, end den tilberedes, i en anden kulturel kontekst; børnehaven eller skolen. Madpakken bliver således bærer af familiens forbundethed og symbol på familien. En familie, hvis ansvarsområder er under forandring. Netop fordi madpakken smøres i én sammenhæng for at blive spist i en anden og institutionel sammenhæng gør, at der er forskellige aktører: familien, institutionspersonale, medier og politikere, som alle har forskellige holdninger til, hvordan madp kken bør være, eller hvad den kunne erstattes med, og netop i sammenstødet mellem disse holdninger fremstår madpakkens symbolværdi.
Kvalitative perspektiver på evalueringer i sundhedsvæsenet
Authors: Jansbøl Kåre , Johansen Katrine Schepelern , Kousgaard Marius Brostrøm
Published: September 2016

I 1924 iværksatte Adolf Meyer – leder af USA's førende psykiatriske forskningsafdeling på Johns Hopkins Medical School – en evaluering af behandlingen på et psykiatrisk statshospital i New Jersey. Hospitalet blev ledet af Meyers kollega og tidligere medarbejder Henry Cotton. Cotton hævdede, at hele 85% af patienter med alvorlige psykiske lidelser kunne helbredes med de metoder, som han havde udviklet og anvendt på New Jersey Statshospital. Cotton gav dermed patienter, pårørende, læger, politikere og skatteborgere håb, idet almindelig behandling af lignende lidelser dengang primært bestod i dyr forvaring. Cottons behandlingsregime lå i forlængelse af den bakteriologiske revolution. I 1913 havde man opdaget den syfilitiske organisme, som var årsagen til den farlige mentale sygdom GPI (General Paralysis of the Insane). Cotton drog vidtrækkende konsekvenser af den bakteriologiske tilgang og mente, at sindssygdomme i det væsentlige skyldtes infektioner. Cottons behandlingsregime bestod derfor i fjernelse og forebyggelse af betændelsestilstande. Hospitalet fjernede patienters tænder, tyktarme, tonsiller, livmoderhalse samt foretog kirurgiske rensninger af kroppens hulrum (f.eks. næse og øre). Evaluatoren, Phyllis Greenacre, opdagede hurtigt, at der var rod i journalerne fra Cottons hospital. Bl.a. vidste man ikke, om patienter blev genindlagt, og definitionen af ’rask’ var tilfældig og skønsmæssigt anslået. Greenacre vurderede også, at ca. 45% af patienterne døde som følge af behandlingen. Hun informerede hurtigt Meyer om dette, og Meyer overbragte Cotton de nedslående evalueringsresultater. Cotton godtog dem imidlertid ikke, og da Meyer ikke ville lade evalueringen publicere mod Cottons ønske, fortsatte Cotton sin behandling. Kort tid efter begyndte offentligheden dog at interessere sig for de mange dødsfald blandt patienterne på sindssygehospitalet, men på trods af en turbulent og kritisk periode, som omfattede en offentlig undersøgelseskommission, kunne Cotton fortsætte behandlingen, indtil han trak sig tilbage i 1930. Den nye overlæge forsatte ikke den kontroversielle behandlingsform. Historien om Henry Cotton rummer flere væsentlige pointer og problemstillinger med relation til artiklerne i dette temanummer om evalueringer i sundhedsvæsenet.
Evidenssproget: Om sprog, viden og virkning i forebyggelse
Authors: Rod Morten Hulvej
Published: September 2016

Inden for den kliniske medicin er effektevalueringer og et dertilhørende ideal om evidensbaseret praksis en fremherskende måde at vurdere og reflektere over praksis, som i disse år er ved at sprede sig til andre af velfærdsstatens områder. Det gælder ikke mindst forebyggelsen. Denne artikel ser nærmere på de forestillinger, der knytter sig til effektevalueringer og evidensbaseret praksis. Jeg undersøger, hvilke konsekvenser det har haft i kommunale forebyggelseskredse, at det særlige specialistsprog, jeg kalder evidenssproget, har fået en stigende udbredelse og anerkendelse. På baggrund af etnografisk feltarbejde med kommunale forebyggelsespraktikere (nærmere betegnet deltagelse ved en række møder og seminarer), samt en analyse af udvalgte rapporter om evidens i forebyggelse, diskuterer jeg, hvordan der med evidenssproget breder sig nogle specifikke forestillinger om viden og virkning. Jeg argumenterer afslutningsvis for, at evidenssproget og de dertilhørende forestillinger har nogle uhensigtsmæssige virkninger for relationen mellem forskning og praksis.
Kan MTV styrkes ved brug af realistisk evaluering? - Udfordringer, barrierer og muligheder ved brug af realistisk evaluering til vurdering af komplekse behandlingsteknologier
Authors: Berger Nichlas Permin , Vrangbæk Karsten
Published: September 2016

Denne artikel diskuterer problemer med MTV-teori og -praksis særligt i forhold til komplekse, sociale teknologier. Det hævdes, at traditionelle statistisk baserede metodetilgange har begrænsninger i forhold til at analysere betydningen af den dynamiske organisatoriske kontekst for opnåelse af kliniske effekter. Dette betyder, at organisationsanalyserne i denne type MTVer bliver meget vigtige, og at de må baseres på andre typer teoretiske og metodiske tilgange. Artiklen diskuterer nyere udviklinger indenfor evalueringsteori, og særligt den kontekstfokuserede ’realistiske’ evalueringstilgang som supplement til de hidtidigt anvendte organisationsteoretiske tilgange til MTV. Den teoretiske diskussion illustreres med eksempler fra en nyligt publiceret MTV om ’diabetiske fodsår’ (Sundhedsstyrelsen, 2011).
Om grænser for kvalitetsteknologier - og om hvorfor det er vigtigt for kvalitetseksperter at reflektere over dem
Authors: Knudsen Morten
Published: September 2016

Kvalitetsteknologier som akkreditering og Den Danske Kvalitetsmodel præsenterer sig som om de er altomfattende – som om de dækker alle sundhedsydelser og adresserer alle relevante forhold. Overfor den forestilling hævder artiklen, at det er afgørende, at disse kvalitetsteknologier indtænker egne begrænsninger – fordi en sådan refleksion er forudsætning for at give andre typer af fornuft og aktører plads til at fremme og sikre kvaliteten af deres ydelser. Hovedparten af artiklen er en analyse af fire forskellige typer af grænser for kvalitet – som de kan iagttages i forhold til Den Danske Kvalitetsmodel, som udgør artiklens empiriske materiale. De fire typer af grænser handler om grænser ved konstruktionen af modellen; om grænser for hvilke forhold man kan formulere standarder og indikatorer for; om grænser for hvilke aktiviteter, der kan formuleres retningslinjer for og endelig om grænser for synliggørelse. De fire eksempler skal belægge den generelle pointe, at der er grænser for kvalitetsteknologier. Men vigtigere er det, at en lokalisering af de konkrete grænser er en forudsætning for at diskutere, hvordan man kan forholde sig til de specifikke begrænsninger. Som bidrag til en sådan diskussion diskuterer artiklen afslutningsvis to mulige reaktioner på lokaliseringen af grænser. Den ene reaktion handler om at udvikle forskellige typer af selvbegrænsning. Den anden handler om at få lavet repræsentationer af det udgrænsede inden for kvalitetskommunikationen.
Muskuloskeletal aldring, arbejdsevne og "sundhedsbrøken"
Authors: Møller Anne , Reventlow Susanne
Published: September 2016

Physical activity in leisure-time is recommended by authorities as healthy while physical activity at work is often considered to be harmful to your health. In Denmark the term ‘nedslidning’ is used to describe the gradual physical deterioration due to exposures in the work environment. This article presents a review of the literature about physical work and health, and the historical and present use of the term ‘nedslidning’ is described. Instead of using the not vey specific term ‘nedslidning’, the article suggests that the process of deterioration is seen as part of the musculoskeletal ageing process. The reader is presented to a ’life course perspective’ on the aging process and to a ‘life course perspective’ on the relationship between the physical activity in work life and the following physical function in midlife. The paper concludes with a recommendation of the use of these perspectives in future occupational research and in daily life, where professionals are working with the relationship between work environment and health.
Social smerte i det moderne arbejdsliv ud fra et arbejdspsykologisk perspektiv
Authors: Baldursson Einar Baldvin
Published: September 2016

It is often argued, that modern work and living in globalized knowledge society involve new demands and social stressors. This paper argues that it is meaningful to assume the existence of a psychological immune system that has emerged through the evolution of social mammals and humans. Accord to the theory, this system is activated in the case of social threats, loss or damage. When activated it causes psychological pain and depressive reaction. Similar to the innate immune system, the psychological immune system involves (social) behavior with the goal to limit damage and improve the odds for recovery. In the paper it is argued that modern work involves increased focus on social relations and cooperation. The experience of permanent changes at work, increased pressure and emotional demands lead to increasing risk for social loss and defeat at work. According to this theory such experiences will lead to psychological pain and depressive mental states. This theory can contribute to explaining the increasing prevalence of stress and depression.
Normative og metodiske vinkler på "arbejde" som et sundhedsøkonomisk begreb
Authors: Brock Steen , Christensen Bo Allesøe
Published: September 2016

This paper begins by recounting important phases in the development of the concept of labour. Then the Capability Approach to welfare economy, by Amartya Sen, is presented as is the direction of socio-psychology called Positioning Theory. Accordingly, the paper advocates a way in which to assess the economy of health programs as a cornerstone within Public Health Strategies to the effect that the concept of labour is important in this context. All way through, the paper examines the inescapable gap between a professionalized authoritative viewpoint on labour and an authentic perspective thereupon.
Må sykefravær legitimeres med legemelding?
Authors: Olsen Torunn S. , Fleten Nils
Published: September 2016

Most Western countries require a medical certificate for payment of sickness benefits in prolonged absence spells. Based on an intervention enabling self-certified sick leave up to 365 days in the municipality of Mandal, this article discusses whether a medical certificate is necessary to legitimate sick leave. The municipality’s absence registry and questionnaire data form the basis of this article. In Mandal self-certification has become the rule, both for short- and long-term sick leave. For short-term absence, the transition to self-certification has reduced absence length and return to work has become more evenly distributed throughout the week. For sick leave in excess of 16 days, absence length has increased, but not significantly. The proportion of graded long-term sick leave significantly increased in self-certified episodes, from 23 percent the first year to 43 percent the third year. A large and increasing majority of the employees are satisfied with extended self-certification. Those whom still prefer a doctor’s sick note, are either critical to how they are followed-up at the workplace or feel that self-certification is a burden. The transition to self-certification as main documentation for sickness absence has not increased absence levels. During long-term absence spells employees consult their doctors. This indicates that the employees behave responsibly when they self-certify and retain contact with their doctor for medical purposes. The intervention suggests that mandatory certification by a doctor is not necessary for legitimising sick leave, even long-term absence.
Forebyggelse på tværs af det offentlige og private: Når patienter trodser myndiggørelse og efterspøger mere professionel involvering
Authors: Villadsen Kaspar , Pii Kathrine Hoffman
Published: September 2016

The article presents findings from an empirical study among patients and professionals involved in a preventive health program at a Danish hospital. It shows how patients enrolled in the program interact with health professionals in ways that challenge assumptions common to governmentality studies of prevention and health promotion. This literature has successfully explored how contemporary health promotion transgresses the public/private boundary by shaping the values of collectivities and individuals to fit better with public health objectives. By exploring the complex co-existence and intertwinements of discipline and biopolitics in preventive practices this study eschews an interpretation that views the powers of the professional health system as invasive and one-directional. Instead, the study demonstrates how patients in various ways defy a ‘patient-centered’ and empowering approach and demand to be treated medically and disciplined in a more traditional sense. The blurring of the public/private boundary, then, cannot be straightforwardly described as a result of a professional health system that, more or less subtly, reaches into the private lives of patients. A more complex picture emerges, as patients’ attitude reflect both traditional medicine and rationalities foreign to the health system.
At udskyde det uundgåelige: Om brugen af kausal viden i forebyggende tiltag
Authors: Rod Morten Hulvej , Curtis Tine
Published: September 2016

This paper discusses the heavy reliance upon a particular kind of causal knowledge in prevention and health promotion. Based on ethnographic fieldwork with prevention professionals working with interventions targeting teenage drinking in Denmark, the paper argues that, while attempting to provide predictions for the future, prevention creates certain problems for itself in the moments of social interaction where it is practiced. The paper suggests that prevention can be seen as an attempt at postponing the future and through empirical examples it is illustrated how this project causes a number of practical problems to prevention professionals. The paper begins by sketching the causal epistemology that dominates current public health research. Next, ethnographic descriptions of (i) an educational intervention in Danish schools and (ii) a meeting for parents arranged by a local public health agency provide the material for discussing the practical use of causal knowledge. It is shown that this knowledge becomes contradicted and undermined in the social interaction between public health practitioners and their target groups, and that – paradoxically – this knowledge tends to actualize the very phenomenon it seeks to prevent. The paper employs Bourdieu’s distinction between two modes of anticipatory intelligence, the project and the protention, and argues that, in the interaction between prevention professionals and target group, the widespread use of causal knowledge might inhibit and counteract the situational competencies of prevention professionals.
Le Service des émissions féminines télévisées au réseau francophone de la Société Radio-Canada (1965-1982) : une histoire du genre dans les organisations
Authors: Laplanche Laurie
Published: September 2016

Cet article porte sur la question du genre dans la production médiatique à la Société Radio-Canada (SRC) entre 1965 et 1982, soit au cours des 17 années de diffusion du magazine télévisé Femme d’aujourd’hui, produit par le Service des émissions féminines télévisées. Nous examinons comment les valeurs, les normes, les qualités, les capacités et les attentes associées à la féminité et à la masculinité ont fait partie intégrante de la culture organisationnelle radio-canadienne, ce qui a favorisé des inégalités, mais également des possibilités pour les femmes travaillant à la Société d’État. À cette fin, nous avons analysé le journal des employés, Circuit fermé, de 1965 à 1982, les outils promotionnels destinés au grand public entre 1965 et 1982 (La semaine à Radio-Canada et Ici Radio-Canada), les rapports sur les mesures d’égalité des chances à Radio-Canada dans les années 1970, ainsi que les documents contenus dans le fonds privé de la chef du Service des émissions féminines télévisées, Mme Michelle Lasnier. Nous exposons tout d’abord la répartition du pouvoir entre les hommes et les femmes, ainsi que les caractéristiques associées à la masculinité et à la féminité à la Société d’État qui ont pu réduire l’efficacité de l’implantation de mesures d’égalité des chances dans les années 1970. Nous avons ensuite comparé ces éléments à l’organisation du travail au sein du Service des émissions féminines télévisées à Montréal.
Historical Distance and Questions of Form in 5½ Points
Authors: Leckie Barbara
Published: September 2016

This paper isolates form, or what Mark Salber Phillips calls making, as a key component of the four-pronged approach to historical distance that he elaborates in On Historical Distance (the other prongs are affect, ideology, and understanding). It focuses, in particular, on linearity, genre, contrast, dialogue, beginnings/endings, and ghosts as dimensions of form. All of these aspects of forms have a double inflection: on the one hand, they relate to a characteristic of form (the linear narrative, for example) and, on the other, they raise broad questions related to historical representation in general (a conception of history understood in linear and sequential terms that is linked with historical distance conventionally understood, for example). This paper argues that the idea of form developed in Phillips’ book both enriches our understanding of historical representations and opens up new questions for critical inquiry.
The Explosion in Grandma’s Attic, the Cabinet of Curiosities, and Chance Encounters at the GLBT History Museum
Authors: de Szegheo Lang Tamara
Published: September 2016

This article proposes that objects might be instrumental in museum exhibitions that promote critical thinking around issues of human rights and social inequity. Objects have the potential to present histories that have been marginalized for far too long and to get away from rehearsed narratives, while also engaging the visitor through emotional connection — making the visitor care about the histories that are being presented. In looking at the GLBT Historical Society Archives and History Museum in San Francisco, this article claims that new museums that grow out of community-based archives might provide the opportunity for the kinds of critical engagements with objects that national-scale museums that attempt to address social problems often do not have. Specifically addressing the GLBT History Museum’s inaugural exhibit, “Our Vast Queer Past,” this article argues that the organization of objects on display, greatly influenced by their archival roots, gives viewers the opportunity for chance encounters with histories that come to matter to them.
A computational approach to map nucleosome positions and alternative chromatin states with base pair resolution
Authors: Zhou Xu , Blocker Alexander W , Airoldi Edoardo M , O'Shea Erin K
Published: September 2016

Understanding chromatin function requires knowing the precise location of nucleosomes. MNase-seq methods have been widely applied to characterize nucleosome organization in vivo, but generally lack the accuracy to determine the precise nucleosome positions. Here we develop a computational approach leveraging digestion variability to determine nucleosome positions at a base-pair resolution from MNase-seq data. We generate a variability template as a simple error model for how MNase digestion affects the mapping of individual nucleosomes. Applied to both yeast and human cells, this analysis reveals that alternatively positioned nucleosomes are prevalent and create significant heterogeneity in a cell population. We show that the periodic occurrences of dinucleotide sequences relative to nucleosome dyads can be directly determined from genome-wide nucleosome positions from MNase-seq. Alternatively positioned nucleosomes near transcription start sites likely represent different states of promoter nucleosomes during transcription initiation. Our method can be applied to map nucleosome positions in diverse organisms at base-pair resolution.
Talk the talk and walk the walk. Evaluation of autonomy in aging and Alzheimer disease by simulating instrumental activities of daily living: the S-IADL
Authors: Quaglino Véronique , Gounden Yannick , Lacot Emilie , Couvillers Frédérique , Lions Amandine , Hainselin Mathieu
Published: September 2016

Objective

The autonomy of individuals is linked to the achievement of instrumental activities of daily living that require complex behavior. In the elderly, the assessment of autonomy is usually based on questionnaires that have strong subjective constraints. Considering this fact, we tested elderly healthy adults and Alzheimer disease patients using a new measure, the S-IADL (Simulation of Instrumental Activities for Daily Living), to assess the ability to perform effectively activities of daily living.

Method

The S-IADL shares many items with the well-known IADL questionnaire proposed by Lawton & Brody (1969). However, as opposed to the IADL, the assessment of autonomy is not based on the completion of a questionnaire but requires the realization or simulation of various activities of daily living. Eighty-three participants (69 healthy elderly, and 14 Alzheimer Disease patients) completed the IADL and performed the S-IADL assessment.

Results

Results revealed that, like the IADL, the S-IADL is able to identify AD patients who are likely to encounter difficulties in performing everyday activities, and no major differences were found between the IADL and the S-IADL.

Conclusions

We outlined some advantages for prefering, in certain situation, this new tool based on simulation of activities in functional evaluation. Finally, we discuss the main limits of the S-IADL that should be investigated prior to its utilization by clinicians.
Decoupling social status and status certainty effects on health in macaques: a network approach
Authors: Vandeleest Jessica J. , Beisner Brianne A. , Hannibal Darcy L. , Nathman Amy C. , Capitanio John P. , Hsieh Fushing , Atwill Edward R. , McCowan Brenda
Published: September 2016

Background

Although a wealth of literature points to the importance of social factors on health, a detailed understanding of the complex interplay between social and biological systems is lacking. Social status is one aspect of social life that is made up of multiple structural (humans: income, education; animals: mating system, dominance rank) and relational components (perceived social status, dominance interactions). In a nonhuman primate model we use novel network techniques to decouple two components of social status, dominance rank (a commonly used measure of social status in animal models) and dominance certainty (the relative certainty vs. ambiguity of an individual’s status), allowing for a more complex examination of how social status impacts health.

Methods

Behavioral observations were conducted on three outdoor captive groups of rhesus macaques (N = 252 subjects). Subjects’ general physical health (diarrhea) was assessed twice weekly, and blood was drawn once to assess biomarkers of inflammation (interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP)).

Results

Dominance rank alone did not fully account for the complex way that social status exerted its effect on health. Instead, dominance certainty modified the impact of rank on biomarkers of inflammation. Specifically, high-ranked animals with more ambiguous status relationships had higher levels of inflammation than low-ranked animals, whereas little effect of rank was seen for animals with more certain status relationships. The impact of status on physical health was more straightforward: individuals with more ambiguous status relationships had more frequent diarrhea; there was marginal evidence that high-ranked animals had less frequent diarrhea.

Discussion

Social status has a complex and multi-faceted impact on individual health. Our work suggests an important role of uncertainty in one’s social status in status-health research. This work also suggests that in order to fully explore the mechanisms for how social life influences health, more complex metrics of social systems and their dynamics are needed.