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- Gröndal, Hedvig, 1983-, et al.
(författare)
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Alignment Work : Medical Practice in Managing Antimicrobial Resistance
- 2021
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Ingår i: Science as Culture. - : Informa UK Limited. - 0950-5431 .- 1470-1189. ; 30:1, s. 140-160
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Tidskriftsartikel (refereegranskat)abstract
- Policies intended to reduce unnecessary use of antibiotics have been promoted as a key to preventing antimicrobial resistance. However, reduction of antibiotic use in health care potentially involves tensions between health of the patient receiving care and the health of the (future) population. An analysis of general practitioners’ talk about everyday medical practice in relation to respiratory tract infections shows how they manage to move between policy and patient interests through ‘alignment work.’ Alignment work is the discursive strategies used to manage risks and demands related to antibiotic resistance as well as patients receiving health care. Through alignment work conflicting demands and risks can be juggled, and antibiotic prescribing becomes discursively doable. Alignment work is not solely a matter of making conflicting demands and risks coherent, but might also involve leaving tensions and ambiguities intact. It enables general practitioners to align with AMR policy and the imperative of being restrictive with antibiotics, while still managing the risks threatening individual patients. As a consequence, lapses from AMR policy do not necessarily undermine it, but can instead be crucial to allowing the policy to work in the context of actual medical practice and, as such, be crucial to the overall success of the policy.
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- Gröndal, Hedvig, 1983-
(författare)
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Bilder av bakterier: streptokocker i sociologisk belysning
- 2013
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Konferensbidrag (refereegranskat)abstract
- Bakterier utmanar flera olika kategoriseringar som är grundläggande i det västerländska tänkandet. De kan få oss att ifrågasätta den västerländska bilden av organismen, individen, enheten och helheten. I förlängningen innebär det att bakterier fungerar som symboler för de tveksamma gränserna mellan yttre och inre och mellan självet och icke-självet. En annan typ av gränsdragning som forskning om bakterier kan utmana är den mellan det sjuka och det friska, och mellan fiende och allierad. Ytterligare en gränsdragning som ständigt blir aktuell i texter om bakterier är den mellan djur och människa, och berättelser om bakterier leder ofta till att föreställningen om människans privilegierade position i ”the web of life” blir mindre självklar. Antibiotikaresistenta bakterier sätter dessutom den moderna föreställningen om ständiga vetenskapliga och medicinska framsteg i gungning.I min presentation diskuterar jag ett antal artiklar från Läkartidningen som handlar om behandling av halsfluss. Jag diskuterar hur bakterien Streptokocker grupp A beskrivs på olika vis i texterna – som konstant eller i förändring, som aktiv eller passiv, som farlig eller ofarlig, som möjlig eller omöjlig att kontrollera. I relation till dessa frågor diskuterar jag hur bilden av bakterien förstärker eller utmanar vedertagna gränser mellan sjukdom och hälsa, liksom bilden av den moderna sjukvården och den medicinska vetenskapen.
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- Gröndal, Hedvig, 1983-
(författare)
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Harmless, friendly and lethal : antibiotic misuse in relation to the unpredictable bacterium Group A streptococcus
- 2018
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Ingår i: Sociology of Health and Illness. - : Wiley. - 0141-9889 .- 1467-9566. ; 40:7, s. 1127-1141
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Tidskriftsartikel (refereegranskat)abstract
- Evidence‐based treatment guidelines for managing infections in health care are promoted as tools to prevent unnecessary use of antibiotics. Antibiotic misuse has been examined as regards the doctor‐patient relation and the social context of medical practice. Less attention has been paid to how the very conceptualisation of human‐microbial relations may influence understandings of antibiotic misuse. The article examines a medical controversy concerning guidelines for managing throat infection and antibiotic treatment in Sweden. It demonstrates how this controversy unfolds around two different ways of relating to a specific bacterium – Group A Streptococcus. The analysis shows how two ‘microbiopolitics’, involving different understandings of human‐microbial relations, are created in the controversy and how different antibiotic prescribing practices are justified. By focusing on Group A Streptococcus, which is commonly observed, but also unpredictable and potentially dangerous, the article provides new insights into the relations between bacteria, humans and policy in an age of antimicrobial resistance. It argues, in particular, that the definition of antibiotic misuse is unstable and consequently that policy measures aimed at reducing misuse must be related to how specific infections and bacteria are conceptualised in the actual context the policy addresses.
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- Gröndal, Hedvig, 1983-
(författare)
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Signs of bacteria: Enacting Sore Throat
- 2015
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Konferensbidrag (refereegranskat)abstract
- In this paper I analyse the diagnostic process in relation to bacterial sore throat and how this disease comes into being, or how it is enacted, at two Swedish health centres. The empirical data analysed consist of interviews with nurses and general practioners as well as observations at the health centres. The concept of enactment implies that disease is relationally constituted in and through relations between human and non-human actors. In the paper the relations between health care personnel, bodies, symptoms, instruments, bacteria and other actors are investigated, and I discuss how different enactments of bacterial sore throat come to being depending on how these relations are organized. When doing this the clinical gaze - the diagnosing gaze that interpret signs of an underlying pathology on the patients body – is explored and in relation to the empirical material this gaze is investigated, that is, how it is employed and how it is established in relation to a number of human and non-human actors.
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- Gröndal, Hedvig, 1983-
(författare)
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The emergence of antimicrobial resistance as a public matter of concern : A Swedish history of a “transformative event”
- 2018
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Ingår i: Science in Context. - 0269-8897 .- 1474-0664. ; 31:4, s. 477-500
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Tidskriftsartikel (refereegranskat)abstract
- This article examines how antimicrobial resistance (AMR) came to be constituted as a matter of public concern in Sweden in conjunction with the development of an inter-professional organization called Strama, founded to promote rational prescription of antibiotics. An outbreak of penicillin-resistant pneumococci in the mid-1990s was crucial for this development, because it brought attention to AMR as an urgent public threat. This outbreak fuelled the constitution of AMR as caused by consumption of antibiotics and as a matter of disease control. As a consequence, Strama was able to mobilize the Swedish health officers responsible for disease control. The outbreak is conceptualized as a “transformative event” – an event that makes an issue and its associated risks concrete and urgent. Transformative events play the crucial role of expediting the transformation of issues into matters of public concern.
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- Gröndal, Hedvig, 1983-
(författare)
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Unpacking Rational Use of Antibiotics : Policy in Medical Practice and the Medical Debate
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Rational use of antibiotics–using antibiotics only when needed and in the right way–is a prioritized goal in policy aimed at preventing antimicrobial resistance. A vast body of research is devoted to understanding why unnecessary antibiotics are prescribed. However, this research tends to treat the definition of rational prescribing as an unproblematic fact, which is given by evidence.The thesis aims to sociologically unpack rational use of antibiotics as medical knowledge and a policy goal. One study examines how rational use of antibiotics in health care was established as a crucial part of AMR prevention in Sweden, and three studies, drawing on different materials, look at how rational antibiotic use for everyday infections is negotiated and performed in medical practice and the medical debate in Sweden. The thesis makes theoretic use of material semiotics and critical policy studies, which enables examination of how medical knowledge, medical objects and policy are performed in webs of relations between human and non-human actors.The studies show that rational use of antibiotics for everyday infections is characterized by uncertainties and tensions. These cannot be reduced to medical professionals’ ignorance, or to how non-medical factors influence medical practice. This implies that social factors are not enough to explain why medical professionals dismiss specific policy definitions of medically appropriate prescribing. Instead, the uncertainties and tensions characterizing rational antibiotic prescribing can be traced to the complex and contingent nature of medical knowledge and medical objects, as well as to the potentially conflicting risks that antibiotic prescribing involves. As a consequence, deviance from, or critique of, a specific definition of rational use of antibiotics may constitute a performance of rational use of antibiotics as a policy goal. In medical practice and the medical debate, rational use of antibiotics as a policy goal can draw on and work with mutable medical knowledge and objects, as well as conflicting medical risks. It is concluded that sociologists need to continue entering the seemingly pure medical sphere to critically investigate policy and policy goals that draw on medical knowledge and that, as such, appear to be neutral and undisputable.
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| 9. |
- Tyrstrup, M., et al.
(författare)
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A study of guidelines for respiratory tract infections and their references from Swedish GPs : a qualitative analysis
- 2020
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 38:1, s. 83-91
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Tidskriftsartikel (refereegranskat)abstract
- Background: National guidelines are important instruments in reducing inappropriate antibiotic prescriptions. Low adherence to guidelines is an acknowledged problem that needs to be addressed. Method: We evaluated established characteristics for guidelines in the guidelines for lower respiratory tract infection, acute otitis media and pharyngotonsillitis in primary care. We studied how doctors used these guidelines by analysing interviews with 29 general practitioners (GPs) in Sweden. Results: We found important between-guidelines differences, which we believe affects adherence. The GPs reported persistent preconceptions about diagnosis and treatment, which we believe reduces their adherence to the guidelines. Conclusion: To increase adherence, it is important to consider doctors’ preconceptions when creating new guidelines.
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