Perspectives of on-farm biosecurity and disease prevention among selected pig veterinarians and pig farmers in Sweden

Background: Biosecurity is important in preventing the spread of infectious diseases inanimal production. Previous studies have identified a disparity between the biosecurityrecommendations provided by veterinarians and the actual practices implemented byfarmers. This study compared group discussions with a few key actors among Swedishpig veterinarians and farmers on pig farm biosecurity.Methods: Two focus group discussions were conducted, one with five Swedish pig vet-erinarians and one with three pig farmers, to explore their views on pig farm biosecurityand efficient biosecurity measures. The discussions were analysed to identify differencesand similarities in how biosecurity was perceived.Results: The study identified differences between the veterinarians and pig farmers inhow they perceived good biosecurity and the level of biosecurity in Swedish pig herds. The veterinarians perceived that adhering strictly to the farming system and its barrierswas essential for good biosecurity. The biosecurity in the pig farms was often consideredinadequate. The veterinarians described difficulties in biosecurity-related communica-tion with the farmers. The pig farmers valued the flexibility of the farming system overstrict barriers and described that the level of biosecurity was good in Swedish pig herds. However, both groups also shared similar views regarding the challenges in farm biose-curity. They highlighted that biosecurity measures with proven efficacy are importantfor farmer motivation.Conclusions: This limited study suggested that different perspectives on biosecuritycan contribute to communication difficulties between pig farmers and veterinarians. Acknowledging both the differences and similarities of the different perspectives mayhelp improve cooperation and communication in biosecurity-related questions

Trust, agreements, and occasional breakdowns: Veterinarians' perspectives on farmer-veterinarian relationships and use of antimicrobials for Swedish dairy cattle

Studies have shown that farmer-veterinarian relationships influence antimicrobial use (AMU) in livestock, though how they do so is unclear. On the one hand, research shows that well-established veterinarian-farmer relationships are positive for implementation of antibiotic stewardship and restrictive AMU. On the other hand, studies also show that farmer demands can increase antimicrobial prescribing and that prescribing antimicrobials can strengthen the veterinarian's relationship with farmer clients. In the present study, we focus on veterinarians' perspectives on the relationships between dairy cattle farmers and veterinarians in Sweden and explore what characterizes these relationships when restrictive AMU is described as unproblematic and when AMU becomes a matter of tension or conflict. The study draws on semistructured interviews with 21 veterinarians working with livestock in Sweden. Interviews were analyzed thematically. The study shows that from the perspectives of veterinarians, well-established veterinarian-farmer relationships generally facilitate restrictive AMU in 3 slightly different but related ways: (1) they create trust in the veterinarian and their prescribing decisions; (2) they create shared understanding concerning when antimicrobials are needed and not needed; and (3) they facilitate constructive discussions between veterinarians and farmers on AMU. To make the farmer feel listened to and to come to an agreement on AMU was described as central for the veterinarians. However, the veterinarians described agreements on restrictive AMU as sometimes requiring strategic work, such as discussions to motivate the farmer and leave the door open for antimicrobials later if needed. Such work takes time and energy and is easier within well-established relationships according to the veterinarians. We also identified examples where veterinarians explained that they occasionally make compromises with farmers concerning antimicrobials—compromises that, according to the veterinarians, facilitate the relationship with the farmer, which in turn facilities restrictive AMU in the longer term. The examples in our interviews where antimicrobials became a matter of tension and even conflict between veterinarians and farmers could, with a few exceptions, be traced to absence of well-established relationships. However, some veterinarians also described AMU as a matter of tension within well-established relationships, especially with older farmers who do not trust new treatment strategies. We also found a small number of examples where disagreements on antimicrobials made a relationship with specific farmers impossible. Thus, even though the interviewed veterinarians generally meant that their restrictive antimicrobial prescribing did not threaten the relationship with the farmer, our study also, to some extent, confirms research showing that restrictive AMU can harm the relationship with some clients who simply choose another, less restrictive, veterinarian. In summary, our study supports that decisions on AMU cannot be reduced to the individual prescriber's behavior, nor to a strict medical judgment. Antimicrobial use for dairy cattle needs to be understood as taking form in relationships in which both veterinarians and farmers are active parts

Restrictive but not restricted: perspectives on antimicrobial use and antimicrobial resistance among Swedish dairy veterinarians

Background and aims In Europe, the antimicrobial use (AMU) for food-producing animals has decreased rapidly. However, studies indicate that a too strict policy, with too restrictive AMU, is potentially problematic for veterinarians because it threatens animal welfare and creates tensions between farmers and veterinarians. The AMU in Sweden is among the lowest in Europe, and regulation of AMU in farm animals is strict. The aim of our study was to explore how Swedish veterinarians describe the relations between (1) being restrictive with antibiotics due to the risk of AMR and (2) concerns for animal welfare and/or the veterinarian-client relationship. Methods Semi-structured interviews with 21 veterinarians, working with dairy cattle, were performed. The transcripts were analysed, and a number of dominant patterns which recurred in all, or most of, the interviews were identified. Result The interviewed veterinarians described AMR prevention and tackling the threat AMR poses towards public health, as central for their profession and as influencing their everyday practice and decisions on AMU. Importantly, veterinarians described accounting for AMR in everyday practice as fairly unproblematic, both in relation to animal welfare as well as in relation to farmers. The veterinarians generally perceived that they could treat animals with antibiotics when justified, and being restrictive with antibiotics was described as an expression of professional skill and not as challenging as animal welfare. Moreover, they stated that restrictive AMU seldom or never caused conflicts with farmers. Conclusion Strict AMU policy and restrictive AMU do not necessarily put veterinarians in a problematic position where they are caught between conflicting demands and risks

Unpacking Rational Use of Antibiotics : Policy in Medical Practice and the Medical Debate

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

Iscensättanden av halsfluss : relationella göranden av en sjukdom i medicinska praktiker

Enacting tonsillitis: Relational performances in medical practices In this paper the diagnostic process of bacterial tonsillitis at two Swedish health centres is described and analysed as to how this disease comes into being, or how it is enacted. The concept of enactment implies that disease is constituted in, and through, relational practises involving human and non-human elements. The study is based on interviews with nurses and doctors as well as field observations from the health centres. In the analysis it becomes apparent that different – and sometimes conflicting – enactments of tonsillitis appear in medical practices, depending on the organization of relations between different elements. It is concluded that diagnostic agency is created in relations between both humans and non-humans, and who and what is given diagnostic agency is changeable depending on the relations at hand. The diagnostic process of tonsillitis shows how the most mundane medical diagnoses involves a number of complex relations, that stretches beyond categories such as social and medical.Sociologisk Forsknings digitala arkiv</p

Unpacking Rational Use of Antibiotics : Policy in Medical Practice and the Medical Debate

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

Alignment Work : Medical Practice in Managing Antimicrobial Resistance

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

The first outbreak of African swine fever in Sweden: a survey of pig farmers' perceptions of information received, risks, biosecurity measures and future prospects

Abstract Background African swine fever (ASF), a viral hemorrhagic disease in domestic pigs and wild boar with up to 100% case fatality, was confirmed in Swedish wild boar in September 2023. The responsible authorities launched a control programme to eradicate the infection. The aim of the current study was to understand (i) how Swedish pig farmers have perceived the information issued by authorities and other stakeholders since the discovery of ASF in wild boar, (ii) which risks they see for introducing the infection to their farm, (iii) what biosecurity measures they have taken on their farms, and (iv) their outlook on the future. Such information is important for evaluating the effectiveness of the early stages of ASF control in Sweden. A questionnaire was designed and distributed to members of the Swedish pig producers’ organisation. Results A total of 155 farmers responded to the survey (response rate 36%). Almost all respondents had received general information about ASF (91%, n = 138), and 72% (n = 109) had received information about how they can protect their farm from ASF introduction. A majority (87%, n = 118) thought the information was easy to understand, 90% (n = 137) that is was relevant, and 77% (n = 117) that they currently did not lack any information. If given the resources necessary, 58% (n = 84) of the farmers would like to take additional measures such as fencing, and heavily reduce or eradicate the wild boar population. Wild boars were considered the greatest risk for introduction of ASF into their herd (39%, n = 57), followed by people (30%, n = 44), and transports (16%, n = 23). Many farmers (66%, n = 88) had a positive outlook on the future, and 89% (n = 127) have not changed their plans for the future since the ASF outbreak. Conclusions The responding farmers were in general satisfied with the information received in the beginning of the ASF outbreak. The majority have a positive outlook on the future and the outbreak has not caused them to change their plans. Actions that were highlighted as important to safeguard Sweden's pig production included measures to control the wild boar population

Near-patient tests and the clinical gaze in decision-making of Swedish GPs not following current guidelines for sore throat - a qualitative interview study

Background: Excessive antibiotics use increases the risk of resistance. Previous studies have shown that the Centor score combined with Rapid Antigen Detection Test (RADT) for Group A Streptococci can reduce unnecessary antibiotic prescribing in patients with sore throat. According to the former Swedish guidelines RADT was recommended with 2-4 Centor criteria present and antibiotics were recommended if the test was positive. C-reactive protein (CRP) was not recommended for sore throats. Inappropriate use of RADT and CRP has been reported in several studies. Methods: From a larger project 16 general practitioners (GPs) who stated management of sore throats not according to the guidelines were identified. Half-hour long semi-structured interviews were conducted. The topics were the management of sore throats and the use of near-patient tests. Qualitative content analysis was used. Results: The use of the near-patient test interplayed with the clinical assessment and the perception that all infections caused by bacteria should be treated with antibiotics. The GPs expressed a belief that the clinical picture was sufficient for diagnosis in typical cases. RADT was not believed to be relevant since it detects only one bacterium, while CRP was considered as a reliable numerical measure of bacterial infection. Conclusions: Inappropriate use of near-patient test can partly be understood as remnants of outdated knowledge. When new guidelines are introduced the differences between them and the former need to be discussed more explicitly