Cancer genetic counseling in China and Denmark; a comparative anthropological perspective

This dissertation compares cancer genetic counseling in China and Denmark using an anthropological perspective.It uses anthropological theory to argue how ideas of genetic responsibility and demands for responsibility investments may be understood as the products of everyday practices unfolding within local worlds. Finding very different forms of cancer genetic counseling in China and Denmark, it analytically argues that the local organization of health care provides a salient example of a local world. It uses an STS framework to analyze how differences in the organization of health care in China and Denmark, may be seen as promoting very different webs of everyday human and non-human actors, resulting in very different cancer genetic counseling practices, respectively. For professionels, patients and their families in China and Denmark, these differences lead to very different demands for patient- family collaboration and interdependence, and ultimately to very different local forms of genetic responsibility. 

Experiences and attitudes of Danish men who were sperm donors more than 10 years ago; a qualitative interview study

Background More knowledge about the long-term impact of sperm donation is essential as the donor’s attitude towards donation may change over time. Personal and social developments may prompt a rethinking of previous actions and decisions, or even regret. Thus, the aim of this study was to explore the experiences and attitudes of men who were sperm donors more than 10 years ago. Methods From May to September 2021, semi-structured, qualitative interviews were conducted with 23 former donors (> 10 years since last donation) from Cryos International sperm bank. Two participants were non-anonymous donors and 21 were anonymous. The interviews were conducted by phone or via video (mean 24 minutes). All interviews were recorded, transcribed verbatim and rendered anonymous. Data were analyzed using thematic analysis. Results The analysis showed that most men had been donors for monetary and altruistic purposes, and now considered sperm donation as a closed chapter that was ’unproblematic and in the past’. Most men valued anonymity and emphasized the non-relatedness between donor and donor conceived offspring. Knowledge about recipients and donor offspring was seen as ’damaging’ as it could create unwanted feelings of relatedness and responsibility towards them. All men acknowledged donor conceived persons’ potential interests in knowing about their genetic heritage in order to understand appearance and personal traits, but also emphasized the donors’ rights to anonymity. Potential breach of anonymity was generally considered ’highly problematic’ as it was expected to disturb their families and force a relationship on them. Conclusion This study reports on former donors who might not have volunteered for research due to lack of interest or protection of privacy. The majority of men valued anonymity and clearly demarcated a line between sperm donation and fatherhood, which was enforced by not knowing about the donor offspring or recipients

Micro practices of coordination based on complex adaptive systems: user needs and strategies for coordinating public health in Denmark

Introduction: Many highly formalised approaches to coordination poorly fit public health and recent studies call for coordination based on complex adaptive systems. Our contribution is two-fold. Empirically, we focus on public health, and theoretically we build on the patient perspective and treat coordination as a process of contingent, two-level negotiations of user needs.Theory and Methods: The paper draws on the concept of user needs-based coordination and sees coordination as a process, whereby needs emerging from the life world of the user are made amenable to the health system through negotiations. The analysis is based on an explorative case study of a health promotion initiative in Denmark. It adopts an anthropological qualitative approach and uses a range of qualitative data.Results: The analysis identifies four strategies of coordination: the coordinator focusing on the individual user or on relations with other professionals; and the manager coaching the coordinator or providing structural support. Crucially, the coordination strategies by management remain weak as they do not directly relate to specific user needs.Discussion: In process of bottom-up negotiations user needs become blurred and this is especially a challenge for management. The study therefore calls for an increased focus on the level nature of negotiations to bridge the gap that currently weakens coordination strategies by management

“But I’ve also tried”

This paper departs in the problem of rising obesity amongst Danish children. The aim is to show how meanings about childhood obesity are constructed in the meeting between the dietician, the obese youngster and parent. The empirical data is based on observations of meetings with the dietician, a youngster named Anna, and Anna’s mother. The study draws on various multi-disciplinary research concerning children and their food worlds in order to broaden the perspective. In particular, the analysis has been inspired by the concept of a joint discourse of ‘being and becoming’, and the idea that children’s lives are structured through a ‘generational order’. The meeting observations reveal that whilst biomedical and parental discourses of obesity are prevalent, a child’s discourse is lacking. This paper suggests that the key issue at stake is an improvement in the knowledge of obese children’s food worlds, which might lead to an enhanced dietetic approach.Cet article traite du problème du développement de l’obésité parmi les enfants Danois. L’objectif est de montrer comment le sens de l’obésité enfantine se construit dans la rencontre entre le diététicien, le jeune obèse et ses parents. Les données empiriques se basent sur l’observation de rencontres avec le diététicien, une enfant nommée Anna et sa mère. L’étude s’appuie sur différents travaux pluridisciplinaires portant sur l’univers alimentaire des enfants afin d’élargir la perspective. En particulier, l’analyse s’inspire du concept de discours conjoint d’ « être et devenir », et l’idée que la vie des enfants est structurée en fonction d’un « ordre générationnel ». L’observation des rencontres révèle que tandis que les discours biomédical et parental sur l’obésité dominent, le discours de l’enfant n’existe pas. Cet article suggère que le problème central est l’amélioration de la connaissance des univers alimentaires des enfants obèses, ce qui pourrait enrichir l’approche diététique

The welfare state driving “me” and “we” medicine – a critical discourse analysis

This study explored the relationship between visions of personalized medicine, for-profit companies, and state governance in the context of an ongoing discussion of “me” vs. “we” medicine. It took its empirical departure in a Scandinavian welfare state, Denmark, and a discourse analysis was conducted based on interviews, documents, webpages, and media sources from vital public and private stakeholders. The analysis demonstrated how the development of a program for personalized medicine in Denmark emerges as largely driven by the state. Although for-profit companies are involved, the Danish state governs the development of the personalized medicine program single-handedly. This results in a form of personalized medicine framed in both “me” and “we” discursive terms. The analysis revealed that the welfare state plays a dominating role and controls these discourses articulating certain ideas of “me” and “we.” When compared to other studies, these results showed how the role of welfare states may still remain potent in the development of personalized medicine, and in the case of a Scandinavian welfare state, this challenges established views of a “me” vs. “we” dichotomy

Nurses' perspectives on challenges and facilitators when implementing a self-management support intervention as an everyday healthcare practice: A qualitative study

AIM: To explore registered nurses' perspectives on challenges and facilitators to implementing a telephone-based self-management support (SMS) intervention (Proactive Health Support) as an everyday healthcare practice, during the early stages of implementation.DESIGN: Data were collected using a qualitative research design involving focus-group interviews and participant observations.METHODS: We conducted participant observation following nine nurses and four focus group interviews with 14 nurses. Data were analysed using thematic analyses.RESULTS: Proactive Health Support was implemented in units organized independently of the existing organizational units within healthcare services. This independent organization, along with the intervention's generic (non-disease specific) design, empowered nurses to become autonomous practitioners capable of prioritizing the operationalization of SMS as an everyday healthcare practice. However, unlearning already embedded medical practices and establishing new nursing roles necessary to accommodate the intervention in practice was experienced a challenge. Education and supervision were identified as valuable tools for successful implementation.CONCLUSION: Our study highlights the significance of organizational context and autonomy in successful SMS implementation. Balancing external factors like organizational context, priority and time is vital, but navigating the internal shift in professional practice is equally crucial. Role transition processes can constitute challenges demanding accommodation.IMPLICATIONS FOR THE PROFESSION: From a nursing perspective, this study highlights that practising SMS requires substantial training and education. Generic SMS interventions can introduce higher levels of contingency due to their versatile nature. Thus, equipping nurses with competencies that enable them to navigate this unpredictability flexibly is crucial.IMPACT: Policymakers and administrators should allocate resources and support implementation processes in ways that accommodate both internal and external conditions to facilitate nurses in delivering effective SMS.REPORTING METHOD: This study adheres to the SRQR guideline.PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.</p