The Microbiopolitics of Human-Microbe Relationships: Hospital-Acquired Infection Control in Latvia

Despite infection control being a quintessential element of biomedicine, the problem of hospital-acquired infections (HAIs) is the most common patient safety problem worldwide. Regardless of the high priority on the global health agenda, evidence shows suboptimal results in terms of providing safe healthcare, free from these infections. Healthcare and research responses have focused upon behaviour change of medical personnel and organisational barriers/facilitators to address the gap between how HAI control should and is done. The research aims to understand the phenomenon of HAI control, by looking at how it is negotiated and navigated within and between different settings and people in Latvia. I achieved this by utilising a conceptual framework of the microbiopolitics of human-microbe relationships and multi-sited ethnographic approach to trace HAI control through media, policy, and hospital settings. In this study, I have offered a recalibration of the HAI problem: instead of scrutinising the imperative of insufficient HAI control, I have steered my research towards ethnographically examining the phenomena of HAI control itself and how it is assembled in the first place. The study reveals that process of achieving germ-free and safe healthcare goes far beyond the individual and isolated behaviour of compliance and non-compliance with HAI control requirements. Instead, research illustrates the phenomenon of HAI control has local and historical embeddedness and it is an instance of dynamic epistemic and socio-material assemblages of human and non-human entities. The study therefore demonstrates that context- and situational-dependent recognition and understanding of microbes and management of microbial encounters manifest in different approaches to HAI control. Moreover, achieving HAI control not only depends on levels of compliance with HAI control policy but also on the quality of policy itself. As study revealed, HAI control can not only produce recognition and management of HAI risks but also spaces of neglect and exclusion

Role of multidimensional factors in the diagnosis and treatment of tonsillopharyngitis in primary care : a qualitative study

Funding Information: We thank to all GPs for their time and support in this study. Publisher Copyright: © 2022, The Author(s).Background: Tonsillopharyngitis is one of the most frequently observed upper respiratory tract infections, for which antibiotics are prescribed in ambulatory care. In most cases, tonsillopharyngitis is benign and self-limiting, mostly a viral condition. The aim of this study was to explore the diagnostic and treatment process of tonsillopharyngitis by general practitioners and to understand decisions regarding antibiotic prescribing and the factors that shape these practices. Methods/design: This was a qualitative interview study in primary care practices in Latvia. Semi-structured face-to-face interviews were conducted with general practitioners from November 2016 to January 2017. Thematic analysis was applied to identify factors that influence the prescribing practice in a primary care setting in conjunction with a specific context in which the prescriber practices. Results: Decisions and practice of general practitioner are not static over time or context; they occur within an environmental setting influenced by individual factors of general practitioners, the health care system, and practice-specific factors that shape the diagnosis and antibiotic prescribing in the tonsillopharyngitis. Interviewed general practitioners rely primarily on their personal experience, perception, and skills acquired in their practice, which are encouraged by the environment, where the necessary tools and resources are not in place to encourage rational prescribing of antibiotics. Conclusions: General practitioners’ decision regarding antibiotic prescribing is an unstable concept that differs between prescribers. The health care system could augment the experience of general practitioners through structural changes such as guidelines, availability of antibiotics, and available antibiotics package size.publishersversionPeer reviewe

The Development of a Screening Tool for Childcare Professionals to Detect and Refer Infant and Toddler Maltreatment and Trauma: A Tale of Four Countries

Abstract: Child maltreatment is considered a pressing social question, compromising the present and future mental and physical health of one in four children in Europe. While children younger than three years of age are especially vulnerable, few screening instruments are available for the detection of risk in this age group. The purpose of this research was to develop a screening tool for childcare professionals working in public and private daycare settings to support them in the early identification and referral of infants and toddlers exposed to emotional and physical abuse and neglect by primary caregivers, to be used in different settings across four European countries: Belgium, Italy, Latvia, and Hungary. Method: A stratified process was used to create the screening tool: We started by using Living lab methodology to co-create the screening tool with its final users, which was followed by testing the tool with a total of 120 childcare professionals from the four participating countries. Results: During the Living Lab phase, a screening tool with three layers was developed. The initial layer includes five “red flags” that signal particular concern and require immediate action. The second layer is a quick screener with twelve items focused on four areas: neglect of basic needs, delays in development, unusual behaviors, and interaction with caregivers. The third layer is an in-depth questionnaire that aids in formalizing a thorough observation of twenty-five items within the same four areas as the quick screener. After a one-day training session, 120 childcare professionals caring for children aged 0–3 from four countries assessed the screening tool and their overall training experience. Childcare professionals reported great satisfaction with the three-layered structure, which made the tool versatile, and agreed on its content, which was considered helpful in the daycare setting for the regular evaluation of the behavior of children and their primary caregivers, thus improving the early observation of change from the normal behavior of the infant or toddler. Conclusion: The three-layered screening tool was reported as feasible, practical, and with great content validity by childcare professionals working in four European countries

Genetic biotechnologies in daily practices of medicine

Izmantojot A. Kleinmana piedāvāto slimības izskaidrošanas modeļu perspektīvu, šajā maģistra darbā tiek aplūkots, kā ģenētiskās biotehnoloģijas maina veselības aprūpes praksēs iesaistīto pušu attiecības un slimības skaidrojumus. Darbā parādīts ģenētiķu, ģimenes ārstu un nespeciālistu skatījums uz šīm tehnoloģijām un to vietu medicīnā. Pētījums atklāj, ka ģenētiskās saslimšanas tiek marginalizētas biomedicīnas modelī, kas, no vienas puses, atklāj daudznozīmīgo biomedicīnas modeļa raksturojumu, taču, no otras puses, neleģitimizētais statuss biomedicīnas modelī apgrūtina tehnoloģiju iekļaušanos medicīnas ikdienas praksēs. Atslēgas vārdi: medicīnas prakses, ģenētiskā testēšana, A. Kleinmana slimības skaidrošanas modeļi.Drawing upon Arthur Kleinman's explanatory model of illness, this paper explores how biotechnology changes the explanations of disease and influences the relationships of participants of the health care system. This paper shows how geneticists, general practitioners and lay persons form their perspective on these technologies and their place in medical system. The theses argue that genetic diseases become marginalized in the biomedical model, on one hand, revealing the polysemantic character of biomedical model, but, on other hand, displaying the illegitimate status of those technologies in the biomedical model and preventing their incorporation in the everyday medical practices. Key words: medical practices, genetic testing, Arthur Kleinman's explanatory model of illness

Care When It Counts: Establishing Trauma-Sensitive Care as a Preventative Approach for 0–3-Year-Old Children Suffering from Trauma and Chronic Stress

Adverse childhood experiences are an important societal concern. Children aged 0–3 are particularly vulnerable to unpredictable chronic stress due to the critical period for brain development and attachment. Trauma-sensitive care is a preventative approach to reduce the burden of stressful experiences by committing to positive relationships. Professional caregivers are ideally placed to offer trauma-sensitive care; however, earlier research reveals that the tools they need to consciously apply trauma-sensitive care principles are missing. The current study organized living labs (co-creative research method) to present trauma-sensitive care as a preventative approach aimed at children aged 0–3. Two living labs were organized in Belgium and Hungary, where professional caregivers collaborated to create a protocol that offers guidelines on how to implement trauma-sensitive care. The resulting protocol included a theoretical foundation on trauma as well as a translation of these guidelines into practical recommendations. The protocol was evaluated by incorporating it into a training intervention delivered to 100 professional caregivers from childcare organizations across four European countries. The protocol received positive feedback from participants, with results indicating a self-reported increase in knowledge, attitude and practice of trauma-sensitive care principles. We conclude that this trauma-sensitive care protocol is a promising answer to the needs of professional caregivers working with children aged 0–3