Stultitia and Type 2 Diabetes: The Madness of Not Wanting to Care for the Self

This paper explores the condition of stultitia, which is described by Michel Foucault in The Hermeneutics of the Subject as a condition one is in, before having started to care for the self.  The purpose is to shed light on one of the paradoxes of patient education by introducing and elaborating an aspect of Foucault’s literary activities, which has not, to my knowledge, been investigated empirically before.  To illustrate this condition, the paper targets the relation between type 2 diabetes, contemporary norms of healthy living, diabetes education, and the situation that sometimes occurs when individuals are not capable of, or motivated to, taking care of themselves.  It specifically targets a situation, which is both incomprehensible to health professionals and patients alike; when patients desire a healthy life, but at the same time do not pursue it according to the recommendations.  Thus, it is a condition of madness, which is investigated; madness in the sense that patients have internalised a rationality, against which their own behaviour rebels

Håndtering af kompleks information. Belyst fra psykologiske, mikrosociologiske og pædagogiske synsvinkler med henblik på at identificere problemer og muligheder for kommunikation og læring i relation til multikriteriel vurdering

Vores særlige opgave i MultiTrust-projektet, og dermed det centrale spørgsmål for os i Task 2.3., har handlet om, hvordan den kompleksitet, som økologisk fødevarersystemer og andre problemstillinger vedrørende bæredygtig udvikling indebærer, kan reduceres, så det på en gang er rimeligt i forhold til problematikken og egnet til at fremme kommunikation, deltagelse og læring. Herunder har vi også interesseret os for muligheder og problemer ved at benytte visualisering i dette arbejde. I ansøgningens projektbeskrivelse var formålet med tasken formuleret således: Review of research on how individuals handle complex information and the implied problems and potentials in relation to reduce complexity by means of multicriteria assessment and communication as this has been done in e.g. risk assessment, eco-labelling and education for sustainability. Samtidig med at rapporten indgår som en integreret del af MultiTrust-projektet, håber vi, at dens sammentænkning og sammenskrivning af materiale om menneskers håndtering af problematikker karakteriseret ved kompleksitet og usikkerhed , vil kunne have en bredere interesse, også uden for MULITTRUST arbejdet

Theories on motivation and their implication for supporting communication, learning and decisionmaking in relation to organic food systems

Efforts to promote communication, learning, decision making and change of individual and/or collective practices in relation to sustainability issues require more or less explicit theories on agents and what motivate them to act. The aim of this paper is to open for an interdisciplinary discussion on how different approaches to motivation make sense or not when focusing on how to develop tools aiming at supporting communica¬tion, learning and decision-making related to organic food systems. We present four quite different approaches to motivation – an economic, an approach challenging conventional understandings of motivational change, a psychosocial, and a relational – and open for a discussion on how these approaches relate to each other and whether it is possible to apply and distinguish between different ways of using the concept of motivation when we cross disciplinary borders in order to cooperate on developing tools for multi-criteria assessment and communication

Three Perspectives on Motivation and Multi-Criteria Assessment of Organic Food Systems

The complexity of values related to organic food systems is normally difficult to ascertain, understand and act upon for both producers and consumers, as well as for other agents. In this paper we have suggested MCA as a method that may help in coping with this complexity. Furthermore, we have pointed to the importance of addressing the challenge of motivation when designing such an MCA tool. In doing so, we have applied three very different concepts of motivation – an economic, a psycho-social and a relational concept. While they represent fundamentally different perspectives, by incorporating all three within a multi-perspective approach, we have been able to explore ’a broader array of relevant aspects of motivation when designing a MCA tool to be used by consumers when dealing with organic food issues. From an economic perspective, motivation is closely related to the buying situation and consumers’ need to choose between products. This stresses the importance of gaining a quick overview and of support in assessing the options. From a psycho-social perspective, the key point is to design the tool in a way that makes it possible for the consumer to include his or her experiences and specific lifeworld strategies in the assessment process. This highlights the importance of an MCA tool which enables users to influence and change criteria and values in decision-making and reflexive processes. Finally, from a relational perspective, motivation is a matter of social interaction and the tool should therefore be designed so as to allow dialogue between the agents involved in the value chain of the organic food system. Applying the three perspectives on motivation to the issue has proven the value of a multi-perspective approach and provided input qualifying the development of a prototype MCA tool for agents participating in the organic food system

Three Perspectives on Motivation and Multi-Criteria Assessment of Organic Food Systems

Abstract: The complexity of values related to organic food systems is normally difficult to ascertain, understand and act upon for both producers and consumers, as well as for other agents. In this paper we have suggested MCA as a method that may help in coping with this complexity. Furthermore, we have pointed to the importance of addressing the challenge of motivation when designing such an MCA tool. In doing so, we have applied three very different concepts of motivation -an economic, a psycho-social and a relational concept. While they represent fundamentally different perspectives, by incorporating all three within a multi-perspective approach, we have been able to explore 'a broader array of relevant aspects of motivation when designing a MCA tool to be used by consumers when dealing with organic food issues. From an economic perspective, motivation is closely related to the buying situation and consumers' need to choose between products. This stresses the importance of gaining a quick overview and of support in assessing the options. From a psycho-social perspective, the key point is to design the tool in a way that makes it possible for the consumer to include his or her experiences and specific lifeworld strategies in the assessment process. This highlights the importance of an MCA tool which enables users to influence and change criteria and values in decision-making and reflexive processes. Finally, from a relational perspective, motivation is a matter of social interaction and the tool should therefore be designed so as to allow dialogue between the agents involved in the value chain of the organic food system. Applying the three perspectives on motivation to the issue has proven the value of a multi-perspective approach and provided input qualifying the development of a prototype MCA tool for agents participating in the organic food system. Keywords: Multi-Criteria Assessment (MCA), Organic food, Motivation INTRODUCTION Organic food systems are based on a complex of value criteria that are often not explicitly considered when consumers, retailers, producers, journalists and other agents think, communicate and make decisions concerning organic food. Eco-labels are widely applied as a means to boil the many aspects down to clearly identifiable symbols offering agents a quick and simple way of coping with the complexity. However, this strong reduction in complexity opens for misconceptions and distrust: moreover, even when eco-labels are ascribed with trust, this trust can be threatened by changes in the mood and focus within the public sphere engendered by scandals and opposing messages. Many value criteria are involved in such systems and a structured method to guide reflections, communication and decision making is needed. It is therefore worth considering whether decision-making tools, designed especially to handle complex issues, might be applied to support agents considering issues of organic food

Synthesis, part of a Special Feature on Multicriteria Assessment of Food System Sustainability Three perspectives on motivation and multicriteria assessment of organic food systems

ABSTRACT. Organic food systems are based on a complex of value criteria that often are not explicitly considered when agents think, communicate, and make decisions concerning organic food. Multicriteria assessment (MCA) refers to a group of tools that help the user to tackle such highly complex issues. The question is how an MCA tool should be designed to facilitate reflections, communication, and decision making in relation to organic food systems. A key issue is motivation. There are several divergent theories of motivation, and the question cannot be adequately answered by using any single theory. We discuss an economic, a psychosocial, and a relational perspective on motivation and MCA. Using the example of a consumer assessing and choosing products in the supermarket, the economic conception of motivation offers a focus on decision-making processes. The psychosocial approach to motivation draws attention to the influence of cognitive structures and experience-based emotional drivers. Finally, the relational approach stresses that motivation is situated in the relations between agents. We discuss how the three perspectives converge and diverge regarding the purpose of using an MCA tool, the scope of the MCA, the strategic focus, and challenges and potentials associated with an MCA tool. Through this multiple-perspective approach, the general idea of MCA is expanded and elaborated to refine the design of an MCA tool for organic food systems

National clinical practice guidelines for the treatment of symptomatic gallstone disease: 2021 recommendations from the Danish Surgical Society

Background and objective:Gallstones are highly prevalent, and more than 9000 cholecystectomies are performed annually in Denmark. The aim of this guideline was to improve the clinical course of patients with gallstone disease including a subgroup of high-risk patients. Outcomes included reduction of complications, readmissions, and need for additional interventions in patients with uncomplicated gallstone disease, acute cholecystitis, and common bile duct stones (CBDS).Methods:An interdisciplinary group of clinicians developed the guideline according to the GRADE methodology. Randomized controlled trials (RCTs) were primarily included. Non-RCTs were included if RCTs could not answer the clinical questions. Recommendations were strong or weak depending on effect estimates, quality of evidence, and patient preferences.Results:For patients with acute cholecystitis, acute laparoscopic cholecystectomy is recommended (16 RCTs, strong recommendation). Gallbladder drainage may be used as an interval procedure before a delayed laparoscopic cholecystectomy in patients with temporary contraindications to surgery and severe acute cholecystitis (1 RCT and 1 non-RCT, weak recommendation). High-risk patients are suggested to undergo acute laparoscopic cholecystectomy instead of drainage (1 RCT and 1 non-RCT, weak recommendation). For patients with CBDS, a one-step procedure with simultaneous laparoscopic cholecystectomy and CBDS removal by laparoscopy or endoscopy is recommended (22 RCTs, strong recommendation). In high-risk patients with CBDS, laparoscopic cholecystectomy is suggested to be included in the treatment (6 RCTs, weak recommendation). For diagnosis of CBDS, the use of magnetic resonance imaging or endoscopic ultrasound prior to surgical treatment is recommended (8 RCTs, strong recommendation). For patients with uncomplicated symptomatic gallstone disease, observation is suggested as an alternative to laparoscopic cholecystectomy (2 RCTs, weak recommendation).Conclusions:Seven recommendations, four weak and three strong, for treating patients with symptomatic gallstone disease were developed. Studies for treatment of high-risk patients are few and more are needed.Endorsement:The Danish Surgical Society

National clinical practice guidelines for the treatment of symptomatic gallstone disease: 2021 recommendations from the Danish Surgical Society

Background and objective:Gallstones are highly prevalent, and more than 9000 cholecystectomies are performed annually in Denmark. The aim of this guideline was to improve the clinical course of patients with gallstone disease including a subgroup of high-risk patients. Outcomes included reduction of complications, readmissions, and need for additional interventions in patients with uncomplicated gallstone disease, acute cholecystitis, and common bile duct stones (CBDS).Methods:An interdisciplinary group of clinicians developed the guideline according to the GRADE methodology. Randomized controlled trials (RCTs) were primarily included. Non-RCTs were included if RCTs could not answer the clinical questions. Recommendations were strong or weak depending on effect estimates, quality of evidence, and patient preferences.Results:For patients with acute cholecystitis, acute laparoscopic cholecystectomy is recommended (16 RCTs, strong recommendation). Gallbladder drainage may be used as an interval procedure before a delayed laparoscopic cholecystectomy in patients with temporary contraindications to surgery and severe acute cholecystitis (1 RCT and 1 non-RCT, weak recommendation). High-risk patients are suggested to undergo acute laparoscopic cholecystectomy instead of drainage (1 RCT and 1 non-RCT, weak recommendation). For patients with CBDS, a one-step procedure with simultaneous laparoscopic cholecystectomy and CBDS removal by laparoscopy or endoscopy is recommended (22 RCTs, strong recommendation). In high-risk patients with CBDS, laparoscopic cholecystectomy is suggested to be included in the treatment (6 RCTs, weak recommendation). For diagnosis of CBDS, the use of magnetic resonance imaging or endoscopic ultrasound prior to surgical treatment is recommended (8 RCTs, strong recommendation). For patients with uncomplicated symptomatic gallstone disease, observation is suggested as an alternative to laparoscopic cholecystectomy (2 RCTs, weak recommendation).Conclusions:Seven recommendations, four weak and three strong, for treating patients with symptomatic gallstone disease were developed. Studies for treatment of high-risk patients are few and more are needed.Endorsement:The Danish Surgical Society