'It is only a pinprick': (or is it?): childhood vaccinations in general practice as 'matter out of place'.

The analysis presented in this paper is part of a larger study, the aim of which is to describe the GPs' everyday taken-for-granted working life. The study is based on multi-sited anthropological fieldwork in Danish general practices. This paper analyses consultations where children are vaccinated and the analysis shows the way these consultations differ from other consultations in relation to flow and communication. Neither parents nor doctors question the value of the vaccination, but the manner in which they talk about it and handle it in the flow of the consultation points to them experiencing it as being problematic. Taking inspiration from Mary Douglas' theory on cultural classification the injection is interpreted as 'matter out of place'. The analysis identifies the infliction of pain and the discomfort this brings to the doctor and the parent as problematic as well as a breach of the doctor-patient relationship. The aim of vaccination is to prevent potential diseases in the future, but its function in the consultation, besides being fulfilment of national guidelines, is not immediately apparent. It has no real function in the consultation and this makes it problematic in the present, causing the ambiguity that both doctors and parents express.

Patient-generated aspects in oral rehabilitation decision making. II. Comparison of an individual systematic interview method and the oral health impact profile.

PURPOSE: The effect of impaired oral functions is best described by the patient, and a shift toward a patient-oriented decision-making process in oral rehabilitation is evident. The Oral Health Impact Profile-49 (OHIP-49) questionnaire has been the most commonly used method to measure oral health-related quality of life (OHRQoL) in dentistry. An individualized method, the Schedule for the Evaluation of Individual Quality of Life-Direct Weighing (SEIQoL-DW), has proven to fulfill most of the criteria for a method to assist in the decision-making process. The purpose of this study was to compare the ability of the OHIP-49 questionnaire and the SEIQoL-DW method in measuring OHRQoL and generating useful information for decision making in oral rehabilitation. MATERIALS AND METHODS: Sixty participants in need of oral rehabilitation were enrolled in the study. Patients received a clinical examination, were interviewed using the SEIQoL-DW, filled out the OHIP-49 questionnaire, and answered two global oral health-rating questions. RESULTS: The SEIQoL-DW generated additional information compared to the OHIP-49. The information was more oral- and treatment-specific, including consultation issues and the patient-practitioner relationship. The overall SEIQoL-DW and OHIP-49 scores were significantly correlated. The OHIP-49 and SEIQoL-DW scores were related to oral health subjectively. CONCLUSIONS: The SEIQoL-DW method proved a useful aid in clinical decision making for oral rehabilitation. The SEIQoL-DW was more appropriate for generating information useful for decision making than measuring OHRQoL; the OHIP-49 was more appropriate for measuring OHRQoL than generating information.

How cancer survivors experience their changed body encountering others.

BACKGROUND: Psychosocial cancer research illustrates how women treated for breast cancer experience physical changes in their bodies and the way they perceive, that, others see their body. But how patients with other types of cancer have experienced changes in their bodies and how this affects their relationship with others is less researched. OBJECTIVES: To explore how cancer survivors with different types of cancer and cancer treatment, experience and handle their changed body, especially when meeting others, and how this influences their everyday life of survivorship, i.e. long after treatment has been completed. METHODS: Participant observation at a Cancer Rehabilitation Centre (CRC). Of the observed participants 23 were selected and interviewed twice. RESULTS: Many participants had a changed body due to the cancer and its treatment. When the cancer survivors meet others they experience that their changed body means that they are avoided, looked at in specific ways, or greeted with a specific compliment. The verbal and nonverbal language that the cancer survivors are met with indicates the existence of a specific discursive aesthetic in relation to the disease and the changed body. This discursive aesthetic represents a silence and secrecy about cancer, which makes it impossible for survivors to talk about their experiences with cancer and a changed body. CONCLUSION: The changed body not only represents the physical sign of cancer, it also represents the social presence and representation of cancer. The analysis gives an insight into general questions of meaning related to the changed body in late modernity.

The meaning of work and working life after cancer: an interview study.

BACKGROUND: Cancer survivors have diverse and complex patterns of return to work, but little attention has been given to individual experiences of returning to work. OBJECTIVES: To analyse the meaning of work and working life for cancer survivors over time. METHODS: Participant observation was carried out at a cancer rehabilitation centre. A total of 23 participants were interviewed twice. RESULTS: Cancer survivors try to get back to work after treatment and try to re-establish their former structure of everyday-life that is seen as a normal and healthy existence. Work contributes to creating the individual as a social being, partaking in social relations with others. Work plays a role in establishing the individual's identity. It is difficult for many to resume work. When they are unable to work, they establish new activities in everyday-life that give meaning to a life. In order to understand the cultural meaning of work in capitalist society, we incorporate the theoretical perspective of Max Weber. CONCLUSION: Those who after cancer treatment are unable to work lose a part of their identity; they lose the personal challenge and satisfaction related to work. They are no longer part of the companionship related to work. Having had cancer means a disruption of the structure of everyday-life that is taken for granted.

Factors influencing GPs' choice between drugs in a therapeutic drug group. A qualitative study.

OBJECTIVE: To explore how GPs choose between drugs in a therapeutic drug group. DESIGN: A qualitative study based on semi-structured ethnographic interviews. SETTING AND SUBJECTS: General practitioners from the counties of both Funen and West Zealand in Denmark. A total of 15 general practitioners (GPs) were selected with reference to variation in organizational structure, age, and gender. MAIN OUTCOME MEASURES: GPs' description of drug choice in relation to specific patient encounters involving a prescription. RESULTS: All informants appeared to consider drug price important as it was a recurring theme during all interviews. External factors outside the GP's control such as governmental regulation on prescribing and the pharmaceutical industry influenced most GPs. Internal factors related to the actual consultation included characteristics of the GP and the patient, drug characteristics, and repeat prescriptions. These factors interact in a non-linear and unpredictable way similar to complex adaptive systems. CONCLUSION: GPs balance both internal and external factors when choosing between analogues. Drug choice is a regulated process in the realm of complex prescribing behaviour with drug costs as a major factor.

Cancer survivors' experience of time: time disruption and time appropriation.

AIM: This paper reports a study to explore how cancer survivors talk about, experience and manage time in everyday life. BACKGROUND: There is an increasing interest in specific physical and psychosocial aspects of life after cancer diagnosis and treatment, but hardly any research follows cancer survivors over time to explore how perceptions and experiences change. METHODS: An exploratory study was carried out in 2002-2004 with a purposive sample of adults who had experienced various forms of cancer. Data collection included 9 weeks of participant observation at a Cancer Rehabilitation Centre and ethnographic interviews with 23 informants. Ten men and 13 women were interviewed twice: 2 weeks after their stay and 18 months later. FINDINGS: Data were analysed from a culture-analytical perspective. Three main themes regarding the survivors' handling and perception of time were found: (1) cancer disrupts time and life; (2) awareness of time increases, time is verbalized and reflected; and (3) the informants appropriate time. A diagnosis of cancer, even for a survivor, means a confrontation with death. It means a disruption of continuous clock and calendar time. Survivors appropriate time, and prioritize how and with whom they want to spend their time. CONCLUSION: With an increasing number of people being cured following a cancer diagnosis, nurses and oncology nurse specialists who work with cancer survivors must be aware of the fact that time is a central theme in understanding cancer survivors' lives, and they must know how to guide these survivors in their new lives and take care of their well-being.

Los Naturistas-Healers Who Integrate Traditional and Biomedical Explanations in Their Treatment in the Bolivian Health Care System.

Medical pluralism is a common feature in most health care systems. In this system integration and exchanges between sectors are common, thus forming complex and hybrid systems. This paper analyses such a pluralistic system, and is based on an anthropological study involving participant observation and ethnographic interviews. The research focuses on a group of healers-Los Naturistas from urban Bolivia. They are Mestizos and serve the Indian and Indian Mestizo population. The study findings suggest they integrate explanatory models from both the traditional Andean medicine and biomedicine, but are selective in the sicknesses they treat. They predominantly use herbal medicine. As a group of healers Los Naturistas are establishing their specific place in the Bolivian health care system.

The patient's perspective: a qualitative study of acute myeloid leukaemia patients' need for information and their information-seeking behaviour.

In recent years there has been an increased focus on cancer patients' information needs. The majority of the studies have led to the conclusion that most patients want as much information as possible about their disease and treatment. These studies have been large survey studies, and most of the patients enrolled in them have been out-patients. Very little is known about the information needs of severely ill cancer patients being treated as in-patients-such as those with acute myeloid leukaemia (AML). As part of a larger study dealing with AML patients' illness narratives, this work describes the information needs from the patients' perspective and their information-seeking behaviour. In-depth ethnographic interviews were conducted with each of 21 patients on two occasions: at the time of diagnosis and again 2-5 months later. Most patients did not recall much information from the time of diagnosis, except the diagnosis itself and the feelings it had aroused in them. All patients had basic medical knowledge about their disease. However, many patients-especially the elderly-expressed no need to receive further medical details about their disease. Avoiding information, in particular about the prognosis, was explained as a strategy to maintain hope. Most patients attached more importance to information about problems affecting their everyday life and how other persons had coped with their illness. They did not seek medical information on their own, although especially younger patients expressed the feeling that they "ought" to do this. There was a discrepancy between their expressed attitudes regarding the need for medical information in general and their actual information-seeking behaviour. Being informed and seeking information are discussed as society's expectations of today's cancer patient.