Adjudications and tinkering with care for socially vulnerable patients with type 2 diabetes in general practice.

OBJECTIVE: To analyse the mechanisms at play in the adjudications made by professionals and socially vulnerable patients with type 2 diabetes about their eligibility for care. DESIGN, SETTING AND SUBJECTS: The study included 14 patients and 10 health professionals in seven general practice surgeries in deprived areas in Greater Copenhagen. The study data consist of 17 semi-structured interviews with patients and 22 with health professionals immediately after observation of 23 consultations. Our analytical approach was inspired by Systematic Text Condensation and the concept of 'candidacy' for access to health care. RESULTS: Adjudications of patients not being candidates for services were common, but we also found that both patients and health professionals worked to align the services to the needs of the patients. This could include using services differently than was intended by the providers or by changing routines to make it easier for patients to use the services. We discuss these processes as 'tinkering'. This usually implies that the best individual solution for the patient is aimed for, and in this study, the best solution sometimes meant not focusing on diabetes. CONCLUSION: The study adds to existing knowledge about access to services for socially vulnerable patients by demonstrating that both patients and professionals in general practice engage in tinkering processes to make services work.

Unequal use and benefits of health services play a significant role in relation to social inequality in healthFlexibility in services and alternatives to school-like rehabilitation are needed to reduce inequality in access to health carePatients were sometimes judged as unsuitable for available routine services, but professionals 'tinkered' with services to make them fitAdaptation of services by professionals in general practice implies a longer time frame for obtaining goals.

A Data-Political Spectacle: How COVID-19 Became A Source of Societal Division in Denmark.

The COVID-19 pandemic has been a data-political spectacle. Data are omnipresent in prediction and surveillance, and even in resistance to governmental measures. How have citizens, whose lives were suddenly governed by pandemic data, understood and reacted to the pandemic as a data-political phenomenon? Based on a study carried out in Denmark, we show how society became divided into those viewing themselves as supporters of the governmental approach to the COVID-19 pandemic, and those who oppose it. These groups seem to subscribe to very different truths. We argue, however, that both sides share a positivist ideal and think that data and facts ought to rule. Both sides have also come to acknowledge that data are not unambiguous, and both cast increasing doubts on political uses of data. Though the people agreeing with, and the people opposing, the government strategy are in many ways surprisingly similar with respect to epistemic norms, they differ in what they perceive as dangerous or desirable, and in who they believe are telling the "truth" about the pandemic. These different perceptions result in different types of pandemic-related activism. Resistance against restrictions is often understood as inspired by conspiracy theories and in some countries anti-restrictions activism has turned violent. In our case, however, we suggest that when looking at similarities and differences across both groups, the gap between those opposing and those agreeing with the government approach is not as unbridgeable as might be suggested by their beliefs in differing truths and the emerging societal division.

Socioeconomic position and the risk of spontaneous abortion: a study within the Danish National Birth Cohort.

OBJECTIVES: To investigate the relationship between different indicators of socioeconomic position and the risk of spontaneous abortion. DESIGN: Cohort study. SETTING: 1996-2002, Denmark. PARTICIPANTS: All first time participants, a total of 89 829 pregnant women, enrolled in the Danish National Birth Cohort were included in the present study. Overall, 4062 pregnancies ended in spontaneous abortion. Information on education, income and labour market attachment in the year before pregnancy was drawn from national registers. MAIN OUTCOME MEASURE: Spontaneous abortion, that is, fetal death within the first 22 weeks of pregnancy, was the outcome of interest. The authors estimated HRs of spontaneous abortion using Cox regression analysis with gestational age as the underlying time scale. RESULTS: Women with <10 years of education had an elevated risk of spontaneous abortion when compared with women with >12 years of education (HR 1.19 (95% CI 1.05 to 1.34)). The HR estimates for the four lowest income quintiles were all increased (HRs between 1.09 and 1.15) as compared with the upper quintile but did not differ considerably from each other. In general, no statistically significant association was found between labour market attachment and the risk of spontaneous abortion; however, the group of women on disability pension had an increased HR of spontaneous abortion when compared with women who were employed (HR 1.32 (95% CI 0.82 to 2.13)). CONCLUSIONS: Educational level and income were inversely associated with the risk of spontaneous abortion. As these factors most likely are non-causally related to spontaneous abortion, the findings indicate that factors related to social position, probably of the environmental and behavioural type, may affect spontaneous abortion risk. The study highlights the need for studies addressing such exposures in order to prevent spontaneous abortions.