Health and wellbeing in refugee families from Syria resettled in Denmark.

Aims: The aim was to evaluate self-reported health status and wellbeing in a well-defined group of refugee families from Syria 2-4 years after resettlement in Denmark, and, where possible, compare it with a Danish reference population. The purpose was to determine the need for specialized health care to resettled refugees. Methods: This cross-sectional study involved 90 individuals from Syria aged 13-56 years. We used questionnaire survey to assess the general health and wellbeing in the study population in relation to a Danish reference population. Objective measurements of selected health indicators like overweight, hypertension and levels of cholesterol and blood glucose (HbA1c) were also determined for the study population. Results: Mean wellbeing scores and the proportion of study participants rating their health as good were lower among the study participants compared with the Danish population for all age groups. The proportion of participants who reported often being alone against their will was significantly higher than among Danes, as was the proportion who had nobody to talk to when having problems. A significantly higher proportion of participants experienced various forms of pain or discomfort than in the Danish population. Overall, 23.6% and 3.4% of participants had elevated cholesterol and HbA1c levels, respectively, and the prevalence of overweight (BMI ≥ 25) was 70%. Hypertension was more frequent (16.2%) than in another refugee population in Denmark (9%). Conclusions: The study demonstrated various mental and physical health challenges among the Syrian refugee families, and their health and wellbeing appeared to be substantially poorer as compared to the Danish reference population. The findings emphasize the need for systematic and specialized health care services at a municipality level to resettling refugees as a prerequisite for the refugees to become contributing citizens.

Reliability of the Wii Balance Board for measurement of steady state balance in children aged 6-9 years.

PURPOSE: The Wii Balance Board (WBB) can be used for assessment of steady state balance (SSB), but its reliability has not been studied in children aged 6-9 years. This study aimed to determine the test-retest reliability of the WBB for measuring SSB in this population. A secondary aim was to determine the minimum detectable change (MDC) and standard error of measurement (SEM) of the WBB in children aged 6-9 years. METHODS: 52 children between 6-9 years of age participated. "One leg stand balance" was used to assess center of pressure velocity (COPV) and center of pressure area (COPA) on three occasions by the same tester. Two tests were conducted on the same day (Day 1) and the third test was performed on another day (Day 2), with a period of 5-13 days between the two test days. Intraclass correlation coefficient (ICC 3,1), SEMs, and MDC were calculated. RESULTS: Intra-day test-retest reliability of COPA was found to be good (ICC3,1 =0.86; 95% confidence interval [CI]: 0.75, 0.92) and that of COPV was also found to be good (ICC3,1 =0.87; 95% CI: 0.77, 0.92). Inter-day test-retest reliability was found to be good for COPA (ICC3,1 = 0.87; 95% CI: 0.75, 0.93) and COPV (ICC3,1 = 0.89; 95% CI: 0.81, 0.94). SEM for COPA in intra-day testing was 18.90 mm2 (15.78%), and in inter-day testing it was 16.44 mm2 (13.61%). SEM for COPV in intra-day testing was 1.12 mm/s (7.6%), and in inter-day testing it was 1.01 mm/s (6.9%). MDC for COPA in intra-day testing was 52.41mm2 (42.75%), and in inter-day testing was 45.58 mm2 (35.75%). MDC for COPV in intra-day testing was 3.11 mm/s (21.2%), and in inter-day testing it was 2.80 mm/s (18.9%). CONCLUSION: The WBB has good test-retest reliability for assessing SSB of children between 6-9 years. COPA measurements appear to be less sensitive to clinical changes in SSB when compared to COPV. Assessment of validity of the WBB in this age group is recommended before it can be considered as a potential balance assessment tool in children.

Dementia-friendliness - Inclusion or exclusion: A critical discourse analysis.

This article explores how individuals with dementia and their relatives discursively construct dementia-friendliness in a situation where different definitions of this term exists. Thirteen semi-structured interviews were conducted, including seven individual interviews with people living with dementia. The remaining six interviews consisted of three interviews with the relatives of a person with dementia and three with married couples of which one were diagnosed with dementia. Notes taken by the first author during 6 months of fieldwork at a day centre and a drop-in centre for people with dementia and their families were used to supplement the interviews. Critical discourse analysis provides an analytical tool for revealing the discourses constructing dementia-friendliness. The analysis revealed that people with dementia and their relatives draw on the three discourses of sameness, security and care and autonomy during their attempts to construct dementia-friendliness. The ensuing discursive battles over dementia-friendliness appear to constitute a tightrope walk between the inclusion and exclusion of people with dementia, which underscores the importance of including the voices of people living with dementia when dementia-friendly initiatives and communities are developed.

Patient-centeredness in Physiotherapy - A literature mapping review.

BACKGROUND AND PURPOSE: Research on patient-centeredness within physiotherapy points to a need for clarification about what the concept entails in science and practice and how research positions itself within health care. Thus, the aim is to systematically map the characteristics of research on patient-centeredness in physiotherapy and critically discuss the dominant understandings within. METHODS: A systematic research mapping was carried out, based on searches in leading bibliographic databases. Four categories were selected in order to characterize the research field: focus, design, theoretical approach and inherent logic. FINDINGS: Of 5,324 studies, 101 were included in the final mapping, pointing to a limited amount of research. The papers included were published in 47 different journals. Two major research foci emerges: one testing or developing technologies (tools) to promote patient-centeredness and one exploring patients' or professionals' experiences related to physiotherapy practice. Most papers reported on empirical research and there seems to be a dearth of conceptual papers. The theoretical approaches applied were mainly psychological, pedagogical and biomedical. The papers included were divided into equal amounts of studies carried out within inherent logics of causality and complexity. CONCLUSION: The mapping suggests an incipient awareness of patient-centeredness within the research field of physiotherapy. Empirical studies dominate the field, whereas conceptual and critical papers seem in need of wider acknowledgment. The research field is divided into two mutually disconnected trends: one concerned with understanding the complexity of clinical practice and patients' experiences of treatment and illness, and another trend concerned with solving "the problem" of patient involvement.

Dementia-Friendliness in Danish and International Contexts: A Critical Discourse Analysis.

BACKGROUND AND OBJECTIVES: Initiatives to create dementia-friendly environments are subject to political attention all over the world. As the interpretation of dementia-friendliness is influenced by current cultural trends, the concept is highly ambiguous. The present study aims to explore how discourses concerning dementia-friendliness are manifested in Danish and international policy documents and how they interact internationally. RESEARCH DESIGN AND METHODS: Inspired by Fairclough's critical discourse approach, 21 policy documents were analyzed to reveal how power is exerted through language and the discursive construction. RESULTS: We identified 5 types of discourses, namely, those concerning the domains of socioeconomy, rehabilitation, knowledge, responsibility, and a good life. Dementia-friendliness was found to be embedded in an overall ideology aimed toward supporting the individual's autonomy in life and health choices and their participation in society. DISCUSSION AND IMPLICATIONS: Our analysis furthermore suggests that dementia-friendly initiatives are used collectively as a lever to achieve these policy aims to ultimately compensate for and protect people with dementia against the consequences of the loss of competencies, identity, and control. Thus, to develop and establish sustainable dementia-friendly environments and communities that meet the needs of people living with dementia, we need to be aware of and discuss the implications of the discourses constructing dementia-friendliness and their influence on the appearance of dementia-friendliness in society.

Dementia-friendliness - A matter of knowledge, responsibility, dignity, and illusion.

Worldwide, dementia-friendly initiatives are being developed primarily based on and driven by political strategies. Health professionals, local government officials, and initiators alike are working to create dementia-friendly communities, but little is known about how professionals discursively construct dementia-friendliness and how their various interpretations affect current practices in the field. This study aimed to explore how those involved in establishing dementia-friendly initiatives, nursing homes, and dementia villages ascribe meaning to and construct dementia-friendliness. Three focus groups were conducted, including two with five health professionals each from two nursing homes for people with dementia and one with seven initiators involved in the development and establishment of nursing homes and dementia villages. We further conducted a small-group interview with a consultant and a project worker representing a local authority. Seeing dementia-friendliness as a discursive construction, we conducted a critical discourse analysis, taking inspiration from the work of Norman Fairclough. The surveyed professionals reported relying on knowledge, responsibility, dignity, and illusion discourses to construct dementia-friendliness. Our results also indicated that the construct of dementia-friendliness fosters discursive battles indicated by dilemmas concerning the adequate and dignified treatment of people with dementia and health professionals' critical stances toward the construct of dementia-friendliness.

The conditions of possibilities for recovery: A critical discourse analysis in a Danish psychiatric context.

AIMS AND OBJECTIVES: This paper explores the conditions for the possibilities of recovery in a Danish mental healthcare practice, expressed from the perspective of nurses. The results and discussion of the study help to make visible and explore the muddle of conceptualisations of recovery in mental healthcare practice. BACKGROUND: Few studies examine the possibilities of recovery for inpatients and outpatients in mental health centres from a nursing perspective. DESIGN: A qualitative design using a critical social constructionist frame of understanding, in which the real world is considered as a series of social constructions. METHOD: A Fairclough-inspired critical discourse analysis was chosen as the analytical strategy. The analysis is comprised of ten interviews in mental health care and notes, written by nurses, in medical records of ten patients with a mental illness admitted to a mental healthcare centre in 2016-2017. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline to secure accurate and complete reporting of the study (See Appendix S1). RESULTS: From the findings of the textual analysis and the analysis of the discourse practice, it seems clear that the social relations and structures relating to recovery in Danish psychiatry are steered and controlled by discourses that reflect, in general terms, the essence of the core of neoliberal ideology. CONCLUSION: Recovery is generally articulated from an overall discourse of neoliberalism with its embedded discourses of paternalism, biomedicine, self-care and holism. All these discourses coexist in nursing practice, but the paternalistic discourse becomes the framework for the conditions for the possibility of how recovery is expressed in practice. RELEVANCE TO CLINICAL PRACTICE: Nurses need to be supported to seek clarity in the understanding and operationalisation of a recovery-oriented approach, if the agenda is to be truly adopted and strengthened.

Patient participation as discursive practice-A critical discourse analysis of Danish mental healthcare.

Patient participation is one of the most prevalent focus areas in the Danish healthcare debate. Patient participation is generally presented as a fundamental democratic right, and is stated in an objective language with legal requirements for healthcare professionals to ensure that patients systematically participate in their own courses of care and treatment. In the research literature, it is not clear what is meant by 'patient participation', and several discourses on patient participation exist side by side. This study explores how discourses of patient participation unfold and are at play in the articulations in official legal and political documents and patient records relating to a Danish psychiatric context. The documents and patient records have been analyzed using a Fairclough-inspired critical discourse approach which is concerned with how power is exercised through language. The research findings show that patient participation within Danish psychiatric healthcare is governed within a neoliberal discourse where underlying discourses; discourse of biomedicine, paternalism, management, evidence and ethics of care are embedded, and a discourse that seems to ascribe stigmatizing traits to mentally ill patients.

Discourses in stroke rehabilitation as they present themselves in current physiotherapy and occupational therapy.

Aim This study aims to discuss current perceptions of rehabilitation and how present rehabilitation practice is affected by dominating discourses in Danish society by exploring discourses expressed in official publications and the constructed journal notes of occupational and physiotherapists' practice of stroke rehabilitation. Method The frame of reference is Fairclough's critical discourse analysis. The analysis comprises seven official documents relevant to stroke rehabilitation provided in Danish health services in 2012-2013. Also, notes written by occupational therapists and physiotherapists in medical records of 10 patients with a stroke diagnosis admitted to hospital in 2012. The documents included were read thoroughly. The texts were analyzed deductively, focusing on discursive practice on articulated understandings of rehabilitation, health practice approaches, and social practice. Results The dominating discourses seem to be Western neoliberalism organizational, medical and ethical discourses. The macro level of discourses consisted of political documents addressing rehabilitation nationally. The meso level mainly concerned medical discourses within stroke rehabilitation whereas the micro level represented local medical and ethical discourses. Conclusion The neoliberal discourse supports the medical discourse with strong emphasis on evidence-based interventions. In contrast to ethical discourses, documentation of rehabilitation practice marked more attention being paid to facilitating the patient's independence than to enabling the regaining of meaningful activities and participation. Implications for Rehabilitation Individualized rehabilitation must be organized with flexibility as it is a complex process Critical reflectiveness among health professionals is needed to provide individualized rehabilitation of high quality A broader range of stake holders, including patient organizations, are in demand within health policy making The discourses that construct rehabilitation policy and practices are sometimes in conflict, which may impact on, and impede, the rehabilitation for the individual patient.

Physiotherapy as a disciplinary institution in modern society - a Foucauldian perspective on physiotherapy in Danish private practice.

In many Western countries, physiotherapy in a private context is practiced and managed within a neoliberal ideology. Little is known about how private physiotherapeutic practice functions, which is why this study aims to explore how physiotherapy is practiced from the perspective of physiotherapists in Danish private practice, within a Foucauldian perspective. This study consisted of 21 interviews with physiotherapists employed in private practice and observation notes of the clinic. Interviews and observation notes were analyzed through the lens of Foucault's concepts of discipline, self-discipline, power and resistance. Three categories were constructed: (1) the tacit transition from person to patient; (2) the art of producing docile bodies; and (3) the inhibition of freedom of action by practicing in private homes. From a Foucauldian perspective, private physiotherapeutic practices have a disciplinary function in modern society as the physiotherapists produce docile bodies through disciplinary technologies, whereby their business becomes profitable. Most patients support the physiotherapists' "regime of truth" but if they resist, they are either excluded or accepted as "abnormal" but as a necessary source of income. The physiotherapists appear to be unconscious of the bio-powers working "behind their backs" as they are subject to the Western medical logic, and the neoliberal framework that rules their businesses.

Client involvement in home care practice: a relational sociological perspective.

'Client involvement' has been a mantra within health policies, education curricula and healthcare institutions over many years, yet very little is known about how 'client involvement' is practised in home-care services. The aim of this article is to analyse 'client involvement' in practise seen from the positions of healthcare professionals, an elderly person and his relative in a home-care setting. A sociologically inspired single case study was conducted, consisting of three weeks of observations and interviews. The study has a focus on the relational aspects of home care and the structural, political and administrative frames that rule home- care practice. Client involvement is shown within four constructed analytical categories: 'Structural conditions of providing and receiving home care'; 'Client involvement inside the home: performing a professional task and living an everyday life'; 'Client involvement outside the home: liberal business and mutual goal setting'; and 'Converting a home to a working place: refurnishing a life'. The meaning of involvement is depending on which position it is viewed from. On the basis of this analysis, we raise the question of the extent to which involvement of the client in public home-care practice remains limited.

Practicing physiotherapy in Danish private practice: an ethical perspective.

Despite an increasingly growth of professional guidelines, textbooks and research about ethics in health care, awareness about ethics in Danish physiotherapy private practice seen vague. This article explores how physiotherapists in Danish private practice, from an ethical perspective, perceive to practice physiotherapy. The empirical data consists of interviews with twenty-one physiotherapists. The interviews are analysed from a hermeneutic approach, inspired by Ricoeur's textual interpretation of distanciation. The analysis follows three phases: naïve reading, structural analysis and comprehensive analysis. Four main themes are constructed: Beneficence as the driving force; Disciplining the patient through the course of physiotherapy; Balancing between being a trustworthy professional and a businessperson; The dream of a code of practice. Private practice physiotherapy is embedded in a structural frame directed by both political and economical conditions that shape the conditions for practicing physiotherapy. It means that beneficence in practice is a balance between the patient, the physiotherapists themselves and the business. Beneficence towards the patient is expressed as an implicit demand. Physiotherapeutic practice is expressed as being an integration of professionalism and personality which implies that the physiotherapists also have to benefit themselves. Private practice seems to be driven by a paternalistic approach towards the patient, where disciplining the patient is a crucial element of practice, in order to optimise profit. Physiotherapists wish for a more beneficent practice in the future by aiming at bridging 'to be' and 'ought to be'.

Ethical issues in physiotherapy--reflected from the perspective of physiotherapists in private practice.

BACKGROUND: An important aspect of physiotherapy professional autonomy is the ethical code of the profession, both collectively and for the individual member of the profession. The aim of this study is to explore and add additional insight into the nature and scope of ethical issues as they are understood and experienced by Danish physiotherapists in outpatient, private practice. METHODS: A qualitative approach was chosen and semi-structured interviews with 21 physiotherapists were carried out twice and analyzed, using a phenomenological hermeneutic framework. RESULTS: One main theme emerged: The ideal of being beneficent toward the patient. Here, the ethical issues uncovered in the interviews were embedded in three code-groups: 1) ethical issues related to equality; 2) feeling obligated to do one's best; and 3) transgression of boundaries. CONCLUSIONS: In an ethical perspective, physiotherapy in private practice is on a trajectory toward increased professionalism. Physiotherapists in private practice have many reflections on ethics and these reflections are primarily based on individual common sense arguments and on deontological understandings. As physiotherapy by condition is characterized by asymmetrical power encounters where the parties are in close physical and emotional contact, practiced physiotherapy has many ethical issues embedded. Some physiotherapists meet these issues in a professional manner, but others meet them in unconscious or unprofessional ways. An explicit ethical consciousness among Danish physiotherapists in private practice seems to be needed. A debate of how to understand and respect the individual physiotherapist's moral versus the ethics of the profession needs to be addressed.

The perceptions of Danish physiotherapists on the ethical issues related to the physiotherapist-patient relationship during the first session: a phenomenological approach.

BACKGROUND: In the course of the last four decades, the profession of physiotherapy has progressively expanded its scope of responsibility and its focus on professional autonomy and evidence-based clinical practice. To preserve professional autonomy, it is crucial for the physiotherapy profession to meet society's expectations and demands of professional competence as well as ethical competence. Since it is becoming increasingly popular to choose a carrier in private practice in Denmark this context constitutes the frame of this study. Physiotherapy in private practice involves mainly a meeting between two partners: the physiotherapist and the patient. In the meeting, power asymmetry between the two partners is a condition that the physiotherapist has to handle. The aim of this study was to explore whether ethical issues rise during the first physiotherapy session discussed from the perspective of the physiotherapists in private practice. METHODS: A qualitative approach was chosen and semi-structured interviews with 21 physiotherapists were carried out twice and analysed by using a phenomenological framework. RESULTS: Four descriptive themes emerged: general reflections on ethics in physiotherapy; the importance of the first physiotherapy session; the influence of the clinical environment on the first session and; reflections and actions upon beneficence towards the patient within the first session. The results show that the first session and the clinical context in private practice are essential from an ethical perspective. CONCLUSIONS: Ethical issues do occur within the first session, the consciousness about ethical issues differs in Danish physiotherapy private practice, and reflections and acts are to a lesser extent based on awareness of ethical theories, principles and ethical guidelines. Beneficence towards the patient is a fundamental aspect of the physiotherapists' understanding of the first session. However, if the physiotherapist lacks a deeper ethical awareness, the physiotherapist may reason and/or act ethically to a varying extent: only an ethically conscious physiotherapist will know when he or she reflects and acts ethically. Further exploration of ethical issues in private practice is recommendable, and as management policy is deeply embedded within the Danish public sector there are reasons to explore public contexts of physiotherapy as well.