Imagining a post-antibiotic era: a cultural analysis of crisis and antibiotic resistance.

The study presented in this article is about the role played by imagination when national and international organisations convey the idea of a dystopian crisis involved in the real transition to a postantibiotic era. The present is an era that can be defined as a time when no new antibiotics are discovered or developed, and existing antibiotics simultaneously become less effective since bacteria develop resistance against the active substances. Today, antibiotic resistance is an international fact; thousands of people die every year in Europe and the USA as a result of bacteria that have become resistant. Then, imagination can conjure up a different and a much more dystopian future. This article stems from a public debate concerning the global increase of antibiotic resistance; and will examine how the concept of fantasy and imagination is central in picturing such a future crisis in society. The article's empirical basis mainly consists of reports from global and Swedish organisations, dating from the 1990s and onwards. These fantasies show that our society has a strong urge to always try to understand and explain present time and to identify how 'our' era relates to the past as well as the future. The concept of crisis plays an important role in these fantasies, it is key to use it when thinking about change. The analysis builds on texts and illustrations from global organisations like the WHO and also national authorities in Sweden that aim to convey the science behind the challenge. The aim is to develop a theoretical and empirical understanding, from the perspective of cultural analysis, of how fantasy and crisis are linked when the future is conceived.

Social Work Responses to Domestic Violence During the COVID-19 Pandemic: Experiences and Perspectives of Professionals at Women's Shelters in Sweden.

This study explores how social work professionals at women's shelters in Sweden experience, understand, and are responding to domestic violence under the impact of the COVID-19 pandemic. A qualitative longitudinal research design was employed, and multiple semi-structured interviews were conducted with 14 professionals at women's shelters over a period of one year. The results are presented in three overall themes; (a) professional challenges due to increased needs, (b) professionals' adjustments to new circumstances, and (c) professionals' attributions regarding client barriers to help seeking. The results show diverse and changing experiences among the professionals as the pandemic progressed. Clients and professionals have shared the same collective trauma associated with the pandemic, which has affected the professionals' understanding of and response to domestic violence. The professionals understand both clients and themselves as being more vulnerable and susceptible to risk under these new circumstances. Social work adjustments focused on maintaining contact, reducing risk and prioritizing safety, which had both positive and negative consequences for both clients and professionals. The study concludes that the professionals coped with the uncertainty they experienced during the pandemic by relying on both their previous knowledge and work experience of domestic violence and their experience of sharing trauma with clients.

Socio-economic disparities in the dispensation of antibiotics in Sweden 2016-2017: An intersectional analysis of individual heterogeneity and discriminatory accuracy.

Aims: Antimicrobial resistance presents an increasingly serious threat to global public health, which is directly related to how antibiotic medication is used in society. Actions aimed towards the optimised use of antibiotics should be implemented on equal terms and according to the needs of the population. Previous research results on differences in antibiotic use between socio-economic and demographic groups in Sweden are not entirely coherent, and have typically focused on the effects of singular socio-economic variables. Using an intersectional approach, this study provides a more precise analysis of how the dispensation of antibiotic medication was distributed across socio-economic and demographic groups in Sweden in 2016-2017. Methods: Using register data from a nationwide cohort and adopting an intersectional analysis of individual heterogeneity and discriminatory accuracy, we map the dispensation of antibiotics according to age, sex, country of birth and income. Results: While women and high-income earners had the highest antibiotic dispensation prevalence, no large differences in the dispensation of antibiotics were identified between socio-economic groups. Conclusions: Public-health interventions aiming to support the reduced and optimised use of antibiotics should be directed towards the whole Swedish population rather than towards specific groups. Correspondingly, an increased focus on socio-economic or demographic factors is not warranted in interventions aimed at improving antibiotic prescription patterns among medical practitioners.

Transforming trash to treasure Cultural ambiguity in foetal cell research.

BACKGROUND: Rich in different kind of potent cells, embryos are used in modern regenerative medicine and research. Neurobiologists today are pushing the boundaries for what can be done with embryos existing in the transitory margins of medicine. Therefore, there is a growing need to develop conceptual frameworks for interpreting the transformative cultural, biological and technical processes involving these aborted, donated and marginal embryos. This article is a contribution to this development of frameworks. METHODS: This article examines different emotional, cognitive and discursive strategies used by neurobiologists in a foetal cell transplantation trial in Parkinson's disease research, using cells harvested from aborted embryos. Two interviews were analysed in the light of former observations in the processing laboratories, using the anthropologist Mary Douglas's concept of pollution behaviour and the linguist, philosopher, psychoanalyst and feminist Julia Kristeva's concept of the abjective to explain and make sense of the findings. RESULTS: The findings indicate that the labour performed by the researchers in the trial work involves transforming the foetal material practically, as well as culturally, from trash to treasure. The transformation process contains different phases, and in the interview material we observed that the foetal material or cells were considered objects, subjects or rejected as abject by the researchers handling them, depending on what phase of process or practice they referred to or had experience of. As demonstrated in the analysis, it is the human origin of the cell that makes it abjective and activates pollution discourse, when the researchers talk of their practice. CONCLUSIONS: The marginal and ambiguous status of the embryo that emerges in the accounts turns the scientists handling foetal cells into liminal characters in modern medicine. Focusing on how practical as well as emotional and cultural strategies and rationalizations of the researchers emerge in interview accounts, this study adds insights on the rationale of practically procuring, transforming and utilizing the foetal material to the already existing studies focused on the donations. We also discuss why the use and refinement of a tissue, around which there is practical consensus but cultural ambiguity, deserves further investigation.

How dislocation and professional anxiety influence readiness for change during the implementation of hospital-based home care for children newly diagnosed with diabetes - an ethnographic analysis of the logic of workplace change.

BACKGROUND: In 2013-14, the evidence based care model Hospital-based Home Care for children newly diagnosed with diabetes was implemented at a large paediatric diabetes care facility in the south of Sweden. The first step of the implementation was to promote readiness for change among the professionals within the diabetes team through regular meetings. The aim was to analyse the implicit facilitators and barriers evident on a cultural micro level in discussions during the course of these meetings. What conceptions, ideals and identities might complicate, or facilitate, implementation? METHODS: A case study was conducted during the implementation process. This article draw on ethnographic observations carried out at team meetings (n = 6) during the introductory element of implementation. From a discourse theoretical perspective, the verbal negotiations during these meetings were analysed. RESULTS: Three aspects were significant in order to understand the dislocation during this element of implementation: an epistemological disagreement that challenged the function of information within care practice; a paradoxical understanding of the time-knowledge intersection; and expressions of professional anxiety. More concretely, the professionals exhibited an unwillingness to give up the opportunity to provide structured, age-independent information; a resistance against allowing early discharge; and a professional identity formed both by altruistic concern and occupational guardiancy. The findings suggest the necessity of increased awareness of the conceptions and ideals that constitute the basis of a certain professional practice; a deeper understanding of the cultural meaning that influences care practice within a specific logic in order to predict in what way these ideals might be challenged by the implemented evidence. CONCLUSIONS: Our main contribution is the argument that the implemented evidence in itself needs to be examined and problematized from a cultural analytical perspective before initiation in order to be able to actively counter negative connotations and resistance.

An ethnographic observation study of the facilitator role in an implementation process.

BACKGROUND: Even though the importance of a facilitator during an implementation process is well described, the facilitator's role is rarely problematized in relation to the organizational context in terms of power and legitimacy; themes which have recently been brought to the fore when studying change in health care organizations. Therefore, in this article, we present a qualitative study with the aim of identifying key aspects of the experience of being in a facilitator role. The data collection involved ethnographic fieldwork encompassing observations and field notes, as well as two qualitative interviews with the facilitator. The data were analysed using a phenomenological hermeneutical method in order to formulate thematic aspects of the implementation process. The study was conducted in southern Sweden between January 2013 and August 2014. RESULTS: One main theme, "walking a tightrope", and four sub-themes, all of which involved balancing acts of different levels and different ways, were identified. These included: being in control, but needing to adjust; pushing for change, but forced to stand back; being accepted, but dependent; and being reasonable, but culturally sensitive. CONCLUSION: Instead of listing the desirable qualities and conditions of a facilitator, this study shows that being a facilitator can be described more completely by applying the concept of role, thus allowing a more holistic process of reflection and analysis. This in turn makes it possible to move from the reactive stance of balancing to a more proactive stance of negotiating.