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In the Scandinavian countries, reablement has become a principle permeating all parts of elderly care, hence potentially transforming care and care work. This article explores the advent of new knowledge paradigms and practices of physiotherapists and occupational therapists transforming reabling care in particular ways, leading to what we term a logic of training emerging in the field. These professional groups have obtained a dominant position as reablement specialists in Norway and Denmark, where our extensive fieldwork was performed as part of a 3‐year research project. Taking inspiration from Annemarie Mol's concept of logic, we study how professional practices are organised and infused with specific values, meanings and ideals in situated contexts. We hence explore the logic of training, its abstracted image of the body and rational goal‐oriented model for progress measurement and its ramifications when addressing ageing bodies in a complex field marked by the unpredictabilities of the social and lived bodies, administrative rules and temporalities and the quest for empowering and involving clients. The paper concludes by pointing at new contradictions arising when practicing reabling care and particularly points out the tensions arising in care relations, where ambitions on empowering and disciplining the client and the elderly body may collide. [ABSTRACT FROM AUTHOR]

Abstract: Childhood obesity is increasing in many parts of the world. For the child, obesity often involves major social challenges. Within the framework of social studies of children and childhood and employing the concept of biopedagogies, I explore how children with severe obesity who participate in a long‐term rehabilitation programme changed the perception of their bodies from ‘being fat’ to ‘suffering from obesity’ by embracing the biopedagogies involved. Due to this transformation, ‘obesity’ was made into an entity – ‘a thing’ that the children could work on –, which was used for coping and change. The article is based on an ethnographic field study of a Norwegian randomized medical intervention trial for children with obesity. A virtual abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease ( COPD) is a progressive illness that changes the lives of patients and their spouses dramatically. The aim of this paper is to show how spouses of COPD patients integrate their tasks as informal carers with their role as spouses and the tensions and challenges involved in this. The study draws on qualitative interviews with spouses of COPD patients, recruited from the patient pool of ambulatory pulmonary services of two hospitals in Oslo, Norway. The spouses described their great efforts to re-establish normality and continuity in their everyday lives. Accomplishing this was a delicate process because they faced several dilemmas in this work. They balanced the need to sustain the independence and integrity of both parties against the need to ensure safety and deal with the progression of the illness. We propose 'biographical we' as a concept that can highlight the great effort spouses put into establishing a sense of continuity in their lives. In times when healthcare policy involves mobilising informal caregiving resources, an awareness of the complexity of caregiving relationships is crucial when developing appropriate support for informal carers. [ABSTRACT FROM AUTHOR]

Self‐reported health (SRH) is one of the most frequently used measures for examining socioeconomic inequalities in health. Studies find that when faced with 'identical objective health', individuals in lower socioeconomic groups consistently report worse SRH than those in higher socioeconomic groups. Such findings are often dismissed as being the result of reporting bias, and existing literature dominated by the biomedical conception of SRH has not investigated the underlying social mechanisms at work. To address this limitation, drawing on the work of Bourdieu we employ a relational thinking between health and social position. By way of multiple correspondence analysis, we construct social space of health determinants for three European countries from different welfare states and map the trajectories of educational groups experiencing similar levels of morbidity and their relation to SRH. Differences in SRH observed among social groups for the same level of morbidity are understood in relation to the position and the relative power of individuals in different educational groups to maintain or improve their social conditions, especially with increasing levels of health loss. Our analysis indicates that reporting differences in SRH among educational groups emerges from objectively healthy individuals and follows differences in accumulation of social advantages and disadvantages. [ABSTRACT FROM AUTHOR]

Alongside other Nordic countries, the Norwegian government has introduced Cancer Patient Pathways (CPPs) for faster diagnostic assessment and timely treatment to improve the quality of cancer care. A key aspect of CPPs is the introduction of time limits for each phase of the diagnostic investigation. Occurring simultaneously are ongoing advances in medical technology, complicating the process of diagnosing and treating cancer. In this article, using institutional ethnography, we examine: how does the CPP policy influence physicians' experiences of diagnostic work? Data were collected from May 2018 to May 2019, through semi‐structured interviews with physicians across five hospitals in Norway (N = 27). Our findings indicate that the implementation of various strategies aimed at enhancing quality in cancer care collide, compelling physicians to negotiate between diagnostic precision and rapid decision‐making. We conclude that attention to interfaces between multiple guidelines and their implications for practice is crucial for understanding and developing quality of care. [ABSTRACT FROM AUTHOR]

This study investigates patterns of adoption and diffusion of innovative health technologies by socioeconomic status (SES) in order to assess the extent to which these technologies may be a fundamental cause of health‐related inequalities. Quantitative analyses examined SES‐based inequalities in the adoption and diffusion of diabetes technologies. Diabetes data from three panels of the Nord‐Trøndelag Health Study (HUNT), Norway, were combined with income and education data. Cross‐sectional and longitudinal regression analyses were used to examine relevant inequalities. Cross‐sectional analyses suggest often present SES‐based gradients in the adoption of diabetes technologies, favouring high‐SES groups. Statistically significant differences (p ≤ 0.05) were most often present when technologies were new. In a cohort followed from 1984 to 1997, high SES individuals were more likely to adopt insulin injection technologies but, due to modest sample sizes, these inequalities were not statistically significant after adjusting for age, gender, and duration of illness. Moreover, compared to low SES individuals, high SES individuals are more active users of diabetes technologies. Results suggest that SES‐based variations in access and use of innovative health technologies could act as a mechanism through which inequalities are reproduced. This study provides a discussion of mechanisms and a methodological foundation for further investigation. [ABSTRACT FROM AUTHOR]

This study analyses 'Do‐It‐Yourself' (DIY) gerontechnologies and shows that they can be viable and valuable alternatives to 'ready‐made' gerontechnologies. Using the concept of innosumption, we analyze the work of care workers in gerontechnology showrooms in Norway. We show how and why care workers will sometimes advice older adults to assemble DIY‐gerontechnologies. Such DIY‐gerontechnologies are not high‐tech solutions made by technology producers, but creative solutions that older adults' suit to their specific needs and assemble for themselves from mundane objects that are available in shops. So far, analyses of the design, implementation and use of gerontechnologies have almost exclusively focused on professionally designed and produced 'ready‐made' gerontechnologies. But for various reasons, ready‐made gerontechnologies often do not fit in well with the lives of older people. In such cases, care workers guide older people to the innosumption of DIY‐gerontechnologies that offer workable solutions that are useful, quickly implemented, easily understandable and often cheap. We show that and how the existence of DIY‐gerontechnologies questions the reasons behind the strong and widely accepted assumption that only high‐tech innovations are a proper solution to the needs of older people. [ABSTRACT FROM AUTHOR]

Abstract: It is well documented that emergency service staff consider some patients to be ‘inappropriate attenders’. A central example is ‘trivia’, denoting patients with medical problems considered too ‘trivial’ to warrant attention. Although research has repeatedly shown that frontline staff violate guidelines in turning away ‘trivial’ patients, existing research has paid insufficient attention to why staff are willing to engage in guideline‐violating gatekeeping, which may put both themselves and ‘trivial’ patients at risk. To address this issue, the present article explores nurses’ narratives about ‘trivial’ patients – referred to in this context as ‘GP patients’ – drawing on fieldwork data from a Norwegian emergency service. The article reconstructs three narrative clusters, showing that nurses’ gatekeeping is motivated by concerns for the patient being turned away, for nurses and more critically ill patients, and for the service they work for. Some of the issues embedded in these narratives have been under‐analysed in previous research – most importantly, the role of identity and emotion in nurses’ gatekeeping, and how patient narratives can function as ‘social prognoses’ in nurses’ assessments. Analysis of these narratives also reveals an antagonistic relationship between nurses and ‘trivial’ patients that contradicts nurses’ ethical guidelines and indicates a need for healthcare reform. [ABSTRACT FROM AUTHOR]

This article draws on ethnographic data from a Norwegian emergency primary care clinic ( EPCC) to explore nurses' discretionary application of guidelines. Specifically, it analyses nurses' discretionary use of the Manchester Triage System ( MTS) when performing face-to-face triage, that is, assessing the urgency of patients' complaints. The analysis shows how nurses assessed patients at odds with MTS prescriptions by collecting supplementary data, engaging in differential diagnostic and holistic reasoning, relying on emotion and intuition, and allowing colleagues and patients to influence their reasoning. The findings also show how nurses' reasoning led them to override guidelines both overtly and covertly. Based on this evidence, it is argued that nurses' assessments relied more on internalised 'triage mindlines' than on codified triage guidelines, although the MTS did function as a support system, checklist and system for supervisory control. The study complements existing research on standardisation in nursing by providing an in-depth analysis of nurses' methods for navigating guidelines and by detailing how deviations from those guidelines spring from their clinical reasoning. The challenges of imposing a managerial logic on professional labour are also highlighted, which is of particular relevance in light of the drive towards standardisation in modern healthcare. [ABSTRACT FROM AUTHOR]

We analysed a set of medical certificates to investigate how GPs portray patients who seek disability benefits in Norway, focusing on patient centredness, agency and involvement. We performed a qualitative linguistic analysis of 33 medical certificates collected throughout Norway that were strategically selected based on the patients' sex, age and diagnosis. We found that patients were represented as passive carriers of symptoms, in whom agency was low, failed, conditional or non-existing, or as passive objects of the actions of impersonalised others. Conversely, symptoms were foregrounded as independent and powerful actors. The patient's experience of illness was sometimes reported, but the perspective of the GP tended to be doctor oriented, rather than patient centred. The policy of the social services, which emphasises patient involvement, patient centredness and work, rather than social benefits, was almost completely absent from these medical certificates. If medical certificates are to be a valid basis for decisions within the social services, we suggest that doctor paternalism in these documents must give way to considering the patient as an involved and co-responsible individual in the processes of disability assessment. [ABSTRACT FROM AUTHOR]

Research shows that members of the families with patients suffering from alcohol and other drug-related issues ( AOD) experience stress and strain. An important question is, what options do AOD treatment have for them when it comes to support? To answer this, we interviewed directors and clinicians from three AOD treatment institutions in Norway. The study revealed that family-oriented practices are gaining ground as a 'going concern'. However, the relative position of family-orientation in the services, is constrained and shaped by three other going concerns related to: (i) discourse on health and illness, emphasising that addiction is an individual medical and psychological phenomenon, rather than a relational one; (ii) discourse on rights and involvement, emphasising the autonomy of the individual patient and their right to define the format of their own treatment; and (iii) discourse on management, emphasising the relationship between cost and benefit, where family-oriented practices are defined as not being cost-effective. All three discourses are connected to underpin the weight placed on individualised practices. Thus, the findings point to a paradox: there is a growing focus on the needs of children and affected family members, while the possibility of performing integrated work on families is limited. [ABSTRACT FROM AUTHOR]

Until 1994, pharmaceutical products seeking market authorisation in Norway were required to demonstrate a fulfilment of unmet medical need. This clause enabled the national regulator to dramatically limit the number of products on the market whilst encouraging price competition to keep drug expenditure low and was credited with encouraging the development of drugs with genuine added therapeutic value and reducing the incidence of antimicrobial resistance. Norway was forced to abandon its Medical Need Clause ( MNC) when it joined the European Economic Area as it was incompatible with the acquis communautaire of the European Union. This article reviews Norway's experience with its MNC in light of contemporary debates in European health policy. It discusses the potential contribution of an MNC-style regulation to improving health, reducing illness, ensuring sustainable health systems and fostering pharmaceutical innovation. It concludes by asking how these findings can inform current European Union debates over the growing cost of prescription drugs and direction of pharmaceutical development. [ABSTRACT FROM AUTHOR]