Purpose: The purpose of this paper is to explore the embedding of hospital-based medication review attending to the conflictual and developmental nature of practice. Specifically, this paper examines manifestations of contradictions and how they play out in professional practices and local embedding processes.

Design/methodology/approach: Using ethnographic methods, this paper employs the activity-theoretic notion of contradictions for analyzing the embedding of medication review. Data from participant observation (in total 290?h over 48 different workdays) and 31 semi-structured interviews with different healthcare professionals in two Swedish hospital-based settings (emergency department, department of surgery) are utilized.

Findings: The conflictual and developmental potential related to three interrelated characteristics (contested, fragmented and distributed) of the activity object is shown. The contested nature is illustrated showing different conceptualizations, interests and positions both within and across different professional groups. The fragmented character of medication review is shown by tensions related to the appraisal of the utility of the newly introduced practice. Finally, the distributed character is exemplified through tensions between individual and collective responsibility when engaging in multi-site work. Overall, the need for ongoing ￜrepairￜ work is demonstrated.

Originality/value: By using a practice-theoretical approach and ethnographic methods, this paper presents a novel perspective for studying local embedding processes. Following the day-to-day work of frontline clinicians captures the ongoing processes of embedding medication review and highlights the opportunities to learn from contradictions inherent in routine work practices.

En stor del av den statistik som ligger till grund för medialt uppmärksammade rapporter om ökande psykisk ohälsa bland unga representerar inte alltid psykisk ohälsa utan övergående besvär kopplade till ungdomars vardagliga utmaningar. Detta kan leda till att ungas mående medikaliseras och att insatser som ska främja psykisk hälsa riskerar att hamna snett.

In this article, I discuss collaboration and my experiences of involving orthodontists when representing orthodontic practice. Drawing on an ethnographic study with children and young people getting fixed appliances, the aim is to understand the politics of the practitioners’ receptions of the research result. First, I explore the power balance involved in researching expertise in general. Studying up and down and sideways in a multidirectional collaboration, I demonstrate that direct focus on the practitioners’ reactions to the ethnographic representations can reveal the political and social processes in institutions that deeply affect the lives of children. Secondly, the ethnographic examples show the specific changing conditions within the field of orthodontics that influenced how my analysis was received by the orthodontists. I argue that the result of collaboration, in the form of both agreement and friction, serves as knowledge about the burning questions of the institutional network under study.

This chapter focuses on virginity testing in Nkolokotho in northeastern rural KwaZulu Natal. I argue that testing is a strategy that involves the deployment of collective pressure and symbolic means both to increase the individual’s and the community’s responsibility for sexual relations, and to strengthen girls’ and women’s positions at a time of chronic HIV/AIDS. In the absence of effective measures against AIDS, inhabitants try to find alternative ways to protect young people. An older tradition that emphasizes the status of virgin girls and the significance of the collective is used in a strategy that incorporates HIV blood tests. I show how virginity testing is a ‘preventive ritual’ more than a ‘diagnostic measure’, while emphasizing how both South African and Western projects aimed at improving the situation are grounded in perspectives that sometimes collide with how local people conceive of both relationships and sexuality.

Medication review, the systematic examination of an individual patient’s medicines in order to improve medication therapy, has been advocated as an important patient safety measure. Despite widespread use, little is known about how medication review is conducted when implemented in routine health care. Drawing from an ethnographic case study in a Swedish emergency department and using a practice-based approach, we examine how medication review is practically accomplished and how knowledge is mobilized in everyday practice. We show how physicians construct and negotiate medication safety through situated practices and thereby generate knowledge through mundane activities. We illustrate the centrality of practitioners’ collective reflexive work when co-constructing meaning and argue here that practitioners’ local adaptations can serve as important prerequisites to make “standardized” practice function in everyday work. Organizations need to build a practical capacity to support practitioners’ work-based learning in messy and time-pressured  health care  settings.

Purpose: Since the millennium, manual-based preventive health programmes, drawing on psychological models of behaviour management, have dominated psycho-educational practices in school. The aim of this article is to study the health agency of 13-year-old schoolgirls participating in a programme for improving schoolchildren’s psychological health in Sweden.

Method: Drawing on Deleuze and Guattari’s theories of assemblages, the interaction between schoolchildren, teachers, the manual and psycho-educational techniques is scrutinized. The methodology of assemblage ethnography is used in the analysis of video observations of 13 course meetings.

Results: Three salient attitudes in relation to the possibilities built up for the schoolgirls are identified—silence, upset and cooperation. The girls’ acts and stories question the psycho-centric, individualized and gender-normative approach used in psycho-educational programmes and make visible the relational and contextual aspects of schoolchildren’s psychological health.

Conclusion: Children depend on multiple factors for their agency; the institutional networks they are involved in both allow and restrict their actions. The study demonstrates that focusing on children as health actors, in the sense that agency develops in the assemblages children take part in, can complement the knowledge base and question the predominant framing of psychological health.

Patients with Amelogenesis imperfecta (AI) can present with rapid tooth loss or fractures of enamel as well as alterations in enamel thickness, color, and shape; factors that may compromise aesthetic appearance and masticatory function. The aim was to explore the experiences and perceptions of adolescents and young adults living with AI and receiving early prosthetic therapy. Seven patients with severe AI aged 16 to 23 years who underwent porcelain crown therapy participated in one-to-one individual interviews. The interviews followed a topic guide consisting of open-ended questions related to experiences of having AI. Transcripts from the interviews were analyzed using thematic analysis. The analysis process identified three main themes: Disturbances in daily life, Managing disturbances, and Normalization of daily life. These themes explain the experiences of patients living with enamel disturbances caused by AI and receiving early crown therapy. Experiences include severe pain and sensitivity problems, feelings of embarrassment, and dealing with dental staff that lack knowledge and understanding of their condition. The patients described ways to manage their disturbances and to reduce pain when eating or drinking, and strategies for meeting other people. After definitive treatment with porcelain crown therapy, they described feeling like a normal patient. In conclusion the results showed that adolescents and young adults describe a profound effect of AI on several aspects of their daily life.

Orthodontics offer young peole the chance to improve their bite and adjust their appearances. The most common reasons for orthodontic treatment concern general dentists', parents' or children's dissatisfaction with the esthetics of the bite. My aim is to analyze how esthetic norms are 'done' during three activities preceding possible treatment with fixed appliances. The evaluation indexes signal definitiveness and are the essential grounds for decision-making. In parallel, practitioners and patients refer to self-perceived satisfaction with appearances. Visualizations of divergences and the improved future bite become part of an interactive process that upholds what I conceptualize as 'the exceptional normal'. Insights into thie process contribute to a better understanding of how medical practices intended to measure and safeguard children's and young people's health at the same time mobilize patient to look and feel better. The article is based on an ethnographic study at two orthodontic clinics.

This chapter focuses on virginity testing in Nkolokotho in northeastern rural KwaZulu Natal. I argue that testing is a strategy that involves the deployment of collective pressure and symbolic means both to increase the individual’s and the community’s responsibility for sexual relations, and to strengthen girls’ and women’s positions at a time of chronic HIV/AIDS. In the absence of effective measures against AIDS, inhabitants try to find alternative ways to protect young people. An older tradition that emphasizes the status of virgin girls and the significance of the collective is used in a strategy that incorporates HIV blood tests. I show how virginity testing is a ‘preventive ritual’ more than a ‘diagnostic measure’, while emphasizing how both South African and Western projects aimed at improving the situation are grounded in perspectives that sometimes collide with how local people conceive of both relationships and sexuality.