Settings In Norway Research Articles

Overweight and obesity as risk factors for chronic low back pain: a new follow-up in the HUNT Study

BackgroundNumerous studies have examined associations between overweight and obesity and risk of low back pain (LBP), but the exact magnitude of these associations is not yet clear. The purpose of this work was to assess such sex-specific associations in a community-based setting in Norway, taking into account potential relationships with other risk factors.MethodsA cohort study was conducted combining data from two waves of the Trøndelag Health Study, HUNT3 (2006–2008) and HUNT4 (2017–2019). Separate analyses were performed of risk of chronic LBP in HUNT4 among 14,775 individuals without chronic LBP in HUNT3, and of recurrence or persistence in HUNT4 among 5034 individuals with chronic LBP in HUNT3. Relative risks were estimated in generalised linear models for overweight and obesity compared to normal weight. Body size classification was based on values of BMI computed from measurements of height and weight. Chronic LBP was defined as LBP persisting at least 3 months during last year.ResultsAfter adjustment for age, smoking, physical activity in leisure time and work activity, analysis of risk among women produced relative risks 1.11 (95% CI 1.00–1.23) for overweight, 1.36 (95% CI 1.20–1.54) for obesity class I and 1.68 (95% CI 1.42–2.00) for obesity classes II-III. Relative risks among men were 1.10 (95% CI 0.94–1.28) for overweight, 1.36 (95% CI 1.13–1.63) for obesity class I and 1.02 (95% CI 0.70–1.50) for obesity classes II-III, the last estimate being based on relatively few individuals. Analyses of recurrence or persistence indicated similar relationships but with smaller magnitude of relative risks and no drop in risk among obesity classes II-III in men. The change in BMI from HUNT3 to HUNT4 hardly differed between individuals with and without chronic LBP in HUNT3.ConclusionsRisk of chronic LBP increases with higher values of BMI in both sexes, although it is uncertain whether this applies to very obese men. Very obese women carry a particularly large risk. Probabilities of recurrence or persistence of chronic LBP among those already afflicted also increase with higher values of BMI. Adjustment for other factors does not influence relationships with overweight and obesity to any major extent.

How well can the fetal heart rate baseline be assessed by intrapartum intermittent auscultation? An interrater reliability and agreement study.

We aimed to examine the inter-reliability and agreement among midwives when assessing the fetal heart rate (FHR) using the handheld Doppler. The primary aim was to measure the reliability and agreement of FHR baseline (baseline) as beats per minute (bpm). The secondary aims were to measure fluctuations from the baseline, defined as increases and decreases, and classifications (normal or abnormal) of FHR soundtracks. This is the first interrater reliability and agreement study on intermittent auscultation (IA) to our knowledge. The participant population consisted of 154 women in labor, from a mixed-risk population and admitted to hospital for intrapartum care. The rater population were 16 midwives from various maternity care settings in Norway. A total of 154 soundtracks were recorded with a handheld Doppler device, and the 16 raters assessed 1-min soundtracks once, through an online survey (Nettskjema). They assessed the baseline, FHR increase or decrease, and the FHR classification. The primary outcome, baseline, was measured with intraclass correlation coefficient (ICC). The secondary outcomes were measured with kappa and proportion of agreement. The interrater reliability for the baseline (bpm) was ICC(A,1) 0.74 (95% CI 0.69-0.78). On average, an absolute difference of 7.9 bpm (95% CI 7.3-8.5 bpm) was observed between pairs of raters. Our results demonstrate an acceptable level of reliability and agreement in assessing the baseline using a handheld Doppler.

Evaluation of pediatric vision screening and digital referral routines in an interprofessional setting in Norway

Vision is crucial for childhood development, and ensuring good vision in children is one of the United Nation’s sustainability goals. Most countries have a childhood vision screening programme, and in Norway screening in children aged 4–5 years is performed in community health centres (CHC). Specialist health services such as ophthalmology and/or orthoptics are the referral bodies. However, access to these may be limited and they may be a long distance away from the child’s home, while optometrists are often more available and accessible. This study aims to investigate if vision screening reliably detects vision problems and to explore if using paediatric optometry as a referral body can relieve the specialist health services. The study also aims to report frequency of refractive errors and management of vision problems in this age group. Of 274 children who attended vision screening by school nurses at the CHC in Kongsberg, Norway, parents of 213 (77.7%) consented to a separate eye and vision examination by a paediatric optometrist. Agreements in screening results between school nurses and the paediatric optometrists were evaluated. Separately, an ophthalmologist and an orthoptist assessed records from the eye examinations through a digital communication tool (Eyecheck System AS). Agreements in diagnoses and management decisions between optometrists and the specialist health services were evaluated. Amblyopia or ocular pathology was found in 1.9% of the children, which were all identified by the vision screening. The vision screening had a sensitivity and specificity of 62.3% and 58.6%, respectively, for detecting other vision problems in need of treatment or follow-up. Hypermetropia was present in 82.7% of the children (58.0% low, 18.5% moderate, 6.5% high hypermetropia), 16.4% had emmetropia and 1.0% had myopia. Glasses were prescribed to 8.5% of the children and 16.4% were scheduled for follow-ups. There was a high level of agreement in management between optometrists and specialists (ophthalmologist 80.3%, orthoptist 81.7%). The vision screening reliably detected amblyopia and ocular pathology, and most refractive errors were detected. The high degree of agreement between the three eye care professions suggests that paediatric optometrists can be used as the referral body for this age group. Availability of a digital communication tool provides support for the paediatric optometrists in their decision making and can help relieve the specialist health services by providing children with an eye examination and vision correction earlier and more easily.

The Impact of Urban Allotment Gardens on Physical and Mental Health in Norway.

In Norway, many communities offer low-rent plots of land on which city dwellers can build summer cottages and grow crops. These allotment gardens serve as recreational escapes from urban life. However, little is known about the impact these gardens have on their members. This study attempts to shed light on today's impact of allotment gardens in a public health setting in Norway. The study was based on 17 semi-structured interviews and 2 in-depth interviews with allotment house owners. Informants were mainly recruited by "snowball sampling". Our data show that maintaining an allotment promotes exercise and provides a positive impact on self-perceived well-being and physical health through outdoor activities. Spending time in the garden contributes to new knowledge and experiences. Owning an allotment garden has provided new knowledge, new skills, new hobbies, and thereby an improvement in lifestyle. The allotment garden has a strong impact on perceived health, well-being, and sense of coherence (SOC) for the individuals. It promotes outdoor activities along with social interaction and can prevent feelings of loneliness and isolation.

Transculturation in Arabic literacy education within and beyond mainstream education in Norway and Sweden

Transculturation in Arabic literacy education within and beyond mainstream education in Norway and Sweden

Learning to discuss safety within the European seaweed aquaculture sector

Seaweed is seen as a promising future source of biomass, and significant efforts are taken to upscale seaweed aquaculture production in Europe. Despite regulatory frameworks for food safety, environmental safety, and occupational health and safety applicable to seaweed production, a major barrier to upscaling production is the lack of commonly accepted, uniform frameworks for safety assessment. As a consequence, efforts to deal with food safety, environmental safety, and occupational health and safety are fragmented. Based on a literature review and consultations with stakeholders, this paper introduces a generic protocol on how to approach safety of the production of seaweed. A prototype version of the generic protocol was evaluated in a practical setting in Norway. Results show that a consistent, structured approach to safety makes it possible to identify hazards and prioritize and collect data on key hazards. The protocol facilitated a sector discussion on safety, providing a shared discourse to talk about safety. It must be acknowledged that the farming and processing practices and the location of cultivation strongly influence which hazards are most relevant. The protocol succeeded in bringing focus to data collection, putting effort into the analysis of hazards considered most relevant in a practical setting.

From difficulty to meaning – Experiences of patients with advanced cancer having advance care planning conversations and a palliative care plan

PurposeThis study aimed to explore the experiences of patients with advanced cancer with Advanced care planning (ACP) communication and drawing up a palliative plan in primary healthcare settings in Norway. MethodsIn this exploratory qualitative study, data were collected using semi-structured interviews with five patients with cancer who had undergone ACP and had a palliative care plan. ResultsThe result shows three main themes with subthemes; (1) The difficult ACP conversation about cancer and death was tough, painful, and considered a “taboo.” The patients wished they had been prepared for the conversation and had it in their own homes. (2) Interactions with the doctor/nurse about the palliative care plan helped the patients feel valued and involved and brought their wishes into focus. The next of kin was present but not involved in the process. (3) Having a palliative plan was meaningful for the patients; they felt safe, and it gave them a sense of security. ConclusionsPatients with advanced cancer in a home setting in Norway experienced ACP for the preparation of a palliative plan as a process from difficulty to meaning. In this process, the context and interactions provided by the doctor/nurse and their competency in communicating with the patients and involving them as persons was important. The palliative plan gave the patients a sense of meaning, control, and safety connected to the time for the end of life.

Foraging Eco-Ethology, Incentives and Motivations in the Kindergartens of Norway Based on Sámi and Norwegian Cultures

Early childhood education (ECE) institutions in Norway highly value nature and outdoor activities. The framework plan for kindergartens encourages that children get insights into the origin of food. The approach for imparting this knowledge incentivises foraging in kindergartens. The eco-ethology of humans is dependent on cultural values and practices and what is available for harvest in the local environments in different seasons. This paper explores the incentives and motivations for foraging in kindergartens in Norway through a qualitative approach. The data was collected from Sámi and Norwegian ECE professionals through on-site video documentation, group interviews, in-depth semi-structural interviews, and field notes. It was analysed using reflexive thematic analysis, in which the researchers had an active role in the process through reflexive engagement with theory, data, and interpretation. Three themes related to the incentives and motivations for foraging were found: (1) “viewpoints of nature”, (2) “transfer and production of knowledge”, and lastly (3) “motives and meaning for foraging”. Norwegian ECE professionals seemed to view nature as a place to explore outdoors (termed friluftsliv) and Sámi ECE professionals used nature for a practical purpose (termed meahcci). Nature was used by all the ECE professionals for transfer and production of knowledge. The motives and meaning for foraging in ECE settings in Norway originated from the cultural values of purposeful use of nature’s resources. Further studies are needed to investigate the prevalence and importance of foraging practices in ECE, especially in terms of its significance to education for sustainability.

Death Holds No Fear: Overdose Risk Perceptions Among People Who Inject Drugs

Drug overdose is an important public health problem. Despite well-known risk factors and various preventive measures, the overdose mortality rate has increased substantially in several countries worldwide over the past decade. There is therefore a need to understand overdoses on the basis of how people who inject drugs (PWID) perceive and experience risk. Based on qualitative interviews with 80 PWID recruited from low-threshold settings in Norway, this study explores the complex lived experiences and perceptions of overdose. The qualitative approach is sensitive towards lived experiences and provides new understandings of overdoses. The analysis revealed three types of accounts concerning perceived overdose risk. First, interviewees described death as natural and not frightening, based on perceptions of death as universal, a part of their high-risk lifestyle and their previous overdose experiences. Second, they presented accounts of how they perceived others to be at greater risk of overdose than themselves, in respect of experience, skills and tolerance. Finally, interviewees described an indifference towards death, on a continuum between the wish to live and death as relief from various life challenges. This study illustrates how PWID inhabit drug-using environments which entail a high-risk lifestyle. Faced with these risks, the interviewees presented stories which may serve several functions, such as neutralizing feelings of risk and stigma and gaining a sense of agency and control. They also created symbolic boundaries in order to form positive perceptions of self, by distancing themselves from other stereotypical people who use drugs. The participants additionally expressed an indifference towards overdose death. This may entail that avoiding death, the main rationale of overdose interventions, is viewed with indifference by some PWID. This is important for understanding the complexity of overdose mortality and should be reflected in future harm-reduction initiatives.

Governing by commissioning services - Implementing alcohol screening and brief interventions in hospital settings in Norway

Norwegian health services have undergone marked logistical changes in organization and funding over recent decades. One significant change was the new public management-inspired commissioner’s document, first issued in 2013 by the Norwegian Ministry of Health and Care Services, to establish medical and surgical departments’ identification of patients with underlying substance abuse problems (Ministry of Health and Care Services, 2013). Herein, we investigate how multiple stakeholders and actors, who bear responsibility in regional and local health trusts, have responded to the commissioned services to establish routines for identifying alcohol and substance abuse problems among patients admitted to medical and surgical wards. First, an extensive literature search was conducted. Second, we conducted qualitative interviews with informants who have responsibility for applying the commissioner’s document in regional health authorities and local hospitals. The study results demonstrate that responsible actors at all levels take establishing alcohol routines seriously, and that hospitals’ self-assessment of their achievements on internal goals indicate that they have made satisfactory progress. Nevertheless, improvement is needed to meet the goal of discussing alcohol use with all patients admitted to medical and surgical wards within local health trusts. Recommendations for the next steps, based on these findings, include further research and training priorities.

Patients', relatives' and nurses' experiences of palliative care on an advanced care ward in a nursing home setting in Norway.

Patients, relatives and nurses were involved in this study. The aim was to explore patients', relatives' and nurses' experiences of palliative care on an advanced care ward in a nursing home setting after implementation of the Coordination Reform in Norway. Secondary analysis of qualitative interviews. Data from interviews with 19 participants in a nursing home setting: severely ill older patients in palliative care, relatives and nurses. Data triangulation influenced by Miles and Huberman was used. The overall theme was "Being in an unfamiliar and uncaring culture leaves end-of-life patients in desperate need of holistic, person-centred and co-creative care". The main themes were: "Desire for engaging palliative care in a hopeless and lonely situation", "Patients seeking understanding of end-of-life care in an unfamiliar setting" and "Absence of sufficient palliative care and competence creates insecurity". The patients and relatives included in this study experienced an uncaring culture, limited resources and a lack of palliative care competence, which is in direct contrast to that which is delineated in directives, guidelines and recommendations. Our findings reveal the need for policymakers to be more aware of the challenges that may arise when healthcare reforms are implemented. Future research on palliative care should include patients', relatives' and nurses' perspectives.

Impact of distance monitoring service in managing healthcare demand: a case study through the lens of cocreation

BackgroundThere is a consensus among healthcare providers, academics, and policy-makers that spiraling demand and diminishing resources are threatening the sustainability of the current healthcare system. Different telemedicine services are seen as potential solutions to the current challenges in healthcare. This paper aims to identify how distance monitoring services rendered for patients with chronic conditions can affect the escalating demand for healthcare. First, we identify how distance monitoring service changes the care delivery process using the lens of service cocreation. Next, we analyze how these changes can impact healthcare demand using the literature on demand and capacity management.MethodIn this qualitative study, we explore a distance monitoring service in a primary healthcare setting in Norway. We collected primary data from nurses and general physicians using the semi-structured interview technique. We used secondary patient data collected from a study conducted to evaluate the distance monitoring project. The deductive content analysis method was used to analyze the data.ResultThis study shows that the application of distance monitoring services changes the care delivery process by creating new activities, new channels for interaction, and new roles for patients, general physicians, and nurses. We define patients’ roles as proactive providers of health information, general physicians’ roles as patient selectors, and nurses’ roles as technical coordinators, data workers, and empathetic listeners. Thus, the co-creation aspect of the service becomes more prominent demonstrating potential for better management of healthcare demand. However, these changes also render the management of demand and resources more complex. To reduce the complexities, we propose three mechanisms: foreseeing and managing new roles, developing capabilities, and adopting a system-wide perspective.ConclusionThe main contribution of the paper is that it demonstrates that, although distance monitoring services have the potential to have a positive impact on healthcare demand management, in the absence of adequate managerial mechanisms, they can also adversely affect healthcare demand management. This study provides a means for practitioners to reflect upon and refine the decisions that they make regarding telemedicine deployment and resource planning for delivering care.

Kindergarten practitioners’ perspectives on intergenerational programs in Norwegian kindergartens during the COVID-19 pandemic: exploring transitions and transformations in institutional practices

ABSTRACT Intergenerational programs have benefits for both children and older adults; however, the ongoing pandemic has changed social situations across the globe. The focus of this article is on exploring transitions and transformations due to societal conditions and demands that drive the implementation of intergenerational programs during a time of a global crisis that is the COVID-19 pandemic. Through an online survey form and focus group discussion, a total of 64 kindergarten practitioners shared their perspectives on intergenerational programs between young children and older adults in kindergartens in Norway. Kindergarten practitioners identified challenges that hinder intergenerational programs in kindergarten settings during the pandemic, as well as conditions that facilitate its implementation. Implications from this research indicate the need to think differently to be able to provide children with intergenerational experiences in kindergarten settings in Norway even during the pandemic and beyond.

Attitudes towards priority setting in the Norwegian health care system: a general population survey

BackgroundIn an ideal world, everyone would receive medical resources in accordance with their needs. In reality, resources are often scarce and have an alternative use. Thus, we are forced to prioritize. Although Norway is one of the leading countries in normative priority setting work, few descriptive studies have been conducted in the country. To increase legitimacy in priority setting, knowledge about laypeople’s attitudes is central. The aim of the study is therefore to assess the general population’s attitudes towards a broad spectrum of issues pertinent to priority setting in the Norwegian publicly financed health care system.MethodsWe developed an electronic questionnaire that was distributed to a representative sample of 2 540 Norwegians regarding their attitudes towards priority setting in Norway. A total of 1 035 responded (response rate 40.7%). Data were analyzed with descriptive statistics and binary logistic regression.ResultsA majority (73.0%) of respondents preferred increased funding of publicly financed health services at the expense of other sectors in society. Moreover, a larger share of the respondents suggested either increased taxes (37.0%) or drawing from the Government Pension Fund Global (31.0%) as sources of funding. However, the respondents were divided on whether it was acceptable to say “no” to new cancer drugs when the effect is low and the price is high: 38.6% somewhat or fully disagreed that this was acceptable, while 46.5% somewhat or fully agreed. Lastly, 84.0% of the respondents did not find it acceptable that the Norwegian municipalities have different standards for providing care services.ConclusionAlthough the survey suggests support for priority setting among Norwegian laypeople, it has also revealed that a significant minority are reluctant to accept it.

Partnerships in multicultural ECEC settings in Norway: Perspectives from parents and professionals

Partnerships between parents and professionals in early childhood education and care (ECEC) are wellestablished as being important for children’s well-being and learning, and may be especially significantfor children with immigrant backgrounds. The present study uses data from the Inclusive Education and Social Support to Tackle Inequalities in Society (ISOTIS) project to investigate perspectives from parents and professionals regarding their mutual partnership as well as their views on multicultural and multilingual education in culturally and linguistically diverse ECEC settings in Norway. The findings indicate positive partnership views among the parents and professionals, but also suggest the opportunity to create a more shared understanding of the child’s behaviour and potential. The findings further suggest that both parents and professionals value educational practices that promote cultural diversity. However, beliefs regarding multilingual education diverge, indicating that although ECEC may play an important role in children’s multilingual education, there is little agreement on how this role should best be played.

We are also music lovers: Testing vocal tastes in higher musical theater education

This article explores taste processes within a group of musical theater students and their voice teacher, the latter also acting as researcher, while working with an aesthetically broad repertoire in a higher education setting in Norway. The study is designed using an action research approach, and the collected data—students’ reflection notes, the researcher’s field notes, and workshop recordings—are analyzed through Antoine Hennion’s theoretical framework of taste as a performance that acts, engages, transforms, and is felt, and which involves skills and sensitizing. In the social sciences, taste is commonly regarded as a matter of cultural consumption. This article argues that tastes are also part of cultural production: musicians, here musical theater performers, are to be seen as music lovers, performing tastes that stabilize or challenge established taste patterns in the form of styles, genres, or traditions. Accounting for situations where tastes are performed, tested, and negotiated, this article argues that tastes have a history but are brought into a negotiating presence, producing implications for the future; in this case, tastes form vocal behaviors and vocal behaviors form tastes. Hence, in musical theater education, taste, taste-making, and taste-testing are part of systematic and formal pedagogics and students’ ongoing vocal training.

Modeling and executing cyber security exercise scenarios in cyber ranges

The skill shortage in global cybersecurity is a well-known problem; to overcome this issue, cyber ranges have been developed. These ranges provide a platform for conducting cybersecurity exercises; however, conducting such exercises is a complex process because they involve people with different skill sets for the scenario modeling, infrastructure preparation, dry run, execution, and evaluation. This process is very complex and inefficient in terms of time and resources. Moreover, the exercise infrastructure created in current cyber ranges does not reflect the dynamic environment of real-world systems and does not provide adaptability for changing requirements. To tackle these issues, we developed a system that can automate many tasks of the cybersecurity exercise life cycle. We used model-driven approaches to (1) model the roles of the different teams present in the cybersecurity exercises and (2) generate automation artifacts to execute their functions efficiently in an autonomous manner. By executing different team roles such as attackers and defenders, we can add friction in the environment, making it dynamic and realistic. We conducted case studies in the form of operational cybersecurity exercises involving national-level cybersecurity competitions and a university class setting in Norway to evaluate our developed system for its efficiency, adaptability, autonomy, and skill improvement of the exercise participants. In the right conditions, our proposed system could create a complex cybersecurity exercise infrastructure involving 400 nodes with customized vulnerabilities, emulated attackers, defenders, and traffic generators under 40 minutes. It provided a realistic environment for cybersecurity exercises and positively affected the exercise participants’ skill sets.

Project LifeLab Food and Health – Innovative Teaching for the Future: Development of Student Active Learning Tasks for Home Economics Education in the 21st Century

Food and Health, previously referred to as Home Economics, is a mandatory school subject in Norway. It has the unique advantage of giving all students, regardless of their social background, practical skills and knowledge, life skills that are important for their future health. In the LifeLab Food and Health project, we have developed a research-based and innovative teaching programme and evaluated how it is perceived in a school setting in Norway. This teaching programme is for use in Food and Health teacher education, but also in the education of primary and lower secondary school students in the same subject. LifeLab Food and Health consists of learning tasks in which students in the sixth and ninth grades in school gain first-hand knowledge and an understanding of life skills that are important to manage everyday life. In this paper, we present the learning activities developed and how the students experienced them. Examples of such learning tasks are tasks revealing the science behind dietary guidelines and the promotion of a healthy diet through student active tasks. Our aim is to establish LifeLab Food and Health as a “best practice” within master’s education in Home Economics at the University of Agder in Norway.

Tick-transmitted co-infections among erythema migrans patients in a general practice setting in Norway: a clinical and laboratory follow-up study

BackgroundErythema migrans (EM) is the most common manifestation of Lyme borreliosis. Here, we examined EM patients in Norwegian general practice to find the proportion exposed to tick-transmitted microorganisms other than Borrelia, and the impact of co-infection on the clinical manifestations and disease duration.MethodsSkin biopsies from 139/188 EM patients were analyzed using PCR for Neoehrlichia mikurensis, Rickettsia spp., Anaplasma phagocytophilum and Babesia spp. Follow-up sera from 135/188 patients were analyzed for spotted fever group (SFG) Rickettsia, A. phagocytophilum and Babesia microti antibodies, and tested with PCR if positive. Day 0 sera from patients with fever (8/188) or EM duration of ≥ 21 days (69/188) were analyzed, using PCR, for A. phagocytophilum, Rickettsia spp., Babesia spp. and N. mikurensis. Day 14 sera were tested for TBEV IgG.ResultsWe detected no microorganisms in the skin biopsies nor in the sera of patients with fever or prolonged EM duration. Serological signs of exposure against SFG Rickettsia and A. phagocytophilum were detected in 11/135 and 8/135, respectively. Three patients exhibited both SFG Rickettsia and A. phagocytophilum antibodies, albeit negative PCR. No antibodies were detected against B. microti. 2/187 had TBEV antibodies without prior immunization. There was no significant increase in clinical symptoms or disease duration in patients with possible co-infection.ConclusionsCo-infection with N. mikurensis, A. phagocytophilum, SFG Rickettsia, Babesia spp. and TBEV is uncommon in Norwegian EM patients. Despite detecting antibodies against SFG Rickettsia and A. phagocytophilum in some patients, no clinical implications could be demonstrated.

The Power of Belonging: Interactions and Values in Children\u2019s Group Play in Early Childhood Programs

This article explores belonging as social interaction in relation to power and values. Power has both positive and negative aspects. We view children as active agents with the power to include or exclude others, create space for each other or set boundaries. The article shows how children’s powers are limited by education staff’s structural power and discusses the ethical and pedagogical implications of children’s and staff’s use of power. We find that well-considered use of power may widen children’s horizons and provide them with social opportunities that they would otherwise miss. The data consist of video observation and interviews with children and teachers in three Early Childhood Education and Care settings in Norway. The article uses a lifeworld hermeneutical approach to study children’s belonging as a complex and sometimes ambiguous phenomenon. The article shows that children’s possibilities to position themselves and belong are made possible and limited by their social group via relational and structural power. By becoming aware of these contradictory tendencies, teachers can provide children with a variety of social experiences that promote belonging, which requires knowledge of how groups are formed by dynamic power relations that condition different social experiences.