How general practitioners used job crafting strategies during the COVID-19 pandemic in Sweden.

OBJECTIVE: General practitioners (GPs) played a crucial role in limiting the impact of the COVID-19 pandemic, and many GPs experienced they did not have the prerequisites to provide adequate care. However, GPs developed approaches that helped them to provide care to patients through various job crafting strategies. The aim of this study is to identify how job crafting strategies were deployed by GPs at the beginning of the COVID-19 pandemic in Sweden and the significance of the strategies on their work situation. DESIGN: A qualitative design with semi-structured interviews. The data was analysed using qualitative content analysis with job crafting as the conceptual framework for the analysis process. SETTING: Primary healthcare in five healthcare regions in Sweden. SUBJECTS: Fourteen GPs participated in individual interviews. RESULTS: In their endeavours to organise and provide care, GPs shaped the task, relational and cognitive boundaries of their work. GPs felt proud about finding new ways of working when given room to manoeuvre. Intensified collaboration between healthcare professionals made GPs more confident in their clinical work. GPs expressed that they consequently felt stronger in their professional role through what they accomplished in the organisation of care. CONCLUSIONS/IMPLICATIONS: The results suggest that the job crafting strategies GPs used were meaningful to them in clinical practice. Knowledge about how GPs' job crafting strategies were deployed might be useful for healthcare organisations in preparing for future health crises. Taking advantage of GPs' experiences and strategies is considered important for promoting sustainable working conditions for GPs in the future.

During the onset of the COVID-19 pandemic in Sweden, general practitioners took immediate action to re-organise their day-to-day work tasks.To manage professional uncertainty about how to provide the best possible care, general practitioners sought support from other healthcare peers.The professional self-confidence of general practitioners increased through what they accomplished when facing a major health crisis.

COVID-19- related work, managerial factors and exhaustion among general practitioners in Sweden: a cross-sectional study.

INTRODUCTION: A significant number of international studies show that general practitioners (GPs) suffered from burnout when working during the COVID-19 pandemic. A Swedish study found that more than 16% of GPs had exhaustion in spring 2021. Exhaustion can be regarded as an initial stage of burnout. A knowledge gap remains on GPs´ working conditions, the impact of management during the pandemic and how it was associated with exhaustion. This study aims to explore the association between severe symptoms of exhaustion and COVID-19 pandemic-related work and managerial factors among Swedish GPs and whether managerial factors have an impact on the association between exhaustion and COVID-19-related work factors. METHODS: Cross-sectional data was drawn from the Longitudinal Occupational Health survey in Health Care Sweden (LOHHCS), which included a representative sample of practicing doctors in Sweden. The sample consisted of 6699 doctors with a response rate of 41.2%. This study constitutes a sample of doctors who reported working in primary care facilities at the time of data collection, i.e. 1013 GPs. The Burnout Assessment Tool (BAT) was used to assess severe symptoms of exhaustion. Questions were also asked about pandemic-related work and managerial factors. The data was analysed using descriptive statistics and multivariate logistic regression to identify the association between exhaustion, work and managerial factors. RESULTS: The multivariate analysis showed that GPs who managed COVID-19 patients were about twice as likely to report severe symptoms of exhaustion. Further, GPs who reported that management was unsupportive, provided unsatisfactory working conditions and unsatisfactory policies for patient prioritisation were between two and four times more likely to report severe symptoms of exhaustion. CONCLUSIONS: COVID-19-related work and managerial factors had a significant impact on the mental health of GPs. Furthermore, the potentially protective effect that satisfactory management actions had on mental health was limited. In the aftermath of the COVID-19 pandemic and in preparation for future major crises that have a high impact on healthcare, there is a need to investigate the measures that can be taken to enable GPs to carry out their work, while maintaining their wellbeing.

Effects of Hypothermia vs Normothermia on Societal Participation and Cognitive Function at 6 Months in Survivors After Out-of-Hospital Cardiac Arrest: A Predefined Analysis of the TTM2 Randomized Clinical Trial.

Importance: The Targeted Hypothermia vs Targeted Normothermia After Out-of-Hospital Cardiac Arrest (TTM2) trial reported no difference in mortality or poor functional outcome at 6 months after out-of-hospital cardiac arrest (OHCA). This predefined exploratory analysis provides more detailed estimation of brain dysfunction for the comparison of the 2 intervention regimens. Objectives: To investigate the effects of targeted hypothermia vs targeted normothermia on functional outcome with focus on societal participation and cognitive function in survivors 6 months after OHCA. Design, Setting, and Participants: This study is a predefined analysis of an international multicenter, randomized clinical trial that took place from November 2017 to January 2020 and included participants at 61 hospitals in 14 countries. A structured follow-up for survivors performed at 6 months was by masked outcome assessors. The last follow-up took place in October 2020. Participants included 1861 adult (older than 18 years) patients with OHCA who were comatose at hospital admission. At 6 months, 939 of 1861 were alive and invited to a follow-up, of which 103 of 939 declined or were missing. Interventions: Randomization 1:1 to temperature control with targeted hypothermia at 33 °C or targeted normothermia and early treatment of fever (37.8 °C or higher). Main outcomes and measures: Functional outcome focusing on societal participation assessed by the Glasgow Outcome Scale Extended ([GOSE] 1 to 8) and cognitive function assessed by the Montreal Cognitive Assessment ([MoCA] 0 to 30) and the Symbol Digit Modalities Test ([SDMT] z scores). Higher scores represent better outcomes. Results: At 6 months, 836 of 939 survivors with a mean age of 60 (SD, 13) (range, 18 to 88) years (700 of 836 male [84%]) participated in the follow-up. There were no differences between the 2 intervention groups in functional outcome focusing on societal participation (GOSE score, odds ratio, 0.91; 95% CI, 0.71-1.17; P = .46) or in cognitive function by MoCA (mean difference, 0.36; 95% CI,-0.33 to 1.05; P = .37) and SDMT (mean difference, 0.06; 95% CI,-0.16 to 0.27; P = .62). Limitations in societal participation (GOSE score less than 7) were common regardless of intervention (hypothermia, 178 of 415 [43%]; normothermia, 168 of 419 [40%]). Cognitive impairment was identified in 353 of 599 survivors (59%). Conclusions: In this predefined analysis of comatose patients after OHCA, hypothermia did not lead to better functional outcome assessed with a focus on societal participation and cognitive function than management with normothermia. At 6 months, many survivors had not regained their pre-arrest activities and roles, and mild cognitive dysfunction was common. Trial Registration: ClinicalTrials.gov Identifier: NCT02908308.

Nurses' use of social media during the COVID-19 pandemic-A scoping review.

BACKGROUND: During the COVID-19 pandemic, nurses stand in an unknown situation while facing continuous news feeds. Social media is a ubiquitous tool to gain and share reliable knowledge and experiences regarding COVID-19. The article aims to explore how nurses use social media in relation to the COVID-19 pandemic. METHOD: A scoping review inspired by Arksey and O'Mally was conducted by searches in Medline, CINAHL, Academic Search Complete and Web of Sciences. Empirical research studies investigating nurses' use of social media in relation to COVID-19 were included. Exclusion criteria were: Literature reviews, articles in languages other than English, articles about E-health, and articles investigating healthcare professionals without specification of nurses included. Articles, published in January-November 2020, were included and analysed through a thematic analysis. The PRISMA-ScR checklist was used. RESULTS: Most of the eleven included studies were cross-sectional surveys, conducted in developing countries, and had neither social media nor nurses as their main focus of interest. Three themes were identified: 'Social media as a knowledge node', 'Social media functioned as profession-promoting channels' and 'Social media as a disciplinary tool'. Nurses used social media as channels to gain and share information about COVID-19, and to support each other by highlighting the need for training and changes in delivery of care and redeployment. Further, social media functioned as profession-promoting channels partly sharing heroic self-representations and acknowledgment of frontline persons in the pandemic, partly by displaying critical working conditions. Finally, nurses used social media to educate people to perform the 'right 'COVID-19' behaviours in society. CONCLUSION: This review provided snapshots of nurses' uses of social media from various regions in the world, but revealed a need for studies from further countries and continents. The study calls for further multi-methodological and in depth qualitative research, including theoretically framed studies, with a specific focus on the uses of social media among nurses during the pandemic.

When ethnographic work turns into distant screen visits: A note on flexible inflexibility during the COVID-19 pandemic.

This colloquium shares experiences from doing ethnographic fieldwork with young children and the challenges that followed due to the COVID-19 pandemic. The project DIGIKIDS Sweden has its focus on very young children (birth to three years) and their engagement with digital media technologies in their homes. The pandemic put the project on hold, but in the families where the fieldwork had already started, the authors decided to change the methods of data collection. Digital screen visits were introduced and, at first, this seemed to be flexible, and they adjusted to the new environment. At the same time, this flexibility also became an inflexible experience due to the use of technology.

Advert saliency distracts children's visual attention during task-oriented internet use.

The general research question of the present study was to assess the impact of visually salient online adverts on children's task-oriented internet use. In order to answer this question, an experimental study was constructed in which 9- and 12-year-old Swedish children were asked to solve a number of tasks while interacting with a mockup website. In each trial, web adverts in several saliency conditions were presented. By both measuring children's task accuracy, as well as the visual processing involved in solving these tasks, this study allows us to infer how two types of visual saliency affect children's attentional behavior, and whether such behavioral effects also impacts their task performance. Analyses show that low-level visual features and task relevance in online adverts have different effects on performance measures and process measures respectively. Whereas task performance is stable with regard to several advert saliency conditions, a marked effect is seen on children's gaze behavior. On the other hand, task performance is shown to be more sensitive to individual differences such as age, gender and level of gaze control. The results provide evidence about cognitive and behavioral distraction effects in children's task-oriented internet use caused by visual saliency in online adverts. The experiment suggests that children to some extent are able to compensate for behavioral effects caused by distracting visual stimuli when solving prospective memory tasks. Suggestions are given for further research into the interdiciplinary area between media research and cognitive science.

Understanding newsworthiness of an emerging pandemic: international newspaper coverage of the H1N1 outbreak.

BACKGROUND AND OBJECTIVES: During an evolving public health crisis, news organizations disseminate information rapidly, much of which is uncertain, dynamic, and difficult to verify. We examine factors related to international news coverage of H1N1 during the first month after the outbreak in late April 2009 and consider the news media's role as an information source during an emerging pandemic. METHODS: Data on H1N1 news were compiled in real time from newspaper websites across twelve countries between April 29, 2009 and May 28, 2009. A news sample was purposively constructed to capture variation in countries' prior experience with avian influenza outbreaks and pandemic preparation efforts. We analyzed the association between H1N1 news volume and four predictor variables: geographic region, prior experience of a novel flu strain (H5N1), existence of a national pandemic plan, and existence of a localized H1N1 outbreak. RESULTS: H1N1 news was initially extensive but declined rapidly (OR = 0.85, P < .001). Pandemic planning did not predict newsworthiness. However, countries with prior avian flu experience had higher news volume (OR = 1.411, P < .05), suggesting that H1N1 newsworthiness was bolstered by past experiences. The proportion of H1N1 news was significantly lower in Europe than elsewhere (OR = 0.388, P < 0.05). Finally, coverage of H1N1 increased after a first in-country case (OR = 1.415, P < .01), interrupting the pattern of coverage decline. CONCLUSIONS: Findings demonstrate the enhanced newsworthiness of localized threats, even during an emerging pandemic. We discuss implications for news media's role in effective public health communication throughout an epidemic given the demonstrated precipitous decline in news interest.

Characterisation of the post-translational modifications of a novel, human cell line-derived recombinant human factor VIII.

INTRODUCTION: Host cell lines used for recombinant protein expression differ in their ability to perform post-translational modifications (PTMs). The currently available recombinant human FVIII (rhFVIII) products are produced in mammalian, non-human cell lines. For rhFVIII, glycosylation and sulfation are vital for functionality and von Willebrand factor (VWF)-binding affinity. Here we present the characterisation of the PTMs of a novel, human cell line-derived recombinant human FVIII (human-cl rhFVIII). rhFVIII expression in a human cell line avoids expression of undesirable mammalian glycoforms like Galα1-3Galß1-GlcNAc-R (α-Gal) and N-glycolylneuraminic acid (Neu5Gc), which constitute epitopes antigenic to humans. MATERIALS AND METHODS: We describe sulfation analysis, glycan profiling and characterisation using liquid chromatography-mass spectrometry and high performance anion exchange chromatography with pulsed amperometric detection. RESULTS AND CONCLUSIONS: Human-cl rhFVIII is confirmed to be sulfated and glycosylated comparable to human plasma-derived FVIII. Most importantly, human-cl rhFVIII is devoid of the antigenic Neu5Gc or α-Gal epitopes observed in Chinese Hamster Ovary- and Baby Hamster Kidney-derived rFVIII products. Both the avoidance of non-human glycan structures and the achievement of complete sulfation are proposed to lower the intrinsic immunogenicity of human-cl rhFVIII compared with current rFVIII products.

Functional characteristics of the novel, human-derived recombinant FVIII protein product, human-cl rhFVIII.

INTRODUCTION: Hemophilia A is routinely treated by administration of exogenous coagulation factor VIII (FVIII). As safety and efficacy of FVIII products have improved over the years, development of FVIII-neutralizing antibodies (FVIII inhibitors) has emerged as the most serious complication. The new human cell line-derived recombinant human FVIII (human-cl rhFVIII) is the first recombinant FVIII product produced in a human cell line without additive animal proteins, with a goal of minimizing the risk of inhibitor development. MATERIALS AND METHODS: Biochemical analyzes of purity, molecular and functional attributes of the novel human-cl rhFVIII were undertaken for product characterization. RESULTS AND CONCLUSIONS: Human-cl rhFVIII was shown to be highly pure, with host-cell protein and DNA traces comparable to, or lower than, currently marketed recombinant FVIII (rFVIII) products. Human-cl rhFVIII was shown to have high specific FVIII activity and characteristics similar to full-length rFVIII products. Furthermore, no significant discrepancy between one-stage and chromogenic assay results were observed for human-cl rhFVIII, indicating potency ratios of these assays comparable to the full-length rFVIII products. In functional tests, human-cl rhFVIII exhibited physiological thrombin generation and a normal rate of inactivation by activated protein C. Importantly, human-cl rhFVIII displayed higher binding capacity with von Willebrand factor than comparator products, thus minimizing circulating unbound FVIII and further reducing the potential risk of inhibitor development.

Characterization of γ-carboxylated tryptic peptides by collision-induced dissociation and electron transfer dissociation mass spectrometry.

Vitamin K-dependent carboxylation of glutamic acid (Glu) residues into γ-carboxyglutamic acid (Gla) is a post-translational modification essential for normal protein activity of, for example, proteins involved in the blood coagulation system. These proteins may contain as many as 12 sites for γ-carboxylation within a protein sequence of 45 amino acid residues. In the biopharmaceutical industry, powerful analytical techniques are required for identification and localization of modified sites. We here present comparatively easy and rapid methods for studies of Gla-containing proteins using recent technology. The performances of two mass spectrometric fragmentation techniques, collision-induced dissociation (CID) and electron transfer dissociation (ETD), were evaluated with respect to γ-carboxylated peptides, applying on-line LC-ion trap MS. ETD MS has so far not been reported for Gla-containing peptides and the applicability of CID for heavily γ-carboxylated proteins has not been evaluated. The anticoagulant protein, protein C, containing nine Gla-sites, was chosen as a model protein. After tryptic digestion, three peptides containing Gla-residues were detected by MS; a 1.2 kDa fragment containing two Gla-residues, a 4.5 kDa peptide containing seven residues and also the 5.6 kDa tryptic peptides containing all nine Gla-residues. Regarding the shortest peptide, both CID and ETD provided extensive peptide sequencing. For the larger peptides, fragmentation by CID resulted in loss of the 44 Da CO(2)-group, while little additional fragmentation of the peptide chain was observed. In contrast, ETD resulted in comprehensive fragmentation of the peptide backbone. The study demonstrates that the combination of both techniques would be beneficial and complementary for investigation of γ-carboxylated proteins and peptides.

Laypeople blog about fruit and vegetables for self-expression and dietary influence.

Private health information websites run by laypeople are more often visited than websites of official agencies. Understanding the role of weblogs in dietetic communication-i.e., sharing personal perceptions on healthy eating-is still lacking. This study aims to describe the nature of noncommercial Swedish blogs with fruits and vegetables (F&V)-related content and to identify different blogger types. A qualitative content analysis with abduction was performed on 50 weblogs. Most bloggers presented themselves as women. Only one-third reported their age (range 17 to over 50 years). The bloggers had either an active or passive influential purpose, and they approached F&V through either lived or mediated experiences. From these two dimensions, four F&V blogger ideal types were identified: the Persuader, the Authority, the Exhibitionist, and the Mediator. Particularly women wrote about their lived experiences close to the personal level, whereas men were more equally distributed across the different ideal types. Self-expression (typical for the Exhibitionist) and purpose to influence others' diets (typical for the Persuader and the Authority) were frequently expressed in these weblogs. The current findings on blogging purposes, approaches, and F&V blogger types may help to improve online dietetic communication, which sets new challenges for media strategies of health and nutritional professionals.

Combination of two hydrophilic interaction chromatography methods that facilitates identification of 2-aminobenzamide-labeled oligosaccharides.

Hydrophilic interaction chromatography (HILIC) is used to separate 2-aminobenzamide- (2-AB) labeled N-linked oligosaccharides. The glycans of the model protein, bovine fetuin, are identified following comparison of elution patterns of seven 2-AB-labeled glycan standards, of which two are of the high-mannose type and five are of the complex type. The combination of two HILIC methods, using an Amide-80 column, having different resolutions and selectivities, markedly facilitates the identification of the fetuin glycans. These HILIC methods are suitable for obtaining glycan profiles of complex mixtures.

Separation of monosaccharides by hydrophilic interaction chromatography with evaporative light scattering detection.

Hydrophilic interaction liquid chromatography (HILIC) was used to separate monosaccharides that are common in N-linked oligosaccharides in glycoproteins and other compounds. A TSKgel Amide-80 column was eluted with 82% acetonitrile, in 5 mM ammonium formate (pH 5.5). Column temperature was 60 degrees C and evaporative light scattering was used for detection (ELSD). With this method, L-fucose, D-galactose, D-mannose, N-acetyl-D-glucosamine, N-acetylneuraminic acid, and D-glucuronic acid were separated, with detection limits of 0.3-0.5 microg for each monosaccharide, and intermediate precisions were 3-6% RSD (n=6).

Information and communication in society.

UNLABELLED: In late modernity, the media is one of the most important social institutions in influencing people's knowledge, perceptions and actions. The media supply citizens with health-related messages and contribute thereby to their health development. The abundant flow of health-related messages, however, makes it difficult for the individual to separate good and reliable information from information of poor quality. The prevalence of overweight and obesity is rising each year in Sweden as well as in other countries. The future scenario is troublesome. The presented study deals with two questions: (1) How is overweight represented in the media? (2) What consequences do these representations have on public perceptions of overweight? A multidisciplinary approach has been chosen for the study. Theories and concepts are derived from four areas of research: consumption, bodily issues, risks and media & journalism. The aim was to describe, analyse and problematize how overweight is presented quantitatively and qualitatively in the media. The method used is content analysis. The study is limited to media content in Swedish daily newspapers, 1997-2001. In all, 1925 articles from four different papers have been analysed. CONCLUSION: The ideals of journalism are easy to accept but too often difficult to realize. Reporters as well as physicians and scientists must make more of an effort to communicate comprehensible and useful information about overweight and obesity to their audiences. Still we know little about the amount, the quality and the utility of health information in the media. There is a need for further research in this field if we want to understand what chances people have in making informed health-related decisions and how they make sense of and use the health information at their disposal.

Preclinical pharmacology of albumin-free B-domain deleted recombinant factor VIII.

A second-generation recombinant factor VIII molecule was developed with an albumin-free formulation. In this modified form of factor VIII, the N- and C-terminal sections of the B-domain are retained and fused at serine 743 and glutamine 1638, resulting in a B-domain deleted factor VIII protein known as ReFacto (Genetics Institute, Andover, MA). Preclinical studies of ReFacto have focused on efficacy of the product for the hemophilia A patient population. The efficacy and pharmacokinetic profiles of ReFacto were similar to plasma-derived factor VIII in correcting the hemostatic defect of hemophilia A dogs. Both ReFacto and plasma-derived human factor VIII (Octonativ-M7, Pharmacia, Stockholm, Sweden) were found to associate with von Willebrand factor (vWF) after infusion into hemophilia A dogs as demonstrated by size exclusion chromatography. Infusion of either ReFacto or Octonativ-M7 quickly corrected factor VIII coagulant activity (FVIIIc), whole blood clotting time (WBCT), and activated partial thromboplastin time (aPTT). No obvious differences were seen between ReFacto and Octonativ-M7. Both ReFacto and Octonativ-M7 treatment reduced secondary bleeding time to less than 6 minutes. The clearance was faster and the volume of distribution at steady state was larger for plasma-derived factor VIII compared with ReFacto. The half-life was similar between Octonativ-M7 and ReFacto. These data predict that ReFacto will be effective in correcting human factor VIII deficiency states.