(De)constructing health news: an analysis of the lifecycle of elderly-related news stories through multi-­sited, linguistic ethnographic research

‘(De)constructing Health News’ is a transdisciplinary project of the Health, Media & Society research centre (Ghent University), aiming at investigating the processes and stakeholder interaction involved in the (de)construction of elderly-related health news in Belgium. Today, laypeople are overwhelmed with health-related news and information, and they often have difficulties processing it all (Andreassen et al., 2010); meanwhile, the aging of the population drastically changes the demographic landscape and makes health care costs surge. To examine the societal background, processes and impact of these issues, four PhD researchers are working on four work packages, i.e.: (1) Stakeholder analysis; mapping the political-economic and institutional relations between different actors involved, like pharmaceutical companies, health insurance companies, journalists, researchers, doctors, patients, etcetera. (2) Lifecycle analysis of elderly-related health news stories in press releases, newspapers and online weblogs; by taking a multi-sited, linguistic ethnographic perspective, the complex discursive processes and professional routines at work will be examined. (3) Quantitative analysis of the output of the news production, by scrutinizing news sourcing, and conducting a frame and discourse analysis on elderly-related health news content. (4) Qualitative audience research; to gain understanding of uptake, perception, interpretation of elderly-related health news. As a PhD student focusing on the second work package, my research sets out to answer how and why elderly-related health news stories are selected by journalists, how news stories travel back and forth between stakeholders, and to map the lifecycle of news that is initiated by PR-offices. Are these news stories reproduced more or less verbatim by the news media, or do journalists make critical inquiries into the facts they are provided with and recontextualize these (Catenaccio et al., 2011)? The linguistic ethnographic fieldwork will show which of these two scenarios occur most often in journalistic practice, and which factors influence the processes and decisions involved

Power and socialization in sibling interaction:Establishing, accepting and resisting roles of socialization target and agent

This paper analyses socialization processes in the interaction between two Belgian, Dutch-speaking sisters, aged 10 and 8, more specifically with regard to power dynamics and establishing the roles of socialization target and agent. Socialization is collaborative, but usually entails some division of roles, which is intricately linked to power dynamics. Consequently, socialization efforts, and the socialization roles of target and agent, can be discarded or contested as part of these power dynamics. The analysis shows that socialization efforts between the sisters are often accepted, but also regularly contested and resisted. Moreover, the data indicates that roles and goals of some socialization efforts are so unclear that the boundaries between socialization efforts and interactional actions that aim to gain control become blurred. In conclusion, socialization must not only be considered in terms of its learning potential, but also as a power struggle with intricate and complex negotiation dynamics

The produsing expert consumer : co-constructing, resisting and accepting health-related claims on social media in response to an infotainment show about food and nutrition

This article examines the Twitter and Facebook uptake of health messages from an infotainment TV show on food, as broadcasted on Belgium’s Dutch-language public broadcaster. The interest in and amount of health-related media coverage is rising, and this media coverage is an important source of information for laypeople, and impacts their health behaviours and therapy compliance. However, the role of the audience has also changed; consumers of media content increasingly are produsers, and, in the case of health, expert consumers. To explore how current audiences react to health claims, we have conducted a quantitative and qualitative content analysis of Twitter and Facebook reactions to an infotainment show about food and nutrition. We examine (1) to which elements in the show the audience reacts, to gain insight in the traction the nutrition-related content generates and (2) whether audience members are accepting or resisting the health information in the show. Our findings show that the information on health and production elicit the most reactions, and that health information incites a lot of refutation, low acceptance and a lot of suggestions on new information or new angles to complement the show’s information

Machines, journeys, prisons and yo-yos:Metaphors of pain, illness and medicine in consultations with chronic pain patients

Introduction: This paper examines pain, illness and medicine metaphors as used in consultations between chronic pain patients and anaesthesiologists, physiotherapists and psychologists in a Belgian pain clinic. As metaphors frame and highlight aspects of understanding and experiences of life events, including illness, they can provide insight in how health professionals and patients construct illness, pain and medicine in interaction. Materials and method: 16 intake consultations (collected in Belgium in April–May 2019) between 6 patients and 4 health professionals were qualitatively coded twice ATLAS. TI by a team of 3 coders, using an adjusted form of the Metaphor Identification Procedure. Each metaphor was labelled for source domain, target domain and speaker. Results: A number of metaphors that have been previously documented in past research were frequent in our data too, such as journey and machine metaphors, although sometimes also used differently, like war metaphors. Our data set also contained many few-used and sometimes more novel metaphors, such as ILLNESS IS A YO-YO. Many metaphors highlight particular aspects of living with and talking about chronic pain, such as its duration and persistent presence, a lack of agency and feelings of powerlessness, and a dualistic perspective on body and mind. Discussion and conclusion: The metaphors used by health professionals and patients give insight in the lived experience of having and treating chronic pain. In this way, they can contribute to our understanding of patients’ experiences and challenges, how they recur in clinical communication, and how they are related to wider discourses on health, illness and pain.</p

In the land of pharma : a qualitative analysis of the reputational discourse of the pharmaceutical industry

The pharmaceutical industry has been battling a negative reputation and has been confronted with accusations such as putting profits before patients and manipulating clinical trial results. In this study, we focus on how pharmaceutical companies address what we define as the Bad Pharma discourse. Drawing on interviews, press releases, corporate documentation and ethnographic fieldwork, we analyse the main themes that are used by the Belgian pharmaceutical industry to construct its reputational discourse, and we focus on how this discourse is shaped by the Bad Pharma discourse. Our results illustrate that on the one hand, the industry contests the Bad Pharma discourse by generating an alternative discourse. On the other hand, they also partly embrace and reframe this Bad Pharma discourse. This way, current societal debates are entextualised in the reputational discourses of the pharmaceutical industry

Diversiteit en complexiteit van kennis in zorginteracties

The empirical papers in this special issue show that how knowledge is made relevant and negotiated in interaction is a complex matter. Traditionally, research on knowledge conceptualizes knowledge as being distributed across patients and health care providers, who respectively have access to experiential knowledge and medical knowledge of illness. In this view, both forms of knowledge then need to be transferred from one party to the other. However, our contributions show that interactions are more complex in many ways. First of all, there are more actors involved in medical interaction, such as translators and family members, who each uniquely contribute to what knowledge is constructed and how. Secondly, the forms and domains of knowledge cannot be reduced to medical and experiential knowledge, but for instance also concern knowledge on how health care interactions are structured. Thirdly, knowledge is not only about informing the other party in interaction but is for instance also used to account for decisions or to seek alignment. In this contribution we explore how these insights can inform future research and how it can help deepen our understanding of patient centredness and shared decision making in health care communication

Sargramostim to treat patients with acute hypoxic respiratory failure due to COVID-19 (SARPAC) : a structured summary of a study protocol for a randomised controlled trial

ObjectivesThe hypothesis of the proposed intervention is that Granulocyte-macrophage colony-stimulating factor (GM-CSF) has profound effects on antiviral immunity, and can provide the stimulus to restore immune homeostasis in the lung with acute lung injury post COVID-19, and can promote lung repair mechanisms, that lead to a 25% improvement in lung oxygenation parameters. Sargramostim is a man-made form of the naturally-occurring protein GM-CSF.Trial designA phase 4 academic, prospective, 2 arm (1:1 ratio), randomized, open-label, controlled trial.ParticipantsPatients aged 18-80 years admitted to specialized COVID-19 wards in 5 Belgian hospitals with recent ( 20 mg methylprednisolone or equivalent), (6) enrolment in another investigational study, (7) pregnant or breastfeeding or (8) ferritin levels > 2000 mu g/mL.Intervention and comparatorInhaled sargramostim 125 mu g twice daily for 5 days in addition to standard care. Upon progression of disease requiring mechanical ventilation or to acute respiratory distress syndrome (ARDS) and initiation of mechanical ventilator support within the 5 day period, inhaled sargramostim will be replaced by intravenous sargramostim 125 mu g/m(2) body surface area once daily until the 5 day period is reached. From day 6 onwards, progressive patients in the active group will have the option to receive an additional 5 days of IV sargramostim, based on the treating physician's assessment. Intervention will be compared to standard of care. Subjects progressing to ARDS and requiring invasive mechanical ventilatory support, from day 6 onwards in the standard of care group will have the option (clinician's decision) to initiate IV sargramostim 125m mu g/m(2) body surface area once daily for 5 days.Main outcomesThe primary endpoint of this intervention is measuring oxygenation after 5 days of inhaled (and intravenous) treatment through assessment of a change in pretreatment and post-treatment ratio of PaO2/FiO(2) and through measurement of the P(A-a)O-2 gradient (PAO(2)= Partial alveolar pressure of oxygen, PaO2=Partial arterial pressure of oxygen; FiO(2)= Fraction of inspired oxygen).RandomisationPatients will be randomized in a 1:1 ratio. Randomization will be done using REDCap (electronic IWRS system).Blinding (masking)In this open-label trial neither participants, caregivers, nor those assessing the outcomes will be blinded to group assignment.Numbers to be randomised (sample size)A total of 80 patients with confirmed COVID-19 and acute hypoxic respiratory failure will be enrolled, 40 in the active and 40 in the control group.Trial StatusSARPAC protocol Version 2.0 (April 15 2020). Participant recruitment is ongoing in 5 Belgian Hospitals (i.e. University Hospital Ghent, AZ Sint-Jan Bruges, AZ Delta Roeselare, University Hospital Brussels and ZNA Middelheim Antwerp). Participant recruitment started on March 26(th) 2020. Given the current decline of the COVID-19 pandemic in Belgium, it is difficult to anticipate the rate of participant recruitment.Trial registrationThe trial was registered on Clinical Trials.gov on March 30(th), 2020 (ClinicalTrials.gov Identifier: NCT04326920) - retrospectively registered; https://clinicaltrials.gov/ct2/show/NCT04326920?term=sarpac&recrs=ab&draw=2&rank=1 and on EudraCT on March 24th, 2020 (Identifier: 2020-001254-22).Full protocolThe full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol

Treatment of severely ill COVID-19 patients with anti-interleukin drugs (COV-AID) : a structured summary of a study protocol for a randomised controlled trial

ObjectivesThe purpose of this study is to test the safety and effectiveness of individually or simultaneously blocking IL-6, IL-6 receptor and IL-1 versus standard of care on blood oxygenation and systemic cytokine release syndrome in patients with COVID-19 coronavirus infection and acute hypoxic respiratory failure and systemic cytokine release syndrome.Trial designA phase 3 prospective, multi-center, interventional, open label, 6-arm 2x2 factorial design study.ParticipantsSubjects will be recruited at the specialized COVID-19 wards and/or ICUs at 16 Belgian participating hospitals. Only adult (>= 18y old) patients will be recruited with recent (<= 16 days) COVID-19 infection and acute hypoxia (defined as PaO2/FiO2 below 350mmHg or PaO2/FiO2 below 280 on supplemental oxygen and immediately requiring high flow oxygen device or mechanical ventilation) and signs of systemic cytokine release syndrome characterized by high serum ferritin, or high D-dimers, or high LDH or deep lymphopenia or a combination of those, who have not been on mechanical ventilation for more than 24 hours before randomisation. Patients should have had a chest X-ray and/or CT scan showing bilateral infiltrates within the last 2 days before randomisation. Patients with active bacterial or fungal infection will be excluded.Intervention and comparatorPatients will be randomized to 1 of 5 experimental arms versus usual care. The experimental arms consist of Anakinra alone (anti-IL-1 binding the IL-1 receptor), Siltuximab alone (anti-IL-6 chimeric antibody), a combination of Siltuximab and Anakinra, Tocilizumab alone (humanised anti-IL-6 receptor antibody) or a combination of Anakinra with Tocilizumab in addition to standard care. Patients treated with Anakinra will receive a daily subcutaneous injection of 100mg for a maximum of 28 days or until hospital discharge, whichever comes first. Siltuximab (11mg/kg) or Tocilizumab (8mg/kg, with a maximum dose of 800mg) are administered as a single intravenous injection immediately after randomization.Main outcomesThe primary end point is the time to clinical improvement defined as the time from randomization to either an improvement of two points on a six-category ordinal scale measured daily till day 28 or discharge from the hospital or death. This ordinal scale is composed of (1) Death; (2) Hospitalized, on invasive mechanical ventilation or ECMO; (3) Hospitalized, on non-invasive ventilation or high flow oxygen devices; (4) Hospitalized, requiring supplemental oxygen; (5) Hospitalized, not requiring supplemental oxygen; (6) Not hospitalized.RandomisationPatients will be randomized using an Interactive Web Response System (REDCap). A 2x2 factorial design was selected with a 2:1 randomization regarding the IL-1 blockade (Anakinra) and a 1:2 randomization regarding the IL-6 blockade (Siltuximab and Tocilizumab).Blinding (masking)In this open-label trial neither participants, caregivers, nor those assessing the outcomes are blinded to group assignment.Numbers to be randomised (sample size)A total of 342 participants will be enrolled: 76 patients will receive usual care, 76 patients will receive Siltuximab alone, 76 patients will receive Tocilizumab alone, 38 will receive Anakinra alone, 38 patients will receive Anakinra and Siltuximab and 38 patients will receive Anakinra and Tocilizumab.Trial StatusCOV-AID protocol version 3.0 (15 Apr 2020). Participant recruitment is ongoing and started on April 4(th) 2020. Given the current decline of the COVID-19 pandemic in Belgium, it is difficult to anticipate the rate of participant recruitment.Trial registrationThe trial was registered on Clinical Trials.gov on April 1st, 2020 (ClinicalTrials.gov Identifier: NCT04330638) and on EudraCT on April 3rd 2020 (Identifier: 2020-001500-41).Full protocolThe full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol