Transforming social relations : how caregiving sons "do" gender subversively

In this dissertation, I explored how social relationships influence, and are influenced by, men's experiences of caregiving to their aging parents. Because of sociodemographic trends such as fewer siblings in younger generations and the growth of women seeking professional careers, men are increasingly likely to be called upon to meet parental care needs. When assuming care responsibility for their parents, however, men must confront the gender ideology that defines family caregiving as "women's work." Positioning social relationships as a component of men's gendered experiences of parental caregiving, I addressed two research questions. First, I sought to understand the role of social relationships in caregiving sons' negotiation of masculinity. Second, I examined whether and how caregiving sons (re)organize their social networks so as to better manage care responsibility. In pursuing these questions, my ultimate goals were to identify (a) whether and how men's parental caregiving can subvert gender relations, and (b) whether and how social partners link men's experiences of parental caregiving to gendered structural arrangements. In this research, I focused on caregiving sons in Japan, where, despite an increase in sons who (are required to) take on the role of parental caregiver, men's parental caregiving is still seen as "atypical." This dissertation consists of three studies. In the first study, I sought to clarify how Japanese men typically view and carry out care responsibility for their parents in relation to traditional familial institutions, Ie, that are comprised of multiple norms regarding such dimensions as birth order, inheritance, and the family membership of married women. Using data from a nationally representative sample of men in Japan (N = 964), results of latent class analyses indicated that Japanese men can be classified into three groups according to level of conformity to each norm in the Ie tradition. Further, through multiple group regression analyses on men with at least one living parent in the sample (n = 553), I found family circumstances associated with their actual involvement in parental caregiving differ across the three groups. The results suggest possible sociohistorical changes in the influence of Ie ideas on Japanese men's views about and styles of parental caregiving. In the second study, from the perspective of doing gender, I examined how caregiving sons account for their atypical family role, with particular attention paid to their nonnormative use of normative conceptions of gender and family. Using a constructivist version of grounded theory applied to interview data from adult sons in Japan who are primary caregivers for their parents with dementia (N = 21), I found they attempt to legitimize their care responsibility by invoking (a) traditional Ie norms and (b) stereotypical ideas about masculinity/femininity, both of which have been used in the past to tie women to family caregiving. The findings suggest that sons might deconstruct normative conceptions in an attempt to frame their parental caregiving as accountable. In the final study grounded in social convoy theory, I examined (a) how Japanese caregiving sons perceive feedback about their caregiving from members of their social networks, and (b) how, in response, they reconstruct their social relationships. Using a constructivist version of grounded theory, I analyzed interview data from adult sons in the role of primary caregivers for their parents who have dementia (N = 21). Despite relatively frequent contact with colleagues, friends, and neighbors, to avoid possible negative reactions, sons rarely told these network members about their care experiences; thus, their parental caregiving was compartmentalized from other aspects of their social lives. The findings suggest that the restricted social relationships of caregiving sons are at least partly the product of their efforts to assume parental care responsibility in a society that marginalizes men's caregiving. In conclusion, although parental caregiving is a likely context in which men might destabilize the ideological basis for gender relations within attempts to do gender, their network members appear to compel them to confine such subversive gender performance within the caregiving setting. At the same time, the findings also suggest that men in younger generations may take on the role of parental caregiver in different social environments than that of their older counterparts. Building on these findings, I offer suggestions about how to approach both caregiving sons' and their social partners' ideas about gender such that these sons can be more open about their care experiences.Keywords: Caregiving, Gender, Social Relationship

Case report: Thyroid storm in a three-year-old girl presenting with febrile status epilepticus and hypoglycemia

Thyroid storm, though extremely rare in toddlers, requires prompt diagnosis and treatment because it can be fatal if left untreated. However, thyroid storm is not often considered in the differential diagnosis of a febrile convulsion due to its rarity in children. Herein, we report the case of a 3-year-old girl with thyroid storm who presented with febrile status epilepticus. Although the seizure was stopped by diazepam administration, her tachycardia and widened pulse pressure persisted, and severe hypoglycemia was observed. Based on the findings of thyromegaly, a history of excessive sweating and hyperactivity, and a family history of Graves' disease, she was eventually diagnosed with a thyroid storm. The patient was successfully treated with thiamazole, landiolol, hydrocortisone, and potassium iodide. Propranolol, a non-selective β-blocker, has been used to manage tachycardia during thyroid storm. However, a cardio-selective β1-blockers, landiolol hydrochloride, was used in our case to avoid worsening hypoglycemia. Febrile status epilepticus is one of the most common medical emergencies in childhood; it is necessary to rule out treatable underlying critical diseases such as septic meningitis and encephalitis. Thyroid storm should be considered in children presenting with prolonged febrile convulsion accompanied by findings that are not usually observed with febrile convulsions

Results of laparoscopic subtotal cholecystectomy by laparoscopic linear stapler in difficult cases with severe cholecystitis

Laparoscopic subtotal cholecystectomy (LSC) has been recognized as a safe and feasible alternative surgical procedure for a difficult laparoscopic cholecystectomy (LC) with severe inflammation in Calot’s triangle. We compared the surgical outcomesof cholecystectomy for acute cholecystitis between standard LC and LSC using laparoscopic linear stapler. 172 patients were diagnosed as acute cholecystitis, among them, 16 patients who underwent LSC and other 156 patients who underwent standardLC were enrolled in this study. The severity grading of acute cholecystitis in LSC group was significantly higher than LC group. Operation time was longer in the LSC group than LC group. LSC had significantly more intraoperative blood loss compared to LC. However, there was no significant difference in the postoperative complications between two groups. LSC using laparoscopic linear stapler contributes surgeons avoid common bile duct injury in difficult LC