A softer side to men

“I am on time. It’s the afternoon of my medical for life-insurance suitability. The AMP building in Sydney is my destination. I arrive with about twenty minutes to spare. I don’t remember the receptionist. I don’t remember the faces of the doctors who attended me that day. All I can remember is that I could see the clouds passing over the glass ceiling as my blood pressure was taken several times. The first doctor took my blood pressure three times before seeking another opinion. The second doctor confirmed his fears. I was in the “too high” risk category. At the time I was 22 years of age, and weighing, on average, one-hundred and fifty kilograms. Over the next nine months I reach an extreme level of weight loss. At my lightest I weighed eighty-two kilograms.” I am a male researcher, researching masculine bodyweight and masculine embodiment. In the qualitative tradition, seven men (primary participants) who underwent significant weight gain. and loss were interviewed with the purpose of understanding how they experienced their sense of self as socially reflected. In addition to this, seven significant others (secondary participants) were interviewed in relation to their observations of primary participants during these periods. This is an interdisciplinary study which utilises symbolic interactionist concepts of self, and social identity, in conjunction with sociological and philosophical concerns about body-image, bodyweight, and the expression of subjective and social masculine identities in a gendered socio-cultural context, where tension exists between individual freedom and social control (See Bordo, !999a: Cooley, 1964; Drummond, 2002; Foucault, 1980; Goffman 1963b, 1967; Mead, 1934; Sparkes, 1999). It was found that different levels of male body fat influences subjective conceptions of self, subjective expressions of masculine identities, and social projections of what it means to be a fat and thin man. This study reveals that men went to extremes to lose weight, in most cases by restricting their food intake. In addition to this, it was also found that thinner men consume more fashion than fatter men, and that happy fat men in sexual relationships were least likely to regulate their bodyweight until these relationships ended. Self-regulation was found to be more prominent in those men competing for intimacy in the sexual market. In brief, this study establishes here is a softer reflective side of men than had been previously documented

Dancing With Difference

This is a symbolic interactionist study into behaviours surrounding social interaction. The study has two components, asking how people with able-bodies interact with a young person with a disability, and how does the young person, who is non-verbal, respond to and interpret such interactions? Participants were observed and recorded using a digital camera whilst interacting at a social venue. The able-bodied participants were not aware of the camera at the time of filming, and were approached after the filming to participate in the study. Seven participants were later interviewed and asked to explain what they were aware of as they interacted. Lyndon, the young person with a disability, was involved in the planning and implementation of the research from the beginning. Most research undertaken on interactions between able-bodied people and people with disabilities has not been able to move past the way in which people with disabilities are dehumanised during the interaction process (Jahoda, Markova & Catterrnale, 1989). Little attention has been given to the possibility that able-bodied people are unsure of how to go about interacting with people with disabilities (Soder, 1990). The study found that able-bodied people were concerned about being seen to stare at Lyndon (because staring is rude) and thought that asking personal questions about his disability would be impolite. There was a fear of drawing undue attention to him and his disability during the interaction. Participants interacted with Lyndon using a set of projections and abstract assumptions of how they saw him. They constructed these through what they observed in his physical appearance and body language. The themes used to interact with him were; the chosen one, public awareness, pity or tragedy and sexually safe. Lyndon was unable to alter these constructions through dialogue and instead had to accept them or reject them. Lyndon also projected a set of assumptions onto participants he interacted with, yet during the interactions he was unable to convey to the other what they were. In this context, each encounter is masked by people\u27s inability to understand and interpret not only theirs, but the others intention and motivation behind each interaction

Distorted body image and anorexia complicating cystic fibrosis in an adolescent

AbstractA 15 year old girl with cystic fibrosis has been dieting and losing weight for 2 years. Despite being underweight she aims to lose a further 6 kg to become a “size zero”. Her falling weight has been associated with deteriorations in her general health and lung function, which is exacerbated by poor compliance. The situation has been complicated further by her becoming pregnant

A review of prednisolone prescribing for children with acute asthma in the UK

Abstract: Introduction: Worldwide asthma guidelines recommend short courses of oral prednisolone in children with acute exacerbations generating high prescription numbers. There is a paucity of evidence to inform the optimal dose and course duration. This has led to a variation in the recommendations for prednisolone prescribing. Our objective was to assess prednisolone prescribing practise for children with acute asthma in a representative sample of UK prescribers. Methods: We developed an online questionnaire asking prescribers the prednisolone dosage, course duration and formulation used, whether they discussed oral prednisolone side effects with the family and at what child's age they changed from prescribing soluble to non-soluble formulations. This was sent to 1006 UK prescribers including Paediatric Respiratory Consultants, doctors in training, asthma nurses and General Practitioners. Results: 200 complete responses were received (response rate 20%). The majority of surveyed prescribers follow the British National Formulary for Children recommendations on dosage rather than those included in the British Thoracic Society and the Scottish Intercollegiate Guidelines Network. Despite this, we highlighted a 4-fold variation in prednisolone dosages for acute asthma. The majority of prescribers chose 3 days as the course duration. High use of soluble formulations was highlighted. Conclusions: There is wide variation in the dose of prednisolone prescribed for children with acute asthma in the UK. This reflects a relative lack of evidence that needs addressing

Tidal breathing parameters measured using structured light plethysmography in healthy children and those with asthma before and after bronchodilator

Structured light plethysmography (SLP) is a light‐based, noncontact technique that measures tidal breathing by monitoring displacements of the thoracoabdominal (TA) wall. We used SLP to measure tidal breathing parameters and their within‐subject variability (v) in 30 children aged 7–16 years with asthma and abnormal spirometry (forced expiratory volume in 1 sec [FEV1] <80% predicted) during a routine clinic appointment. As part of standard care, the reversibility of airway obstruction was assessed by repeating spirometry after administration of an inhaled bronchodilator. In this study, SLP was performed before and after bronchodilator administration, and also once in 41 age‐matched controls. In the asthma group, there was a significant increase in spirometry‐assessed mean FEV1 after administration of bronchodilator. Of all measured tidal breathing parameters, the most informative was the inspiratory to expiratory TA displacement ratio (IE50SLP, calculated as TIF50SLP/TEF50SLP, where TIF50SLP is tidal inspiratory TA displacement rate at 50% of inspiratory displacement and TEF50SLP is tidal expiratory TA displacement rate at 50% of expiratory displacement). Median (m) IE50SLP and its variability (vIE50SLP) were both higher in children with asthma (prebronchodilator) compared with healthy children (mIE50SLP: 1.53 vs. 1.22, P < 0.001; vIE50SLP: 0.63 vs. 0.47, P < 0.001). After administration of bronchodilators to the asthma group, mIE50SLP decreased from 1.53 to 1.45 (P = 0.01) and vIE50SLP decreased from 0.63 to 0.60 (P = 0.04). SLP‐measured tidal breathing parameters could differentiate between children with and without asthma and indicate a response to bronchodilator

Tidal breathing parameters measured by structured light plethysmography in children aged 2-12 years recovering from acute asthma/wheeze compared with healthy children

© 2018 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.Peer reviewedPublisher PD

Exhaled breath hydrogen cyanide as a marker of early Pseudomonas aeruginosa infection in children with cystic fibrosis

Hydrogen cyanide is readily detected in the headspace above Pseudomonas aeruginosa cultures and in the breath of cystic fibrosis (CF) patients with chronic (P. aeruginosa) infection. We investigated if exhaled breath HCN is an early marker of P. aeruginosa infection. 233 children with CF who were free from P. aeruginosa infection were followed for 2 years. Their median (interquartile range) age was 8.0 (5.0–12.2) years. At each study visit, an exhaled breath sample was collected for hydrogen cyanide analysis. In total, 2055 breath samples were analysed. At the end of the study, the hydrogen cyanide concentrations were compared to the results of routine microbiology surveillance. P. aeruginosa was isolated from 71 children during the study with an incidence (95% CI) of 0.19 (0.15–0.23) cases per patient-year. Using a random-effects logistic model, the estimated odds ratio (95% CI) was 3.1 (2.6–3.6), which showed that for a 1- ppbv increase in exhaled breath hydrogen cyanide, we expected a 212% increase in the odds of P. aeruginosa infection. The sensitivity and specificity were estimated at 33% and 99%, respectively. Exhaled breath hydrogen cyanide is a specific biomarker of new P. aeruginosa infection in children with CF. Its low sensitivity means that at present, hydrogen cyanide cannot be used as a screening test for this infection

Bacterial distribution in the lungs of children with protracted bacterial bronchitis

OBJECTIVES: Flexible bronchoscopy with bronchoalveolar lavage (FB-BAL) is increasingly used for the microbiological confirmation of protracted bacterial bronchitis (PBB) in children with a chronic wet cough. At our centre, when performing FB-BAL for microbiological diagnosis we sample 6 lobes (including lingula) as this is known to increase the rate of culture positive procedures in children with cystic fibrosis. We investigated if this is also the case in children with PBB. METHODS: We undertook a retrospective case note review of 50 children investigated for suspected PBB between May 2011 and November 2013. RESULTS: The median (IQR) age at bronchoscopy was 2.9 (1.7-4.4) years and the median (IQR) duration of cough was 11 (8.0-14) months. Positive cultures were obtained from 41/50 (82%) and 16 (39%) of these patients isolated ≥2 organisms. The commonest organisms isolated were Haemophilus influenzae (25 patients), Moraxella catarrhalis (14 patients), Staphylococcus aureus (11 patients) and Streptococcus pneumoniae (8 patients). If only one lobe had been sampled (as per the European Respiratory Society guidance) 17 different organisms would have been missed in 15 patients, 8 of whom would have had no organism cultured at all. The FB-BAL culture results led to an antibiotic other than co-amoxiclav being prescribed in 17/41 (41%) patients. CONCLUSIONS: Bacterial distribution in the lungs of children with PBB is heterogeneous and organisms may therefore be missed if only one lobe is sampled at FB-BAL. Positive FB-BAL results are useful in children with PBB and can influence treatment

Неправильное использование ингаляторов: оценка ингаляционной техники и предпочтений пациентов при сравнении семи различных ингаляционных устройств

Inefficient inhaler technique is a common problem resulting in decreased disease control and increased inhaler use. The aim of this study was to assess patients' use of different inhaler devices and to ascertain whether patient preference is indicative of ease of use and whether current inhaler use has any influence on either technique or preference. We also wished to define the most appropriate method of selecting an inhaler for a patient, taking into account observed technique and device cost. One hundred patients received instruction, in randomized order, in the use of seven different inhaler devices. After instruction they were graded (using predetermined criteria) in their inhaler technique. After assessment patients were asked which three inhalers they most preferred and which, if any, they currently used. Technique was best using the breath-actuated inhalers; the Easi-Breathe and Autohaler, with 91 % seen to have good technique. The pressurized metered dose inhaler (pMDI) fared poorly, in last position with only 79 % of patients showing good technique, despite being the most commonly prescribed. The Easi-Breathe was by far the most popular device with the patients. The Autohaler came in second position closely followed by the Clickhaler and Accuhaler. The majority of patients (55 %) currently used the pMDI but the pMDI did not score highly for preference or achieve better grades than the other devices. Only 79 % of patients tested could use the pMDI effectively even after expert instruction yet it continues to be commonly prescribed. This has important repercussions for drug delivery and hence disease control. Prescribing a patient's preferred device increases cost but can improve efficiency and therefore be cost effective in the long term. Using an inexpensive device (pMDI) when technique is good and the patient's preferred inhaler device when not is one way to optimize delivery and may even reduce cost.Неправильная техника ингаляций — частая проблема, приводящая к плохой доставке лекарства в дыхательные пути, снижающая контроль над болезнью и увеличивающая частоту применения ингаляторов. Цель данного исследования — оценить технику использования больными ингаляционных устройств различных видов и сделать вывод, являются ли предпочтения пациентов в выборе ингалятора показателем правильности его использования, и влияет ли постоянное применение ингалятора на технику ингаляций и предпочтения пациента. Мы также хотели определить наиболее приемлемый способ подбора ингалятора для конкретного больного с учетом техники использования и стоимости ингалятора. 100 пациентам в рандомизированном порядке были даны инструкции по применению 7 различных ингаляционных устройств. Затем была оценена техника ингаляций по заранее определенным критериям. Далее пациентам было предложено выбрать 3 наиболее предпочитаемых ими ингалятора, и задан вопрос, какими ингаляторами они пользуются постоянно. Лучшая техника ингаляций наблюдалась при использовании активируемых вдохом ингаляционных устройств, ингаляционной системы "Легкое Дыхание" и Аутохалера — 91 % больных показали хорошую технику их применения. Техника использования дозированных аэрозольных ингаляторов (ДАИ) была на последнем месте — только 79 % больных показали хорошую технику ингаляций, несмотря на то, что эти ингаляторы назначаются наиболее часто. Ингалятор "Легкое Дыхание" был наиболее популярным среди пациентов. Аутохалер занял второе место, близко к нему оказались Кликхалер и Аккухалер. Большинство больных (55 %) постоянно пользуются обычными дозированными аэрозольными ингаляторами (ДАИ), но не отдают им предпочтения перед другими ингаляционными устройствами. Только 79 % обследованных пациентов могли эффективно использовать ДАИ даже после инструкции экспертов, хотя эти ингаляторы остаются наиболее часто назначаемыми. Это имеет большое значение для доставки лекарства в дыхательные пути и, следовательно, контроля над болезнью. Назначение больному того ингалятора, который он предпочитает, увеличивает стоимость, но зато может улучшить эффективность лечения и, таким образом, стать экономически более выгодным при длительном применении. Использование недорогих ингаляционных устройств ДАИ целесообразно при хорошей технике ингаляций и положительном отношении больного к этим ингаляторам; в противном случае необходимо оптимизировать доставку лекарства в дыхательные пути, что также может снизить стоимость лечения