The impact of severe asthma on patients’ autonomy: a qualitative study

Background People living with severe asthma may have ongoing debilitating symptoms despite high‐dose treatment. Clinical guidelines for severe asthma recommend concepts such as patient centeredness, shared decision making and self‐management, at the heart of which lies autonomy. Objective This study aimed to explore the role of autonomy in patients’ narratives about their experiences of living with and managing severe asthma. Methods In‐depth semi‐structured interviews were video‐ and/or audio‐recorded and transcribed. Data were categorized using a hybrid approach to analysis incorporating both inductive and deductive methods, informed by the self‐determination construct of autonomy. Analysis and comparison across and within categories were conducted to develop final themes. Results Twenty‐nine face‐to‐face interviews, lasting 1.5‐4 hours, were conducted across Australia. Patients’ autonomy was enacted or challenged in a range of situations, such as interacting with health‐care providers, maintaining employment, managing symptoms, and dealing with threats to self‐identity. Two main themes were discerned from the analysis: (a) the desire to live an “unconstrained” life; and (b) preservation of self‐identity. Conclusion Our findings suggest that autonomy is broader than conventional medical concepts such as decision making and information seeking. Future research should consider these findings when developing and implementing patient‐driven self‐management interventions for those living with severe asthma

Chronic groundwater decline: a multi-decadal analysis of groundwater trends under extreme climate cycles

Chronic groundwater decline is a concern in many of the world’s major agricultural areas. However, a general lack of accurate long-term in situ measurement of groundwater depth and analysis of trends prevents understanding of the dynamics of these systems at landscape scales. This is particularly worrying in the context of future climate uncertainties. This study examines long‐term groundwater responses to climate variability in a major agricultural production landscape in southern Queensland, Australia. Based on records for 381 groundwater bores, we used a modified Mann-Kendall non-parametric test and Sen’s slope estimator to determine groundwater trends across a 26-year period (1989–2015) and in distinct wet and dry climatic phases. Comparison of trends between climatic phases showed groundwater level recovery during wet phases was insufficient to offset the decline in groundwater level from the previous dry phase. Across the entire 26-year sampling period, groundwater bore levels (all bores) showed an overall significant declining trend (p0.05). Spatially, both declining and rising bores were highly clustered. We conclude that over 1989–2015 there is a significant net decline in groundwater levels driven by a smaller subset of highly responsive bores in high irrigation areas within the catchment. Despite a number of targeted policy interventions, chronic groundwater decline remains evident in the catchment. We argue that this is likely to continue and to occur more widely under potential climate change and that policy makers, groundwater users and managers need to engage in planning to ensure the sustainability of this vital resource

Socio-demographic inequalities in the prevalence, diagnosis and management of hypertension in India: analysis of nationally-representative survey data.

BACKGROUND: Hypertension is a major contributing factor to the current epidemic of cardiovascular disease in India. Small studies suggest high, and increasing, prevalence especially in urban areas, with poor detection and management, but national data has been lacking. The aim of the current study was to use nationally-representative survey data to examine socio-demographic inequalities in the prevalence, diagnosis and management of hypertension in Indian adults. METHODS: Using data on self-reported diagnosis and treatment, and blood pressure measurement, collected from 12,198 respondents aged 18+ in the 2007 WHO Study on Global Ageing and Adult Health in India, factors associated with prevalence, diagnosis and treatment of hypertension were investigated. RESULTS: 22% men and 26% women had hypertension; prevalence increased steeply with body mass index (<18.5 kg/m(2): 18% men, 21% women; 25-29.9 kg/m(2): 35% men, 35% women), was higher in the least poor vs. poorest (men: odds ratio (95%CI) 1.82 (1.20 to 2.76); women: 1.40 (1.08 to 1.81)), urban vs. rural men (1.64 (1.19 to 2.25)), and men recently vs. never using alcohol (1.96 (1.40 to 2.76)). Over half the hypertension in women, and 70% in men, was undetected with particularly poor detection rates in young urban men, and in poorer households. Two-thirds of men and women with detected hypertension were treated. Two-thirds of women treated had their hypertension controlled, irrespective of urban/rural setting or wealth. Adequate blood pressure control was sub-optimal in urban men. CONCLUSION: Hypertension is very common in India, even among underweight adults and those of lower socioeconomic position. Improved detection is needed to reduce the burden of disease attributable to hypertension. Levels of treatment and control are relatively good, particularly in women, although urban men require more careful attention

Maximising the potential of people in sport and life: lessons from Benson Community Project

This is an accepted manuscript of an article published by UK Coaching in Applied Coaching Research Journal on 25/04/2021, available online: https://www.ukcoaching.org/resources/topics/research/applied-coaching-research-journal The accepted version of the publication may differ from the final published version.This paper explores how one particular community sport project in the West Midlands uses a coaching for development approach to maximise the potential of people in sport and in life. It has frequently been suggested that it shouldn���t be a taken for granted assumption that positive development will simply occur, rather, key decisions need to be made about the best way to shape sports projects to maximise the chance that they will result in successful outcomes . This paper examines how one club ���coaches for development���, and in doing so, supports individual development-one of the outcomes identified by Sport England in their 2016 strategy- Towards an Active Nation. An independent evaluation of Benson Community Project was carried out by the University of Wolverhampton in 2019. Observations of sessions were carried out over a 5 week period. Observations were followed up by semi structured interviews with 6 volunteer coaching staff to capture in depth accounts about the project. Four emergent themes were identified from the observations and interviews. These were safe space, freestyling, relationship strategy and alternative pathways

Maximising the potential of people in sport and life. Lessons from the Benson community project

This paper explores how one particular community sport project in the West Midlands uses a coaching for development approach to maximise the potential of people in sport and in life. It has frequently been suggested that it shouldn’t be a taken for granted assumption that positive development will simply occur, rather, key decisions need to be made about the best way to shape sports projects to maximise the chance that they will result in successful outcomes . This paper examines how one club ‘coaches for development’, and in doing so, supports individual development-one of the outcomes identified by Sport England in their 2016 strategy- Towards an Active Nation. An independent evaluation of Benson Community Project was carried out by the University of Wolverhampton in 2019. Observations of sessions were carried out over a 5 week period. Observations were followed up by semi structured interviews with 6 volunteer coaching staff to capture in depth accounts about the project. Four emergent themes were identified from the observations and interviews. These were safe space, freestyling, relationship strategy and alternative pathway

Groundwater thresholds for drought resilience in floodplain woodlands: a case study from the northern Murray-Darling Basin

In ephemeral river systems, canopy condition in dominant riparian and floodplain tree species may depend on access to shallow groundwater resources, particularly during drought. However, unsustainable groundwater extraction and chronic groundwater decline, evident in many agricultural landscapes worldwide, effectively decouples tree roots from deep soil moisture resources, increasing the susceptibility of trees to changes in precipitation. In such regions, drought may trigger loss of canopy condition and have long term consequences for the function and survival of trees and the composition, structure and function of ecosystems they dominate. However, critical groundwater depth thresholds have been difficult to identify. This study used a novel approach including boosted regression trees, quantile regression and threshold analysis to explore the relationship between groundwater depth and tree condition for two dominant tree species, Eucalyptus camaldulensis (river red gum) and E. populnea (poplar box); both species occur on the Upper Condamine floodplain, a region experiencing groundwater depth declines of 25+m in the northern Murray-­‐Darling Basin, southern Queensland. Distinct non-­‐linear responses were apparent, with minimum groundwater depth thresholds identified at 12.1m for E. camaldulensis and 12.6m for E.populnea, beyond which canopy condition declined significantly. This approach represents a repeatable method of quantifying ecological response thresholds along groundwater depth gradients. Its application may enable safe operating limits for groundwater resource management to be identified, supporting improved decision making to support resilient floodplain ecosystems. This will be particularly important in regions where groundwater decline driven by increasing water demand and drying climates is predicted

“…I’ve said I wish I was dead, you’d be better off without me”: a systematic review of people’s experiences of living with severe asthma

Objective: Our aim was to conduct a systematic review and synthesis of qualitative evidence exploring the lived experience of adults with severe asthma. Data sources: We searched MEDLINE via OvidSP, PsycINFO via OvidSP, PubMed, CINAHL, EMBASE, Sociological Abstracts, Google Scholar, the journals Qualitative Health Research and Qualitative Research, and a study of experiences of living with asthma by the Health Experiences Research group. Study selections: Studies were included if they used qualitative methods and explored the subjective experiences of adults (≥18 years) with a clear diagnosis of severe asthma. Results: From 575 identified studies, five met the inclusion criteria. Synthesis revealed an overarching theme of efforts that people living with severe asthma engage in to achieve personal control over their condition. Individuals ‘strive for autonomy’ through dealing with symptoms and treatment, acquiring knowledge, making decisions and reclaiming identity. Conclusion: This systematic review found a paucity of qualitative studies reporting on people's perspectives of living with severe asthma, and a focus on clinical rather than personal issues. Our synthesis reveals that severe asthma was disempowering, and a threat to identity and life roles. What was important to people living with severe asthma was striving to achieve a greater level of personal control over their condition, but these efforts received little support from their healthcare providers. Thus, more attention should be paid to understanding the self-management strategies and personal goals of people living with severe asthma. This may assist in designing interventions to better support patient self-management and improve health outcomes

Groundwater depth thresholds for tree condition

A range of ecological processes supported by groundwater are at risk where socio-economic and climate drivers increase net groundwater demand. Previous research has indicated close links between groundwater and riparian/floodplain tree condition. However, little is known about the nature of the relationship or whether critical groundwater-tree condition thresholds exist. Threshold responses may indicate the existence of groundwater depths associated with rapid ecological change. This study provides evidence of threshold responses between groundwater depth and tree condition in the Condamine catchment in eastern Australia, where groundwater decline due to over-extraction is well documented. It collates tree condition data (118 sites) from recent studies of two dominant Australian floodplain species, Eucalyptus camaldulensis Denh. (river red gum) and E. populnea F. Muell. (poplar box). Boosted regression trees and quantile regression were used to investigate the nature of the relationship and threshold values. A distinct non-linear response of tree condition to groundwater depth was identified, with thresholds identified at 12.5–17.2 m for E. camaldulensis and 15.6–22.0 m for E. populnea. Threshold responses may be explained in terms of physiological limitations to rooting depth in these and similar floodplain/riparian species, with groundwater decline effectively decoupling tree roots from accessible moisture resources leaving trees more vulnerable to hydraulic stress and/or failure particularly under drought conditions. The existence of thresholds suggest that groundwater decline may trigger rapid ecological changes in riparian and floodplain tree species, which may have important implications not only for their future persistence but also the various ecological functions they support