Under-investigation of older people with abnormal chest radiographs

Background: Whilst many authors have previously suggested that older people are under-represented in the investigation and management of lung cancer, few data are available as to the effect of age on the subsequent investigation and management of a patient with an abnormal chest radiograph. Methods: During a 3-month period in a university teaching hospital, all abnormal chest radiographs suggestive of a possible diagnosis of lung cancer were identified, and patients subsequently followed to determine investigation, management and date of death over a 5-year period. Results: Thirty-seven younger (less than or equal to69 years, median age 62 years) and 43 older patients ( 670 years, median age 80 years) were identified. Of the 80 patients with a possible bronchial carcinoma only 59% had a further chest radiograph performed. Bronchoscopy was performed in 34% of patients, but a biopsy of the lesion was undertaken in only 24% of patients. Sixteen of the 80 patients, irrespective of what investigations had been undertaken, were referred for an oncological or surgical opinion. During the study period ( 3 months), 24% of the patients died. At 6, 24 and 60 months, respectively, the total deaths were 40, 78 and 88%. Conclusion: Older patients compared with those aged less than 70 years were less likely to be investigated, further, were more likely to be managed differently (i.e., less aggressively) and more likely to die within each time interval. In more of the older group a presumed death certificate diagnosis of pneumonia was made. When an abnormal chest radiograph raises the possibility of an underlying bronchial carcinoma, the finding of this study suggests that an ageist attitude influences the subsequent management of some patients. Copyright (C) 2005 S. Karger AG, Basel.

‘Rapt up with joy’: children’s emotional responses to death in early modern England

The chapter is an investigation of the child’s emotional response to death in early modern England. While much valuable scholarship has been produced on parents’ responses to the deaths of children, the reactions of the young themselves have rarely been explored. Drawing on a range of printed and archival sources, I argue that children expressed diverse and conflicting emotions, from fear and anxiety, to excitement and ecstasy. By exploring the emotional experiences of Protestants, the chapter contributes to the bourgeoning literature on emotion and religion, and contests earlier depictions of reformed Protestantism as an inherently intellectual, rather than an affective, faith. This study also suggests that we revise the way we classify the emotions, resisting the intuitive urge to categorise them as ‘positive’ or ‘negative’. The fear of hell, for example, though profoundly unpleasant, was regarded as a rational, commendable response, which demonstrated the work of the Holy Spirit in the soul, and was a prerequisite for the attainment of a joyful assurance of heaven. An underlying question is to what extent children’s responses to death differed from those of adults. I propose that although their reactions were broadly similar, the precise preoccupations of dying children were different. Through highlighting these distinctive features, we can come to a closer idea of what it was like to be a child in the early modern period.