Challenge of culture, conscience, and contract to general practitioners' care of their own health: qualitative study

Objective: To explore general practitioners' perceptions of the effects of their profession and training on their attitudes to illness in themselves and colleagues. Design: Qualitative study using focus groups and indepth interviews. Setting: Primary care in Northern Ireland. Participants: 27 general practitioners, including six recently appointed principals and six who also practised occupational medicine part time. Main outcome measures: Participants' views about their own and colleagues' health. Results: Participants were concerned about the current level of illness within the profession. They described their need to portray a healthy image to both patients and colleagues. This hindered acknowledgement of personal illness and engaging in health screening. Embarrassment in adopting the role of a patient and concerns about confidentiality also influenced their reactions to personal illness. Doctors' attitudes can impede their access to appropriate health care for themselves, their families, and their colleagues. A sense of conscience towards patients and colleagues and the working arrangements of the practice were cited as reasons for working through illness and expecting colleagues to do likewise. Conclusions: General practitioners perceive that their professional position and training adversely influence their attitudes to illness in themselves and their colleagues. Organisational changes within general practice, including revalidation, must take account of barriers experienced by general practitioners in accessing health care. Medical education and culture should strive to promote appropriate self care among doctors.

‘‘Capital of Culture - you must be having a laugh!” Challenging the official rhetoric of Liverpool as the 2008 European cultural capital’

Major cultural events are increasingly seen by local stakeholders as important opportunities to stimulate urban regeneration, city branding and economic development. The European Capital of Culture programme is a prominent example. Since 1985 over thirty cities have hosted the title and today it remains a highly sought-after prize. This paper analyses competing interpretations of the success of Liverpool's hosting of the European Capital of Culture in 2008. It unpacks contrasting views of Liverpool08, from the official triumphant message of urban regeneration and economic renaissance to more critical analyses that problematise important elements of the event and its social and spatial impacts. In so doing, it challenges the hyperbole of culture-led transformation to reveal different geographies of culture, different cultural experiences and different socio-economic realities; it also offers an additional cultural reading of Liverpool in 2008. Through the example of Liverpool this paper shows how local culture is politicised, manipulated and sanitised in order to stimulate urban regeneration and construct a spatial re-branding of the city.

De grands événements culturels sont de plus en plus perçus par les rentiers locaux comme des opportunités importantes pour stimuler la régénération urbaine, produire la devise des villes et le développement économique. L'initiative La Capitale Européenne de la Culture est un exemple proéminent. Depuis 1985, plus de trente villes ont accueilli le titre et maintenant il reste un prix largement recherché. Cet article analyse des interprétations en concurrence du succès de l'accueil de Liverpool de la Capitale Européenne de la Culture en 2008. Il déballe des vues contrastées de Liverpool08, du message officiel et triomphal de la régénération urbaine et de la renaissance économique à des analyses plus critiques qui problématisent des éléments importants de l'événement et ses impacts sociaux et spatiaux. De cette façon, il conteste l'hyperbole de la transformation menée par la culture pour révéler des géographies différentes de la culture, des expériences différentes de la culture et des réalités socioéconomiques différentes; il offre aussi une interprétation culturelle différente de Liverpool en 2008. Au travers de l'exemple de Liverpool cet article montre comment la culture locale est politisée, manipulée et aseptisée pour stimuler la régénération urbaine et construire un relookage spatial de la ville.

Cada vez más, los inversores locales vean a los eventos culturales como oportunidades importantes para estimular regeneración urbana, el desarollo económico y la branding a una ciudad. El Capital Europeo de Cultura es un ejemplo prominente. Desde 1985, más que treinta ciudades han presentado el título y hoy sigue siendo un premio deseable. Este papel se analiza interpretaciones competitivos del éxito del Capital Europea de Cultura 2008 en Liverpool. Se deshace las perspectivas opuestas del Liverpool08, del mensaje triunfante de regeneración urbana y renacimiento económico, a analices críticos que problematizan elementos importantes del evento y sus impactos sociales y espaciales. Al hacer esto, se cuestiona el hipérbole de la transformación cultural para revelar geografías diferentes de cultura, experiencias culturales diferentes y realidades diferentes socio-económicas; también ofrece un entendimiento cultural adicional de Liverpool en el 2008. Através el ejemplo de Liverpool, este papel demuestra como la cultura local está politizada, manipulada, y desinfectado para estimular regeneración urbana y construir una nueva branding de la ciudad.

Use of culture and molecular analysis to determine the effect of antibiotic treatment on microbial community diversity and abundance during exacerbation in patients with cystic fibrosis

Background: Anaerobic bacteria are increasingly regarded as important in cystic fibrosis (CF) pulmonary infection. The aim of this study was to determine the effect of antibiotic treatment on aerobic and anaerobic microbial community diversity and abundance during exacerbations in patients with CF.

Methods: Sputum was collected at the start and completion of antibiotic treatment of exacerbations and when clinically stable. Bacteria were quantified and identified following culture, and community composition was also examined using culture-independent methods.

Results: Pseudomonas aeruginosa or Burkholderia cepacia complex were detected by culture in 24/26 samples at the start of treatment, 22/26 samples at completion of treatment and 11/13 stable samples. Anaerobic bacteria were detected in all start of treatment and stable samples and in 23/26 completion of treatment samples. Molecular analysis showed greater bacterial diversity within sputum samples than was detected by culture; there was reasonably good agreement between the methods for the presence or absence of aerobic bacteria such as P aeruginosa (kappa=0.74) and B cepacia complex (kappa=0.92), but agreement was poorer for anaerobes. Both methods showed that the composition of the bacterial community varied between patients but remained relatively stable in most individuals despite treatment. Bacterial abundance decreased transiently following treatment, with this effect more evident for aerobes (median decrease in total viable count 2.3 x 10(7) cfu/g, p=0.005) than for anaerobes (median decrease in total viable count 3 x 10(6) cfu/g, p=0.046).

Conclusion: Antibiotic treatment targeted against aerobes had a minimal effect on abundance of anaerobes and community composition, with both culture and molecular detection methods required for comprehensive characterisation of the microbial community in the CF lung. Further studies are required to determine the clinical significance of and optimal treatment for these newly identified bacteria.

The influence of culture on home-based family caregiving at end-of-life: A case study of Dutch reformed family care givers in Ontario, Canada

Families are facing increased pressure to provide care to their terminally-ill or dying kin in the home. It is known that balancing care with other personal and social roles can adversely affect family caregivers' (FCGs) health, yet access to supportive services which can mitigate burden is often inadequate. Cultural factors are known to shape the experience of caregiving; however, most research to date tends to neglect the experiences of FCGs from different cultural groups. This understanding is necessary to ensure that supportive services are both meaningful and culturally-appropriate. Using qualitative methods, we undertook longitudinal research with a sample of Dutch Reformed FCGs (n = 5) to understand their experiences of caregiving and bereavement. The results of the study are suggestive of a cultural specificity with respect to caregiving that impacts both responsibilities and reactions to care. Three themes were salient to this group as a cultural entity: cultural attitudes towards care, religious beliefs and coping, and c. ulturally-informed care-seeking behaviours. These three themes were seen to be a function of their religious and ethnic identities and were reinforced by ties to the communities in which they resided. Cultural identity provided a framework through which to understand and make sense of the experience, while group membership provided access to networks of informal support. This research contributes to the geographical literature on care/caregiving by providing insight into the social, cultural and religious context of informal family caregiving with a population who live in close geographic proximity. On a practical level, this case study indicates the importance of considering how these factors may operate in other settings in order to implement timely and appropriate interventions to better support FCGs who are caring for their terminally-ill loved-ones at home.