In their own words: early childhood asthma and parents’ experiences of the diagnostic process

Scand J Caring Sci; 2010; 24; 299–306
In their own words: early childhood asthma and parents’ experiences of the diagnostic process This paper explores the experiences of parents of asthmatic children in the period leading up to their child receiving a formal medical diagnosis. To what extent did the parents face difficulties in obtaining this diagnosis? How did they describe their encounters with the healthcare professionals? In particular, did parents portray themselves as passive and dominated or active and participating during the prediagnosis phase? In‐depth interviews with individuals and participants in a focus group exposed the prediagnosis phase as a distinct and memorable phase of the disease, often recalled as a period of frustration and uncertainty. Results show that instead of accepting the authority of the professional, parents eventually acquire knowledge elsewhere about the diagnosis and the healthcare system, and act according to that knowledge. As a fundamental uncertainty appears involved in the diagnostic process, parents dealing with this uncertainty use a number of strategies to gain control of the process of alleviating their child’s disease. The paper discusses the status of the information that the researcher obtained from parents. Lay narratives cannot be treated as simple reports of an external reality. As the parental role is rooted in normative conceptions about what constitutes ‘responsible parenthood’, information given to the observer may therefore be influenced by the informants’ concern with their appearance as moral persons or adequate parents. Although a research strategy based on one‐sided interviews has limitations, using parents as a source of information offers a rare glimpse into the realities of patient‐physician encounters.     

Mid‐term results of bariatric surgery in morbidly obese Japanese patients with slow progressive autoimmune diabetes

Introduction

Bariatric surgery is recognized as an effective treatment for type 2 diabetes mellitus, but data on its efficacy for type 1 diabetes mellitus, especially slowly progressive insulin‐dependent diabetes mellitus, are limited.

Methods

We investigated five Japanese patients with slowly progressive insulin‐dependent diabetes mellitus who underwent bariatric surgery at our center.

Results

Five morbidly obese glutamic acid decarboxylase antibody‐positive diabetic patients underwent two different types of bariatric surgery. The mean titer of anti‐glutamic acid decarboxylase antibody was 4.6 U/mL, and the mean preoperative bodyweight and BMI were 113 kg and 39.6 kg/m², respectively. The mean hemoglobin A1c was 8.4%. The mean fasting serum C‐peptide was 5.0 ng/mL. Laparoscopic sleeve gastrectomy was performed in two patients, while laparoscopic sleeve gastrectomy with duodenojejunal bypass was performed in three patients. At one year after surgery, the mean bodyweight and BMI significantly dropped, and the mean percentage of excess weight loss was 96.4%. The mean hemoglobin A1c was 5.7%. This favorable trend was maintained at mid‐term.

Conclusion

Bariatric surgery for morbidly obese patients with anti‐glutamic acid decarboxylase antibody–positive type 1 diabetes mellitus, especially slow progressive autoimmune diabetes, seemed effective in achieving mid‐term glycemic control. Longer follow‐up with a larger number of patients, as well as validation with more advanced patients with slowly progressive insulin‐dependent diabetes mellitus, will be needed.