Queering the history of South African psychology: From apartheid to LGBTI+ affirmative practices.

This article constructs a brief history of how lesbian, gay, bisexual, transgender and intersex (LGBTI) issues have intersected with South African psychology at key sociopolitical moments, filling a gap in current histories. Organized psychology-a primary focus of this analysis-since its first formations in 1948, mostly colluded with apartheid governments by othering queerness as psychopathology or social deviance. The National Party, both homophobic and racist, ruled the country from 1948 until the first democratic elections in 1994. The acceleration of antiapartheid struggles in the 1980s saw progressive psychologists develop more critical forms of theory and practice. However, LGBTI+ issues remained overshadowed by the primary struggle for racial equality and democracy. Psychology's chameleon-like adaptation to evolving eras resulted in a unified organization when apartheid ended: the Psychological Society of South Africa (PsySSA). Democratic South Africa's Constitution took the bold step of protecting sexuality as a fundamental human right, galvanizing a fresh wave of LGBTI+ scholarship post-1994. However, LGBTI+ people still suffered prejudice, discrimination, and violence. Additionally, psychology training continued to ignore sexual orientation and gender-affirmative health care in curricula. PsySSA therefore joined the International Psychology Network for Lesbian, Gay, Bisexual, Transgender and Intersex Issues (IPsyNet) in 2007, catalyzing the PsySSA African LGBTI+ Human Rights Project in 2012 and two pioneering publications: a position statement on affirmative practice in 2013, and practice guidelines for psychology professionals working with sexually and gender-diverse people in 2017. This article traces a neglected history of South African psychology, examining the political, social, and institutional factors that eventually enabled the development of LGBTI+ affirmative psychologies. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Exhaled nitric oxide: a predictor of steroid response.

RATIONALE: The initial management of patients who present with persistent respiratory symptoms includes recognizing those with the potential to benefit from inhaled steroid therapy. To date, this has required undertaking a "trial of steroid" to identify responders. There is increasing evidence that steroid response is more likely in patients with eosinophilic airway inflammation, and this can be assessed indirectly using exhaled nitric oxide (FENO) measurements. OBJECTIVES: We aimed to assess the predictive accuracy of FENO to identify steroid response in 52 patients presenting with undiagnosed respiratory symptoms in a single-blind, fixed-sequence, placebo-controlled trial of inhaled fluticasone for 4 weeks. METHODS: Comparisons of predictive accuracy were made between FENO and other conventional predictors: peak flows, spirometry, bronchodilator response, and airway hyperresponsiveness measured at baseline. "Steroid response" was defined as change in symptoms, peak flows, spirometry, or airway hyperresponsiveness to adenosine based on established guidelines and recommendations. RESULTS: Steroid response was significantly greater in the highest FENO tertile (> 47 ppb) for each endpoint. This outcome was independent of the diagnostic label. The predictive values for FENO were significantly greater than for almost all other baseline predictors, with an optimum cut point of 47 ppb. CONCLUSIONS: FENO measurements greater than 47 ppb provide a means of predicting steroid response in patients with undiagnosed respiratory symptoms. Assessing airway inflammation is of more practical value than diagnostic labeling when considering the potential usefulness of inhaled antiinflammatory therapy.

Diagnosing asthma: comparisons between exhaled nitric oxide measurements and conventional tests.

International guidelines recommend a range of clinical tests to confirm the diagnosis of asthma. These focus largely on identifying variable airflow obstruction and responses to bronchodilator or corticosteroid. More recently, exhaled nitric oxide (FE(NO)) measurements and induced sputum analysis to assess airway inflammation have been highlighted. However, to date, no systematic comparisons to confirm the diagnostic utility of each of these methods have been performed. To do so, we investigated 47 consecutive patients with symptoms suggestive of asthma, using a comprehensive fixed-sequence series of diagnostic tests. Sensitivities and specificities were obtained for peak flow measurements, spirometry, and changes in these parameters after a trial of steroid. Comparisons were made against FE(NO) and sputum cell counts. Sensitivities for each of the conventional tests (0-47%) were lower than for FE(NO) (88%) and sputum eosinophils (86%). Overall, the diagnostic accuracy when using FE(NO) and sputum eosinophils was significantly greater. Results for conventional tests were not improved, using a trial of steroid. We conclude that FE(NO) measurements and induced sputum analysis are superior to conventional approaches, with exhaled nitric oxide being most advantageous because the test is quick and easy to perform.