World Toilet Day takes place on November 19th and focuses mainly on the sanitation needs in developing countries. It highlights how important toilets can be and how they can truly make all the difference in the battle against disease and widespread infection. However, we’re looking at a campaign closer to home and one which has a huge impact on the lives of people living with disabilities in the UK. The Changing Places campaign is staging an event as part of a worldwide awareness raising efforts called ‘The Big Squat’.
Changing Places is a campaign which is pushing for the installation of accessible changing rooms in a range of public places across the UK. There are many reason why properly accessible changing rooms are essential and many people living with different disabilities need more support and space to be able to toilet in public places comfortably.
Currently standard disabled toilets do not meet the needs of all people living with disabilities and their carers or support staff. People living with profound and multiple disabilities including learning disabilities, spinal damage and acquired brain injury often find themselves needing additional facilities to be able to comfortably utilise public toilets.
Changing Places toilets are different and provide initial facilities and apparatus to allow for easier usage.
Changing Places Toilets
Changing Places toilets provide the right equipment, enough space and a safe and clean changing environment. The equipment provides will either be a height adjustable adult-sized changing bench and a fully functional tracking hoist system or mobile hoist where this isn’t possible.
The changing areas will also have enough space for the disabled person as well as up to two carers and the toilet will be centrally placed to allow for support from carers on either side. Curtains or screens are also fitted so the disabled person and carer can have some privacy during the change.
The safety and cleanliness is provided by tear off paper roll to cover the bench before use and a large waste bin to allow for the disposal of pads. The floors are all non-slip to avoid any other accidents or risks.
Where do we want them?
The Changing Places campaign want to see their unique and potentially life changing toilets installed in all large public places. Their list of places includes:
• city centres
• shopping centres
• arts venues
• motorway service stations
• leisure complexes
• large railway stations
They also highlight that these new changing facilities should be installed in addition to pre-existing accessible toilets and not as a replacement. We definitely agree and think accessibility to comfortable toilets should be a basic right for all. Below is a case study looking at one mother and daughter who definitely see the need for accessible Changing Places toilets in every possible location.
Bethan and Lowri – A Case Study
Bethan is the mother of two daughters, Elin and Lowri, and the youngest, Lowri, lives with Retts Syndrome. Retts Syndrome means Lowri needs support with all her daily activities as she has no independent mobility. She uses continence pads for comfort and Bethan, Elin and Lowri were all pleased to have the chance to enjoy a happy family day out thanks to a Changing Places toilet.
The mum and daughters were able to enjoy a day out in Nottingham City Centre including shopping, lunch and a show at the local theatre. Nottingham City Council had the initiative to install a Changing Places toilet which allows for Bethan to help her daughter with her toileting needs without stress or difficulty, utilising the specialist hoist and changing equipment.
Bethan highlighted that without the Changing Places toilet there days out were very different as they had to plan their days out around specific times, ensuring to be home for mealtimes as Lowri would need to go to the toilet and they simply wouldn’t be able to change her comfortably in regular disabled toilets, as it would involve lying her on the floor. My own son Joe, has Dravet Syndrome and cannot be changed in most toilets. We had our vehicle specially adapted with a bench, curtains and a small hoist because of this issue.
Changing Places have taken Bethan and Lowri’s story as a great positive and use them regularly in their campaigns to show the importance of their toilets for whole families as well as individuals. This video tells a little more about their story:
(Full Transcript Below)
Take Part In the BIG SQUAT for World Toilet Day
The Big Squat event will be at 12 noon on 19 November
The squatting exercise is highly symbolic of the problems faced by many people in the developing world, where a lack of toilets forces people to squat in fields, in the bush, along train tracks, or in other open places. Open defecation is a major problems: it spreads disease, resulting in over 1.8 million deaths from diarrhoeal disease every year. It also affects women’s wellbeing and safety: in many developing countries, women are forced to relieve themselves either before sunrise or after sunset, causing them immense discomfort and inconvenience as well as putting them at risk of rape and other attacks.
In the UK the Changing Places campaign will be using the Big Squat to help highlight the need for Changing Places toilets in public spaces in order to meet the needs of the 230,000 people who need additional support and appropriate facilities in order to use the toilet.
Some of their campaigners in London will be heading to the Queen Elizabeth II Olympic Park in Stratford to do a very public mass squat. We also think this is a great opportunity to celebrate the availability of Changing Places facilities at the park and the accessibility legacy left behind by the London 2012 Olympic and Paralymplic games.
One of our favourite products comes from Uriwell as they cater for every member of the family and can be a great aid to keep to hand if you often find yourself in situations where your bladder gives you little warning. It’s also very valuable for helping young children who are learning to use the toilet.
On the theme of toilet training for younger children we also rate the Game of Pee which adds a bit of fun to the process. The game includes a Happy Pee and the game comes with different faces for the Uriwell as well as an educational booklet that can be coloured in. A wall chart allows you to mark your child’s progress and help them feel a sense of achievement as they move up the steps. The range has even expanded to include the Happy Poo and so toilet training really can be simpler than you thought.
World Toilet Day and the UK Changing Places campaign needs your support and we’re hoping after reading this you might take part in the Big Squat! (#BigSquat or contact @CP_consortium on Twitter)
00:06 Speaker 1: My name is Bethan, and this is Lowri who is my 10-year-old daughter. Lowri is profoundly disabled. She has a condition called Rett syndrome. And she is completely dependent on us for all her activities of daily living. Lowri wears incontinence pads or nappies and so obviously, we have to change her during the day and in an ordinary disabled toilet that involves putting her on the floor because she is getting a big girl, and it’s no joke to manhandle that. You’ve got to keep her hands off the dirty floor ’cause the next place they’ll go is to her mouth. So, that’s why we need Changing Places toilets. We’ve got to get her onto this height adjustable table, so that’s either lift but ideally you want some kind of an equipment to help you with that because really you do far too much lifting. So, a ceiling track hoist is really ideal. It’s changed our life in the sense that coming to Nottingham for a day out, we can come here, we know it’s here, we can plan our whole day.
01:06 S1: When there’s a Changing Places toilet, it just increases the length of time that you can spend somewhere, and it means you are not time limited, you haven’t got that worry about how long am I going to be out? Where do I go next? If you know that there is a decent facility, then you can build that into your day, and it just takes the pressure off you. The Changing Places campaign is really important for people with profound and multiple learning disabilities and their family. I see it as being the next step. We’ve got standard accessible disabled toilets everywhere these days, everybody expects them. We’ve got baby changing everywhere and it’s expected. I think that having Changing Places toilets is the next step.
At the Museum of Liverpool there’s a small, unassuming exhibition which looks like the recreation of a normal house. When you get inside you realise it has been setup with every possible gadget and gizmo to support independence. The Mi Smarthouse is a project put together by More Independent (Mi).
More Independent is a Government-funded initiative that is being piloted across four UK regions. As there website says the scheme exists to:
enable you to take charge of your health, wellbeing and lifestyle
use technology to allow you to feel safer and live more independently in your own home
give peace of mind to yourself and your family
reduce the amount of time you have to spend on appointments, by supporting you to manage better at home
The Mi Smarthouse at the museum is kitted out with a wide range of equipment covering all the key areas of the home. Here we’re taking a look at some of the gadgets they’ve highlighted and used in their perfect, accessible home.
These gadgets could be useful at any place in your home and can make it feel more safe and secure.
A fall detector can be worn around your neck and it connected to a system which will alert your carer if you do fall even if they’re not on the premises.
Large Buttons Picture Telephone
Phone keypads can be hard to use and it can also be difficult to remember phone numbers. This phone has spaces for photographs of those people you call regularly as well as large, clear numbers for when you need to dial out.
Home Safety Alert
The Mi Smarthouse has a bonus caller panic button installed by the front door, giving the residents the chance to press the button if anyone arrives at the door who they’re not comfortable with. Similar home safety alarm system can be found elsewhere too.
The Supra KeySafe is the UK’s first police approved key safe and is the perfect place to store your emergency keys. You choose a combination number and you can share this number only with somebody you trust implicitly.
Carbon Monoxide Sensor
Carbon monoxide can kill. It’s odourless and can’t be seen so the only way to sense it before it is too late is with a dedicated carbon monoxide sensor. Sensors can be easily installed and can save your life.
A fingerprint lock is a great option if you struggle with keys. You can add the details of your carer and friends as authorised ‘pad-pressers’ so they can get in and out with ease when necessary too.
We’ve talked regularly about the importance of gadgets to make access to the kitchen easier. It’s potentially a dangerous environment so anything to make it less so is a good invention in our book. In the Mi Smarthouse they demonstrated a range of kitchen-specific gadgets.
The controls on a microwave oven can be difficult if you have difficulties with your vision or dexterity. A Talking Microwave Oven can help guide you to the buttons you need and it will also tell you when the door is open or closed and let you know whether the food needs stirring or left to stand.
An induction hob only cooks the pot upon it. There is next to no danger of being burned by it and they’re becoming a common installation in supported living environments to aid independence. This type of hob is also energy efficient and reaches top temperatures in record time. In the Mi House the hob was fitted but they can also be bought as separate electric units .
One cup Kettle
We’ve talked before about how useful the one cup kettle can be. Never worry about spilling boiling water as the kettle will dispense the exact amount you need with the simple pressing of a button.
Entertainment and Living Area
Many of these items listed below could be used all around the house but are most useful when you’re relaxing in front of the TV or lounging on the sofa.
If speech has always been or is becoming difficult then these small voice recorder switches can be used to record key phrases. They can have messages such as ‘I’m hungry’ or ‘I want to go home’ ready recorded for when you’re home or out and about when speech has become difficult.
Chair Occupancy Alert
This item is extremely useful if you have an outside care team supporting you as it allows them to monitor the time spent out of your chair. If it seems exceptionally long they may phone you or come around the check everything is OK.
Big Jack Controller
Big Jack Multi-Controller
The Big Jack can replace all your smaller, fiddly remotes and switches. It can be programmes for a whole range of jobs and can be used to change channels on the TV, switch off lights and even use the telephone.
The personal care element of the home is the most private. Both the bedroom and bathroom are places where you want to maintain as much independence as possible and some of these gadgets are designed to guarantee this as well as ensure you can get the help you need, when you need it.
Living with any form of epilepsy or convulsions can be extremely frightening – especially if you’re alone when one occurs. This epilepsy sensor will alert an outdoor care team if a seizure is taking place, allowing them to provide the right support ASAP.
Designed to fit comfortable under the top sheet, an enuresis sensor will alert your carer to the fight signs of dampness whilst in bed – ensuring you’re not left uncomfortable for a long period of time. We have looked at these aids previously for helping children but they can be equally useful later in life.
A flood detector will guarantee you never forget about another bath. It’s very easy to forget the bath is running but with the installation of a simple detector, it will be safe and you can avoid the risks of damage to your home and the even higher risk of slipping.
The Mi Smarthouse in Liverpool is one of the first examples of how all this technology can come together and successfully be used to help people remain in their own homes independently. You can take a virtual tour of the Smarthouse here. We recently visited the £D printing exhibition at the London Science Museum and will cover the potential benefits in a future post.
Bad breath can be an embarrassing issue to tackle. Most of us will feel as though we’ve had a bad breath day at some point in our lives. Usually this is fixed by a quick brushing of teeth or swill of mouth wash. However for some dealing with bad breath, or halitosis, can be a socially devastating experience.
Bad Breath or ‘Halitosis’ and its Causes
Problems with bad breath do not always start in the mouth. Although oral health is the most likely cause of bad breath, it can also depend on other issues.
Low Carb Diet Bad Breath
What we eat and drink has a huge effect on our breath. Eating foods with a strong flavour, such as garlic and spices can cause temporary bad breath. However many will find that simply cutting down on these ingredients will solve the problem quickly.
Dieting, especially low-carbohydrate based diets, can also cause bad breath. This is because as the body starts to break down fat at a fast rate, chemicals called ketones are produced. These ketones escape through urine and unfortunately, your breath. Ketone-based bad breath has a distinct odour. If you are on a low-carb diet and suffer from bad breath, it is more than likely that ketosis is to blame.
Bad breath is an unfortunate side-effect of dieting. However when the body is producing ketones, it is proof that you are actually burning fat. Products such as Ketostix can show if you are producing ketones. They are dip-sticks for testing levels of ketones in your urine. These will help you find out if your bad breath is ketosis, whilst also providing proof that you are loosing weight via fat loss.
Cigarette Bad Breath
A build up of dental plaque will cause gum disease, which causes halitosis.
Bad breath is obviously the least important health issue caused by smoking. However, as well as the damage to your lungs, smoking can cause gum disease. Gums can become irritated by smoke, causing further complications such as gum disease. Gum disease, also known as gingivitis, makes gums swollen, infected and painful.
It is mostly noticed when there is blood whilst brushing your teeth. The gum tissue is very sensitive to cigarette smoke, and is eroded over time. This is mostly caused by the extra bacteria in the mouth due to smoking. This bacteria cause plaque, which will deteriorate the gums and then cause bad breath.
The most sensible cure for bad breath due to smoking is obviously to stop smoking. However keeping up to date with dental appointments and maintaining good oral health will help stop cigarette bad breath.
The NHS provides a “Quit kit” to will help you to stop smoking.
Medicines That Cause Bad Breath
There are a number of medicines that cause bad breath. If these drugs are vital to your health, bad breath is an unfortunate yet unavoidable side effect. However if you are deeply concerned about your bad breath, talking to your GP may help. They maybe able to offer you an alternative medicine to avoid getting bad breath.
Post Nasal Drip Bad Breath
Post nasal drip is also known as upper airway cough syndrome. It is caused by an excess production of mucous in the nose. This mucous then gathers in the throat causing bad breath. Post nasal drip can be a side-effect of further health issues, such as sinusitis or swallowing disorders.
Bad Breath in Babies and Children
Children can occasionally fall foul of bad breath, too. As stated by Dr Lewis First in this article for NBC 5 News, the main cause of halitosis in children is tooth decay. Many children dislike having to brush their teeth and see it as a chore. This is why it is important to try and make cleaning their teeth a fun experience.
Make cleaning teeth fun! Photo Credit: Stuart Berry http://www.flickr.com/photos/stuartberry/
There are a range of toothbrushes available to encourage your child to brush. Finding a fun toothbrush for your child will help them take an interest in brushing. Character brushes based on cartoons and toys are a firm winner with most children. Also you will find many of these character brushes include built-in flashing lights. These Barbie and Spiderman toothbrushes light up once activated, not only to entertain, but to also act as a timer. They will flash continuously for 1-2 minutes, ensuring your child has brushed for the right amount of time.
Studies have also found that “mouth breathing” can also contribute towards halitosis in young children. Mouth breathing often takes place when a child is ill with a cold. Their noses become blocked and stuffy, leaving no option other than to breathe mainly through the mouth. The intake of air through the mouth then dries out saliva, leaving bacteria to fester. This is usually a short term problem that is solved once the child no longer has a cold. However taking extra time for brushing during this time can help lessen bad breath.
Bad Breath and Disease Symptoms
As mentioned previously, bad breath can sometimes be a symptom of an underlying health condition. Below we cover some of the more common illnesses and conditions that can include bad breath as a symptom.
Halitosis is simply the umbrella term for of all disorders that cause bad breath. This covers everything from morning breath to oral hygiene issues. Morning breath happens for the opposite reason that children suffer bad breath due to mouth breathing. At night the mouth is exposed to less oxygen than during the day time. This lack of oxygen circulating around the mouth again allows the bacteria to breed. This is why ensuring you clean your mouth, teeth and gums properly before bed is so important for oral health.
Gum disease, also known as gingivitis is the most common form of dental disease. It is caused by a build-up of plaque that then allows bacteria to grow in the mouth. This bacteria then starts to effect the gums and can lead to periodontitis. The most common symptoms of gingivitis are:
bleeding gums, especially when brushing
swelling of the gums
changes in the colour of the gums, most notably a dark red colour
It is important to spot and treat gingivitis before it leads to periodontitis. Once periodontitis sets in it can destroy the gums when bacteria travels under the tooth. Teeth can then become loose as the gums become more infected. Eventually this will lead to loss of teeth permanently.
Bad breath caused by gingivitis is easily remedied by keeping on top of oral hygiene. Making visits to your dentist for check-ups and maintaining a good brushing routine.
The kidneys are vital organs that help to cleanse the blood and keep your body chemicals balanced. Waste and toxins that are taken into the body through food, air and drink eventually end up in your blood. It is the job of the kidneys to filter the blood of these toxins and then convert them to urine. People with kidney disease will often complain of bad breath. This is because when the kidneys are not functioning properly, they fail to remove toxins from the body. One of these toxins is ammonia, which is found in urine. This build-up of toxins within the body then escapes through the digestive system to the mouth, causing a ‘fishy odour’ in the breath.
Bad breath occurs for people with type 1 diabetes due to excess ketones caused by lack of insulin.
Bad breath caused by diabetes is related to ketosis, as mentioned in our low carb diet section. However as ketosis is a temporary side-effect of low-carb dieting, diabetic ketoacidosis can be life-threating.
Generally found in people with type 1 diabetes, ketoacidosis is caused by a lack of insulin to convert blood sugars to energy. Instead the body will start metabolising fat stores rather than converting sugars from food. This rapid burning of fat causes an influx of ketones; a byproduct of fat breakdown. The body will then become overwhelmed with ketones which are highly acidic, and change the PH of the blood.
The presence of these ketones within the digestive system then cause bad breath as they escape the body via urine or the mouth. This in turn causes the breath to smell unpleasant. Some people describe this as like the smell of the sweets called ‘pear drops’.
Dogs detecting diabetes in the breath
Specially trained dogs can detect the smell of ketones and are being used to help warn people with diabetes. So called ‘Hypo dogs‘, can alert people before they notice the symptoms themselves and can be especially helpful for small children or people whose glucose levels drop very quickly.
Sinus infection, also known as sinusitis, is an inflammation of the lining of the sinuses. This is usually caused by a bacterial infection. The sinuses are located in several areas in the head. However it is the sinuses in the nose that cause bad breath when infected. Very similar to post nasal drip, the excess mucus produced can build up and allow bacteria to grow. This influx in bacteria produces a bad odour, that is noted as bad breath.
When your body fails to pass solid waste on a regular basis this is called constipation. This then slows down the digestive process of food. Undigested food will then remain in the bowls where it becomes toxic and emits gas. This gas will eventually travel back up the digestive system and into the mouth, causing bad breath.
Keeping yourself regular and avoiding constipation is key to preventing bad breath. Statistics show that unto 25% of bad breath cases are caused by constipation. A diet of high fibre, fruit, veg and at least 4-6 glasses of water a day can prevent constipation. However it is also important to remain physically fit if this is possible. Maintaining a healthy weight and exercising the middle of the body will keep bowl muscles toned. This in turn will make passing solid waste easier and more regular, avoiding bad breath.
For people who find it hard to eat enough natural fibre, a useful alternative is fybogel drinks or psyllium husks added to food.
Bad Breath Remedies
Brushing teeth for at least 2 minutes helps ensure plaque removal.
Sometimes it can be difficult to find a bad breath cure. Knowing the cause is your first step before trying to cure it. Disorders such as post nasal drip can often be cured using antibiotics or nasal steroids. However if your bad breath is due to oral hygiene rather than an underlying health condition it might be less simple to cure.
Treating and preventing bad breath should start with your daily brushing routine:
Always ensure you spend at least 2 minutes brushing with a quality toothpaste. Pastes such as Weleda’s Salt Toothpaste include natural ingredients that not only freshen but help neutralise plaque acids.
Ensure you floss between your teeth every time you brush, to further prevent plaque and tartar build-up. Plaque is the number one cause of gum disease and then bad breath.
It will help to brush your tongue as well as your teeth. Using a soft bristle brush for a longer brushing time is advised. The softer brushes cause less damage to gums and the tongue.
Use a mouth wash several times a day. It can help to carry a small bottle of mouth wash around with you for between snacks and meals. Brushing your teeth whilst at work or out and about can be difficult. However a quick swill of quality mouth wash between meals will help to dislodge particles of food until you can brush again.
Avoid brushing teeth for around 30 minutes after drinking fruit juice. Due to the acid in the juice, brushing straight away can cause further erosion of the teeth.
Once you have a solid oral hygiene routine in place, it is advised that you continue to avoid spicy foods, alcohol intake, smoking and coffee drinking. If after 2 weeks you are still suffering from bad breath, it may be time to consult your GP and dentist. They can rule out any underlying health issues that could be the cause of your bad breath.
Cognitive Behavioural Therapy for Bad Breath
Although bad breath is a very serious concern for the sufferer, it is not rare for the bad smell to be a psychological issue. Some can become convinced that they suffer bad breath when they actually don’t. In his recent interview with BBC Radio 4, Dr Tim Hodgson says up to 80% of self-referring halitosis patients don’t really have bad breath.
This paranoia of having bad breath is called halitophobia. People can become obsessed with oral hygiene and avoid social situations due to embarrassment of their bad breath. If a dental professional or GP feels halitosis is not present, the patient will be referred for cognitive behavioural therapy.
Cognitive Behavioural Therapy helps a patient with anxieties to understand the link between how they think, feel and act.
Cognitive behavioural therapy is usually referred to by the initials CBT. CBT is a therapy that involves discussing problems with a professional to find the root of your problems. CBT helps you to examine your emotions, actions and thoughts to understand how they are all interlinked.
Often those that are referred for CBT have at some time in the past suffered from bad breath. However this is usually no longer a problem yet they still think in the same way as they did during that time. Patients create a perception of themselves based on situations that occurred during the previous period of bad breath. This builds an anxiety that makes them concentrate on potential problems related to bad breath.
This is where cognitive behavioural therapy comes in. CBT sessions help the patient to see that their negative actions or negative reactions of those around them are actually caused by their own negative thoughts. This in turn helps the patient to filter all social and emotional information relating to bad breath equally. Rather than concentrating on only the negative they can see and feel, CBT helps them to interpret their apparent bad breath issue in a clearer light.
Products That May Help with Bad Breath
We have compiled a selection of over-the-counter products that are available to treat bad breath. If you have any recommendations or any experience with these products, please comment below.
This all inclusive oral hygiene kit has garnered fantastic reviews. It includes an oral rinse, tooth gel, tongue scraper and tooth brush all specifically designed to eliminate bad breath.
One of the many five star reviews on amazon comes from bumblebee:
It really does help! I ordered it for my close relative who was feeling really bad about her bad breath and although I really doubted it would help, it worked and I really do recommend that product to anyone who has bad breath!
The Tung Brush is especially designed to remove odour caused by bacteria. The unique design of the flat head and bristles keep the tongue extra clean to avoid bad breath.
This review by amazon reviewer “Me” explains how important tongue hygiene is in combating bad breath:
This product is absolutely amazing. 80% of bad breath comes from the back of your tongue. I’m surprised no one else has thought of this idea. We see tongue scrapers and mouthwashes on the market but we hardly see a good quality tongue brush to clean out tongue.
All the companies want us to buy mouthwashes to clean and freshen out breath, but the truth is that mouthwash just masks your breath for a very short period..that’s it. It won’t remove the bacteria, it won’t scrub it off, it will just stay there.
Now about this Tung Brush. There is also a special kind of zinc tongue gel sample that comes with this brush, which I think is not very good. This is how I use the brush, firstly after brushing your teeth with your toothbrush, apply a strip of normal toothpase (anything that you normally use, I use Aquafresh), then put some water onto it, and then scrub your tongue with it, but only go from back to front motions not back, front, front back etc. But most importantly remember your focus is to clean the very back of your tongue as this is where all the odour smelling bacteria is! This may make you gag a few times, but it is worth it. Afterwards spit, rinse and gargle. And now your tongue and mouth will feel so clean, that your sense of taste will change aswell, it will feel much cleaner and fresher.
You can also buy a Tung tongue scraper from Amazon to use after the Tung brush, this just adds to removing even more bacteria and foul smelling breath.
This is my first review, I wrote it because I think this Tung Brush is an absolute essential for clean and fresh breath. It really will affect your sense of taste.
Transcript from Video
00:01 Speaker 1: From bad hair, to bad breath. Halitosis is a tricky problem for us GP’s, not because we’re particularly prone to it, you understand, but because we’re often the last port of call for desperate patients. People complaining of persistent bad breath often end up coming back to their GP after their dentist has checked their mouth and various specialists who have looked at their throats, lungs and stomach. So, what can the GP add if there is no abnormality to find? Well, the first thing he or she can do is actually check that their patient has bad breath. Offering to smell someone’s breath can be embarrassing for both parties but it’s essential, as I discovered when I met Tim Hodgson, Consultant in oral medicine at the Eastern Dental Hospital in London.
00:42 Tim Hodgson: I think the most important thing to say to these individuals is, “Is it there or is it not?” And you’ve got to be very careful how you say it cause often these people are coming to you with a problem that they feel is real. And then, if you turn immediately around to them and say, “This is not real”, you can run into problems. But I think it’s very important within the first discussion to smell the breath cause that’s the gold standard test, and if they haven’t got bad breath you can say at that moment in time they don’t have halitosis but it is possible that in times previously that they had. And it’s often the case that people have halitosis, address their gum health.
01:22 S1: And gum health being the most common cause of it?
01:24 TH: Yeah. And after that they’re left with this perception that they’ve still got halitosis even though they’ve corrected the cause. And that’s sometimes reinforced by family members, friends and relatives. And often they come along with a very considered construct that people on their bus or on the Tube are turning away from them or covering their face or won’t talk to them directly because they feel they’ve got bad breath. And they look, almost looking for people who are avoiding them because of their bad breath.
01:58 S1: And that reinforces their notion that they’ve got bad breath.
01:59 TH: Yeah, it reinforces and helps build a construct in their own head.
02:03 S1: As a rough guide, what sort of proportion of people that you see here with halitosis would, in your mind, not necessarily have a real problem but have a perceived problem? Are they a significant minority?
02:14 TH: I would say probably 80% of patients referred with halitosis to our service don’t have halitosis.
02:21 S1: Do they believe you when you smell their breath and say, “Look, I can’t smell anything”.
02:26 TH: Some do, and others don’t.
02:29 S1: Working along side Tim Hodgson at the Eastern Dental Hospital is clinical psychologist, Claire Daniel.
02:34 Claire Daniel: For some of these people, they may well have had halitosis in the past so they’ve set up this way of thinking is… We work in a cognitive behavioural way which basically looks at the way in which people think, they way in which they feel, what they do and the physical symptoms and how they all interact. So, this patient in the past may well have had halitosis. They’ve set up this belief system thinking about their breath, maybe they’re focusing on their breath. And as Tim said, they’ve had past experiences of people reinforcing that they’ve got halitosis. Now, even if the halitosis disappears some patients may well remain quite anxious about that and so they will keep on focusing on the potential symptoms. And they become very biased in the way in which they see and hear information so they become very focused on the negative stuff that will reinforce their beliefs and will sort of ignore the other bits of information that may well support a more helpful, more realistic way of thinking about their situation.
03:25 S1: So, when a doctor or a dentist tells them that they haven’t got bad breath, they’ll say, “Well, that’s not true or I haven’t got my bad breath today but, trust me, I had it yesterday because I saw someone in the pub wince”.
03:36 CD: Yes, absolutely. So, it’s either, “Well yes, it’s okay today but it wasn’t yesterday or it won’t be tomorrow”. But also, some people initially will be reassured by somebody saying they haven’t got bad breath but, as we know, reassurance is for people who believe they have medical difficulties can only be short-lived for most people. So, they’ll feel very reassured in the consulting room and then will go home and their whole belief system will trigger again, maybe reinforced by the people. So, their anxiety maintains.
04:02 S1: Looking at this from the outside, Tim’s got perhaps the easy part of the job when he says, “Look, I don’t think you have halitosis”, and he then does the referral to you.
04:09 CD: Absolutely.
04:09 S1: And you’ve got to do something about it. It’s quite a complex problem so what can you do and how successful might you be?
04:14 CD: Yeah, it’s very complex. Cognitive behavioural therapy is an anxiety about health in general, we don’t set out to tell people that they’re wrong. We set out to try and help people understand what’s going on. So, we don’t just talk about their physical reported symptoms. We’ll talk about the way in which they’re interpreting things, they way in which they’re thinking about things, and how those interpretations actually may be unhelpful. They might seem helpful to the patients, like go to the doctor, go to the dentist, focus on their breath to check, maybe clean their teeth, but in the long term they can be very unhelpful and maintain the problem. So, we help people to take a broader outlook on their situation. We don’t tell them what it’s not, we help them to understand what it could be and then we help them to develop evidence to support what it could be rather than maybe what it’s not.
05:01 S1: And practically, what is involved and how often do you see them?
05:04 CD: So, we’d see people maybe every week, every two weeks.
05:08 S1: Is this one-on-one?
05:09 CD: Yes, one-on-one, for this particular condition. One-on-one, so one patient with one psychologist for about 50 minutes about, on average about eight times.
05:17 S1: And in terms of success rate, how effective is it?
05:20 CD: I would say, we do help… With particularly halitosis, we probably help about 80-90% of people.
05:28 S1: That’s pretty good.
05:28 CD: But I wouldn’t… But then it’s a continuum, we might help some people just a little bit. And I think with things like anxiety about health, it’s a life-long issue. We’re not just going to suddenly stop people’s anxieties. It’s about helping them to live with uncertainty and live with a degree of anxiety about their condition. So, they’ll still have times when they think their breath smells.
05:46 S1: Clinical psychologist Claire Daniel. Just time to tell you about the next Inside Health when I will be investigating the side effect of cancer treatment…
There are many reasons you could need a toilet aid. Urinary incontinence is a problem which effects 200 million people worldwide and a large number of these are women. UI can have serious social, sexual and professional consequences which make it a particularly embarrassing problem which many people find hard to deal with. There are a range of female toilet aids on the market designed to help with the problem. This video shows one woman dealing with her problem publicly on the Embarassing Bodies television programme. It also has some interesting facts and figures about the problem.
There are a range of female toilet aids designed to make it easier to handle with an incontinence problem.
Different Types of Urinary Incontinence
There are two main types of urinary incontinence: stress incontinence and urge incontinence. The NHS describes them thus:
stress incontinence – when the pelvic floor muscles are too weak to prevent urination, causing urine to leak when your bladder is under pressure, for example when you cough or laugh
urge incontinence – when urine leaks as you feel an intense urge to pass urine, or soon afterwards
There are many causes of this problem and in woman it can often be due to pregnancy and vaginal birth as well as ageing. Other causes include overweightness and obesity as well as a family history of the problem. It can be an extremely embarrassing thing to live with but there are methods and products designed to make the condition less debilitating and embarrassing.
According to the National Association for Continence one third of men ages 30-70 have experienced loss of bladder control at least once and the symptoms can be long lasting. What’s more many men and women wake in the night with the urge to urinate and a percentage admits to losing urine on the way to the bathroom. A toilet aid can be a sensible way of handling this embarrassing issue.
Female Toilet Aids for Everyone
You could have many reasons for needing a female toilet aid and it doesn’t necessarily mean you’re living with incontinence. Post-pregnancy and often after bariatric operations there’s a need to use a catheter and once it is removed there can often be a short-term problem getting used to passing urine again. Female toilet aids provide a solution to this short-term problem.
Illnesses that cause Urinary Incontinence
There are many different conditions which can lead to long-term incontinence; in fact it isn’t considered a disease in its own right as it’s usually a symptom of something else.
The NHS provide a list of the main causes of stress incontinence:
nerve damage during childbirth
increased pressure on your tummy, for example because you are pregnant or very overweight
a lack of the hormone oestrogen in women (less oestrogen is produced after the menopause)
They do the same for the causes of urge incontinence:
neurological conditions, which affect the brain and spinal cord, such as Parkinson’s disease or multiple sclerosis
conditions affecting the lower urinary tract (urethra and bladder), such as urinary tract infections (UTIs) or tumours in the bladder
drinking too much alcohol or caffeine
Living with any of these conditions could explain the development of your urinary incontinence but there are ways of managing the problem.
Women’s Toilet Aids for Travel
Toilet Aids can be used by campers
The toilet aids on the market are also a great idea if you travel. Anybody camping could really benefit from using one of the toilet aids on the market. These small portable facilities are a much more sensible alternative to some of the large bulky toilet-style products out there. The same could be said for festival-goers as using the on-site facilities isn’t always the wisest decision – if you’ve got any sense that is!
Women’s Outdoor Toilet
Personal or portable toilet aids exist to give people the option of passing urine when it may otherwise be impossible to do so discreetly and without feeling under pressure or embarrassed. The two leading devices are the Uriwell Personal Toilet and the Me Too – Outdoor Toilet Aid for Women. Let’s take a closer look at the benefits of each device as a women’s toilet aid.
Uriwell Toilet Aid
A Uriwell Female Personal Toilet
The Uriwell is an affordable and portable personal toilet. It’s concertina design makes it easy to carry and keep stored discreetly but it can also hold a large volume. It’s made of hygienic plastic so can be easily cleaned and kept sterile. It’s ideal for times where there’s no chance to get to the bathroom such as in the car or in the bedroom when you’re caught unfortunately short. It can be kept discreetly in a drawer at home or in a handbag whilst you’re out and about. This video shows the Uriwell personal toilet being demonstrated:
Me Too – Finally Standing Up
Me Too – Outdoor Toilet Aid for Women
Me Too is a short term alternative to the Uriwell toilet aid. It’s disposable and gives women the freedom to urinate standing up, which can be essential when there’s the desperate urge to go and no opportunity to get somewhere appropriate. It’s designed with female anatomy in mind and is both hygienic and practical for use when out and about. The funnel and spout fit design can be separated to make carrying more simple and this device is considered great even for those who aren’t suffering with any form of incontinence and may just be attending an outdoor event. They’re great value and come in packs of five. They are designed to be thrown away after use making them completely hygienic.
Advantages of Female Toilet Aids
Using a female toilet aid can save time; dignity and help users feel like they’re able to get on with their lives normally. You can avoid the stress of always needing to know where the nearest toilet is, as long as you have access to somewhere discreet such as your car.
There is no need to be ashamed or embarrassed as many people live with the problem and there are products on the market designed to make it less of a problem. No one needs to live with this problem ashamedly and can make actions towards living a full life despite having to manage the condition.
We are pleased to announce the launch of Equ4L.com – Equipped 4 Life. Equ4L.com is a fresh and new online boutique-style store stocking the most innovative and inclusive gadgets and products on the market.
I bought the Go Girl in preparation for my first summer festival in July and a walking holiday in August. This is after many years of ‘near misses’ because of lack of toilet facilities and a reluctance to expose myself on woodland or mountain walks. Even with someone acting as ‘lookout’it can be embarrassing to have your bottom on display! My Go Girl arrived within a few days of ordering it. I couldn’t believe how small the tube is and therefore discreet to carry around. I tried it out in the shower first…..all went well, so then risked the toilet…….all went well again. My only criticism is the need to still pull down trousers/jeans for fear of ending up wet. Although, leaning forward with one hand on the wall helped to direct the flow away from the body. Maybe an extension tube could be sold? I have thought of wearing skirts for walking to make the process easier. Skirts and walking boots? Hmmmn. Not sure!
Is this the best design for toilet seat transfers in the world?
Comfort and Safety in the Bathroom
Update: AXS Wingman in the running for a Mission Main Street Grant
Before reading about this fantastic product we wanted to let you know that it’s in the running for a potentially life-changing grant. The AXS Wingman is in the final running for a Chase Mission Main Street Grant where they will be awarded $250,000. The company has big plans for this kind of money and believe it will help them take the product to a larger scale – allowing it to be rolled out further afield. As a unique inclusive toilet seat design it is the kind of product the world genuinely needs. The more funding they can get the better and we’re supporting their drive for votes. You can cast your vote for them here and voting is open until November 15th.
What is a Mission Main Street Grant?
A Mission Main Street is a grant programme which sees 12 small businesses in America given a grant of $250,000. The final grant winners are decided over December and in January 2014 all winners will be notified.
To apply for the grant businesses have to be for profit and the business also has to have been actively engaged in the current business activity for a minimum of two years to the Launch Date of the program.
We’re keeping our fingers crossed for AXS Wingman and you can find out more about the company below.
The AXS Wingman, A Safe Inclusive Toilet Seat
Wheelchair users who regularly do toilet seat transfers will know what a problem this can be. We were really pleased to discover this new brilliant design from the US. It is a toilet seat with a difference, there are supports built in to the seat which make transferring from the wheelchair to the toilet much easier and safer. The name ‘Wingman’ gives you some idea as to how it works. It has wings! These ‘wings’ mean that you have quite literally something to hold on to and lean on when you’re hauling yourself onto the toilet.
To see just the transfer click below:
Support on all sides for safer use with the AXS Wingman
Installing the super strong toilet seat
The Wingman can be fitted on any standard toilet in place of a normal seat so you won’t need any special fitting equipment which will cost you extra. No hidden costs at all. This is a very simple, effective design that installs with a minimum of fuss and with maximum benefit to people needed to transfer.
Using a transfer wheelchair toilet seat
People who use a wheelchair regularly know how hard it is raise and lower yourself onto a standard toilet seat. There’s not much to hold on to and it’s not great having to hook your hands around a wobbly toilet seat, especially if the toilet you’re using is in a public place. It’s just not very hygienic to put your hands so close to the toilet bowl. The AXS Wingman is perfect because you don’t have to put your hands as close to the actual bowl of the toilet itself, much nicer to use. The surface of the Wingman is made from material which is easier to grip and has “smoothly integrated palming surfaces” as it’s designer describes them. This is a very well thought out bit of equipment.
Easy and safe toilet transfers
With the Wingman you can lean and hold onto the wings and at the front of the seat without worrying about breaking the seat, and for added stability too. Twisting your body and leaning to either side isn’t such a worry, because you have something sturdy to hold on to.
The AXS Wingman wing can take the weight of 767lbs, it is a very strong toilet seat!
When you lift yourself from your chair, you can easily hold onto one or both of the wings or the shaped front of the seat and hoist yourself onto the toilet. No more worrying about breaking the seat or falling whilst transferring. The surface of the Wingman is made from material which is easier to grip onto as well, so this is a very well thought out bit of equipment.
Durability – a very strong toilet seat
Traditional toilet seats can end up breaking over time because of the pressures put on them. The AXS Wingman has been tried and tested so you know you can trust it to support you even after a lot of use. If you have a wall bar in your bathroom, it makes using this toilet seat even easier as you have even more handholds. You can use this seat in whatever way you find most comfortable for you.
Designed for a need
The AXS wingman was created by inventer Stephen Cowen who saw that his 87 year old father was struggling with a traditional seat. It is being made in small batches at the moment. Seats produced are going into ‘Case and Pilot studies’. When installing a public toilet, architects should be thinking of installing a toilet that is easiest for anyone to use, particularly in a disabled toilet. For wheelchair accessible toilets in shop or an office, this design should be added to the budget.
Unfortunately it isn’t available in the UK. As soon as it is we will let you know. The best way to keep in touch with them is via the Wingman Google + page. or via twitter @axswingman
Getting a bra on with one hand is very difficult without the help of a Bra Angel
The Buckingham Bra Angel
This week we thought we would feature a Bra Angel review. Not to be confused with the The Bra Angel Bra Repair Kit : instant bra repair kit that is a also available, the Buckingham Bra Angel is a gadget to help with putting on a bra with one hand
Dressing and personal care are among the most intimate and private areas in somebody’s life and the need for support in this can be upsetting and cause anxiety. At Living with Disability, we have searched to find a range of products which support individuals with their independence in personal care including the Uriwell Range and the Denham Brush and the latest product we’ve discovered is the Buckingham BraAngel. At the best of times fastening and unfastening bras can be difficult and it can become even more taxing if you live with a disability or injury. Women living with upper limb restrictions including weaknes following a stroke, arthiritis or permanent damage after trauma can find drawing together the ends of the bra very difficult and then realise they need support getting dressed. The Buckingham Bra Angel can even be used successfully by those who have the use of one arm or have had an amputation.
The Buckingham Bra Angel Dressing Aid
The BraAngel Dressing Aid has been specifically developed with this problem in mind by a trained and experienced occupational therapist. The aid is designed to provide support whether it’s needed for just a short period after a fracture or for longer more permanent usage.
As the image shows the BraAngel holds one end of the bra tightly whilst the other end can be brought around the body and attached to the secure end. As you can see the BraAngel is comfortably positioned around the neck, between the cleavage and comes with a useful soft chin pad to allow you to maintain its position whilst clearly seeing the fastenings so you can easily put on the bra.
The features of the BraAngel cannot be underestimated and as a truly universal design, it should be possible to use it with all different styles and types of bra and all collar sizes. The product is designed to allow for easy discreet storage and should require next to no cleaning as it’s designed with no obvious dirt traps. The product is 100% free of latex allowing those with allergies to use it when necessary and the heart shaped chin pad allows for comfort and extra functionality when securing the device.
Bra Angel Review
Using the Bra Angel
The Bra Angel has it’s fans and was reviewed recently by the ’British Mobility Scooters’ blog who said “The Bra-Angel holds one end of the brassiere securely whilst the other end is brought round the body and attached together. It even enables those who only have the use of one arm to be able to put on their brassiere independently.”
An original, ingenious idea that can give women back their independence and privacy when dressing, the BraAngel is truly an innovation. To find out more and purchase your own, click to buy in confidence from the Equ4l.com webstore.
High-Tech Helpers: EnuSens Toilet Training Alarm System
Helping your child understand toilet training
Having an older child who suffers from bladder weakness and needs more support in their toilet training can be a very testing and difficult thing to live with. However, this new product, exhibited at Naidex’s New Product Showcase has been designed with education and sensitivity in mind. EnuSens is an enurises monitor which has education and support as its main goals, helping to guide children into waking up when nature calls without having to be attached to a noisy buzzer or rely on uncomfortable training underwear, that never ever feels good. This new toilet training alarm system is designed to work on your child’s confidence, understanding their own body and their self-esteem.
Working with your child to understand their body
High Tech sensors make this system discrete and reliable for detecting enuresis
EnuSensTM can be used to help educate children to wake up and use the bathroom. Some children can respond faster than others to this type of training, depending on age and other various factors. What’s more this product also helps children understand how their body works, if they have the capacity to do and it also can be used in a number of healthcare settings. Receiving positive feedback from the Convention has seen the product easily available online and the soft cotton sensor means all chances of being uncomfortable can be eliminated. What’s more, you could use these product in conjunction with Brolly Sheets or the Uriwell range to create an even less clinical atmosphere.
Used by Adults
This product can also be used by adults, either in bed or perhaps whilst out and about in a wheelchair. The hardwearing sensor allows for comfort as well as easy positioning in the correct position in the chair and if you have a support team or carers, it allows them to respond immediately to any accidents or leakage. Even better, although there is an alarm option this can be silenced so there is no need to feel undignified or embarrassed by any little accidents and they can be handled safely without any need for upset.
If you’re interested in this product, click in the below box:
DRI Sleeper Bed Wetting Alarm
Wet-Stop3 Bedwetting Alarm-Green
TensCare Dry Night Trainer Bed Wetting Alarm
Rodger Wireless Bedwetting Enuresis Alarm – NEW 2012 Model
At Living with Disability we have previously discussed the importance of dignity and independence for personal care and hygiene processes and have looked at items which supported this process. Today, we’re looking more closely at the range of adjustable shower chairs on the market and how they can be a huge help if you don’t have an adapted bathroom but need support using your shower or bath.
Shower Chairs make personal care dignified
Adjustable shower chairs are a great option as you can position them at the right level for you to ensure you can shower easily, comfortable and without risk of falling or slipping. The range of height adjustable shower chairs make showering safer and less stressful if you live with a condition which affects your mobility. Modern adjustable shower chairs allow for more comfort and the newer, more modern designs are more compact and lightweight than previous models. Some models even feature wheels making transfer to and from the bedroom or dressing room much simpler too. The lightweight and compact models make supporting someone living with disabilities slightly easier too as providing personal care becomes much easier whilst using a specifically designed piece of equipment.
Showering and bathing are very private elements of your personal care routine and any support you need needs to be given with dignity. Additional apparatus such as adjustable shower chairs can really make the process less uncomfortable. Customers who have already purchased their chair sing their praises, recommending them for being both lightweight and sturdy and providing much needed support in homes without adapted bathrooms.
This video from a company specialising in Multiple Sclerosis relief shows clearly how shower chairs can be correctly used:
There are a huge range of shower chairs on the market but all the reputable branded models are of equal quality. If you click in the box below you’ll be able to purchase one of the most competitively priced models on the market:
Shower Chair with Adjustable Height
Shower Perching Stool with Arms Adjustable Height
Clean Shower & Toilet Chair – Adjustable Height
Extra Wide Shower & Commode Chair – Adjustable Height with Detachable Arms
Shower Chair With Back – Lightweight, Adjustable Height And Integral Handles
Travel shower chair a best seller at DisabledGear.com
The shower chair from DisabledGear is a superior shower chair and is easily folded away when not required. A real boon for short term storage and carrying it with you, it uses a patented folding design. The light blue foam padded back support is comfy and firm for resting against and the non-slip foam seat has a convenient U-shaped hole for er.. convenience
The armrests are also padded with foam for comfortable support when seated or rising and they also reposition out of the way to help you get onto the seat. The foam arms can be locked down by a push-release catch for peace of mind. The clever shape and ergonomics of the shower chair ensures that it is firmly anchored to the floor whilst transferring your weight to another chair or surface – something that other makes and models cannot always achieve.
The legs are height adjustable and have ferrules to stop the shower chair from slipping or moving while it is being used. An aluminium frame means that it is one of the lightest models available is fully resistant to rust or corrosion.
Seat size 406 x 406mm (16 x 16′). Height adjustable to max.483mm / 19″. Weight 5kg. Price £133 Ex VAT
If you buy from Guy you know you have a guarantee of quality and top class customer service and the backing of the ethical and service led KanduGroup.com of which he is chairman.
Personal care is one of those extremely private concerns which we at Living with Disability understand should be treated with dignity and respect. The Uriwell product range is a fantastic set of products which make dealing with urinary or bladder weakness in both adults and children, providing a means of discreetly and comfortably relieving yourself without having to worry about searching for the less than easy to access toilet facilities or when in the car.
The Original Uriwell
The Adult Uriwell product is designed to be used by unisex customers and allows for easy and discreet urination without worry or upset. It becomes your own portable toilet. It can help you avoid those awkward situations where you are no longer able to hold on and also allows for more dignity and control in situations where there simply is no facility available. Small and easy to store, you can secrete your Uriwell away with no issues and easily access it when necessary. Fitted with a leak proof lid and easy to clean, this product solves a problem for which there may not have been an answer before.
This short video shows the Uriwells specifications and features:
The video doesn’t focus specifically on some of the more common uses of the Uriwell but does show the full range including the children’s HappyPee
HappyPee for Kids
The Bright and Amusing HappyPee
The HappyPee product has been designed with young children in mind and can even be used as a potty training aid for older children, or those who suffer anxiety in public places and therefore would struggle to handle public toilets and such like. As the photo shows the HappyPee has been designed with humour in mind and could easily distract an anxious child from their worries whilst they go. Portable and easy to use, the HappyPee is a great way of ensuring your child feels happy when out and about and needs toilet access. Like the adult Uriwell, the HappyPee is a unisex product.
Reviews for both products have been fantastic, solving many ‘caught short’ problems but also removing the anxiety from trips out and making travelling a much less stressful experience. With your Uriwell to hand you never have to worry about being caught short, suffering from an impromptu accident or anything else.
A recent reviewer said
The product exactly as described, my grandson is most willing to use it – its made going for a wee-wee exciting.
Uriwell have also introduced a multipack option: the Happy Family – Multipack Range. This is a 3 pack including a blue Uriwell, a pink Uriwell (an identical design but in pink), and a Happy Pee, the child friendly shape that can, of course, still be used by adults. Repackage these as gifts or use them yourself as a way of getting 3 uriwells at a very low price. One for the car, one for the bedroom and one for carrying with you.
To purchase any uriwell product click in the relevant box below:
When living with disabilities, it’s understandable that many people rely on a range of medications to ensure they can live comfortably and independently. For some, this can mean a combination of lots of different medications which all need to be taken at the correct time of the day and it can get confusing. Whilst pharmacies can send out your pills in a organised manner, your own medication organiser can be much more useful and make it easier to find the pills you need when you need them.
Vibrating Alert Organisers
There are a huge range of pill organisers on the market from the very cheap and basic to more advanced designs which hope to help you remember to take your medication as well as keeping it in order. The development of vibrating and alarmed organisers mean you’ll never need to forget another pill and you can always feel safe without having to keep reminding yourself to take your pills when you need them. This video shows one model of vibrating pill box and how it can remind you to take the pills you need:
Discrete and portable
There are many designs like this wallet model, which make your pill organiser look a lot less clinical and easy to carry about your person without feeling like a walking pharmacy. Alternatively, there are a range of brighly coloured pill boxes on the market and if you only rely on a small number of meds, you could consider this fashionable Swarovski pill box or this prettily designed pill organiser.
It may seem like a small thing but it can really make a difference, especially when out and about and needing to remember to take your pills on time. Relying on medication can be a pain so any steps that can be taken to make it less of a chore are welcomed. If you’re interested in finding out more about the range of pill boxes available and also making a purchase click on any of the boxes below:
We like to find new gadgets or uses of existing products that help people with disabilities. We don't like clinical or stigmatising looking ugly products that make your home look like a hospital ward!
Please leave a comment if you would like to submit a review or suggest a product. You can always talk to us on twitter @lwdisability or facebook. We love to be offered guest posts and happily include your bio with blog link or for a chosen cause or charity.
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