Anxiety is one of the most common and debilitating mental health disorders, and is related to changes in interoception (perception of bodily states). While anxiety is more prevalent in women than men, gender differences in interoception-anxiety associations are often overlooked. Here we examined gender-specific relationships between anxiety and interoception in the breathing domain, utilising multicentre data pooled from four study sites (N=175; 51% female). State anxiety scores were quantified via the Spielberger State-Trait Anxiety Inventory, and interoceptive measurements via an inspiratory load detection task. From this task, breathing-related interoceptive dimensions of sensitivity, decision bias, metacognitive bias (confidence in interoceptive decisions), and metacognitive insight (congruency between performance and confidence) were quantified. Regression analyses revealed a significant negative relationship between state anxiety and metacognitive bias (=-0.28; p=0.01) and insight (=-0.09; 95% Highest Density Interval [HDI] in a hierarchical Bayesian regression=[-0.18,-0.004]) across the whole sample, while anxiety did not relate to interoceptive sensitivity nor decision bias. No mean effects of gender were observed for any interoceptive variables, however, the relationship between anxiety and metacognitive insight into breathing perception was driven by women (women: =-0.18; HDI=[-0.31,-0.05]; men: =0.02; HDI=[-0.12,0.15]) with a significant interaction effect ( difference=-0.20; HDI=[-0.37, -0.01]). In summary, anxiety was associated with decreased metacognitive bias across all participants, while decreased interoceptive insight was only associated with anxiety in women but not men. Therefore, treatment programs focusing on interoceptive metacognitive bias may be useful for all anxiety patients, while interoceptive insight might represent a specific treatment target for women with anxiety.

Tracheostomies are indicated in children to facilitate long-term ventilatory support, aid in the management of secretions, or to manage upper airway obstruction. Children with tracheostomies often experience ongoing airway complications, of which respiratory tract infections are common. They subsequently receive frequent courses of broad spectrum antimicrobials for the prevention or treatment of respiratory tract infections. However, there is little consensus in practice with regard to the indication for treatment/ prophylactic antimicrobial use, choice of antimicrobial, route of administration, or duration of treatment between different centres. Routine antibiotic use is associated with adverse effects and an increased risk of antimicrobial resistance. Tracheal cultures are commonly obtained from paediatric tracheostomy patients, with the aim of helping guide antimicrobial therapy choice. However, a positive culture alone is not diagnostic of infection and the role of routine surveillance cultures remains contentious. Inhaled antimicrobial use is also widespread in the management of tracheostomy associated infections; this is largely based upon theoretical benefits of higher airway antibiotic concentrations. The role of prophylactic inhaled antimicrobial use for tracheostomy associated infections remains largely unproven. This systematic review summarises the current evidence base for antimicrobial selection, duration, and administration route in paediatric tracheostomy associated infections. It also highlights significant variation in practice between centres and the urgent need for further prospective evidence to guide the management of these vulnerable patients.