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Jain RP, Als D, Vaivada T, Bhutta ZA. Prevention and Management of High-Burden Noncommunicable Diseases in School-Age Children: A Systematic Review. Pediatrics 2022; 149:186938. [PMID: 35503327 DOI: 10.1542/peds.2021-053852f] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Noncommunicable diseases (NCDs) are chronic conditions requiring health care, education, social and community services, addressing prevention, treatment, and management. This review aimed to summarize and synthesize the available evidence on interventions from systematic reviews of high-burden NCDs and risk factors among school-aged children. METHODS The following databases were used for this research: Medline, Embase, The Cochrane Library, and the Campbell library. The search dates were from 2000 to 2021. We included systematic reviews that synthesized studies to evaluate intervention effectiveness in children aged 5 to 19 years globally. Two reviewers independently extracted data and assessed methodological quality of included reviews using the AMSTAR 2 tool. RESULTS Fifty studies were included. Asthma had the highest number of eligible reviews (n = 19). Of the reviews reporting the delivery platform, 27% (n = 16) reported outpatient settings, 13% (n = 8) home and community-based respectively, and 8% (n = 5) school-based platforms. Included reviews primarily (69%) reported high-income country data. This may limit the results' generalizability for school-aged children and adolescents in low- and middle- income countries. CONCLUSIONS School-aged children and adolescents affected by NCDs require access to quality care, treatment, and support to effectively manage their diseases into adulthood. Strengthening research and the capacity of countries, especially low- and middle- income countries, for early screening, risk education and management of disease are crucial for NCD prevention and control.
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Affiliation(s)
- Reena P Jain
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Daina Als
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Tyler Vaivada
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Canada.,Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
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2
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Moore DA, Nunns M, Shaw L, Rogers M, Walker E, Ford T, Garside R, Ukoumunne O, Titman P, Shafran R, Heyman I, Anderson R, Dickens C, Viner R, Bennett S, Logan S, Lockhart F, Thompson Coon J. Interventions to improve the mental health of children and young people with long-term physical conditions: linked evidence syntheses. Health Technol Assess 2020; 23:1-164. [PMID: 31122334 DOI: 10.3310/hta23220] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although mental health difficulties can severely complicate the lives of children and young people (CYP) with long-term physical conditions (LTCs), there is a lack of evidence about the effectiveness of interventions to treat them. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of interventions aiming to improve the mental health of CYP with LTCs (review 1) and explore the factors that may enhance or limit their delivery (review 2). DATA SOURCES For review 1, 13 electronic databases were searched, including MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Science Citation Index. For review 2, MEDLINE, PsycINFO and CINAHL were searched. Supplementary searches, author contact and grey literature searches were also conducted. REVIEW METHODS The first systematic review sought randomised controlled trials (RCTs) and economic evaluations of interventions to improve elevated symptoms of mental ill health in CYP with LTCs. Effect sizes for each outcome were calculated post intervention (Cohen's d). When appropriate, random-effects meta-analyses produced pooled effect sizes (d). Review 2 located primary qualitative studies exploring experiences of CYP with LTCs, their families and/or practitioners, regarding interventions aiming to improve the mental health and well-being of CYP with LTCs. Synthesis followed the principles of metaethnography. An overarching synthesis integrated the findings from review 1 and review 2 using a deductive approach. End-user involvement, including topic experts and CYP with LTCs and their parents, was a feature throughout the project. RESULTS Review 1 synthesised 25 RCTs evaluating 11 types of intervention, sampling 12 different LTCs. Tentative evidence from seven studies suggests that cognitive-behavioural therapy interventions could improve the mental health of CYP with certain LTCs. Intervention-LTC dyads were diverse, with few opportunities to meta-analyse. No economic evaluations were located. Review 2 synthesised 57 studies evaluating 21 types of intervention. Most studies were of individuals with cancer, a human immunodeficiency virus (HIV) infection or mixed LTCs. Interventions often aimed to improve broader mental health and well-being, rather than symptoms of mental health disorder. The metaethnography identified five main constructs, described in an explanatory line of argument model of the experience of interventions. Nine overarching synthesis categories emerged from the integrated evidence, raising implications for future research. LIMITATIONS Review 1 conclusions were limited by the lack of evidence about intervention effectiveness. No relevant economic evaluations were located. There were no UK studies included in review 1, limiting the applicability of findings. The mental health status of participants in review 2 was usually unknown, limiting comparability with review 1. The different evidence identified by the two systematic reviews challenged the overarching synthesis. CONCLUSIONS There is a relatively small amount of comparable evidence for the effectiveness of interventions for the mental health of CYP with LTCs. Qualitative evidence provided insight into the experiences that intervention deliverers and recipients valued. Future research should evaluate potentially effective intervention components in high-quality RCTs integrating process evaluations. End-user involvement enriched the project. STUDY REGISTRATION This study is registered as PROSPERO CRD42011001716. FUNDING The National Institute for Health Research (NIHR) Health Technology Assessment programme and the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
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Affiliation(s)
- Darren A Moore
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Michael Nunns
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Liz Shaw
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Morwenna Rogers
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Erin Walker
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tamsin Ford
- Child Mental Health Group, University of Exeter Medical School, Exeter, UK
| | - Ruth Garside
- The European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK
| | - Obi Ukoumunne
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Penny Titman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Roz Shafran
- University College London Institute of Child Health, London, UK
| | - Isobel Heyman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rob Anderson
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Chris Dickens
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Russell Viner
- University College London Institute of Child Health, London, UK
| | - Sophie Bennett
- University College London Institute of Child Health, London, UK
| | - Stuart Logan
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Fiona Lockhart
- Biomedical Research Centre Patient & Public Involvement Group, University College London Hospitals, London, UK
| | - Jo Thompson Coon
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
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3
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Marsland AL, Gentile D, Hinze-Crout A, von Stauffenberg C, Rosen RK, Tavares A, Votruba-Drzal E, Cohen S, McQuaid EL, Ewing LJ. A randomized pilot trial of a school-based psychoeducational intervention for children with asthma. Clin Exp Allergy 2019; 49:591-602. [PMID: 30657230 DOI: 10.1111/cea.13337] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/30/2018] [Accepted: 12/29/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Asthma is a common childhood illness with high morbidity and mortality among minority and socio-economically disadvantaged children. Disparities are not fully accounted for by differences in asthma prevalence, highlighting a need for interventions targeting factors associated with poorer asthma control. One such factor is psychological stress. OBJECTIVE Here, we examine the feasibility and acceptability of "I Can Cope (ICC)," a school-based stress management and coping intervention for children with asthma. METHODS A parallel randomized pilot trial was conducted. One hundred and four low-income children (mean age 10 years; 54% male; 70% African American) with persistent asthma were recruited from 12 urban schools and randomized to the following: (a) ICC or one of two control conditions: (b) "Open Airways for Schools (OAS)"-an asthma education intervention or (c) no treatment. RESULTS Seventy one percentage of eligible children participated in the study, with a dropout rate of 12%. ICC was rated as highly acceptable by participating children and parents. Preliminary efficacy data suggest that when compared with no treatment, ICC resulted in decreased symptoms of depression, perceived stress and child-reported symptoms of asthma, and improvements in sleep quality and child-reported asthma control. There were no intervention-related changes in objective measures of asthma morbidity. The magnitude of intervention effects on psychological function did not differ between the ICC and OAS groups. CONCLUSIONS Results support the feasibility and acceptability of utilizing school-based interventions to access hard to reach children with asthma. Preliminary findings offer support for future, large-scale efficacy studies of school-based interventions designed to target multiple factors that contribute to asthma disparities.
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Affiliation(s)
| | | | | | | | | | - Amy Tavares
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Sheldon Cohen
- Carnegie Mellon University, Pittsburgh, Pennsylvania
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4
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Dharmage SC, Perret JL, Custovic A. Epidemiology of Asthma in Children and Adults. Front Pediatr 2019; 7:246. [PMID: 31275909 PMCID: PMC6591438 DOI: 10.3389/fped.2019.00246] [Citation(s) in RCA: 534] [Impact Index Per Article: 106.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/29/2019] [Indexed: 11/23/2022] Open
Abstract
Asthma is a globally significant non-communicable disease with major public health consequences for both children and adults, including high morbidity, and mortality in severe cases. We have summarized the evidence on asthma trends, environmental determinants, and long-term impacts while comparing these epidemiological features across childhood asthma and adult asthma. While asthma incidence and prevalence are higher in children, morbidity, and mortality are higher in adults. Childhood asthma is more common in boys while adult asthma is more common in women, and the reversal of this sex difference in prevalence occurs around puberty suggesting sex hormones may play a role in the etiology of asthma. The global epidemic of asthma that has been observed in both children and adults is still continuing, especially in low to middle income countries, although it has subsided in some developed countries. As a heterogeneous disease, distinct asthma phenotypes, and endotypes need to be adequately characterized to develop more accurate and meaningful definitions for use in research and clinical settings. This may be facilitated by new clustering techniques such as latent class analysis, and computational phenotyping methods are being developed to retrieve information from electronic health records using natural language processing (NLP) algorithms to assist in the early diagnosis of asthma. While some important environmental determinants that trigger asthma are well-established, more work is needed to define the role of environmental exposures in the development of asthma in both children and adults. There is increasing evidence that investigation into possible gene-by-environment and environment-by-environment interactions may help to better uncover the determinants of asthma. Therefore, there is an urgent need to further investigate the interrelationship between environmental and genetic determinants to identify high risk groups and key modifiable exposures. For children, asthma may impair airway development and reduce maximally attained lung function, and these lung function deficits may persist into adulthood without additional progressive loss. Adult asthma may accelerate lung function decline and increase the risk of fixed airflow obstruction, with the effect of early onset asthma being greater than late onset asthma. Therefore, in managing asthma, our focus going forward should be firmly on improving not only short-term symptoms, but also the long-term respiratory and other health outcomes.
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Affiliation(s)
- Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Adnan Custovic
- Department of Paediatrics, Imperial College London, London, United Kingdom
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5
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Doğru H, Sürer-Adanır A, Özatalay E. Psychopathology, health-related quality-of-life and parental attitudes in pediatric asthma. J Asthma 2018; 56:1204-1211. [PMID: 30335531 DOI: 10.1080/02770903.2018.1531995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Considering that unknown psychopathology might play a role in the management of pediatric asthma, this study examines how self-esteem and psychosocial family environment (child-raising attitudes and parental coping strategies) influence the physical and psychosocial well-being of these children. Hence, this paper aims to predict psychosocial factors influencing health-related quality-of-life (HRQL) in children with asthma without a documented history of mental illness. Methods: 32 patients with asthma and 32 controls aged 8-18 years were included in the study. All participants were largely middle-income, Caucasian school-aged children. The child-raising attitudes examined were: dependency, egalitarianism/democratic attitude, rejection of the homemaking role, marital conflict, and strictness/authoritarianism. The parental coping strategies were; social support seeking, problem-solving attitude and avoidance. Results: Psychiatric comorbidity was present in 72% of asthma patients and 22% of the controls. The most common mental illness identified was generalized anxiety disorder; 32% vs 13%, respectively. Dependency was the only parental child-raising attitude that differed significantly between groups (47 ± 8 vs 41 ± 11, respectively. p = 0.035). There was a negative correlation between the PARI dependency subscale and the total HRQL score according to the parents (rp= -0.39, p = 0.027). The most influential factors connected with the total HRQL score in asthma were Rosenberg self-esteem scale score, presence of psychopathology and dependency according to the child. Conclusions: Simple ways to overcome emotional dependency and fortify self-esteem (exercises promoting self-awareness, opportunities cultivating decision-making, and a considerable freedom-of-choice to experience consequences) worth recommending to parents of children with asthma. Patients with suspected mental illness must be referred for psychiatric evaluations.
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Affiliation(s)
- Hicran Doğru
- Department of Child and Adolescent Psychiatry, Erzurum Regional Education and Research Hospital , Erzurum , Turkey
| | - Aslı Sürer-Adanır
- Department of Child and Adolescent Psychiatry, School of Medicine, Akdeniz University , Antalya , Turkey
| | - Esin Özatalay
- Department of Child and Adolescent Psychiatry, School of Medicine, Akdeniz University , Antalya , Turkey
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6
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Romieu H, Charbonnier F, Janka D, Douillard A, Macioce V, Lavastre K, Abassi H, Renoux MC, Mura T, Amedro P. Efficiency of physiotherapy with Caycedian Sophrology on children with asthma: A randomized controlled trial. Pediatr Pulmonol 2018; 53:559-566. [PMID: 29493875 DOI: 10.1002/ppul.23982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/25/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Asthma is the most common chronic disease in pediatrics. Along with the usual drug therapy using corticosteroids and bronchodilators, some interest has been shown for adjuvant therapies, such as sophrology. However, the level of evidence for non-pharmaceutical therapies in asthma remains low, especially in children. This study aimed to assess whether in children with asthma, peak expiratory flow (PEF) improved more after a sophrology session alongside standard treatment than after standard treatment alone. METHODS We carried out a prospective randomized controlled clinical trial among 74 children aged 6-17 years old, hospitalized for an asthma attack. Group 1: conventional treatment (oxygen, corticosteroids, bronchodilators, physiotherapy) added to one session of sophrology. Group 2: conventional treatment alone. The primary outcome was the PEF variation between the initial and final evaluations (PEF2 -PEF1 ). RESULTS Demographic and clinical characteristics were similar in both groups at baseline. Measures before and after the sophrology session showed that the PEF increased by mean 30 L/min in the sophrology group versus 20 L/min in the control group (P = 0.02). Oxygen saturation increased by 1% versus 0% (P = 0.02) and the dyspnea score with visual analogue scale improved by two points point (P = 0.01). No differences were observed between the two groups in terms of duration of hospitalization, use and doses of conventional medical treatment (oxygen, corticosteroids, and bronchodilators), and quality of life scores. CONCLUSIONS Sophrology appears as a promising adjuvant therapy to current guideline-based treatment for asthma in children.
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Affiliation(s)
- Huguette Romieu
- Department of Pediatric Cardiology and Pulmonology, University Hospital, Montpellier, France
| | - Françoise Charbonnier
- Department of Pediatric Cardiology and Pulmonology, University Hospital, Montpellier, France
| | - Dora Janka
- Department of Pediatric Cardiology and Pulmonology, University Hospital, Montpellier, France
| | - Aymeric Douillard
- Department of Epidemiology and Clinical Research, University Hospital, Montpellier, France
| | - Valérie Macioce
- Department of Epidemiology and Clinical Research, University Hospital, Montpellier, France
| | - Kathleen Lavastre
- Department of Pediatric Cardiology and Pulmonology, University Hospital, Montpellier, France
| | - Hamouda Abassi
- Department of Pediatric Cardiology and Pulmonology, University Hospital, Montpellier, France.,Self-Perceived Health Assessment Research Unit, EA3279, Department of Public Health, Mediterranean Medical School, Marseille, France
| | - Marie-Catherine Renoux
- Department of Pediatric Cardiology and Pulmonology, University Hospital, Montpellier, France
| | - Thibault Mura
- Department of Epidemiology and Clinical Research, University Hospital, Montpellier, France.,INSERM U1061, University of Montpellier, Montpellier, France
| | - Pascal Amedro
- Department of Pediatric Cardiology and Pulmonology, University Hospital, Montpellier, France.,Physiology and Experimental Biology of Heart and Muscles Laboratory-PHYMEDEXP, UMR CNRS 9214-INSERM U1046, University of Montpellier, Montpellier, France.,Self-Perceived Health Assessment Research Unit, EA3279, Department of Public Health, Mediterranean Medical School, Marseille, France
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7
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Booster GD, Oland AA, Bender BG. Psychosocial Factors in Severe Pediatric Asthma. Immunol Allergy Clin North Am 2017; 36:449-60. [PMID: 27401618 DOI: 10.1016/j.iac.2016.03.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Asthma is the most common chronic illness among children in the United States and can impact nearly all aspects of functioning. Most research suggests that children with severe asthma display more emotional and behavioral problems than their healthy peers. These psychological difficulties are associated with increased risk for functional impairments and problematic disease course. Multidisciplinary teams that assess and treat these psychosocial factors using psychoeducational and behavioral interventions are important for children whose asthma is poorly controlled. Future research should examine the ways in which stress, emotions, and immune functions interact, so as to develop more preventative interventions.
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Affiliation(s)
- Genery D Booster
- Pediatric Behavioral Health, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
| | - Alyssa A Oland
- Pediatric Behavioral Health, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
| | - Bruce G Bender
- Pediatric Behavioral Health, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
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8
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Oland AA, Booster GD, Bender BG. Psychological and lifestyle risk factors for asthma exacerbations and morbidity in children. World Allergy Organ J 2017; 10:35. [PMID: 29075362 PMCID: PMC5644196 DOI: 10.1186/s40413-017-0169-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/13/2017] [Indexed: 12/13/2022] Open
Abstract
Asthma is the most common childhood illness and disproportionately affects low-income, minority children who live in urban areas. A range of risk factors are associated with asthma morbidity and mortality, such as treatment non-adherence, exposure to environmental triggers, low-income households, exposure to chronic stress, child psychological problems, parental stress, family functioning, obesity, physical inactivity, and unhealthy diets. These risk factors often have complex interactions and inter-relationships. Comprehensive studies that explore the inter-relationships of these factors in accounting for asthma morbidity and mortality are needed and would help to inform clinical intervention. Considerable research has focused on interventions to improve adherence, asthma management, asthma symptoms, and quality of life for patients with asthma. Educational interventions combined with psychosocial interventions, such as behavioral, cognitive-behavioral, or family interventions, are beneficial and provide care in schools, homes, and emergency rooms can help to address barriers to accessing care for children and families. Additional recent research has explored the use of multidisciplinary, collaborative, integrated care with pediatric asthma patients, providing promising results. Integrated care could be ideal for addressing the multitude of complex psychosocial and wellness factors that play a role in childhood asthma, for increasing patient-centered care, and for promoting collaborative patient-provider relationships. Further research in this area is essential and would be beneficial.
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9
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Yorke J, Fleming S, Shuldham C, Rao H, Smith HE. Nonpharmacological interventions aimed at modifying health and behavioural outcomes for adults with asthma: a critical review. Clin Exp Allergy 2016; 45:1750-64. [PMID: 25675860 DOI: 10.1111/cea.12511] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Evidence suggests that living with asthma is linked with psychological and behavioural factors including self-management and treatment adherence, and therefore, there is a reasonable hypothesis that nonpharmacological treatments may improve health outcomes in people living with this condition. A systematic review of randomized controlled trials (RCTs) of nonpharmacological interventions for adults with asthma was designed. Databases searched included The Cochrane Airways Group Register of trials, CENTRAL and Psychinfo. The literature search was conducted until May 2014. Twenty-three studies met the inclusion criteria and were organized into four groups: relaxation-based therapies (n = 9); mindfulness (n = 1), biofeedback techniques (n = 3); cognitive behavioural therapies (CBT) (n = 5); and multicomponent interventions (n = 5). A variety of outcome measures were used, even when trials belonged to the same grouping, which limited the ability to conduct meaningful meta-analyses. Deficiencies in the current evidence base, notably trial heterogeneity, means that application to clinical practice is limited and clear guidelines regarding the use of nonpharmacological therapies in asthma is limited. Relaxation and CBT, however, appear to have a consistent positive effect on asthma-related quality of life and some psychological outcomes, and lung function (relaxation only). Future trials should be informed by previous work to harmonize the interventions under study and outcome measures used to determine their effectiveness; only then will meaningful meta-analyses inform clinical practice.
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Affiliation(s)
- J Yorke
- Nursing, University of Manchester, Manchester, UK
| | - S Fleming
- Nursing Research, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - C Shuldham
- Nursing and Quality, Royal Brompton and Harefield Foundation Trust, London, UK
| | - H Rao
- Public Health and Primary Care, University of Brighton, Brighton, UK
| | - H E Smith
- Public Health and Primary Care, University of Brighton, Brighton, UK
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10
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Bennett S, Shafran R, Coughtrey A, Walker S, Heyman I. Psychological interventions for mental health disorders in children with chronic physical illness: a systematic review. Arch Dis Child 2015; 100:308-16. [PMID: 25784736 DOI: 10.1136/archdischild-2014-307474] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Children with chronic physical illness are significantly more likely to develop common psychiatric symptoms than otherwise healthy children. These children therefore warrant effective integrated healthcare yet it is not established whether the known, effective, psychological treatments for symptoms of common childhood mental health disorders work in children with chronic physical illness. METHODS EMBASE, MEDLINE, PsycINFO and CINAHL databases were searched with predefined terms relating to evidence-based psychological interventions for psychiatric symptoms in children with chronic physical illness. We included all studies (randomised and non-randomised designs) investigating interventions aimed primarily at treating common psychiatric symptoms in children with a chronic physical illness in the review. Two reviewers independently assessed the relevance of abstracts identified, extracted data and undertook quality analysis. RESULTS Ten studies (209 children, including 70 in control groups) met the criteria for inclusion in the review. All studies demonstrated some positive outcomes of cognitive behavioural therapy for the treatment of psychiatric symptoms in children with chronic physical illness. Only two randomised controlled trials, both investigating interventions for symptoms of depression, were found. CONCLUSIONS There is preliminary evidence that cognitive behavioural therapy has positive effects in the treatment of symptoms of depression and anxiety in children with chronic physical illness. However, the current evidence base is weak and fully powered randomised controlled trials are needed to establish the efficacy of psychological treatments in this vulnerable population.
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Affiliation(s)
- Sophie Bennett
- UCL Institute of Child Health, University College London, London, UK
| | - Roz Shafran
- UCL Institute of Child Health, University College London, London, UK
| | - Anna Coughtrey
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Susan Walker
- UCL Institute of Child Health, University College London, London, UK Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Isobel Heyman
- UCL Institute of Child Health, University College London, London, UK Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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11
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12
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Koh YI. Asthma and psychological disorders. ALLERGY ASTHMA & RESPIRATORY DISEASE 2014. [DOI: 10.4168/aard.2014.2.3.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Young-Il Koh
- Division of Allergy, Asthma, and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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13
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Stewart M, Letourneau N, Masuda JR, Anderson S, McGhan S. Impacts of online peer support for children with asthma and allergies: It just helps you every time you can't breathe well". J Pediatr Nurs 2013; 28:439-52. [PMID: 23398896 DOI: 10.1016/j.pedn.2013.01.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 01/03/2013] [Accepted: 01/08/2013] [Indexed: 11/17/2022]
Abstract
Children with asthma and allergies experience social isolation and gaps in social support particularly from peers. The objective of this pilot study was to design and test an accessible online support intervention for these children. Support was delivered by peer mentors with asthma and allergies and a professional. Weekly support groups were conducted over 8 weeks using Go to Meeting and Club Penguin. Quantitative measures and a qualitative interview were administered. Significant increases in perceived support and support-seeking coping and trends in decreased loneliness emerged at post-test. Participants also reported increased self-confidence and satisfaction with the intervention.
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14
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Ringlever L, Hiemstra M, Engels RCME, van Schayck OCP, Otten R. The link between asthma and smoking explained by depressive feelings and self-efficacy. J Psychosom Res 2013; 74:505-10. [PMID: 23731748 DOI: 10.1016/j.jpsychores.2013.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 03/04/2013] [Accepted: 03/08/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Adolescents with asthma consistently smoke at higher or similar rates as non-asthmatic peers, although smoking might involve more health risks. This study examined possible mechanisms (i.e. depressive feelings and self-efficacy to refrain from smoking) explaining the association between asthma and smoking initiation. METHODS An indirect path from asthma to self-efficacy through depressive feelings was examined in two independent samples. Sample 1 consisted of 4531 adolescents (mean age 12.8) and sample 2 consisted of 1289 children (late childhood, mean age 10.1). Data were gathered from maternal and self-report. In the adolescent sample, whether the relationship between depressive feelings at baseline and smoking initiation two years post-baseline runs via self-efficacy was also examined. RESULTS Higher amounts of depressive feelings decreased adolescents' self-efficacy to refrain from smoking, which subsequently increased the risk to initiate smoking. A diagnosis of asthma was also associated with higher levels of depressive feelings which in turn decreased self-efficacy. A marginal significant indirect effect was found in the childhood sample. CONCLUSION Smoking prevention efforts should start as early as mid to late childhood. The results indicate that focus should be placed on preventing depressive feelings with the aim of increasing children's self-efficacy to refrain from smoking. This is especially important for children and adolescents with asthma.
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Affiliation(s)
- Linda Ringlever
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
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15
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Stewart M, Letourneau N, Masuda JR, Anderson S, McGhan S. Online support for children with asthma and allergies. JOURNAL OF FAMILY NURSING 2013; 19:171-197. [PMID: 23559663 DOI: 10.1177/1074840713483573] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Children with asthma and allergies experience social isolation and gaps in social support particularly from peers. The objective of this pilot study was to design and test an accessible online support intervention for these children. Children (n = 27) aged 7 to 11 from across Canada participated. GoToMeeting was employed for the support group sessions and Club Penguin for social connections during and between support group meetings. Content included: strategies for coping with asthma and allergies, role playing and games to help children deal with difficult situations, fun and enjoyment, and presentations by positive role models. Participation in the online peer support intervention was high, 86.3% on average over the 8-week intervention. By sharing their experiences, listening to peers' experiences, and role playing, children were introduced to practical skills: problem solving, communicating, seeking support, and self-advocacy.
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Affiliation(s)
- Miriam Stewart
- Faculty of Nursing & School of Public Health, University of Alberta, Edmonton, AB, Canada
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16
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17
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Kosti RI, Priftis KN, Anthracopoulos MB, Papadimitriou A, Grigoropoulou D, Lentzas Y, Yfanti K, Panagiotakos DB. The association between leisure-time physical activities and asthma symptoms among 10- to 12-year-old children: the effect of living environment in the PANACEA study. J Asthma 2012; 49:342-8. [PMID: 22300140 DOI: 10.3109/02770903.2011.652328] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study evaluated the interrelationships of living environment, physical activity, lifestyle/dietary habits, and nutritional status on the prevalence of childhood asthma. METHODS In a cross-sectional survey 1125 children (529 boys), 10 to 12 years old, were selected from 18 schools located in an urban environment (Athens, n = 700) and from 10 schools located in rural areas (n = 425) in Greece. RESULTS Children living in Athens had higher likelihood of "ever had" asthma compared with children living in rural areas (odds ratio (OR) = 1.78, 95% confidence interval (CI) = 1.25-2.54), after adjusting for age and sex. After adjusting for age, sex, body mass index, and adherence to the Mediterranean diet (KIDMED score), leisure-time physical activity was inversely associated with "ever had" asthma. When stratifying by county of residence, a trend toward reduced asthma symptoms among children engaged in outdoor physical activities during their leisure time who reside in rural (but not urban) environment was observed (OR = 0.88, 95% CI = 0.77-1.01). CONCLUSIONS The inverse relationship between asthma symptoms and leisure-time physical activity in the rural environment and the lack of an association between asthma symptoms and organized sports-related activities should draw the attention of public healthcare authorities. Their efforts should focus on the planning of a sustainable natural environment, which will promote the physical health of children and reduce the burden of childhood asthma.
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Affiliation(s)
- Rena I Kosti
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
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18
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Long KA, Ewing LJ, Cohen S, Skoner D, Gentile D, Koehrsen J, Howe C, Thompson AL, Rosen RK, Ganley M, Marsland AL. Preliminary evidence for the feasibility of a stress management intervention for 7- to 12-year-olds with asthma. J Asthma 2011; 48:162-70. [PMID: 21332379 DOI: 10.3109/02770903.2011.554941] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Evidence supports a bidirectional relationship between stress and asthma exacerbations in children, suggesting that interventions to reduce stress may improve both psychosocial quality of life and disease course. Here, we examine the feasibility of a stress management intervention for 7- to 12-year-olds with asthma. METHODS Two trials were conducted. Cohort 1 (n = 11) was recruited from the community and attended intervention sessions at an urban university. Cohort 2 (n = 7) was school based and recruited from an African American charter school. Six individual intervention sessions focused on psychoeducation about asthma, stress, and emotions; problem-solving and coping skills training; and relaxation training paired with physiological feedback. Pre- and post-intervention stress, mood, and lung function data were collected. Satisfaction surveys were administered after intervention completion. RESULTS The intervention was rated as highly acceptable by participating families. Feasibility was much stronger for the school-based than the university-based recruitment mechanism. Initial efficacy data suggest that both cohorts showed pre- to post-intervention improvements in lung function, perceived stress, and depressed mood. CONCLUSION Findings provide evidence for the feasibility of offering asthma-related stress management training in a school setting. Initial findings offer support for future, large-scale efficacy studies.
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Affiliation(s)
- Kristin A Long
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA.
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19
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Anxiety and asthma symptoms in urban adolescents with asthma: the mediating role of illness perceptions. J Clin Psychol Med Settings 2011; 17:349-56. [PMID: 21086026 DOI: 10.1007/s10880-010-9214-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Twenty to 40% of adolescents with asthma experience significant symptoms of anxiety. This study examined the mediational role of illness perceptions in the relationship between anxiety and asthma symptoms in adolescents. One hundred fifty-one urban adolescents (ages 11-18) with asthma completed measures of illness perceptions, and anxiety and asthma symptoms. Using the Baron and Kenny approach and Sobel tests, we examined whether illness perceptions mediated the anxiety-asthma symptom relationship. Three illness perceptions significantly mediated the relationship between anxiety and asthma symptoms, z = 1.97-2.13, p < .05; adjusted R(2) = 0.42-0.51, p < .05. Greater anxiety symptoms were associated with perceptions that asthma negatively impacted one's life and emotions and was difficult to control. These negative illness perceptions were, in turn, related to greater asthma symptoms. Illness perceptions helped explain the anxiety-asthma symptoms link in adolescents. Results suggest that targeting illness perceptions in adolescents with asthma and anxiety may help reduce asthma symptoms.
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20
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Fasciglione MP, Castañeiras CE. [The educational component in an integrated approach to bronchial asthma]. J Bras Pneumol 2010; 36:252-9. [PMID: 20485948 DOI: 10.1590/s1806-37132010000200015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 10/15/2009] [Indexed: 11/22/2022] Open
Abstract
Bronchial asthma is an inflammatory chronic disease of the respiratory tract whose prevalence is increasing worldwide. Since there is no curative treatment available, the principal objective of every approach is to control the disease and to improve the quality of life of patients. Over the last few decades, intervention programs supplementing conventional medical treatments have been tested and implemented. The majority of such programs consist of educational interventions or include some type of educational component. In this study, we attempted to determine the characteristics and the impact of educational interventions on asthma by means of the following: a) an updated review of the various educational interventions developed and implemented for asthma patients; b) the identification of aspects that are common to all of these interventions; and c) the analysis of the findings in the literature regarding the impact that these interventions have on the health and quality of life of patients. We conclude that educational interventions are effective in improving the health and quality of life of asthma patients, as well as in reducing the use and costs of health resources. These findings indicate the importance of including an educational component as part of an integrated approach to this population. Likewise, the inherent complexity of the educational process highlights the importance of a complementary joint effort including various health professionals.
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Affiliation(s)
- María Paola Fasciglione
- Consejo Nacional de Investigaciones Científicas y Técnicas de la República Argentina, Mar del Plata, Argentina.
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21
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Clarke DM, Currie KC. Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence. Med J Aust 2009; 190:S54-60. [PMID: 19351294 DOI: 10.5694/j.1326-5377.2009.tb02471.x] [Citation(s) in RCA: 347] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 11/18/2008] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To review the evidence for an association between depression and anxiety and the National Health Priority Area conditions -- heart disease, stroke, diabetes mellitus, asthma, cancer, arthritis and osteoporosis -- and for the effectiveness of treatments for depression and anxiety in these settings. DATA SOURCES Systematic literature search of systematic reviews, meta-analyses and evidence-based clinical practice guidelines published between 1995 and 2007, inclusive. DATA EXTRACTION Each review was examined and summarised by two people before compilation. DATA SYNTHESIS Depression is more common in all disease groups than in the general population; anxiety is more common in people with heart disease, stroke and cancer than in the general population. Heterogeneity of studies makes determination of risk and the direction of causal relationships difficult to determine, but there is consistent evidence that depression is a risk factor for heart disease, stroke and diabetes mellitus. Antidepressants appear to be effective for treating depression and/or anxiety in patients with heart disease, stroke, cancer and arthritis, although the number of studies in this area is small. A range of psychological and behavioural treatments are also effective in improving mood in patients with cancer and arthritis but, again, the number of studies is small. CONCLUSION The evidence for the association of physical illness and depression and anxiety, and their effects on outcome, is very strong. Further research to establish the effectiveness of interventions is required. Despite the limits of current research, policy and practice still lags significantly behind best evidence-based practice. Models of integrated care need to be developed and trialled.
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Affiliation(s)
- David M Clarke
- Psychological Medicine, Monash University, Melbourne, VIC, Australia.
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22
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Collins JE, Gill TK, Chittleborough CR, Martin AJ, Taylor AW, Winefield H. Mental, emotional, and social problems among school children with asthma. J Asthma 2008; 45:489-93. [PMID: 18612902 DOI: 10.1080/02770900802074802] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To use representative population chronic disease and risk factor data to investigate the relationship between asthma and social factors in school-age children. METHODS Representative cross-sectional data for children 5 to 15 years of age were collected from 2002 to June 2007 (n = 4,611) in the South Australian Monitoring and Surveillance System (SAMSS) using Computer-Assisted Telephone Interviews (CATI). Univariate and multivariate analyses were conducted to investigate the variables that were associated with asthma among children. RESULTS The overall prevalence of self-reported asthma among children 5 to 15 years of age was 18.6% (95% CI = 17.5-19.8). Children with asthma were more likely to have been treated for a mental health problem, have been unhappy at school, have been absent from school in the last month, have fair or poor overall health and well-being, have ongoing pain or chronic illness, and less likely to have a group of friends to play with. Asthma was also more prevalent among males and less likely to occur in children from households where the gross annual income was greater than $AU80,000. CONCLUSIONS Children with asthma were more likely to be treated for a mental health problem and demonstrate more negative social outcomes as well as poorer overall health and well-being. Asthma management plans need to be sensitive to these psychosocial factors for adequate care of these vulnerable young patients.
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Affiliation(s)
- Joanne E Collins
- Department of Health, Population Research and Outcome Studies Unit, South Australia.
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23
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Shuldham C, Fleming S, Yorke J. Undertaking a systematic review: the road to successful completion. J Res Nurs 2008. [DOI: 10.1177/1744987108093527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract The systematic review is an important research method that allows for the critical analysis of the results from a range of existing studies to answer research questions. The findings can be used to inform clinical decisions, as well as the development of protocols and guidelines. The aim of this paper is to explore the steps involved in undertaking a Cochrane systematic review and to encourage more nurses to participate in this world wide collaboration to answer questions that are relevant to nursing practice. The first stage of a review involves initiating a focussed clinical question in which the patient group or problem is identified as are the intervention, comparison and outcome, which will become the focus of study. Each review is guided by a protocol that is subject to peer review and followed by a structured search of the worldwide literature on the subject. Quality assessment and data extraction are done systematically and subject to cross-checking. The results are analysed using statistical methods, including meta-analysis. Publication is electronic in the Cochrane Library and many will also be published in other journals. As with all research, findings should be presented in a way that enables the reader to assess whether the review can be applied to their patient.
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Affiliation(s)
- Caroline Shuldham
- Royal Brompton and Harefield NHS Trust, London, UK; Honorary clinical senior lecturer; National Heart and Lung Institute, Imperial College, London, UK
| | - Sharon Fleming
- Royal Holloway and Royal Brompton and Harefield NHS Trust, London, UK
| | - Janelle Yorke
- School of Nursing, Faculty of Health and Social Care, University of Salford, Greater Manchester, UK
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24
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Abstract
Asthma has long been considered a condition in which psychological factors have a role. As in many illnesses, psychological variables may affect outcome in asthma via their effects on treatment adherence and symptom reporting. Emerging evidence suggests that the relation between asthma and psychological factors may be more complex than that, however. Central cognitive processes may influence not only the interpretation of asthma symptoms but also the manifestation of measurable changes in immune and physiologic markers of asthma. Furthermore, asthma and major depressive disorder share several risk factors and have similar patterns of dysregulation in key biologic systems, including the neuroendocrine stress response, cytokines, and neuropeptides. Despite the evidence that depression is common in people with asthma and exerts a negative impact on outcome, few treatment studies have examined whether improving symptoms of depression do, in fact, result in better control of asthma symptoms or improved quality of life in patients with asthma.
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Affiliation(s)
- Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON
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25
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Yorke J, Cameron-Traub E. Patients’ perceived care needs whilst waiting for a heart or lung transplant. J Clin Nurs 2008; 17:78-87. [DOI: 10.1111/j.1365-2702.2007.02078.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Korta Murua J, Valverde Molina J, Praena Crespo M, Figuerola Mulet J, Rodríguez Fernández-Oliva CR, Rueda Esteban S, Neira Rodríguez A, Vázquez Cordero C, Martínez Gómez M, Román Piñana JM. [Therapeutic education in asthma management]. An Pediatr (Barc) 2007; 66:496-517. [PMID: 17517205 DOI: 10.1157/13102515] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
All guidelines, protocols and recommendations underline the importance of therapeutic education as a key element in asthma management and control. Considerable evidence supports the efficacy and effectiveness of this measure. Health personnel, as well as patients and their parents, can and should be educated with two main objectives: to achieve the best possible quality of life and to allow self control of the disease. These goals can be attained through an educational process that should be individually tailored, continuous, progressive, dynamic, and sequential. The process poses more than a few difficulties involving patients, health professionals, and the health systems. Knowledge of the various psychological factors that can be present in asthmatic patients, as well as the factors related to the highly prevalent phenomenon of non-adherence, is essential. Awareness of the factors influencing physician-patient-family communication is also highly important to achieve the objectives set in therapeutic education. The educational process helps knowledge and abilities to be acquired and allows attitudes and beliefs to be modified. Patients and caregivers should be provided with an individual written action plan based on symptoms and/or forced expiratory volume in 1 second. Periodic follow-up visits are also required.
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Affiliation(s)
- J Korta Murua
- Grupo de Trabajo Asma y Educación de la Sociedad Española de Neumología Pediátrica, Spain.
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