Effect of asthma in childhood on psycho-social problems in the family

Relationship between psychosocial characteristics and asthma management self-efficacy of caregiver mothers: a pilot study of pediatric asthma management in Turkey

We analyzed the relationships between family functionality, caregiver burden, perceived social support, and asthma management self-efficacy of 300 Turkish mothers who provide care to pediatric asthma patients in this cross-sectional sampling study. The mean age of the caregiver mothers was 31.82 ± 5.08. Our study results showed that the participants had above moderate but insufficient perceived social support and asthma management self-efficacy and they were moderately satisfied with caregiver burden and family functioning. As mothers' perceived social support increased, their satisfaction with family functioning and asthma management self-efficacy also increased but their caregiver burden decreased. Additionally, the caregiver mothers had a sufficiently high level of self-confidence in caregiving to children with asthma, and the caregiver mothers who received training or more information about asthma believed that they were able to manage asthma to a great degree. The researchers conducted regression analysis and they found that biological and social factors and the degree of caregiving burden were significantly associated with asthma management self-efficacy levels. The multivariate biopsychosocial model accounted for 37.4% of the total variance in asthma management self-efficacy. Parent asthma management self-efficacy levels of the caregiver mothers are largely linked to their biological and psychosocial characteristics.

Skin and Psychosomatics - Psychodermatology today

Modern psychodermatology relies on the bio-psycho-social disease model in psychosomatics, according to which biological, psychological and social factors (on various levels, from molecules to the biosphere) play a major role in the disease pathogenesis through complex, non-linear interactions over the entire disease course. It is nowadays experimentally proven that "emotions get into the skin". Recent research shows close anatomical, physiological and functional connections between skin and nervous system, already known to be ontogenetically related. These connections are reflected in many skin diseases where psychological and somatic etiological factors are closely intertwined. A holistic approach by the physician should do justice to this interdependence; biological, psychological and social factors should be adequately taken into account when taking anamnesis, making a diagnosis and choosing a therapy. The "visibility" of the skin organ bestows dermatology a special position among the various other clinical subjects, and renders a holistic, psychosomatic approach to the patient that is particularly important. The life course belongs also to modern psychodermatological approaches. Based on the modern psychodermatology concept, other corresponding sub-areas such as psychogastroenterology, psychocardiology etc. have emerged. After the theoretical part of this article, some selected skin diseases are discussed in more detail from the psychosomatic point of view.

Psychopathology, health-related quality-of-life and parental attitudes in pediatric asthma

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 (r_p= -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.

Working and caring for a child with chronic illness: A review of current literature

BACKGROUND

Advances in medical knowledge have contributed to the increase in the number of children living with some form of long-term chronic illness or condition. As a consequence of these advancements, treatments that are more accessible and easier to administer, usually within a child's home, have been developed. However, this may mean that parents take on greater treatment responsibility and require extra time and energy to meet these tasks, additional to other responsibilities. This review paper aims to summarize and critique existing literature on working parents of children with a chronic condition, by focusing on patterns of parent work, the challenges experienced, and the flow-on consequences to well-being.

METHODS

Employing a narrative, meta-synthesis of the current literature, this review identified 3 key themes related to working parents of children with chronic illness.

RESULTS

The paper first identifies that although employment is less common, these parents are not necessarily nonworking. Second, these parents experience numerous challenges including balancing work and family, time constraints, stress, and feelings of "doing it all." And third, the above challenges lead to additional impacts on parental quality of life.

CONCLUSIONS

This review summarizes what is currently known about work patterns, challenges, and consequences in parents of children with chronic conditions. Employment is clearly impacted for these parents. Although workplace challenges have been extensively researched, other challenges (eg, personal and family) and impacts on their well-being have not. This review discusses the present standing of this research. It outlines the strengths and limitations of the current literature, makes recommendations for future research, and suggests theoretical and practical implications of the further findings.

The role of emotional control in the regulation of mood in parents of children with mucopolysaccharidosis

The aim of our study was to evaluate whether, on the basis of variables related to emotional control, we can anticipate mood change in parents of chronically ill children. Fifty-four parents of children with diagnosed mucopolysaccharidosis participated in the study that was carried out during a rehabilitation programme for children with rare metabolic diseases. To assess emotional control, a Polish adaptation of the Courtauld Emotional Control Scale was used, and mood was measured with the UWIST Mood Adjective Checklist (UMACL). Mood was assessed twice, at an interval of 8 days, on the dimensions of hedonic tone, tense arousal and energetic arousal. The baseline level of each mood dimension accounted for about 30% of the mood variance measured after 8 days. After excluding the part of the mood variance associated with the baseline level, the variables related to emotional control appeared to be significant predictors of the mood assessed 8 days later. For hedonic tone, variables related to emotional control explained 15% of the variance; for tense arousal, it was 14% of the variance; and for energetic arousal, it was 10% of the variance. Depending on the type of emotion and the degree of control, differences in tendencies to respond with a particular mood were observed.

Childhood chronic physical condition, self-reported health, and life satisfaction in adolescence

The present study investigates the prevalence and type of chronic conditions at 7 years of age-with special reference to atopic conditions-and their longitudinal associations with self-reported health and life satisfaction in adolescence. The data were obtained from Northern Finland Birth Cohort 1986 (NFBC 1986), which is a longitudinal 1-year birth cohort from an unselected, regionally defined population (n = 9,432). The present study investigated a sample of 8,036 children with data of chronic conditions at 7 years of age and a sample of 6,680 children with data of chronic conditions at 16 years of age. According to parents' report the prevalence of CC at 7 years of age was 14.8 % among boys and 13.2 % among girls, these figures being at 16 years of age 20.7 and 19.4 %, respectively. Atopic conditions were the most common chronic conditions at 7 years of age (12.7 % vs. other chronic conditions 4.7 %). Childhood chronic condition was associated with subsequent self-reported health in adolescence, but not with subsequent self-reported life satisfaction. Chronic condition at 7 years of age increased the risk of reporting health as "poor" even if the chronic condition was no longer prevalent at 16 years of age. Atopic conditions seemed to be linked with self-reported poor/moderate health more often than other chronic conditions among girls. Conclusion Childhood chronic conditions seem to affect adolescent's subjective health, but fortunately, they do not affect adolescents' subjective well-being to such an extent that it could lower their life satisfaction.

Pediatric Asthma Quality of Life Questionnaire (PAQLQ): validation among asthmatic children in Thailand

Quality of life (QoL) is an important consideration among asthma sufferers. The Pediatric Asthma Quality of Life Questionnaire (PAQLQ) is one of the most widely used instruments for measuring health-related QoL in children with asthma. The standardized version of PAQLQ contains 23 questions in three domains, i.e., activity limitation, symptoms and emotional function. The objective of this study was to validate the Thai-translated version of the PAQLQ. The study design consisted of a five-week single cohort study. Patients recorded symptoms, and peak expiratory flow rate (PEFR) each morning and evening during the first and fifth week of the study in asthma diary. At each clinic visit, a trained-interviewer administered the PAQLQ and performed spirometric measurements. Fifty-one children, ages between 7 and 17 yr participated in the study. Scores from the asthma diary were used to classify patients into stable vs. unstable groups. The construct validity of the questionnaire was confirmed in both cross-sectional and longitudinal studies by demonstrating correlations between various PAQLQ domains with clinical asthma parameters (asthma diary, beta-agonist use and PEFR). There was high internal consistency for scores of the three domains (Cronbach's alpha-coefficient = 0.83-0.95). For those with stable asthma, the reliability of PAQLQ was good for the rating scale (intra-class correlation coefficient--ICC = 0.84) and for total score (alpha = 0.97) indicating high reproducibility of the PAQLQ. The significant difference of changes QoL scores between stable and unstable groups was observed in all domains. We conclude that the Thai version of PAQLQ is valid and reliable for implementing in Thai children with asthma.

Effect of progressive muscle relaxation in adolescent female bronchial asthma patients: a randomized, double-blind, controlled study

OBJECTIVE

The aim of this study is to examine the efficacy of progressive muscle relaxation (PMR) on change in blood pressure, lung parameters and heart rate in female adolescent asthmatics.

METHOD

In a prospective, randomized, double-blind, controlled study, adolescent female asthmatics (n=31) were tested to find out how the systolic blood pressure (SBP), forced expiratory volume in the first second (FEV(1)), peak expiratory flow (PEF) and heart rate change after PMR. The control group (CG; n=30) received a placebo intervention.

RESULTS

A significant reduction in SBP and a significant increase in the FEV(1) and PEF were observed after PMR. The heart rate showed a significant increase in the coefficient of variation (CV), root-mean-square of successive differences (RMSSD) and at the high frequency (HF) range, in addition to a significant reduction at the low and middle frequency (LF and MF, respectively) ranges.

CONCLUSION

PMR appears to be effective in improvement of blood pressure, lung parameter and heart rate in adolescent female asthmatics.

Family therapy for chronic asthma in children

BACKGROUND

Psychosocial and emotional factors are important in childhood asthma. Nevertheless, drug therapy alone continues to be the main treatment. Treatment programmes that include behavioural or psychological interventions have been developed to improve disturbed family relations in the families of children with severe asthma. These approaches have been extended to examine the efficacy of family therapy to treat childhood asthma in a wider group of patients. This review systematically examines these studies.

OBJECTIVES

Recognition that asthma can be associated with emotional disturbances has led to the investigation of the role of family therapy in reducing the symptoms and impact of asthma in children. The objective of this review was to assess the effects of family therapy as an adjunct to medication for the treatment of asthma in children.

SEARCH STRATEGY

We searched the Cochrane Airways Group trials register, Psychlit and Psychinfo. Searches are current as of January 2005.

SELECTION CRITERIA

Randomised trials comparing children undergoing systematic therapy focusing on the family in conjunction with asthma medication, with children taking asthma medication only.

DATA COLLECTION AND ANALYSIS

Two reviewers assessed the studies for inclusion in the review.

MAIN RESULTS

Two trials with a total of 55 children were included. It was not possible to combine the findings of these two studies because of differences in outcome measures used. In one study, gas volume, peak expiratory flow rate and daytime wheeze showed improvement in family therapy patients compared to controls. In the other study, there was an improvement in overall clinical assessment and number of functionally impaired days in the patients receiving family therapy. There was no difference in forced expiratory volume or medication use in both studies.

AUTHORS' CONCLUSIONS

There is some indication that family therapy may be a useful adjunct to medication for children with asthma. This conclusion is limited by small study sizes and lack of standardisation in the choice of outcome measures.