Perceived control and immune and pulmonary outcomes in children with asthma

Flipping Patients and Frames: The Patient in Relational Medicine

Medicine has evolved in two opposite directions. Evidence-based medicine focuses more on laboratory and computer data than on the patient. Yet experimental data also provide growing evidence for the importance of the patient's social-psychological "demand" side of medicine, to complement the doctor's bio-cognitive "supply" side. The patient's mindset has major diagnostic and therapeutic effects. The patient's experience is shaped by perceptions of four dimensions: meaning, agency, self-image, and temporal focus. The patient's perceptions are linked in part to the therapeutic context, through the interaction between doctor and patient. In that proximal setting, the dimensions can be reshaped, for better and worse. These dynamics point to the inherently interactional nature of medicine and to the significant role of medical social sciences in the therapeutic context.

The Paradoxical Role of Perceived Control in Late Life Health Behavior

Research has established the health benefits of psychological factors, including the way individuals appraise outcomes. Although many studies confirm that appraising outcomes as controllable is adaptive for health, a paradoxical possibility is largely ignored: Perceived control may be detrimental under some conditions. Our premise was that appraising health as controllable but at the same time ascribing little value to it might signal a dysfunctional psychological mindset that fosters a mistaken sense of invincibility. During face-to-face interviews with a representative sample of older adults (age range = 72–99), we identified individuals with such a potentially maladaptive “invincible” mindset (high perceived control and low health value) and compared them to their counterparts on several outcomes. The findings were consistent with our hypotheses. The invincibles denied future risks, they lacked the activating emotion of fear, and they visited their physicians less often over a subsequent five-year period. Moreover, in contrast to their counterparts, the invincibles did not appear strategic in their approach to seeking care: Even poor health did not prompt them to seek the counsel of a physician. The recognition that psychological appraisals are modifiable highlights the promise of remedial methods to alter maladaptive mindsets, potentially improving quality of life.

Sense of Control in Late Life

Believing that one can influence outcomes presumably fosters a psychological sense of control. So too, however, might adaptive ways of thinking known as secondary control (SC) processes that operate when outcomes are believed to be unattainable. Using a 5-year prospective design and a representative sample of adults (ages 79-98), folk beliefs (e.g., “negative experiences can be a blessing in disguise”) were used to assess SC processes. The authors expected SC Folk Beliefs would predict Sense of Control (Hypothesis 1) which, in turn, would predict self-rated health, hospital admissions, and survival (Hypothesis 2). An indirect relationship was hypothesized: SC Folk Beliefs were expected to predict outcomes through the Sense of Control (Hypothesis 3). Support was found for all hypotheses providing insights into the antecedents and consequences of a sense of control and about how SC beliefs and a sense of control function in the context of health.

Genetic biomarkers of health-related quality of life in pediatric asthma

OBJECTIVES

To determine the relationship between single nucleotide polymorphisms in candidate genes associated with multiple asthma phenotypes and health-related quality of life (HRQOL).

STUDY DESIGN

A cross-sectional study was conducted at a pediatric hospital in 275 school-aged children diagnosed with asthma and their caregivers. Genomic DNA was obtained from children, and caregivers completed a measure of their child's HRQOL. Analysis of variance was used to investigate the association between single nucleotide polymorphisms and HRQOL.

RESULTS

Children homozygous for the major variant at IL-4RA rs 1805010 had significantly better HRQOL than their counterparts. Significant associations with pulmonary function were not observed.

CONCLUSIONS

Genes associated with asthma phenotype can be associated with HRQOL at least partly independent of pulmonary function.

How stress and anxiety can alter immediate and late phase skin test responses in allergic rhinitis

Allergic rhinitis (AR) is the fifth most common chronic disease, and the association between allergic disorders and anxiety is well-documented. To investigate how anxiety and stressors modulate skin prick test (SPT) responses and associated inflammatory responses, 28 men and women with AR were selected by clinical history and skin test responses. The participants were admitted twice to a hospital research unit for 4h in a crossover trial. Changes in SPT wheals were assessed before and after a standardized laboratory speech stressor, as well as again the following morning; skin responses assessed twice during a lab session without a stressor and again the following morning served as the contrast condition. Anxiety heightened the magnitude of allergen-induced wheals following the stressor. As anxiety increased, SPT wheal diameters increased after the stressor, compared to a slight decrease following the control task. Anxiety also substantially enhanced the effects of stress on late phase responses: even skin tests performed the day after the stressor reflected the continuing impact of the speech stressor among the more anxious participants. Greater anxiety was associated with more IL-6 production by Con A-stimulated leukocytes following the stressor compared to the control visit. The data suggest that stress and anxiety can enhance and prolong AR symptoms.

The Control Attitudes Scale-Revised: psychometric evaluation in three groups of patients with cardiac illness

BACKGROUND

Perceived control is a construct with important theoretical and clinical implications for healthcare providers, yet practical application of the construct in research and clinical practice awaits development of an easily administered instrument to measure perceived control with evidence of reliability and validity.

OBJECTIVE

To test the psychometric properties of the Control Attitudes Scale-Revised (CAS-R) using a sample of 3,396 individuals with coronary heart disease, 513 patients with acute myocardial infarction, and 146 patients with heart failure.

METHODS

Analyses were done separately in each patient group. Reliability was assessed using Cronbach's alpha to determine internal consistency, and item homogeneity was assessed using item-total and interitem correlations. Validity was examined using principal component analysis and testing hypotheses about known associations.

RESULTS

Cronbach's alpha values for the CAS-R in patients with coronary heart disease, acute myocardial infarction, and heart failure were all greater than .70. Item-total and interitem correlation coefficients for all items were acceptable in the groups. In factor analyses, the same single factor was extracted in all groups, and all items were loaded moderately or strongly to the factor in each group. As hypothesized in the final construct validity test, in all groups, patients with higher levels of perceived control had less depression and less anxiety compared with those of patients who had lower levels of perceived control.

CONCLUSION

This study provides evidence of the reliability and validity of the 8-item CAS-R as a measure of perceived control in patients with cardiac illness and provides important insight into a key patient construct.

Review of the literature: integrating psychoneuroimmunology into pediatric chronic illness interventions

OBJECTIVE

Provide an orientation to psychoneuroimmunology, a rationale for including assessments of immune function in intervention studies of pediatric chronic illness, review the current literature, and provide recommendations for future research.

METHODS

Using electronic searches and previous reviews, selected and reviewed published studies in which immunological changes related to psychological interventions were assessed in pediatric samples.

RESULTS

Eight studies were identified and included in the review. These utilized a range of interventions (e.g., disclosure and hypnosis) and included a variety of pediatric samples (e.g., those with asthma, HIV infection, or lupus).

CONCLUSIONS

Results suggest that psychological intervention can influence immune function in pediatric samples. Recommendations for advancing our knowledge by studying populations for whom the immune system plays an active role in disease pathophysiology, measuring disease-relevant immune mediators, studying pediatric patients under times of stress, and focusing on interventions aimed at altering the stress system are provided.

Hyperventilation symptoms are linked to a lower perceived health in asthma patients

BACKGROUND

Hyperventilation symptoms are among the sensations asthma patients tend to report during exacerbations of their disease. However, little is known about their importance for the patients' perceived well-being.

METHOD

We therefore studied the association of reported hyperventilation symptoms (Asthma Symptom Checklist) with perceived physical and mental health (36-item Short-form Health Survey) in a sample of primary care asthma patients (N = 190). We also studied the potential role of perceived control of asthma (Perceived Control of Asthma Questionnaire) in mediating any association between these variables.

RESULTS

In hierarchical multiple regression analyses controlling for demographics, asthma severity, and other asthma symptoms (obstruction, congestion, panic-fear, irritation, and fatigue), hyperventilation symptoms were significantly associated with both physical and mental health status. This association was partially mediated by perceived control of asthma.

CONCLUSION

It is possible that hypocapnia creates symptoms that asthma patients cannot control by using their antiasthmatic medication, thus compromising their perceived control over the management of their asthma, and consequently their perceived health. Behavioral interventions should address the problem of hyperventilation in asthma.

Impact of socioeconomic status on physiological health in adolescents: an experimental manipulation of psychosocial factors

OBJECTIVE

To examine the effects of a brief psychosocial manipulation on physiological responses to laboratory stress in lower and higher socioeconomic status (SES) adolescents.

METHODS

A total of 115 adolescents participated in two acute laboratory stress tasks: one with psychosocial intervention and one with no intervention. In the intervention condition, half of the adolescents were given control over the stressor parameters; the other half received social informational resources (hints provided by another person) for dealing with the stressor. Physiological reactivity was monitored.

RESULTS

Lower SES adolescents exhibited less physiological reactivity when provided with intervention compared with no intervention. Within the lower SES group, the resource condition reduced physiological reactivity more than the control condition did. Higher SES adolescents did not respond physiologically to intervention.

CONCLUSIONS

This study provides a preliminary illustration of an experimental laboratory approach to studying SES-health relationships and suggests that providing informational support during a stressor may have beneficial implications for the physiological health of lower SES adolescents.