Parental stress and the onset and course of childhood asthma

Frequent occurrence of respiratory symptoms in children is associated with exposure to air pollution, land use types, and parental mental health in the Greater Taipei area

Although studies have investigated the individual effects of air pollution, land use types, and parental mental health on children's respiratory health, few studies have examined the effects of these risk factors simultaneously in children aged <2 years. We investigated the effects of exposure to air pollution, land use types surrounding residences, and parental mental health on the frequent occurrence of respiratory symptoms in children aged <2 years in the Greater Taipei area. Participants were recruited from an ongoing Taiwanese birth cohort study. We analyzed the data of the participants who had been recruited from January 2011 to April 2014 and had responded to the follow-up questionnaires at 6, 12, and 24 months. Self-administered questionnaires were used to collect participants' sociodemographic background and health, such as respiratory symptoms, and parental mental health. Pre- and postnatal pollution levels were estimated using the spatial interpolation technique (ordinary kriging) at children's residential addresses. Land use types surrounding participants' homes were evaluated by performing buffer analysis. Multiple logistic regression analyses were conducted to examine the effects of risk factors on the frequent occurrence of child respiratory symptoms in children aged 6, 12, and 24 months. We included 228, 360, and 441 children aged 6, 12, and 24 months, respectively. Our results indicated that postnatal exposure to PM_2.5 and O₃ was positively associated with children's respiratory symptoms. Traffic-related land-use types, sports facilities, and commercial land surrounding homes exerted adverse effects on children's respiratory symptoms, whereas the presence of schools in the neighborhood was beneficial. Parental mental health was also associated with children's respiratory symptoms. Postnatal exposure to air pollution and land use types surrounding residences were associated with respiratory health in children aged <2 years. The residential environment is a critical factor affecting children's respiratory health of children aged <2 years.

Indoor Environmental Factors May Modify the Response to Mouse Allergen Reduction Among Mouse-Sensitized and Exposed Children with Persistent Asthma

BACKGROUND

Whether concomitant home exposures modify the effectiveness of mouse allergen reduction among mouse-sensitized children with asthma is unknown.

OBJECTIVE

To determine whether a lower baseline home mouse allergen level, lower particulate matter 10 μ or less (PM₁₀), and the absence of sensitization and exposure to other indoor allergens are associated with greater improvements in asthma associated with mouse allergen reduction.

METHODS

A secondary analysis of a randomized clinical trial of a home mouse allergen intervention was performed to examine the effect of 3 indoor factors on the relationship between mouse allergen reduction and a range of asthma outcomes.

RESULTS

Participants (N = 297) were predominantly minority (78% African American, 22% Hispanic) and publicly insured (88%). Higher baseline mouse allergen levels were associated with a greater response to mouse allergen reduction for several symptom and exacerbation outcomes. Lower indoor PM₁₀ levels were associated with a greater response to mouse allergen reduction for several symptom outcomes, but not exacerbation outcomes. Overall, sensitization and exposure to other indoor allergens did not appear to modify the effect of mouse allergen reduction.

CONCLUSIONS

In this population of predominantly low-income children with persistent asthma and mouse sensitization, mouse allergen reduction was associated with improvements in asthma, especially among those with high baseline mouse allergen exposure. Lower indoor PM₁₀ was associated with greater improvements in asthma symptoms.

Parents' Acceptance of Learning about Mindfulness for Managing Pediatric Asthma

Background: Emerging research suggests mindfulness may reduce stress and asthma symptoms in children, yet there is a gap in understanding parental views towards learning about mindfulness. Objective: This study aimed to compare the perceived acceptance to learn about mindfulness among parents of children with and without asthma, and to understand differences across income levels. Methods: This was a national, cross-sectional, online survey of parents of children 0–18 years. Acceptance was measured with questions on whether parents believe mindfulness could be beneficial while parenting, and if they would be willing to learn about mindfulness. Comparisons of mindfulness acceptance between income level were conducted using chi-square and Fisher’s exact test. Results: Parents of children with asthma were more likely to be interested in learning about mindfulness from their health care provider compared to those without asthma (46% vs. 38%, p < 0.0001). At all income levels examined in the study, parents (63–75%) of children with asthma indicated that they agreed or strongly agreed that mindfulness can be beneficial when parenting. Conclusion: Findings suggest an opportunity to incorporate mindfulness teaching into asthma care for pediatric patients of all income levels.

A Qualitative Study on Family Role in the Care and Prevention of Acute Respiratory Infection Among Children in Primary Health Care

Background. Acute Respiratory Infection (ARI) is a common reason that parents seek help to primary health care. In 2016, almost 65% (64.4%) pneumonia and less than 36% (35.6%) non-pneumonia cases were found among the children in Malang. Members of families have important roles to play in individual's health, especially the children. The aim of this study was to explore the roles of family members in the care and prevention of children with ARI. Method. This was a qualitative study, with a phenomenological approach involving 12 informants. An in-depth interview was conducted on each informant having children with recurrent ARI during a space of 3 months in the primary health care. Information collected from the interviews were transcribed and analyzed into different themes. Results. The 4 themes identified include ARI in children, parent roles, influences of family members, and family problems. Different styles of parenting were established between the fathers and mothers also between the mothers and grandmothers on preventing ARI. The behavior of other family members impact both on the risk and prevention of ARI. Some of the identified problems capable of affecting children's health include inability to control the children, unstable income and the stressed condition of most mothers. Conclusion. Behavior of family members impacts on the prevention of ARI among the children. Problems within the family could affect the mothers' or caregivers' psychology, which might in turn impact on the care given to the children infected with ARI or in preventing it.

Understanding the dynamics of asthma symptoms between childhood and adolescence using latent transition analysis

OBJECTIVES

Asthma patterns in childhood are important predictors of unwanted outcomes in adolescence. We aimed to define asthma phenotypes in childhood and adolescence and evaluate the transitions between these phenotypes and factors potentially associated with the transitions.

METHODS

Baseline (1445 children), first round (1363 children/early adolescents) and second round (1206 adolescents) data from the SCAALA Project in Salvador, Brazil, were used. Phenotypes were defined by latent class analysis at three time points. Transitions between phenotypes were described and the effects of factors associated with transition probabilities estimated using latent transition analysis.

RESULTS

The "asymptomatic" and "symptomatic" phenotypes were identified. Approximately 5-6% of asymptomatic children in childhood/later childhood and early adolescence became symptomatic later in time. Maternal common mental disorders were identified as important risk factor for unhealthy states.

CONCLUSIONS

Asthma manifestations are characterized by frequent movements, especially between childhood and adolescence. Our study, by simultaneously defining disease subtypes, and examining the transitions and their potential predictors, highlights the importance of longitudinal studies to advance the understanding of the effects of social, environmental and biological mechanisms underlying asthma trajectories over time.

Effects of gut microbiome and environment on the development of eczema in Chinese infants

BACKGROUND

Eczema is a relapsing and persistent inflammatory skin disease affecting about one-fifth of children worldwide. As in other developed countries, the prevalence of this chronic disease in Hong Kong is approximately 30%. Moreover, the number of local cases reported has been on a rising trend since 1995. Eczema frequently starts in early infancy. A total of 45% of all cases begin within the first six months of life, 60% during the first year and 85% before the age of 5. The pathophysiology of eczema is multi-factorial and is a complex inter-relationship between skin barrier, genetic predisposition, immunologic development, microbiome, environment, nutrition, and pharmacological and psychological factors.

OBJECTIVE

To characterize the longitudinal changes of gut microbial profile in early childhood and to examine the association between gut microbiome diversity, environmental factors and the development of eczema in early childhood.

METHOD

We will conduct a longitudinal cohort study that follows 1250 Hong Kong Chinese infants for 2 years and assess the gut microbiome and other potential environmental factors in the aetiology of eczema. Parents will be asked to provide demographic data, their infant birth data, allergy condition, diet, environmental conditions as well as the data on maternal stress. Stool specimen will be collected for gut microbiome diversity analysis. We will examine newborn infants at enrollment, at 4 months, 1 year and 2 years after birth.

EXPECTED RESULTS

This study will evaluate the association between gut microbiome, environmental factors and the development of eczema in Chinese infants. Findings from this study may be used to develop a predictive path model to guide effective health promotion, disease prevention and management.

Maternal history of asthma modifies the risk of childhood persistent asthma associated with maternal age at birth: Results from a large prospective cohort in Canada

BACKGROUND

Asthma is a prevalent disease that affects many Canadians. Persistent asthma can affect quality of life, and has multiple health implications. Maternal age at birth has been associated with many adverse health outcomes in children. Conflicting study results exist regarding maternal age at birth and childhood asthma. The association between maternal age at birth and persistent asthma in children is still unknown.

OBJECTIVE

To investigate the relationship between maternal age at birth and persistent asthma in children at ten years of age.

METHODS

This is a prospective cohort study including all children aged 0-2 years who took part in the first cycle of the National Longitudinal Survey of Children and Youths (NLSCY) and were followed every two years until eight to ten years of age in Cycle 5. An interaction term between maternal age at birth and maternal asthma history was introduced in a multivariate model to examine modification effects of maternal asthma history on the association.

RESULTS

Multivariate logistic regression demonstrated that older maternal age at birth was significantly associated with an increased risk of childhood persistent asthma in mothers with a history of asthma (OR = 1.20, 95% CI: 1.04-1.40, p = .016). No relationship was found in mothers without a history of asthma.

CONCLUSION

Maternal history of asthma has an impact on the association between maternal age at birth and childhood persistent asthma in children by age ten. The finding may help explain the inconsistent results in the literature regarding the risk of asthma associated with maternal age at birth.

Stress reduction intervention with mothers of children/adolescents with asthma: a randomized controlled study in Brazil

Brazil has a high prevalence of pediatric asthma, which can be a stressor to parents/caretakers. Researchers aimed to assesses the efficacy of a stress reduction intervention for mothers of children/adolescents with asthma through a randomized controlled study. Stress, anxiety, and depression were evaluated in three moments. The intervention group (n = 20), entailed 5-weekly sessions; the control group (n =34) had waiting list format. There was a significant decrease in stress, anxiety, and depression in the intervention group. This study indicates that the intervention directed to mothers of children/adolescents with asthma was efficient not only in reducing stress but also anxiety and depression reduction.

Validity and reliability of the Beck Depression Inventory II (BDI-II) in family caregivers of children with chronic diseases

BACKGROUND

Information on the psychometric properties of the Beck Depression Inventory II (BDI-II) in family caregivers of children with chronic diseases is currently unavailable, indicating a significant gap in the literature. Therefore, we investigated 1) which of the five evaluated measurement models had the best fit, 2) the scale's reliability, and 3) the scale's convergent validity.

METHODS

In 2018, a cross-sectional ex post facto study with non-probability convenience sampling was conducted in 446 family caregivers of children with chronic diseases at the National Institute of Health in Mexico City; the family caregivers responded to the BDI-II and a battery of instruments measuring anxiety, caregiver burden, parental stress, well-being, and quality of life. A confirmatory factor analysis was conducted to determine the fit of the five models. Cronbach's alpha and composite reliability were calculated to assess the scale's reliability, and Spearman´s rank correlation was used to investigate the scale's convergent validity.

RESULTS

This study provided evidence that the two-factor somatic-affective and cognitive model had the best fit. The BDI-II demonstrated adequate reliability and evidence of convergent validity, as the BDI-II factors were positively correlated with anxiety, caregiver burden, and parental stress and negatively correlated with well-being and quality of life.

CONCLUSIONS

The findings reveal that the BDI-II is a valid, reliable, and culturally relevant instrument to measure depression in family caregivers of children with chronic diseases.

When Control Exacerbates Distress: A Qualitative Study Exploring the Experiences of Hong Kong Chinese Parents in Caring for a Child with Asthma

Background: Many parents have difficulty managing childhood asthma. In Hong Kong (HK), while medication is the primary form of treatment, traditional Chinese medicine is another favored option. In addition, HK follows a dual-track healthcare system, which may pose unique experiences for Chinese parents in managing childhood asthma. This qualitative descriptive study aimed to explore the experiences of HK Chinese parents in caring for their children with asthma. Methods: Fourteen HK Chinese mothers of children (aged 3⁻10) suffering from asthma were purposively sampled to participate in individual, semi-structured interviews. A realist approach following conventional content analysis was used to interpret the interviews. Results: The mothers expressed feelings of uncertainty, fear of asthma crises, and searched for ways to cope. As long as their child&rsquo;s asthma symptoms recurred, the mothers&rsquo; distress continued. Their distress was sometimes exacerbated by self-doubt and worries over whether they would receive adequate support from their family and healthcare professionals. Conclusions: Helping parents to understand their limits may help them be more open to varied aspects of their caregiving experiences, and thus to cope better. Psychological interventions together with traditional educational training may help to alleviate the psychological difficulties of parents.

Maternal age and asthma in Latino populations

BACKGROUND

Younger maternal age at birth is associated with increased risk of asthma in offspring in European descent populations, but has not been studied in Latino populations.

OBJECTIVES

We sought to examine the relationship between maternal age at birth and prevalence of asthma in a nationwide study of Latino children.

METHODS

We included 3473 Latino children aged 8-21 years (1696 subjects with physician-diagnosed asthma and 1777 healthy controls) from five US centres and Puerto Rico recruited from July 2008 through November 2011. We used multiple logistic regression models to examine the effect of maternal age at birth on asthma in offspring overall and in analyses stratified by ethnic subgroup (Mexican American, Puerto Rican and other Latino). Secondary analyses evaluated the effects of siblings, acculturation and income on this relationship.

RESULTS

Maternal age < 20 years was significantly associated with decreased odds of asthma in offspring, independent of other risk factors (OR = 0.73, 95% CI: 0.57-0.93). In subgroup analyses, the protective effect of younger maternal age was observed only in Mexican Americans (OR = 0.53, 95% CI: 0.36, 0.79). In Puerto Ricans, older maternal age was associated with decreased odds of asthma (OR = 0.65, 95% CI: 0.44-0.97). In further stratified models, the protective effect of younger maternal age in Mexican Americans was seen only in children without older siblings (OR = 0.44, 95% CI: 0.23-0.81).

CONCLUSION AND CLINICAL RELEVANCE

In contrast to European descent populations, younger maternal age was associated with decreased odds of asthma in offspring in Mexican American women. Asthma is common in urban minority populations but the factors underlying the varying prevalence among different Latino ethnicities in the United States is not well understood. Maternal age represents one factor that may help to explain this variability.

Evaluating the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma: A randomized control trial

BACKGROUND

Empowerment can be an effective strategy for changing an individual's health behaviours. However, how to empower whole families to manage their children's asthma is a challenge that requires innovative nursing intervention based on family-centred care.

AIMS

To evaluate the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma compared to those receiving traditional self-management only.

DESIGN

A randomized control trial.

METHODS

Sixty-five families were recruited from one asthma clinic in a medical centre in Taiwan. After random assignment, 34 families in the experimental group received the family empowerment program consisting of four counselling dialogues with the child and its family. We empowered the family caregiver's ability to manage their child's asthma problems through finding the problems in the family, discovery and discussion about the way to solve problems, and enabling the family's cooperation and asthma management. The other 31 families received the traditional care in asthma clinics. The Parental Stress Index and Family Environment Scale of family caregivers, and pulmonary function, and asthma signs of children with asthma were collected at pre-test, 3-month post-test, and one-year follow-up. We utilized the linear mixed model in SPSS (18.0) to analyze the effects between groups, across time, and the interaction between group and time.

RESULTS

The family empowerment program decreased parental stress (F=13.993, p<.0001) and increased family function (cohesion, expression, conflict solving, and independence) (F=19.848, p<.0001). Children in the experimental group had better pulmonary expiratory flow (PEF) (F=26.483, p<.0001) and forced expiratory volume in first second (FEV1) (F=7.381, p=.001) than children in the comparison group; however, no significant change in forced expiratory volume in first second (FEV1)/forced vital capacity (FVC) was found between the two groups. Sleep problems did not show significant changes but cough, wheezing, and dyspnoea were significantly reduced by family caregiver's observations.

CONCLUSION

We empowered families by listening, dialogues, reflection, and taking action based on Freire's empowerment theory. Nurses could initiate the families' life changes and assist children to solve the problems by themselves, which could yield positive health outcomes.

Prenatal maternal distress affects atopic dermatitis in offspring mediated by oxidative stress

BACKGROUND

Recent evidence suggests that prenatal maternal distress increases the risk of allergic diseases in offspring. However, the effect of prenatal maternal depression and anxiety on atopic dermatitis (AD) risk remains poorly understood.

OBJECTIVE

We investigated whether prenatal maternal distress is associated with AD risk in offspring and whether the mechanism is mediated by reactive oxygen species.

METHODS

Two general population-based birth cohorts formed the study. One cohort (Cohort for Childhood Origin of Asthma and Allergic Diseases [COCOA]) consisted of 973 mother-baby dyads, and the other (Panel Study on Korean Children [PSKC]) consisted of 1531 mother-baby dyads. The association between prenatal distress and AD was assessed by using Cox proportional hazards and logistic regression models. In COCOA placental 11β-hydroxysteroid dehydrogenase type 2 and glutathione levels and serum IgE levels in 1-year-old children were measured.

RESULTS

In COCOA and PSKC AD occurred in 30.6% (lifetime prevalence) and 11.6% (1 year prevalence) of offspring, respectively. Prenatal maternal distress increased the risk of AD in offspring, both in COCOA (hazard ratio for depression, 1.31 [95% CI, 1.02-1.69]; hazard ratio for anxiety, 1.41 [95% CI, 1.06-1.89]) and PSKC (odds ratio for distress, 1.85 [95% CI, 1.06-3.25]). In COCOA both prenatal maternal depression and anxiety scores were positively related to the predicted probability of AD (P < .001 in both). Prenatal distress decreased placental glutathione to glutathione disulfide ratios (P = .037) and, especially in those who later had AD, decreased placental 11β-hydroxysteroid dehydrogenase type 2 levels (P = .010) and increased IgE levels at 1 year of age (P = .005).

CONCLUSION

Prenatal maternal depression and anxiety promote risk of AD in offspring. Maternal distress increases the predicted probability of AD. The mechanism might involve chronic stress, abnormal steroid levels, and reactive oxygen species.