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.
asthma; depression; pathophysiology; treatment
In children, the prevalence’s of both obesity and asthma are disconcertingly high. Asthmatic children with obesity are characterised by less asthma control and a high need for asthma medication. As the obese asthmatic child is becoming more common in the clinical setting and the disease burden of the asthma-obesity phenotype is high, there is an increasing need for effective treatment in these children. In adults, weight reduction resulted in improved lung function, better asthma control and less need for asthma medication. In children this is hardly studied. The Mikado study aims to evaluate the effectiveness of a long term multifactorial weight reduction intervention, on asthma characteristics in children with asthma and a high body weight.
The Mikado study is a two-armed, randomised controlled trial. In total, 104 participants will be recruited via online questionnaires, pulmonary paediatricians, the youth department of the Municipal Health Services and cohorts of existing studies. All participants will be aged 6–16 years, will have current asthma, a Body Mass Index in the overweight or obesity range, and no serious comorbidities (such as diabetes, heart diseases). Participants in the intervention arm will receive a multifactorial intervention of 18 months consisting of sessions concerning sports, parental involvement, individual counselling and lifestyle advices including dietary advices and cognitive behavioural therapy. The control group will receive usual care. The primary outcome variables will include Forced Expiratory Volume in one second and Body Mass Index - Standard Deviation Score. Secondary outcomes will include other lung function parameters (including dynamic and static lung function parameters), asthma control, asthma-specific quality of life, use of asthma medication and markers of systemic inflammation and airway inflammation.
In this randomised controlled trial we will study the potential of a multifactorial weight reduction intervention to improve asthma-related outcome measures in asthmatic children with overweight. Moreover, it will provide information about the underlying mechanisms in the relationship between asthma and a high body weight in children. These findings can contribute to optimal management programs and better clinical guidelines for children with asthma and overweight.
Asthmatic; BMI; Child; Obesity; Paediatric; Weight loss
Subjective and objective sleep disturbance was studied in
children with nocturnal asthma. Relations between such disturbance and
daytime psychological function were also explored, including possible
changes in learning and behaviour associated with improvements in
nocturnal asthma and sleep. Assessments included home polysomnography, parental questionnaires concerning sleep disturbance, behaviour, and
mood and cognitive testing. Compared with matched controls, children
with asthma had significantly more disturbed sleep, tended to have more
psychological problems, and they performed less well on some tests of
memory and concentration. In general, improvement of nocturnal asthma
symptoms by changes in treatment was followed by improvement in sleep
and psychological function in subsequent weeks. The effects of asthma
on sleep and the possible psychological consequences are important
aspects of overall care.
Acute asthma attacks remain a frequent cause of emergency department (ED) visits and hospital admission. Many factors encourage patients to seek asthma treatment at the emergency department. These factors may be related to the patient himself or to a health system that hinders asthma control. The aim of this study was to identify the main factors that lead to the frequent admission of asthmatic patients to the ED.
A cross-sectional survey of all the patients who visited the emergency room with bronchial asthma attacks over a 9-month period was undertaken at two major academic hospitals. The following data were collected: demographic data, asthma control in the preceding month, where and by whom the patients were treated, whether the patient received education about asthma or its medication and the patients’ reasons for visiting the ED.
Four hundred fifty (N = 450) patients were recruited, 39.1% of whom were males with a mean age of 42.3 ± 16.7. The mean duration of asthma was 155.90 ± 127.13 weeks. Approximately half of the patients did not receive any information about bronchial asthma as a disease, and 40.7% did not receive any education regarding how to use asthma medication. Asthma was not controlled or partially controlled in the majority (97.7%) of the patients preceding the admission to ED. The majority of the patients visited the ED to receive a bronchodilator by nebuliser (86.7%) and to obtain oxygen (75.1%). Moreover, 20.9% of the patients believed that the ED managed them faster than the clinic, and 21.1% claimed that their symptoms were severe enough that they could not wait for a clinic visit. No education about asthma and uncontrolled asthma are the major factors leading to frequent ED visits (three or more visits/year), p-value = 0.0145 and p-value = 0.0003, respectively. Asthma control also exhibited a significant relationship with inhaled corticosteroid ICS use (p-value =0.0401) and education about asthma (p-value =0.0117).
This study demonstrates that many avoidable risk factors lead to uncontrolled asthma and frequent ED visits.
Asthma; Control; Inhaled cortisone; Emergency department
Bronchial asthma is a clinical syndrome characterized by proximal dysphasia and wheeze due to increased resistance to the flow of air through the narrowed bronchi. Asthma has become the most common chronic disease in the world and epidemiological studies suggest that its prevalence, severity and mortality are rising at a time when mortality from other common treatable conditions is falling. The reasons for the above statistics are environmental factors such as increased exposure to allergens and atmospheric pollutants. Antiasthmatic treatment includes corticosteroids, which are very effective in the treatment of asthma. But corticosteroids are costly and if given systemically, have many severe adverse effects. Hence, the present research work involves the use of a herbal compound formulation Pentapala -04 prepared from five medicinal plants namely, Adhatoda vasica Need, Ocimum sanctum Linn, Coleus aromaticus Benth, Glycyrrhiza glabra Linn and Alpiania galangal Sw.
The effect of “Pentapala-04” on ova albumin and aluminium hydroxide induced lung damage in albino wistar rats was investigated. The rats were divided into three groups of four animals each. Group I, II and III serves as control, toxic and post treatment group respectively. Our results showed that their was increased level of lipid peroxidation and secreased level of antioxidants in toxic group animals. But the levels of antioxidant enzymes were restored in post-treated groups of animals, which might be due to the ability of “ability of “Pentapala-04 to scavenge the reactive oxygen species.
Ova albumin; alumininum hydroxide; Pentapala-04
Bronchial asthma is a common and life threatening problem affecting school children and adolescents. The flare-up of asthma may lead to impaired daily function and absence from school. These complications of bronchial asthma could be influenced by poor knowledge, poor use of inhaler technique, non-compliance and negative attitude toward the illness and drugs. The study is designed to assess the asthma knowledge of school students suffering form asthma and identify the resources of the knowledge.
All diagnosed asthma students (131 cases) selected from school health register grade 7-12 was included in this study. The self administrated questionnaire was distributed among them. It was designed to collect information of the students about epidemiology of asthma, source of their information and effect of the disease on their school attendance. Special knowledge score was constructed to measure the level of the students’ knowledge.
The study showed that from 131 diagnosed asthma cases 90% (118) aware about their diagnosis. Medical and paramedical personnel were found to be the source of knowledge for 49.4% (65) of the students, while teachers were mentioned by only 9.2% (12) of the students as their source of information. Regarding the effect of asthma on school absenteeism, 66% (87) of school students may miss their school due asthma attack.
Health education about bronchial asthma is a need for school students. This require inter-disciplinary approach from various organization particularly the schools. It is vital that school teachers’ knowledge be improved and continuously updated that it can reflect in students’ knowledge and attitudes too.
Bronchial Asthma; School students; Health education; Asthma knowledge
When symptoms are poorly controlled, patients with bronchial asthma may show a symptom gap: a cognitive divergence between the true severity of symptoms and the severity evaluated by the patients themselves. The aim of this study was to determine which factors (emotional cognition of the self and others) are associated with this symptom gap.
Forty-two patients with bronchial asthma, who were found with the Comprehensive Asthma Inventory (a bronchial asthma symptom questionnaire) to have psychosocial factors associated with a deep concern about the onset of asthma attacks, were studied by means of validated scales for alexithymia (the Toronto Alexithymia Scale-20) and for empathy (the Interpersonal Reactivity Index: IRI) and questions about how patients evaluate the severity of asthma.
Of the patients, 42.5% showed a cognitive divergence regarding asthma symptoms. The scores for “perspective taking” on the IRI were significantly higher in patients who felt symptoms were less severe than they actually than in patients who felt symptoms were more severe than they actually were. No association was found between alexithymia and the symptom gap.
The results show that empathy, the ability to understand the emotions of others, is associated with a symptom gap in patients with bronchial asthma and that high scores for “perspective taking” on the IRI may indicate problems of treatment and symptom control in asthma.
Bronchial asthma in children may be difficult to diagnose. Education of the parents regarding allergic conditions, specifically bronchial asthma, is exceedingly important in order to assure satisfactory treatment and clinical results.
Chest symptoms of unexplained origin in early life should immediately arouse suspicion of allergic disease. Other causes of asthmatic symptoms must be borne in mind and excluded before a positive diagnosis of bronchial asthma is established.
Of the many factors to be considered in investigating a child with asthma, a comprehensive history is most essential. The climate to which the patient is exposed and the psychic influences must be taken into account. Physical examination, x-ray films and laboratory procedures should be carefully executed. Skin testing, especially with food allergens, should not be relied upon to give all the information in allergic disease. Some form of diet trial, such as elimination diets, should be used if sensitivity to food is suspected.
The assessment of bronchial hyperresponsiveness (BHR) is considered essential for determining asthma diagnosis and asthma control. Recently a specific-condition questionnaire was developed on this purpose for asthma patients in primary care practice (Riemersa et al., 2009). The aim of the present study is to validate the BHR questionnaire in a Greek population.
Patients and methods
A cross-sectional study was conducted at the Asthma Outpatient clinic of the Pulmonary Department, Aristotle University of Thessaloniki, Greece. Inclusion criteria were males and females, age 14 to 75, with recent history of asthma symptoms and without any other known respiratory/systemic disease that might affect BHR. During patient assessment, translated copies of the BHR questionnaire (BHRQ) were delivered to eligible subjects who had given informed consent. The gold standard method selected to validate the BHRQ was the mannitol challenge test.
Sixty-two patients in total (21 males and 41 females) were recruited: mean age 34±14.9 years, mean total score of the questionnaire 54.39±40.88 years and mean subscores for symptoms and stimuli 28.29±19.97 and 26.10±24.07 years respectively. During mannitol challenge subjects showed a mean fall of FEV1 of 13.41±6.97% from baseline and a mean provocative dose of mannitol, PD15 of 373.11±240.92 mg. Spearman’s rank correlations among variables have shown significant positive correlations among all score variables and negative correlations among the scores and the mannitol test variables. Construct validity was assessed with principal component analysis and managed to identify one underlying factor that explains 42.4% of the variance. The reliability of the questionnaire, as estimated with Cronbach’s alpha, was 0.957, which is considered to be a very good reliability regarding the internal consistency of the questionnaire items. Receiver Operating Curve (ROC) analysis has determined a cut off value of 26 of the total score for BHR response with sensitivity of 78.6% and specificity of 55%.
It is the first time that a BHR questionnaire was validated in a Greek population and it has been shown to be a usable and valid tool for assessing BHR in primary care practice.
Background: The importance of psychosocial variables in asthma is increasingly recognised, although attempts to relate these to asthma outcomes often produce only weak relationships. This study aimed to identify whether such relationships might be obscured by the effects of recent asthma experience on psychological status.
Methods: An adult community sample of 37 patients who had suffered a recent attack of asthma and 37 with stable asthma were given measures of panic fear and control confidence. The relationship with subsequent emergency service use was examined using two way ANOVA and correlational analyses. Covariate influences (psychiatric morbidity, age, sex, treatment level, asthma duration, social status) were considered.
Results: Control confidence predicted emergency service use in different ways for recent attack and stable asthma patients. This interaction was highly significant (F(1,69) = 10.32, p<0.005) with high confidence relating to an increased risk of an attack in the recent attack group and low confidence relating to increased risk for the stable asthma group. There was also an interaction between panic fear and attack context (F(1,69) = 11.05, p<0.005) with low panic fear resulting in more attacks for recent attack cases.
Conclusions: Attack context (having a recent attack) is an important mediator of psychological status. Strong cognitive/affective responses to attacks may motivate improved self-care and this represents a window of opportunity for self-care interventions. Weak cognitive/affective responses to attacks may reflect denial and require different intervention approaches. For those with recently stable asthma the relationships are qualitatively and quantitatively different, and the implications for intervention are also discussed.
Psychosocial and other factors that may affect patient self care in acute asthma were investigated in 210 asthmatic adults recruited from general practice and hospital clinics. Interviews and self complete questionnaires were used to assess patients' management of a hypothetical slow onset and rapid onset attack of asthma, attitudes to asthma, family support, psychiatric morbidity, recent asthma morbidity, and knowledge of drug treatment. The patients with the highest morbidity from asthma delayed longest before taking appropriate action in the hypothetical acute attack. One in four patients expressed strong feelings of stigma and pessimism about being asthmatic, but attitudes were only weakly associated with behaviour. Other factors showed no significant relation to self care. The results suggest that there is no single important factor or group of factors governing patients' management of acute asthma. Health education might therefore prove more effective if it paid less attention to the possible cause or causes of poor self care and instead offered pragmatic advice on changing behaviour.
Inner city children make heavy use of accident and emergency (A&E) services for asthma. Developing strategies to reduce this requires a better understanding of the risk factors.
A case‐control study was carried out of children with asthma living in south‐east London: 1018 children who attended A&E for asthma over 1 year and 394 children who had not attended A&E for asthma over the previous year. The main risk factors were socioeconomic status, home environment, routine asthma management and parents' psychological responses to and beliefs about the treatment of asthma attacks.
A&E attendance was more common in children living in poorer households. No associations were found with home environment or with measures of routine asthma care. Children who had attended outpatients were much more likely to attend A&E (odds ratio (OR) 13.17, 95% CI 7.13 to 24.33). Other risk factors included having a parent who reported feeling alone (OR 2.58, 95% CI 1.71 to 3.87) or panic or fear (OR 2.62. 95% CI 1.75 to 3.93) when the child's asthma was worse; and parental belief that the child would be seen more quickly in A&E than at the GP surgery (OR 2.48, 95% CI 1.62 to 3.79). Parental confidence in the GP's ability to treat asthma attacks reduced the risk of attending A&E (OR 0.30, 95% CI 0.17 to 0.54).
There is no evidence that passive smoking, damp homes or poor routine asthma care explains heavy inner city use of A&E in children with asthma. Reducing A&E use is unlikely to be achieved by improving these, but identifying appropriate settings for treating children with asthma attacks and communicating these effectively may do so.
Physicians are quite often surveyed with the aim to investigate their opinions regarding provision and improvement of health care. However, in many cases response rates tend to be rather low. The aim of the study is to reflect methodological aspects regarding survey conduction and to analyse factors that cause physicians to take part in a study on delivering end-of-life care for the elderly.
N = 4,727 physicians in Lower Saxony, Germany, received a standardised questionnaire on their attitudes about end-of-life care for the elderly. Non-responders were asked to state the reasons for non-participation. Comparison of the sociodemographic characteristics between responders and non-responders, and evaluation of the reasons for non-participation were made.
The response rate to the questionnaire on end-of-life care for the elderly was 40% (n = 1,892). Of the non-responders to the questionnaire, 12.8% (n = 364) stated the reasons for non-participation. Overall, the response rate to the questionnaire varied with specialty and location of the practice: radiotherapists answered significantly more frequently than other categories of physician (e.g. general practitioners) and physicians in rural areas significantly more frequently than their colleagues in urban areas. The reasons most frequently given for non-participation were "Not concerned with the subject" and "No time".
The varying rates of response indicate that the survey was not sufficiently relevant to all groups of physicians, or that the awareness of the topic may be partly underdeveloped.
Background & objectives:
High prevalence and poor control of asthma make its management a major public health issue worldwide, especially in developing countries. Optimum review of asthma management in the community is essential to improve asthma control. This study was conducted to investigate the quality of asthma management, knowledge about asthma and quality of life of asthma patients referred to a public tertiary care chest hospital in Delhi.
Diagnosis of asthma was confirmed by symptoms and reversible spirometry in 50 referred patients on their first visit. Patients were interviewed using three questionnaires on quality of asthma management before visiting referral hospital, asthma knowledge and asthma quality of life (AQLQ). Correlation amongst quality of treatment, asthma quality of life, and asthma knowledge was also determined.
Findings revealed that only 60 per cent of patients were informed about their disease, and 10 per cent had undergone lung function tests previously. Only 44 per cent of patients were prescribed inhalers. None were provided with any educational material. Patients had poor knowledge of aetiology, pathophysiology, medication and how to assess the severity of their asthma. The mean scores in AQLQ indicated a moderate degree of impairment in quality of life.
Interpretations & conclusions:
This study provides evidence of unsatisfactory asthma management and patient-doctor interaction as patients had limited knowledge of asthma disease, its management and had poor quality of life as measured by a standardized questionnaire. Thus, there is need to implement suitable interventions to improve asthma management according to standard treatment guidelines in the community.
Asthma; asthma knowledge; asthma management; India; quality of life
Bronchial asthma is recognized as a highly prevalent health problem in the developed and developing world with significant social and economic consequences. Increased asthma severity is not only associated with enhanced recurrent hospitalization and mortality but also with higher social costs. The pathogenetic background of allergic-atopic bronchial asthma is characterized by airway inflammation with infiltration of several cells (mast cells, basophils, eosinophils, monocytes, and T-helper (Th)2 lymphocytes). However, in atopic asthma the trigger factors for acute attacks and chronic worsening of bronchial inflammation are aeroallergens released by pollens, dermatophagoides, and pets, which are able to induce an immune response by interaction with IgE antibodies. Currently anti-inflammatory treatments are effective for most asthma patients, but there are asthmatic subjects whose disease is not completely controlled by inhaled or systemic corticosteroids and who account for a significant portion of the healthcare costs of asthma. A novel therapeutic approach to asthma and other allergic respiratory diseases involves interference in the action of IgE, and this antibody has been viewed as a target for novel immunological drug development in asthma. Omalizumab is a humanized recombinant monoclonal anti-IgE antibody approved for treatment of moderate to severe IgE-mediated (allergic) asthma. This non-anaphylactogenic anti-IgE antibody inhibits IgE functions, blocking free serum IgE and inhibiting their binding to cellular receptors. By reducing serum IgE levels and IgE receptor expression on inflammatory cells in the context of allergic cascade, omalizumab represents a new class of mast cells stabilizing drugs; it is a novel approach to the treatment of atopic asthma. Omalizumab therapy is well tolerated and significantly improves symptoms and disease control, reducing asthma exacerbations and the need to use high dosage of inhaled corticosteroids. Moreover, omalizumab improves quality of life of patients with severe persistent allergic asthma which is inadequately controlled by currently available asthma medications. In conclusion omalizumab may fulfil an important need in patients with moderate to severe asthma.
airway hyper-reactivity; asthma; allergic respiratory diseases; atopic respiratory diseases; anti-IgE therapy; hypersensitivity; monoclonal anti-IgE antibody; omalizumab
There is a popular conviction that psychological disturbance is invariably a reaction to environmental events. This approach is associated with total rejection of the so-called ‘medical model’. However, allowance must be made for the fact that contemporary knowledge of psychiatric illness is well behind what is now known about general medicine, and current ideas about psychiatric aetiology may be emotionally determined to give satisfying concepts which are often almost impossible to refute.
By tracing the progress of some hypotheses in general medicine, as they developed in the past, there are similarities with some current observations about the methods of action of physical treatments in psychiatry, treatments which have been discovered empirically.
There is a widespread assumption that psychological responses relate precisely to the degree of evoking stress or the patient's personal attitudes to the stress. However, emotional responsiveness may show an intrinsic individual variation so that many patients who over-respond to stress may do so because of enhanced responsiveness rather than necessarily because psychological events have brought about a state of vulnerability.
The exclusively dynamic approach to psychiatry has been perhaps unnecessarily encouraged by naming an illness ‘endogenous depression’ which could well be a primarily physical metabolic disturbance in the central nervous system but which happens to present with prominent depression, as well as other abnormalities. The emphasis on the component of depressed mood artificially delineates the illness and tends to impede consideration of its wider implications.
Adolescents with asthma, their peers, and their teachers were studied in order to establish the level of knowledge concerning asthma and its management, their attitudes towards asthma, and the degree quality of life impairment due to asthma. A community survey was conducted among year 8 high school students (n = 4161) and their teachers (n = 1104). There was a good response rate to the questionnaires from students (93%) and teachers (61%). Twenty three per cent of students had asthma and this caused mild to moderate quality of life impairment, particularly with strenuous exercise. Asthma was provoked by passive smoke exposure in 30% of asthmatic students and up to 51% of students avoided situations because of asthma triggers. Asthma knowledge was low in teachers (mean score 14.90 out of a possible 31), students without asthma (11.25) and students with asthma (14.50). Specific knowledge on the prevention and treatment of exercise induced asthma was poor. There was a moderate degree of tolerance towards asthma among all three groups. Most considered internal locus of control as important, although students without asthma also considered chance to be a determinant of outcomes for people with asthma. Asthma is a common cause of quality of life impairment among year 8 high school students. Although specific knowledge on asthma is low, students and teachers hold favourable attitudes towards asthma. There are opportunities to intervene and improve asthma management among adolescents.
gastrointestinal abnormalities have been reported in children with
asthma, but the prevalence of gastrointestinal symptoms in these
children has not been studied.
with bronchial asthma and an age and sex matched control group were
recruited. Parents completed a questionnaire on gastrointestinal
symptoms and on asthma. Weight and height were measured; a clinical
evaluation of asthma was undertaken and skin prick tests were performed.
with asthma had a significantly greater frequency of gastrointestinal
symptoms, particularly diarrhoea, vomiting, and abdominal pain, than
did controls. Gastrointestinal symptoms were slightly more common in
children with atopic symptoms other than asthma, or with positive skin
prick tests to foods. There was no association between current
gastrointestinal symptoms and medications or attacks of asthma.
occurrence of gastrointestinal symptoms appears to be common in
children with asthma. These symptoms might be caused by an atopic
gastroenteropathy, which might play a part in the pathogenesis of
asthma in some cases.
Frequent co-existence of bronchial asthma and depression or anxiety is an unquestioned phenomenon. In contrast, little is known about the relationship between the degree of asthma control and the prevalence of depression and anxiety. The aim of this study was to determine the potential relationship between the degree of asthma control and the prevalence of depression and anxiety.
This study included a group of 128 randomly selected asthmatic individuals with various degree of asthma control. The study was based on a questionnaire survey, using the following tools: the Asthma Control Test, Beck Depression Inventory, and State-Trait Anxiety Inventory (STAI) – X-1 and X-2 questionnaires. All the questionnaires were completed during a single follow-up visit at the clinic.
The occurrence of depression and its severity significantly correlated with the degree of asthma control. Individuals with depression were characterized by a significantly lower degree of asthma control compared to depression-free individuals (p<0.001). The degree of asthma control decreased significantly with increasing severity of depression (R=−0.367; p<0.001). No significant correlation was observed between the degree of asthma control and the levels of trait anxiety (R=−0.095; p=0.295) and state anxiety (R=−0.093; p=0.308).
The prevalence of depression and its severity significantly correlate with the degree of asthma control. Large, standardized multicenter studies of the relationship between the degree of asthma control and the prevalence of depression and other psychopathological symptoms are needed. Furthermore, it seems reasonable to introduce the screening of asthmatics for mental disorders.
bronchial asthma; asthma test control; depression; anxiety
This study explores the psychological, socio-cultural and economic consequences of infertility on couples' life. The purpose of this research is to improve knowledge about the potentially serious implications of infertility in the South of Vietnam.
This study included 118 infertile couples who filled in questionnaires and 28 men and women who were interviewed.
Data of the questionnaire show men and women do not differ in their responses and attitudes towards infertility. Almost one-third of the participants require psychological support. Interviewees experience secrecy, social pressure and economic hardship.
Offspring are very important to Vietnamese couples. Their future depends on children. Family plays an important role in the experiences of the infertile couple. Economic consequences are a particular distressing factor. There is a need for psychological counselling in the treatment of infertile couples in the South of Vietnam. It should be realised that in developing countries, despite overpopulation, unwanted childlessness is an important social and economical burden that needs attention.
The aim of the present study was to investigate the relationship between three major allergic diseases, asthma, allergic rhinitis (AR), and atopic dermatitis (AD), and psychological and behavioural problems in preschoolers based on a community survey.
A cross-sectional survey was conducted using a modified International Study of Asthma and Allergies in Childhood questionnaire to determine the prevalence of symptoms and diagnosed allergic diseases, and a Korean version of the Child Behaviour Checklist to assess internalizing, externalizing, and sleep problems among 780 preschoolers. Five-hundred and seventy-five preschoolers with valid data were included in this study.
The prevalence of lifetime diagnosis and treatment in the past 12 months was 8.7% and 4.4% for asthma, 24.4% and 19.2% for AR, and 35.1% and 16.6% for AD, respectively. Scores for internalizing and sleep problems were significantly higher in those diagnosed with AR. Preschoolers who had been treated for AD in the past 12 months had higher attention problem and attention-deficit/hyperactivity disorder scores. Sleep problems were more severe in moderate to severe AD compared to control and mild AD groups, categorised according to SCOring index of AD. The severity of sleep problems correlated positively with the percentage of eosinophils in peripheral blood.
Psychological and behavioural problems differed among the three major allergic diseases, weaker association for asthma and stronger association for AR and AD. The results of this study may lead to the identification of potential underlying shared mechanisms common to allergic diseases and psychological and behavioural problems.
Preschool child; psychometrics; asthma; allergic rhinitis; atopic dermatitis
Unexpected diagnoses and treatment recommendations can be awkward for both hand specialist and patient. We tested the hypothesis that psychological factors predict an unexpected hand specialist diagnosis after referral from a primary care provider (PCP) for management of an atraumatic hand condition.
One hundred and thirty patients referred to a hand surgeon by their PCP were asked to complete measures of symptoms of depression, catastrophic thinking, hypochondriacal attitudes and beliefs, and disability prior to the visit. Patients indicated their impression of the diagnosis and treatment recommendations. The hand specialist recorded a diagnosis and treatment recommendations after the visit.
Patients receiving unexpected diagnoses had more psychological symptoms than patients receiving expected diagnoses. In logistic regression analysis, symptoms of depression were the sole predictor of an unexpected diagnosis. Patients receiving unexpected treatment recommendations had greater catastrophic thinking and hypochondriacal attitudes and beliefs than patients receiving expected treatment recommendations. In logistic regression analysis, catastrophic thinking was the sole predictor of unexpected treatment recommendations.
Given that unexpected hand diagnoses or treatment recommendations are both inherently awkward and associated with greater symptoms of depression, catastrophic thinking, and hypochondriacal beliefs, a practiced, thoughtful, and empathetic communication strategy may improve patient satisfaction and health outcomes.
Unexpected diagnosis; Depression; Catastrophic thinking; Hand illness
The health condition of workers is known to impact on productivity outcomes. The relationship between health and productivity is of increasing interest amid the need to increase productivity to meet global financial challenges. Prevalence of psychological distress is also of growing concern in Australia with a two-fold increase in the prevalence of psychological distress in Australia from 1997-2005.
We used the cross-sectional data set from the Australian Work Outcomes Research Cost-benefit (WORC) study to explore the impacts of health conditions with and without co-morbid psychological distress, compared to those with neither condition, in a sample of approximately 78,000 working Australians. The World Health Organisation Health and Performance Questionnaire was used which provided data on demographic characteristics, health condition and working conditions. Data were analysed using negative binomial logistic regression and multinomial logistic regression models for absenteeism and presenteeism respectively.
For both absenteeism and presenteeism productivity measures there was a greater risk of productivity loss associated when health conditions were co-morbid with psychological distress. For some conditions this risk was much greater for those with co-morbid psychological distress compared to those without.
Co-morbid psychological distress demonstrates an increased risk of productivity loss for a range of health conditions. These findings highlight the need for further research to determine whether co-morbid psychological distress potentially exacerbates lost productivity.
OBJECTIVES--To assess the psychological impact of recurrent genital herpes and to determine if longterm acyclovir has any impact on this morbidity. SETTING AND SUBJECTS--Patients with frequently recurring genital herpes attending a department of genitourinary medicine who were considered suitable for longterm acyclovir. METHODS--Patients completed an 80 item, self-administered psychological questionnaire before starting acyclovir and every three months for one year. Treatment was then stopped and three months later a further questionnaire was completed. The questionnaire consisted of the General Health Questionnaire (GHQ); the Hospital Anxiety and Depression Questionnaire (HADQ); Illness Attitude Scales and Illness Concern. Data were analysed by McNemar's test for changes in proportions and by Wilcoxon's test for changes in scores. RESULTS--102 patients were recruited: 55 men, and 47 women. Eighty two (80%) patients completed three months treatment, 75 (74%) six months, 64 (63%) nine months and 61 (60%) a year. Fifty (49%) of the original 102 patients completed the three months post treatment follow up. At first visit 63% (64/102) were designated as GHQ "cases". Within three months this decreased to 26% (21/82). McNemar's test showed that 67% (34/51) of the patients who were initially classified as GHQ "cases" became "noncases" after three months (p < 0.0001). There was a significant decrease in the proportion of HAD anxiety cases from visit one to visit two (p < 0.0001) and a decrease in illness concern scores from visit one to visit two (p < 0.0001). All these decreases were maintained throughout the years treatment with acyclovir. CONCLUSIONS--There is a substantial morbidity associated with frequently recurring genital herpes. However, acyclovir suppression significantly reduces illness concern and anxiety and is a useful addition to the treatment of this infection.
prevalence of asthma in children has increased in many countries over
recent years. To plan effective interventions to reverse this trend we
need a better understanding of the risk factors for asthma in early
life. This study was undertaken to measure the prevalence of, and risk
factors for, asthma in preschool children.
children aged 3-5 years living in two cities (Lismore, n=383; Wagga
Wagga, n=591) in New South Wales, Australia were surveyed by
questionnaire to ascertain the presence of asthma and various proposed
risk factors for asthma in their children. Recent asthma was defined as
ever having been diagnosed with asthma and
having cough or wheeze in the last 12 months
and having used an asthma medication in the
last 12 months. Atopy was measured by skin prick tests to six common allergens.
of recent asthma was 22% in Lismore and 18% in Wagga Wagga. Factors
which increased the risk of recent asthma were: atopy (odds ratio (OR)
2.35, 95% CI 1.49 to 3.72), having a parent with a history of asthma
(OR 2.05, 95% CI 1.34 to 3.16), having had a serious respiratory
infection in the first 2 years of life (OR 1.93, 95% CI 1.25 to 2.99),
and a high dietary intake of polyunsaturated fats (OR 2.03, 95% CI
1.15 to 3.60). Breast feeding (OR 0.41, 95% CI 0.22 to 0.74) and
having three or more older siblings (OR 0.16, 95% CI 0.04 to 0.71)
decreased the risk of recent asthma.
factors tested, those that have the greatest potential to be modified
to reduce the risk of asthma are breast feeding and consumption of