Living with silence.

This is the first qualitative study using content analysis of elderly nursing home residents' statements to describe their perceptions of communication rules and beliefs that regulate their talking. Data were collected by using a role-play interview technique. The perceived communication rules and self-regulatory beliefs identified by residents were found to inhibit them from talking with one another. Implications of the study address communication as a basic human need that serves as an essential mechanism of adaptation to the nursing home environment.     

Living with acromegaly.

Acromegaly is an unusual insidious but potentially serious chronic pituitary disorder. The delay in diagnosis results not only in unique somatic disfigurement but is also associated with significant mental and emotional dysfunction. This article reviews and describes some of these nonclassic and often overlooked features of acromegaly. Particular emphasis is placed on presenting the patients' perspectives of the condition. The author offers some suggestions on the care and counseling of the acromegalic patient.     

Living with therapy

Michael Helquist, an AIDS writer since 1980, communicates his feelings about being diagnosed with AIDS. Helquist describes how he has dealt with his own therapy for Pneumocystis carinii pneumonia (PCP) for 2 1/2 years. Helquist recognized the need to be heard and understood by a therapist and specified that a therapist should have knowledge, empathy, and flexibility. A therapist should know about the primary treatments for AIDS, including the prophylactic drugs used to treat infections and their side effects. Helquist notes that while therapists may not be able to learn everything about AIDS, they should be able to surrender themselves to their client's experiences by listening, analyzing, and entering the client's world. A therapist should be flexible in understanding that a client may want to communicate or deal with problems in alternative ways. He notes that as HIV-positive people live longer, dealing with HIV-related illness will change. Therapists should therefore also address nutrition, exercise, body weight, and medication with their client as these factors become more important to longer survival.     

Living with Asthma

This paper traces the roots of Living with Asthma, a self-management program for childhood asthma, from the Children's Asthma Research Institute and Hospital (CARIH), a residential treatment center in Denver, Colorado. The basic components of the program were developed and tested over the 40-year history of CARIH; the findings of an educational unit were added to this accumulated knowledge and expertise to complete the system.

The program rests heavily on social learning theory, particularly two major tenets: 1) the concept of reciprocal determinism and 2) the learning/performance dichotomy. The crucial role of these concepts is described here, especially with respect to the design of the program and the selection of dependent variables.

The remainder of this article describes the essentials of Living with Asthma, particularly the skills taught and performed by patients in a formal evaluation of the system. The design of the study, characteristics of patients enrolled in the program, and results obtained with the system are discussed. The program proved highly effective in significantly improving the knowledge of asthma in parents and their children, and in developing positive attitudes in both groups. It also produced significant reductions in the number of attacks experienced by the youngsters and improved their peak flow values. Participation in the program resulted in changes in morbidity indices of asthma, including significant reductions in school absenteeism and health-care costs incurred because of the disorder. These changes, it was concluded, reflected the result of the performance by patients of the self-management skills taught in Living with Asthma, coupled with the exceptional medical treatment they received.     

Living with hypoglycemia

OBJECTIVE: To increase understanding of the everyday experiences of hypoglycemia for patients with type 1 diabetes through the use of a narrative research approach. SETTING: Center for diabetes treatment and research. DESIGN: Cross-sectional assessment using a narrative research approach. PATIENTS/PARTICIPANTS: Twenty outpatients (aged 21–30 years) diagnosed with type 1 diabetes for at least 10 years. MEASUREMENTS AND MAIN RESULTS: Experiences of hypoglycemia were investigated during in-depth, semistructured interviews that were tape-recorded, transcribed, and analyzed to identify common themes, Self-report measures of depression (Revised Hamilton Rating Scale for Depression) and anxiety (State-Trait Anxiety Inventory) also were administered. Subjects reported the following common themes: interpersonal conflict including fears of dependency and loss of control and problems addressing concerns about hypoglycemia with significant others; difficulty making sense of their hypoglycemic behaviors in relation to their usual ways of functioning; and perceived lack of understanding by others, including physicians, about the emotional experiences of hypoglycemia. Subjects were neither clinically depressed nor anxious. CONCLUSIONS: These findings suggest that type 1 diabetes patients’ experiences of hypoglycemia negatively affect their interpersonal relationships and views of themselves. Hypoglycemia also was described as an extremely private experience that was rarely discussed with others. Patient education and professional support in the treatment of hypoglycemia are recommended to enhance treatment decision making for patients with type 1 diabetes. Funded by Behavioral and Mental Health Research Department Funding, Joslin Diabetes Center.     

How significant others cope with problem drinkers

About half of the 234 college students surveyed have a close friend or relative whose drinking creates problems for the significant other. A variety of coping responses were identified but none of them was considered effective for either the drinker or significant other.     

Living with Asthma: Part II. Beyond CARIH

This article focuses on the evolution and assessment of additional self-management programs and strategies following the original development and evaluation of Living with Asthma. In particular, it describes the basis and philosophy underlying a self-management program for adults with asthma. In doing so, it introduces strategies that can be used by adults to process and evaluate the information they gather, and to make decisions as to what steps to take to predict and prevent asthma attacks. These strategies rely upon techniques ranging from the use of decision-making trees to the calculation of conditional probabilities to enhance the patients' knowledge that an attack is apt to occur within a prescribed period. It is hoped that further refinement of these procedures will not only provide greater control over asthma, but may help reverse the recent trend of increased mortality due to the disorder.     

Living with lupus: a prospective pan-Canadian study.

OBJECTIVE: To portray life with lupus for women affected by this disease and to identify predictors of fatigue, a common symptom that compromises patients' quality of life. METHODS: A sample of 120 female patients (mean age 42.5 yrs) with systemic lupus erythematosus (SLE) from 9 rheumatology clinics across Canada were followed prospectively for 15 months. Assessments of psychosocial functioning took place at baseline, and at 3, 9, and 15 months. Physician examinations were conducted at baseline and 15 months. RESULTS: Significant time effects were found for: global psychological distress (p < 0.001), stress (p < 0.01), emotion-oriented coping (p < 0.001), physical health status (p < 0.001), and fatigue (p < 0.001), indicating that patients improved from baseline to 15 months. Disease activity worsened for 40.3%, improved for 50.8%, and remained the same for 8.8% of the patients from baseline to 15 months. Controlling for baseline disease activity and fatigue, and considering sleep problems, decreases in stress and depression predicted less fatigue at 15 months (p < 0.001; adjusted R2 = 0.43). CONCLUSION: Despite fluctuations in disease activity, patients with SLE, as a group, cope adequately with their disease over time. There is, nonetheless, a subset of patients (about 40%) who remain distressed and who may benefit from psychosocial interventions.     

Living with Type 2 diabetes: a family perspective.

AIM: To explore the beliefs, attitudes and perceptions of adults with Type 2 diabetes and their family members. METHODS: Focus groups were conducted with: (i) people with good diabetes control (HbA1c < 7.0%); (ii) their family members; (iii) people with poor diabetes control (HbA1c > 8.5%); and (iv) their family members. RESULTS: There were no discernible differences between those with good and poor diabetes control or between the family members of each group. Overall, family members perceived diabetes to be more serious and as having a greater impact on daily life than those with the illness. Those with diabetes were unaware of this heightened concern and had a more relaxed approach to living with diabetes. The lack of information and perceived knowledge about diabetes impacted upon participants' causal attributions about the illness and its perceived severity. CONCLUSIONS: Diabetes is an illness that affects both individuals and families. There is a need for further investigation into the impact that family members have on the management of diabetes.