Urban American Indian family caregivers' perceptions of barriers to management of childhood asthma

American Indian family caregivers of children with asthma face numerous barriers to effective management of the illness. The purpose of this qualitative, community-based study is to identify those barriers as perceived by family caregivers in a large Midwestern city. An ecological perspective and principles of family-centered care provided the theoretical orientation for the study. Interviews were conducted with 16 urban Ojibwe family caregivers of children with asthma. Five categories of barriers characterize the families' experiences: provider (individual and system), condition-related, family caregiver, socioeconomic, and environmental. Examination of these findings suggests directions for improving care to American Indian children with asthma and their families.     

A conceptual model of childhood adaptation to type 1 diabetes

The Childhood Adaptation Model to Chronic Illness: Diabetes Mellitus was developed to identify factors that influence childhood adaptation to type 1 diabetes (T1D). Since this model was proposed, considerable research has been completed. The purpose of this article is to update the model on childhood adaptation to T1D using research conducted since the original model was proposed. The framework suggests that, in individuals and families, characteristics such as age and socioeconomic status as well as the individuals' and families' responses (self-management, coping, self-efficacy, family functioning, social competence) influence the level of adaptation; in children with T1D, characteristics such as treatment modality (pump vs injections) and psychosocial responses (depressive symptoms and anxiety) also influence the level of adaptation. Adaptation has both physiologic (metabolic control) and psychosocial (Quality of Life [QOL]) components. This revised model provides greater specificity to the factors that influence adaptation to chronic illness in children. Research and clinical implications are discussed.     

The natural history of asthma from childhood to adulthood

Medical Practitioners are often questioned regarding the prognosis of a child with asthma. We have performed a literature review of the natural history of childhood asthmatics. Factors which affect the natural history and prognosis of childhood asthma are discussed. Current evidence suggests that evolution of asthma severity is fairly predictable. Features of childhood asthma such as severity, duration, atopy, bronchial hyperresponsiveness and exposure to smoking can predict the course of asthma into adulthood. Most children with mild intermittent asthma will outgrow their asthma, or have mild episodic asthma. Early commencement of anti-inflammatory therapy, such as inhaled corticosteroids may prevent the progression of the disease. Most patients with mild asthma have good functional outcome and low healthcare utilisation.     

Biometeorological triggers in childhood asthma

The relationship between child asthma admissions and biometeorological factors was investigated over a 16-month period. No relationship was found with many commonly suspected precipitants such as temperature, humidity and wind. There was however a strong association with rainfall (P much less than 0.001). Associations occurred with low barometric pressure and counts of coloured basidiospores and green algae, but no significant relationship was found with grass pollen.     

Self-management plans in childhood asthma

Current literature supports the use of self-management plans in childhood asthma. The aim of this article is to describe the purpose of such plans. It gives step-by-step advice on how to prepare an individualized management plan and discusses important considerations on how they can best be implemented in clinical practice.     

Acute asthma attacks in childhood

The diagnosis of an acute asthmatic attack in a child is made on a clinical basis. The severity of the exacerbation can be assessed by physical examination and measurement of the transcutaneous oxygenation saturation. A blood gas analysis can be helpful in this assessment. A child with a severe asthma exacerbation should be promptly referred to an emergency department of a hospital. Oxygen should be given to keep the oxygen saturation above 92% and short-acting, selective beta-2 agonists should be administered. Beta-2 agonists can be delivered by intermittent nebulization, continuous nebulization or by metered dose inhaler (MDI) with a spacer They can also be given intravenously in patients who are unresponsive to escalating therapy. The early administration of systemic corticosteroids is essential for the management of acute asthma in children. When tolerated, systemic corticoseroids can be given orally but inhaled corticosteroids are not recommended. Oxygen delivery, beta-2 agonists and steroid therapy are the mainstay of emergency treatment. Hypovolemia should be corrected either intravenously or orally. Administration of multiple doses of ipratropium bromide has been shown to decrease the hospitalization rate in children and adolescents with severe asthma. Clinical response to initial treatment is the main criterion for hospital admission. Patients with failure to respond to treatment should be transferred to an intensive care unit. A critical aspect of management of the acute asthma attack in a child is the prevention of similar attacks in the future.     

Applying the family adjustment and adaptation response model to care of an AIDS patient's family

Discrimination against AIDS patients occurs in our society, not only influencing the patients but also restricting their usage of social resources. We report on a 31-year-old AIDS patient facing a family crisis because of an imbalance between the meanings, demands, and capabilities of his family. In this paper, we have applied the family adjustment and adaptation response (FAAR) model to assess this family, and identified three health problems, including (1) poor communication among family members, (2) deficiency in disease-related knowledge and skill, and (3) dysfunctional processing among the family. Throughout the care, we adopted a family-centered belief to communicate with the family to resolve their misunderstandings. We provided the family with information related to the disease to reduce their stress arising from caring for the patient. We also helped the family to utilize social resources by coordinating multi-disciplinary care. The family successfully restored a balance between meanings, demands, and capabilities. If we can apply this model clinically to understand the capabilities, demands and meanings of family existence as well as to help family members to develop their capabilities, reduce demands and recognize the positive meanings of family, we can help AIDS patients and their families to achieve positive adaptation.