Respecting the circle of life: one year outcomes from a randomized controlled comparison of an HIV risk reduction intervention for American Indian adolescents

Potential for widespread transmission of HIV/AIDS among American Indian (AI) adolescents exists, yet no evidence-based interventions (EBIs) have been adapted and evaluated with this population. Intensive psychoeducation may improve knowledge and decision-making which could potentially translate to reductions in HIV risk behaviors. A peer group randomized controlled comparison of an adapted EBI vs. control was delivered over an eight-day summer basketball camp in one reservation-based tribal community to adolescents ages 13–19. Outcome data were gathered immediately post-camp and at 6 and 12 months follow-up. Self-selected peer groups were randomized to intervention (n = 138) or control (n = 129) conditions for a total sample of 267 participants (56.2% female), mean age 15.1 years (SD = 1.7). Intervention participants had better condom use self-efficacy post-camp (Adjusted Mean Difference [AMD] = ?0.75, p < 0.005) and at 6 (AMD = ?0.44, p < 0.005) and 12 months (AMD = ?0.23, p < 0.05) follow-up. Intervention participants also had higher HIV prevention and transmission knowledge (post-camp: AMD = 0.07, p < 0.01; 6 months: AMD = 0.06, p < 0.01) were more likely to believe condoms prevent sexually transmitted infections (post-camp: RR = 1.41, p < 0.005; 6 months: RR = 1.34, p < 0.05), to talk with an adult about HIV/AIDS (post-camp: RR=1.78, p < 0.005; 6 months: RR = 1.14, p < 0.005), had higher partner negotiation efficacy related to substance use during sex (post-camp: AMD = 0.37, p < 0.01), and were more likely to intend to use a condom (post-camp: RR = 1.39, p < 0.01). The adapted intervention had short- and medium-term impacts on AI adolescent risk for HIV/AIDS, but attenuated at 12 months. Intervention delivery through a community-based camp is feasible and acceptable with strong retention. Additional study is needed to evaluate the adapted intervention's impact on sexual risk behaviors and if booster sessions and parent involvement translate to long-term impacts.     

Randomized trial of a health communication intervention for parents of children with asthma

Objective: To determine if a health communication intervention targeting parents of high-risk, urban, minority children with asthma could (i) improve parental perceptions of connectedness to and communication with their child's primary care providers (PCP) and (ii) decrease reliance on emergency departments (EDs) and other urgent care services for their child's asthma-related care. Methods: The design was a single blind, parallel groups, randomized controlled trial. Parents were recruited from an ED-based asthma clinic serving primarily low-income, minority children in Washington, DC. The intervention involved face-to-face education on effective communication followed by a single booster call. Standardized instruments were administered to assess primary care connectedness and healthcare utilization at baseline and 2- and 6-months post-enrollment. Results: A total of 150 parents of children 1–12 years old were randomized (77 intervention and 73 usual care), and 137 (91%) were successfully followed for six months. Only at the two-month follow-up time-point, parents in the intervention group were significantly more likely to identify a PCP as the main source of their child's asthma care (adjusted odds ratio: 12.6, 95% confidence interval: 1.1–142.1) and to report a significant reduction in ED visits for asthma care (adjusted incidence rate ratio: 0.3, 95% confidence interval: 0.1–0.8). There was no significant effect on parent communication self-efficacy or number of PCP visits. Conclusions: A brief, in-person health communication intervention for parents of high-risk children with asthma resulted in improved identification of PCPs as the usual source of asthma care and reduced reliance on EDs for asthma care, albeit only for two months post-intervention.     

Psychosocial characteristics of inner-city children with asthma: A description of the NCICAS psychosocial protocol

Previous research has demonstrated a significant reciprocal relationship between psychosocial factors and asthma morbidity in children. The National Cooperative Inner-City Asthma Study investigated both asthma-specific and non-specific psychosocial variables, including asthma knowledge beliefs and management behavior, caregiver and child adjustment, life stress, and social support. This article presents these psychosocial characteristics in 1,528 4–9-year-old asthmatic urban children and their caretakers. Caretakers demonstrated considerable asthma knowledge, averaging 84% correct responses on the Asthma Information Quiz. However, respondents provided less than one helpful response for each hypothetical problem situation involving asthma care, and most respondents had more than one undesirable response, indicating a potentially dangerous or maladaptive action. Both adults and children reported multiple caretakers responsible for asthma management (adult report: average 3.4, including the child); in addition, children rated their responsibility for self-care significantly higher than did adults. Scores on the Child Behavior Checklist indicated increased problems compared to normative samples (57.3 vs. 50, respectively), and 35% of children met the criteria for problems of clinical severity. On the Brief Symptom Inventory, adults reported elevated levels of psychological distress (56.02 vs norm of 50); 50% of caretakers had symptoms of clinical severity. Caretakers also experienced an average of 8.13 undesirable life events in the 12 months preceding the baseline interview. These findings suggest that limited asthma problem-solving skills, multiple asthma managers, child and adult adjustment problems, and high levels of life stress are significant concerns for this group and may place the inner-city children in this study population at increased risk for problems related to adherence to asthma management regimens and for asthma morbidity. Pediatr. Pulmonol. 1997;24:263–276. © 1997 Wiley-Liss, Inc.     

Reducing emergency department visits utilizing a primary care asthma specialty clinic in a high-risk patient population

Objective: Asthma is a leading cause of pediatric emergency department (ED) use. Optimizing asthma outcomes is a goal of Nationwide Children's Hospital (NCH) and its affiliated Accountable Care Organization. NCH's Primary Care Network, comprised of 12 offices serving a predominantly Medicaid population, sought to determine whether an Asthma Specialty Clinic (ASC) operated within a single primary care office could reduce ED asthma rates and improve quality measures, relative to all other network offices. Methods: An ASC was piloted with four components: patient monitoring, provider continuity, standardized assessment, and multi-disciplinary education. A registry was established to contact patients at recommended intervals. At extended-length visits, a general pediatrician evaluated patients and a multi-disciplinary team provided education. Novel educational tools were utilized, guideline-based templates recorded and spirometry obtained. ED asthma rate, spirometry utilization, and controller fills by intervention office patients were compared to all other network offices before and after ASC initiation. Results: At baseline, asthma ED visits by intervention and usual care populations were similar (p = 0.43). After, rates were significantly lower for intervention office patients versus usual care office patients (p < 0.001), declining in the intervention population by 26.2%, 25.2%, and 31.8% in 2013, 2014, and 2015, respectively, from 2012 baseline, versus increases of 3.8%, 16.2%, and 9.5% in the usual care population. Spirometry completion, controller fills, and patients with favorable Asthma Medication Ratios significantly increased for intervention office patient relative to the usual care population. Conclusions: A primary care-based asthma clinic was associated with a significant and sustainable reduction in ED utilization versus usual care. What's new: This study describes a comprehensive, multi-disciplinary, and innovative model for an asthma management program within the medical home that demonstrated a significant reduction in ED visits, an increase in spirometry utilization, and an increase in controller fills in a high-risk asthma population versus comparison group.     

Exercise behavior in asthmatic children: effects of a summer camp fitness program in Taiwan

This quasi experimental study aimed to examine the effects of a swimming-focused summer camp program on self-efficacy and exercise behavioral change in schoolchildren with asthma and their parental support. Forty-one asthmatic schoolchildren were recruited from a medical center and an asthma education association in southern Taiwan. The participants in the summer camp program were assigned to the experimental group; the control group comprised those who did not attend the summer camp program. Each child was paired with a parent. A total of 16 child-parent pairs in the experimental group and 25 pairs in the control group were followed-up. This 1.5-day asthma summer camp program included 20 minutes of health education in physical activity, two sessions of swimming practice for the children, and a 2-hour conference with the parents. The outcome measures included an Exercise Self-Efficacy Questionnaire, Stages of Exercise Behavior Change Questionnaire, and a Parental Support for Exercise Questionnaire. Before implementing the program, the two groups differed significantly in terms of the severity of their asthma, as well as their pre-camp test scores of exercise self-efficacy. Therefore, asthma severity levels and scores from the pre-camp exercise self-efficacy test were selected as two ANCOVA covariates. The adjusted means for stages of exercise behavior change on the 2-month post-camp test were significantly different between the two groups, F(1, 37) = 5.88 and p = 0.02. Compared with the control group, subjects who attended the summer camp reported more regular exercise behavior at the 2-month post-camp test. Thus, a summer camp program with swimming instruction can enhance the exercise behavior of schoolchildren with asthma. This program is highly recommended for managing schoolchildren with asthma.     

Job strain,bullying and violence at work and asthma in Peruvian cleaners—a cross-sectional analysis

Objectives: An increased asthma prevalence was found in cleaners. Many of them work in precarious employment conditions, potentially leading to stress, a known risk factor for asthma. We aimed to analyze whether asthma in cleaners might partly be explained by psychosocial working conditions. Methods: The study population of this cross-sectional study included 199 cleaners employed at regional public health services in Puno Province (Peru). They were compared to 79 unexposed workers from Lima, Peru (response 83%). Both groups answered the short version of the European Working Condition Survey and a modified version of the European Community Respiratory Health screening questionnaire. After multiple imputation, the association between psychosocial working conditions and asthma (wheeze without cold or use of asthma medication) was assessed. Results: The 12-months prevalence of asthma was 22% among cleaners versus 5% among unexposed workers (p_Chi² = .001). Cleaners were more likely than unexposed workers to work with temporary or sub-contracts, have a high employment insecurity, high strain working conditions and low social support (all p_Chi² < .05). Twenty-six percent vs. 10% reported a high bullying score; 39% vs. 8% had experienced violence at work (both p_Chi² < .001). High bullying score (adjusted Odds Ratio 5.6; 95% Confidence Interval 1.5–21.4) and violence (2.4; 1.1–5.4) were the main predictors of asthma. Taking these factors into account, being a cleaner was not statistically significantly associated with the outcome (3.5; 0.9–13.8). Conclusions: Poor psychosocial working conditions of cleaners may partly explain the high prevalence of asthma. The underlying mechanism might be a stress-induced inflammatory immune response.     

Effectiveness of a Comprehensive Lifestyle Modification Program for Asthma Patients: A Randomized Controlled Pilot Trial

Objective. The aim of the study was to investigate the effectiveness and feasibility of conducting a complementary 8-week comprehensive lifestyle modification program (CLMP) compared to standard care in patients with bronchial asthma over a 6-month period. Methods. This was a randomized controlled pilot trial with two groups: intervention (N = 15) group and attention-placebo control (N = 14) group. The intervention group received an 8-week CLMP in addition to standard care. Quality of life, asthma control, lung function, reduction of rescue medication, perceived stress, and psychosocial and spiritual status were measured at the end of the intervention and at the 4-month follow-up. Results. In the intervention group, there was a statistically significant difference in the improvements of quality of life, asthma control, lung function, and the reduction of rescue medication intake at both the end of the intervention and at the 4-month follow-up, with no change being observed in the control group. Significant stress reduction and greater psychosocial and spiritual well-being were observed during the 8-week CLMP in the intervention group. At the end of the intervention, the measures of stress and psychological and spiritual well-being reached statistical significance. Conclusions. Preliminary findings suggest that adding a CLMP to standard care in patients with bronchial asthma offers greater clinical benefit than standard care alone and also suggest that conducting a large randomized clinical trial is feasible.     

Alcohol Use Post AUD Treatment Initiation as a Predictor of Later Functioning

Objective: To replicate and extend the earlier work of Maisto and colleagues showing an association between early post-treatment alcohol use and later functioning (). Methods: The present study classified adults presenting for alcohol use disorders (AUD) treatment (n = 114) into one of three drinker groups (i.e., abstainer, moderate drinker, or heavy drinker) based upon alcohol use during the first 6-months following outpatient AUD treatment initiation, and examined the associations between drinker group classification and later alcohol use and psychosocial functioning. Results: Study results showed that individuals classified within the heavy drinker group tended to have the poorest outcomes (i.e., greater alcohol use and poorer psychosocial functioning) relative to individuals classified within the abstainer or moderate drinker groups. Conclusions: Study findings are consistent with the prior work of Maisto and colleagues. In addition, it appears that alcohol use, particularly heavy alcohol consumption, during the early post-treatment initiation period may serve as a marker for later alcohol related problems and poorer overall psychosocial functioning.     

Psychopathology,health-related quality-of-life and parental attitudes in pediatric asthma

Objective: Considering that unknown psychopathology might play a role in the management of pediatric asthma, this study examines how self-esteem and psychosocial family environment (child-raising attitudes and parental coping strategies) influence the physical and psychosocial well-being of these children. Hence, this paper aims to predict psychosocial factors influencing health-related quality-of-life (HRQL) in children with asthma without a documented history of mental illness. Methods: 32 patients with asthma and 32 controls aged 8–18?years were included in the study. All participants were largely middle-income, Caucasian school-aged children. The child-raising attitudes examined were: dependency, egalitarianism/democratic attitude, rejection of the homemaking role, marital conflict, and strictness/authoritarianism. The parental coping strategies were; social support seeking, problem-solving attitude and avoidance. Results: Psychiatric comorbidity was present in 72% of asthma patients and 22% of the controls. The most common mental illness identified was generalized anxiety disorder; 32% vs 13%, respectively. Dependency was the only parental child-raising attitude that differed significantly between groups (47?±?8 vs 41?±?11, respectively. p?=?0.035). There was a negative correlation between the PARI dependency subscale and the total HRQL score according to the parents (r_p=??0.39, p?=?0.027). The most influential factors connected with the total HRQL score in asthma were Rosenberg self-esteem scale score, presence of psychopathology and dependency according to the child. Conclusions: Simple ways to overcome emotional dependency and fortify self-esteem (exercises promoting self-awareness, opportunities cultivating decision-making, and a considerable freedom-of-choice to experience consequences) worth recommending to parents of children with asthma. Patients with suspected mental illness must be referred for psychiatric evaluations.     

Improving childcare staff management of acute asthma exacerbation – An Australian pilot study

Objective: This study aimed to evaluate the effectiveness of an asthma first-aid training tool for childcare staff in Australia. The effects of training on both asthma knowledge and skills were assessed. Methods: A pre/post-study design was utilised to assess changes in asthma knowledge and asthma first-aid skills in childcare staff before and after an educational intervention. Asthma first-aid skills were assessed from the participant's response to two scenarios in which a child was having a severe exacerbation of asthma. Asthma knowledge and asthma skills scores were collected at base-line and 3 weeks post the education session, which involved feedback on each individual's skills and a brief lecture on asthma delivered via PowerPoint presentation. Results: There was a significant improvement after intervention in asthma knowledge (Z = ?3.638, p < 0.001) and asthma first-aid skills for both scenario 1 (Z = ?6.012, p < 0.001) and scenario 2 (Z = ?6.018, p < 0.001). In scenario 1 and 2, first-aid skills improved by 65% (p < 0.001) and 57% (p < 0.001), respectively. Asthma knowledge was high at baseline (79%) and increased by 7% (p < 0.001) after the educational intervention. These asthma knowledge results were not significant when adjusted for prior knowledge. Results suggest that knowledge assessment alone may not predict the practical skills needed for asthma first-aid. Conclusions: Skills assessment is a useful adjunct to knowledge assessment when gauging the ability of childcare staff to manage acute asthma exacerbation. Skills assessment could be considered for incorporation into future educational interventions to improve management of acute asthma exacerbation.     

Breathing retraining for African-American adolescents with asthma: a pilot study of a school-based randomized controlled trial

Objective: Asthma affects approximately seven million children/adolescents in the USA, with African-American children disproportionately affected. Breathing retraining techniques have been shown to improve asthma outcomes in adults, though research in youth is limited. The purpose of this pilot study was to test the feasibility and preliminary efficacy of a school-based randomized controlled trial of breathing retraining for asthma outcomes and anxiety symptoms in a sample of urban, African-American adolescents. Methods: Adolescents were randomized into either the intervention group (20-min breathing retraining plus education) or control group (20-min standard education). Participants completed two study visits, one month apart. Asthma control, asthma quality of life and lung functioning (FEV1 and peak flow) were the primary outcomes, and state anxiety (pre-post the intervention) and trait anxiety (over the one-month period) were the secondary outcomes. Results: Thirty-three African-American adolescents participated in the study, with a 90% retention rate between visit 1 and visit 2. Asthma control and asthma quality of life, significantly improved over time (p?≤?0.01) with no differences between intervention and control groups. State anxiety significantly decreased (p?≤?0.01) immediately post intervention at both time points with no differences between groups. There were no significant differences found in lung functioning or trait anxiety over the one-month time period. Conclusions: These preliminary results suggest that breathing retraining is a feasible, acceptable and potentially efficacious intervention (although no significant differences between groups were found) for improving asthma symptoms in urban adolescents with asthma in a school-based setting.     

Self-efficacy and response-efficacy: critical components of sexual and reproductive health interventions targeting condom use intention among American Indian adolescents

ABSTRACT

The Respecting the Circle of Life (RCL) intervention is a comprehensive, skills-based sexual/reproductive health program shown to be effective for reducing sexual risk among American Indian (AI) adolescents (13-19 years of age). This paper seeks to identify critical program components of the RCL intervention for replication of impacts on condom use intention (CUI) when scaling to additional communities. RCL was tested among AI adolescents through a cluster randomized controlled trial (N?=?267) embedded in an 8-day basketball camp. Data were collected at baseline, immediately post-camp, at 6 and 12 months post-camp. Previously established predictors of CUI that were statistically significantly impacted by RCL at the post-camp time point were tested as mediators of RCL impact on CUI. Condom use self-efficacy and response efficacy fully mediated the effect of RCL on CUI. The indirect path through condom use self-efficacy had the greatest effect on CUI, explaining 79% of the direct effect. When stratified by gender, there was only evidence of mediation among girls. Results indicate condom use self-efficacy and response efficacy are critical components of the RCL intervention for AI girls, and sexual/reproductive health programs should include practical skills training to improve these constructs to maximize intervention impact on CUI.     

Effectiveness of an asthma integrated care program on asthma control and adherence to inhaled corticosteroids

Objective: To measure the effectiveness of an integrated care program for individuals with asthma aged 12–45 years, on asthma control and adherence to inhaled corticosteroids (ICS). Methods: Researchers used a theoretical model to develop the program and assessed effectiveness at 12 months, using a pragmatic controlled clinical trial design. Forty-two community pharmacists in Quebec, Canada recruited participants with either uncontrolled or mild-to-severe asthma. One group was exposed to the program; another received usual care. Asthma control was measured with the Asthma Control Questionnaire; ICS adherence was assessed with the Morisky medication adherence scale and the medication possession ratio. Program effectiveness was assessed with an intention-to-treat approach using multivariate generalized estimating equation models. Results: Among 108 exposed and 241 non-exposed, 52.2% had controlled asthma at baseline. At 12-months, asthma control had improved in both groups but the interaction between study groups and time was not significant (p?=?0.09). The proportion of participants with good ICS adherence was low at baseline. Exposed participants showed improvement in adherence and the interaction between study groups and time was significant (p?=?0.02). Conclusion: An integrated intervention, with healthcare professionals collaborating to optimize asthma control, can improve ICS adherence.     

Results from a community-based trial testing a community health worker asthma intervention in Puerto Rican youth in Chicago

Abstract

Objective: Puerto Rican children suffer disproportionately from asthma. Project CURA tested the efficacy of a community health worker (CHW) intervention to improve use of inhaled corticosteroids (ICS) and reduce home asthma triggers in Puerto Rican youth in Chicago. Methods: This study employed a behavioral randomized controlled trial design with a community-based participatory research approach. Medications and technique were visually assessed; adherence was determined using dose counters. Home triggers were assessed via self-report, visual inspection and salivary cotinine. All participants received education on core asthma topics and self-management skills. Participants in the CHW arm were offered home education by the CHW in four visits over four months. The attention control arm received four newsletters covering the same topics. Results: While most of the participants had uncontrolled persistent asthma,?<?50% had ICS at baseline. In the CHW arms, 67% of participants received the full four-visit intervention. In the Elementary school cohort (n?=?51), the CHW arm had lower odds of having an ICS (OR?=?0.2; p?=?0.02) at 12-months; no differences were seen in other outcomes between arms at any time point. The only significant treatment arm difference in the high school cohort (n?=?50) was in inhaler technique where the CHW arm performed 18.0% more steps correct at five months (p?<?0.01) and 14.2% more steps correct at 12 months (p?<?0.01). Conclusions: While this CHW intervention did not increase the number of participants with ICS or reduce home asthma triggers, important lessons were learned including challenges to CHW intervention fidelity and the need for CHWs to partner with clinical providers.     

An asthma sports camp series to identify children with possible asthma and cardiovascular risk factors

Background: The prevalence of asthma and obesity in children has increased over the past several years, with obesity being associated with higher rates of asthma. In response to known disparities in asthma prevalence and morbidity, along with barriers to diagnosis, assessment and education, a comprehensive asthma sports camp series was developed and implemented.Objective: The primary objective was to evaluate the effectiveness of utilizing a sports camp model to identify children with undiagnosed and uncontrolled asthma, and to provide recommendations for follow-up care. The secondary objectives were to identify the presence of and associations between related co-morbidities and risk factors for asthma morbidity such as obesity, hypertension and exposure to tobacco smoke; and to assess asthma medication use.Methods: Six daylong camps at an inner-city university were offered to children 5–17 years of age over a period of two years. Asthma, body mass index, blood pressure (BP) and carbon monoxide screenings were conducted at each camp.Results: In this sample, 43.7% of children had previously diagnosed asthma, and 12.6% were classified as having potential, undiagnosed asthma. Of the children with previously diagnosed asthma, 76% were considered uncontrolled. Thirty-eight percent were determined to be overweight or obese and 17% had elevated BP.Conclusions: An interdisciplinary sports camp model can be used to identify children with undiagnosed and uncontrolled asthma and cardiovascular risk factors; and to provide recommendations for follow-up care.     

Caregiver depression and perceptions of primary care predict clinic attendance in head start children with asthma

Objective: The purpose of this study is to evaluate the mediating role of perceptions of primary care (PC) on the association between depression and PC clinic attendance among caregivers of children with asthma. In adults, depression is associated with lower PC clinic attendance and ～25% of mothers presenting to a pediatric PC clinic will screen positive for depression. Adults’ perceptions about their medical care mediate the depression-clinic attendance relation, but this has not been tested in children or in an asthma population. Methods: This is a secondary prospective data analysis of 141 caregivers of Head Start children diagnosed with asthma, offered an intervention to reduce barriers to PC. Caregivers rated their depressive symptoms and perceptions of PC (access, provider contextual knowledge, and continuity of care) at baseline. PC clinic attendance was tracked prospectively for 6-months. Results: At baseline, 26% of caregivers screened positive for depression. Within 6-months, 66% of children attended a PC appointment. A positive depression screen was not associated with PC attendance (p?=?0.07) or continuity of care (p?=?0.98) but was inversely associated with perceptions of both access (p?=?0.03) and provider contextual knowledge (p?=?0.02). Though the total indirect effect was not significant, the specific indirect effect of depression on PC attendance through access was significant (95% CI: 0.01, 0.68). Conclusions: Providing tangible resources to reduce barriers to PC without addressing perceptions of access may not sufficiently improve PC clinic attendance in pediatric asthma. Screening caregivers for depression may identify families requiring targeted interventions to improve their perceptions of access.     

Metabolic control and educational status in children with type 1 diabetes: effects of a summer camp and intensive insulin treatment

Abstract Our aim was to evaluate prospectively, in our diabetic patients, the impacts of a summer camp and intensive insulin treatment (IIT) on both metabolic control and disease-related educational level. Twenty-five patients participated in a 7-day-long summer camp. Before the camp, all patients were on therapy with short-acting human insulin (SAI) and intermediate-acting insulin (IAI) twice daily. On arrival, their insulin therapy regimen was changed by IIT including either SAI or rapid-acting insulin analogue (RAI) three times before meals supplemented by IAI at bedtime. Following the camp, all participants were given IIT with RAI plus IAI. Frequency of hypoglycaemia, insulin dose, body mass index (BMI) and glycohaemoglobin (HbA1c) levels were assessed at pre-camp and post-camp controls. To evaluate the effectiveness of camp-assisted education, all participants were regularly tested. We observed significant elevations in total daily dose of insulin and BMI at months 3 and 6 when compared with the pre-camp values but, by month 12, they were not significantly different from precamp values. The mean HbA_1c level decreased significantly at months 6 and 12. Severe hypoglycaemic episodes and ketoacidosis were not detected during the camp and the following year. Significant improvements in knowledge about diabetes and self-management were determined at the end of the camp, after 6 and 12 months. Camp-assisted IIT with RAI improved metabolic control of diabetic children. Additionally, camp-assisted education has a positive effect on disease-related educational level and self-management.     

Psychosocial Functioning and Stress-Processing of Children with Asthma in the School Context: Differences and Similarities with Children without Asthma

Objective.?To characterize children with asthma by their stress processing at school and their psychosocial functioning. To establish similarities and differences between children with and without asthma. Methods.?Participants were 79 children with asthma and 359 children without asthma (ages 8–12). Children completed questionnaires on stress processing and their well-being at school. Parents filled in a questionnaire on behavior problems, and teachers provided data on school performance and absence rate. Results.?Children with asthma had higher scores on absence rates, teacher-rated well-being, internalizing behavior problems, occurrence of “rejection by peers,” and use of aggression when coping with “problems with school work.” However, using discriminant analyses, the groups could not reliably be distinguished from one another by these variables. Conclusions.?Children with asthma are similar to other children with regard to their stress processing at school and their psychosocial functioning. The value of conducting multivariate analysis over several univariate tests is underscored.     

Effect of Extended-Release Naltrexone (XR-NTX) on Quality of Life in Alcohol-Dependent Patients

Background: Extended‐release naltrexone (XR‐NTX) is a once‐a‐month injectable formulation for the treatment of alcohol dependence previously shown to reduce drinking and heavy drinking relative to placebo ( Garbutt et al., 2005 ). A 24‐week, randomized, double‐blind, placebo‐controlled study established the efficacy and safety of XR‐NTX in this patient population. In this report, the effect of XR‐NTX on quality of life (QOL) was examined. Methods: Alcohol‐dependent patients were randomly assigned to receive XR‐NTX 380 mg (N = 205), XR‐NTX 190 mg (N = 210), or placebo (N = 209), combined with a standardized psychosocial intervention. QOL was assessed using the Medical Outcomes Study 36‐item short‐form health survey, administered at baseline and at 4‐week intervals during 24 weeks of treatment. Results: Compared with U.S. population norms, patients showed initial impairment in the health‐related QOL domains of mental health, social functioning, and problems with work or other daily activities due to emotional problems. Adherence to all 6 injections was 65% for XR‐NTX 190 mg, 63% for XR‐NTX 380 mg, and 64% for placebo. Generalized estimating equations analyses using an intention‐to‐treat sample revealed that XR‐NTX 380 mg was associated with significantly greater improvements from baseline in mental health (p = 0.0496), social functioning (p = 0.010), general health (p = 0.048), and physical functioning (p = 0.028), compared with placebo. Linear regression analyses revealed that reductions from baseline in drinking (percentage of drinking days and percentage of heavy drinking days in the last 30 days) were significantly (p < 0.05) correlated with improvements in quality of life. Conclusion: Extended‐release naltrexone 380 mg in combination with psychosocial intervention was associated with improvements in QOL, specifically in the domains of mental health, social functioning, general health, and physical functioning.     

The impact of asthma on quality of life and anxiety: a pilot study

Introduction: Asthmatic patients are at risk for psychiatric symptoms. The objective of this study is to test the hypothesis that asthmatics have worse quality of life and anxiety scores in relation to a control group. Methods: This study is a cross-sectional study in which quality of life and anxiety scores were compared in a sample of 102 individuals, 51 asthmatics and 51 non-asthmatics. Quality of life and anxiety scores were quantified using validated questionnaires. The differences between the averages and the correlations between the total score for quality of life and anxiety were compared with t-tests and Pearson's correlation tests, respectively. The odds ratio compared the prevalence of moderate and severe anxiety between the groups. Results: The asthma group had higher average anxiety (p?<?0.001) and lower averages in all areas of quality of life: physical functioning, physical role functioning, bodily pain, general health, vitality, social functioning, emotional role functioning and mental health (p?<?0.05 for all variables). There was a significant and inverse correlation between the total score for quality of life and anxiety scores but only in the asthma group (r?=??0.71). Conclusions: Asthmatics have worse indicators of quality of life and anxiety, even though the symptoms of asthma are under clinical control. Moreover, the inverse correlation between the quality of life and the average anxiety scores in the asthma group suggests that the pulmonary inflammatory process of asthma may be related to the pathophysiology of emotional commitment in that group.