Caregiver's depressive symptoms and asthma control in children from an underserved community

Caregiver's or maternal depression has been associated with increased asthma morbidity in children from prosperous nations, but little is known about this link in low and middle-income countries. Objective: To examine if caregiver's depressive symptoms are associated with poor asthma control and abnormal immune responses in school-aged children. Methods: Case-control study of 87 asthmatic children (aged 4–11 years) attending a primary care clinic in an underserved area of Santiago (Chile). Cases were children with poor asthma control (Child Asthma Control Test [cACT] <20 points) and controls were children with adequate asthma control (cACT ≥20 points). The Beck Depression Inventory-II (BDI) and a locally validated family health vulnerability test (SALUFAM) were used to assess caregivers’ depression and family health vulnerability. Serum from participating children was assayed for IFN-γ, IL-4, IL-13, TGF-β, cortisol, and total IgE. Results: The mean (SD) age of study participants was 8.23 (2.15 years), and 55.2% were females. Use of inhaled corticosteroids (ICS), family health vulnerability, and caregiver's depressive symptoms were significantly more common in cases than in controls (65.4% vs. 34.6%, p = 0.003; 41.3% vs. 24.8%, p = 0.07; and 39.1% vs. 19.5%, p = 0.04, respectively). There was no significant difference in the level of any serum biomarkers between groups. In a multivariate analysis, only ICS use was significantly associated with better asthma control (OR = 3.56 [1.34–9.48], p = 0.01). Conclusions: Presence of caregiver's depressive symptoms is associated with poor asthma control among children from an underserved community, but this association was no longer significant after accounting for ICS use.     

Moderating effects of coping styles on anxiety and depressive symptoms caused by psychological stress in Chinese patients with Type 2 diabetes

Aims This study aimed to assess possible interactive effects of coping styles and psychological stress on depression and anxiety symptoms in Chinese patients with Type 2 diabetes. Methods Three hundred and four patients with Type 2 diabetes underwent a face‐to‐face interview by trained research staff according to a standardized questionnaire including information on socio‐demographic characteristics, psychological stress, coping styles and anxiety and depressive symptoms. The interactive effects of coping styles and psychological stress on depression and anxiety symptoms were assessed by hierarchical multiple regression analyses. Results There were significant associations of the four domains of psychological stress with anxiety and depressive symptoms, except for the relationship between ‘reduced economic condition’ and depressive symptoms. ‘Negative coping style’ significantly increased the level of both anxiety and depressive symptoms; whereas, ‘active coping style’ and ‘avoidant coping style’ decreased the risk of depressive symptoms. The interactions of ‘negative coping style’ with ‘worrying about decline in body/physical function’ and ‘reduced economic condition’ significantly increased the risk of anxiety and depressive symptoms, and the interaction of ‘social/family crisis caused by the disease’ with ‘avoidance coping style’ and ‘worrying about decline in body/physical function’ with ‘active coping style’ significantly decreased the risk of depressive symptoms. Conclusions The results of this study suggest that certain coping styles might moderate the association of psychological stress with anxiety and depressive symptoms in Chinese patients with Type 2 diabetes.     

The association of childhood asthma with mental health and developmental comorbidities in low-income families

Objective: The objective of the study was to determine the relationship of childhood asthma with mental health and developmental indicators in low-income families. Methods: Parents/guardians of approximately 400 children, aged 2–14 years, were recruited from a charity hospital serving low income neighborhoods in the outskirts of Karachi, Pakistan. Mothers of children were interviewed in their local language by a trained nurse. Eight self-reported comorbidities were grouped into two constructs based on factor analysis and conveniently labeled as mental health (anxiety, attention and behavioral problems) and developmental problems (learning, developmental delay, hearing impairment, sleep and speech problems). Data were analyzed using multiple logistic regression, adjusted for age, sex, presence of older siblings, number of people in the household, child birth weight, presence of mold, and family history of asthma or hay fever. Results: Children with asthma had 18 times greater odds of mental health problems (adjusted OR?=?18.0, 95% CI: 9.2, 35.1) as compared to children without asthma. The odds of developmental problems were more than 14 times greater for children with asthma (adjusted OR?=?14.3, 95% CI: 7.8, 26.1) as compared to children without asthma. Conclusions: This study found mental and developmental adverse consequences of childhood asthma in low-income families. Identifying and treating asthma at an early age could reduce the burden of comorbidities in this population.     

Medication use,sleep, and caregiver smoking status among urban children with asthma

Objective: Children living in urban settings from low-income, minority families are at a high risk for experiencing asthma morbidity. Environmental tobacco smoke (ETS, i.e., secondhand) exposure, typically from caregiver smoking, has been associated with increased quick-relief medication use and child nocturnal awakenings due to increased asthma symptoms as well as worse sleep quality in children with asthma. This study investigated the moderating role of caregiver smoking status on the association between quick-relief medication use and child's sleep quality in urban children with persistent asthma. Methods: Fifty-four urban children with persistent asthma and their primary caregivers completed a baseline research session. Caregivers then completed ecological momentary assessment surveys via smartphones twice daily for two weeks in which smoking behaviors, child quick-relief medication use, and child's sleep quality were assessed. Results: Twenty caregivers (37%) reported smoking at least one day across the two-week period. The caregiver smoking status significantly moderated the association between quick-relief medication use and child's sleep quality after controlling for child age and monthly household income. The caregiver smoking status exacerbated the association between quick-relief medication use and child's sleep quality, such that more medication usage was associated with worse sleep quality. Conclusions: Findings suggest that in urban families with a caregiver who smokes, more daily quick-relief medication use may put children at an increased risk for worse sleep quality. The effects of ETS exposure on child's sleep quality in addition to child asthma symptoms should be an integral part of discussions between pediatric healthcare providers and families of children with asthma.     

Biomass fuel exposure and asthma symptoms among rural school children in Nigeria

Background: Approximately 70% of rural Nigerian households rely on biomass fuels for cooking. The International Study of Asthma and Allergies in Childhood (ISAAC) estimates the prevalence of current wheeze among children in Nigeria to have risen from 10.7% in 1999 to approximately 20% in 2014. Objective: To examine the effects of biomass smoke exposure on asthma symptom prevalence in rural children in Nigeria. Methods: We conducted a cross-sectional survey in rural communities in Nigeria. Asthma symptoms were defined according to ISAAC definitions. Biomass smoke exposure was determined by the types of fuel used for cooking. Logistic regression was used to explore associations between biomass smoke and asthma symptoms. Results: The study population comprised 1,690 school children, of which 865 lived in households cooking with biomass and 825 lived in households not using biomass. Asthma symptoms were reported in 481 (28.5%) children. Biomass fuel was associated with increased odds of asthma symptoms. Adjusted odds ratios (aORs) were 1.38 (95% CI: 1.05–1.80) for nocturnal cough, 1.26 (95% CI: 1.00–1.61) for current wheeze, and 1.33 (95% CI: 1.05–1.69) for report of any asthma-related symptoms. Sex modified the associations between asthma symptoms with biomass fuel: aORs were stronger and significant for males (nocturnal cough = 1.85, 95% CI: 1.24–2.76; current wheeze = 1.48, 95% CI: 1.03–2.13; report of any asthma-related symptoms = 1.60, 95% CI: 1.12–2.28), but weaker and non-significant for females.Conclusion: The risk of asthma symptoms related to biomass smoke exposure appears to differ by sex.     

北京市城区支气管哮喘患者的控制现状及对疾病认知程度的调查

目的了解北京市城区支气管哮喘（简称哮喘）患者的控制现状和对疾病的认知程度，为进一步开展本地区的哮喘防治工作提供参考依据。方法由6个城区所在的6所大型教学医院完成。调查开始前对参与调查的医师进行集中统一培训。采用与患者面对面的调查方法。结果完成此次问卷调查的患者共527例，87．1％（459／527）的患者享受医疗保障体系。根据全球哮喘防治创议（GINA）的严重度分级标准，其中间歇状态、轻度持续、中度持续和重度持续的比例分别为19．2％（101／527），26．0％（137／527），36．8％（194／527）和18．0％（95／527）。19．5％（103／527）的患者在过去的一年中因疾病加重而住院，29．2％（154／527）的患者因疾病加重需要看急诊。在职上班者中，因疾病加重请假误工者为33．8％（76／225）。22例学生中休病假4例（18．2％）。参照获得哮喘最佳控制研究（GOAL）制定的完全控制和良好控制标准，完全控制率为25．2％（133／527），良好控制率为27．7％（146／527）。在过去的1年中进行肺功能随访的患者仅46．1％（243／527）。拥有峰流速仪者为23．1％（122／527），每日规律使用峰流速仪者仅6．1％（32／527）。患者每日规律吸入糖皮质激素的比例为59．6％（314／527）。患者对疾病的认知程度较前有明显提高。结论随着近年来对哮喘长期管理工作的重视以及哮喘规范化治疗的推广，哮喘总体控制水平有明显改善，患者对疾病的认知程度也有较大程度的提高。     

Current asthma,respiratory symptoms and airway infections among students in relation to the school and home environment in Japan

Objective: To study associations between the school and home environment and current asthma, respiratory symptoms and airway infections among Japanese students. Methods: Japanese students (12–15 y) (N = 1048) in four schools responded to a questionnaire on respiratory health, allergy and the home environment. Temperature, relative air humidity (RH) and student density (students/m² floor area) was measured in the classrooms: dust was collected from floors and in classroom air and analysed for cat (Fel d 1) and dog (Can f 1) allergens. Health associations were analysed by multi-level logistic regression. Results: Doctor's diagnosed asthma was common (13.4%), 8.8% reported cat allergy and 6.1% dog allergy. The median level in floor dust was 41 ng/g (IQR 23–92) for Fel d 1 and 101 ng/g (IQR 54–101) for Can f 1. The median level in air was 18.6 ng/ m²/ day (IQR5.9–25.1) for Fel d 1 and 18.6 ng/ m²/ day (IQR 6.0–13.3) for Can f 1. High RH, high student density and airborne cat allergen was associated with airway infections. In the home environment, recent indoor painting, new floor materials, odour, having cats as pets, window pane condensation in winter, and dampness in floor construction were associated with respiratory illness. Conclusion: High relative air humidity, high student density and airborne cat allergens at school may increase the risk of airway infections. Having cats as pets, chemical emissions from paint and new floor materials, odour and dampness can constitute domestic risk factors for respiratory symptoms while having dogs as pets could be protective.     

Burden of illness,metabolic control,and complications in relation to depressive symptoms in IDDM patients

Relationships between demographic-, treatment-, and sickness-related factors, metabolic control (HbA_1c), perceived burden of illness, and degree of depressive symptoms were examined in a group of 155 insulin-dependent diabetic patients, aged 35.3 ± 8.9 years. The patients completed a questionnaire measuring depressive symptoms and three aspects of perceived burden of illness. No gender differences in HbA_1c level or occurrence of late diabetic complications were found. Both men and women showed a modestly elevated degree of depression compared with norm groups. Self-reported burden of illness was strongly related to depression but was largely unrelated to objective disease-related measures. Level of depression was correlated neither with degree of metabolic control nor with the presence of such late diabetic complications as retinopathy and nephropathy. Some 44 % of the variance in depression could be explained by worries about complications in those patients with the lowest HbA_1c levels, by perceived restrictions in everyday life in patients with intermediate metabolic control, and by problems of glycaemic regulation in patients with poor metabolic control. Degree of depression was largely unrelated to disease severity, but was found to be related to the perceived daily burden of living with the disease, the specific worries and concerns associated with a depressed mood varying with degree of metabolic control. © 1997 John Wiley & Sons, Ltd.     

Cardiovascular, cortisol and coping responses in urban Africans: the SAPBA study

Objectives

To assess the relationships between progression of target-organ damage and cardiovascular, cortisol and coping responses in black urban Africans.

Methods

Urban black African gender groups (n = 200) aged 21–62 years from the Sympathetic Activity and Ambulatory Blood Pressure in Africans study were stratified into normotensive and hypertensive groups. Resting and reactivity Finometer blood pressure, fasting sodium fluoride glucose and salivary cortisol values were obtained before and after applying the Stroop and cold pressor tests. Coping strategies were determined and high-resolution ultrasound carotid intima–media scans were done to determine progression of target-organ damage.

Results

A trend of high-normal resting cortisol values during sampling time 1 was demonstrated in all hypertensive men. Both hypertensive gender groups showed increased vascular responses during both mental stressors. During the cold pressor test, vascular responses predicted sub-clinical atherosclerosis in all hypertensive men, independent of sampling time.

Conclusion

Early morning vascular responses in all the hypertensive men could have occurred secondarily to the permissive effect of cortisol on norepinephrine secretion, with subsequent α-adrenergic vasoconstriction. Their α-adrenergic vascular responses during the cold pressor test, however, predicted sub-clinical atherosclerosis, independent of sampling time and cortisol level.     

Temperament traits, coping style and trauma symptoms in HIV+ men and women

This article presents a study of relations between temperament traits and coping style, and intensity of trauma symptoms in HIV+ men and women. The study was run on 310 HIV + individuals (157 men and 153 women) in or not in the AIDS phase. Temperament traits were assessed with the Formal characteristics of behaviour - temperament inventory. Coping styles were assessed with the Coping inventory for stressful situations. Intensity of trauma symptoms was assessed with the Factorial version of the post-traumatic stress disorder inventory. Coping style had the greatest effect on intensity of trauma symptoms. Emotion-focused coping accounted for 13% of the variance of trauma symptom intensity in HIV + participants. Together, sensory sensibility, emotional reactivity and emotion-focused coping accounted for 26% of the variance of trauma intensity symptoms. Emotion-focused coping and emotional reactivity were conducive to increased trauma symptom intensity in HIV+ participants whereas sensory sensibility tended to reduce symptom intensity.     

HIV-related stigma and quality of life in people living with HIV and depressive symptoms: indirect effects of positive coping and perceived stress

ABSTRACT

Despite a strong evidence on the negative association between HIV-related stigma and quality of life (QoL), few studies have examined the indirect effects of this relationship. This study aimed to examine the association between HIV-related stigma and QoL and the indirect effects of positive coping and perceived stress in people living with HIV and depressive symptoms (PLWHD). This study used baseline date from a randomized controlled trial. Structural equation model was used to examine the association between HIV-related stigma and QoL as well as the indirect effects of positive coping and perceived stress. Perceived and internalized stigma had negative direct (β?=??0.14, p?<?0.05) effect on QoL. Moreover, perceived and internalized stigma had indirect effects on QoL through decreased positive coping and increased perceived stress (β?=??0.23, p?<?0.001). Multilevel interventions to reduce perceived and internalized stigma and perceived stress as well as programs to enhance positive coping may improve QoL of PLWHD. Integrated interventions that both enhance positive coping and reduce perceived stress and stigma are potentially more effective in improving QoL than programs that focus on only one aspect of stigma reduction among PLWHD.     

Depressive symptomatology,quality of life and disease control among individuals with well-characterized severe asthma

Abstract

Objectives: A thorough examination of the relationship of asthma severity and control with symptoms of depression is needed to identify groups of asthmatics at high risk for poor disease control outcomes. This study examines the relationship of symptoms of depression with severity and control in a well-characterized cohort of asthmatics and healthy controls. Methods: Depressive symptoms and quality of life were assessed using the Beck Depression Inventory. Disease control was measured by a composite index incorporating symptoms, activity limitation and rescue medication use. Results: Individuals with asthma (n?=?91) reported more symptoms of depression than controls (n?=?36; p?<?0.001). Those with severe asthma (n?=?49) reported more symptoms of depression (p?=?0.002) and poorer asthma control (p?<?0.0001) than those with not severe asthma. Worse asthma control was associated with more depressive symptoms in severe (r?=?0.46, p?=?0.002) but not in not severe (r?=?0.13, p?=?0.40) asthmatics. The relationship of symptoms of depression among severe asthmatics was attenuated by disease control. Exploratory analyses identified specific disease symptom characteristics, as opposed to exacerbations, as associated with symptoms of depression. Conclusions: Among individuals with severe asthma, increased symptom burden is positively associated with risk for co-morbid depression. These findings point to a need for regular mood disorder screenings and treatment referrals among this group. Further research is warranted to examine whether treatment of comorbid depression improves treatment adherence and asthma-related quality of life.     

Patient-reported and physician-reported depressive conditions in relation to asthma severity and control

BACKGROUND: Depressive conditions in asthma patients have been described mostly from patient reports and less often from physician reports. While patient reports can encompass multiple symptoms, physician assessments can attribute symptoms to a mental health etiology. Our objectives were to identify associations between patient- and physician-reported depressive conditions and asthma severity and control. METHODS: Patient-reported depressive symptoms were obtained using the Geriatric Depression Scale (GDS) [possible score 0 to 30; higher score indicates more depressive symptoms]. Patients were categorized as having a physician-reported depressive disorder if they had the following: a diagnosis of depression, depressive symptoms described in medical charts, or were prescribed antidepressants at doses used to treat depression. Patients also completed the Severity of Asthma Scale (SOA) [possible score 0 to 28; higher score indicates more severe] and the Asthma Control Questionnaire (ACQ) [possible score 0 to 6; higher score indicates worse control]. RESULTS: Two hundred fifty-seven patients were included in this analysis (mean age, 42 years; 75% women). Mean SOA and ACQ (+/- SD) scores were 5.9 +/- 4.2 and 1.4 +/- 1.2, respectively; and mean GDS score was 6.3 +/- 6.4. After adjusting for age, sex, race, Latino ethnicity, education, medication adherence, body mass index, and smoking status, patient-reported depressive symptoms were associated with asthma severity (p = 0.007) and with asthma control (p = 0.0007). In contrast, physician-reported depressive disorders were associated with asthma severity (p = 0.04) but not with asthma control (p = 0.22) after adjusting for covariates. CONCLUSIONS: Physician- and patient-reported depressive conditions were associated with asthma severity. In contrast, patient-reported depressive symptoms were more closely associated with asthma control than were physician-reported depressive disorders. Identifying associations between depressive conditions and asthma severity and control is necessary to concurrently treat these conditions in this population. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT00195117.     

Effects of poor asthma control,insomnia, anxiety and depression on quality of life in young asthmatics

Objective: Asthma-related quality of life has previously been shown to be associated with asthma control. The aims of the present study were to further analyze this correlation, identify other variables with impact on asthma-related quality of life and investigate the covariance among these variables. Methods: Information was retrieved from a cohort of 369 patients, aged 12–35, with physician-diagnosed asthma requiring anti-inflammatory treatment for at least 3 months per year. Questionnaire data [including the mini-Asthma Quality of Life Questionnaire (mAQLQ), asthma control test (ACT) and Hospital Anxiety and Depression Scale (HADS)], quality of sleep, lung function data and blood samples were analyzed. Linear regression models with the mAQLQ score as the dependent scalar variable were calculated. Results: ACT was the single variable that had the highest explanatory value for the mAQLQ score (51.5%). High explanatory power was also observed for anxiety and depression (17.0%) and insomnia (14.1%). The population was divided into groups depending on the presence of anxiety and depression, uncontrolled asthma and insomnia. The group that reported none of these conditions had the highest mean mAQLQ score (6.3 units), whereas the group reporting all of these conditions had the lowest mAQLQ score (3.8 units). Conclusions: The ACT score was the single most important variable in predicting asthma-related quality of life. Combining the ACT score with the data on insomnia, anxiety and depression showed considerable additive effects of the conditions. Hence, we recommend the routine use of the ACT and careful attention to symptoms of insomnia, anxiety or depression in the clinical evaluation of asthma-related quality of life.     

Impact of anxiety and depressive symptoms on perceptions of stigma in persons living with HIV disease in rural versus urban North Carolina

This analysis examined the relationships between HIV-related stigma, depression, and anxiety in rural and urban sites. Participants were HIV-positive urban (n?=?100) and rural (n?=?100) adult residents of a US southern state, drawn from a sample for a larger international study of self-esteem and self-compassion. Measures included demographic and health information, the HIV Stigma Scale, the Center for Epidemiology Studies Depression Scale (CES-D), and the Symptom Checklist 90 Revised (SCL-R-90) anxiety scale. Independent sample t-tests showed no significant differences between urban/rural groups on measures of HIV-related stigma, anxiety, or depression, except that rural participants reported greater disclosure concerns (t?=?2.11, df?=?196, p?=?.036). Both groups indicated high levels of depression and anxiety relative to published norms and clinically relevant cut-off scores. Hierarchical regression analyses were conducted for the HIV Stigma Scale including its four subscales and total stigma scores. Block 1 (control) contained health and demographic variables known to predict HIV-related stigma. Block 2 included the CES-D and the SCL-R-90, and Block 3 was urban/rural location. Mental health symptom scores contributed a significant amount to explained variance in total stigma scores (5.5%, FΔ?=?6.020, p?FΔ?=?5.035, p?FΔ?=?12.289, p?FΔ?=?5.228, p?FΔ?=?3.899, p?FΔ?=?5.446, p?FΔ?=?4.169, p?相似文献   

Interaction of job-related psychological flexibility,coping style and personality types in depression in Chinese physicians: A cross-section study

To investigate the associations of job-related psychological flexibility, coping style and personality types with and their interactions in depression in Chinese physicians. A cross-sectional survey of 444 physicians was conducted by using the convenience sampling method in the municipal hospitals in Zhengzhou, Henan province. Center for Epidemiological Studies Depression, Work-related Acceptance and Action Questionnaire, the Simplified Coping Style Questionnaire and Eysenck Personality Questionnaire-Revision Short Scale of China were administered to each participant. Depression tendency scores were significantly higher in healthcare workers with intermediate title, age 31 and older, introvert unstable personality than other counterparts, (P < .01). Female and extrovert stable healthcare workers had significantly higher coping score than male and other personality types (P < .05). The scores of job-related psychological flexibility in healthcare workers with Introvert Stable or working in emergency department were significantly higher than their counterparts (P < .01). General linear model algorithm of machine learning showed that Extrovert Unstable was the main risk factor for depression (β = 6.74), followed by Extrovert Stable (β = −4.90), negative coping, positive coping, and length of service. Multivariate regression models showed that a significant interaction existed between coping style, work-related psychological flexibility and Extroversion (β = −0.103, P < .05), independently explaining 0.7% variance of depression, and that a significant interaction existed between coping style, work-related psychological flexibility and neuroticism (β = 0.116, P < .05), independently explaining 1.0% variance of depression. Interactions existed between personality types, coping style and work-related psychological flexibility in depression tendency in Chinese healthcare workers, with neuroticism (extrovert unstable) being a risk factor and extroversion (extrovert stable) being a protective factor. Precision prevention strategies could be made based on personality types to reduce depression in health workers.