Caregiver role in HIV medication adherence among HIV-infected orphans in Tanzania

Youth living with HIV in sub-Saharan Africa face numerous challenges in adhering to HIV treatment. The AIDS epidemic has left many of these youth orphaned due to AIDS-related death of one or both parents. It is imperative to understand the family context of youth living with HIV in order to develop responsive interventions to improve adherence to antiretroviral therapy. We conducted qualitative in-depth interviews with 17 HIV-infected AIDS orphans, ages 13–24 years, screened positive for mental health difficulties according to the Patient Health Questionaire-9 (PHQ-9) or UCLA PTSD Reaction Index (PTSD-RI), and receiving outpatient HIV care at an adolescent medical clinic in Moshi, Tanzania. Treatment-related support varied by orphan status. Paternal orphans cared for by their biological mothers and maternal orphans cared for by grandmothers described adherence support such as assistance taking medication and attending clinic. Double orphans did not report adherence support. Several maternal and double orphans faced direct interference from caregivers and household members when they attempted to take their medications. Caregivers play a significant role in treatment adherence and must be considered in interventions to increase medication adherence in HIV-infected orphans. Findings from this study informed caregiver participation in Sauti ya Vijana (The Voice of Youth), a mental health intervention for youth living with HIV in Tanzania.     

Severe asthma in children: Evaluation and management

Severe asthma in children is associated with significant morbidity. Children with severe asthma are at increased risk for adverse outcomes including medication-related side effects, life-threatening exacerbations, and impaired quality of life. It is important to differentiate between severe therapy resistant asthma and difficult-to-treat asthma due to comorbidities. The most common problems that need to be excluded before a diagnosis of severe asthma can be made are poor medication adherence, poor medication technique or incorrect diagnosis of asthma. Difficult to treat asthma is a much more common reason for persistent symptoms and exacerbations and can be managed if comorbidities are clearly addressed. Children with persistent symptoms and exacerbations despite correct inhaler technique and good medical adherence to standard Step 4 asthma therapies according to the guidelines^1,2, should be referred to an asthma specialist with expertise in severe asthma.     

Caregiver knowledge and its relationship to asthma control among children in Saudi Arabia

Objective: The objective of this study was to examine caregiver responses to individual questions of the asthma knowledge questionnaire and to compare the prevalence of uncontrolled asthma among children according to caregiver responses (correct vs. incorrect). Methods: We conducted an analytical cross-sectional study among 158 children with asthma aged 4–11 who were attending the pediatric primary care clinic of the King Khalid University Hospital in Riyadh, Saudi Arabia. The asthma knowledge questionnaire for use with parents or guardians of children with asthma was used to measure the knowledge of caregivers. Asthma control in the children was measured using an Arabic version of the childhood asthma control test. Pearson’s chi-square or Fisher’s exact tests were used to compare the prevalence of uncontrolled asthma according to the caregivers’ responses. Results: This study showed substantial gaps in knowledge among caregivers of children with asthma. The answer to only one of 17 questions was well known (86.1%); this question involved the harm of smoking near a child with asthma. Answers on 11 of 17 questions were significantly (p?Conclusions: Although innovations are needed to help patients improve their adherence to treatment and to effectively utilize the benefits of contemporary asthma medications, we observe substantial knowledge-related problems in the asthma management of children in Saudi Arabia.     

儿童重症支气管哮喘的识别与管理

儿童重症支气管哮喘(哮喘)具有高度异质性,临床上常与难治性哮喘混淆.排除用药依从性差、吸入技术差、误诊等因素,积极处理共存疾病,正确诊断重症哮喘,选择相应的治疗,对减轻药物相关不良反应、减少危及生命的哮喘发作、改善远期预后等方面具有重要作用.     

The relevance of symptom perception in the management of severe asthma in adolescents

Severe asthma is a compelling challenge in clinical practice. Adolescence represents a relevant aspect of this issue. We report a series of adolescents with severe asthma and evaluated before and after a one-year standardized guideline-oriented treatment. We explored the relevance of symptom perception, including nasal and bronchial complaints, assessed by visual analog scale (VAS) and the perception of asthma control measured by the asthma control test (ACT). The current study demonstrated that adolescents perceived a significant improvement in their symptoms (p < 0.0001) and asthma control (p < 0.001) after adequate treatment. In conclusion, the management of severe asthma in adolescents should be carefully addressed to also consider the patient’s perception.     

他汀类药物在支气管哮喘治疗中的作用

支气管哮喘是一种气道慢性炎症性疾病.他汀类药物是临床最常用的调脂药物.大量研究显示,他汀类药物具有降脂之外的抑制炎症、抑制平滑肌细胞增生和免疫调节等作用.该文就他汀类药物在支气管哮喘治疗中可能的作用机制研究进展作一综述.     

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.     

Improved quality-of-life of caregivers of children with asthma through guideline-based management

Objective: The quality of life (QOL) of caregivers of children with asthma may be related to children's responses to asthma management. Aim: To evaluate change in QOL over time of caregivers of children with asthma through guideline-based management. Design: This was a 3-year prospective cohort study of children with asthma referred to our pediatric asthma center. Families completed Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ), the Asthma Control Test? (ACT), and reported the number of days/month of albuterol use and wheezing at each clinic visit. Results: We enrolled 143 children, ages 7–17 years (mean = 10.6 ± 2.9), 56.6% male, 70.6% Caucasian. Patients were managed by the same MD (n = 65,45.5%) or APN (n = 78,54.5%) over time. The mean total PACQLQ significantly increased over the 3-year period (F = 67.418, p < .001). Total scores at the first visit were 4.8 ± 1.6, which improved to 6.1 ± 1 at the 3-month follow-up visit. This improvement was sustained at the 1, 2, and 3-year clinic visits. PACQLQ emotional function (F = 60.798, p < .001) and activity limitation (F = 41.517, p < .001) domains significantly improved as well. PACQLQ scores were significantly associated with improved ACT scores (r = .37 to .47, p < .05), fewer days/month of albuterol use (r = ?.25 to ?.36., p < .05), and wheezing (r = ?.28 to ?.33, p < .05). There were no significant differences in PACQLQ, or asthma clinical outcome measures between MD and APN providers. Conclusion: Use of National Asthma Education and Prevention Program (NAEPP) guidelines significantly improved QOL of caregivers of children with asthma and in asthma-related symptoms. Improvements over time were independent of type of providers.     

Assessing and Managing Caregiver Stress: Development of a Teaching Tool for Medical Residents

ABSTRACT

Forty medical residents from major teaching hospitals in Boston, Massachusetts, participated in small group teaching sessions about caregiver stress. A teaching tool was developed that included a teaching handout, interactive cases, standard instruments for assessing caregiver stress, peer-reviewed articles about caregiving, and a list of resources that would be useful to a caregiver. These materials and teaching format were evaluated using a pre- and posttest and a feedback form. Forty residents completed the pretest and posttest. They scored significantly higher on the posttest for questions that covered estimated cost of caregiving (p = 0.0073), physical stress from caregiving (p = 0.0196), and identifying elder abuse (p = 0.0006). Ninety percent of the residents completed the evaluation form and rated the intervention highly. Teaching medical residents about caregiver stress resulted in a significant increase in knowledge about this topic. This study makes the case for the integration of “Caregiver Stress” into the primary care residency curriculum.     

哮喘对儿童生活质量的影响

支气管哮喘为儿童常见的慢性炎症性疾病，近年来其发病率在各国明显上升，影响了患儿及其家庭的生活质量。本文主要讨论哮喘给患儿家庭带来沉重的经济负担以及对家庭成员的身心健康的影响，疾病导致的缺课以及夜间的睡眠打断对患儿白天的学习表现的不良影响，患儿与同龄儿童相处的影响，以及疾病带来的不同程度体育运动受限和各种心理行为障碍。     

Office-based management of asthma in adults

Asthma is a systemic inflammatory disease manifested most often as episodic dyspnea with wheeze or cough. It is the pulmonary manifestation of an immunoregulatory imbalance that involves the release of pro-inflammatory cytokines into the airway by either IgE-mediated or other poorly understood immunologic mechanisms. Efforts are currently underway to identify asthma susceptibility genes that will allow office-based internists of the future to determine a genetic risk profile to identify asthma susceptibility and risk factors before it occurs. Present therapies allow management of the great majority of adults with asthma such that these patients can have normal lifestyles.     

Association between second hand smoke (SHS) exposure and caregiver stress in children with poorly controlled asthma

Objective: Urban children with asthma experience high rates of second hand smoke (SHS) exposure. The objective was to examine whether SHS exposure is associated with symptom frequency in children with poorly controlled asthma. Methods: Children were enrolled in a RCT to test the efficacy of an environmental control behavioral intervention versus an attention control group and followed over 12 months. SHS exposure assessed using salivary cotinine measurement. Frequency of child asthma symptoms, healthcare utilization, household smoking and caregiver daily life stress were obtained via caregiver report. Time of enrollment was recorded to assess seasonal factors. Symptom days and nights were the primary outcomes. Multivariable models and odds ratios examined factors that best predicted increased frequency of daytime/nighttime symptoms. Results: Children (n?=?222) with a mean age of 6.3 (SD 2.7) years, were primarily male (65%), African American (94%), Medicaid insured (94%), and had poorly controlled asthma (54%). The final multivariable model indicated symptoms in the fall (OR 2.78; 95% CI 1.16, 6.52) and increased caregiver daily life stress (OR 1.13, 95% CI 1.02, 1.25) were significantly associated with increased symptom days when controlling for cotinine level, intervention status, child age and home and car smoking restrictions. Conclusions: There was no impact of SHS exposure on increased symptom frequency. High caregiver daily life stress and symptoms in fall season may place children with asthma at risk for increased day/nighttime symptoms. Close monitoring of symptoms and medication use during the fall season and intervening on caregiver life stress may decrease asthma morbidity in children with poorly controlled asthma.     

"三位一体"支气管哮喘教育管理模式对支气管哮喘患者病情控制水平的影响

目的 评价"三位一体"支气管哮喘教育管理模式对支气管哮喘患者病情控制水平的影响.方法 由经过培训的北京市6所大型教学医院的呼吸科医生,以面对面的方式连续不加选择地问卷调查各自医院门诊成年支气管哮喘患者病情控制水平,比较以"三位一体"(哮喘专病门诊、哮喘宣教中心、哮喘患者协会)模式系统教育管理的支气管哮喘患者(教育组)与未进行"三位一体"系统教育管理的支气管哮喘患者(对照组)的问卷调查结果.结果 教育组患者100例,对照组患者427例.教育组支气管哮喘控制测试(ACT)评分达20分以上的占85%,显著高于对照组的37%(χ2=74.345,P<0.01);过去1年中教育组因支气管哮喘加重住院、急诊就诊、误工的分别占4%、18%、20%(10/49),显著低于对照组的23%、32%、55%(76/137)(χ2值分别为19.431、7.515、17.853,P值均小于0.01).结论 "三位一体"支气管哮喘教育管理模式可显著提高患者的病情控制水平.     

Influence of current or former smoking on asthma management and control

BACKGROUND:

In patients with asthma, smoking has been associated with accelerated decline in pulmonary function, poor disease control and reduced responsiveness to corticosteroids.

OBJECTIVE:

To assess the influence of current and former smoking on self-reported asthma control and health care use in a large population of asthma patients.

METHODS:

The present analysis was conducted following a telephone survey of adult Canadians aged 18 to 54 years who had physician-diagnosed asthma and a smoking history of less than 20 pack-years.

RESULTS:

Of 893 patients, 268 were former smokers and 108 were current smokers. Daytime and nighttime symptoms, absenteeism from work or school, emergency care use for asthma in the past year, and use of a short-acting bronchodilator without controller medication were reported more frequently by current smokers than non-smokers and former smokers. Former smokers were not significantly different from nonsmokers with respect to most asthma outcomes.

CONCLUSIONS:

Current smokers with asthma show evidence of poorer asthma control and greater acute care needs than lifelong nonsmokers or former smokers. These observations stress the importance of smoking cessation to help achieve asthma control.     

Gender differences in the perception of asthma and respiratory symptoms in a population sample of asthma patients in four Brazilian cities

OBJECTIVE:

To evaluate the impact of asthma, by gender, in a population sample of asthma patients in Brazil.

METHODS:

We conducted face-to-face interviews with 400 subjects (> 12 years of age) included in a national probability telephone sample of asthma patients in the Brazilian state capitals of São Paulo, Rio de Janeiro, Curitiba, and Salvador. Each of those 400 subjects completed a 53-item questionnaire that addressed five asthma domains: symptoms; impact of asthma on quality of life; perception of asthma control; exacerbations; and treatment/medication.

RESULTS:

Of the 400 patients interviewed, 272 (68%) were female. In relation to respiratory symptoms, the proportion of women reporting extremely bothersome symptoms (cough with sputum, tightness in the chest, cough/shortness of breath/tightness in the chest during exercise, nocturnal shortness of breath, and nocturnal cough) was greater than was that of men. Daytime symptoms, such as cough, shortness of breath, wheezing, and tightness in the chest, were more common among women than among men. Women also more often reported that their asthma interfered with normal physical exertion, social activities, sleep, and life in general. Regarding the impact of asthma on quality of life, the proportion of subjects who reported that asthma caused them to feel that they had no control over their lives and affected the way that they felt about themselves was also greater among women than among men.

CONCLUSIONS:

Among women, asthma tends to be more symptomatic, as well as having a more pronounced effect on activities of daily living and on quality of life.