儿童支气管哮喘社区干预效果研究

目的探讨社区综合管理模式对儿童支气管哮喘的干预效果,为社区防治儿童支气管哮喘提供依据。方法将108例儿童支气管哮喘患儿随机分为对照组和干预组,各54例,对照组采用被动式门诊管理,而干预组采用社区综合管理模式,比较两组的症状、生活质量、肺功能及疗效等指标。结果干预组干预前发作次数、急诊次数、缺课天数与对照组比较差别均无统计学意义（P〉．05）;而干预1年后,干预组的发作次数、急诊次数、缺课天数均明显小于对照组（P〈0.01）,说明干预组患儿经干预后病情有所减轻、生活质量有所提高。干预组干预前的FEV1、PEF％与对照组相比差别均无统计学意义（P〉0．05）;而干预1年后,干预组的FEV1、PEF％均明显高于对照组（P〈0．01）,说明干预组患儿经干预后肺功能指标有明显好转。干预组干预1年的总有效率为92．59％,明显高于对照组的66．67％（P〈0．01）,说明干预组经过干预后患儿的疗效明显得到提高。结论对儿童支气管哮喘患儿实施社区综合管理模式后,可明显降低患儿的发作频率,改善肺功能,提高疗效和生活质量。     

Use and misuse of oral contraceptives by adolescents attending a free-standing clinic

A total of 216 adolescents attending a free-standing clinic completed a questionnaire on oral contraceptive use. Over 80% knew the brand name of their pill and took it correctly from cycle to cycle. About a third had missed at least one pill in the previous three months. Those who took their pills irregularly were more likely to miss them. In the event of missing a pill only 25% would use additional contraceptive measures such as condoms. Over half thought that not menstruating was harmful. The pill-taking pattern in this group of adolescents does not appear to differ significantly from that in adults. Oral contraceptive packs containing 28 tablets (including placebos) appear to produce fewer cycle-to-cycle problems than packs containing 21 active tablets.

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Resumen Un total de 216 adolescentes asistentes a una clínica, completaron un cuestionario sobre el uso de anticonceptivos orales. Más del 80% supieron la marca de su pastilla y la tomaron correctamente de ciclo a ciclo. Aproximadamente un tercio olvidaron al menos una pastilla en los tres meses previos. Las que tomaban la pastilla irregularmente era más posible que se olvidaran de hacerlo. En el caso de olvidar una pastilla, solamente un 25% usaron medidas anticonceptivas adicionales tales como el condón. Más de la mitad pensó que no menstruar es dañino. La manera de tomar la pastilla en este grupo de adolescentes parece no diferir significativamente con la de las adultas. Los paquetes que contienen 28 pastillas (incluyendo placebos) parecen producir menos problemas ciclo a ciclo que los paquetes de 21 pastillas activas.

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Resumé Un nombre total de 216 adolescentes fréquentant une clinique itinérante ont rempli un questionnaire sur les contraceptifs oraux. Plus de 80% d'entre elles connaissaient la marque de leurs pillules, qu'elles prenaient correctement d'un cycle à l'autre. Un tiers d'entre elles avaient oublié de prendre au moins une pillule pendant les trois mois précédents. Celles qui ne prenaient pas leurs pillules régulièrement étaient plus susceptibles de les oublier. Dans les cas où elles avaient oublié d'en prendre une, 25% seulement utilisaient des moyens de contraception supplémentaires tels que des préservatifs. Plus de la moitié pensaient que l'absence de règles était nuisable. Les habitudes de ce groupe d'adolescentes en ce qui concerne la prise de la pillule ne semblent pas différer de façon significative de celles des adultes. Les boîtes contenant 28 pillules (placebos compris) semblent produire moins de problèmes d'un cycle à l'autre que les boîtes ne contentant que 21 pillules actives.

     

支气管哮喘急性发作舒适型护理干预的体会

目的：研究对支气管哮喘急性发作患者进行护理干预的临床效果。方法回顾支气管哮喘急性发作患者76例,将其分成实验组38例,对照组38例,给予对照组常规护理干预,给予实验组舒适型护理干预,通过观察两组患者的护理有效率,比较两组患者的临床疗效。结果与对照组（总有效率78．9％）相比,实验组（总有效率94．7％）的临床效果更显著,相关数据处理显示,两组疗效差异显著,具有统计学意义（P＜0．05）。结论对支气管哮喘急性发作患者,进行舒适型护理取得的疗效显著,能提高患者生活质量,该护理方法具有很高的临床应用价值。     

东莞市哮喘儿童过敏原无痛性体外筛查及干预的临床研究

目的:探讨儿童支气管哮喘的防治方法。方法:对89例哮喘儿童进行吸入性及食物性过敏原无痛性体外筛查,对111例过敏原阳性者分为健康教育组、脱敏组和对照组进行疗效观察。结果:89例哮喘儿童过敏原测定均为阳性。111例过敏原阳性者临床疗效与肺功能变化,脱敏组与健康教育组均显著优于对照组(P<0.05)。结论:对支气管哮喘儿童进行过敏原无痛性体外筛查并进行脱敏与健康教育,可减少复发或减轻病情,对防治儿童哮喘具有积极意义。     

儿童支气管哮喘患者综合护理干预效果

目的探讨儿童支气管哮喘患者实施综合护理干预的效果。方法将120例儿童支气管哮喘患儿随机分为对照组和观察组,各60例,对照组采用常规护理,而观察组采用综合护理干预,比较两组的情绪状态、心理状况及生活质量等指标。结果观察组干预后的抑郁、焦虑、负性情绪得分均低于对照组（P〈0．05）,而正性情绪则高于对照组（P〈0．01）;观察组干预后的自尊、人际安全感、确定控制感得分均高于对照组（P〈0．05）,而情感孤独得分则低于对照组（P〈0．01）;观察组的哮喘症状、活动受限、对刺激原反应、心理功能状态、对自身健康关心等指标得分均明显低于对照组（P〈0．01）。结论儿童支气管哮喘患儿实施综合护理干预后,可明显改善情绪状态和心理状况,提高生活质量。     

Outcomes of an intervention programme for treatment of asthma in a primary care clinic for Bedouins in southern Israel

BACKGROUND: Asthma is one of the most common disorders affecting children and adults. There is a large variation in the theoretical and practical knowledge and skills of physicians, and patients often do not receive optimal treatment. Thus, asthma represents a great challenge to the primary health care system. OBJECTIVE: Our aim was to evaluate an intervention programme for the optimization of treatment of asthma in a primary care clinic in the Muslim Bedouin sector in southern Israel. METHODS: Over a 3-month period, data were collected on the number of nebulizer treatments received by asthma patients in the clinic, referrals to the emergency room, hospitalizations and availability of electric nebulizer equipment or space chambers in the homes of children with asthma. Following this, an intervention programme was designed and implemented to improve treatment of asthma. At the end of the intervention 1 year later, the same data were again collected in the same season as the pre-intervention data. RESULTS: Of 3428 children registered in the clinic, 267 were diagnosed with asthma (7.8%). During the 3-month period before the intervention, 73 children had home inhalation equipment, 61 referrals to the emergency room were documented and six children were hospitalized for exacerbation or complications of the disease. Over this time period, 5.54 nebulizer treatments were conducted in the clinic per month per 100 children and adults. Following the intervention, the number of referrals to the emergency was reduced to six children, none of whom was hospitalized. The number of children with home nebulizers was doubled. The number of nebulizer treatments in the clinic dropped to 4.7 per month per 100, a reduction of 15%. CONCLUSIONS: An intervention including self-management of asthma with an emphasis on the proper use of inhalers and medications, together with improved disease management at the clinic itself, led to a reduction in the episodes of asthma and its complications.     

Interobserver variability in medical record review: an epidemiological study of asthma.

Interobserver variability during the data collection for a large retrospective study of asthma was assessed. After extensive training by three physician investigators, two nurses collected study data from existing medical records using an explicit protocol. At four time intervals, samples of records already abstracted by one nurse were reviewed and re-abstracted by another nurse assigned to the project. The unweighted kappa coefficient was used to evaluate observer reliability. Most of the kappa coefficients were > or = 0.6, suggesting good to excellent agreement. Agreement was highest for demographic, clinical and medication variables, while judgement variables had the lowest kappa coefficients. The well known dependence of kappa on the prevalence of the variable studied was evident in these data. We strongly recommend periodic monitoring of observer reliability in any study using more than one individual to collect data to ensure reliable data collection.     

Stress reduction intervention with mothers of children/adolescents with asthma: a randomized controlled study in Brazil

Abstract

Brazil has a high prevalence of pediatric asthma, which can be a stressor to parents/caretakers. Researchers aimed to assesses the efficacy of a stress reduction intervention for mothers of children/adolescents with asthma through a randomized controlled study. Stress, anxiety, and depression were evaluated in three moments. The intervention group (n?=?20), entailed 5-weekly sessions; the control group (n?=34) had waiting list format. There was a significant decrease in stress, anxiety, and depression in the intervention group. This study indicates that the intervention directed to mothers of children/adolescents with asthma was efficient not only in reducing stress but also anxiety and depression reduction.     

健康教育干预对大学生支气管哮喘控制水平的影响研究

目的探讨大学生支气管哮喘(哮喘)患者实施健康教育干预后对哮喘控制水平的影响。方法 2014年9月—2015年6月从湖北大学选取82例大学生哮喘患者,对其实施规范的健康教育,并在干预前后对所有患者进行问卷调查,了解其对哮喘的认知水平、长期药物治疗情况、规律随访、哮喘日记、过去10个月内的哮喘急性发作次数、哮喘控制测试(asthma control test,ACT)评分、呼气流量峰值(peak expiratory flow,PEF)。两组间计量资料比较采用独立样本t检验,组内比较采用配对t检验;配对计数资料比较采用配对χ~2检验,P0.05为差异有统计学意义。结果通过实施10个月的哮喘健康教育,干预后患者对哮喘相关知识的认知水平较干预前有明显改善,差异均有统计学意义(均P0.05)。干预后患者长期规律使用吸入激素、按需使用短效β2受体激动剂(short-actingβ2agonists,SABA)、长期使用白三烯调节剂、长期使用缓释茶碱、哮喘急性发作期使用抗生素、使用成分不明的平喘药、规律随访、非急性发作期坚持药物治疗、记录哮喘日记情况均比干预前有所改善,差异均有统计学意义(均P0.05)。干预后患者的PEF、ACT评分[(450.25±38.20)L/min、(22.85±2.21)分]均高于干预前[(308.62±65.24)L/min、(16.11±5.40)分],差异均有统计学意义(均P0.05);干预后患者过去10个月内的哮喘急性发作次数[(1.05±0.78)次]明显少于干预前[(2.98±1.42)次],差异有统计学意义(P0.05)。干预前患者完全控制率为6.10%(5/82);干预后为29.17%(21/72),干预前后患者哮喘完全控制率比较,差异有统计学意义(χ~2=14.54,P0.05)。结论对大学生哮喘患者实施健康教育,可提高患者对哮喘的认知水平和自我管理能力,促进患者坚持规范化的药物治疗,减少哮喘急性发作次数,改善肺功能,提高哮喘控制水平。     

Effects of creating visual illness narratives on quality of life with asthma: A pilot intervention study

PurposeTo determine whether self-examination through video, by creating visual illness narratives of living with asthma, is associated with improved disease-specific quality of life.MethodsNineteen children and adolescents (aged 8–19 years) with moderate or severe asthma by 1992 National Heart, Lung, and Blood Institute criteria were administered the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) twice before (T1 and T2) and once immediately after (T3) they made Video Intervention/Prevention Assessment (VIA) visual narratives of their lives with asthma. The PAQLQ is a previously validated scale (range 1–7) that measures asthma-specific quality of life in three domains: activity limitation, symptoms, and emotional function. Overall and domain-specific PAQLQ scores were compared using general linear model repeated measures analysis. Participant exit interviews about the VIA experience were analyzed using grounded theory.ResultsThe mean PAQLQ score did not change between T1 and T2, but significantly increased from 4.78 at T1 to 5.30 at T3 (p = .045). The activity level domain score increased from a mean of 4.08 at T1 to 5.08 at T3 (p ≤ .001). Qualitative data indicated that VIA was associated with increased disease-awareness and more confident self-management for most participants.ConclusionsThe results of this pilot study suggest that creating visual illness narratives is associated with improved quality of life for children and adolescents with asthma. Research with larger numbers and a control group is needed to evaluate VIA as an intervention and to further quantify its impact on health-related quality of life.     

Team collaboration: a case study of an early intervention team

The study described in this article sought to examine the workings of an interdisciplinary team as a research entity and as a service provider. There were two levels of analysis in the study: the process of collaborating on the research and the results of the research observation of an interdisciplinary team in a clinical setting. An interdisciplinary research team studied the interaction of a single clinical team over a 6-month period working with one child in a hospital-based early intervention program. The data were collected through intensive interviews, direct observations of the family and team members, and selected videotaping of team meetings. Qualitative data analysis methods were used, and five themes emerged: who takes the lead, the classroom as a way station, we like our freedom but..., who is giving and who is taking advice, and communication comes in few forms.     

心理干预在哮喘儿童治疗中的作用

目的:探讨心理干预在哮喘儿童治疗中的作用,为提高患儿的心理健康水平,更好地控制哮喘发作提供依据。方法:采用随机对照方法,将符合标准的哮喘患儿分为干预和非干预组,两组均进行规范治疗,干预组同时给予12周的心理治疗;采用儿童状态-特质焦虑问卷(STAIC)、儿童抑郁自评量表(SSDC)对哮喘患儿82例和健康对照儿童38例进行焦虑和抑郁情绪的心理评估,比较干预前后两组患儿在情绪、躯体症状、肺功能和唾液中SIgA含量的变化。结果:哮喘患儿焦虑、抑郁得分明显高于健康儿童,而SIgA含量明显低于健康儿童;两组患儿的焦虑、抑郁评分均低于治疗前,干预组患儿的焦虑、抑郁评分明显低于非干预组(P<0.01);肺功能改善亦优于非干预组(P<0.05);唾液中SIgA含量明显高于非干预组。结论:心理干预能明显改善患儿的情绪障碍、躯体症状和肺功能,是一种有效地辅助治疗方法。