Browsing by Subject "Asthma"
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Item Factors related to the emotional responses of rural school-aged children who have asthma(2014-05) Walker, Veronica Garcia; Horner, Sharon D.Asthma is a complex, chronic disorder of the airways that is characterized by underlying inflammation, airflow obstruction, and bronchial hyperresponsiveness. Asthma symptoms can be frightening and can have an effect on the emotional functioning Quality of Life (QOL) of school-aged children who have asthma. The purpose of this exploratory, descriptive, cross-sectional, correlational study was to explore the influence of factors identified in the literature on school-aged children’s emotional responses to asthma. Guiding this study was a theoretical model that proposed that the impact of chronic illness severity on QOL is potentially mediated by both resource and barrier factors. The population of interest was 85 school-aged children (ages 6-12) and parents of children who have asthma that were recruited from participants already enrolled in year 4 of the Asthma in Central Texas (ACT) study (R01NR007770, Sharon D. Horner, P.I.) at The University of Texas at Austin. Significant inverse correlations were found between asthma related child emotional functioning QOL and each of the following variables: asthma severity, r = -.30, p < .01; child internalizing behaviors, r = -.26, p < .05, and child externalizing behaviors, r = -.43, p < .001. Significant inverse relationships were found between caregiver emotional functioning QOL and each of the following variables: asthma severity, r = -.39, p < .001; child internalizing behaviors, r = -.22, p < .05 and child externalizing behaviors, r = -.25, p < .05. Multiple regression analysis revealed that asthma severity and child externalizing problems accounted for 26% of the variance in child emotional functioning QOL. No moderators or mediators were identified. Findings from this study imply that externalizing problem behaviors of school-aged children may be a predictor of their negative feelings about their asthma. Nursing educators should consider including the emotional impact of asthma on children in nursing curriculums as this may ultimately influence health care providers to more skillfully address this important issue in both assessment and intervention settings.Item Medication utilization, adherence and use of relief agents among Texas medicaid patients with persistent asthma(2014-05) Makhinova, Tatiana Victorovna; Barner, Jamie C.Asthma is a prevalent chronic disease with high health care utilization and excessive costs. Adherence to asthma long-term controller medications is one of the key drivers to improve asthma management. The purpose of this study was to investigate how patient characteristics and medication regimens, including adherence, impact asthma-related outcomes, which was represented by the use of quick-relief medications: oral corticosteroids (OCSs) and short-acting [beta]2-agonists (SABAs). Texas Medicaid prescription claims from July 1, 2008 to August 31, 2010 were retrospectively analyzed. Patients aged 5-63 years with a primary diagnosis of asthma (ICD-9 code 493) and four or more prescription claims for any asthma medication in one year (persistent asthma) were included. The primary outcomes were adherence to asthma long-term controller medications estimated by Proportion of Days Covered (PDC) and asthma control defined by the number of OCS and SABA claims. A total of 32,172 patients were included in the study. The majority of the patients were on monotherapy (58.9%), with leukotriene receptor antagonists (LTRAs) being most commonly prescribed (65.6%). Among patients on combination therapy (41.1%), fixed dose combinations of inhaled corticosteroids (ICSs) plus long-acting β-agonists (LABAs) were most commonly prescribed (51.9%). Mean (±SD) adherence to controller therapy was 32.2% (±19.7). Patients on LTRAs were 7.7% more adherent compared to patients on ICS therapy, and patients on fixed dose combination therapy were 4.5% more adherent compared to patients on concurrent therapy, while controlling for covariates (age, gender, race, number of non-study medications) (p<0.0001). The likelihood of having 6 or more claims for SABA in one year was significantly higher for adherent (PDC≥50%) patients (p<0.0001). However, the likelihood of OCS use was significantly higher for nonadherent (PDC<50%) patients compared to those who were adherent (p<0.0001). In conclusion, adherence to long-term controller medications was low among patients with asthma. Healthcare providers should emphasize adherence to controller therapy among patients with asthma. Being adherent is critical in prevention of asthma exacerbations requiring OCS use. As frequent SABA use signals poor asthma control, healthcare providers and patients (both adherent and nonadherent) should be educated/re-educated about SABA inhaler use.Item Parental stress and perceived quality of life in adolescents with asthma(2009-05) Howard, Elise; Colwell, Malinda J.; Hart, Sybil L.; McCarty, MichaelThis study examined the relationship between parental stress and quality of life in adolescents with asthma. It was expected that more parental stress would be related to lower quality of life scores and that mothers and fathers would experience different amounts of stress and stress in different areas. The sample included 39 adolescents with asthma and one of their parents. Data were collected from parents assessing parental stress, their child’s severity of asthma, and demographic information. Adolescents reported on their perceived quality of life. A relationship was found between parental stress and quality of life, with significant relationships for parents of daughters. Severity and parental stress also were found to be related.Item Predicting emergency department events due to asthma : results from the BRFSS Asthma Call Back Survey 2006-2009(2012-05) Chancellor, Courtney Marie; Meyers, Lauren Ancel; Scott, JamesThe identification of asthma patients most at risk of experiencing an emergency department event is an important step toward lessening public health burdens in the United States. In this report, the CDC BRFSS Asthma Call Back Survey Data from 2006 to 2009 is explored for potential factors for a predictive model. A metric for classifying the control level of asthma patients is constructed and applied. The data is then used to construct a predictive model for ED events with the rpart algorithm.Item Prescription asthma medication expenditures: are there social disparities?(Texas Tech University, 2005-05) Khosla, Ankur; Xu, Tom K.; Arif, Ahmed; Borders, TyroneThis study estimates the national averages for total, out-of-pocket, and out-of-pocket proportion of total expenditures on prescription asthma medications by adult asthmatic patients using 2000 MEPS data. Additionally, using these estimates disparities were identified among age, race/ethnicity, and poverty level groups. The use of a two part empirical model to evaluate those expenditures was employed in conjunction with the Anderson Behavioral Theoretical Model. The significance of several predisposing, need, and enabling factors in predicting the likelihood and level of expenditures indicate that disparities exist among prescription asthma expenditures. Specifically, differences exist in the out-of-pocket and total spending between the elderly and non-elderly on prescription asthma medications. Additionally, differences exist in the out-of-pocket and out-of-pocket proportion of total expenditures between blacks and whites.Item Prescription asthma medication expenditures: Are there social disparities?(2005-05) Khosla, Ankur; Xu, Tom K.; Arif, Ahmed; Borders, TyroneThis study estimates the national averages for total, out-of-pocket, and out-of-pocket proportion of total expenditures on prescription asthma medications by adult asthmatic patients using 2000 MEPS data. Additionally, using these estimates disparities were identified among age, race/ethnicity, and poverty level groups. The use of a two part empirical model to evaluate those expenditures was employed in conjunction with the Anderson Behavioral Theoretical Model. The significance of several predisposing, need, and enabling factors in predicting the likelihood and level of expenditures indicate that disparities exist among prescription asthma expenditures. Specifically, differences exist in the out-of-pocket and total spending between the elderly and non-elderly on prescription asthma medications. Additionally, differences exist in the out-of-pocket and out-of-pocket proportion of total expenditures between blacks and whites.Item The Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR16): a Psychometric Evaluation in Patients With Asthma and Major Depression(2006-05-15) Murray, Michelle; Rush, A. JohnStatement of the Problem: Despite research evidence of high comorbidity between depression and asthma, few studies have addressed the performance of assessment tools which may assist physicians in assessing depression among asthma patients. The present study is the first to evaluate the psychometric properties of the self-report Quick Inventory of Depressive Symptomatology (QIDS-SR16), a 16-item measure of depressive symptom severity, in asthma patients. Methods: The psychometric properties of the QIDS-SR16 are compared and evaluated in relation to the self-report Inventory of Depressive Symptomatology (IDS-SR30) and the17- item, clinician-rated Hamilton Rating Scale for Depression (HRSD17) in 73 asthma outpatients treated for nonpsychotic Major Depressive Disorder. Correlations between the depression rating scales and the Mini Asthma Quality of Life Questionnaire (MiniAQLQ) were calculated. Results: Internal consistency at exit was strong for the QIDS-SR16 (Cronbach's a =.87) and the IDS-SR30 (Cronbach's a =.95). Total scores for the QIDS-SR16 showed high correlations with the HRSD17 (.85) and the IDS-SR30 (.97) total scores. One-hundred percent of the QIDS-SR16 items and 93% of the IDS-SR30 item-total score correlations reached statistical significance of p<.0001. The QIDS-SR16, the IDS-SR30, and the HRSD17 showed comparable sensitivity to symptom change, indicating high concurrent validity for all three scales. The total QIDS-SR16 baseline to exit change score demonstrated a significant negative correlation to the MiniAQLQ, providing another indicator of concurrent validity. Conclusions: The QIDS-SR16 shows good reliability and impressive construct validity, including test homogeneity, content validity, and concurrent validity. Strong psychometric properties as well as a self-report format, brief administration time, and sensitivity to treatment change make the QIDS-SR16 a valuable clinical and research instrument.Item Statistical Analysis of Proposed Pediatric Asthma Screening Survey(2005-04-15) Alexander, John C.; Oeffinger, Kevin C.Background: Poor asthma control is responsible for considerable morbidity and mortality among children (1). Current pharmacotherapy can suppress exacerbations of asthma symptoms. Thus, proper treatment of asthma is imperative in limiting the toll of this disease process on individuals as well as society. Treatment protocols tend to be based on measurement of asthma severity (3), but there are currently no widely accepted guidelines defining efficacy of treatment (i.e.- asthma control). Objective: This study aimed to assess the construct validity and reliability of an asthma survey among a group of known asthmatics. Furthermore, we intended to determine the level of correlation between survey responses and asthma severity amongst survey participants as well as to discern the ability of the survey to discriminate between mild persistent, moderate persistent and severe persistent asthma. Methods: Surveys from 207 parents/guardians of children aged 5-17 with physician-diagnosed asthma were evaluated for construct validity using Principal Components Factor Analysis. Reliability was assessed via Cronbach's alpha coefficient scale. Severity/response correlations were tested by Chi-square exact tests and the strength of each relationship was assessed using Spearman's correlation. Discriminating ability was analyzed by ROC curve, sensitivity, specificity and odds ratio. Results: Construct validity testing showed that the scale is unidimensional with a Cronbach's alpha coefficient of 0.8076, indicating a high degree of reliability. Significant associations between asthma severity and each question were found, indicating that more severe asthmatics reported significantly greater symptom frequency (p-value range <0.001 - 0.019, Spearman's range = 0.152 - 0.396). ROC analysis yielded an area under the curve of 0.728. Analysis of the ROC curve indicated an optimal cutoff score of =6 to indicate moderate-to-severe asthma. This cutoff yielded a sensitivity and specificity of 65.2% and 70.2%, respectively. Odds ratio was 4.407 (95% CI of 2.366 - 8.207). Conclusion: Our results indicate that, among asthmatics, the survey is valid and reliable. We also noted more frequent symptoms as severity increased, indicating sub-optimal control among more severe asthmatics. Finally, the ability of the survey to predict asthma severity is not supported as the survey seems to assess asthma control, with higher scores indicating poorer control.Item The Effect of a Physical Activity Program on Asthmatic Children(Texas Tech University, 1974-05) Jones, Jacquelyn BarnesNot Available.Item The relation between family functioning and psychological adjustment in children with asthma and children with diabetes(Texas A&M University, 2007-04-25) Fontaine, Eve NicoleThe goals of this study were to evaluate the relationships among family functioning, psychological adjustment, and health-related quality of life in children with asthma and children with diabetes. A secondary goal of this study was to examine the relations between illness severity, psychological adjustment, and health-related quality of life in the children with asthma. Participants included 41 children with asthma and 109 children with diabetes, and one primary caregiver of each child. Questionnaires were given to children to assess their levels of anxiety, depression, and health-related quality of life. Questionnaires pertaining to parenting stress, family functioning, and psychological adjustment also were completed by the participating primary caregiver. Results suggested these two groups of children do not differ in their psychological adjustment, family functioning, or health-related quality of life. Normal levels of anxiety and depression were reported, which both supports and contradicts current research in this area. Additionally, parenting stress mediated the relationship between family cohesion and parent-reported depression in children with diabetes; however, this result was not obtained in the children with asthma. In children with diabetes, significant relationships were found between self-reported anxiety and parenting stress and between parent-reported anxiety and health-related quality of life. Additionally, parent-reported depression was significantly related to parenting stress, health-related quality of life, and family cohesion. Self-reported depression was significantly predicted by health-related quality of life. In children with asthma, health-related quality of life significantly predicted self-reported anxiety and parenting stress was significantly related to parentreported depression. Illness severity did not predict psychological adjustment or healthrelated quality of life in children with asthma.Item The relationship between BMI and asthma is a significant health concern among pre-adolescent and adolescent children(2009-06-02) Furman, Jennifer LeahIn the U.S., the prevalence rates of obesity and asthma have increased over the past 20 years and led to speculation that a correlation exists between them. Most of the research that has been conducted on the association between obesity and asthma has been done so in adults. Little data are available on this association in children. Obesity and asthma are associated with significant morbidity and mortality risk. Concern that the prevalence of overweight and asthma in children will persist and/or worsen in adulthood has prompted the current study. This study analyzed the association between asthma and allergy prevalence and measures of overweight, dietary intake, supplement use, ethnicity, child?s guardian, mother?s education level, and whether the mother smokes among children aged 9 to 11 years and 13 to 15 years. This study also analyzed the association between the use of prescription asthma and allergy medication and asthma and allergy diagnosis, measures of overweight, dietary intake, supplement use, ethnicity, guardian, mother?s education level, and whether the mother smokes. The findings of this study revealed that non-White children had greater odds of asthma diagnosis and were more likely to use asthma medications. A positive correlation was found between asthma diagnosis and allergy diagnosis and between asthma diagnosis and the use of allergy medication. Positive correlations were found between asthma diagnosis and BMI category, subscapular skinfold thickness, and waist circumference among children 9 to 11 years old. Age and weight were found to be inversely correlated with asthma diagnosis among children 13 to 15 years old. BMI category was found to be positively associated with asthma diagnosis among males, but not among females. Asthma diagnosis in females was not found to be significantly correlated with any of the variables. Dietary intake, multi-vitamin/mineral and omega-3 fatty acid supplementation, guardian, waist/hip ratio, mother?s smoking habit, and mother?s education level were not found to be significantly correlated with asthma or allergy diagnosis or with asthma or allergy medication use. A significance value of p<0.05 was used for all analyses.