Doctoral dissertation. Short summary
Dissertation text. Children with asthma and their families
Kjell, Reichenberg, MD, DrPH. Senior lecturer at the Nordic School of Public Health
Publications
CV Kjell Reichenberg
Children with Asthma
Doctoral dissertation. Short summary
Dissertation
text. Children with asthma and their families
Kjell, Reichenberg, MD, DrPH. Senior lecturer at the Nordic School of Public
Health
Publications
CV Kjell Reichenberg
| Contents |
|
|
|
|
GLOBAL SELF WORTH IN CHILDREN WITH ASTHMA
Reichenberg, K. And Broberg, AG. Presented at the Quality of Life Research in Medicine Conference, S:t Peterburg, Russia, October 3-5, 2002.
Background.
As in other studies, we have found
that parents of preadolescent children with asthma report more emotional and
behavioural problems than parents of healthy children do, using the Child
Behaviour Checklist. To our knowledge, no study demonstrates a self reported
impaired global self worth in preadolsecents with asthma.
Aims.
Compare self reported global self
worth in healthy children and children with asthma.
Methods.
The I Think I am, a 32-item
questionnaire assesseing global self worth, was scored by 47 7-9-year olds with
asthma treated at a hospital clinic and 383 healthy children of the same age.
The child answers “yes” or “no” to statements concerning physical
characteristics (6 items), skills, talents and abilities (6 items),
psychological well-being (8 items), relationships with the family (6 items) and
relationships with others (6 items). The possible range is from –32 to +32.
Results.
Global self worth of the children with
asthma was no different from that of healthy children, mean 22.6 (95 %
confidence interval of mean 20.0-25.0) and 22.3 (21.6-23.0) respectively. While
healthy girls scored their self worth higher than boys did, there was no sex
difference in the children with asthma. Among the children with asthma
cohabitation of parents, peak flow rate and absence of exercise-induced asthma
were connected with high scores.
Summary/conclusions.
In a hospital-treated sample of
7-9-year olds with asthma, global self worth as assessed by the I Think I am was
not impaired. Among the children with asthma family factors and variables of
asthma severity predicted high scores. The direction of the link between global
self worth, family situation and reports of asthma severity is not clear.
FAMILY THERAPY TO IMPROVE QUALITY OF LIFE IN FAMILIES WITH ASTHMATIC CHILDREN.
Topics of discussion and experienced benefit to parents.
Kjell Reichenberg MD and Lotta Dellve RN. Nordic School of Public Health and Asthma/allergy Family Unit, The Queen Silvia Children´s Hospital. Göteborg. Sweden.
Background: Asthma in childhood affects the quality of life of the child and his/her family. To gain control parents utilise different strategies in coming to terms with and becoming effective managers of their children’s asthma.
In collaboration with a Parents’ Association and a Child Psychiatric Department an experimental work was started, offering families with asthmatic/allergic children to take part in up to 6 sessions of family dialogues with staff trained in pediatric allergy and family therapy. The purpose was to improve the adaptation of the family to the disease and to give the parents the opportunity to consider how the coping strategies of the family evolved and developed.
50 families participated in 1-6 sessions. Consistent topics have been: parents’ experience of sibling neglect, family strain at first onset of asthma/allergy symptoms, problems introducing child to day care/school, family isolation and uncertainty of significance of behavioural problems as related to disease, family situation or medication.
Evaluation: 26 participating parents were interviewed in depth. A method of qualitative analysis was used based on grounded theory with systematic coding searching core variables, main processes and patterns.
Reported benefits of parents after sessions were increased reflective and structured thinking, improved family communications, a sense of balance in the family and an ability of considering the situation as a whole, increased self competence initiated by confirming the family experience and strengthening their sense of ability through detailed discussion of medical and family factors.
Conclusion: there is a need for discussion of family issues on asthma/allergy. 1-6 family sessions is sufficient for parents to experience significant benefit and better quality of life.
At present we are conducting a quantitative study of the effect on quality of life of asthmatic children and their family. Questionnaires addressing asthma specific problems, behaviour, psychiatric symptoms and self confidence of the child are used. Parents’ ability to control their child, their worry about the disease and family climate are studied. The different measures are compared to the severity of the disease.
Abstract: IInd International Paediatric Asthma Conference – School. Vilnius, April 23-24 1998.
Kjell Reichenberg
DISEASE SPECIFIC QoL IN 7 TO 9 YEAR-OLD ASTHMATIC CHILDREN
K. REICHENBERG, AG. Broberg. Nordic School of Public Health and Child & Adolescent Psychiatry Centre. Göteborg. Sweden.
Background: the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) [Juniper EF. Guyatt GH. Feeny DH. Ferrie PJ. Griffith LE. Townsend M. Measuring quality of life in children with asthma. Quality of Life Research. 1996;5:35-46.] was translated to Swedish. We have validated the instrument and used it to study determinants of disease specific QoL.
Methods: In a cross-sectional study 72 7 to 9-year-old children and their families were approached, of which 61 (85%) participated (25 girls). Mean age was 8.7 years. Children’s asthma was graded according to established criteria, 11 children had mild asthma, 40 intermediate and 10 severe.
Results: The most common restricted activities during
the week preceding the investigation were: running (74%), gymnastics (30%), walking uphill
(26%), playing football (20%), and shouting (13%).
Parental rating of symptoms (Spearman’s rho = 0.40, one-sided p < .01), per cent
of expected PEFR (rho = 0.30, p <. 01), and FEF25-75 (rho = 0.30, p < .05) all
correlated with PAQLQ-scores. Scores were also significantly (p < .05) related to
physicians’ grading of severity of children’s disease (mild asthma median 5.9,
intermediate 5.8 and severe 5.3). Younger children reported lower PAQLQ. So did children
of single parents (median 5.30, children of cohabiting parents median 5.91, p < .01).
Children’s gender or presence of eczema or rhinoconjunctivitis did not significantly
affect scores. Children suffering from food allergy reported less impairment of disease
specific QoL.
The PAQLQ-instrument was easy to administer, well accepted by the children, and showed
acceptable internal consistency.
Conclusion: The PAQLQ is valid in the sense that it corresponds well with measures of disease severity, that is spirometry, clinical grading and parental ratings of amount of symptoms. – How is the reported impaired disease specific QoL of children with single parents mediated? Possible differences in: smoking habits, utilisation of preventive health measures, ease of transportation (access to a car) and general domestic burden, matters not included in our study, need further study.
Selected references:I want to see the whole poster about this study. Requires Acrobat Reader.
DISEASE SPECIFIC QoL IN PARENTS OF CHILDREN WITH ASTHMA
K. REICHENBERG, AG. Broberg. Nordic School of Public Health and Child & Adolescent Psychiatry Centre. Göteborg. Sweden.
Background: the Paediatric Asthma Caregiver’s Quality of Life Questionnaire (PACQLQ) [Juniper EF., Guyatt GH., Feeny DH., Ferrie PJ., Griffith LE., Townsend M. Measuring quality of life in the parents of children with asthma. Quality of Life Research. 1996;5:27-34] was developed to estimate the impact of a child’s asthma on limitation of caregivers’ normal activities (4 items) and their worries over the disease (9 items). Each item is scored from 1 (maximal impairment) to 7 (no impairment at all). The PACQLQ was recently translated to Swedish, and the purpose of our study was to analyse the relation between PACQLQ-scores and measures of disease severity, disease-specific QoL in children and socio-economic factors.
Methods: In a cross-sectional study, 72 7 to 9 year-old children and their families were approached. 61 families participated of which 11 had a child with mild asthma, 40 intermediate and 10 severe according to established criteria. Non-parametric statistics was used for hypothesis testing.
Results: Parental grading of symptoms (Spearman’s
rho=0.637, p<0.001), the asthma specific quality of life of the child (rho=0.359,
p=0.002) and gradings of asthma from medical records (mild asthma median score 6.69,
intermediate 6.27 and severe 5.12, p=0.001) were all related to overall PACQLQ.
The sex of child, the presence of other diseases related to allergy, peak flow rate (PEFR)
and socio-economic level did not affect scores. Lower scores on the emotional domain were
seen in parents of children on steroids (p=0.049).
The distribution of scores was heavily skewed towards the positive end of the scale,
leading to limited power to discriminate among patents of children with mild asthma. --
The instrument had acceptable internal consistency and was well accepted by the parents.
Conclusion: The PACQLQ corresponds well with disease severity as perceived by the parents, the child and the physician. PACQLQ can be used in clinical trials and in the development of medical and psycho-social care of asthmatic children. - There is a need to investigate if mothers and fathers of the same asthmatic child experience different QoL and if single parents have the same impairment in QoL as cohabiting parents.
Selected references:
Osman L, Silverman M. Measuring quality of life for young children with asthma and their
families. Eur Respir J Suppl 1996; 21: 35s-41S
Schulz RM, Dye J, Jolicoeur L, Cafferty T, Watson J. Quality-of-life factors for parents
of children with asthma. J Asthma 1994; 31: 209-19
Guyatt GH, Juniper EF, Griffith LE, Feeny DH, Ferrie PJ. Children and adult perceptions of
childhood asthma. Pediatrics 1997; 99: 165-8
Wamboldt FS, Spahn JD, Klinnert MD, Wamboldt MZ, Gavin LA, Szefler SJ et al. Clinical
outcomes of steroid-insensitive asthma. Ann Allergy Asthma Immunol 1999; 83: 55-60
I want to see the whole poster about this study. Requires Acrobat Reader.