Jing-Long Huang

Effect of relaxation-breathing training on anxiety and asthma signs/symptoms of children with moderate-to-severe asthma: a randomized controlled trial.

BACKGROUNDnEmotional stress triggers and exacerbates asthma in children. Reducing anxiety in adults by relaxation-breathing techniques has been shown in clinical trials to produce good asthma outcomes. However, more evidence is needed on using this intervention with asthmatic children.nnnOBJECTIVEnTo evaluate the effectiveness of combined self-management and relaxation-breathing training for children with moderate-to-severe asthma compared to self-management-only training.nnnDESIGNnTwo-group experimental design.nnnSETTING AND PARTICIPANTSnPediatric outpatient clinic of a medical center in central Taiwan. Participants were 48 children, ages 6-14 years, with moderate-to-severe asthma and their parents.nnnMETHODSnParticipants were randomly assigned to an experimental or comparison group and matched by gender, age, and asthma severity. Both groups participated in an asthma self-management program. Children in the experimental group were also given 30 min of training in a relaxation-breathing technique and a CD for home practice. Data on anxiety levels, self-perceived health status, asthma signs/symptoms, peak expiratory flow rate, and medication use were collected at baseline and at the end of the 12-week intervention. Effects of group, time, and group-time interaction were analyzed using the Mixed Model in SPSS (12.0).nnnRESULTSnAnxiety (especially state anxiety) was significantly lower for children in the experimental group than in the comparison group. Differences in the other four physiological variables were also noted between pre- and post-intervention, but these changes did not differ significantly between groups.nnnCONCLUSIONSnA combination of self-management and relaxation-breathing training can reduce anxiety, thus improving asthmatic childrens health. These results can serve as an evidence base for psychological nursing practice with asthmatic children.

Lipid profiles alter from pro-atherogenic into less atherogenic and proinflammatory in juvenile idiopathic arthritis patients responding to anti TNF-α treatment.

Objective Dyslipidemia with higher inflammatory states, disease activity, and longer disease duration in juvenile idiopathic arthritis (JIA) patients seemed to increase the risks of atherosclerosis. Tumor necrosis factor- α (TNF-α) receptor blocking agent etanercept has been proven to be effective in JIA. However, data about the correlation of anti-inflammatory treatment on lipid profiles and atherogenic index in JIA patients remains limited. This study aimed to investigate the longitudinal changes on lipid profiles and atherogenic index in JIA patients after etanercept treatment. Methods Twenty-three patients diagnosed with JIA (polyarticular type nu200a=u200a7; oligoarticular type, nu200a=u200a2; systemic type, nu200a=u200a10, Enthesitis-related arthritisu200a=u200a4) received treatment with etanercept during the period 2004–012 in a medical center. We measured their serum lipid profiles at baseline and 2, 4, 6, 12 months later, and determined whether there were differences in complete blood counts, inflammatory mediators, lipid levels and atherogenic indices between patients who had inactive disease (responders) and those who were poor responders (non-responders) to etanercept treatment. Results Analysis of dynamic change in total JIA patients before and after TNF inhibitor therapy showed modest increases in hemoglobin levels (Pu200a=u200a0.02) and decreases in WBC counts, Platelet and CRP levels progressively (pu200a=u200a0.002, pu200a=u200a0.006 and pu200a=u200a0.006, respectively).Twelve of the 23 patients achieved inactive disease status (responders) after 12-months of treatment. In responders, compared to non-responders, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) increased significantly (Pu200a=u200a0.007,Pu200a=u200a0.044,P<0.001), whereas triglyceride and atherogenic index (TC/HDL-C ratio) significantly decreased (Pu200a=u200a0.04, Pu200a=u200a0.01, respectively) after etanercept treatment. Conclusion Disease severity was associated with triglyceride level, atherogenic index and was inversely associated with total cholesterol, HDL-C, and LDL-C levels and can be improved substantially by using anti TNF-α treatment. Such treatment may have a beneficial effect on the cardiovascular risk in patients with JIA.

Evaluating the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma: A randomized control trial.

BACKGROUNDnEmpowerment can be an effective strategy for changing an individuals health behaviours. However, how to empower whole families to manage their childrens asthma is a challenge that requires innovative nursing intervention based on family-centred care.nnnAIMSnTo evaluate the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma compared to those receiving traditional self-management only.nnnDESIGNnA randomized control trial.nnnMETHODSnSixty-five families were recruited from one asthma clinic in a medical centre in Taiwan. After random assignment, 34 families in the experimental group received the family empowerment program consisting of four counselling dialogues with the child and its family. We empowered the family caregivers ability to manage their childs asthma problems through finding the problems in the family, discovery and discussion about the way to solve problems, and enabling the familys cooperation and asthma management. The other 31 families received the traditional care in asthma clinics. The Parental Stress Index and Family Environment Scale of family caregivers, and pulmonary function, and asthma signs of children with asthma were collected at pre-test, 3-month post-test, and one-year follow-up. We utilized the linear mixed model in SPSS (18.0) to analyze the effects between groups, across time, and the interaction between group and time.nnnRESULTSnThe family empowerment program decreased parental stress (F=13.993, p<.0001) and increased family function (cohesion, expression, conflict solving, and independence) (F=19.848, p<.0001). Children in the experimental group had better pulmonary expiratory flow (PEF) (F=26.483, p<.0001) and forced expiratory volume in first second (FEV1) (F=7.381, p=.001) than children in the comparison group; however, no significant change in forced expiratory volume in first second (FEV1)/forced vital capacity (FVC) was found between the two groups. Sleep problems did not show significant changes but cough, wheezing, and dyspnoea were significantly reduced by family caregivers observations.nnnCONCLUSIONnWe empowered families by listening, dialogues, reflection, and taking action based on Freires empowerment theory. Nurses could initiate the families life changes and assist children to solve the problems by themselves, which could yield positive health outcomes.

Influential Factors of Insufficient Physical Activity among Adolescents with Asthma in Taiwan

Purpose Little research has been reported concerning insufficient physical activity in Taiwanese adolescents with asthma. The aims of this paper are to compare the amount of physical activity between asthmatic and non-asthmatic adolescents in Taiwan, as well as to investigate the influential factors associated with insufficient physical activity in asthmatic adolescents. Methods Self-reporting structured questionnaires (socio-economic status, scale of family support for physical activity, amount of physical activity) and peak expiratory flow were assessed from 286 adolescents with asthma and 588 non-asthmatic adolescents in a cross-sectional design. Insufficient amount of physical activity was based on less than 300 minutes per week of moderate and vigorous physical activity. Results Adolescents with asthma have a greater amount of physical activity and a higher level of family support than those who are non-asthmatic. In Taiwan, adolescents with asthma, girls relative to boys, obesity relative to average weight, and low family support relative to high family support were found to be associated with insufficient physical activity. Conclusion Physical activity in adolescents with asthma is insufficient especially in girls, in asthmatics with obesity, and in those with low family support. We suggest that physical activity programs should be applied to Taiwan adolescents with asthma in order to match the criteria of 300 minutes per week of moderate and vigorous physical activity, especially for girls, the obese and those with a low level of family support.

Factors Influencing Physical Activity Levels in Children with Asthma

Purpose. The purposes of this study were to assess the amount of physical activity children with asthma participate in and to explore the factors which influence their levels of physical activity. Methods. A total of 152 children with asthma, ranging in age from 8 to 11 years, were enrolled in this study. The amount of physical activity for each child was gathered from self-reported 3-day physical activity logs (3d-PAL). Personal, diseased-related, psychological and environmental factors influencing physical activity were gathered from questionnaires completed by children and from parent interviews. Results. Only 32.9% of children with asthma took part in 20 minutes or more of vigorous physical activity (VPA) more than three times per week, much less than the 85% participation rate advised by the Healthy People 2010 objectives. Access to exercise facilities, exercise-induced attack (EIA), and gender were predictors of moderate-to-vigorous physical activity (MVPA) (p＜0.001). Children with more access to exercise facilities (p ＜0.01) and fewer episodes of EIA (p ＜0.01) were more likely to engage in MVPA; furthermore, boys with asthma participated more in MVPA than girls (p ＜0.01). Access to team sports was the determinant of VPA (p ＜ 0.05). Conclusions. Inactive children with asthma need appropriate exercise prescriptions to increase physical activity. Pediatric practitioners can enhance physical activity by advising parents to improve access for their children to exercise facilities, prescribing appropriate treatment for EIA, and encouraging girls with asthma to be more active.