The Barriers to Shared Decision-making in Exercise Prescription for Children With Asthma: A Qualitative Study From Parents' Perspective.

INTRODUCTION: The knowledge of barriers from the parental perspective is essential for facilitating shared decision-making in the field of pediatric asthma. METHOD: Participants who were parents of children with a diagnosis of asthma were recruited, and in-depth, semistructured interviews were conducted. The interview transcripts were analyzed thematically using framework methods. RESULTS: Seventeen participants undertook interviews. Three themes and nine subthemes emerged: (1) decision-making need level-limited understanding of decision-making knowledge, ambiguity regarding self-empowerment roles, and lack of family member support; (2) decision-making support level-insufficient ability to evaluate information, inefficient communication with health care professionals, and excessive use of professional terminology; and (3) decision-making outcome level-doubts about the final decision-making choices, time constraints on decision-making, and absence of mechanisms to track decisions made. DISCUSSION: The findings would serve as crucial foundations for the development of decision-aid programs within the context of pediatric asthma.

Lipid metabolism-related genes are involved in the occurrence of asthma and regulate the immune microenvironment.

BACKGROUND: Lipid metabolism plays a pivotal role in asthma pathogenesis. However, a comprehensive analysis of the importance of lipid metabolism-related genes (LMRGs) in regulating the immune microenvironment in asthma remains lacking. The transcriptome matrix was downloaded from the Gene Expression Omnibus (GEO) dataset. Differentially expressed analysis and weighted gene coexpression network analysis (WGCNA) were conducted on the GSE74986 dataset to select hub LMRGs, and gene set enrichment analysis (GSEA) was conducted to explore their biological functions. The CIBERSORT algorithm was used to determine immune infiltration in the asthma and control groups, and the correlation of diagnostic biomarkers and immune cells was performed via Spearman correlation analysis. Subsequently, a competitive endogenous RNA (ceRNA) network was constructed to investigate the hidden molecular mechanism of asthma. The expression levels of the hub genes were further validated in the GSE143192 dataset, and RT‒qPCR and immunofluorescence were performed to verify the reliability of the results in the OVA asthma model. Lastly, the ceRNA network was confirmed by qRT-PCR and RNAi experiments in the characteristic cytokine (IL-13)-induced asthma cellular model. RESULTS: ASAH1, ACER3 and SGPP1 were identified as hub LMRGs and were mainly involved in protein secretion, mTORC1 signaling, and fatty acid metabolism. We found more infiltration of CD8+ T cells, activated NK cells, and monocytes and less M0 macrophage infiltration in the asthma group than in the healthy control group. In addition, ASAH1, ACER3, and SGPP1 were negatively correlated with CD8+ T cells and activated NK cells, but positively correlated with M0 macrophages. Within the ceRNA network, SNHG9-hsa-miR-615-3p-ACER3, hsa-miR-212-5p and hsa-miR-5682 may play crucial roles in asthma pathogenesis. The low expression of ASAH1 and SGPP1 in asthma was also validated in the GSE74075 dataset. After SNHG9 knockdown, miR-615-3p expression was significantly upregulated, while that of ACER3 was significantly downregulated. CONCLUSION: ASAH1, ACER3 and SGPP1 might be diagnostic biomarkers for asthma, and are associated with increased immune system activation. In addition, SNHG9-hsa-miR-615-3p-ACER3 may be viewed as effective therapeutic targets for asthma. Our findings might provide a novel perspective for future research on asthma.

Parenting style and child asthma control in families of school-age children with asthma: The mediating effects of children's general self-efficacy and medication adherence.

PURPOSE: Parenting style plays a pivotal role in children's chronic disease control. However, the relationship and underlying mechanism between parenting style and asthma control remain unclear. This study investigated the effects of parenting style on children's general self-efficacy, medication adherence and asthma control and the mediating effects of general self-efficacy and medication adherence among school-age children with asthma. DESIGN AND METHODS: A cross-sectional study with a convenience sampling approach was conducted. This study followed the STROBE guidelines. School-age children with asthma and their parents (N = 211) from pediatric respiratory clinics in China completed the General Questionnaire, Short-Egna Minnen av. Barndoms Uppfostran-Chinese, General Self-Efficacy Scale, Medication Adherence Questionnaire and Childhood Asthma Control Test. Structural equation modeling was used to examine the mediation models. RESULTS: Positive parenting style was positively correlated with child general self-efficacy, medication adherence and asthma control (r = 0.602, 0.572, 0.613, p < 0.001). Negative parenting style was negatively correlated with child general self-efficacy, medication adherence and asthma control (r = -0.535, -0.598, -0.586, p < 0.001). Structure Equation Modle (SEM) results indicated that the relationships between positive parenting style, negative parenting style and child asthma control were mediated by general self-efficacy (Effect Size [ES]: 0.209, 95%CI [0.075, 0.372]; and ES: -0.229, 95%CI [-0.387, -0.103], respectively) and medication adherence (ES: 0.128, 95%CI [0.032, 0.322]; and ES: -0.190, 95%CI [-0.432, -0.071], respectively) and together in serial (ES: 0.177, 95%CI [0.076, 0.295]; and ES: -0.118, 95%CI [-0.235, -0.020], respectively). CONCLUSIONS: Parenting style may impact child asthma through both child general self-efficacy and medication adherence. The study may provide useful intervention targets for improving asthma control. PRACTICE IMPLICATIONS: Nurses should encourage parents to increase positive parenting style while decreasing negative parenting style. Family interventions focusing on general self-efficacy and medication adherence may be advantageous to improve asthma control.

Sleep duration affects the sequential change of body mass index and muscle strength: a contribution to dynapenic obesity.

BACKGROUND: With aging, body mass index (BMI) increases and muscle strength declines, resulting in dynapenic obesity. It remains unknown whether and how sleep duration contributes to the sequence of BMI and muscle strength change in the progression of dynapenic obesity. METHODS: Data were derived from the first two waves of China Health and Retirement Longitudinal Study. Sleep duration was self-reported. BMI was calculated and grip strength (GS) was measured to reflect muscle strength. The effect of baseline sleep duration on the sequential change of BMI and GS was assessed using two mediation models considering the nonlinear associations between them. The moderating effect of metabolic disorder was also tested. RESULTS: Totally 4986 participants aged ≥ 50 years (50.8% females) with complete information on variables were included. Baseline BMI fully mediated the nonlinear association between sleep duration and follow-up GS change, but baseline GS did not mediate between sleep duration and follow-up BMI change for older men and women. Short sleep duration positively affected BMI-induced GS change (ß = 0.038; 95%CI, 0.015-0.074), while this favorable effect became nonsignificant for moderate sleep duration (ß = 0.008; 95% CI, -0.003-0.024) and turned negative with prolonged sleep duration (ß = - 0.022; 95%CI, - 0.051 to - 0.003). This nonlinear mediation effect was more pronounced in older women who are relatively metabolically healthy at baseline. CONCLUSION: For older adults in China, the influence of sleep duration on BMI-induced GS change but not the GS-induced BMI change suggested the contribution of sleep duration to the sequential course in the progression of dynapenic obesity. Sleep duration deviated either above or below normal range may confer adverse impact on GS through BMI. Strategies addressing sleep and obesity jointly to improve muscle function and delay the progression of dynapenic obesity are required.

Positive Self-perceptions of Aging Increase Physical Resilience to Facilitate Social Re-engagement of Older Adults Who Fall: Analysis Based on Health and Retirement Study Data.

OBJECTIVE: To determine whether self-perceptions of aging (SPAs) predict physical resilience after a fall and whether SPA and physical resilience affect subsequent social engagement in older adults with a fall. DESIGN: Prospective cohort study. SETTING: General community. PARTICIPANTS: Older adults who reported a fall within 2 years after baseline data collection (N=1707, mean age 72.9 years, 60.9% women). MAIN OUTCOME MEASURE: Physical resilience indicates the ability to resist or recover from functional decline from a stressor. The change in frailty status from directly after the fall to up to 2 years of follow-up was used to generate 4 physical resilience phenotypes. Social engagement was dichotomized based on the presence at 1 of the 5 social activities at least once a month. The 8-item Attitudes Toward Own Aging Scale was used to assess SPA at baseline. Multinomial logistic regression and nonlinear mediation analysis were used. RESULTS: Positive prefall SPA predicted more resilient phenotypes after a fall. Both positive SPA and physical resilience affected subsequent social engagement. Physical resilience partially mediated the association between SPA and social re-engagement (mediated percentage of 14.5%, P=.004). This mediation effect was fully driven by those with previous falls. CONCLUSION: Positive SPA promotes physical resilience in older adults with a fall, both of which affect subsequent social engagement. Physical resilience partially mediated the effect of SPA on social engagement but only for previous fallers. Multidimensional recovery incorporating psychological, physiological, and social aspects should be stressed in the rehabilitation of older adults who fall.

Ferroptosis-related genes are involved in asthma and regulate the immune microenvironment.

Background: Asthma was a chronic inflammatory illness driven by complicated genetic regulation and environmental exposure. The complex pathophysiology of asthma has not been fully understood. Ferroptosis was involved in inflammation and infection. However, the effect of ferroptosis on asthma was still unclear. The study was designed to identify ferroptosis-related genes in asthma, providing potential therapeutic targets. Methods: We conducted a comprehensive analysis combined with WGCNA, PPI, GO, KEGG, and CIBERSORT methods to identify ferroptosis-related genes that were associated with asthma and regulated the immune microenvironment in GSE147878 from the GEO. The results of this study were validated in GSE143303 and GSE27066, and the hub genes related to ferroptosis were further verified by immunofluorescence and RT-qPCR in the OVA asthma model. Results: 60 asthmatics and 13 healthy controls were extracted for WGCNA. We found that genes in the black module (r = -0.47, p < 0.05) and magenta module (r = 0.51, p < 0.05) were associated with asthma. CAMKK2 and CISD1 were discovered to be ferroptosis-related hub genes in the black and magenta module, separately. We found that CAMKK2 and CISD1 were mainly involved in the CAMKK-AMPK signaling cascade, the adipocytokine signaling pathway, the metal cluster binding, iron-sulfur cluster binding, and 2 iron, 2 sulfur cluster binding in the enrichment analysis, which was strongly correlated with the development of ferroptosis. We found more infiltration of M2 macrophages and less Tregs infiltration in the asthma group compared to healthy controls. In addition, the expression levels of CISD1 and Tregs were negatively correlated. Through validation, we found that CAMKK2 and CISD1 expression were upregulated in the asthma group compared to the control group and would inhibit the occurrence of ferroptosis. Conclusion: CAMKK2 and CISD1 might inhibit ferroptosis and specifically regulate asthma. Moreover, CISD1 might be tied to the immunological microenvironment. Our results could be useful to provide potential immunotherapy targets and prognostic markers for asthma.

What caregivers believe affected the quality of implementation of asthma-related family management models (AFMM) during COVID-19: A phenomenological qualitative study.

PURPOSE: The recurrent COVID-19 epidemic in China has disrupted many aspects of daily life for children with asthma and their caregivers, while negatively impacting their asthma family management models (AFMM). This phenomenological qualitative study identifies what affects the quality of implementation of AFMM in this population and outlines potential coping strategies for the caregivers. METHODS: We used purposive sampling to conduct semistructured interviews with primary caregivers of school-age children with asthma from community healthcare centers (CHCs), which focused on understanding what factors influenced caregivers' implementation of AFMM during quarantine. The Colaizzi seven-step method was used to independently code and categorize the transcript and to generate themes and identify associated key subthemes. RESULTS: Twenty-four caregivers were interviewed, and they provided greater insight into barriers and motivators to implement AFMM. The three themes and nine relevant subthemes generated, (a) the "individual-family" internal-level factors: weak health literacy and beliefs, quietly changing family relationships, the dramatic increase in the care burden, gradual adjustment of negative psychology; (b) the "hospital-community" external-level factors: the endless power of peer support, strict community quarantine policy; and (c) the "health system-public" social-level factors: the enormous potential of internet-based telemedicine, improved public awareness of prevention, government's prompt assistance. CONCLUSIONS: This qualitative study reveals that the quality of AFMM implementation during pandemic is impacted by three different levels. Therefore, a targeted and comprehensive caring model that provides caregivers with the necessary coping strategies around these three levels is needed to achieve better asthma control outcomes.

Construction of Severe Eosinophilic Asthma Related Competing Endogenous RNA Network by Weighted Gene Co-Expression Network Analysis.

Background: Currently, disease control in patients with severe eosinophilic asthma is not optimistic. Competing endogenous RNA (ceRNA) networks have been found to play a key role in asthma in recent years. However, it is unclear whether ceRNA networks play an important part in severe eosinophilic asthma. Methods: Firstly, gene expression profiles related to severe eosinophilic asthma were downloaded from the Gene Expression Omnibus (GEO) database. Secondly, the key modules were identified by the weighted gene co-expression network analysis (WGCNA). Thirdly, genes in modules highly associated with severe eosinophilic asthma were selected for further construction of the ceRNA network. Fourthly, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed on hub genes. Finally, the results of this study were validated on the GSE143303, GSE137268, and GSE147878 datasets. Results: 22 severe eosinophilic asthmatics and 13 healthy controls were extracted for WGCNA. We found that the genes in the black module (r = -0.75, p < 0.05) and yellow module (r = 0.65, p < 0.05) were highly associated with severe eosinophilic asthma. EP300 was discovered to serve the key connecting function in the ceRNA network. Surprisingly, lncRNAs seem to eliminate the role of EP300 in the black module and we discovered that CCT8 and miRNA-mRNA formed a circRNA-miRNA-mRNA network in the yellow module. We found that EP300 and FOXO3 in the black module were regulated by steroid hormones in the enrichment analysis, which were related to the medication used by the patient. Through validation of other datasets, we found that the hub genes in the yellow module were the key genes in the treatment of severe eosinophilic asthma. In particular, RPL17 and HNRNPK might specifically regulate severe eosinophilic asthma. Conclusion: RPL17 and HNRNPK might particularly regulate severe eosinophilic asthma. Our results could be useful to provide potential immunotherapy targets and prognostic markers for severe eosinophilic asthma.

Relationships among thriving at work, organisational commitment and job satisfaction among Chinese front-line primary public health workers during COVID-19 pandemic: a structural equation model analysis.

OBJECTIVES: This study aims to explore the mediating effect and influence mechanism of organisational commitment on the association among thriving at work and job satisfaction among frontline primary public health workers (PHWs) in China during the COVID-19 pandemic. DESIGN: This study is a cross-sectional written survey. SETTING: We included 20 primary care units in northern provinces of China. PARTICIPANTS: A total of 601 PHWs who worked in primary organisations and against COVID-19 on the front line were included. METHODS: We collected the data from the participants' written questionnaire (Minnesota Satisfaction Questionnaire, thriving at work scale and organisational commitment scale), and programmed AMOS V.26.0 to develop a structural equation model (SEM) based on the relationships among the three variables. RESULTS: The thriving at work scores of the primary PHWs were (M=3.17, SD=0.65), and job satisfaction was (M=3.05, SD=0.69); the scores of their thriving at work, organisational commitment and job satisfaction were all significantly correlated (p<0.01); and the SEM indicated that organisational commitment had a significant partial mediating effect between thriving at work and job satisfaction. The overall effect value was 0.867, and the mediated effect value was 0.422, accounting for 48.7% of the total effect size. CONCLUSION: The thriving at work and job satisfaction scores of primary PHWs in China are moderate, and thriving at work not only affects job satisfaction directly, but also indirectly through organisational commitment. This study suggests that health policy-makers should promote job satisfaction among PHWs through relative inventions aiming to improve their thriving at work and organisational commitment.

Association of infant antibiotic exposure and risk of childhood asthma: A meta-analysis.

BACKGROUND: Infant antibiotic exposure may be associated with childhood asthma development. OBJECTIVE: To examine and detail this association considering potential confounders. STUDY DESIGN: PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for publications from January 2011 to March 2021. Eligible studies were independently reviewed to extract data and assess quality. Random effect model was used to pool odds ratio (OR) and corresponding 95% confidence intervals (CIs). RESULTS: A total of 52 studies were included. The association of infant antibiotic exposure and childhood asthma was statistically significant for overall analysis (OR, 1.37; 95% CI, 1.29-1.45) and for studies that addressed reverse causation (RC) and confounding by indication (CbI) (1.19; 95% CI, 1.11-1.28). Significance remained after stratification by adjustment for maternal antibiotic exposure, medical consultation, sex, smoke exposure, parental allergy, birth weight, and delivery mode. In detailed analyses, macrolides (OR, 1.56; 95% CI, 1.31-1.86), antibiotic course≥5 (OR, 1.79; 95% CI, 1.36-2.36), exposure within 1 week of birth (OR, 1.82; 95% CI, 1.34-2.47), asthma developed among 1-3 years (OR, 1.84; 95% CI, 1.63-2.08), short time lag between exposure and asthma onset (OR, 2.05; 95% CI, 1.91-2.20), persistent asthma (OR, 2.61; 95% CI, 1.49-4.59), and atopic asthma (OR, 2.14; 95% CI, 1.58-2.90) showed higher pooled estimates. CONCLUSION: Infant antibiotic exposure is associated with increased risk of childhood asthma considering confounding, and the association varied with different settings of exposure and outcomes. This highlights the need for prevention of asthma after early antibiotic exposure. Heterogeneity among studies called for caution when interpretation.

Physical activity and childhood asthma control: Mediation and moderation role of body mass index.

BACKGROUND: Physical activity (PA) may be associated with asthma management. Whether PA is associated with childhood asthma control is not well studied, and the role of body mass index (BMI) in this association remains unclarified. This study aimed to evaluate the association between PA and childhood asthma control and investigate the potential mediating and modifying role of BMI in the association. METHODS: This cross-sectional study involved 303 asthmatic children aged 5-14 years. Information on PA was collected from children. Asthma control was assessed using a valid questionnaire by children and their parents. Height and weight were objectively measured and BMI was calculated and classified. Multiple linear regression, mediation, and moderation analyses were performed. RESULTS: There was a positive association between PA and childhood asthma control with adjustment for variates (B = 0.144, p = .012). Mediation analysis indicated that BMI status negatively mediated the association (estimate = -0.656, 95% credit interval: -1.645, -0.006), and such indirect effect is lower than the direct effect (indirect effect/direct effect = 58.3%). No evidence of effect modification by BMI was observed (Pinteraction = 0.516). Stratified analyses showed that the significant association was only observed in children with overweight/obesity (normal weight: B = 0.863, p = .189; overweight/obese: B = 1.494, p = .044). CONCLUSIONS: Increased PA is associated with improved childhood asthma control, especially for children with higher BMI. BMI exhibited a negative effect but not effect modification in this association. PA should be encouraged to improve asthma control for asthmatic children. Besides, mechanisms other than weight loss may explain the association.

Impact of Caregiving Burden on Quality of Life of Caregivers of COPD Patients: The Chain Mediating Role of Social Support and Negative Coping Styles.

Purpose: Caregivers of COPD patients experience various caregiving burden, which is related to their quality of life. We aimed to explicitly explore whether social support and negative coping styles play the chain mediating roles in the relationship between the caregiving burden of caregivers of COPD patients and their health-related quality of life. Methods: We conducted a multicenter cross-sectional survey in four hospitals using a convenience sample. Participants who met the inclusion criteria completed five relevant scales, including a sociodemographic scale. One-way ANOVA and Pearson's method were used to analyze the data accordingly, and chain mediated effect values were estimated by bootstrap method to determine whether the model holds. Results: Among the 201 caregivers who participated in this study, the mean age was 55.94 years, most of them were female (61.2%), the mean caregiving burden score was 52.39 ± 14.65, and the quality of life score was 37.97 ± 3.55. Among them, age, gender, education, relationship with the patient, and the number of chronic diseases were the main factors affecting the quality of life score of the caregivers. According to Pearson results, there was a negative correlation between quality of life and caregiving burden, and negative coping styles. The model result showed that caregiving burden could directly and negatively predict quality of life, and also predict quality of life through the chain mediation of social support and negative coping styles. Conclusion: In China, caregivers of patients with COPD experience severe levels of caregiving burden and low quality of life. The combination of adequate perceived social support and lower negative coping can be effective in alleviating caregiving burden and improving their quality of life. Therefore, healthcare professionals should provide targeted guidance to caregivers with the help of social support and interventions that regulate negative coping styles.

Impact of the COVID-19 pandemic on asthma control among children: a qualitative study from caregivers' perspectives and experiences.

OBJECTIVES: To understand the impact of the COVID-19 epidemic on asthma control in children based on caregivers' perspectives and experiences. DESIGN: This was a qualitative study deploying face-to-face, semistructured interviews. Thematic analysis was carried out to analyse the data. SETTING: Paediatric respiratory clinics in three tertiary hospitals. PARTICIPANTS: 16 caregivers providing unpaid asthma-related care and assistance to children under 14 years who had been diagnosed with asthma for more than 1 year and were not only treated with short-acting ß2-agonists. RESULTS: Six main themes were identified: (1) improved asthma control; (2) decreased willingness to seek medical care driven by fear; (3) increased adherence due to enhanced awareness of asthma control; (4) coping strategies for changes caused by COVID-19; (5) a new opportunity and (6) managing new challenges in asthma control. CONCLUSIONS: The COVID-19 outbreak and the measures in response to it have had significant impacts on asthma control among children. Children with asthma are advised to continue good asthma management, take their prescribed asthma medications as normal, wash their hands regularly and wear face masks. Regularly supported self-management and remote consultations should be provided during the COVID-19 pandemic. In addition, supporting people financially, providing continued medical support and alleviating any fear and anxiety should be considered. We anticipate that our findings will inform health promotion interventions.

High Serum Uric Acid Was a Risk Factor for Incident Asthma: An Open Cohort Study.

BACKGROUND: Several cross-sectional studies have suggested an association between SUA and asthma. However, few studies have investigated this relationship longitudinally. Although SUA is an independent risk factor for chronic kidney disease and cardiovascular diseases, its contribution to incident asthma remains uncertain. OBJECTIVE: To determine whether a high SUA was a risk factor for adult incident asthma. METHODS: By using health care data from the Shandong multicenter health check-up, 76,369 participants, aged 20 to 79 years, were identified who had an SUA determination with a mean follow-up period of 3.73±2.21 years. Multivariate modeling employed Cox proportional hazards models to verify the association between SUA and incident asthma by adjusting age, BMI, smoking habits, drinking habits, and asthma-like diseases. RESULTS: A total of 51,389 individuals were included in the analysis. Cut-off values of SUA able to discriminate asthma status were identified by means of maximally selected rank statistics in the whole participants (≥376.80umol/L), women (≥314.45umol/L), and men (≥376.80umol/L). Multivariate Cox regression analyses adjusted for covariates (age, body mass index (BMI), smoking habit, drinking habit, and asthma-like disease) identified an independent association between SUA and incident asthma in the whole participants (hazard ratio (HR) 2.92, 95% confidence intervals (CI), 1.76-4.48, P=0.00) and men (HR 3.02, 95% CI 1.70-5.39, P=0.00), but not in women. CONCLUSION: The results of the current study confirmed that high SUA was an independent risk factor for incident asthma after adjustment of potential covariates and suggested that a cut-off value related to incident asthma could be identified only in men.

Metabolic Syndrome and Incident Asthma in Chinese Adults: An Open Cohort Study.

BACKGROUND: Although metabolic syndrome is awell-known risk factor for many non-communicable diseases, its contribution to asthma remains controversial. OBJECTIVE: The aim of this study was to explore the associations of metabolic syndrome and its components with incident asthma in Chinese adults. METHODS: We conducted an open cohort study of participants who were asthma-free at baseline (n=42,304) in the Shandong multi-center health check-up longitudinal study from 2004 to 2015. Participants aged ≥20 years and had regular physical examination (once ayear) more than three times during follow-up. RESULTS: Ninety subjects (38 women and 52 men) developed incident asthma over 12 years of follow-up. Our study suggested that metabolic syndrome itself was not significantly associated with incident asthma in either women or men (P>0.050). Interestingly, we found that overweight and/or obesity was arisk factor for incident asthma among women but not men in the Cox proportional hazards model after adjusting covariates (adjusted incidence rate ratio (IRR)= 2.940, 95% confidence interval (CI): 1.467-5.894, P=0.002). The result was consistent with the Poisson regression model (hazard ratio (HR)= 2.241, 95% CI: 1.135-4.988, P=0.026). After stratifying according to overweight and/or obesity, we found that female subjects with overweight and obesity were associated with the occurrence of incident asthma (P<0.050). However, we did not find this result among men. CONCLUSION: Metabolic syndrome was not significantly associated with incident asthma in both women and men; however, overweight and/or obesity was shown to be asignificant risk factor for incident asthma but only in women, not in men.