Assessing quality of life in Mexican-American children with asthma: impact-on-family and functional status.

OBJECTIVE: To assess the internal consistency reliability and construct validity of two questionnaires, the Impact on Family (IOF) and the Functional Status II (R) (FSIIR), in a Mexican-American population of children with asthma. METHODS: We interviewed 115 Hispanic parents of children with asthma and compared the IOF and FSIIR scores and reliability coefficients for the following subgroups: English or Spanish language and high or low educational level. We assessed the construct validity of the IOF Total score and FSIIR Illness score by examining the relationship between these scores and other health status variables. RESULTS: The IOF Total score and FSIIR Illness score demonstrated acceptable construct validity and reliability for language and education subgroups, although several of the IOF subscales had low reliability. CONCLUSIONS: IOF Total score and FSIIR Illness score can be recommended for use by Spanish- and English-speaking Mexican-American respondents.

Implementation of individualized patient education for Hispanic children with asthma.

An educational program known as the Childhood Asthma Project (CAP) was implemented to reduce morbidity among Hispanic children with chronic asthma. Seventy-three children, ages 6-16, participated in 4 program phases: baseline assessment, one-on-one child-centered education, application, and maintenance. During baseline assessment, child and parent asthma beliefs and behaviors were evaluated and used to create educational modules on symptom recognition, peak low meters, medications, and precipitating factors in Spanish and English. Children learned the importance of self-management, practiced using inhalers and peak flow meters and charted peak flow recordings. Videotapes provided peer modeling by showing Hispanic children with asthma performing self-management tasks. During the application phase, patients practiced self-management behaviors at home and reviewed progress with a nurse educator. During maintenance, the success of self-monitoring was reviewed at follow-up appointments. Recommendations for designing health education interventions for Hispanic children are provided.

A taxonomy for lay risk perceptions of dentistry.

OBJECTIVE: This paper aims to develop and organize a set of variables that can be used to: (1) test the widely held but unproven assumption that lay risk perceptions can adversely affect dental care, (2) investigate the possible influence of lay risk perceptions on dental care and (3) permit the evaluation of risk communication strategies in dentistry. METHODS: We reviewed the literature regarding risk perception and risk communication in health care and technology. We then selected a set of variables that could be measured in a study of the general public and organized these in a taxonomy to suggest likely relationships among the variables. RESULTS: The central relationship of the proposed taxonomy is between a lay person's perception of dental risk and a set of measurable outcomes that could affect that person's dental care. The taxonomy lists three possible influences on the lay person's risk perception: attributes of the individual, attributes of the dental procedure or technology perceived as risky, and attributes of the dental practice. CONCLUSIONS: Systematic testing of the proposed variables should demonstrate whether lay risk perceptions substantially influence dental care, and if so, which factors most strongly influence risk perceptions. A model of lay risk perceptions of dentistry then could be developed and strategies could be devised to minimize the detriment, if any, to dental care from risk perception.

Implementation of a physician education intervention. The Childhood Asthma Project.

OBJECTIVES: To increase pediatric residents' knowledge of the Guidelines for the Diagnosis and Management of Asthma (GDMA) developed by the Expert Panel of the National Asthma Education Program and to increase the residents' confidence in their ability to implement these guidelines. Emphasis was placed on the diagnosis and treatment of Hispanic children with asthma, a population at increased risk for morbidity. SETTING: A continuity care clinic located in an urban ambulatory care facility. SUBJECTS: Forty-four pediatric residents: 17 first-year residents, 15 second-year residents, and 12 third-year residents. METHODS: Residents participated in a multicomponent asthma management curriculum that stressed active learning strategies, including the following: focus groups, computer-based testing, lectures, hands-on skill development seminars, role modeling by attending pediatricians, provision of GDMA pocket cards and posters, access to peak flowmeters and spirometry, and an interactive computer-based module. Content focused on pulmonary function testing with spirometry and peak flowmeters, stepwise use of medications, recognition of asthma symptoms and triggers, and cultural considerations that impact asthma management. Pediatric faculty and fellows also participated in a series of asthma seminars to increase the likelihood that faculty would role model the GDMA and provide appropriate feedback to residents. RESULTS: Pediatric residents demonstrated significant increases in knowledge about evaluation of asthma, pulmonary function testing, and clinical management, displayed significantly enhanced levels of confidence, and were enthusiastic about the asthma management curriculum, rating it significantly higher than 15 other content areas in the general pediatric curriculum.

Assessment of physicians' information needs in five Texas counties.

In 1990, a questionnaire was mailed to all physicians in four counties in the lower Rio Grande Valley of Texas and to a random sample of physicians in Bexar County, Texas (San Antonio). Two hundred and eighty of 573 Valley physicians (48.9%) and 162 of 273 Bexar County physicians (59.3%) responded to the survey, for an overall response rate of 52.2%. The two groups were compared primarily to determine differences between physicians who have access to established medical libraries and physicians who practice in remote areas without local access to medical information. Demographic variables, professional practice characteristics, and patient characteristics were compared. Information resource use, particularly reasons for use and non-use of MEDLINE, was explored. Questions also were asked about the availability of various types of information technology. The results indicated that differences in the health care profile did not affect the information usage of the physicians but that differences did exist between the two groups in the use of MEDLINE and libraries. There was no statistically significant difference in either group's rating of experience with using databases, with more than 40% in each group rating themselves as not at all experienced.

Hispanic children with asthma: morbidity.

Hispanic children represent a large and growing segment of the poor and disadvantaged children in our country. Asthma and other chronic respiratory diseases have a significant impact on poor children. Yet there are few descriptions of the specific morbidities and barriers to health that Hispanic children with asthma encounter, and data on predictors of morbidity among these children are unavailable. The purpose of this study is to describe the morbidity associated with asthma in Hispanic children and to identify factors that predict morbidity. A group of Hispanic children with moderate asthma followed in the clinics of the University of Texas Health Science Center at San Antonio were studied. Children aged 6 to 16 years with at least two acute-care visits or one hospitalization for asthma during the previous year were enrolled. Data sources included standardized questionnaires, spirometry, medical records, and school attendance records. Seventy-eight Hispanic children were enrolled in the study (mean age = 9.4 +/- 2.7 [SD]; 62% male). Fifty-two (67%) of children had been hospitalized previously. The other morbidity variables (mean +/- SD) were number of days/week impaired (1.1 +/- 1.2), number of days absent from school per year (13 +/- 9.6), number of acute-care visits per year (3.3 +/- 2.4), and number of hospital admissions per year (0.6 +/- 0.8). The mean forced expiratory volume in 1 second/forced vital capacity was 79.3% (+/- 9.1) and the mean forced expiratory flow, mid-expiratory phase, percent predicted was 69.9% (+/- 25.1). Thirty-four children (44%) were exposed to cigarette smoke in the home.(ABSTRACT TRUNCATED AT 250 WORDS)