Integrative Review of Programs to Improve Outcomes for Children With Comorbid Asthma and Anxiety/Depressive Symptoms.

Asthma is one of the most common pediatric chronic physical conditions. Youth with comorbid asthma and anxiety/depressive symptoms tend to have less controlled asthma and an increased use of health services in schools. The purpose of this integrative review was to examine the literature on educational and behavioral/ cognitive behavioral skills interventions for children with asthma and anxiety/depressive symptoms. Five electronic databases and forward/backward citations were searched. Eleven peer reviewed articles were retained for review. Main findings of the limited evidence suggest that educational and behavioral/cognitive behavioral skills programs may increase asthma knowledge and asthma-related self-efficacy while reducing anxiety/depressive symptoms. One study showed a decrease in use of quick relief inhalers and another had increased adherence to asthma controller medication. The literature indicates that educational and cognitive behavioral skills programs can have a positive impact on children with asthma and symptoms of anxiety/depression. School-based skills programs had better retention than outpatient programs.

A multilevel perspective on goals, barriers, and facilitators of school-based asthma management.

BACKGROUND: School based asthma care is being increasingly used to combat uncontrolled pediatric asthma. OBJECTIVE: The purpose of these secondary analyses was to explore multi-level perspectives regarding school-based asthma medical management for inner city, school-aged children with poor asthma control. METHODS: Sixty-six participants from two large U.S. urban school districts and key stakeholders participated in 1:1 interviews and focus groups. Participants were selected from across the asthma care community (children/caregivers, school personnel, nurses, pharmacists, healthcare providers, and administrators/insurers). Qualitative and descriptive techniques were used to analyze data. RESULTS: Goals: Children/caregivers prioritized living a normal active life with few asthma worries. Other stakeholders prioritized reducing student's asthma related emergency room visits and lost learning time. Facilitators: Continuity of care, strong relationships between care community members, and incentivizers were commonly suggested facilitators. School-based asthma management was viewed as a strong facilitator, particularly in the presence of a full-time school nurse. Barriers: Four themes were identified. (1) Greater systems and policy support for asthma management is needed in general, and at school in particular. (2) Overburdened families and systems often operate in crisis-mode, and asthma management is often not a priority until crisis is reached. (3) Discordance and distrust between members of the asthma care community can hinder shared asthma management. (4) Better communication is needed at all levels to improve care. CONCLUSION: Moving away from a crisis-based approach to asthma management for high-risk children will require increased systemic support for proactive asthma care and optimized communication within the asthma care community.Supplemental data for this article is available online at https://dx.doi.org/10.1080/02770903.2021.2018704.

Considerations in pediatric intervention research: Lessons learned from two pediatric pilot studies.

BACKGROUND AND PURPOSE: Pediatric populations represent a vulnerable research group. Careful thought must be given to many factors when designing and implementing pediatric intervention research studies. This article discusses methodological and implementation lessons learned from two pediatric intervention pilot studies and highlights facilitators and barriers encountered. TYPE OF METHOD: Both studies used a pre/post with 6-week follow-up method and were adapted versions of an evidence-based program, Creating Opportunities for Personal Empowerment (COPE). ESSENTIAL FEATURES: COPE is a 7-session, cognitive behavioral skills building intervention. COPE for Asthma was implemented in schools with small groups for elementary-aged children with asthma and symptoms of anxiety. Mindstrong to Combat Bullying was implemented individually in the outpatient mental health setting for adolescents who had experienced bullying with concurrent symptoms of depression/anxiety. METHODOLOGICAL APPLICATION: Both intervention studies were successful in achieving their research aims, but more importantly the authors learned important lessons in how to successfully work with pediatric populations in research studies. Legal considerations, such as mandated reporting, suicide risk assessment and the inclusion of parents are reviewed. Other components, such as working with children vs. adolescents, integrating research into school-based settings vs. clinic-based settings, and completing intervention research in a group setting vs. individual setting are discussed. CONCLUSIONS: The two pilot studies highlight important factors to consider when designing and implementing pediatric intervention studies. While challenges arise in working with this vulnerable population, research is ultimately needed to provide the best evidence-based care for our future generations. CLINICAL TRIAL REGISTRATION: The COPE for Asthma study is registered at www. CLINICALTRIALS: govNCT03481673.

Summary of the 2020 focused updates to U.S. asthma management guidelines: What has changed and what hasn't?

ABSTRACT: Despite the availability of effective medications, the majority of pediatric and adult patients with persistent asthma have uncontrolled symptoms. This has been attributed to patient nonadherence and poor self-management, but clinicians also contribute through inaccurate assessment of asthma and lack of familiarity with best practice guidelines for medication management. Thus, improving patient outcomes will require improving clinical management by health care providers, including utilization of evidence-based practice guidelines. In this report, we briefly summarize key points of the national guidelines for asthma management and delineate important changes enacted by 2020 Expert Panel Report-4 updates. These include revised recommendations on the use of fractional exhaled nitric oxide testing, indoor allergen mitigation, bronchial thermoplasty, adjunctive immunotherapy, and important modifications to medication management that are likely to have widespread impact on prescribing throughout the United States. In particular, for all patients aged five years and older taking stepwise therapy levels 3-4, it is now recommended to use Single Maintenance and Reliever Therapy, whereas the use of intermittent inhaled corticosteroids (ICSs) administered at the same time as short-acting beta agonist is recommended for step 2 to reduce symptom burden, improve control, and minimize total ICS dose.

Factors Associated With Healthy Lifestyle Behaviors Among Adolescents.

OBJECTIVE: Guided by cognitive theory, this study tested an explanatory model for adolescents' beliefs, feelings, and healthy lifestyle behaviors and sex differences in these relationships. METHODS: Structural equation modeling evaluated cross-sectional data from a healthy lifestyle program from 779 adolescents 14 through 17 years old. RESULTS: Theoretical relationships among thoughts, feelings, and behaviors were confirmed and sex differences identified. Thoughts had a direct effect on feelings and an indirect effect through feelings on healthy behaviors for both sexes. A direct effect from thoughts to behaviors existed for males only. DISCUSSION: Findings provide strong support for the thinking-feeling-behaving triangle for adolescents. To promote healthy lifestyle behaviors in adolescents, interventions should incorporate cognitive behavioral skills-building activities, strengthening healthy lifestyle beliefs, and enhancing positive health behaviors.

Nursing Across the Lifespan: Implications of Lifecourse Theory for Nursing Research.

Despite the lifecourse focus of nursing clinical care, nursing research largely remains cross-sectional or process-oriented within silos determined by patient characteristics such as age, acuity, or disease process. Incorporating interdisciplinary lifecourse theory into pediatric nursing research provides the opportunity to expand nursing theories and research beyond practice, age, and disease silos. One such theory is the Lifecourse Health Development (LCHD) framework. LCHD takes a more expansive view of health development from preconception through old age based on the premise that health is a consequence of transactions between genetic, biological, behavioral, social, and economic contexts that change as a child develops over time (Halfon & Hochstein, 2002). LCHD also explains how intergenerational influences and prevention during early life help predict health development and disease over the lifespan. The preventive and lifecourse focus of LCHD is well-aligned with the lifespan wellness foci of pediatric nurses. The purpose of this article is to introduce pediatric nurse researchers to LCHD and discuss proposed augmentations and implications related to expanding LCHD into pediatric nursing research.