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Thesis (M.Sc.)--University of Alberta, 2009. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Science in Epidemiology, Department of Public Health Sciences. Title from pdf file main screen (viewed on November 6, 2009). Includes bibliographical references.

This study describes ways that parents attempt to help their preschool children with asthma meet their basic human needs. Information about such parental guidance is lacking in the literature and yet parents need assistance from health professionals about how to accomplish the task of rearing their chronically ill children. Ten couples with asthmatic preschool children from the Lower Mainland region of British Columbia were identified and interviewed in their homes. The couples were asked about the actions they took to help their preschool children with asthma meet their basic human needs and the ways they perceived asthma and its treatment affecting their efforts to help these children. An Interview Guide was developed based on the University of British Columbia's Model for Nursing. It is a model with a basic human needs and systems theory framework. All interviews with the couples were audiotaped and later analyzed for content of their communications. The analysis revealed 17 specific helpful actions common to all of the couples, and additional emotions, decisions, and physical efforts to normalize their asthmatic children's and family's daily lives. It was concluded that the couples in this study assumed the responsibilities of helping their preschool children, sick or well, meet their needs to grow and develop according to parental tasks. The intensity of the helping behaviours tended to increase during the children's asthmatic attacks. There are implications for health professionals for developing programs to assist parents to acquire the knowledge, skills and attitudes: to facilitate the growth and development of their children with a chronic disease such as asthma. / Applied Science, Faculty of / Nursing, School of / Graduate

The Self-Regulation Model (Leventhal, Nerenz & Steele, 1984) highlights the roles of patients' illness representations, coping, emotional reactions and appraisal of coping in the progression of chronic disease. This thesis incorporates previous literature on adherence, panic-fear and selfmanagement interventions into the model in order to (a) investigate coping with asthma and (b) develop an intervention aimed at improving asthmatic control. New measures of asthmatic control and illness representations of the consequences of having asthma were developed in order to operationalise the model. A cross-sectional study investigated factors influencing asthmatic control in a sample of 35 adult asthma sufferers recruited through a single general practice. Coping was poor, adherence being low and less than 50% of participants reporting current Peak Flow monitoring or medical contact during the previous 12 months. Good coping appeared to be a response to poor asthmatic control, rather than prophylactic. Good asthmatic control was associated with low perceived consequences, recent medical contact, moderate panic-fear and low general avoidance coping. These results imply that asthmatic control may be improved by encouraging sufferers to maintain regular contact with outpatient services and to implement prophylactic coping. Since epidemiological and clinical evidence suggested asthmatic control to be poor in young adults, an intervention was developed to improve asthmatic control in this group by modifying illness representations, coping and panic-fear. The intervention was evaluated in a randomised controlled study of 50 student asthma sufferers identified initially through an epidemiological screening of 2,979 students. It led to increased Preventer medication use and Peak Flow monitoring and decreased distress over the condition. However, the coping process changed and asthmatic control improved even in the control group, perhaps because self-monitoring of asthmatic control for the study constituted a change in coping. This unanticipated result was entirely compatible with the Self-Regulation Model. The thesis dearly demonstrates value of the Self-Regulation Model in understanding asthma self-management and developing clinical interventions.

Co-culture of eosinophils and BEAS-2B cells was found to increase the release of cytokine IL-6 and chemokines MIG, MCP-1, IL-8 and IP-10 and up-regulate the corresponding genes expression in BEAS-2B cells or eosinophils. Interaction of eosinophil-BEAS-2B cells could also elevate adhesion molecules ICAM-1, VCAM-1, ICAM-3, and CD49d expression on the surface of BEAS-2B cells, and CD18 and ICAM-3 on eosinophils, and up-regulate ICAM-1 gene expression in BEAS-2B cells. Lipopolysaccharide (LPS) and tumor necrosis factor (TNF)-alpha could induce or further induce ICAM-1 expression on eosinophils and BEAS-2B cells upon their interaction. Moreover, activities of both NF-kappaB and p38 MAPK in BEAS-2B cells were markedly elevated after co-cultured with eosinophils. / Freshly isolated eosinophils from human peripheral blood and confluent BEAS-2B cells were co-cultured together in tissue culture plate for a pre-determined time period. Cytokines including interleukin (IL)-1beta, IL-2, IL-4, IL-6, IL-10, IL-12p70, tumor necrosis factor (TNF)-alpha, and interferon (IFN)-gamma and chemokines regulated upon activation normal T cell expressed and secreted (RANTES), monokine induced by interferon-gamma (MIG), monocyte chemoattractant protein (MCP)-1, IL-8, and interferon inducible protein (IP)-10 in culture supernatant were evaluated by protein array and quantified by cytometric bead array (CBA) kit of Th1/Th2 cytokines, inflammatory cytokines, and human chemokines using flow cytometry and enzyme linked immunosorbent assay (ELISA) kit. / In order to investigate the immunopathological mechanism in allergic asthma of eosinophils interacting with bronchial epithelium in inflammation site, a in vitro system of co-culture of human bronchial epithelial cells and eosinophils was set up to mimic the inflammatory reaction. / In summary, co-culture of epithelial cells, BEAS-2B cells, and eosinophils could activate NF-kappaB and p38 MAPK signal transduction pathways to induce inflammatory cytokine IL-6, and chemokines IL-8, MCP-1, MIG and IP-10 release in culture supernatant, and up-regulated the expression of surface adhesion molecules ICAM-1, VCAM-1, ICAM-3 and CD49d protein on BEAS-2B, and CD18 and ICAM-3 on eosinophils. (Abstract shortened by UMI.) / In this study, co-culture of a human epithelial cell line, BEAS-2B cells, and peripheral eosinophils was adopted as an in vitro model to investigate the effect of interaction of epithelial cells and eosinophils in airways on pathophysiology of asthma. / Wang Chengbin. / "July 2005." / Advisers: Wai kei Lam; Chun kwok Wong; Yaping Tian. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3723. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 119-134). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

<p>Asthma is a lung disease characterized by wide variations in airflow over short periods of time. Exacerbations of asthma can be accompanied by symptoms of chest tightness, shortness of breath and wheezing; airway inflammation characterized by an influx of eosinophils and/or neutrophils; and the expression of pro-inflammatory cytokines in the airway. There is strong evidence supporting a central role for the T cell in asthma. In atopic asthma, T cells are documented components of the late-phase response to inhaled allergen, driving airway inflammation, mucus hypersecretion, and bronchoconstriction through the release of cytokines and other mediators. T cells have also been shown to produce inflammatory cytokines in response to allergen in nonatopic asthmatics, indicating a potential role in mediating disease in this phenotype. In both atopic and nonatopic asthma, aberrant T cell responses to allergen may drive the infiltration of neutrophils and eosinophils into the airway through the production of pro- inflammatory cytokines, leading to exacerbations of disease. This project has investigated the role of several T cell cytokines in driving disease and acting as biomarkers in asthma: interleukin-5, interleukin-17A, interleukin-23, interleukin- 10, and interferon-γ. We have measured allergen-induced cytokine production by peripheral blood mononuclear cells (PBMCs) and examined its ability to distinguish between different asthma phenotypes: asthma vs normal, atopic vs nonatopic asthma, eosinophilic bronchitis vs noneosinophilic bronchitis, and neutrophilic vs nonneutrophilic bronchitis. Our data shows that allergen-induced peripheral blood mononuclear cell responses to allergen are not good biomarkers of disease in asthma. No differences in PBMC cytokine production are seen in patients with asthma, compared with normal controls, or between patients with different asthmatic phenotypes. It is not possible to determine a patient’s disease state, atopic status, or type of bronchitis by examining their PBMC cytokine responses to allergen.</p> / Master of Science (MSc)

The control of asthma is a very important part of an asthmatic's life. Decreasing control can lead to asthma attacks, which can be fatal. For this reason, the researchers have set out to create an instrument to measure control of asthma, and have suggested five possible instruments. Before an instrument can be used, it must be shown to be reliable, valid, and responsive. Reliability will be shown using various intraclass correlation coefficients, depending on the model being used for the data. Construct validity will be shown by how well the instrument's correlation coefficients with other instruments correspond to a priori predictions. Responsiveness will be shown by three methods, t tests comparing the change in changers and stable subjects, a responsiveness index, and Receiver Operating Characteristic (ROC) curves. All five instruments are shown to be highly reliable. No conclusions can be drawn as of yet about the validity, as the a priori predictions have yet to made. For all three methods of assessing responsiveness, the five instruments were ranked identically. In choosing the best instrument, no final decisions can be made, as validity has yet to be shown, but at this time it appears as though the simplest instrument (involving only five questions on the patient's asthma symptoms asked at a visit to a clinic) is also the best as it has high reliability and is highly responsive. / Thesis / Master of Science (MS)

Dissertation submitted in partial compliance with the requirements for the Masterà ¢ s Degree in Technology: Chiropractic, Durban University of Technology, 2008. / Objectives: To determine the short-term effect of an inhaled, short-acting 2-agonist bronchodilator on chest wall expansion (cm) and lung function parameters (FEV1, FVC and FEV1/FVC%) in chronic moderate asthmatics. To determine the short-term effect of spinal manipulation (SMT) and ribcage mobilisation on chest wall expansion (cm) and lung function parameters (FEV1, FVC and FEV1/FVC%) in chronic moderate asthmatics. To determine the short-term effect of a combination of SMT, ribcage mobilisation and an inhaled, short-acting 2-agonist bronchodilator on chest wall expansion (cm) and lung function parameters (FEV1, FVC and FEV1/FVC%) in chronic moderate asthmatics. Methods: Forty-five chronic moderate asthmatics who met all the inclusion criteria of the study were divided into three groups of fifteen each. Group A received a short-acting 2-agonist bronchodilator, Group B received SMT and ribcage mobilisation and Group C received a combination of SMT, ribcage mobilisation and a short-acting 2-agonist bronchodilator. Baseline measurements and testing included chest wall expansion and the lung function parameters FEV1, FVC and FEV1/FVC%. These measurements were repeated 15 minutes post-intervention. Data was analyzed using SPSS version 15.0. Results: There were no statistically significant changes between pre- and post-intervention in the short-acting 2-agonist bronchodilator group with respect to any of the chest wall expansion measurements. There was a statisticallly significant increase in FEV1 between pre- and post-intervention in the short-acting 2-agonist bronchodilator group (p = 0.008). There was a statistically significant increase in the mean pre- and post-intervention axillary chest wall expansion (p = 0.014) as well as the mean of the half-way measurement (p = 0.014) and the overall mean chest wall expansion value (p = 0.001) following SMT and ribcage mobilisation. There were no statistically significant changes in any of the lung function parameter values following SMT and ribcage mobilisation. There was a significant increase for the half-way measurement in chest wall expansion (p = 0.018) in the combination of SMT, ribcage mobilisation and the inhaled, short-acting 2-agonist bronchodilator group. There were no statistically significant changes in any of the lung function parameter values in the combination of SMT, ribcage mobilisation and an inhaled, short-acting 2-agonist bronchodilator. For FEV1, the effect in the short-acting 2-agonist bronchodilator group vs. the SMT and ribcage mobilisation group was statistically significant (p = 0.018). There was no statistical difference in any of the chest wall expansion measurements and FVC and FEV1/FVC% parameters between all three groups. Conclusions The results did not point specifically to one intervention over another for all outcomes. SMT and rib mobilisation had no effect on the lung function parameters, at least in the short term. There was a statisticallly significant increase in FEV1 between pre- and post-intervention in the short-acting 2-agonist bronchodilator group.

Asthma is one of the most frequently reported types of chronic illness in children. In an attempt to increase our understanding of childhood asthma in general, and of the individual variations in its clinical severity and the epidemiological variations in its prevalence, a series of social psychological investigations were conducted. Thirty children with asthma and their mothers were interviewed about various facets of the illness. Content analysis of their replies showed that the children with the more mild clinical symptoms, and their mothers, had the more optimistic and sophisticated views of the nature of, and treatment for, asthma. It is suggested that such views may actually help diminish the clinical severity of the children's asthma. The thirty children with asthma and thirty others without asthma answered a test designed to examine how 'responsible' they considered children with and without asthma to be. The children without asthma praised children with asthma more than they blamed them, whereas they blamed children without asthma more than they praised them. This attributional tendency would discourage children without asthma from interacting with children who they perceived as having asthma. The children with asthma, themselves,praised both children with and without asthma more than they blamed them. This attributional tendency would enduce a feeling of helplessness, a sensitivity to adverse comments, and a desire for frequent praise among children with asthma. Both groups of children described their friends and their families. The children with asthma were less able to differentiate their friends and their siblings from themselves and their environment. These children would be awkward in their interaction with their peers and siblings and would find it difficult to establish stable relationships with them. Their reported lack of participation in physical games would exaggerate these problems. The children with more severe clinical asthma reported certain peculiarities in their homelife which may be a reaction to the illness. Teachers answered a questionnaire about the children's classroom behaviour. The children with asthma were more often described as withdrawn and lacking in confidence. The children with more clinically severe asthma were more dissatisfied with school. In conclusion, the different findings are drawn together to provide a social psychological explanation of the different characteristics of childhood asthma. As a result, certain therapeutic strategies are suggested which might help diminish both the extent of the psychological problems of children with asthma and the clinical severity of their illness.

Doctor of Philosophy / Asthma can be a chronic disorder requiring regular medications if the symptoms are persistent. The regimen is often complex, involving a number of drugs and a variety or routes of administration. Although drug therapy may not alter the natural history of asthma it can improve lung function enabling those with asthma to lead as near a normal life as possible. Thus medication compliance is an important factor in the managemnt of asthma. (Note : Special enclosures (Publication reprints) at end of thesis have been removed for digital submission, with permission of author)