Childhood asthma is a chronic condition affecting up to one in every seven children. Self-management programs have been developed to help improve children's abilities to both manage and cope with their asthma. If these programs are to be fully effective, an understanding of the psychological factors that influence children's sense of competence to manage their condition is required. This study aimed to identify psychological variables that may influence children's asthma self-efficacy including children's health locus of control, child's attitudes toward illness and children's level of anxiety. The relationship between children's level of asthma knowledge and their sense of competence to manage the illness was explored. The importance of parent's level of asthma knowledge and parent asthma self-efficacy was also examined in relation to children's level of asthma self-efficacy. The study adopted a within group cross-sectional approach. Children aged 7-15 years of age with asthma were invited to participate in the research. Data were collected on 71 children and their parents based on self-report measures rating child and parent asthma self-efficacy and asthma knowledge, child health locus of control, child attitudes toward illness and anxiety. A correlational design was employed to test for associations and relationships between children's asthma self-efficacy and the factors noted above. Results will be given and discussed with reference to previous research findings with conclusions reached.

The study was conducted with a total of 13980 children of the 1995 birth cohort, who were living in Manitoba by the end of December, 2006. Higher frequency of RSV-associated LRTI before 2 years was associated with higher risks of asthma diagnosis at 7 and 11 years and also with risks of transient wheeze and early persistent asthma. Higher risk of asthma diagnosis was associated with more severe episode(s) of RSV-associated LRTI within the first 2 years of life. First clinically significant RSV-LRTI between 6 and 12 months was associated with the highest risks of asthma diagnosis at 7 and at 11 years. But first RSV-associated LRTI within the first 6 months of life was associated with the highest risk of asthma/transient wheezing before the age of 3 years and early persistent asthma and transient wheeze. These associations were diminishing with increasing age of the children of the study cohort.

The study was conducted with a total of 13980 children of the 1995 birth cohort, who were living in Manitoba by the end of December, 2006. Higher frequency of RSV-associated LRTI before 2 years was associated with higher risks of asthma diagnosis at 7 and 11 years and also with risks of transient wheeze and early persistent asthma. Higher risk of asthma diagnosis was associated with more severe episode(s) of RSV-associated LRTI within the first 2 years of life. First clinically significant RSV-LRTI between 6 and 12 months was associated with the highest risks of asthma diagnosis at 7 and at 11 years. But first RSV-associated LRTI within the first 6 months of life was associated with the highest risk of asthma/transient wheezing before the age of 3 years and early persistent asthma and transient wheeze. These associations were diminishing with increasing age of the children of the study cohort.

1. I have described a population of children and young adults with asthma in primary and secondary care, in terms of relevant history, medication use and exacerbations. 2. My thesis presents observations reported for the first time that asthmatic children and young adults homozygous for the Arg16 allele on the ß2 adrenergic receptor gene (ADRB2), on frequent doses of on demand short-acting ß2-agonists are at greater risk of asthma exacerbations.I have shown an increase in the risk of exacerbations per copy of Arg16 allele in children and young adults with asthma on the regular long-acting ß2-agonist salmeterol. 4. I have shown that there is an increase in risk of exacerbations per copy of Arg16 allele in children and young adults with asthma on frequent (once daily or more) as required doses of inhaled salbutamol. This effect is not observed on participants with asthma who are not exposed to ß2-agonist on a daily basis. 5. I have shown that the Arg16Arg variant status may be associated with worse airway obstruction, as measured by the FEV1/FVC ratio.6. I have shown that the individuals with FLG null alleles have a significantly increased risk of exacerbations requiring hospital admissions, courses of oral steroids, or experiencing school absences

The establishment of trust in the nurse-parent relationship is espoused to be fundamental in achieving partnership-in-care within paediatric nursing. Paediatric nursing has progressed since the 1960's and in the 1990's, the major breakthrough was the emergence of the partnership model. Hence, it would be ideal to investigate the elements facilitating the foundation of trust in the formation of a nurse-parent relationship. The purpose of this study is to identify the concept of formation of trust in the relationship between parents whose children suffer from chronic asthma and the paediatric nurses responsible for their care in a paediatric medical setting. The study also determined and explored the characteristics of a trustworthy nurse, and identified those factors which facilitated or impeded the development of trust between the paediatric nurse and the parent within the culture of the paediatric medical setting. Parents of hospitalised children were sought for data collection. Data was collected using field observations and semi-structured interviews. Participant observation and all ethnographic field notes were used to describe culture in relation to the concept of trust in the nurse-parent relationship. The findings indicated that elements vital to the development of trust between parents and paediatric nurses were pre-existing trust, knowledge of asthma, communication, building a relationship and confidentiality. Based on these findings, a model of trust and partnership was developed. The implications of the findings have been significantly related to keeping parents informed of their child's condition, the continuity in nursing care and paediatric nurses to introduce themselves at the beginning of each change of shift.

No description available.

INTRODUCTION: Asthma is one of the most common chronic diseases in the United States, affecting the quality of life of at least 20 million Americans. Almost half of the affected (approximately 9.5 million) are children under the age of 18. While Hispanics overall (5.4%) had lower asthma prevalence compared to non-Hispanics (7.4%), those of Puerto Rican descent (14.5%) have a higher burden of asthma than those of Mexican descent (3.9%). AIM: The purpose of this study was to use data collected from a cohort of Puerto Rican infants born in New York City to examine associations between indoor pesticides use and wheeze and asthma in the first two years of life. The data were collected in a prospective birth cohort of Puerto Rican children born to mothers with a history of allergy or asthma. METHODS: Data analysis was conducted using SAS. Descriptive statistics were calculated and reported as percentages. Bivariate statistics were carried out to test independent associations. Logistic regression models for asthma and wheeze at each time point and generalized estimating equation (GEE) models (for wheeze at the end of the study period) were then created with adjustment of potential confounders. RESULTS: After controlling for confounders, no forms of pesticides were associated with wheeze using logistic regression and GEE. However, use of rodenticides at baseline yielded a hazardous relationship with asthma at two years of age (OR = 3.64, 95% CI = 1.26 - 10.52). DISCUSSION: The strong association with exposure to rodenticides at baseline reveals the importance of early life exposures, specifically those that occur prenatally or perinatally. Because rodenticide exposures have not been specifically identified as a possible risk factor in previous scientific literature, it is difficult to ascertain the mechanism behind exposure and asthma onset. Findings from this study and previous studies indicate that more research is needed to further elucidate the role of pesticides and physiological processes, specifically lung and immune system development, in children, especially those in highly allergenic environments.

No description available.

Neighbourhood stressors have an incubating effect for a variety of health-related disorders involving children. It is of interest is to determine if asthma prevalence is greater amongst school children at age 7-8 resident of chronic stress neighbourhoods in Winnipeg, after adjusting for family history of asthma and socioeconomic status. The urban component of children (1472 entire; 698 birth home) extracted from the Study of Asthma, Genes and the Environment (SAGE) Survey administered in 2002-2003 to a birth cohort from 1995 in Manitoba. Dichotomous parent report of child asthma from the SAGE Survey nested within birth cohort was geocoded by postal code, which allowed designation of neighbourhood in hierarchical linear modelling. Children living in census tracts assigned low SES scores by compositional stressors were found to have a decreased odds of parent report of asthma, while those inhabiting profiles with high contextual crime rates were at increased risk.

Asthma is the most common chronic disease in children and the effects of air pollution exposure on asthma and respiratory health in children have been a growing concern over recent decades. Although a number of epidemiological studies have been carried out in this field, these have produced conflicting results. The aim of this study was to assess the effects of long term exposure to nitrogen dioxide (NO2) and particulate matter (PM10) on asthma prevalence and lung function in children. To achieve this, a novel exposure model was developed and evaluated, which allowed retrospective exposure assessment of children participating in a population based birth cohort study – the Manchester Asthma and Allergy Study (MAAS). MAAS is a prospective birth cohort study comprising 1185 children specifically designed to study asthma and allergies. Clinical follow up took place at ages 3, 5, 8 and 11 years. At each follow up parents completed questionnaires on asthma diagnosis and symptoms and children underwent skin prick tests for common allergens. Children’s specific airways resistance (sRaw, at ages 3, 5, 8, 11) and forced expiratory volume in one second (FEV1, at ages 5, 8, 11) were measured. At ages 5 and 11 years FEV1 was measured at baseline and after bronchodilator treatment. The exposure model developed during this study incorporated outdoor and indoor air pollution, spatio-temporal variation in air pollution and time-activity patterns of children. The model was based on the concept of microenvironmental exposure. It modelled personal exposure based on PM10 and NO2 concentrations in children’s home, school and journey microenvironments (MEs) and the length of time they spend in these MEs. Land use regression (LUR) models were used to model PM10 and NO2 concentrations in outdoor MEs. These LUR models were specifically developed for the Greater Manchester area. A novel method was used to develop the LUR models, which used the output from an air dispersion model as dependent variables in the regression analysis. Furthermore, a novel approach was used to obtain annual concentration of PM10 and NO2 from 1996 to 2010, which involved the recalibration of the LUR models for each year. A mass balance model and indoor to outdoor ratios were used to model concentrations in indoor MEs. The performance of the exposure model was evaluated through a personal monitoring study in schoolchildren attending a local secondary school. Children wore personal NO2 monitors for two consecutive days in four seasons. Parental questionnaires and time-activity diaries were used to obtain information for the exposure model and to model NO2 exposure for the same time period. The results showed good agreement between monitored and modelled NO2 concentrations (Normalised mean bias factor=-0.04). Multiple linear regression and generalised estimating equations (GEE) were used to assess the cross-sectional and longitudinal effect of modelled exposure on sRaw and FEV1 (as % predicted). Multiple logistic regression and GEE were used to assess the effect of modelled exposure on the prevalence of asthma and current wheeze.The longitudinal analyses showed significant associations between PM10 and NO2 exposure and % predicted FEV1 (PM10: B=-1.37, p=0.019; NO2: B=-0.83, p=0.003), but no association with sRaw (PM10: B=0.009, p=0.37; NO2: B=-0.007, p=0.16). The cross-sectional analyses showed no association between pollutant exposure during the summer or winter prior to age 11 and any of the lung function measures (p>0.05). Long term PM10 or NO2 exposure were not associated with asthma or current wheeze (p>0.05).This study developed and evaluated a novel air pollution exposure model for epidemiological research. The results of this study suggest a negative impact of long term exposure to NO2 and PM10 on growth in FEV1 during primary school age. However, no evidence of an association between long term exposure to NO2 and PM10 and childhood asthma was found.