Control Questionnaire Research Articles

The Effect of Clinical Observations on Nursing Students' Compliance with Standard Precautions: A Cross-sectional Study.

Healthcare-associated infections pose a significant global challenge, highlighting the need for enhanced knowledge and practices among healthcare professionals. This study investigates the impact of clinical observations on nursing students' compliance with standard precautions. Employing a cross-sectional descriptive design, the study surveyed 405 nursing students using a 'Personal Information Form', the 'Nurses' Observations on Infection Control and Prevention Questionnaire', the 'Standard Precautions Scale', and the 'Factors Affecting Compliance with Standard Precautions Scale'. The mean scores for the Nurses' Observations on Infection Control and Prevention Questionnaire, the Standard Precautions Scale, and the Factors Affecting Compliance with Standard Precautions Scale were 33.39±12.98, 10.93±4.79, and 53.38±10.35, respectively. A significant negative correlation was found between students' observations on infection control and their compliance with standard precautions (r=-.254, p<0.01), with their observations explaining only 6% of the variance in compliance. The findings suggest that the influence of nursing students' observations during clinical practice on their compliance to standard precautions is minimal. This study highlights the necessity of developing more effective strategies to improve nursing students' compliance to standard precautions, extending beyond observational learning alone.

Assessing the utility of fractional exhaled nitric oxide-guided management in adult patients with asthma: A systematic review and meta-analysis.

Fractional exhaled nitric oxide (FeNO) has been utilized as a reliable biomarker for diagnosis, treatment response, and prediction of future risks in asthma care, that potentially ensures the efficacy of FeNO-guided asthma management. As previous systematic reviews reported limited efficacy with this approach, we evaluated the efficacy of FeNO-guided management in monitoring adults with asthma. In this systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Review and Meta-Analyses Statement and the Minds Manual for Guideline Development, we updated a Cochrane systematic review in 2016 by adding six papers reporting randomized controlled trials with a treatment duration ≥12 weeks published between June 2016 and July 2022, and conducted a sub-analysis of two groups stratified by the strategy used: the FeNO-alone and FeNO with symptom score groups. In thirteen RCTs included, FeNO-guided management improved the numbers of participants with one or more asthma exacerbations and the number of exacerbations per 52 weeks. Compared with conventional management, FeNO-guided management marginally improved asthma control questionnaire scores and decreased inhaled corticosteroid doses. In contrast, FeNO-guided management did not improve severe exacerbations requiring oral corticosteroids or hospitalization, percent predicted forced expiratory volume in 1s, FeNO levels, or asthma-related quality of life scores. Subgroup analysis revealed that, compared with conventional management, both FeNO-symptom score- and FeNO alone-based management decreased the number of asthma exacerbations. FeNO-guided management can effectively reduce exacerbations in adults with asthma.

Development and Testing of the Spinal Cord Injury Bladder and Bowel Control Questionnaire (SCI-BBC-Q).

Recovery of lower urinary tract (LUT) and lower gastrointestinal tract (LGIT) is a high priority for people with lived experience following spinal cord injury (SCI). A universally accepted validated patient-reported outcome (PRO) measure of the individual sensory and motor components of LGIT and LUT function, which allows tracking of recovery is lacking. To address this literature gap, the SCI Bladder and Bowel Control Questionnaire (SCI-BBC-Q) was developed. The SCI-BBC-Q was developed as a direct assessment of the micturition and defecation experiences of an individual with SCI with possible neurogenic LUT and LGIT dysfunction. The SCI-BBC-Q development process consisted of two phases, measure development and evaluation. Measure development was guided by a conceptual framework, review of existing instruments and literature, and an iterative process of item incorporation, review, feedback, and consensus revision. Evaluation included cognitive interviewing, and assessments of feasibility, reliability, and content validity. The final 6-item SCI-BBC-Q is a PRO, which assesses motor and sensory function related to micturition and defecation, requiring ~5 min to complete. Assessments of clarity of the instrument components with regard to understanding of what is being asked in the questionnaire, feasibility of administration, reliability, internal consistency, and agreement with proxy measures have demonstrated that the SCI-BBC-Q provides consistent, stable, and reproducible data. Significant correlations were found between SCI-BBC-Q scores and the anorectal motor and sensory components of the International Standards for the Neurological Classification of SCI. The SCI-BBC-Q is a practical and reliable method for baseline and ongoing evaluation of patients with neurogenic LUT and LGIT dysfunction, especially in the acute and subacute period when function is changing due to neurological plasticity. It is also appropriate for use in monitoring response to treatments related to neurological recovery.

Rome IV functional defecation disorder: time for a change in symptom criteria for improved clinical relevance?

Defecatory disorders are common affecting up to 8% of the population. Rome IV diagnostic criteria are used to define this condition and therefore select patients for the gold standard therapy, anorectal biofeedback. The aim of this study was to test the current Rome IV FDD criteria in a real-world population by utilizing the response to biofeedback as a validation tool. 485 patients (F 437 mean age 50±17.6) with defecatory symptoms presenting to a Neurogastroenterology clinic underwent anorectal biofeedback therapy regardless of whether they met formal Rome IV FDD criteria or not. Patients were assessed extensively with Rome questionnaire, constipation questionnaire and visual analog scales for satisfaction, control and quality of life and anorectal manometry. Rome IV FDD was no better at predicting response to biofeedback compared to non-Rome IV FDD (p=NS). Digitation (p=0.043) and increasing cumulative number of defecatory symptoms (p=0.038) were correlated with improvement with biofeedback (≥2 point increase in bowel satisfaction). Those with abnormal physiology only responded well to biofeedback (83% response rate) but this was not statistically different to non-physiology patients (73%). There was a trend for increasing cumulative number of abnormal physiology factors to correlate with biofeedback (p=0.086). Rome IV symptom criteria need revision to include more defecatory symptoms, include all subtypes of IBS, and be inclusive of those with either loose stools or more frequent stools such as those previously labelled with "pseudodiarrhea" or "hyperdefecation". Continuing to include physiology criteria in the Rome diagnosis of FDD appears valid.

Clinical importance of patient-reported outcome measures in severe asthma: results from U-BIOPRED

RationaleKnowledge about the clinical importance of patient-reported outcome measures (PROMs) in severe asthma is limited.ObjectivesTo assess whether and to what extent asthma exacerbations affect changes in PROMS over time and asthma-specific PROMs can predict exacerbations in adult patients with severe asthma in usual care.MethodsData of 421 patients with severe asthma (62% female; mean age 51.9 ± 13.4 years; mean FEV1 67.5 ± 21.3%pred) from the U-BIOPRED cohort were analyzed. The included PROMs were: Asthma Control Questionnaire (ACQ5); Asthma Quality of Life Questionnaire (AQLQ); Hospital Anxiety and Depression scale (HADS); Epworth Sleepiness Scale (ESS); Medication Adherence Report Scale (MARS); Sino-Nasal Outcomes Test (SNOT20). Participants were assessed at baseline and after 12–18 months of usual care.ResultsPROMs showed very weak to weak correlations with clinical characteristics such as age, body mass index, FEV1, FeNO and eosinophilic cell count. Patients presenting no exacerbations during follow-up showed a statistically significant improvement in all PROMs (except for MARS), whereas individuals experiencing > 2 exacerbations showed a deterioration. Baseline ACQ5 was a predictor of exacerbations with an AUC of 0.590 (95%CI 0.514–0.666).ConclusionsThe association of PROMs with clinical measures was poor in severe asthmatics. Moreover, PROMs were prone to changes in usual care, with exacerbations playing a key role. PROMs need to be systematically evaluated in severe asthma to improve clinical care based on specific patient’s needs.

The effectiveness of vaccination against pneumococcal infection in patients with severe bronchial asthma

The article discusses topical issues of the use of conjugated 13-valent pneumococcal vaccine Prevenar®13 (PCV13) in patients with severe bronchial asthma (SBA), including those receiving targeted therapy with genetically engineered biological drugs (GEBD). To study the effectiveness of vaccination against pneumococcal infection (PI) in patients with SBA. The study included 381 patients with SBA. The average age in the study groups was 45.5 (42.0; 52.5) years. All patients underwent clinical and instrumental studies, including spirography with bronchodilation test. After confirming the diagnosis of BA, the patients were divided into 2 observation groups. Group 1 (n=191) consisted of patients undergoing treatment with GEBD. Group 2 included patients with asthma receiving standard therapy, according to the 4th-5th stage according to the criteria of the Global Initiative for Asthma 2022 (Global Initiative for Asthma - GINA). The observation group consisted of 190 patients. In each group, there are subgroups of patients who have been vaccinated against PI and have not been vaccinated for various reasons. The following criteria were used as the main endpoints of observation for 12 months to assess the effectiveness: the number of pneumonia during the observation period, the number of exacerbations of asthma (severe, non-severe), the number of hospitalizations, the duration of exacerbations, the level of control according to the Asthma Control Questionnaire (ACQ5), functional indicators. The coverage of PI vaccination in patients with BA remains quite low, further organizational and methodological work is required to increase their involvement in vaccination. Immunization of PCV13 in patients with SBA at the 4th-5th stage of therapy reduces the risk of community-acquired pneumonia by at least 28.5%. PCV13 vaccination may be an additional effective tool for controlling the symptoms of SBA, including in patients undergoing treatment with GEBD. Vaccination allows to normalize the functional parameters of respiratory function in patients with SBA. PCV13 is well tolerated and does not cause any significant allergic reactions in patients with asthma. PCV13 vaccination is an effective tool for reducing the risk of community-acquired pneumonia in patients with severe bronchial asthma, including those on targeted therapy with genetically engineered biological drugs.

Exploring the Correlation between the Cycle Threshold value of Syncytial Virus and Paraclinical Characteristics of Patients with Severe Asthma

Background and objectives Asthma is an important chronic disease of the respiratory tract that can present with different severities. Several factors play a role in its exacerbation; yet, the role of human respiratory syncytial virus (HRSV) on persistent severe asthma is not fully understood. Therefore, this study aimed to investigate the association of HRSV threshold cycles (Ct) with persistent severe asthma. Materials and methods In this study, 100 severe asthma were enrolled, and 45 adults infected with HRSV participated; their demographics (age, sex, body mass index), asthma control status (measured by asthma control questionnaire and asthma exacerbation severity classification), lung tests (spirometric breathing test and exhaled nitric oxide), were recorded. A sputum sample was collected from all participants; after extracting the RNA, real-time PCR was performed and the association of Ct values with the study variables was studied. Results The analysis revealed significant correlations between HRSV and clinical parameters such as BMI, FEV1, and exacerbation severity. Specifically, there was a reverse correlation between HRSV and BMI (r=0.492, p=0.03) as well as exacerbation severity (r=-0.481, p=0.02). Additionally, a positive correlation was found between HRSV and PEF (r=0.633, p=0.04), and a notable correlation with FEV1 (r=-0.502, p=0.02). Conclusion The study highlights that Human Respiratory Syncytial Virus (HRSV) significantly impacts respiratory health and may worsen asthma in affected patients. Therefore, effective preventive measures, such as vaccination or early treatment, are essential for better asthma management.

Baseline Characteristics of Dupilumab-Treated Patients with Asthma in the Real World: The RAPID Global Registry.

Patients with uncontrolled, moderate-to-severe asthma have a higher risk for exacerbations, negatively impacting lung function and quality of life. Dupilumab, a fully human monoclonal antibody, blocks interleukins 4 and 13, key and central drivers of type 2 inflammation. Dupilumab has been effective in the treatment of certain types of moderate-to-severe asthma across several clinical trials. We describe the characteristics of patients enrolled in RAPID, a global prospective registry, who initiated dupilumab (primary indication: asthma) in a real-world clinical setting. A total of 205 patients (aged≥12years) were enrolled between March 2020 and October 2021 and are included in this analysis. Data are shown as mean (SD) unless stated otherwise. Patients were aged 50.1 (17.4) years and were mostly female (65.4%) and white (74.1%). At enrollment, 24.4% reported being current/former smokers and 86.8% had moderate-to-severe asthma (Global Initiative for Asthma steps 3-5). A mean (SD) of 4.4 (6.4) severe asthma exacerbations were reported in the year before enrolling in the registry in 78 of 152 patients with available data. Patients had reduced lung function [pre-bronchodilator forced expiratory volume in 1s (FEV1): 2.3 (1.1) L; pre-bronchodilator percent predicted FEV1: 70.3 (20.3) %] and poor asthma control [6-item Asthma Control Questionnaire: 2.4 (1.2); Asthma Quality of Life Questionnaire: 4.1 (1.3)]. The median (Q1-Q3) blood eosinophil count was 305 (200-695) cells/µL and the mean (SD) fractional exhaled nitric oxide levels were 42 (35) ppb (range: 4-186ppb). Our findings suggest that most patients who enrolled in RAPID and initiated dupilumab in real-world clinical settings had a high disease burden, despite receiving current standard-of-care treatment at enrollment.

EFFECTIVENESS OF AUGMENTED REALITY-BASED THERAPEUTIC PATIENT EDUCATION ON HEALTH LOCUS OF CONTROL IN TYPE 2 DIABETES MELLITUS PATIENTS

Background: Type 2 Diabetes Mellitus (T2DM) is a chronic disease with a rising global prevalence, significantly affecting patients' quality of life and the health system. Effective management of T2DM requires patients to actively regulate their diet, physical activity, and adherence to treatment. Health Locus of Control (HLC) measures the extent to which individuals believe their health is influenced by their actions (internal), others (powerful others), or chance. Augmented Reality (AR) technology presents an innovative method for therapeutic education, potentially enhancing patient engagement and learning effectiveness. Objectives: To analyze the effect of Augmented Reality-based therapeutic patient education on health locus of control in T2DM patients. Methods: A quasi-experimental design with pre- and post-tests and a control group was used. Non-probability purposive sampling selected 100 respondents, divided into an intervention group (50) and a control group (50). The Multidimensional Health Locus of Control questionnaire served as the research instrument. Univariate analysis described respondents' frequency distribution, mean, median, and standard deviation. Bivariate analysis utilized the Wilcoxon test. Results: Augmented Reality based Therapeutic Education significantly improved HLC scores in T2DM patients: Internal (p = 0.01), Powerful Others (p = 0.02), and Chance (p = 0.00). However, no significant difference was found between the intervention and control groups in terms of overall HLC improvement, indicating the need for further research to confirm these preliminary findings. Conclusion: Augmented Reality-based Therapeutic Education shows promise in enhancing patients' perception of control over their health. This innovative approach could significantly impact clinical practice and patient education.

Factors associated with uncontrolled severe asthma in the biologic era

BackgroundDespite the development of biologics for severe asthma, individuals with uncontrolled status persist, posing a significant social problem. This multicenter prospective study aimed to identify factors associated with the uncontrolled status of patients with severe asthma in the biologic era assessed using the Asthma Control Questionnaire (ACQ). MethodsSubjects with severe asthma diagnosed by respiratory specialists were enrolled from 11 hospitals. Clinical data and questionnaires were collected. We compared controlled (ACQ-5 <1.5) with uncontrolled severe asthma (ACQ-5 ≥1.5) and assessed factors linked to uncontrolled severe asthma using logistic regression analysis. ResultsOne hundred fifty-four patients were analyzed (median age, 66 years; 62.3 % female; 52.6 % administered biologics). Among them, 56 patients (36.4 %) had uncontrolled severe asthma (ACQ-5 ≥1.5). The uncontrolled group had more frequent exacerbations (≥2 times in the previous year) and elevated blood neutrophil counts compared with the controlled group. Factors associated with uncontrolled status were analyzed in the overall population, with patients stratified into two groups: those receiving biologics and those not receiving biologics. Multivariate analysis revealed that frequent exacerbations and elevated blood neutrophil counts were associated with uncontrolled status in the overall population and in patients without biologics, whereas elevated blood neutrophil counts were significantly associated with uncontrolled status in patients receiving biologics. ConclusionElevated blood neutrophil counts and frequent exacerbations were independently associated with uncontrolled severe asthma. Specifically, elevated blood neutrophil counts were a significant factor related to uncontrolled status irrespective of biologics, suggesting their potential utility as a biomarker in the biologic era.

Early life events may be the first steps on the multistep path to amyotrophic lateral sclerosis

A combination of multiple genetic and environmental factors appear to be required to trigger the onset of amyotrophic lateral sclerosis (ALS). Early life environmental exposures have been reported to be risk factors for a variety of adult-onset diseases, so we used data from an online international ALS case–control questionnaire to estimate whether any of these could be risk factors for the clinical onset of ALS. Responses were obtained from 1,049 people aged 40 years or more, 568 with ALS and 481 controls. People with ALS were more likely to have been born and lived longer in a country area than in a city area, to have younger parents, and to have lower educational attainment and fewer years of education. No ALS-control differences were found in sibling numbers, birth order, adult height, birth weight, parent smoking, Cesarean delivery, or age of starting smoking. In conclusion, early life events and conditions may be part of a group of polyenvironmental risk factors that act together with polygenetic variants to trigger the onset of ALS. Reducing exposure to adverse environmental factors in early life could help to lower the risk of later developing ALS.

Locus Of Control As Correlates Of Mathematics Achievement Among Senior Secondary School High Ability Students In Calabar Metropolis Of Cross River State, Nigeria

This study adopted correlational survey design to established the relationship between the locus of control and Mathematics academic achievement of senior secondary school high ability students in Calabar Metropolis of Cross River State, Nigeria. Two research questions were posed which were translated into two null hypotheses. Multiple sampling approaches including stratified, and purposive sampling approaches, teacher nomination check list, school record were used to select a sample of 100 students for the study. Two instruments titled “Locus of Control questionnaire (LCQ) and Mathematics Achievement Test (MAT) were developed by the researcher and validated by experts and used for data collection. Then reliability of the questionnaire using Cronbach Alpha reliability estimate ranges from .84 for internal locus of control to .86 for external locus of control while the reliability estimate of the high ability Students’ Mathematics achievement test was established through Kuder Richardson formula K-R20 which gives .85. This therefore imply that both internal and external locus of control influence Mathematics achievement of high ability students. The hypotheses were tested using Pearson Product Moment. Correlation Coefficient. All hypotheses were tested at -05 level of significance. The findings of the study revealed that internal locus of control and external locus of control individually relate to academic achievement in Mathematics of high ability students in Calabar Metropolis of Cross River State, Nigeria. It was therefore concluded that Mathematics achievement of high ability students depends on their internal and external locus control. Based on finding and conclusion of the study, it was recommended amongst others that educational institutions should integrate programs that promote an internal locus of control among high ability students. This should include training in goal-setting, self-reflection, and self-regulation strategies to help students recognize the impact of their efforts on their academic outcomes.

Early Treatment Response to Mepolizumab Predicts Clinical Remission in Severe Eosinophilic Asthma

Mepolizumab can induce an early response and clinical remission in people with severe eosinophilic asthma (SEA). To find whether early response to mepolizumab (100 mg) could predict future asthma remission and to identify the best predictor of treatment response to mepolizumab for achieving remission. The Australian Mepolizumab Registry was used to investigate the early response to mepolizumab at 3 and 6 months and relate this to clinical remission at 12 months. Treatment response was assessed using the 5-item Asthma Control Questionnaire (ACQ-5), oral corticosteroid (OCS) dose, exacerbation frequency, and postbronchodilator FEV1. Clinical remission, assessed at 12 months, was defined as an ACQ-5 score less than or equal to 1.0 at 12 months, no exacerbations in the previous 6 months, and no OCS use for asthma in the previous 6 months. We estimated the optimism-corrected area under the curve for internal validation. We analyzed 255 participants with SEA. Seventy-eight (30.6%) participants achieved clinical remission at 12 months. A prediction model including ACQ-5 score, exacerbation frequency, OCS dose, and postbronchodilator FEV1 at 6 months was more predictive of achieving remission than measures at 3 months. The ACQ-5 score at 6 months had the highest optimism-corrected area under the curve of 0.778 (95% CI, 0.719-0.833). An ACQ-5 score less than 1.5 at 6 months had a sensitivity of 85.9% for achieving clinical remission, whereas an ACQ-5 score less than 0.75 had a specificity of 84.7%. The ACQ-5 score at 6 months was the best predictor of achieving clinical remission at 12 months in people with SEA treated with mepolizumab. These results can be used to design a treat-to-target paradigm for asthma, in which treatment response is assessed at 6 months to predict clinical remission.

Clinical Remission in Patients With Biologic-Naïve Asthma: A Multicenter Study in Japan

BackgroundClinical remission (CR) is a new realistic management goal for patients with asthma, regardless of the disease severity. ObjectiveTo investigate the rate of achievement of CR in patients treated with inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) and non-biologics, and the characteristics of patients who achieved CR. MethodsWe performed a post hoc analysis from a multicenter, cross-sectional survey in Japan. 3-way CR was defined as the absence of exacerbation, no use of maintenance oral corticosteroids, and the absence of significant asthma symptoms (5-item Asthma Control Questionnaire [ACQ] < 1.5). We defined 4-way CR as 3-way CR plus having normalized lung function (forced expiratory volume [%FEV1] ≥ 80%). Deep remission (DR) was defined as 4-way CR plus suppressed type-2 airway inflammation (fractional exhaled nitric oxide [FeNO] < 35 ppb). ResultsThe criteria for 3-way CR, 4-way CR, and DR were met by 56.9%, 35.0%, and 24.7% of patients, respectively. Compared to patients who achieved the 3-way CR, unachieved patients have lower %FEV1 (77.6% vs. 85.4%, p<0.0001), higher FeNO levels (42 ppb vs. 34 ppb, p=0.0182), and there were more discordances in asthma control perception between patient-physicians (38.5% vs. 9.3%, p<0.0001). Physician-patient discordance was an independent factor that prevented the achievement of the 3-way CR in the logistic regression analysis, even when adjusted for %FEV1 and FeNO (odds ratio 0.397, p<0.0001). ConclusionAchieving CR in patients treated with ICS/LABA without biologics is challenging. Discrepancies between patient and physician perceptions on asthma control are significant barriers to achieving CR.

Benralizumab: Effectiveness in Patients with Uncontrolled Severe Eosinophilic Asthma at 6 and 12 Months at a Third-Level Care Hospital. Capacity for ICS-LABA Therapy Reduction.

Asthma is a health condition with worldwide relevance, evaluated based on the necessary treatment to control symptoms and exacerbations. Severe asthma is uncontrolled despite high doses of ICS-LABA and treatment for triggering factors. Severe eosinophilic asthma is characterized by an increase in eosinophils in the peripheral circulation, walls, and passages of the respiratory tract. Biologic treatments such as benralizumab have demonstrated effectiveness as aids in decreasing respiratory tract inflammation and improving the management of symptoms in patients living with asthma. To assess the efficacy and safety of benralizumab as an add-on therapy for patients with severe, uncontrolled asthma and elevated blood eosinophil counts. Observational, analytic and ambispective study in 21 patients diagnosed with severe eosinophilic asthma treated with benralizumab, to determine the treatment's effectiveness through the change in estimated respiratory function by spirometry through the forced expiratory volume in one second (FEV1) value, reduction in second controlling treatment, serum eosinophil reduction, change in the Asthma Control Test score and the Asthma Control Questionnaire test at 6 and 16 months of treatment. An average difference of 241.43 mL (±461.43) in FEV1 at 6 months was found, as well as an average FeNO reduction of 49.8 ppm and eosinophil reduction of 612.78 cells at 12 months of treatment, additionally, CSI requirements were reduced in 95% of patients. Benralizumab improved respiratory function as well as key biomarkers such as eosinophil count, exhaled nitric oxide fraction (FeNO), which reflected in a decreased requirement of inhaled corticosteroids and improved symptom control.

Considering different Montreal Cognitive Assessment cutoff scores for older adults with asthma.

Background: There is a greater prevalence of cognitive impairment among ethnic and/or racial minorities, and cognitive impairment is a barrier to asthma self-management (SM) behaviors and outcomes in older adults. Objective: The aim of this study was to examine the relationship between cognitive impairment, assessed by using the Montreal Cognitive Assessment (MoCA), and asthma SM behaviors and outcomes in a sample of predominantly Black and Latino participants. In addition, we evaluated whether using two different MoCA cutoff scores influenced the association between cognitive impairment and asthma outcomes. Methods: Baseline cross-sectional data were extracted from a longitudinal study of older adults with asthma (N = 165) ages ≥60 years. Cognition was assessed by using the MoCA. Asthma Control Questionnaire, asthma-related quality of life (AQOL), and inhaled corticosteroid (ICS) adherence were assessed by using self-report. ICS dosing was collected through chart review and inhaler technique was observed and rated. Results: Using established MoCA cutoff scores of 23 and 26 yielded 45% and 74% cognitive impairment rates, respectively. Cognitive impairment, defined by using the cutoff score of 23, was significantly associated with worse asthma control (p = 0.04) and worse ICS adherence (p = 0.01). With a cutoff score of 26, only AQOL was significantly associated with cognitive impairment (p = 0.03). Race and/or ethnicity moderated the relationship between cognitive impairment and asthma control with a MoCA cutoff score of 23, and between cognitive impairment and AQOL with a MoCA cutoff score of 26. Conclusion: Cognitive impairment in older adults with asthma is associated with important clinical outcomes, but this relationship is influenced by the cutoff score used to define cognitive impairment.

Inhaled Reliever Therapies for Asthma

The optimal inhaled reliever therapy for asthma remains unclear. To compare short-acting β agonists (SABA) alone with SABA combined with inhaled corticosteroids (ICS) and with the fast-onset, long-acting β agonist formoterol combined with ICS for asthma. The MEDLINE, Embase, and CENTRAL databases were searched from January 1, 2020, to September 27, 2024, without language restrictions. Pairs of reviewers independently selected randomized clinical trials evaluating (1) SABA alone, (2) ICS with formoterol, and (3) ICS with SABA (combined or separate inhalers). Two reviewers independently extracted data and assessed risk of bias. Random-effects meta-analyses synthesized outcomes. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) was used to evaluate the certainty of evidence. Asthma symptom control (5-item Asthma Control Questionnaire; range, 0-6, lower scores indicate better asthma control; minimum important difference [MID], 0.5 points), asthma-related quality of life (Asthma Quality of Life Questionnaire; range, 1-7, higher scores indicate better quality of life; MID, 0.5 points), risk of severe exacerbations, and risk of serious adverse events. A total of 27 randomized clinical trials (N = 50 496 adult and pediatric patients; mean age, 41.0 years; 20 288 male [40%]) were included. Compared with SABA alone, both ICS-containing relievers were associated with fewer severe exacerbations (ICS-formoterol risk ratio [RR], 0.65 [95% CI, 0.60-0.72]; risk difference [RD], -10.3% [95% CI, -11.8% to -8.3%]; ICS-SABA RR, 0.84 [95% CI, 0.73-0.95]; RD, -4.7% [95% CI, -8.0% to -1.5%]) with high certainty. Compared with SABA alone, both ICS-containing relievers were associated with improved asthma control (ICS-formoterol RR improvement [MID] in total score, 1.07 [95% CI, 1.04-1.10]; RD, 4.1% [95% CI, 2.3%-5.9%]; ICS-SABA RR, 1.09 [95% CI, 1.03-1.15]; RD, 5.4% [95% CI, 1.8%-8.5%]) with high certainty. In an indirect comparison with ICS-SABA, ICS-formoterol was associated with fewer severe exacerbations (RR, 0.78 [95% CI, 0.66-0.92]; RD, -5.5% [95% CI, -8.4% to -2.0%]) with moderate certainty. Compared with SABA alone, ICS-formoterol (RD, -0.6% [95% CI, -1.3% to 0%]) was not associated with increased risk of serious adverse events (high certainty) and ICS-SABA (RD, 0% [95% CI, -1.1% to 1.2%]) was not associated with increased risk of serious adverse events (moderate certainty). In this network meta-analysis of patients with asthma, ICS combined with formoterol and ICS combined with SABA were each associated with reduced asthma exacerbations and improved asthma control compared with SABA alone.

Cross-cultural adaptation and validation of a French version of the perceived personal control questionnaire as an outcome measure instrument for genetic counseling.

The perceived personal control (PPC) questionnaire serves as an instrument to assess the concept of PPC, which refers to a person's perception of their ability to achieve positive outcomes while avoiding the negative effects of a given situation. Developed and used as a patient-reported outcome measure (PROM) in genetic counseling, the PPC questionnaire has been translated and validated in several languages, but not in French. The aim of this study was to cross-culturally adapt and validate a French version of the PPC questionnaire to evaluate genetic counseling services for hereditary breast and ovarian cancer (HBOC). After the translation into French, cognitive interviews were conducted with nine participants who had attended genetic counseling for HBOC to examine the adequacy of this French version and to verify participants' understanding of the questionnaire items. Cognitive interview data suggested that slight modifications should be made to four of the nine items and that it would be beneficial to add a short introduction to ensure that participants' interpretation corresponded to the intended meaning. Psychometric validation was then conducted with 99 participants who had also attended genetic counseling for HBOC. Counselees completed the questionnaire before and after their genetic consultation. The acceptability of the questionnaire was demonstrated by the presence of few missing items. The original three-factor solution was not confirmed by our exploratory factor analysis, suggesting that the questionnaire should be used as a one-dimensional instrument. The internal consistency of the questionnaire was high, with Cronbach's alpha of 0.89 before genetic counseling and 0.88 after. The significant increase in PPC scores before and after genetic counseling supports the responsiveness of the questionnaire. Convergent validity was confirmed by positive association with counselees' satisfaction with genetic counseling. These properties suggest the French PPC questionnaire is a valuable instrument for use as a PROM in genetic counseling research.

The Climate-Asthma Connection: Examining the Influence of Climate Change Anxiety on Asthma Control and Quality of Life: A Multi-National Study.

This study aims to identify the impact of climate change anxiety and asthma control on asthmatics' quality of life and examine the moderating role of climate change anxiety in this linkage. A multi-national cross-sectional study was conducted in four Arabian countries on 1266 asthmatics selected by convenience sampling. Data were collected from November 2023 to February 2024 using a climate anxiety scale, mini-asthma quality of life questionnaire, and an asthma control questionnaire. Climate anxiety was higher among middle-aged participants, as well as those with longer disease durations and previous hospitalisations. Climate anxiety showed strong negative correlations with asthma control (r = -0.704, p ≤ 0.05) and asthma quality of life (r = - 0.638, p ≤ 0.05). Climate anxiety and asthma control are powerful predictors of quality of life among asthmatics. Climate anxiety moderates the relationship between asthma control and quality of life, making it less positive (B = -0.094, p > 0.001). Covariates such as gender, age, comorbidities, employment status, disease duration, and previous hospitalisation showed significant associations with asthma quality of life. Assessment and mitigation of climate anxiety among asthmatics is a key strategy for controlling asthma and improving the quality of life. So, nurses must incorporate climate anxiety assessment into the care plan for asthmatics. Climate change is a global concern, and insights into how climate-related psychological stressors exacerbate asthma symptoms and overall health outcomes are necessary. The findings provide actionable data for healthcare professionals to underscore the need for integrated healthcare approaches considering environmental and psychological factors. This study adheres to strengthening the reporting of observational studies in epidemiology (STROBE) statement. Clients with asthma across multiple nationalities actively contributed to our paper.

Community Health Workers Linking Clinics and Schools and Asthma Control

Childhood asthma is characterized by pervasive disparities, including 3-fold higher hospitalization rates and 7-fold higher death rates for Black children compared with White children. To address asthma disparities, one must intervene in all lived environments. To determine if a community health worker (CHW) intervention to connect the primary care, home, and school for low-income minoritized school-aged children with asthma and their caregivers improves asthma control. This study was a hybrid effectiveness/implementation trial using a 2 × 2 factorial, cluster randomized clinical trial design of 36 schools crossed with participant-level randomization into a clinic-based CHW intervention. The study was conducted from May 2018 to June 2022. The intervention took place in primary care offices, homes, and 36 West Philadelphia, Pennsylvania, public and charter schools. Children aged 5 to 13 years with uncontrolled asthma were recruited from local primary care practices. Asthma management, trigger remediation, and care coordination occurred in school, home, and primary care settings. Children were followed up for 12 months. The Yes We Can Children's Asthma Program, Open Airways For Schools Plus, and school-based asthma therapy were implemented. Improvement in asthma control, as measured by the Asthma Control Questionnaire, comparing the mean difference between groups 1 year after randomization with their baseline (difference in differences). Both primary care and school interventions were dramatically disrupted by the COVID-19 pandemic; therefore, stratified analyses were performed to assess per-protocol intervention efficacy before the pandemic disruptions. A total of 1875 participants were approached, 1248 were excluded, and 1 was withdrawn. The 626 analyzed study participants (mean [SD] age, 8.7 [2.4] years; 363 male [58%]) self-identified as Black race (96%) and non-Hispanic ethnicity (98%). Although all groups had statistically significant improvements in asthma control from baseline to 12 months (P- group: -0.46; 95% CI, -0.58 to -0.33; P+ group: -0.57; 95% CI, -0.74 to -0.44; S- group: -0.47; 95% CI, -0.58 to -0.35; S+ group: -0.59; 95% CI, -0.74 to -0.44), none of the difference-in-differences estimates from the primary prespecified models showed a clinically meaningful improvement in asthma control. Analysis from the prepandemic interval, however, demonstrated that children in the combined clinic-school intervention had a statistically significant improvement in asthma control scores compared with control (-0.79; 95% CI, -1.40 to -0.18). This randomized clinical trial provides preliminary evidence that connecting all lived environments for care of children can be accomplished through linkages with CHWs. ClinicalTrials.gov Identifier: NCT03514485.