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Biomedical subjects

R A Kinsman

Publications and source records attributed to R A Kinsman.

At least 19 recordsLinked to original sources
PubMed1993

As-needed medication use in asthma usage patterns and patient characteristics.

Daily inhaled bronchodilator medication usage was recorded using an electronic device and airway obstruction by daily peak flow measurement. The demographic, clinical, and psychological characteristics of the subjects were noted. Subjects were allocated to as-needed (prn) medication usage groups according to the mean number of inhaler activations on days with zero, moderate, and severe airway obstruction. Segregation into arbitrary and nonarbitrary use, and into overuse, appropriate use, and underuse resulted in six usage groups. Appropriate use was observed in only 10 of 39 subjects. The major psychological variable to differ among groups was the MMPI variable Pt, representing general anxiety. Arbitrary users had a significantly higher mean score than nonarbitrary users. The variable Specific Internal Awareness, representing a perceived difficulty in recognizing the premonitory symptoms of an asthma attack, also differed among the usage groups, with arbitrary users having the lowest scores. These findings raise the possibility that reliance on an objective measurement of airway obstruction rather than on subjective symptomatology might enhance compliance with prn medication in some patients.

Adolescent↗
PubMed1991

Compliance in clinical trials of two nonbronchodilator, antiasthma medications.

An electronic monitoring device was used to assess patient compliance during clinical trials of two new aerosolized nonbronchodilator, antiasthma drugs. Compliance was poor, but similar, in both trials. Patients took the study drug as instructed on a mean of 37.3% days (range 10% to 77%) in one trial and 37.4% days (range 0% to 63%) in the other. Both underuse and overuse were observed. Underuse was seen on a mean of 38.9% days (range 9% to 81%) and 46.0% (range 15% to 80%) respectively; overuse on a mean of 23.5% days (range 6% to 54%) and 16.6% days (range 0% to 41%). In some patients ten or more activations of the device were recorded at the same time. In six patients such multiple simultaneous activations were recorded on two or more separate days. These patients were among the most noncompliant in the study. Multiple simultaneous activations frequently followed underuse days or preceded followup visits, suggesting the possibility of duplicity. Overall compliance was such that valid conclusions about efficacy of the drugs could only have been drawn in six of 34 patients.

Administration, Inhalation↗
PubMed1984

Subscales to the Taylor Manifest Anxiety Scale in three chronically ill populations.

In a sample of 150 people drawn from a population of asthma, tuberculosis, and chronic pain patients, a key cluster analysis revealed five different clusters of items in the Taylor Manifest Anxiety Scale: Restlessness, Embarrassment, Sensitivity, Physiological Anxiety, and Self-Confidence. These clusters are consistent and four of them appear moderately related, whereas Embarrassment is fairly independent of the others.

Adult↗
PubMed1983

Multidimensional analysis of the symptoms of chronic bronchitis and emphysema.

Subjective symptoms and experiences were explored within a group of 146 severe, chronic bronchitis and emphysema patients. Eighty-nine symptoms and experiences, derived from initial interviews with 29 patients, were rated according to the frequency of occurrence during breathing difficulties. Key cluster analyses were used to derive a Bronchitis-Emphysema Symptom Checklist (BESC) measuring 11 symptom categories: Helplessness-Hopelessness, Decathexis, Fatigue, Poor Memory, Peripheral-Sensory Complaints, Dyspnea, Congestion, Sleep Difficulties, Irritability, Anxiety, and Alienation. The BESC symptom categories are highly reliable and the relationships among categories are stable across two subgroups of patients. The BESC provides one way to describe how patients cope with and experience chronic bronchitis and emphysema.

Adaptation, Psychological↗
PubMed1983

Interactions among behavioral style, ventilatory drive, and load recognition.

We previously demonstrated that specific behavioral styles influenced recognition of resistive loads to breathing. However, the basis for this finding remained unclear. Because others have found a relationship between behavioral style and ventilatory drive, we evaluated the relationships among resting ventilatory drive, behavioral style, and recognition of loads to breathing. Twelve healthy subjects were divided into 3 behavioral style groups by the MMPI Panic-Fear Scale. Inspiratory neuromuscular activity, detected by mouth occlusion in relaxed subjects, served as an index of resting ventilatory drive, and the resistance added to inspiration recognized during 50% of the applications was termed threshold resistance. Across all subjects, there was a significant inverse correlation between resting inspiratory neuromuscular activity and the amount of added resistance required for recognition. The higher the ventilatory drive the lower the added resistance needed for recognition. Anxious, dependent subjects had lower resting ventilatory drive and lower mean inspiratory flow rates. They required more added resistance for recognition than generally adaptive or rigidly independent subjects who had higher resting neuromuscular activity and lower detection thresholds. We conclude: (1) that the level of resting ventilatory drive may play a role in the ability to recognize added resistive loads to breathing, and (2) that behavioral style and level of resting ventilatory drive appear related.

Adult↗
PubMed1983

Symptoms and experiences in chronic bronchitis and emphysema.

A heterogeneous group of 146 patients with chronic bronchitis and emphysema were asked to rate the frequency with which 89 symptoms and experiences occurred during their breathing difficulties. Normative values and the reported frequency of occurrence for the 11 symptom categories are presented. As expected, symptoms of dyspnea were the most frequently reported during breathing difficulties. In decreasing order, symptoms of dyspnea were followed by symptoms of fatigue, sleep disturbance, congestion, irritability, anxiety, decathexis, helplessness-hopelessness, poor memory, alienation. Separation of the patients into subgroups revealed that women reported more anxiety and helplessness-hopelessness than men. Younger patients reported more irritability and anxiety than older patients. Patients with mixed disease reported more dyspnea than those with chronic bronchitis or emphysema, although patients with emphysema reported more loss of interest in life than patients with chronic bronchitis. Self-ratings of functional incapacitation were clearly related to the symptom reports. Relationships among the symptom categories were discussed, as was the potential usefulness of symptom patterns in exploring coping styles in respiratory disease.

Adult↗
PubMed1983

Effects of particulate air pollution on asthmatics.

Twenty-four asthmatic subjects in Denver were followed from January through March 1979, a three-month period in which Denver air pollution levels are generally high and variable. Dichotomous, virtual impactor samplers provided daily measurements (micrograms/m3) of inhaled particulate matter (total mass, sulfates, and nitrates) for coarse (2.5--15 micrograms in aerodynamic diameter) and fine fractions (less than 2.5 micrometers). Carbon monoxide, sulfur dioxide, ozone, temperature, and barometric pressure were also measured. Twice daily measurements of each subject's peak expiratory flow rates, use of as-needed aerosolized bronchodilators, and report of airways obstruction symptoms characteristic of asthma were tested for relationships to air pollutants using a random effects model across subjects. During the time actually observed, there were very few days in which high levels of suspended particulates were recorded. Of the environmental variables studied, only fine nitrates were associated with increased symptom reports and increased aerosolized bronchodilator usage.

Adult↗
PubMed1982

Patterns of depression in chronic illness.

An understanding of the existence and action of depression is essential to the medical management of patients with chronic illness. This study found thirteen unique patterns of depression in depressed persons being treated for chronic medical conditions. Of the 132 persons sampled, 96.2% fell clearly into one of these groups. The fact that these people manifested their clinical depression in such a variety of ways argues against a unilateral approach to the treatment of affective distress among those with a chronic medical illness. While patients manifest their affective distress in a variety of ways, self-esteem issues are significantly involved in almost half of the identified patterns.

Adult↗
PubMed1982

Alexithymic asthmatics: age and alexithymia across the life span.

The relationship between age and alexithymia was evaluated within a large (n = 476) group of asthmatic patients ranging in age from 14 to 76 years. Alexithymia was found to occur more frequently in the upper age ranges (middle and late adulthood) than in adolescence and early adulthood. Hypotheses regarding this relationship are addressed.

Adolescent↗
PubMed1982

Recognition of added resistive loads in asthma: the importance of behavioral styles.

The wide range of recognition thresholds to added resistive loads previously observed in asthmatic patients was hypothesized to be at least partially dependent on psychologic factors. Therefore, we compared thresholds to added inspiratory and expiratory resistive loads obtained on each of 2 days for (1) 12 asthmatic and 12 normal subjects, while equating for behavioral styles related to anxiety and dependency, and (2) behavioral styles when the presence and absence of asthma was controlled. The threshold values for inspiration and expiration did not differ between asthmatic and normal subjects; on contrast, anxious, dependent subjects had significantly greater threshold values for inspiration and expiration than adaptive or rigidly independent subjects. Thresholds were unrelated to baseline airway resistance. In addition, inspiratory threshold was not reproducible across days of the study (r = 0.34, ns), and the expiratory threshold was only moderately reproducible across days (r = 0.48, p less than 0.05). There was a good relationship between inspiratory and expiratory threshold values within Day 1 (r = 0.68, p less than 0.001) and Day 2 (r = 0.69, p less than 0.001). The results suggest that behavioral style and time of testing are more important determinants of the recognition of added resistive loads than the presence or absence of asthma.

Adaptation, Psychological↗
PubMed1982

Death in asthma: a psychosomatic autopsy.

In most, if not all, chronic illnesses, the patient is a participant in medical management. Attitudes and behaviors during treatment can influence medical outcome in important ways that are becoming increasingly understood. This case history illustrates how a personal style may have contributed to the worst possible outcome, death, in an illness that is usually not fatal. There is a need to unravel the complex interplay between the psychological and medical factors contributing to such extremes in medical treatment failure in order to permit timely and appropriate intervention.

Adult↗
PubMed1981

Clinical prediction of medical rehospitalization: psychological assessment with the Battery of Asthma Illness Behavior.

Psychomaintenance in chronic illness refers to the perpetuation of chronicity or the defeat of medical management because of psychological, as opposed to strictly physical, reasons. The Battery of Asthma Illness Behavior (BAIB) has been developed to assess psychomaintenace potentials among chronic asthmatics. In this study of 57 adult asthmatic patients, the clinical utility of the BAIB was assessed by having two psychologists predict the likelihood of rehospitalization within six months following intensive medical treatment. Independent, blind predictions using the BAIB, but in the absence of any demographic or medical information, enabled hit rates of 70% and 84% by te psychologists. Moreover, the predictions were independent of the objective severity of the patients' asthma, indicating that the clinical judgments were not merely readings of the patients' asthma severity on the basis of the BAIB scores. The need for rapid, clinical assessment of psychological factors maintaining chronic illness was discussed.

Adolescent↗
PubMed1981

Bender-Gestalt performance and recall in an asthmatic sample.

In a sample of intractable adult asthmatics, the prevalence of Bender-Gestalt signs suggestive of neuropsychological problems was documented. Sixty-five per cent of the sample was found to have equivocal or definite Bender-Gestalt signs suggestive of cerebral dysfunction. A clear majority of the asthmatics manifested definite signs of memory impairment when they were asked to recall the Bender designs. The study provides the first documentation of the neuropsychological sequelae of asthma in adults.

Adult↗
PubMed1981

Calibration and stability of Standard and Mini-Wright peak flow meters.

Periodic checks of peak flow meter (PFM) stability is essential to ensure meaningful application even when the PFMs are only used to measure the relative changes in patient peak flow rate. Calibration of PFMs becomes necessary, however, when peak flow readings are to be interpreted precisely. Techniques and flow systems which offer ease and accuracy in calibrating and/or checking PFMs were tested on Standard Wright and Mini-Wright PFMs. Individual Wright PFMs were found to be stable over a six-month testing period. The PFM readings varied from actual flow, however, and the variation from actual flow was greatest among the Mini-Wright PFMs.

Forced Expiratory Flow Rates↗
PubMed1980

Levels of psychological experience in asthma: general and illness-specific concomitants of panic-fear personality.

Coping styles in asthma indexed by a Panic-Fear personality measure are known to influence physicians' medical decisions and long-term treatment outcome. Unusually High or Low Panic-Fear personality styles are maladaptive, the former characterized by anxious, helpless dependency and the latter by an extreme counterphobic independence. In this study (N = 90), the psychological experiences among Panic-Fear personality groups (LOW, Moderate, and High) of asthma patients are described at three levels of assessment: (1) general personality characteristics; (2) attitudes toward asthma and its treatment; and (3) the subjective symptoms reported during breathing difficulties. Comparisons among the groups delineated the linkages between Panic-Fear personality and more illness-specific attitudes, symptoms, and experiences in asthma. Discussion centered upon how general personality and illness-specific characteristics associated with extreme High and Low Panic-Fear personality may contribute to the psychomaintenance of asthma.

Adolescent↗