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Biomedical subjects

T L Creer

Publications and source records attributed to T L Creer.

At least 19 recordsLinked to original sources
PubMed1992

A life activities questionnaire for adult asthma.

The development, testing, and applicability of an instrument, the Life Activities Questionnaire for Adult Asthma is described that can be used to assess activity restriction in adults with asthma. It explains how items for the instrument were selected to insure the validity of the developed instrument. The reliability of the questionnaire is also discussed. The result is a valid and reliable paper-and-pencil instrument that should have wide applicability as a component of quality of life measurement. This instrument has potential for functional use in clinical settings, research environments, and policy-making procedures.

Activities of Daily Living↗
PubMed1992

Behavioral consequences of illness: childhood asthma as a model.

Several areas of research on childhood asthma are discussed within a transactional model of asthma. The model emphasizes the multidirectional influences that affect the severity of asthma and associated behavioral disability. The initial focus is on how the clinical presentation and morbidity of asthma are affected both by somatic predisposition and by interactions with multiple internal and external elements. Specific elements include emotional factors, neuroimmunology, temperament, and medication side effects. Second, the impact of asthma on the child, his or her family, and segments of the community are described, as are consequences of the disorder on quality of life. Third, there is a synopsis of preventative interventions for reducing the medical and behavioral impact of childhood asthma. The motif is that the interaction of medical and behavioral procedures can improve the management of asthma while consequences of the disorder are mollified. Finally, as examples of a transactional model of asthma, self-management programs for teaching children to become partners with their physicians in establishing and maintaining control over the disorder are described. A representative of self-management--the ACT (Asthma Care Training) program--is described, along with the impact such programs have on children, their families, and institutions. The conclusion emphasizes that asthma is a complicated and unpredictable disorder that puzzles physicians, behavioral scientists, and patients. Although new treatments may be over the horizon, controlling childhood asthma and its consequences currently rests on the cooperation and increased interaction of medical and behavioral scientists.

Asthma↗
PubMed1991

Long-term effects of biofeedback-induced facial relaxation on measures of asthma severity in children.

We studied the effects of electromyographic biofeedback on measures of asthma severity in children. Fifteen children received biofeedback training to reduce facial tension, and 14 children, who served as controls, received biofeedback training to maintain facial tension at a stable level. Assignment to experimental condition was random. As a result of training, electromyographic levels decreased in children trained in facial relaxation and remained fairly constant in children trained in facial tension stability. Biofeedback training was augmented for children in both groups by having them practice their facial exercises at home. Each child's condition was followed for a five-month period subsequent to biofeedback training. Throughout the experiment, the following measures of asthma severity were monitored: lung function, self-rated asthma severity, medication usage, and frequency of asthma attacks. In addition, standardized measures of attitudes toward asthma, self-concept, and chronic anxiety were recorded at regular intervals. As compared to the facial stability subjects, the facial relaxation subjects exhibited higher pulmonary scores, more positive attitudes toward asthma, and lower chronic anxiety during the follow-up period. Subjects in the two groups, however, did not differ on self-rated asthma severity, medication usage, frequency of asthma attacks, or self-concept. Based on the improvements we observed in pulmonary, attitude, and anxiety measures, we concluded that biofeedback training for facial relaxation contributes to the self-control of asthma and would be a valuable addition to asthma self-management programs.

Adolescent↗
PubMed1991

The application of behavioral procedures to childhood asthma: current and future perspectives.

The development and application of behavioral procedures to childhood asthma during the past three decades is reviewed, with particular implications for researchers and practitioners. In particular, the article describes two major categories of procedures that comprise the current state of the art of behavioral intervention; prevention and management of attacks and self-management by patients of their asthma. Much of the discussion focuses on self-management skills, particularly the essential ingredients of data collection, information processing and evaluation, steps required to manage attacks and self-reaction to performance. A final section of the paper speculates on the future directions of applying behavioral techniques to childhood asthma. The need to analyze individual attacks suffered by individual patients is emphasized; in addition, the scientific skills required to successfully manage asthma, performed both by medical personnel and patients, are described. It is hoped that the future will see these skills applied in a manner so that each attack is treated as if it were an experiment.

Asthma↗
PubMed1991

The COPD Self-Efficacy Scale.

Many individuals with COPD develop a lack of confidence regarding their ability to avoid breathing difficulty while participating in certain activities, however minimal the physical demands of the activity may be. This lack of confidence may be expressed as low self-efficacy. As a result of low self-efficacy, COPD patients may refrain from many routine activities of daily living. Identifying situations in which individuals with COPD experience low self-efficacy would allow the development of specific treatment interventions designed to increase the patient's self-efficacy in those situations and consequently increase activity. We developed a 34-item COPD Self-Efficacy Scale (CSES) to assess self-efficacy in individuals afflicted with COPD. The CSES has good test-retest reliability (r = .77), excellent internal consistency (Cronbach's alpha = .95), and a five-factor structure (negative affect, intense emotional arousal, physical exertion, weather/environmental, and behavioral risk factors.

Activities of Daily Living↗
PubMed1991

Predicting asthma in individual patients.

The degree to which asthma attacks were related to seven environmental variables was determined for each of 17 individuals. Using stepwise regression procedures, cladosporium mold, ragweed pollen, and a change in temperature were significant predictors of asthma attacks in 5 of 17 individuals. The information provided by these analyses could prove useful in helping some individuals manage their asthma.

Adult↗
PubMed1991

Prediction of asthma episodes in children using peak expiratory flow rates, medication compliance, and exercise data.

Asthmatic patients demonstrate considerable variation in the extent to which their subjective evaluations and objective measures of airways obstruction correspond. The detection and prediction of asthma episodes have been improved through the use of objective pulmonary measures, such as peak expiratory flow rate (PEFR). Furthermore, information regarding adherence to medication regimens and specific asthma triggers (ie, exercise) may also improve the predictability of asthma in children. The utility of using PEFR values, medication compliance information, and exercise data for the prediction of asthma episodes in individual children was investigated in the present study. Individual logistic regression equations were calculated for ten asthmatic children. In predicting asthma episodes, PEFR was present in the model for nine out of ten subjects; exercise was included for two out of five subjects providing such data; whether an attack had occurred in the preceding 12-hour period was predictive for one out of ten participants; and whether an attack had been experienced in the previous 24 hours was present for four out of ten subjects. Hosmer-Lemeshow values indicated that the models fit the data well for nine subjects (alpha greater than .05). The mean model prediction rate (80.85%) was higher than the mean base rate (75.72%). The relative risk ratio values ranged from 0 to 5.72, with a mean of 3.50. These results suggest that the prediction of episodes may be enhanced by using PEFR, exercise, and time of day.

Adolescent↗
PubMed1990

Environmental control of asthma self-management.

We describe a model of asthma self-management based on environmental control of behavior. The model emphasizes aspects of the environment that either prompt or strengthen asthma self-management behavior. In prompting behavior, environmental events function as behavioral cues; in strengthening behavior, they represent reinforcers. We describe concepts related to cueing and reinforcement, and how these operations might be incorporated in individualized self-management programs. Finally, we discuss evidence supporting asthma self-management programs based on environmental control behavior.

Asthma↗
PubMed1989

Psychological problems associated with drug therapy in childhood asthma.

Ten studies designed to evaluate the psychological and behavioral effects of the antiasthma agent theophylline in children have been carried out to date. In this review, we evaluate the strengths and weaknesses of those investigations and discuss whether theophylline is responsible for learning disabilities or behavioral disorders such as hyperactivity. We also discuss the similarities between studies of theophylline and those of other xanthines, such as caffeine, to suggest that some persons appear to have a heightened response to these substances and would benefit from closer monitoring, not only of serum drug levels but also of their consumption of food and beverages that contain caffeine. In addition, we describe strategies for examining whether a functional relationship exists between theophylline use and behavioral and psychological changes in children.

Asthma↗
PubMed1989

The Revised Asthma Problem Behavior Checklist.

The Asthma Problem Behavior Checklist (APBC) has proved to be an accurate and invaluable instrument for pinpointing potential behavioral problems in children with the disorder. This article presents the Revised Asthma Problem Behavior Checklist (RAPBC). The value of the RAPBC is that: (a) it has proven reliability when tested with asthmatic adults; (b) the change from a dichotomous yes/no format, used in the APBC, to a 5-point Likert-type answer format adds greater sensitivity to the instrument; and (c) data gathered with the RAPBC compare favorably to information gathered in two previous studies with the APBC. Considering the reliability and validity of the RAPBC, it should prove useful in both clinical and research settings.

Adolescent↗
PubMed1989

Living with asthma: Part II. Beyond CARIH.

This article focuses on the evolution and assessment of additional self-management programs and strategies following the original development and evaluation of Living with Asthma. In particular, it describes the basis and philosophy underlying a self-management program for adults with asthma. In doing so, it introduces strategies that can be used by adults to process and evaluate the information they gather, and to make decisions as to what steps to take to predict and prevent asthma attacks. These strategies rely upon techniques ranging from the use of decision-making trees to the calculation of conditional probabilities to enhance the patients' knowledge that an attack is apt to occur within a prescribed period. It is hoped that further refinement of these procedures will not only provide greater control over asthma, but may help reverse the recent trend of increased mortality due to the disorder.

Adult↗
PubMed1989

A reinterpretation of psychologically induced airways changes.

Psychologically induced airways changes in asthmatic individuals may be a function of variation in general activation level, not variation in asthma severity. The evidence for this hypothesis derives from work showing that healthy individuals exhibit psychologically induced airways changes similar to those exhibited by asthmatics. Individuals from both normal and healthy populations display increases in bronchomotor tone in response to stress and decreases in bronchomotor tone in response to relaxing stimulation. Although these responses are not limited to asthmatics, they are not irrelevant to asthma. Knowledge of specific relationships between airways changes and psychological factors is helpful in the management of asthma.

Asthma↗
PubMed1988

The effects of suggestion on the total respiratory resistance of nonasthmatic female subjects.

Bronchodilation suggestion, bronchoconstriction suggestion, or neutral suggestion was given to thirty nonasthmatic female subjects; the effect of the suggestion on the total respiratory resistance (Rt) of the subjects was examined. Subjects were told either (a) that they would inhale a substance which would make their breathing better, (b) that they would inhale a substance which would make their breathing worse, or (c) that they would inhale a substance which would have no effect on their breathing. In actuality, no subject inhaled any substance. Those subjects who were told that their breathing would worsen exhibited a reliable increase in R1, whereas those subjects who were told that their breathing would become better or that their breathing would not be affected exhibited no reliable change in Rt. This study confirmed earlier work, showing that bronchoconstriction suggestion increases Rt in healthy individuals. Furthermore, this study showed that bronchodilation suggestion alone is not sufficient to produce a decrease in Rt.

Adult↗
PubMed1988

Living with Asthma. I. Genesis and development of a self-management program for childhood asthma.

This paper traces the roots of Living with Asthma, a self-management program for childhood asthma, from the Children's Asthma Research Institute and Hospital (CARIH), a residential treatment center in Denver, Colorado. The basic components of the program were developed and tested over the 40-year history of CARIH; the findings of an educational unit were added to this accumulated knowledge and expertise to complete the system. The program rests heavily on social learning theory, particularly two major tenets: 1) the concept of reciprocal determinism and 2) the learning/performance dichotomy. The crucial role of these concepts is described here, especially with respect to the design of the program and the selection of dependent variables. The remainder of this article describes the essentials of Living with Asthma, particularly the skills taught and performed by patients in a formal evaluation of the system. The design of the study, characteristics of patients enrolled in the program, and results obtained with the system are discussed. The program proved highly effective in significantly improving the knowledge of asthma in parents and their children, and in developing positive attitudes in both groups. It also produced significant reductions in the number of attacks experienced by the youngsters and improved their peak flow values. Participation in the program resulted in changes in morbidity indices of asthma, including significant reductions in school absenteeism and health-care costs incurred because of the disorder. These changes, it was concluded, reflected the result of the performance by patients of the self-management skills taught in Living with Asthma, coupled with the exceptional medical treatment they received.

Absenteeism↗
PubMed1988

Measures of asthma severity recorded by patients.

Twenty-nine children with asthma made daily recordings of the severity of their asthma for 8 months. Each child recorded four measures of severity: a medication usage score, a morning peak expiratory flow rate (PEFR), an evening PEFR, and a subjective rating of overall severity. We determined the relationships between the four measures. Except for the morning and evening PEFRs, the relationships between the measures were weak; the PEFR measures were highly related to one another. The relationship between PEFR scores and medication usage scores increased following biofeedback relaxation training.

Adolescent↗