Severe asthma and adherence to peak flow monitoring: longitudinal assessment of psychological aspects.

BACKGROUND: Adherence in severe asthma is a difficult health problem. Although psychosocial factors may be responsible for non-adherence, few longitudinal studies have investigated their link with adherence, with most studies having focused on pharmacology. METHODS: Sixty patients with severe asthma were recruited. Adherence was electronically monitored using peak flow measurements at entry and after 1 year of follow-up. Eysenck's Personality Inventory, Rotter's Locus of Control (LOC), and health control beliefs were all studied. Multiple logistic regression (MLR) was used for risk calculations. RESULTS: Initially, subjects with poor adherence had an external LOC (P=.001) and a high extraversion score (P=.003) compared to those with good adherence. The lie score was high in all patients. Nocturnal awakenings were highly significantly correlated with poor adherence (P=.006). After 1 year, patient adherence, extraversion, and neuroticism remained unchanged. The LOC changed in subjects with poor adherence, showing a less "external" orientation (P=.007). The health parameters were better at the end of the study. By MLR analysis, externality, extraversion, and low social desirability were associated with poor adherence. Patients with poor adherence had a greater probability of nocturnal symptoms. CONCLUSION: No specific personality type was associated with lack of adherence in the present study, but a high extraversion score, a low social desirability score, and a high level of externality were all predictors of poor adherence.

Interference of psychological factors in difficult-to-control asthma.

BACKGROUND: Most patients with asthma can be controlled with suitable medication, but 5-10% of them remain difficult to control despite optimal management. OBJECTIVE: We investigated whether patients with difficult-to-control asthma (DCA) or controlled asthma (CA) differ with respect to psychological factors, such as general control beliefs on life events. METHODS: DCA was defined as an absence of control despite optimal management. Recent control was measured using the Asthma Control Questionnaire. General control beliefs were investigated using a Locus of Control scale (LOC). RESULTS: Patients with DCA had a significantly higher external LOC as compared to patients with CA (P=0.01). In the DCA group, the hospital admission rate was highly significant in association with the external LOC (P=0.004) as compared to the internal LOC trend. CONCLUSION: This study showed that patients with DCA had different general control beliefs which might have hampered their management and interfered with their therapeutic adherence. The present findings could enhance management of DCA in a clinical setting.

The use of the Strengths and Difficulties Questionnaire (SDQ) in Southern European countries.

This paper reports a selection of completed or ongoing studies that have evaluated or applied the Strengths and Difficulties Questionnaire (SDQ) in five countries of Southern Europe: Italy, Spain, Portugal, Croatia, and France. In Italy, the SDQ has been used to study its concurrent validity with other norm-based instruments (Child Behavior Checklist-CBCL and Disruptive Behavior Disorder Rating Scale-DBDRS), to assess the efficacy of a behavioural school training, and as part of an epidemiological study. In Spain, the SDQ was used to analyse the association between respiratory and other behavioural problems. In Portugal and Croatia, psychometric properties of the three versions of the SDQ (parent, teacher, and self-reports) were investigated in samples of children ranging from 5 to 16 years. Past and ongoing studies in France have administered the SDQ to estimate inter-rater agreement between parents, teachers, and pupils, to carry out a large-scale epidemiological study, and to evaluate the efficacy of a parent training programme. In a second section, scale means obtained with the teacher version of the SDQ in three community-based samples of 7-8 year-old children from Italy, Portugal, and Spain are compared. The results show that, according to their teachers' ratings, Italian pupils showed less prosocial behaviour than their Spanish and Portuguese agemates, whereas the Portuguese children were rated as being more hyperactive and inattentive than comparable Italian and Spanish children. Possible causes underlying the observed differences between national SDQ means are discussed.