低社会经济地位哮喘患儿的心理反弹：适应应激
2011/10/13
摘要
背景：低社会经济状态（SES）是包括哮喘在内的诸多卫生问题的较强预测因子，然而对于一些哮喘患者，尽管处在较差的环境中，却仍然具有较好的哮喘控制，这一点我们了解尚少。
目的：本试验研究一种心理学特征，即转换和坚持策略（通过更加正面的重新塑造自己来处理应激，同时对未来抱有持续乐观的思想），是否能对低SES的哮喘患儿产生保护作用。
方法：121名年龄为9～18岁、患有医生诊断的哮喘患儿通过医院和社区入选（平均年龄为12.6岁，67%为男性，61%为白人）。基线状态下评价转换和坚持评分和哮喘炎症（嗜酸性粒细胞计数和刺激的IL-4细胞因子产生），基线状态下和6个月随访后，检测哮喘影响（通过每日日志分析急救用药和旷课）和每日峰值流量。
结果：低SES背景的哮喘患儿，如果采取转换和坚持策略，基线状态下的哮喘炎症较轻(β = 0.19, P <0.05)，而且6个月的随访后哮喘影响也较小（降低急救用药和更少的旷课天数，β = 0.32, P <0.01）。相反，对于高SES的哮喘患儿，转换和坚持策略无有益作用。
结论：关注低SES哮喘患儿在适应压力过程中形成的心理素质，可能是为缩短健康差距而迈出的有实际效果的第一步。不过适用于高SES社区的方法可能对低SES社区并不一定有效。
（刘国梁 审校）
J Allergy Clin Immunol. 2011 Aug 6. [Epub ahead of print]
Resilience in low-socioeconomic-status children with asthma: Adaptations to stress.
Chen E, Strunk RC, Trethewey A, Schreier HM, Maharaj N, Miller GE.
Source
University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
BACKGROUND: Low socioeconomic status (SES) is a strong predictor of many health problems, including asthma impairment; however, little is understood about why some patients defy this trend by exhibiting good asthma control despite living in adverse environments.
OBJECTIVE: This study sought to test whether a psychological characteristic, the shift-and-persist strategy (dealing with stressors by reframing them more positively while at the same time persisting in optimistic thoughts about the future), protects low-SES children with asthma.
METHODS: One hundred twenty-one children aged 9 to 18 years with a physician’s diagnosis of asthma were recruited from medical practices and community advertisements (mean age, 12.6 years; 67% male; 61% white). Shift-and-persist scores and asthma inflammation (eosinophil counts and stimulated IL-4 cytokine production) were assessed at baseline, and asthma impairment (daily diary measures of rescue inhaler use and school absences) and daily peak flow were monitored at baseline and at a 6-month follow-up.
RESULTS: Children who came from low-SES backgrounds but who engaged in shift-and-persist strategies displayed less asthma inflammation at baseline (β = 0.19, P < .05), as well as less asthma impairment (reduced rescue inhaler use and fewer school absences; β = 0.32, P < .01) prospectively at the 6-month follow-up period. In contrast, shift-and-persist strategies were not beneficial among high-SES children with asthma.
CONCLUSION: An approach that focuses on the psychological qualities that low-SES children develop to adapt to stressors might represent a practical and effective starting point for reducing health disparities. Moreover, the approaches that are effective in low-SES communities might be different from those that are optimal in a high-SES context.
J Allergy Clin Immunol. 2011 Aug 6. [Epub ahead of print]
背景：低社会经济状态（SES）是包括哮喘在内的诸多卫生问题的较强预测因子，然而对于一些哮喘患者，尽管处在较差的环境中，却仍然具有较好的哮喘控制，这一点我们了解尚少。
目的：本试验研究一种心理学特征，即转换和坚持策略（通过更加正面的重新塑造自己来处理应激，同时对未来抱有持续乐观的思想），是否能对低SES的哮喘患儿产生保护作用。
方法：121名年龄为9～18岁、患有医生诊断的哮喘患儿通过医院和社区入选（平均年龄为12.6岁，67%为男性，61%为白人）。基线状态下评价转换和坚持评分和哮喘炎症（嗜酸性粒细胞计数和刺激的IL-4细胞因子产生），基线状态下和6个月随访后，检测哮喘影响（通过每日日志分析急救用药和旷课）和每日峰值流量。
结果：低SES背景的哮喘患儿，如果采取转换和坚持策略，基线状态下的哮喘炎症较轻(β = 0.19, P <0.05)，而且6个月的随访后哮喘影响也较小（降低急救用药和更少的旷课天数，β = 0.32, P <0.01）。相反，对于高SES的哮喘患儿，转换和坚持策略无有益作用。
结论：关注低SES哮喘患儿在适应压力过程中形成的心理素质，可能是为缩短健康差距而迈出的有实际效果的第一步。不过适用于高SES社区的方法可能对低SES社区并不一定有效。
（刘国梁 审校）
J Allergy Clin Immunol. 2011 Aug 6. [Epub ahead of print]
Resilience in low-socioeconomic-status children with asthma: Adaptations to stress.
Chen E, Strunk RC, Trethewey A, Schreier HM, Maharaj N, Miller GE.
Source
University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
BACKGROUND: Low socioeconomic status (SES) is a strong predictor of many health problems, including asthma impairment; however, little is understood about why some patients defy this trend by exhibiting good asthma control despite living in adverse environments.
OBJECTIVE: This study sought to test whether a psychological characteristic, the shift-and-persist strategy (dealing with stressors by reframing them more positively while at the same time persisting in optimistic thoughts about the future), protects low-SES children with asthma.
METHODS: One hundred twenty-one children aged 9 to 18 years with a physician’s diagnosis of asthma were recruited from medical practices and community advertisements (mean age, 12.6 years; 67% male; 61% white). Shift-and-persist scores and asthma inflammation (eosinophil counts and stimulated IL-4 cytokine production) were assessed at baseline, and asthma impairment (daily diary measures of rescue inhaler use and school absences) and daily peak flow were monitored at baseline and at a 6-month follow-up.
RESULTS: Children who came from low-SES backgrounds but who engaged in shift-and-persist strategies displayed less asthma inflammation at baseline (β = 0.19, P < .05), as well as less asthma impairment (reduced rescue inhaler use and fewer school absences; β = 0.32, P < .01) prospectively at the 6-month follow-up period. In contrast, shift-and-persist strategies were not beneficial among high-SES children with asthma.
CONCLUSION: An approach that focuses on the psychological qualities that low-SES children develop to adapt to stressors might represent a practical and effective starting point for reducing health disparities. Moreover, the approaches that are effective in low-SES communities might be different from those that are optimal in a high-SES context.
J Allergy Clin Immunol. 2011 Aug 6. [Epub ahead of print]
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哮喘控制测试评分与FEV1及NO相关——希腊哮喘患者的治疗影响研究
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提高城市青少年哮喘防治水平的初步研究
