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Biagina-Carla Farnesi,1 Francine M Ducharme,2,3 Lucie Blais,4 Johanne Collin,4 Kim L Lavoie,5,6 Simon L Bacon,1,6 Martha L McKinney,7 Sandra Peláez3,8 1Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC Canada; 2Departments of Pediatrics and of Social and Preventive Sciences, University of Montreal, Montreal, QC Canada; 3Research Centre, CHU Sainte-Justine, University of Montreal, Montreal, QC Canada; 4Faculty of Pharmacy, University of Montreal, Montreal, QC Canada; 5Psychology Department, University of Quebec at Montreal, Montreal, QC Canada; 6Research Center, Sacré-Cœur de Montréal Hospital, CIUSSS du Nord-de-l’Ile-de-Montréal, Montreal, QC Canada; 7CHU Ste-Justine, University of Montreal, Montreal, QC Canada; 8School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada Purpose: The purpose of this study was to better understand patients’ perspective of asthma self-management by focusing on the sociocultural and medical context shaping patients’ illness representations and individual decisions. Patients and methods: We conducted a secondary analysis of semi-structured interviews carried out as part of a multicentered collective qualitative case study. In total, 24 patients, aged 2–76 years with a confirmed diagnosis of asthma (or were parents of a child), who renewed the prescription for inhaled corticosteroids in the past year, participated in this study. The thematic analysis focused on asthma-related events and experiences reported by the patients. Consistent with narrative inquiry, similar patterns were grouped together, and three vignettes representing the different realities experienced by the patients were created. Results: The comparison of experiences and events reported by the patients suggested that patients’ perceptions and beliefs regarding asthma and treatment goals influenced their self-management-related behaviors. More specifically, the medical context in which the patients were followed (ie, frame in which the medical encounter takes place, medical recommendations provided) contributed to shape their understanding of the disease and the associated treatment goals. In turn, a patient’s perception of the disease and the treatment goals influenced asthma self-management behaviors related to environmental control, lifestyle habits, and medication intake. Conclusion: Current medical recommendations regarding asthma self-management highlight the importance of the physicians’ guidance through the provision of a detailed written action plan and asthma education. These data suggest that while physicians contribute to shaping patients’ beliefs and perceptions about the disease and treatment goals, patients tend to listen to their own experience and manage the disease accordingly. Thus, a medical encounter between the patient and the physician, aiming at enhancing a meaningful conversation about the disease, may lead the patient to approach the disease in a more effective manner, which goes beyond taking preventative paths to avoid symptoms. Keywords: asthma, adherence, self-management, written action plan, patient-physician relationship, narrative inquiry

Kim L Lavoie,1–3 Gregory Moullec,1,2,4 Catherine Lemiere,2 Lucie Blais,2 Manon Labrecque,2 Marie-France Beauchesne,2 Veronique Pepin,2,4 André Cartier,2 Simon L Bacon1,2,41Montreal Behavioural Medicine Centre, 2Research Centre, Hôpital du Sacré-Cœur de Montréal – A University of Montreal Affiliated Hospital, Montréal, 3Department of Psychology, University of Quebec at Montreal (UQAM), Succursale Center-Ville, Montreal, 4Department of Exercise Science, Concordia University, Montreal, Quebec, CanadaPurpose: Daily adherence to inhaled corticosteroid (ICS) regimens is one of the most important factors linked to achieving optimal asthma control. Motivational interviewing (MI) is a client-centered communication style that focuses on enhancing intrinsic motivation to engage in appropriate self-management behaviors. MI has been shown to improve a variety of health behaviors including medication adherence in other disorders, but its efficacy for the improvement of ICS adherence in asthmatics has yet to be examined. This pilot “proof of concept” trial assessed the feasibility of MI to improve daily ICS adherence and asthma control levels in adult asthmatics.Methods: Fifty-four poorly controlled (Asthma Control Questionnaire [ACQ] score ≥1.5), highly nonadherent (filled

The purpose of this study was to evaluate the influence of trait and state rumination on cardiovascular recovery following a negative emotional stressor. Cardiovascular data was collected from 64 undergraduate women during a 10-min baseline period, 5-min emotional recall stress task, and a 15-min recovery period. Trait rumination was assessed using the Stress Reactive Rumination Scale and state rumination was assessed 5 and 10 min after the stressor, using a thought-report technique. Results indicated that trait and state rumination interacted such that low trait ruminators who were ruminating at 10 min after the termination of the stressor had poorer diastolic blood pressure and high-frequency heart rate variability recovery compared to low trait ruminators who were not ruminating. State rumination was not associated with cardiovascular recovery in high trait ruminators. Results suggest that rumination may play a role in the association between stress and hypertension by prolonging cardiovascular activation following stress. [ABSTRACT FROM AUTHOR]

An unhealthy lifestyle, including excess caloric intake, lack of exercise, smoking, and excessive alcohol consumption, increases one's risk of developing cardiovascular disease (CVD). However, the exact mechanisms by which these behaviors influence the development and progression of CVD have yet to be determined. Endothelial function (EF) has been shown to be a potent predictor of CVD, yet the effects of health behaviors on EF are not clear. The literature assessing the role of four health behaviors, obesity (a proxy of excess caloric intake), smoking, physical inactivity, and alcohol consumption, on the development of endothelial dysfunction is reviewed. Potential mechanisms through which these behaviors may influence EF are discussed. Smoking, being overweight or obese, and physical inactivity are all associated with decreased EF. A direct causal relationship between these measures and EF is suggested by the fact that improvements in these behaviors leads to parallel improvements in EF. The influence of alcohol consumption is somewhat more contentious, with some studies indicating a dose-response relationship such that those with greater consumption have poor EF. However, other studies have shown that those who drink moderately have the best EF. Although there is a growing body of literature implicating poor health behaviors in the development of endothelial dysfunction, more work is needed to establish the exact mechanisms by which this occurs. To our knowledge, there are no studies that have assessed the impact of multiple health behaviors or the interaction of health behaviors on EF. [ABSTRACT FROM AUTHOR]

BACKGROUND: The high burden of asthma appears to be related to poor asthma control. Although previous studies have reported associations between depressive disorders (DDs) and anxiety disorders (ADs) and worse asthma control and quality of life, the relative impact of these disorders on asthma control and quality of life has not been explored. This study evaluated the relative impact of having a DD and/or AD on asthma control and quality of life. METHOD: Five hundred four consecutive adults with confirmed, physician-diagnosed asthma underwent a brief, structured psychiatric interview using the Primary Care Evaluation of Mental Disorders. Asthma control and asthma-related quality of life were assessed using the Asthma Control Questionnaire (ACQ) and the Asthma Quality of Life Questionnaire (AQLQ). All patients underwent standard spirometry. RESULTS: Thirty-one percent of patients (n = 157) met the diagnostic criteria for one or more psychiatric disorders (8% had DD only, 12% had AD only, and 11% had both). Analyses revealed independent effects for DDs on total ACQ scores (p < 0.01), and for DDs and ADs on total AQLQ scores and all four AQLQ subscales (p < 0.05). There were no interaction effects. CONCLUSIONS: Results suggest that DDs and ADs are associated with worse asthma-related quality of life, but only DDs are associated with worse asthma control. Interestingly, having both a DD and an AD did not confer additional risk for worse asthma control or quality of life. Physicians may want to consider the differential impact of negative mood states when assessing levels of asthma control and quality of life. [ABSTRACT FROM AUTHOR]