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Islam MS, Huq S, Ahmed S, Roy S, Schwarze J, Sheikh A, Saha SK, Cunningham S, Nair H. Operational definitions of paediatric asthma used in epidemiological studies: A systematic review. J Glob Health 2021; 11:04032. [PMID: 34326990 PMCID: PMC8285759 DOI: 10.7189/jogh.11.04032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Researchers use different definitions to identify children with asthma in epidemiological surveys. We conducted a systematic review to describe the definitions used in epidemiologic studies for wheeze and asthma in the paediatric population, aimed to inform the development of a uniform definition of paediatric asthma for future epidemiological research. Methods We systematically searched terms to identify asthma and/or wheeze among children aged <13 years and published between 1995-2020 across seven databases (MEDLINE, EMBASE, PsycINFO, Global Health, AMED, LILACS and CINAHL). PRISMA guidelines were followed for this review. Results We extracted a total of 11 886 records, where 190 met our eligibility criteria and included in the analysis. Among the included studies, 62.1% (n = 118/190) used the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires, predominantly in developing countries (80%, n = 64/80). ‘Wheeze’ was reported in five categories, subdivided by 14 different definitions. “Current wheeze”, defined as caregivers report of wheezing sounds from the chest of the child in the past 12 months and “Wheeze ever”, defined as caregivers’ report of wheezing or whistling in the chest of the child at any previous time, were the most common wheeze category reported in 129 and 95 studies, respectively. Asthma was reported in nine categories using 53 definitions. The most common asthma category was “Asthma ever”, which was reported in 89 studies, based on caregiver statement that the child had asthma in the past. Conclusion Definitions of wheeze and asthma for children used in surveys are primarily based on parent-reported clinical features. Studies from developing countries more frequently used the ISAAC definitions to report childhood asthma and wheeze compared to the studies from developed counties. The use of a uniform asthma definition will aid the interpretation of research findings globally.
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Affiliation(s)
- Mohammad Shahidul Islam
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, UK.,Child Health Research Foundation, Dhaka, Bangladesh
| | - Samin Huq
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Salahuddin Ahmed
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, UK.,Projahnmo Research Foundation, Dhaka, Bangladesh
| | - Sudipto Roy
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, UK.,KEM Hospital Research Centre, Pune, India
| | - Jürgen Schwarze
- Child Life and Health, University of Edinburgh, UK.,Centre for Inflammation Research, University of Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, UK
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Steve Cunningham
- Child Life and Health, University of Edinburgh, UK.,Centre for Inflammation Research, University of Edinburgh, UK
| | - Harish Nair
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, UK
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McCarville M, Sohn MW, Oh E, Weiss K, Gupta R. Environmental tobacco smoke and asthma exacerbations and severity: the difference between measured and reported exposure. Arch Dis Child 2013; 98:510-4. [PMID: 23606711 DOI: 10.1136/archdischild-2012-303109] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the impact of measured versus reported environmental tobacco smoke (ETS) exposure on asthma severity and exacerbations in an urban paediatric population. DESIGN We analysed cross-sectional data from the Chicago Initiative to Raise Asthma Health Equity study that followed a cohort of 561 children aged 8-14 with physician-diagnosed asthma between 2003 and 2005. Participant sociodemographic data and asthma symptoms were gathered by parental survey; exposures to ETS were determined by salivary cotinine levels and parent report. Multivariable negative binomial and ordered logistic regressions were used to assess associations between ETS and asthma outcomes. RESULTS Among 466 children included in our analysis, 58% had moderate or severe persistent asthma; 32% had >2 exacerbations requiring a hospitalisation or an emergency room visit or same day care in the previous year. Half of caregivers reported that at least one household member smoked. In multivariable analyses, salivary cotinine was significantly associated with frequently reported exacerbations in the previous year (adjusted incidence rate ratio=1.39, 95% CI 1.09 to 1.79), but not significantly associated with asthma severity. Reported household smoking was not significantly associated with either asthma severity or frequency of exacerbations. CONCLUSIONS Salivary cotinine was more predictive of asthma exacerbation frequency but caregiver- reported household smoking was not. Use of a nicotine biomarker may be important in both the clinical and research settings to accurately identify an important risk factor for asthma exacerbations.
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Affiliation(s)
- Megan McCarville
- Department of Pediatrics, University of Illinois at Chicago, 840 South Wood Street, Room 1410, Chicago, IL 60612, USA.
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Parental compliance--an emerging problem in Liverpool community child health surveys 1991-2006. BMC Med Res Methodol 2012; 12:53. [PMID: 22520150 PMCID: PMC3464653 DOI: 10.1186/1471-2288-12-53] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 04/10/2012] [Indexed: 11/18/2022] Open
Abstract
Background Compliance is a critical issue for parental questionnaires in school based epidemiological surveys and high compliance is difficult to achieve. The objective of this study was to determine trends and factors associated with parental questionnaire compliance during respiratory health surveys of school children in Merseyside between 1991 and 2006. Methods Four cross-sectional respiratory health surveys employing a core questionnaire and methodology were conducted in 1991, 1993, 1998 and 2006 among 5-11 year old children in the same 10 schools in Bootle and 5 schools in Wallasey, Merseyside. Parental compliance fell sequentially in consecutive surveys. This analysis aimed to determine the association of questionnaire compliance with variation in response rates to specific questions across surveys, and the demographic profiles for parents of children attending participant schools. Results Parental questionnaire compliance was 92% (1872/2035) in 1991, 87.4% (3746/4288) in 1993, 78.1% (1964/2514) in 1998 and 30.3% (1074/3540) in 2006. The trend to lower compliance in later surveys was consistent across all surveyed schools. Townsend score estimations of socio-economic status did not differ between schools with high or low questionnaire compliance and were comparable across the four surveys with only small differences between responders and non-responders to specific core questions. Respiratory symptom questions were mostly well answered with fewer than 15% of non-responders across all surveys. There were significant differences between mean child age, maternal and paternal smoking prevalence, and maternal employment between the four surveys (all p<0.01). Out-migration did not differ between surveys (p=0.256) with three quarters of parents resident for at least 3 years in the survey areas. Conclusion Methodological differences or changes in socio-economic status of respondents between surveys were unlikely to explain compliance differences. Changes in maternal employment patterns may have been contributory. This analysis demonstrates a major shift in community parental questionnaire compliance over a 15 year period to 2006. Parental questionnaire compliance must be factored into survey designs and methodologies.
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Stingone JA, Ramirez OF, Svensson K, Claudio L. Prevalence, demographics, and health outcomes of comorbid asthma and overweight in urban children. J Asthma 2011; 48:876-85. [PMID: 21958346 DOI: 10.3109/02770903.2011.616615] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Asthma and overweight are epidemic in urban children but the relationship between these conditions is not fully understood. This study presents demographic and risk profiles of comorbidity for overweight asthmatic children, characterizes morbidity by comparing health outcomes among overweight asthmatics and healthy weight asthmatics, and examines socioeconomic factors associated with comorbidity. OBJECTIVE To construct a demographic profile of overweight asthmatic children in an urban setting and identify factors that contribute to prevalence. METHOD Cross-sectional study of 5250 children in New York City public elementary schools using a parent-report questionnaire on body mass index, socioeconomic status, asthma, and asthma-related outcomes. RESULTS Prevalence of overweight (body mass index ≥ 85th percentile for age and gender) was 50.9%. The prevalence of overweight and ever being diagnosed with asthma was 10.9%. The prevalence of overweight with current asthma was 6.2%. Overweight current asthmatics had more night symptoms, missed school days, and asthma medication use than healthy weight asthmatics. Almost 50% of overweight current asthmatic children reported emergency department visits for asthma compared with 30% of healthy weight asthmatics. Comorbidity was most prevalent among males, Latinos, and children in low-income households, with the highest prevalence among Puerto Ricans. In multivariate analysis stratified by gender, the most significant factors associated with comorbidity among girls were low income and minority race/ethnicity, while among boys significant factors were parental education and parental history of asthma. Interestingly, there were few underweight children (7.8%) but they had high prevalence of asthma (13.8%). CONCLUSIONS The comorbidity of overweight and asthma has a large impact on urban populations, causing greater disease burden than asthma alone. Overweight asthmatics show more uncontrolled asthma, evidenced by emergency department visits, quick-relief medication use, and days with asthma symptoms. The relationship between socioeconomic factors and the asthma-obesity comorbidity may vary by gender and requires further study to identify successful interventions to reduce disease in children.
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Affiliation(s)
- Jeanette A Stingone
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
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Household smoking behavior: effects on indoor air quality and health of urban children with asthma. Matern Child Health J 2011; 15:460-8. [PMID: 20401688 DOI: 10.1007/s10995-010-0606-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The goal of the study was to examine the association between biomarkers and environmental measures of second hand smoke (SHS) with caregiver, i.e. parent or legal guardian, report of household smoking behavior and morbidity measures among children with asthma. Baseline data were drawn from a longitudinal intervention for 126 inner city children with asthma, residing with a smoker. Most children met criteria for moderate to severe persistent asthma (63%) versus mild intermittent (20%) or mild persistent (17%). Household smoking behavior and asthma morbidity were compared with child urine cotinine and indoor measures of air quality including fine particulate matter (PM(2.5)) and air nicotine (AN). Kruskal-Wallis, Wilcoxon rank-sum and Spearman rho correlation tests were used to determine the level of association between biomarkers of SHS exposure and household smoking behavior and asthma morbidity. Most children had uncontrolled asthma (62%). The primary household smoker was the child's caregiver (86/126, 68%) of which 66 (77%) were the child's mother. Significantly higher mean PM(2.5), AN and cotinine concentrations were detected in households where the caregiver was the smoker (caregiver smoker: PM(2.5) μg/m(3): 44.16, AN: 1.79 μg/m(3), cotinine: 27.39 ng/ml; caregiver non-smoker: PM(2.5): 28.88 μg/m(3), AN: 0.71 μg/m(3), cotinine:10.78 ng/ml, all P ≤ 0.01). Urine cotinine concentrations trended higher in children who reported 5 or more symptom days within the past 2 weeks (>5 days/past 2 weeks, cotinine: 28.1 ng/ml vs. <5 days/past 2 weeks, cotinine: 16.2 ng/ml; P = 0.08). However, environmental measures of SHS exposures were not associated with asthma symptoms. Urban children with persistent asthma, residing with a smoker are exposed to high levels of SHS predominantly from their primary caregiver. Because cotinine was more strongly associated with asthma symptoms than environmental measures of SHS exposure and is independent of the site of exposure, it remains the gold standard for SHS exposure assessment in children with asthma.
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Recent contributions of air- and biomarkers to the control of secondhand smoke (SHS): a review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:648-82. [PMID: 21556172 PMCID: PMC3083663 DOI: 10.3390/ijerph8030648] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 01/12/2011] [Accepted: 01/21/2011] [Indexed: 11/25/2022]
Abstract
Since the publication of the US Surgeon General Reports in 1996 and 2006 and the report of the California Environmental Protection Agency in 1999, many reports have appeared on the contribution of air and biomarkers to different facets of the secondhand smoke (SHS) issue, which are the targets of this review. These recent studies have allowed earlier epidemiological surveys to be biologically validated, and their plausibility demonstrated, quantified the levels of exposure to SHS before the bans in various environments, showed the deficiencies of mechanical control methods and of partial bans and the frequently correct implementation of the efficient total bans. More stringent regulation remains necessary in the public domain (workplaces, hospitality venues, transport sector, etc.) in many countries. Personal voluntary protection efforts against SHS are also needed in the private domain (homes, private cars). The effects of SHS on the cardiovascular, respiratory and neuropsychic systems, on pregnancy and fertility, on cancers and on SHS genotoxicity are confirmed through experimental human studies and through the relationship between markers and prevalence of disease or of markers of disease risk.
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Koshy G, Delpisheh A, Brabin BJ. Trends in prevalence of childhood and parental asthma in Merseyside, 1991-2006. J Public Health (Oxf) 2010; 32:488-95. [PMID: 20410066 DOI: 10.1093/pubmed/fdq027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To determine changes in prevalence of parental and childhood asthma in Merseyside between 1991 and 2006. METHODS Four standardized cross-sectional respiratory surveys using a parent-completed questionnaire were completed in 1991 (n = 1171), 1993 (n = 2368) 1998 (n = 1964) and in 2006 (n = 1074) among primary school children attending the same schools in lower socio-economic areas of Merseyside. Main outcome measures were prevalence of doctor diagnosed asthma (DDA) and the symptom triad of cough, wheeze and breathlessness (C+W+B+). RESULTS Between 1991 and 1998 prevalence of DDA increased (P < 0.001), but in 2006 this decreased from 29.8 to 19.4% (P < 0.001). Prevalence of C+W+B+ increased from 7.8 to 8.0% by 1998, then decreased to 6.7% in 2006 (P = 0.39). Between 1998 and 2006, childhood hospital admissions for respiratory illness decreased from 11.3 to 9.7% (P = 0.23). During this period paternal asthma prevalence increased from 8.6 to 10.7% (P = 0.001) and maternal asthma from 11.2 to 13.4% (P = 0.09). CONCLUSIONS An increase in the prevalence of DDA and asthmatic respiratory symptoms occurred in children prior to 1998, but this had decreased by 2006. Prevalence of parental asthma increased during the same period.
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Affiliation(s)
- Gibby Koshy
- Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Abstract
PURPOSE OF REVIEW Despite overall improvements in asthma care through an increasing evidence base, disparities in outcomes of children of ethnic minorities and low socioeconomic status are well documented across healthcare systems. New interventions to reduce gaps in outcomes among these children are continually being evaluated. This article reviews the most relevant and influential recent studies. RECENT FINDINGS A number of interventions aimed at vulnerable children with asthma have been successful. Most of these include a component of education and self-management. There is some evidence that culturally competent care produces improved outcomes, whereas stronger evidence exists for multifaceted programs and community health workers providing home visits for education and environmental allergen reduction. Targeting children and families through school-based programs may be an effective outreach strategy. Use of novel technologies such as educational messages on MP3 players shows promise in reaching at-risk adolescents. SUMMARY There are promising strategies proven to significantly decrease disparities in asthma among vulnerable children. Further research must be performed to elucidate the interventions that produce the greatest impact on asthma-related outcomes while being feasible, sustainable, and cost-effective.
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Thomas MV, Branscum A, Miller CS, Ebersole J, Al-Sabbagh M, Schuster JL. Within-subject variability in repeated measures of salivary analytes in healthy adults. J Periodontol 2009; 80:1146-53. [PMID: 19563296 DOI: 10.1902/jop.2009.080654] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Saliva contains a large number of biomolecules, some of which have putative diagnostic usefulness. A potential problem with the use of biomolecules in diagnosis is day-to-day fluctuation due to within-subject variability. This study evaluated the intraindividual variability of six salivary analytes in healthy adults and determined their normal range. METHODS Unstimulated whole saliva (5 ml) was collected every 2 to 3 days on six occasions from 30 subjects in good oral and systemic health. Four of the samples were collected in the clinic, and two were collected by the subject at home. The concentration ranges of interleukin (IL)-1beta, IL-6, matrix metalloproteinase-8, prostaglandin E(2), tumor necrosis factor-alpha, interferon-alpha, and albumin were examined. Descriptive statistics were computed, and a one-way random-effects model was used to quantify within- and between-subject components of variability. Intraclass correlation coefficients (ICCs) were calculated for each subject/analyte combination. RESULTS Within-subject coefficients of variation for these analytes ranged from 67.6% to 172.1% for the in-clinic samples and from 111.9% to 201.0% for the at-home samples. The ICC for the various analytes ranged from 41% to 61% for the in-clinic samples. The at-home samples exhibited significantly more variability than did those obtained in the clinic under supervision. CONCLUSIONS There was marked within-subject variation in the salivary concentrations of these analytes. With increased interest in salivary diagnostics, the within-subject variability, normal range, and threshold levels for abnormal levels of individual salivary analytes need to be determined if these diagnostics tests are to have clinical usefulness.
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Affiliation(s)
- Mark V Thomas
- Division of Periodontology, Department of Oral Health Practice, University of Kentucky College of Dentistry, Lexington, KY, USA.
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Avşar A, Darka Ö, Bodrumlu EH, Bek Y. Evaluation of the relationship between passive smoking and salivary electrolytes, protein, secretory IgA, sialic acid and amylase in young children. Arch Oral Biol 2009; 54:457-63. [DOI: 10.1016/j.archoralbio.2009.01.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 01/23/2009] [Accepted: 01/26/2009] [Indexed: 10/21/2022]
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Abstract
PURPOSE OF REVIEW We aim to discuss current insights into our understanding of the mechanisms by which socioeconomic status influences the prevalence and severity of asthma in ethnic minorities. In addition, we review potential risk factors for ethnic disparities in asthma that are not mediated by socioeconomic status. RECENT FINDINGS Exposures and factors correlated with ethnicity through socioeconomic status (e.g. indoor and outdoor air quality, smoke exposure, and access to healthcare) are likely to explain a significant proportion of the observed ethnic differences in asthma morbidity. However, other factors correlated with ethnicity (e.g. genetic variation) can impact ethnic disparities in asthma independently of and/or interacting with socioeconomic status-related factors. SUMMARY Socioeconomic status is a rough marker of a variety of environmental/behavioral exposures and a very important determinant of differences in asthma prevalence and severity among ethnic minorities in the United States. However, socioeconomic status is unlikely to be the sole explanation for ethnic disparities in asthma, which may also be due to differences in genetic variation and gene-by-environment interactions among ethnic groups.
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Affiliation(s)
- Erick Forno
- Channing Laboratory, Dept. of Medicine, Brigham and Women’s Hospital, Boston, MA
- Division of Respiratory Diseases, Dept. of Pediatrics, Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Juan C. Celedón
- Channing Laboratory, Dept. of Medicine, Brigham and Women’s Hospital, Boston, MA
- Division of Pulmonary/Critical Care Medicine, Dept. of Medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Current World Literature. Curr Opin Allergy Clin Immunol 2009; 9:177-84. [DOI: 10.1097/aci.0b013e328329f9ca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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