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Schuler CL, Kercsmar C, Mansour M, McDowell KM, Huang G, Hossain MM, Robinette ED, Beck AF. Identifying asthma-related risks during hospitalization using the child asthma risk assessment tool. J Asthma 2023; 60:2189-2197. [PMID: 37345884 DOI: 10.1080/02770903.2023.2228897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/20/2023] [Indexed: 06/23/2023]
Abstract
Objective: The Child Asthma Risk Assessment Tool (CARAT) identifies risk factors for asthma morbidity. We hypothesized that CARAT-identified risk factors (using a CARAT adapted for inpatient use) would be associated with future healthcare utilization and would identify areas for intervention.Methods: We reviewed CARAT data collected during pediatric asthma admissions from 2010-2015, assessing for risk factors in environmental, medical, and social domains and providing prompts for inpatient (specialist consultation or social services engagement) and post-discharge interventions (home care visit or home environmental assessment). Confirmatory factor analysis identified groups of CARAT-identified risk factors with similar effects on healthcare utilization (latent factors). Structural equation models then evaluated relationships between latent factors and future utilization.Results: There were 2731 unique patients admitted for asthma exacerbations; 1015 (37%) had complete CARAT assessments and were included in analyses. Those with incomplete CARAT assessments were more often younger and privately-insured. CARAT-identified risk factors across domains were common in children hospitalized for exacerbations. Risks in the environmental domain were most common. Inpatient asthma consults by pulmonologists or allergists and home care referrals were the most frequent interventions indicated (62%, 628/1015, and 50%, 510/1015, respectively). Two latent factors were positively associated with healthcare utilization in the year after index stay - social stressors and known/suspected allergies (both p < 0.05). Stratified analyses analyzing data just from those children with prior healthcare utilization also indicated known/suspected allergies to be positively associated with future utilization.Conclusions: Inpatient interventions to address social stressors and allergic profiles may be warranted to reduce subsequent asthma morbidity.
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Affiliation(s)
- Christine L Schuler
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Carolyn Kercsmar
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mona Mansour
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Karen M McDowell
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Guixia Huang
- Division of Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Md Monir Hossain
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eric D Robinette
- Division of Infectious Disease, Akron Children's Hospital, Akron, OH, USA
| | - Andrew F Beck
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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2
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Volerman A, Kappel N, Tayal A, Rosenwinkel M, Salem E, Vipond L. Student knowledge gains among first-time and repeat attendees of school-based asthma education program. BMC Pulm Med 2023; 23:249. [PMID: 37430273 DOI: 10.1186/s12890-023-02544-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 06/29/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Because children spend much of their time in schools, schools can play an important role in asthma education for the one in 12 affected children in the United States. School-based asthma education programs are commonly repeated annually, however few studies have evaluated the impact of repeated participation in asthma education in school-based programs. METHODS This observational study evaluated the impact of Fight Asthma Now© (FAN), a school-based asthma education program for children in Illinois schools. Participants completed a survey at the start and end of the program, including demographics, prior asthma education, and 11 asthma knowledge questions (maximum knowledge score = 11). RESULTS Among 4,951 youth participating in the school-based asthma education program, mean age was 10.75 years. Approximately half were male and Black. Over half reported no prior asthma education (54.6%). At baseline, repeat attendees had significantly higher knowledge versus first-time attendees (mean: 7.45 versus 5.92; p < 0.001). After the program, both first-time and repeat attendees had significant knowledge improvements (first-time: mean = 5.92◊9.32; p < 0.001; repeat: mean = 7.45◊9.62; p < 0.001). CONCLUSIONS School-based asthma education is effective for increasing asthma knowledge. Notably, repeated asthma education in school leads to incremental benefits for knowledge. Future studies are needed to understand the effects of repeated asthma education on morbidity.
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Affiliation(s)
- Anna Volerman
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, United States of America.
- Department of Pediatrics, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, United States of America.
| | - Nicole Kappel
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, United States of America
| | - Ashu Tayal
- University of Chicago, Harris School of Public Policy, 1307 E 60th St, Chicago, IL, 60637, United States of America
| | - Mary Rosenwinkel
- Respiratory Health Association, 1440 W Washington Blvd, Chicago, IL, 60607, United States of America
| | - Erica Salem
- Respiratory Health Association, 1440 W Washington Blvd, Chicago, IL, 60607, United States of America
| | - Lesli Vipond
- Respiratory Health Association, 1440 W Washington Blvd, Chicago, IL, 60607, United States of America
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3
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Ancheta AJ, Cunningham PB, Liu J, Powell JS, Halliday CA, Bruzzese JM. Asthma is associated with bullying victimization in rural adolescents. J Asthma 2023; 60:1409-1417. [PMID: 36413706 DOI: 10.1080/02770903.2022.2151466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We characterized bullying among rural adolescents and examined the association between asthma and bullying victimization. METHODS Participants (N = 1905; 44.5% Black) were students attending rural high schools who were screened for a randomized trial to address uncontrolled asthma. Screening questions asked students about asthma diagnosis and symptoms, bullying victimization, and demographic characteristics. Logistic regression analyses with school as a fixed effect were employed to examine the extent to which demographic factors, asthma diagnosis, asthma status (i.e. current asthma, no asthma, possible undiagnosed asthma), and among those with current asthma, asthma severity, were associated with bullying victimization. Sensitivity analyses using bullying frequency as the outcome were also conducted. RESULTS 26.0% reported being bullied. Younger age and self-identifying as White were associated with increased risk of bullying victimization. Compared to those with no asthma, those with current asthma or possible undiagnosed asthma were at increased risk for bullying victimization (adjusted odds ratio [AOR] = 2.46; 95% confidence interval (CI) = 1.76-3.46 and AOR = 2.42; 95% CI = 1.87-3.14, respectively). Among those with current asthma, persistent symptoms increased the risk for bullying victimization (AOR = 2.59; 95% CI = 1.45-4.71). Similar results were obtained with sensitivity analyses. CONCLUSIONS In a large rural community cohort, asthma was associated with bullying victimization. Findings suggest that rural students with asthma, with or without diagnosis, could benefit from schools creating inclusive environments that reduce victimization based on this medical condition. School administrators should foster environments that are accepting of all students' abilities and statuses, and healthcare providers can provide proper asthma management education to these adolescents.
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Affiliation(s)
- April J Ancheta
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Phillippe B Cunningham
- Division of Global and Community Health, Medical University of South Carolina, Charleston, SC, USA
| | - Jianfang Liu
- Office of Scholarship and Research, Columbia University School of Nursing, New York, NY, USA
| | - Jennifer S Powell
- Division of Global and Community Health, Medical University of South Carolina, Charleston, SC, USA
| | - Colleen A Halliday
- Division of Global and Community Health, Medical University of South Carolina, Charleston, SC, USA
| | - Jean-Marie Bruzzese
- Office of Scholarship and Research, Columbia University School of Nursing, New York, NY, USA
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4
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Adams EK, Johnson VC, Hogue CJ, Franco-Montoya D, Joski PJ, Hawley JN. Elementary School-Based Health Centers and Access to Preventive and Asthma-Related Care Among Publicly Insured Children With Asthma in Georgia. Public Health Rep 2022; 137:901-911. [PMID: 34436955 PMCID: PMC9379825 DOI: 10.1177/00333549211032973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We assessed the effects of 3 new elementary school-based health centers (SBHCs) in disparate Georgia communities-predominantly non-Hispanic Black semi-urban, predominantly Hispanic urban, and predominantly non-Hispanic White rural-on asthma case management among children insured by Medicaid/Children's Health Insurance Program (CHIP). METHODS We used a quasi-experimental difference-in-differences analysis to measure changes in the treatment of children with asthma, Medicaid/CHIP, and access to an SBHC (treatment, n = 193) and children in the same county without such access (control, n = 163) in school years 2011-2013 and 2013-2018. Among children with access to an SBHC (n = 193), we tested for differences between users (34%) and nonusers of SBHCs. We used International Classification of Diseases diagnosis codes, Current Procedural Terminology codes, and National Drug Codes to measure well-child visits and influenza immunization; ≥3 asthma-related visits, asthma-relief medication, asthma-control medication, and ≥2 asthma-control medications; and emergency department visits during the child-school year. RESULTS We found an increase of about 19 (P = .01) to 33 (P < .001) percentage points in the probability of having ≥3 asthma-related visits per child-school year and an increase of about 22 (P = .003) to 24 (P < .001) percentage points in the receipt of asthma-relief medication, among users of the predominantly non-Hispanic Black and Hispanic SBHCs. We found a 19 (P = .01) to 29 (P < .001) percentage-point increase in receipt of asthma-control medication and a 15 (P = .03) to 30 (P < .001) percentage-point increase in receipt of ≥2 asthma-control medications among users. Increases were largest in the predominantly non-Hispanic Black SBHC. CONCLUSION Implementation and use of elementary SBHCs can increase case management and recommended medications among racial/ethnic minority and publicly insured children with asthma.
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Affiliation(s)
- E. Kathleen Adams
- Department of Health Policy and Management, Rollins School of
Public Health, Emory University, Atlanta, GA, USA
| | - Veda C. Johnson
- Department of Pediatrics, Emory University School of Medicine,
Atlanta, GA, USA
| | - Carol J. Hogue
- Department of Epidemiology, Rollins School of Public Health,
Emory University, Atlanta, GA, USA
| | - Daniela Franco-Montoya
- Department of Health Policy and Management, Rollins School of
Public Health, Emory University, Atlanta, GA, USA
| | - Peter J. Joski
- Department of Health Policy and Management, Rollins School of
Public Health, Emory University, Atlanta, GA, USA
| | - Jonathan N. Hawley
- Department of Health Policy and Management, Rollins School of
Public Health, Emory University, Atlanta, GA, USA
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5
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Uchima O, Keaulana S, Okihiro M, Sentell T. A scoping review of school-based asthma education programs for reducing children’s need for acute care services. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2091568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Olivia Uchima
- Graduate of the PhD in Public Health, The University of Hawaii of Manoa, Honolulu, HI, USA
| | - Samantha Keaulana
- Doctoral Candidate of the Office of Public Health Studies, The University of Hawaii of Manoa, Honolulu, HI, USA
| | - May Okihiro
- Pediatrician in the Department of Pediatrics, The University of Hawaii at Manoa, Honolulu, HI, USA
| | - Tetine Sentell
- Director and Professor of the Office of Public Health Studies, the University of Hawaii at Manoa, Honolulu, HI, USA
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Amelioration of Ovalbumin-Induced Allergic Asthma by Juglans regia via Downregulation of Inflammatory Cytokines and Upregulation of Aquaporin-1 and Aquaporin-5 in Mice. J Trop Med 2022; 2022:6530095. [PMID: 35401757 PMCID: PMC8986429 DOI: 10.1155/2022/6530095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/22/2022] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
Juglans regia (J. regia) has been used traditionally to treat cough and asthma. The present study evaluates the immunomodulatory and anti-inflammatory potential of J. regia against ovalbumin (OVA)-induced allergic asthma. Intraperitoneal sensitization proceeded by intranasal challenge with OVA was used to induce allergic asthma. BALB/c mice were treated with methanol, n-hexane, and ethyl acetate extracts of J. regia and methylprednisolone one week after 2nd sensitization with OVA and continued for 7 days. mRNA expression levels of IL-4, IL-5, IL-13, AQP-1, AQP-5 TNF-α, TGF-β, and NF-kB were determined using reverse transcription polymerase chain reaction. Hematoxylin and eosin, and periodic acidic-Schiff stains were used for histopathological studies of lung tissues. The data presented all three extracts of J. regia significantly ameliorated airway inflammation by reducing expression levels of IL-4, IL-5, and IL-13 and TNF-α in OVA-treated mice. The suppression of goblet cells hyperplasia and inflammatory cells infiltration by J. regia involved low TGF-β and NF-kB levels. Pretreatment with J. regia also increased the AQP-1 and AQP-5 expression levels in mice treated with OVA. This study supported the traditional use of J. regia and proposed that J. regia ameliorated allergic asthma by suppression of proinflammatory cytokines and elevation of AQP-1 and AQP-5 expression levels.
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Bryant-Stephens T, Williams Y, Kanagasundaram J, Apter A, Kenyon CC, Shults J. The West Philadelphia asthma care implementation study (NHLBI# U01HL138687). Contemp Clin Trials Commun 2021; 24:100864. [PMID: 34926863 PMCID: PMC8649219 DOI: 10.1016/j.conctc.2021.100864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/05/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022] Open
Abstract
Asthma is the most common chronic condition among children, with low-income families living in urban areas experiencing significantly higher rates. Evidence based interventions for asthma are routinely implemented in either the home, school, or primary care setting. However, even when caregivers of poor children are engaged in asthma interventions in one setting, they often have to navigate challenges in another setting, such as an under-resourced home, non-supportive school, or disengaged health care provider. The West Philadelphia Asthma Care Implementation Plan aims to compare the effectiveness of a primary care-based intervention, school-based intervention, and combined primary care and school intervention to usual care for improving asthma control in school-age children to explore if the synergistic effect of Community Health Worker (CHW) support in the home, school, and health care environments will result in improved asthma control. Children ages 5-13 with uncontrolled asthma from four West Philadelphia recruitment sites will be eligible for enrollment. The families of school age children interested in participating will be randomized to receive a primary care CHW or usual care. Those identified as attending a participating school will have a CHW-led school intervention or usual care in school. If proven effective, this care coordination program will assist caregivers in assessing resources, improving self-management skills, and ultimately reducing asthma-related ED visits and hospitalizations as well as provide additional information for healthcare systems and policy makers to inform their decisions about how and where to focus additional resources and investments in childhood asthma care to improve health outcomes.
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Key Words
- ACQ, Asthma Control Questionnaire
- Asthma
- Asthma in children
- CAPP, Communitiy Asthma Prevention Program
- CHOP, Children's Hospital of Philadelphia
- CHW, Community Health Worker
- Community research
- EBI, Evidence-based intervention
- ED, emergency department
- EHR, electronic health record
- IRB, institutional review board
- Implementation science
- OAS, Open Airways for Schools
- SAMPRO, School-based Asthma Management Program
- SBAT, School-based Asthma Therapy
- WEPACC, West Philadelphia Asthma Care Collaborative
- pCHW, primary care community health worker
- sCHW, school-based community health worker
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Affiliation(s)
- Tyra Bryant-Stephens
- Community Asthma Prevention Program, Sr Director, Center for Health Equity, Associate Professor of Pediatrics, United States
| | | | | | - Andrea Apter
- Perelman School of Medicine at the University of Pennsylvania, United States
| | - Chén C. Kenyon
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, United States
| | - Justine Shults
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, United States
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8
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Fox E, Fu LY. The Role of Pediatric Health-care Providers in Promoting Students' Asthma Health. Pediatr Rev 2021; 42:439-448. [PMID: 34341085 DOI: 10.1542/pir.2020-000703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Eduardo Fox
- Department of Pediatrics, Children's National Hospital, Washington, DC.,The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Linda Y Fu
- Department of Pediatrics, Children's National Hospital, Washington, DC.,The George Washington University School of Medicine and Health Sciences, Washington, DC
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9
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Abstract
PURPOSE OF REVIEW This article reviews the approach to a child or adolescent with headache, the criteria for common diagnoses, and the evidence base for treatments. RECENT FINDINGS The guidelines for acute and preventive treatment of migraine were updated in 2019. These guidelines summarize the available evidence and outline the questions that should be addressed in future research. The US Food and Drug Administration (FDA) approval of several new classes of drugs and devices to treat adult migraine in the past few years has resulted in ongoing or planned pediatric trials. SUMMARY Headache is a common symptom in children, and it is important to take a detailed history and perform a thorough physical examination to make the diagnosis. Nearly 1 in 10 children experience recurrent headaches due to migraine, which cause significant impairment in school performance and quality of life. The acute and preventive treatments that are currently available will help at least two-thirds of children with migraine, and several trials of new therapies offer hope for the future.
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Bruzzese JM, George M, Liu J, Evans D, Naar S, DeRosier ME, Thomas JM. The Development and Preliminary Impact of CAMP Air: A Web-based Asthma Intervention to Improve Asthma Among Adolescents. PATIENT EDUCATION AND COUNSELING 2021; 104:865-870. [PMID: 33004234 PMCID: PMC7956908 DOI: 10.1016/j.pec.2020.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Describe the development and preliminary impact of CAMP Air, a web-based intervention for adolescents with uncontrolled asthma. MATERIALS AND METHODS CAMP Air was developed using an iterative process with input from stakeholders and incorporating usability testing results (n = 14 adolescents). To test CAMP Air's initial impact, 61 adolescents from two New York City public high schools (n = 37) and from clinics, community-based organizations, and third-party recruitment services (i.e., community sample; n = 24) were enrolled in a randomized pilot trial. Participants were randomized to CAMP Air (n = 30) or information-and-referral control intervention (n = 31). A point-person worked with school participants to complete CAMP Air. RESULTS CAMP Air participants were satisfied with the intervention and its value for supporting self-management, completing on average 6 of 7 modules. Relative to controls, CAMP Air participants demonstrated significantly improved asthma knowledge, asthma control, night wakening and school absences, and less risk for urgent care visits. Adolescents enrolled in schools completed more modules and had significantly fewer nights woken and school absences than community enrollees. CONCLUSION CAMP Air improves asthma outcomes among adolescents with uncontrolled asthma. PRACTICE IMPLICATIONS A web-based intervention CAMP Air is a promising intervention. When a point-person works with adolescents, CAMP Air's access and impact are improved.
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Affiliation(s)
| | | | - Jianfang Liu
- Columbia University School of Nursing, United States
| | - David Evans
- Columbia University Mailman School of Public Health, United States
| | - Sylvie Naar
- Florida State University, Center for Translational Behavioral Science, United States
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11
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Psychosocial stress, sleep quality and interest in mind-body integrative health sleep intervention among urban adolescents in the school-based health setting. Complement Ther Med 2021; 58:102714. [PMID: 33766621 PMCID: PMC10119780 DOI: 10.1016/j.ctim.2021.102714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mind-body integrative health (MBIH) interventions to improve adolescent sleep are lacking. The study characterized sleep quality and bedtime-related psychosocial stressors among urban minority adolescents, explored associations between demographics factors, stressors and sleep quality, and gauged interest in a MBIH sleep intervention. MATERIALS AND METHODS 167 school-based health center (SBHC) patients (mean age = 16.3; 64 % female; 68 % Latino) participated in a needs assessment as part of a quality improvement project. They reported bedtime-related psychosocial stressors using items from the Adolescent Sleep Hygiene Scale (ASHS), sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and interest in a MBIH-based sleep intervention. Chi-square and logistic regression examined associations between demographics, stressors, sleep quality, and interest in the intervention. RESULTS 67 % had poor sleep quality. Females, compared to males, had 2.23 higher odds (95 % Confidence Interval [CI]: 1.12, 4.42) of having poor sleep quality. Nearly 80 % experienced bedtime-related stressors (25 % experienced one stressor, 17 % two stressors and 37 % three or more stressors); relative to those reporting no stressors, those reporting 3+ stressors had 3.15 higher odds (95 % CI: 1.27, 7.84) of having poor sleep quality. Most (77 %) reported they would participate in an SBHC-based intervention that utilized MBIH modalities preferring both one-on-one and group sessions. CONCLUSIONS Urban, predominantly Hispanic and Black, SBHC adolescent patients have poor sleep quality and report bedtime-related psychosocial stressors. Their interest in MBIH interventions to address sleep problems represents a unique opportunity for practitioners and complementary therapists to offer MBIH interventions to a population at high-risk for poor sleep quality.
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12
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Perry TT, Turner JH. School-Based Telemedicine for Asthma Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 7:2524-2532. [PMID: 31706484 DOI: 10.1016/j.jaip.2019.08.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 10/25/2022]
Abstract
Asthma affects 10% of school-age children in the United States. These numbers nearly double in high-risk populations such as low-income and minority populations. Patients in these populations frequently live in communities that are medically underserved, with limited resources to implement comprehensive asthma interventions. It is important for researchers and clinicians to explore avenues to reduce the burden of illness in this population. Incorporating innovative strategies such as school-based telemedicine programs can potentially reduce morbidity, health care utilization, work absenteeism for caregivers, and school absenteeism for children with asthma. The aim of this review is to discuss the potential benefits of school-based asthma telemedicine programs, explore potential implementation models, and provide a comprehensive review of the literature including programs that use telemedicine in schools to assist with the management of asthma. Telemedicine is a feasible approach to increasing access to primary and specialty asthma care; however, there is a need for future randomized trials to establish best practices for implementation of telemedicine programs to aid in the care for children in school settings.
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Affiliation(s)
- Tamara T Perry
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark.
| | - Jessica H Turner
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark
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13
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Everhart RS, Corona R, Mazzeo SE, Dempster KW, Schechter MS. School Nurses' Perspectives on Components of Asthma Programs to Address Pediatric Disparities. J Pediatr Psychol 2020; 45:900-909. [PMID: 32524136 PMCID: PMC7828575 DOI: 10.1093/jpepsy/jsaa039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/29/2020] [Accepted: 05/02/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To use a community engaged, collaborative approach with school nurses working within an urban community, to develop recommendations for future school-based interventions targeting pediatric asthma disparities. METHODS Open-ended survey data were collected from 33 nurses (77% of nurses in the school district) during a face-to-face monthly health services meeting. Questions asked nurses to estimate the proportion of students with asthma with the necessary forms and medications at school and to describe perceived barriers to having such forms and medications, and potential initiatives that could be implemented. A 30-min asthma education class was also piloted with school nurses, who then rated its acceptability and feasibility. Open-ended survey data were analyzed using thematic analysis. RESULTS Nurses estimated that 12% of students with asthma had an asthma action plan, 19% had a medication release form, and 15% had medications at school (i.e. inhalers). Four themes emerged regarding barriers to asthma management in schools and strategies for promoting asthma management in schools: coordination of care, asthma education, access to care, and medication adherence. Nurses noted the need for education focused specifically on teaching inhaler technique, and better communication between schools, providers, and families. CONCLUSIONS School nurses provided valuable information regarding specific barriers, as well as approaches to addressing these barriers in a future intervention. Findings suggest that a school-based intervention needs to address coordination among schools, parents, and medical providers, and will be optimally effective if it also addresses structural barriers.
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Affiliation(s)
| | - Rosalie Corona
- Department of Psychology, Virginia Commonwealth University and
| | | | | | - Michael S Schechter
- Division of Pulmonary Medicine, Department of Pediatrics, Children’s Hospital of Richmond at VCU
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14
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Rehman N, Morais-Almeida M, Wu AC. Asthma Across Childhood: Improving Adherence to Asthma Management from Early Childhood to Adolescence. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:1802-1807.e1. [PMID: 32112922 PMCID: PMC7275896 DOI: 10.1016/j.jaip.2020.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/24/2020] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
Abstract
Asthma affects nearly 6 million US children. Throughout childhood, children undergo a series of biological, developmental, and psychosocial changes. Thus, factors influencing a child's asthma management differ across 3 essential stages-early childhood (0-5 years), school-aged years (5-12 years), and adolescence (12-18 years)-and require varied intervention by parents, school personnel, clinicians, and the children themselves. Because asthma care in children is characterized by fluctuations in severity and coordination among many stakeholders, optimal asthma control is difficult to achieve in this young population. Challenges in childhood asthma management are reflected in the low rates of children's adherence to medication regimes. Although pharmacological and biological factors addressing age in physicians' treatment choices are well outlined, age-specific approaches to patient-provider communication and asthma-related interventions are also important in improving quality of life for patients with pediatric asthma.
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Affiliation(s)
- Narmeen Rehman
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass
| | - Mário Morais-Almeida
- Allergy Center, CUF Descobertas Hospital, CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Ann Chen Wu
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass.
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15
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Kang MG, Yoon SA, Sim JH, Woo SI. Fractional exhaled nitric oxide and forced expiratory volume in 1 second/forced vital capacity have predictive value of asthma exacerbation in Korean school children. Asia Pac Allergy 2020; 10:e7. [PMID: 32099829 PMCID: PMC7016316 DOI: 10.5415/apallergy.2020.10.e7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/23/2020] [Indexed: 12/11/2022] Open
Abstract
Background The incidence of asthma exacerbation (AE) and the predictive value of spirometry and fractional exhaled nitric oxide (FeNO) in school children have not been evaluated. Objective We sought to evaluate the efficacy of spirometry measurement and FeNO monitoring for predicting AE in school children in the Cheongju area in Korea. Methods With parental agreement, we studied 170 students aged 7–12 years. Children were evaluated by an asthma specialist using baseline spirometry, skin prick test, seasonal FeNO measurement, and asthma control test. The study participants underwent a physical examination and their medical history was also evaluated by the specialist. They were assessed for asthma control status during regular doctor visits for 1 year. Results In total, 160 children (94.1%) completed follow-up and FeNO monitoring. Of which, 26 children (16.3%) had AE. AE was associated with male children and children with allergic rhinitis (p < 0.05). While, children with AE tended to have higher FeNO than those without AE, no significant difference was found. The maximum value of FeNO ≥35 ppb was associated with AE (p < 0.05). Children with AE had a significantly decreased baseline forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC), %predicted, forced expiratory flow at 25%–75% of FVC (FEF25%–75%). FEV1/FVC < 80% was associated with AE in children regardless of inhalant allergen sensitization (all p < 0.05). Conclusion Baseline spirometry had a predictive value of AE in school children. Sensitive spirometric parameters such as FEV1/FVC and FEF25%–75% can be used as prognostic factors to predict future childhood AE. FeNO value ≥ 35 ppb during monitoring was associated with AE in school children.
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Affiliation(s)
- Min-Gyu Kang
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Shin-Ae Yoon
- Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ju-Han Sim
- Oksan and Gangnae Elementary School, Chungbuk, Cheongju, Korea
| | - Sung-Il Woo
- Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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16
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Hauptman M, Gaffin JM, Petty CR, Sheehan WJ, Lai PS, Coull B, Gold DR, Phipatanakul W. Proximity to major roadways and asthma symptoms in the School Inner-City Asthma Study. J Allergy Clin Immunol 2020; 145:119-126.e4. [PMID: 31557500 PMCID: PMC6949366 DOI: 10.1016/j.jaci.2019.08.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 07/31/2019] [Accepted: 08/22/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Traffic proximity has been associated with adverse respiratory health outcomes. Less is known about the combined impact of residential and school exposures on pediatric asthma. OBJECTIVE We sought to use spatial analysis methodology to analyze residential and school proximity to major roadways and pediatric asthma morbidity. METHODS The School Inner-City Asthma Study (n = 350) recruited school-aged children with asthma. Each participant's school and home addresses were geocoded, and distances from major roadways were measured to calculate a composite measure accounting for both home and school traffic exposure. Generalized estimating equation models were clustered by subject and adjusted for age, race/ethnicity, sex, income, environmental tobacco smoke, controller medication, upper respiratory tract infections, and seasonality. RESULTS The majority of participants (62%) attended schools within 100 m from major roadways, and 40% also resided within 100 m of major roadways. In multivariate analyses major roadway proximity was independently associated with increased asthma symptom days. At greater than the threshold of 100 m, children had 29% less odds of a symptom day over the past 2 weeks for each 100-m increase in distance from a major roadway (odds ratio, 0.71; 95% CI, 0.58-0.87; P < .01). Children farther from a major roadway also had significantly less reported health care use (odds ratio, 0.63; 95% CI, 0.47-0.85; P < .01) and were significantly less likely to have poor asthma control (odds ratio, 0.80; 95% CI, 0.69-0.94; P < .01). There was not a meaningful association between distance to a major roadway and lung function outcomes. CONCLUSIONS Proximity to a major roadway, a composite measure of home and school exposure but primarily driven by home exposure, was associated with greater asthma morbidity. More studies are needed to evaluate the independent effect of school distance to a roadway on asthma morbidity.
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Affiliation(s)
- Marissa Hauptman
- Division of General Pediatrics, Boston Children's Hospital, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Jonathan M Gaffin
- Harvard Medical School, Boston, Mass; Division of Respiratory Diseases, Boston Children's Hospital, Boston, Mass
| | - Carter R Petty
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - William J Sheehan
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass
| | - Peggy S Lai
- Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass; Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Mass
| | - Brent Coull
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Diane R Gold
- Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass; Division of Respiratory Epidemiology, Channing Laboratory, Brigham and Women's Hospital, Boston, Mass
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass.
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17
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Kakumanu S, Lemanske RF. Asthma in Schools: How School-Based Partnerships Improve Pediatric Asthma Care. Immunol Allergy Clin North Am 2019; 39:271-281. [PMID: 30954176 DOI: 10.1016/j.iac.2018.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Children with asthma experience frequent exacerbations that require careful care coordination among families, clinicians, and schools. Prior studies have shown that children with asthma miss more school each year compared with their healthy peers due to uncontrolled asthma symptoms. Successful school-based asthma programs have built strong partnerships among patients, their families, and clinicians to improve communication and the dissemination of asthma action plans and medications to schools. The widely endorsed School-based Asthma Management Program, consisting of 4 components, provides a comprehensive and expert-supported framework to coordinate care with schools.
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Affiliation(s)
- Sujani Kakumanu
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, William S. Middleton Veterans Memorial Hospital, 600 Highland Avenue CSC 9988, Madison, WI 53792, USA.
| | - Robert F Lemanske
- Department of Pediatrics, Institute for Clinical and Translational Research, University of Wisconsin School of Medicine and Public Health, 4235 HSLC, 750 Highland Avenue, Madison, WI 53705, USA; Department of Medicine, Institute for Clinical and Translational Research, University of Wisconsin School of Medicine and Public Health, 4235 HSLC, 750 Highland Avenue, Madison, WI 53705, USA
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18
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Bryant-Stephens T, Kenyon C, Apter AJ, Wolk C, Williams YS, Localio R, Toussaint K, Hui A, West C, Stewart Y, McGinnis S, Gutierrez M, Beidas R. Creating a community-based comprehensive intervention to improve asthma control in a low-income, low-resourced community. J Asthma 2019; 57:820-828. [PMID: 31082287 DOI: 10.1080/02770903.2019.1619083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Asthma evidence-based interventions (EBI) are implemented in the home, school, community or primary care setting. Although families are engaged in one setting, they often have to navigate challenges in another setting.Objective: Our objective is to design and implement a comprehensive plan which integrates EBI's and connects the four sectors in underserved communities such as Philadelphia.Methods: September 2015-April 2016 we implemented a three-pronged strategy to understand needs and resources of the community including 1) focus groups and key informant interviews, 2) secondary data analysis and 3) pilot testing for implementation to determine gaps in care, and opportunities to overcome those gaps.Results: Analysis of the focus group and key informant responses showed themes: diagnosis fear, clinician time, home and school asthma trigger exposures, school personnel training and communication gaps across all four sectors. EBI's were evaluated and selected to address identified themes. Pilot testing of a community health worker (CHW) intervention to connect home, primary care and school resulted in an efficient transfer of asthma medications and medication administration forms to the school nurse office for students with uncontrolled asthma addressing a common delay leading to poor asthma management in school.Conclusion: Thus far there has been limited success in reducing asthma disparities for low-income minority children. This study offers hope that strategically positioning CHWs may work synergistically to close gaps in care and result in improved asthma control and reduced asthma disparities.
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Affiliation(s)
- Tyra Bryant-Stephens
- The Children's Hospital of Philadelphia Community Asthma Prevention Program, Philadelphia, PA, USA.,University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA
| | - C Kenyon
- The Children's Hospital of Philadelphia Community Asthma Prevention Program, Philadelphia, PA, USA.,University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA
| | - A J Apter
- University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA
| | - Courtney Wolk
- University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA.,Department of Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA
| | - Yolanda S Williams
- The Children's Hospital of Philadelphia Community Asthma Prevention Program, Philadelphia, PA, USA
| | - R Localio
- University of Pennsylvania/Perelman School of Medicine, Philadelphia, PA, USA
| | - K Toussaint
- The Children's Hospital of Philadelphia Community Asthma Prevention Program, Philadelphia, PA, USA
| | - A Hui
- Philadelphia Health Management Corporation, Philadelphia, PA, USA
| | - C West
- Philadelphia Health Management Corporation, Philadelphia, PA, USA
| | | | - S McGinnis
- Philadelphia Health Management Corporation, Philadelphia, PA, USA
| | - M Gutierrez
- Philadelphia Health Management Corporation, Philadelphia, PA, USA
| | - R Beidas
- Department of Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, PA, USA
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19
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Abstract
Pediatric asthma, the most common chronic disease of childhood, remains a significant burden to the health care system. Although there are guidelines for the management of pediatric asthma, there remain several controversies about how best to manage asthma in the primary care setting, and how to prevent asthma exacerbations and subsequent emergency department visits and hospitalizations. In this article, we address four of these controversies: use of written asthma treatment plans, the role of long-acting beta-agonists, spirometry and peak flow measurements in disease management, and engagement of school nurses in the health care team. We provide suggestions and guidance related to these topics for the pediatric primary care provider. [Pediatr Ann. 2019;48(3):e128-e134.].
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20
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Janssen Breen L, Diamond-Caravella M, Moore G, Wruck M, Guglielmo C, Little A, Tedeschi P, Zacharia M, Cataletto M. When reach exceeds touch: Student experiences in a cross-sector community-based academic-practice partnership. Public Health Nurs 2019; 36:429-438. [PMID: 30811064 DOI: 10.1111/phn.12599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/28/2019] [Accepted: 02/04/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE A partnership between three nursing programs, multiple high-needs public school districts and a local asthma coalition was developed as a way to build shared capacity aimed at improving health outcomes for children with asthma. This article explores student perceptions of their clinical experiences teaching asthma self-management within a regional cross-sector, community-based, multi-site academic-practice partnership. DESIGN Nursing faculty from three Long Island, New York-based nursing programs within the partnership jointly created a qualitative focus group methodology to more fully understand the phenomena of interest. A set of open-ended interview questions guided the sessions. SAMPLE Through purposive sampling, 42 undergraduate nursing students participated in 60-min focus group sessions. MEASUREMENT Focus group data were transcribed. Content analysis, coding, and theme development was carried out collaboratively. The unit of analysis was the individual participant responses informed by group interaction. A researcher diary was maintained. RESULTS One overarching theme and three sub-themes emerged from the data, reflecting student understandings in the areas of positioning, professional/personal identity, and social awareness. Ongoing analysis revealed patterns across the data sets linking student learning and the goals, milieu and workings of the partnership. CONCLUSIONS Findings suggest that the context of a thriving community-based academic-practice partnership, established to improve population health outcomes, offered unique clinical learning opportunities for students through exposure to the values, ideas, and innovation of the partnership itself.
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Affiliation(s)
| | | | - Geraldine Moore
- Barbara H. Hagan School of Nursing, Molloy College, Rockville Centre, New York
| | - Michelle Wruck
- Department of Nursing, St. Joseph's College, Patchogue, New York
| | - Claudia Guglielmo
- American Lung Association/Asthma Coalition of Brooklyn & Queens, Hauppauge, New York
| | - Anne Little
- American Lung Association/Asthma Coalition of Long Island, Hauppauge, New York
| | - Pamela Tedeschi
- American Lung Association/Asthma Coalition of Long Island, Hauppauge, New York
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21
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Harris K, Kneale D, Lasserson TJ, McDonald VM, Grigg J, Thomas J. School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review. Cochrane Database Syst Rev 2019; 1:CD011651. [PMID: 30687940 PMCID: PMC6353176 DOI: 10.1002/14651858.cd011651.pub2] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Asthma is a common respiratory condition in children that is characterised by symptoms including wheeze, shortness of breath, chest tightness, and cough. Children with asthma may be able to manage their condition more effectively by improving inhaler technique, and by recognising and responding to symptoms. Schools offer a potentially supportive environment for delivering interventions aimed at improving self-management skills among children. The educational ethos aligns with skill and knowledge acquisition and makes it easier to reach children with asthma who do not regularly engage with primary care. Given the multi-faceted nature of self-management interventions, there is a need to understand the combination of intervention features that are associated with successful delivery of asthma self-management programmes. OBJECTIVES This review has two primary objectives.• To identify the intervention features that are aligned with successful intervention implementation.• To assess effectiveness of school-based interventions provided to improve asthma self-management among children.We addressed the first objective by performing qualitative comparative analysis (QCA), a synthesis method described in depth later, of process evaluation studies to identify the combination of intervention components and processes that are aligned with successful intervention implementation.We pursued the second objective by undertaking meta-analyses of outcomes reported by outcome evaluation studies. We explored the link between how well an intervention is implemented and its effectiveness by using separate models, as well as by undertaking additional subgroup analyses. SEARCH METHODS We searched the Cochrane Airways Trials Register for randomised studies. To identify eligible process evaluation studies, we searched MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the Cochrane Database of Systematic Reviews (CDSR), Web of Knowledge, the Database of Promoting Health Effectiveness Reviews (DoPHER), the Database of Abstracts of Reviews of Effects (DARE), the International Biography of Social Science (IBSS), Bibliomap, Health Technology Assessment (HTA), Applied Social Sciences Index and Abstracts (ASSIA), and Sociological Abstracts (SocAbs). We conducted the latest search on 28 August 2017. SELECTION CRITERIA Participants were school-aged children with asthma who received the intervention in school. Interventions were eligible if their purpose was to help children improve management of their asthma by increasing knowledge, enhancing skills, or changing behaviour. Studies relevant to our first objective could be based on an experimental or quasi-experimental design and could use qualitative or quantitative methods of data collection. For the second objective we included randomised controlled trials (RCTs) where children were allocated individually or in clusters (e.g. classrooms or schools) to self-management interventions or no intervention control. DATA COLLECTION AND ANALYSIS We used qualitative comparative analysis (QCA) to identify intervention features that lead to successful implementation of asthma self-management interventions. We measured implementation success by reviewing reports of attrition, intervention dosage, and treatment adherence, irrespective of effects of the interventions.To measure the effects of interventions, we combined data from eligible studies for our primary outcomes: admission to hospital, emergency department (ED) visits, absence from school, and days of restricted activity due to asthma symptoms. Secondary outcomes included unplanned visits to healthcare providers, daytime and night-time symptoms, use of reliever therapies, and health-related quality of life as measured by the Asthma Quality of Life Questionnaire (AQLQ). MAIN RESULTS We included 55 studies in the review. Thirty-three studies in 14,174 children provided information for the QCA, and 33 RCTs in 12,623 children measured the effects of interventions. Eleven studies contributed to both the QCA and the analysis of effectiveness. Most studies were conducted in North America in socially disadvantaged populations. High school students were better represented among studies contributing to the QCA than in studies contributing to effectiveness evaluations, which more commonly included younger elementary and junior high school students. The interventions all attempted to improve knowledge of asthma, its triggers, and stressed the importance of regular practitioner review, although there was variation in how they were delivered.QCA results highlighted the importance of an intervention being theory driven, along with the importance of factors such as parent involvement, child satisfaction, and running the intervention outside the child's own time as drivers of successful implementation.Compared with no intervention, school-based self-management interventions probably reduce mean hospitalisations by an average of about 0.16 admissions per child over 12 months (SMD -0.19, 95% CI -0.35 to -0.04; 1873 participants; 6 studies, moderate certainty evidence). They may reduce the number of children who visit EDs from 7.5% to 5.4% over 12 months (OR 0.70, 95% CI 0.53 to 0.92; 3883 participants; 13 studies, low certainty evidence), and probably reduce unplanned visits to hospitals or primary care from 26% to 21% at 6 to 9 months (OR 0.74, 95% CI 0.60 to 0.90; 3490 participants; 5 studies, moderate certainty evidence). Self-management interventions probably reduce the number of days of restricted activity by just under half a day over a two-week period (MD 0.38 days 95% CI -0.41 to -0.18; 1852 participants; 3 studies, moderate certainty evidence). Effects of interventions on school absence are uncertain due to the variation between the results of the studies (MD 0.4 fewer school days missed per year with self-management (-1.25 to 0.45; 4609 participants; 10 studies, low certainty evidence). Evidence is insufficient to show whether the requirement for reliever medications is affected by these interventions (OR 0.52, 95% CI 0.15 to 1.81; 437 participants; 2 studies; very low-certainty evidence). Self-management interventions probably improve children's asthma-related quality of life by a small amount (MD 0.36 units higher on the Paediatric AQLQ(95% CI 0.06 to 0.64; 2587 participants; 7 studies, moderate certainty evidence). AUTHORS' CONCLUSIONS School-based asthma self-management interventions probably reduce hospital admission and may slightly reduce ED attendance, although their impact on school attendance could not be measured reliably. They may also reduce the number of days where children experience asthma symptoms, and probably lead to small improvements in asthma-related quality of life. Many of the studies tested the intervention in younger children from socially disadvantaged populations. Interventions that had a theoretical framework, engaged parents and were run outside of children's free time were associated with successful implementation.
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Affiliation(s)
- Katherine Harris
- Queen Mary University of LondonCentre for Child Health, Blizard InstituteLondonUKE1 2AT
| | - Dylan Kneale
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education20 Bedford WayLondonUKWC1H 0AL
| | - Toby J Lasserson
- Cochrane Central ExecutiveEditorial & Methods DepartmentSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Vanessa M McDonald
- The University of NewcastleSchool of Nursing and Midwifery, Priority Reseach Centre for Asthma and Respiratory DiseaseLocked Bag 1000New LambtionNewcastleNSWAustralia2305
| | - Jonathan Grigg
- Queen Mary University of LondonCentre for Child Health, Blizard InstituteLondonUKE1 2AT
| | - James Thomas
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education20 Bedford WayLondonUKWC1H 0AL
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22
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Kneale D, Harris K, McDonald VM, Thomas J, Grigg J. Effectiveness of school-based self-management interventions for asthma among children and adolescents: findings from a Cochrane systematic review and meta-analysis. Thorax 2019; 74:432-438. [PMID: 30686788 DOI: 10.1136/thoraxjnl-2018-211909] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 11/05/2018] [Accepted: 12/10/2018] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The evidence that teaching self-management techniques to children and young people with asthma in schools is effective has not, to date, been the subject of systematic review. METHODS We conducted a systematic review of intervention studies. Studies were eligible if they employed a randomised parallel-group design and were published in English from 1995 onwards. Participants included children with asthma aged 5-18 years who participated within their own school environment. Searches were conducted on the Cochrane Airways Group Specialised Register. Quantitative data were combined using random-effects meta-analyses. RESULTS Thirty-three outcome evaluation studies were included. School-based interventions were effective in reducing the frequency of emergency department visits (OR 0.70, 95% CI 0.53 to 0.92; studies=13), and moderately effective in reducing levels of hospitalisations (standardised mean differences [SMD] -0.19, 95% CI -0.35 to -0.04; studies=6). A meta-analysis of three studies suggest that the intervention approach could reduce the number of days of restricted activity (SMD -0.30, 95% CI -0.41 to -0.18; studies=3). However, there was uncertainty as to whether school-based self-management interventions impacted on reducing absences from school. CONCLUSIONS Self-management interventions for children with asthma delivered in schools reduce the number of acute episodes of healthcare usage. We conclude that the school environment is an important space for delivering interventions to improve children's health.
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Affiliation(s)
- Dylan Kneale
- Evidence for Policy and Practice Information and Coordinating Centre (EPPI-Centre), Social Science Research Unit, UCL Institute of Education, University College London, London, UK
| | - Katherine Harris
- Centre for Child Health, The Blizard Institute, Queen Mary University London, London, UK
| | - Vanessa M McDonald
- Centre of Excellence in Severe Asthma, Priority Research Centre for Asthma and Respiratory Disease, School of Nursing and Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia
| | - James Thomas
- Evidence for Policy and Practice Information and Coordinating Centre (EPPI-Centre), Social Science Research Unit, UCL Institute of Education, University College London, London, UK
| | - Jonathan Grigg
- Centre for Child Health, The Blizard Institute, Queen Mary University London, London, UK
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23
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School-based interventions: Where do we go from here? J Allergy Clin Immunol 2018; 143:550-551. [PMID: 30395889 DOI: 10.1016/j.jaci.2018.10.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/17/2018] [Accepted: 10/29/2018] [Indexed: 11/21/2022]
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Sombans S, Lohana P. Finding a Better Solution for Asthma Control in Children. Cureus 2018; 10:e3344. [PMID: 30473977 PMCID: PMC6248683 DOI: 10.7759/cureus.3344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Asthma is a chronic respiratory condition that is very common among children. With proper management and follow-ups, this condition can be easily controlled in a child. However, there are several factors that are negatively influencing a proper care of asthmatic children throughout the world. In this mini-review, the roles of the parents, the schools and the child himself were analyzed and several possible solutions to improve those hurdles were discussed.
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Affiliation(s)
- Shaheen Sombans
- Internal Medicine, Bharati Vidyapeeth University Medical College and Hospital, Pune, IND
| | - Petras Lohana
- Internal Medicine, Liaquat University of Medical and Health Sciences Hospital, Karachi, PAK
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25
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Bernstein JA, Mansfield L. Step-up and step-down treatments for optimal asthma control in children and adolescents. J Asthma 2018; 56:758-770. [PMID: 29972079 DOI: 10.1080/02770903.2018.1490752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To review therapeutic options for stepwise management of pediatric asthma in the context of this population's unique needs such as potential effects of asthma, treatments, or both on growth and psychosocial development, and caregiver involvement. DATA SOURCES AND STUDY SELECTION We conducted PubMed searches to identify relevant articles then reviewed resultant articles, guidelines for asthma management in children, and articles from personal files. RESULTS Stepwise management of asthma, similar to adults, is recommended for children in current global and US guidelines. Treatment may be stepped up or stepped down temporarily or long-term based on response over time. Inhaled corticosteroids remain the recommended treatment for persistent childhood asthma and any potential small effects on growth are considered relatively minor compared with their benefit. Controller medication options for patients <18 years old are limited, especially for Global Initiative for Asthma Steps 2-5. The long-acting antimuscarinic antagonist tiotropium (Steps 4/5, patients aged ≥12 years) and in certain circumstances (Step 5), anti-immunoglobulin E (aged ≥6 years) and interleukin-5 antibodies (aged ≥12 years) are newer treatment options. Tiotropium is indicated in the United States and Europe for patients ≥6 years old. Stepping down treatment, which is recommended but infrequently practiced, can maintain symptom control and minimize adverse events while substantially reducing costs. Patient education and better monitoring remain important for self-management and optimum outcomes. CONCLUSION A need exists to target individual treatment goals for children with asthma by using step-up and step-down approaches to maximize treatment benefits and minimize potential adverse effects.
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Affiliation(s)
- Jonathan A Bernstein
- a University of Cincinnati, College of Medicine , Cincinnati , OH , USA.,b Clinical Research for the Division of Immunology , Cincinnati , Ohio , USA.,c The Bernstein Allergy Group/Clinical Research Center , Cincinnati , OH , USA
| | - Lyndon Mansfield
- d Pediatrics, Paul L. Foster School of Medicine , El Paso , Texas , USA.,e Department of Pediatrics, Paul Foster School of Medicine , El Paso , TX , USA
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Benka-Coker WO, Gale SL, Brandt SJ, Balmes JR, Magzamen S. Optimizing community-level surveillance data for pediatric asthma management. Prev Med Rep 2018; 10:55-61. [PMID: 29868356 PMCID: PMC5984210 DOI: 10.1016/j.pmedr.2018.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 01/03/2018] [Accepted: 02/05/2018] [Indexed: 11/25/2022] Open
Abstract
Community-level approaches for pediatric asthma management rely on locally collected information derived primarily from two sources: claims records and school-based surveys. We combined claims and school-based surveillance data, and examined the asthma-related risk patterns among adolescent students. Symptom data collected from school-based asthma surveys conducted in Oakland, CA were used for case identification and determination of severity levels for students (high and low). Survey data were matched to Medicaid claims data for all asthma-related health care encounters for the year prior to the survey. We then employed recursive partitioning to develop classification trees that identified patterns of demographics and healthcare utilization associated with severity. A total of 561 students had complete matched data; 86.1% were classified as high-severity, and 13.9% as low-severity asthma. The classification tree consisted of eight subsets: three indicating high severity and five indicating low severity. The risk subsets highlighted varying combinations of non-specific demographic and socioeconomic predictors of asthma prevalence, morbidity and severity. For example, the subset with the highest class-prior probability (92.1%) predicted high-severity asthma and consisted of students without prescribed rescue medication, but with at least one in-clinic nebulizer treatment. The predictive accuracy of the tree-based model was approximately 66.7%, with an estimated 91.1% of high-severity cases and 42.3% of low-severity cases correctly predicted. Our analysis draws on the strengths of two complementary datasets to provide community-level information on children with asthma, and demonstrates the utility of recursive partitioning methods to explore a combination of features that convey asthma severity.
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Affiliation(s)
- Wande O. Benka-Coker
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Sara L. Gale
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Sylvia J. Brandt
- Department of Resource Economics, University of Massachusetts, Amherst, MA, USA
| | - John R. Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
- Division of Occupational and Environmental Medicine, University of California, San Francisco, CA, USA
| | - Sheryl Magzamen
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
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Curricular intervention increases adolescents’ knowledge about asthma: a randomized trial. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Holley S, Walker D, Knibb R, Latter S, Liossi C, Mitchell F, Radley R, Roberts G. Barriers and facilitators to self-management of asthma in adolescents: An interview study to inform development of a novel intervention. Clin Exp Allergy 2018; 48:944-956. [PMID: 29573024 DOI: 10.1111/cea.13141] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/01/2018] [Accepted: 02/09/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Despite literature that spans twenty years describing the barriers to asthma self-management in adolescents, successful, clinically based interventions to address this important issue are lacking. Given the limitations of some of the previous studies, we conducted a study that aimed to gain a broader insight into barriers and facilitators to self-management of asthma by adolescents, not just adherence to treatment, and triangulated their views with those of their parents and healthcare professionals. METHODS Focus groups and interviews were conducted separately for 28 adolescents with asthma aged 12-18 years, 14 healthcare professionals and 12 parents. Focus groups and interviews were audio-recorded, and transcripts from each participant group were analysed separately using inductive thematic analysis. We triangulated the three perspectives by comparing themes that had emerged from each analysis. RESULTS Adolescents', parents' and healthcare professionals' views were summarized into ten related themes that included forgetting and routines, knowledge, embarrassment and confidence, communication with healthcare professionals, triggers, support at school, apathy and taking responsibility. We found that adolescents, parents and healthcare professionals raised similar barriers and facilitators to self-management and our results provide further validation for previous studies. CONCLUSION AND CLINICAL RELEVANCE Our study highlights that healthcare professionals may need to consider a range of psychological and contextual issues influencing adolescents' ability to effectively self-manage their asthma, in particular, how they implement treatment routines and the understanding that adolescents have of their condition and treatments. Crucially, healthcare professionals need to consider how this information is communicated and ensure they facilitate open, inclusive, two-way consultations. From this more comprehensive understanding, we have developed interventional strategies that healthcare professionals can utilize to empower adolescents to improve their asthma self-management.
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Affiliation(s)
- S Holley
- Clinical and Experimental Sciences and Human Development in Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK
| | - D Walker
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - R Knibb
- Aston University, Birmingham, UK
| | - S Latter
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - C Liossi
- School of Psychology, University of Southampton, Southampton, UK.,Department of Paediatric Psychology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - F Mitchell
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK
| | - R Radley
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G Roberts
- Clinical and Experimental Sciences and Human Development in Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Coelho ACC, Souza-Machado CD, Oliveira TSD, Santos TNND, Cruz ÁA, Souza-Machado A. Curricular intervention increases adolescents' knowledge about asthma: a randomized trial. J Pediatr (Rio J) 2018; 94:325-334. [PMID: 28888614 DOI: 10.1016/j.jped.2017.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the impact of a curricular intervention concerning the knowledge about asthma among adolescents from a public school. METHODS This was a randomized, controlled trial study on a curricular intervention in asthma, carried out with asthmatic and non-asthmatic adolescents. The study participants were divided into a curricular intervention group for asthma (IG), and a control group with traditional curriculum (CG). Topics related to asthma were included in the curriculum, such as the disease concept, triggering factors, treatment, symptoms, action plan, and beliefs in popular myths about the disease. These topics were evaluated through a questionnaire with scores ranging from 0 to 20 points, expressed by the mean score. The acquisition of knowledge was evaluated 90 days and 540 days after the start of the intervention (baseline), by applying the mixed linear model for analysis of associations. RESULTS 181 students participated in the study (IG=101 and CG=80). As shown by their scores before the intervention; the students were unaware about asthma (IG: x¯=10.7±2.9vs. CG: x¯=11.5±2.7 points), its treatment (IG: x¯=1.6±0.9vs. CG: x¯=1.6±0.8 points), and reported beliefs in popular myths about the disease (IG: x¯=1.5±1.1vs. CG: x¯=1.7±1.1 points). After the intervention, the IG showed higher overall knowledge (GI: x¯=15.5±3.1 points), as well as knowledge about the treatment (GI: x¯=2.5±1.0 points), and two times more knowledge in the field "beliefs in popular myths about the disease" when compared to the CG. A greater probability of achieving satisfactory knowledge about asthma was noted in the IG (RR=3.5), with NTT=2.0. CONCLUSION The inclusion of the asthma topic in the curriculum improved knowledge about the disease in a subgroup of students.
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Affiliation(s)
- Ana Carla C Coelho
- Universidade Federal da Bahia (UFBA), Escola de Enfermagem, Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Programa para o Controle da Asma na Bahia (ProAR), Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Faculdade de Medicina da Bahia, Programa de Pós-graduação em Medicina e Saúde (PPgMS), Salvador, BA, Brazil.
| | - Carolina de Souza-Machado
- Universidade Federal da Bahia (UFBA), Escola de Enfermagem, Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Programa para o Controle da Asma na Bahia (ProAR), Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Faculdade de Medicina da Bahia, Programa de Pós-graduação em Medicina e Saúde (PPgMS), Salvador, BA, Brazil
| | - Thiara S de Oliveira
- Universidade Federal da Bahia (UFBA), Programa para o Controle da Asma na Bahia (ProAR), Salvador, BA, Brazil
| | - Tássia Natalie N Dos Santos
- Universidade Federal da Bahia (UFBA), Programa para o Controle da Asma na Bahia (ProAR), Salvador, BA, Brazil
| | - Álvaro A Cruz
- Universidade Federal da Bahia (UFBA), Programa para o Controle da Asma na Bahia (ProAR), Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Faculdade Medicina, Salvador, BA, Brazil
| | - Adelmir Souza-Machado
- Universidade Federal da Bahia (UFBA), Programa para o Controle da Asma na Bahia (ProAR), Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Faculdade de Medicina da Bahia, Programa de Pós-graduação em Medicina e Saúde (PPgMS), Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Instituto de Ciências da Saúde (ICS), Departamento de Biomorfologia, Salvador, BA, Brazil
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Walter H, Sadeque-Iqbal F, Ulysse R, Castillo D, Fitzpatrick A, Singleton J. Effectiveness of school-based family asthma educational programs in quality of life and asthma exacerbations in asthmatic children aged five to 18: a systematic review. ACTA ACUST UNITED AC 2018; 14:113-138. [PMID: 27941517 DOI: 10.11124/jbisrir-2016-003181] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Asthma is a common, chronic, non-communicable respiratory disease that affects millions of children worldwide. Asthma exacerbations can range from mild to severe and can have an unfavorable impact on the quality of life of children and their caregivers. Asthma exacerbations often result in absenteeism from school or work, activity intolerance and emergency hospital visits. One strategy to address this health issue in an attempt to improve health outcomes is school-based asthma educational programs. A review of the literature revealed that previous systematic reviews have examined similar topics on the effectiveness of school-based asthma educational programs that have included collaborative efforts between parents and schools. No systematic reviews were found that examined the effectiveness of school-based asthma educational programs that exclusively included children and their caregivers. Research has not been systematically reviewed to determine the effectiveness of a school-based asthma educational program within a familial context. OBJECTIVES To identify the best available evidence on the effectiveness of school-based family asthma educational programs that exclusively included both children and caregivers on the quality of life and number of asthma exacerbations of children aged five to 18 years with a clinical diagnosis of asthma. INCLUSION CRITERIA TYPES OF PARTICIPANTS Children aged five to 18 years of any gender, race or ethnicity with a clinical diagnosis of asthma and their caregivers. TYPES OF INTERVENTION(S) School-based family asthma educational programs. TYPES OF STUDIES Randomized controlled trials. OUTCOMES Quality of life and the number of asthma exacerbations measured by either missed days from school or work, and/or physical activity intolerance, and/or emergency hospital visits. SEARCH STRATEGY The search strategy aimed to find both published and unpublished studies from inception of the database to August 21, 2015. METHODOLOGICAL QUALITY Quantitative papers selected for retrieval were assessed by two independent reviewers for methodological validity before inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute. DATA EXTRACTION Data were extracted from articles included in the review using the standardized data extraction tool from the Joanna Briggs Institute. The data extracted included specific details about the populations, interventions, study methods and outcomes of significance to the review question and its specific objectives. DATA SYNTHESIS Due to the heterogeneity among the included studies, statistical pooling and meta-analysis was not possible. Results are presented in narrative form. RESULTS Six studies examining the intervention were included in this review. All six of the included studies were randomized controlled trials (RCTs). All six studies compared the effects of school-based asthma education to no school-based asthma education/usual care on quality of life and number of asthma exacerbations. Three out of four RCTs showed that children who participated in school-based family asthma educational programs demonstrated a statistically significant improvement in overall quality of life (P < 0.05). All six studies showed improvement in the number of asthma exacerbations that resulted in one or all of the measured outcomes of either missed days from school or work, physical activity intolerance and/or decreased emergency hospital visits. CONCLUSION School-based family asthma educational programs for children that include caregivers can have a positive impact on the quality of life and asthma management of children with asthma. Other outcomes that can be positively affected by school-based family asthma educational programs include absenteeism from school or work, physical activity intolerance and emergency hospital visits as result of asthma exacerbations.
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Affiliation(s)
- Helen Walter
- 1College of Health Professions, Pace University, New York, New York, USA 2The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence
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Walter H, Sadeque-Iqbal F, Ulysse R, Castillo D, Fitzpatrick A, Singleton J. The effectiveness of school-based family asthma educational programs on the quality of life and number of asthma exacerbations of children aged five to 18 years diagnosed with asthma: a systematic review protocol. ACTA ACUST UNITED AC 2018; 13:69-81. [PMID: 26571284 DOI: 10.11124/jbisrir-2015-2335] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW OBJECTIVE The objective of this review is to identify the best available quantitative evidence related to the effectiveness of school-based family asthma educational programs on the quality of life and number of asthma exacerbations of children aged five to18 years with a diagnosis of asthma. BACKGROUND Asthma is a serious public health issue globally and nationally. The World Health Organization (WHO) Global Asthma Report 2014 estimates that 334 million people worldwide currently suffer from asthma. In the United States, asthma currently affects about 25 million people. Although asthma can occur at any age, it most often begins early in life, and is the most common non-communicable disease among children. Approximately 14% of the world's children have asthma. In the United States, 7.1 million children have asthma. Globally, the burden of asthma, measured by disability and premature death, is greatest in children approaching adolescence (ages 10-14). Asthma is also a serious economic concern in primary health care worldwide. In the United States, the estimated total cost of asthma to society was US$56 billion in 2007, or US$3259 per person. In 2008 asthma caused 10.5 million missed days from school and 14.2 missed days from work for caregivers. The estimated total cost of loss of productivity resulting from missed school or work days is US$3.8 billion per year, and premature death US$2.1 billion per year. Globally, asthma ranks 14 in terms of disability adjusted life years (DALYs), which are the number of years lost to ill health, disability or death attributed to asthma. According to a 2011 European study, the estimated total cost of asthma was €19.3 billion among people aged 15 to 64 years. A study conducted in the Asia-Pacific region reported that the direct and indirect costs of asthma per person ranged from US$184 in Vietnam to US$1189in Hong Kong in 2000. A Canadian study showed that C$184 loss of productivity during one week was attributed to asthma in 2012. In Australia, AU$655 million was spent on asthma for 2008-09.Asthma is a chronic respiratory disease that affects millions of people of all ethnicities, ages and genders worldwide. The pathophysiology of asthma is multifaceted, and is characterized by restriction of airflow into and out of the lungs, airway inflammation with increased mucus production, and bronchial hyper-reactivity caused by exposure to environmental irritants and chemicals, often referred to as triggers, which in some cases are modifiable. Asthma triggers include respiratory infections, weather changes, stress, excitement, exercise and other physical activities, allergic hypersensitivity reactions, food additives, animal dander, dust mites, cockroaches, outdoor and indoor pollutants, certain medications and cigarette smoke. Asthma is characterized by recurrent, episodic, reversible symptoms often referred to as asthma exacerbations, or asthma attacks. Asthma symptoms include coughing, shortness of breath, chest tightness and wheezing that most frequently occur at night or in the early morning. Asthma symptoms vary in severity and frequency in affected individuals, and can occur several times a day or week. Asthma symptoms may be mild, moderate, or severe, and are classified according to presenting symptoms and quantitative measurements of lung function using a peak expiratory flow meter (PEF), or of forced expiratory volume in one second (FEV1). Asthma symptoms can be so severe that, if left untreated, death can occur.Exacerbations of asthma symptoms often result in school and work absenteeism, activity intolerance and emergency hospital visits for asthma. Nocturnal asthma exacerbations frequently cause sleeplessness, which may result in daytime fatigue. Asthma symptoms can interfere and disrupt activities of daily life, and can have an unfavorable impact on the quality of life for people with the disease, including children and their caregivers. For this review, quality of life represents how well the asthmatic child is able to manage symptoms of the disease and lead a normal healthy life. Caregiver refers to the primary person who takes care of a child with asthma. Family refers to the caregiver and the child.According to the United States Centers for Disease Control and Prevention (CDC), epidemiologists and clinical researchers concur that the burden of asthma is higher among children compared to adults. Asthma prevalence in children varies within and across countries. Asthma disparities also exist along ethnic and racial lines. The International Study of Asthma and Allergies in Childhood (ISAAC) quantified the prevalence of asthma symptoms of children from around the world. In the United States, non-Hispanic Black and Puerto Rican children have higher asthma prevalence compared to Caucasian children. Children from the Ivory Coast, Costa Rica and Wales have higher asthma prevalence compared to children from Kenya, Brazil and England respectively. Indigenous Australians, Aboriginal and Torres Strait Islander Australian children have a higher prevalence of asthma compared to non-Indigenous Australian children. The international prevalence of asthma prompted governments and communities to create initiatives and strategies to address this public health issue.The global burden of asthma led to the development of the Global Initiative for Asthma (GINA). Formed in 1993, in collaboration with theNational Heart, Lung, and Blood Institute, National Institutes of Health, United States of America and the WHO, GINA's goals include working with healthcare providers and public health officials worldwide to reduce asthma prevalence, morbidity and mortality. In an effort to increase public awareness of the global burden of asthma, GINA created World Asthma Day, which is held annually on the first Tuesday in May. The burden of asthma in the United States fostered the creation of the National Asthma Education and Prevention Program (NAEPP). This program is designed to raise awareness about asthma and the major public health concern it poses to society. In addition to conducting asthma prevention activities, NAEPP collaborates with other stakeholders to develop asthma educational programs for minority populations who are disproportionately affected by asthma. The program believes that adequate control of asthma, through modern treatment and educational programs, can be reinforced by the development of partnerships with caregivers, schools and healthcare providers. The NAEPP Expert Panel Report 3, Guidelines for the Diagnosis and Management of Asthma (EPR-3), has a provision that specifies that asthma education programs for children should include their caregivers. Caregivers' involvement is crucial for achieving the goals of asthma management in children, which supports the interest of GINA and NAEPP to include caregivers in school-based asthma education programs for children. The guidelines recommend education for asthma management should occur at all points of care, including schools. According to the EPR-3, schools are ideal locations to facilitate asthma education programs because they provide access to large numbers of children in an environment in which they are accustomed to learning. The long term effects of these approaches are improved healthcare practices, reduced mortality and morbidity, and reduced costs of asthma care.Although there is no cure for asthma, research evidence has demonstrated that asthma symptoms can be well-controlled with the appropriate medications, adherence to treatment, avoidance of asthma triggers, and education about disease management. Research studies that have investigated the effectiveness of school-based asthma education programs that have included caregivers have demonstrated beneficial effects of these programs on the quality of life and disease management of children with asthma, versus no school-based family asthma education programs.A randomized controlled trial (RCT) conducted by Clark et al. that included 835 children and their parents examined the effects of comprehensive school-based asthma education programs on symptoms, grades and school absences, and parents' asthma management practices. The interventions consisted of six components for children, their parents, classmates and school personnel. One of the six components included "Open Airways for Schools" disease management training for children, which also included handouts and homework for the parents. One of the five interventions for the parents included school fairs with asthma care questions and answers sessions to discuss the frequency and type of asthma symptoms of their children. Results of this study demonstrated that 24 months post intervention, children from the intervention groups had better disease management, which included improved control of daytime and nighttime symptoms, and reduced absences from school and work related to asthma exacerbations, compared to the children from the control group.In another study, Bruzzese et al. conducted a pilot RCT that included 24 families. Each family consisted of an asthmatic child and a caregiver. The study examined the effects of a two-month, school-based asthma education program. The interventions consisted of six interactive 75-minute group sessions for students, held once a week for six weeks, and five 90-minute group sessions for caregivers, held once a week. The student sessions were led by a developmental psychologist, and one of the lesson topics included prevention and management of asthma. The group sessions for caregivers were led by a clinical psychologist, and one of the lesson topics included asthma self-management of their children. The interventions resulted in positive short term changes in family relations and an overall improved health status for the children. (ABSTRACT TRUNCATED)
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Affiliation(s)
- Helen Walter
- 1College of Health Professions, Pace University, New York, NY, USA2The Northeast Institute for Evidence Synthesis and Translation (NEST): a Collaborating Center of the Joanna Briggs Institute
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Oland AA, Booster GD, Bender BG. Psychological and lifestyle risk factors for asthma exacerbations and morbidity in children. World Allergy Organ J 2017; 10:35. [PMID: 29075362 PMCID: PMC5644196 DOI: 10.1186/s40413-017-0169-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/13/2017] [Indexed: 12/13/2022] Open
Abstract
Asthma is the most common childhood illness and disproportionately affects low-income, minority children who live in urban areas. A range of risk factors are associated with asthma morbidity and mortality, such as treatment non-adherence, exposure to environmental triggers, low-income households, exposure to chronic stress, child psychological problems, parental stress, family functioning, obesity, physical inactivity, and unhealthy diets. These risk factors often have complex interactions and inter-relationships. Comprehensive studies that explore the inter-relationships of these factors in accounting for asthma morbidity and mortality are needed and would help to inform clinical intervention. Considerable research has focused on interventions to improve adherence, asthma management, asthma symptoms, and quality of life for patients with asthma. Educational interventions combined with psychosocial interventions, such as behavioral, cognitive-behavioral, or family interventions, are beneficial and provide care in schools, homes, and emergency rooms can help to address barriers to accessing care for children and families. Additional recent research has explored the use of multidisciplinary, collaborative, integrated care with pediatric asthma patients, providing promising results. Integrated care could be ideal for addressing the multitude of complex psychosocial and wellness factors that play a role in childhood asthma, for increasing patient-centered care, and for promoting collaborative patient-provider relationships. Further research in this area is essential and would be beneficial.
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Building school health partnerships to improve pediatric asthma care: the School-based Asthma Management Program. Curr Opin Allergy Clin Immunol 2017; 17:160-166. [PMID: 28177950 DOI: 10.1097/aci.0000000000000347] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Children with asthma require care that is seamlessly coordinated so that asthma symptoms are recognized and managed at home and at school. The purpose of this review is to discuss recent consensus recommendations in school-based asthma care. RECENT FINDINGS The School-based Asthma Management Program (SAMPRO) provides a widely endorsed framework to coordinate care with schools and consists of four components: establishing a circle of support around the child with asthma; facilitating bidirectional communication between clinicians and schools; comprehensive asthma education for schools; and assessment and remediation of environmental asthma triggers at school. SAMPRO standardizes recommendations for school-based asthma care coordination and provides a toolkit with websites and resources useful for the care of children with asthma in the school setting. SUMMARY The review will discuss the need for coordinated school asthma partnerships, the inception and development of SAMPRO, and its vision to improve pediatric asthma care coordination within the circle of support, comprising clinicians, school nurses, families, and communities.
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Louisias M, Phipatanakul W. Managing Asthma in Low-Income, Underrepresented Minority, and Other Disadvantaged Pediatric Populations: Closing the Gap. Curr Allergy Asthma Rep 2017; 17:68. [PMID: 28914405 DOI: 10.1007/s11882-017-0734-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW In this article, we review current understanding of the epidemiology and etiology of disparities in asthma. We also highlight current and emerging literature on solutions to tackle disparities while underscoring gaps and pressing future directions. RECENT FINDINGS Tailored, multicomponent approaches including the home, school, and clinician-based interventions show great promise. Managing asthma in disadvantaged populations can be challenging as they tend to have disproportionately worse outcomes due to a multitude of factors. However, multifaceted, innovative interventions that are sustainable and scalable are key to improving outcomes.
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Affiliation(s)
- Margee Louisias
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.,Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA. .,Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
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Geryk LL, Roberts CA, Carpenter DM. A systematic review of school-based interventions that include inhaler technique education. Respir Med 2017; 132:21-30. [PMID: 29229099 DOI: 10.1016/j.rmed.2017.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Proper use of inhaled medication is essential for the successful treatment of childhood asthma; yet, improper inhaler technique among school-aged children is common. There are many schoolbased asthma education programs, but the extent to which these programs teach inhaler technique is unknown. METHODS We systematically reviewed the literature to identify schoolbased asthma interventions that included inhaler technique instruction. We searched several databases, including PubMed, for relevant articles. Studies were included if they were asthma interventions of any type (programs, curriculums, education) conducted at kindergarten through twelfth grade schools that taught inhaler technique and included inhaler technique as an outcome measure. Of the 285 citations identified, the final nine studies (selected from 71 full-text articles) met the inclusion criteria. RESULTS Findings from this systematic review identified a very small number of school-based interventions that evaluated improvements in students' inhaler technique. Two of the nine studies (22%) used a validated measure of inhaler technique. Inhaler technique instruction varied in length, from 15 min to 1 h and nurses implemented inhaler technique instruction in six of the nine (67%) interventions. Existing studies offer mixed evidence for sustained technique improvements up to a 12-month follow-up period. CONCLUSIONS Evidence suggests that students benefit from school-based inhaler technique education; however, inconsistencies in how technique was measured limit our ability to draw firm conclusions regarding the effectiveness of inhaler technique education on student outcomes. Future studies are needed to identify the most appropriate and feasible inhaler technique education components for use in comprehensive asthma self management interventions.
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Affiliation(s)
- Lorie L Geryk
- Center for Health Systems Effectiveness, Oregon Health & Sciences University, 3181 S.W. Sam Jackson Park Road, Mail Code: MDYCHSE, Portland, OR 97239, USA.
| | - Courtney A Roberts
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina, 301 Pharmacy Lane, CB#7355, Chapel Hill, NC 27599, USA
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina, 301 Pharmacy Lane, CB#7355, Chapel Hill, NC 27599, USA
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Lemanske RF, Kakumanu S, Shanovich K, Antos N, Cloutier MM, Mazyck D, Phipatanakul W, Schantz S, Szefler S, Vandlik R, Williams P. Creation and implementation of SAMPRO™: A school-based asthma management program. J Allergy Clin Immunol 2017; 138:711-723. [PMID: 27596707 PMCID: PMC5085063 DOI: 10.1016/j.jaci.2016.06.015] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 05/23/2016] [Accepted: 06/03/2016] [Indexed: 11/25/2022]
Abstract
Clinicians who care for children with asthma have an obligation to coordinate asthma care with the schools. Aside from routine clinical care of asthmatic children, providers must educate the family and child about the need for an asthma treatment plan in school and support the school nurse meeting the needs of the student requiring school-based asthma care. The following article was developed by multiple stakeholders to address this need. It describes the 4 components of the School-based Asthma Management Program (SAMPRO™). SAMPRO™ details elements necessary for the education of children, families, clinicians, and school-based personnel based on a “circle of support” that would enhance multidirectional communication and promote better care for children with asthma within the school setting.
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Affiliation(s)
- Robert F Lemanske
- Department of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Sujani Kakumanu
- University of Wisconsin School of Medicine and Public Health and the Middleton Memorial Veteran's Hospital, Madison, Wis
| | - Kathleen Shanovich
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Nicholas Antos
- Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wis
| | - Michelle M Cloutier
- Department of Pediatrics, University of Connecticut Health Center, Farmington, and the Asthma Center, CT Children's Medical Center, Hartford, Conn
| | - Donna Mazyck
- National Association of School Nurses, Silver Spring, Md
| | - Wanda Phipatanakul
- Boston Children's Hospital, Division of Allergy and Immunology, Harvard Medical School, Boston, Mass
| | | | - Stanley Szefler
- Children's Hospital Colorado, the Breathing Institute, and Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
| | - Renee Vandlik
- American Academy of Allergy, Asthma & Immunology, Milwaukee, Wis
| | - Paul Williams
- Department of Pediatrics, University of Washington School of Medicine, Allergist, NW Asthma & Allergy Center, Seattle, Wash
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Francisco B, Rood T, Nevel R, Foreman P, Homan S. Teaming Up for Asthma Control: EPR-3 Compliant School Program in Missouri Is Effective and Cost-Efficient. Prev Chronic Dis 2017; 14:E40. [PMID: 28541869 PMCID: PMC5457908 DOI: 10.5888/pcd14.170003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Teaming Up for Asthma Control (TUAC) is a work force development intervention to improve asthma control among children by increasing the competency of school nurses and delivering guideline-based education. We hypothesized that the knowledge and skills of participating school nurses would improve and that this change would positively affect students’ asthma health and reduce health care utilization cost. Methods Asthma education for school nurses was provided online in a pretest/posttest format or in instructor-led groups. Students with persistent asthma were identified by using a checklist. Expert evaluators obtained student participants’ preassessments/postassessments before and after the 3 asthma checkups by the school nurse, and the assessments were compared. Health care costs were assessed using Medicaid administrative claims data. Results A total of 54 school nurses and 178 students in Missouri participated in the TUAC evaluation from 2011 through 2014. Among school nurses who completed the online education (n = 42, 77.8%), knowledge scores significantly increased from pretest (49.1%) to posttest (90.7%, P < .001). Of school nurses who completed assessments on 3 children (n = 34), 91.2% met the ±6% equivalence for 1 or more assessments on forced expiratory volume in 1 second (FEV1) compared with the expert evaluator. At enrollment, 69.7% of students had “not well-controlled” or “very poorly controlled” asthma. Postintervention, FEV1 significantly improved (82.9% to 92.1% predicted), and self-reported impairment and tobacco smoke exposure significantly declined (P < .001). For TUAC students enrolled in Medicaid, there was an average 12-month health care cost difference (−$1,431) compared with controls. Conclusion School nurses effectively assessed asthma status, students’ outcomes improved, and health care utilization costs declined. This evaluation contributed to program improvements to further improve health outcomes among students with asthma.
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Affiliation(s)
- Benjamin Francisco
- University of Missouri Health Care, School of Medicine, Child Health, Pulmonary Medicine & Allergy, Department of Child Health, Asthma Ready Communities and Teaming Up for Asthma Control, University of Missouri, Columbia, Missouri
| | - Tammy Rood
- University of Missouri Health Care, School of Medicine, Child Health, Pulmonary Medicine & Allergy, Department of Child Health, Asthma Ready Communities and Teaming Up for Asthma Control, University of Missouri, Columbia, Missouri
| | - Rebekah Nevel
- Vanderbilt University Medical Center, Pediatric Allergy, Immunology & Pulmonary Medicine, Monroe Carell Jr. Children's Hospital, Nashville, Tennessee
| | - Paul Foreman
- University of Missouri Health Care, School of Medicine, Child Health, Pulmonary Medicine & Allergy, Department of Child Health, Asthma Ready Communities and Teaming Up for Asthma Control, University of Missouri, Columbia, Missouri
| | - Sherri Homan
- Missouri Department of Health and Senior Services, Missouri Asthma Prevention and Control Program and Office of Epidemiology, Division of Community and Public Health, 920 Wildwood Dr, Jefferson City, MO 65109.
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Recent advances in environmental controls outside the home setting. Curr Opin Allergy Clin Immunol 2016; 16:135-41. [PMID: 26859366 DOI: 10.1097/aci.0000000000000250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW It has been well studied that aeroallergen, mold, and airborne pollutant exposure in the inner-city home environment is associated with significant childhood asthma morbidity. Although the home environment has been extensively studied, the school environment is less well understood. RECENT FINDINGS In this article, we discuss the relationship between environmental exposures within the school and daycare environment and pediatric asthma morbidity and novel environmental interventions designed to help mitigate pediatric asthma morbidity. SUMMARY Studies assessing environmental exposures outside the home environment and interventions to mitigate these exposures have the potential to reduce pediatric asthma morbidity. Further study in this area should focus on the complex cost benefit analyses of environmental interventions outside the home setting, while controlling for the home environment.
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Sheikh SI, Pitts J, Ryan-Wenger NA, Kotha K, McCoy KS, Stukus DR. Improved quality-of-life of caregivers of children with asthma through guideline-based management. J Asthma 2016; 54:768-776. [PMID: 27831828 DOI: 10.1080/02770903.2016.1258077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The quality of life (QOL) of caregivers of children with asthma may be related to children's responses to asthma management. AIM To evaluate change in QOL over time of caregivers of children with asthma through guideline-based management. DESIGN This was a 3-year prospective cohort study of children with asthma referred to our pediatric asthma center. Families completed Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ), the Asthma Control Test™ (ACT), and reported the number of days/month of albuterol use and wheezing at each clinic visit. RESULTS We enrolled 143 children, ages 7-17 years (mean = 10.6 ± 2.9), 56.6% male, 70.6% Caucasian. Patients were managed by the same MD (n = 65,45.5%) or APN (n = 78,54.5%) over time. The mean total PACQLQ significantly increased over the 3-year period (F = 67.418, p < .001). Total scores at the first visit were 4.8 ± 1.6, which improved to 6.1 ± 1 at the 3-month follow-up visit. This improvement was sustained at the 1, 2, and 3-year clinic visits. PACQLQ emotional function (F = 60.798, p < .001) and activity limitation (F = 41.517, p < .001) domains significantly improved as well. PACQLQ scores were significantly associated with improved ACT scores (r = .37 to .47, p < .05), fewer days/month of albuterol use (r = -.25 to -.36., p < .05), and wheezing (r = -.28 to -.33, p < .05). There were no significant differences in PACQLQ, or asthma clinical outcome measures between MD and APN providers. CONCLUSION Use of National Asthma Education and Prevention Program (NAEPP) guidelines significantly improved QOL of caregivers of children with asthma and in asthma-related symptoms. Improvements over time were independent of type of providers.
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Affiliation(s)
- Shahid I Sheikh
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , OH , USA.,b Section of Pulmonary MedicineNationwide Children's Hospital , Columbus , OH , USA.,c Section of Allergy & Immunology , Nationwide Children's Hospital , Columbus , OH , USA
| | - Judy Pitts
- b Section of Pulmonary MedicineNationwide Children's Hospital , Columbus , OH , USA
| | - Nancy A Ryan-Wenger
- b Section of Pulmonary MedicineNationwide Children's Hospital , Columbus , OH , USA
| | - Kavitha Kotha
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , OH , USA.,b Section of Pulmonary MedicineNationwide Children's Hospital , Columbus , OH , USA
| | - Karen S McCoy
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , OH , USA.,b Section of Pulmonary MedicineNationwide Children's Hospital , Columbus , OH , USA
| | - David R Stukus
- a Department of Pediatrics , The Ohio State University College of Medicine , Columbus , OH , USA.,c Section of Allergy & Immunology , Nationwide Children's Hospital , Columbus , OH , USA
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Carvalho Coelho AC, Barretto Cardoso LS, de Souza-Machado C, Souza-Machado A. The Impacts of Educational Asthma Interventions in Schools: A Systematic Review of the Literature. Can Respir J 2016; 2016:8476206. [PMID: 27656097 PMCID: PMC5021513 DOI: 10.1155/2016/8476206] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 07/07/2016] [Accepted: 08/07/2016] [Indexed: 01/22/2023] Open
Abstract
Objective. To review the literature on the impact of educational asthma interventions in schools regarding the knowledge and morbidity of the disease among children and adolescents. Methods. A systematic review was conducted for controlled clinical trials investigating the effectiveness of educational asthma interventions for students, asthmatic or nonasthmatic, families, and school staff. Databases were CENTRAL, PubMed, LILACS, MEDLINE, and SciELO. Articles published in any language were considered, in the period from 2005 to 2014, according to the PRISMA guidelines. Results. Seventeen articles were selected (N = 5,879 subjects). 94% of the interventions (16 of 17 studies) were applied in developed countries that were led by health professionals and most of them targeted asthmatics. Asthma education promotes the improvement of knowledge about the disease in at least one of the evaluated areas. 29% of the interventions (5 of 17 studies) showed a reduction of the asthma symptoms, 35% (6 of 17 studies) reduction of the hospitalization instances and emergency visits, 29% (5 of 17 studies) reduction of school absenteeism, and 41% (7 of 17 studies) increase in the quality of life of the individuals. Conclusions. Educational interventions in schools raise the awareness of asthma and weaken the impact of morbidity indicators.
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Affiliation(s)
- Ana Carla Carvalho Coelho
- Escola de Enfermagem, Universidade Federal da Bahia, Salvador, BA, Brazil
- ProAR, Programa para o Controle da Asma na Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil
| | | | - Carolina de Souza-Machado
- Escola de Enfermagem, Universidade Federal da Bahia, Salvador, BA, Brazil
- ProAR, Programa para o Controle da Asma na Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Adelmir Souza-Machado
- ProAR, Programa para o Controle da Asma na Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, BA, Brazil
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, BA, Brazil
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Sweat V, Bruzzese JM, Fierman A, Mangone A, Siegel C, Laska E, Convit A. Outcomes of The BODY Project: A Program to Halt Obesity and Its Medical Consequences in High School Students. J Community Health 2016; 40:1149-54. [PMID: 26001765 DOI: 10.1007/s10900-015-0041-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Adolescent obesity continues to be a major public health issue with a third of American adolescents being overweight or obese. Excess weight is associated with cardiovascular risk factors and pre-diabetes. High school students identified as carrying excess weight [body mass index (BMI) ≥25 kg/m(2), or BMI percentile ≥85 %] were invited to participate in The BODY Project, an intervention that included a medical evaluation and a personalized medical report of the results of that evaluation sent to the parent/guardian at home. The medical evaluation and report was repeated 12 months later. The reports also contained advice on how the individual student could modify their lifestyle to improve the specific medical parameters showing abnormalities. Outcomes were change in BMI, blood pressure, high-density lipoprotein (HDL), low-density lipoprotein (LDL), fasting glucose, and fasting insulin. Students participating in The BODY Project intervention demonstrated modest, yet significant, reductions in BMI (p < 0.001) 1 year later, and also had significant improvements in systolic blood pressure (p < 0.001) and cholesterol profile (HDL p = 0.002; LDL p < 0.001) at follow-up. The BODY Project, by means of a minimal educational program anchored on the principle of teachable moments around the students' increased perception of their own risk for disease from the medical abnormalities uncovered, demonstrates evidence of potential effectiveness in addressing adolescent obesity.
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Affiliation(s)
- Victoria Sweat
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Jean-Marie Bruzzese
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Arthur Fierman
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Alexander Mangone
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Carole Siegel
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Eugene Laska
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Antonio Convit
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA. antonio.@med.nyu.edu
- Department of Medicine, New York University School of Medicine, New York, NY, USA. antonio.@med.nyu.edu
- Department of Radiology, New York University School of Medicine, New York, NY, USA. antonio.@med.nyu.edu
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA. antonio.@med.nyu.edu
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Warren CM, Dyer A, Blumenstock J, Gupta RS. Leveraging Mobile Technology in a School-Based Participatory Asthma Intervention: Findings From the Student Media-Based Asthma Research Team (SMART) Study. AMERICAN JOURNAL OF HEALTH EDUCATION 2016. [DOI: 10.1080/19325037.2015.1133337] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Ashley Dyer
- Northwestern University Feinberg School of Medicine
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Canitez Y, Cekic S, Celik U, Kocak A, Sapan N. Health-care conditions in elementary schools and teachers' knowledge of childhood asthma. Paediatr Int Child Health 2016; 36:64-71. [PMID: 25203843 DOI: 10.1179/2046905514y.0000000150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND For the adequate control of asthma in school-age children, it is recommended that teachers, school health personnel and administrators should have sufficient knowledge of how to manage asthma during school hours. AIM To investigate asthma health care in elementary schools, and teachers' knowledge of childhood asthma and its management. METHODS The extent of knowledge of childhood asthma in 2779 teachers in 141 elementary schools (children aged 6-14, grades 1-8) in Bursa, the fourth largest city in Turkey, was evaluated. Section I comprised questions about asthma health-care in schools, Section II teachers' knowledge of the main characteristics of asthma and Section III (Likert Scale) teachers' detailed knowledge of the signs, triggering factors, treatment and general knowledge of asthma. RESULTS The findings of Section I demonstrated that the organisation of health-care for asthma in schools was insufficient. Of the teachers questioned, 14·7% were not even aware and only 1% and 9·6% of the teachers had been made aware by school health personnel and school records, respectively, of asthmatic children. Only 27·3% of the teachers stated that they were responsible for the health of an asthmatic child. The majority of teachers (70%) said that asthmatic children could use the medication (e.g. inhalers) themselves. In Section II, there were between 44·1% and 75·5% correct answers, while in Section III this figure ranged from 3·3% to 78·4%. The correct answer rate was 60·4% for Sections II and III combined. The results of Sections II and III showed that the teachers' knowledge of asthma was poor in many respects. Teachers who stated that they had asthma or had first-degree relatives with asthma, or those with 10 or more years' experience provided significantly more correct answers in Sections II and III combined than did those without these characteristics (P<0·001). CONCLUSIONS There is a need to improve and standardise health care for asthma (asthma management policies) in schools. The implementation of asthma education programmes for teachers and other staff responsible for pupils' health should result in better control of this common disease.
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Kintner E, Cook G, Marti CN, Stoddard D, Gomes M, Harmon P, Van Egeren LA. Comparative Effectiveness on Cognitive Asthma Outcomes of the SHARP Academic Asthma Health Education and Counseling Program and a Non-Academic Program. Res Nurs Health 2015; 38:423-35. [PMID: 26296595 PMCID: PMC5935115 DOI: 10.1002/nur.21678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 11/06/2022]
Abstract
Asthma morbidity and mortality is higher among older school-age children and early adolescents than other age groups across the lifespan. NIH recommended expanding asthma education to schools and community settings to meet cognitive outcomes that have an impact on morbidity and mortality. Guided by the acceptance of asthma model, an evidence-guided, comprehensive school-based academic health education and counseling program, Staying Healthy-Asthma Responsible & Prepared™ (SHARP), was developed. The program complements existing school curricula by integrating biology, psychology, and sociology content with related spelling, math, and reading and writing assignments. Feasibility, benefits, and efficacy have been established. We compared the effectiveness of SHARP to a non-academic program, Open Airways for Schools, in improving asthma knowledge and reasoning about symptom management. A two-group, cluster-randomized, single-blinded design was used with a sample of 205 students in grades 4-5 with asthma and their caregivers. Schools were matched prior to randomization. The unit of analysis was the student. Certified elementary school teachers delivered the programs during instructional time. Data were collected from student/caregiver dyads at baseline and at 1, 12, and 24 months after the intervention. In multilevel modeling, students enrolled in the academic SHARP program demonstrated significant (p< .001) improvement in asthma knowledge and reasoning over students enrolled in the non-academic program. Knowledge advantages were retained at 24 months. Findings support delivery in schools of the SHARP academic health education program for students with asthma.
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Affiliation(s)
- Eileen Kintner
- Associate Professor, School of Nursing, D0100, The University of Texas at Austin, 1700 Red River Street, NUR 3.446, Austin, TX 78701-1499
| | - Gwendolyn Cook
- Research Associate, Comparison of Asthma Programs for Schools, The University of Texas at Austin School of Nursing, Austin, TX
| | - C Nathan Marti
- Statistician, Division of Statistics and Scientific Computation, The University of Texas at Austin, Austin, TX
| | - Debbie Stoddard
- Site Coordinator, University Outreach and Engagement, Michigan State University, East Lansing, MI
| | - Melissa Gomes
- Licensed School Counselor, C. W. Otto Middle School, Lansing, MI
| | - Phyllis Harmon
- Administrative Research Assistant, Comparison of Asthma Programs for Schools, The University of Texas at Austin School of Nursing, Austin, TX
| | - Laurie A Van Egeren
- Director, Community Evaluation and Research Collaborative, Co-Director, National Collaborative for the Study of University Engagement, University Outreach and Engagement, Michigan State University, East Lansing, MI
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Kneale D, Thomas J, Harris K. Developing and Optimising the Use of Logic Models in Systematic Reviews: Exploring Practice and Good Practice in the Use of Programme Theory in Reviews. PLoS One 2015; 10:e0142187. [PMID: 26575182 PMCID: PMC4648510 DOI: 10.1371/journal.pone.0142187] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 10/19/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Logic models are becoming an increasingly common feature of systematic reviews, as is the use of programme theory more generally in systematic reviewing. Logic models offer a framework to help reviewers to 'think' conceptually at various points during the review, and can be a useful tool in defining study inclusion and exclusion criteria, guiding the search strategy, identifying relevant outcomes, identifying mediating and moderating factors, and communicating review findings. METHODS AND FINDINGS In this paper we critique the use of logic models in systematic reviews and protocols drawn from two databases representing reviews of health interventions and international development interventions. Programme theory featured only in a minority of the reviews and protocols included. Despite drawing from different disciplinary traditions, reviews and protocols from both sources shared several limitations in their use of logic models and theories of change, and these were used almost unanimously to solely depict pictorially the way in which the intervention worked. Logic models and theories of change were consequently rarely used to communicate the findings of the review. CONCLUSIONS Logic models have the potential to be an aid integral throughout the systematic reviewing process. The absence of good practice around their use and development may be one reason for the apparent limited utility of logic models in many existing systematic reviews. These concerns are addressed in the second half of this paper, where we offer a set of principles in the use of logic models and an example of how we constructed a logic model for a review of school-based asthma interventions.
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Affiliation(s)
- Dylan Kneale
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), UCL Institute of Education, University College London, London, United Kingdom
| | - James Thomas
- Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), UCL Institute of Education, University College London, London, United Kingdom
| | - Katherine Harris
- Centre for Paediatrics, Blizard Institute, Queen Mary University of London, London, United Kingdom
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Hauptman M, Phipatanakul W. The school environment and asthma in childhood. Asthma Res Pract 2015; 1:12. [PMID: 26523228 PMCID: PMC4627718 DOI: 10.1186/s40733-015-0010-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/18/2015] [Indexed: 01/25/2023] Open
Abstract
In this article, we discuss the relationship between environmental exposures within the school environment and pediatric asthma morbidity. This article will conclude by reviewing novel school based asthma education and therapeutic programs and environmental interventions designed to help mitigate pediatric asthma morbidity.
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Affiliation(s)
- Marissa Hauptman
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA USA
- Division of Allergy and Immunology, Boston Children’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, MA USA
- Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115 USA
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115 USA
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Harris KM, Kneale D, Lasserson TJ, McDonald VM, Grigg J, Thomas J. School-based self management interventions for asthma in children and adolescents: a mixed methods systematic review. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011651] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Katherine M Harris
- Queen Mary University of London; Centre for Paediatrics, Blizard Institute; Barts and the London School of Medicine and Dentistry London UK E1 2AT
| | - Dylan Kneale
- University College London; EPPI-Centre, Social Science Research Unit, UCL Institute of Education; 20 Bedford Way London UK WC1H 0AL
| | - Toby J Lasserson
- Cochrane Central Executive; Cochrane Editorial Unit; St Albans House 57-59 Haymarket London UK SW1Y 4QX
| | - Vanessa M McDonald
- The University of Newcastle; School of Nursing and Midwifery, Priority Reseach Centre for Asthma and Respiratory Disease; Locked Bag 1000 New Lambtion Newcastle NSW Australia 2305
| | - Jonathan Grigg
- Queen Mary University of London; Institute of Cell and Molecular Science, Blizzard Institute; London UK E1 2AT
| | - James Thomas
- University College London; EPPI-Centre, Social Science Research Unit, UCL Institute of Education; 20 Bedford Way London UK WC1H 0AL
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Using public policy to improve outcomes for asthmatic children in schools. J Allergy Clin Immunol 2015; 134:1238-1244. [PMID: 25482868 DOI: 10.1016/j.jaci.2014.09.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/26/2014] [Accepted: 09/29/2014] [Indexed: 11/21/2022]
Abstract
School-based services to improve asthma management need to be accompanied by public policies that can help sustain services, scale effective interventions, create greater equity across schools, and improve outcomes for children. Several national organizations, including the Centers for Disease Control and Prevention, have recommended specific public policies the adoption of which in school settings can improve asthma outcomes for children. Although many states and school districts have adopted some of these policies, adoption is not universal, and implementation is not always successful, leaving inequities in children's access to asthma services and supports. These issues can be addressed by changing public policy. Policy change is a complex process, but it is one that will benefit from greater involvement by asthma experts, including the researchers who generate the knowledge base on what services, supports, and policies have the best outcomes for children. Asthma experts can participate in the policy process by helping to build awareness of the need for school-based asthma policy, estimating the costs associated with policy options and with inaction, advocating for the selection of specific policies, assisting in implementation (including providing feedback), conducting the research that can evaluate the effectiveness of implementation, and ultimately providing information back into the policy process to allow for improvements to the policies.
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Do United States' teachers know and adhere to the national guidelines on asthma management in the classroom? A systematic review. ScientificWorldJournal 2015; 2015:624828. [PMID: 25729770 PMCID: PMC4333336 DOI: 10.1155/2015/624828] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/01/2015] [Indexed: 11/17/2022] Open
Abstract
Proper asthma management in schools is important in achieving optimum asthma control in children with asthma. The National Heart, Lung, and Blood Institute (NHLBI) has developed guidelines on classroom asthma management. We conducted a systematic review to examine teacher knowledge of the NHLBI guidelines on asthma management in the classroom. We searched PubMed and EMBASE using search terms “asthma management,” “teacher(s),” “school teacher,” and “public school.” The inclusion criteria were articles published in English from 1994 to May 2014 that focus on schools in the United States (US). From 535 titles and abstracts, 9 studies met inclusion criteria. All studies reported that school teachers did not know the policies and procedures of asthma management. Teachers relied on school nurses to handle medical emergencies. Some studies identified that lack of full-time school nurses was a barrier to asthma management. Only one study showed directly that classroom teachers were not following the NHLBI guidelines on asthma management. Our literature review revealed that US teachers do not know the NHLBI guidelines on asthma management in the classroom. Future research should focus on interventions targeted toward training classroom teachers on asthma management as per NHLBI guidelines to ultimately improve asthma management in schools.
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Kintner EK, Cook G, Marti CN, Allen A, Stoddard D, Harmon P, Gomes M, Meeder L, Van Egeren LA. Effectiveness of a school- and community-based academic asthma health education program on use of effective asthma self-care behaviors in older school-age students. J SPEC PEDIATR NURS 2015; 20:62-75. [PMID: 25443867 PMCID: PMC4293278 DOI: 10.1111/jspn.12099] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 10/26/2014] [Accepted: 10/31/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose was to evaluate the effectiveness of Staying Healthy-Asthma Responsible & Prepared, an academic asthma health education and counseling program, on fostering the use of effective asthma self-care behaviors. DESIGN AND METHODS This was a phase III, two-group, cluster randomized, single-blinded, longitudinal design-guided study. Caregivers of 205 fourth- and fifth-grade students completed the asthma health behaviors survey at preintervention, and 1, 12, and 24 months postintervention. Analysis involved multilevel modeling. RESULTS All students demonstrated improvement in episode management, risk reduction/prevention, and health promotion behaviors; Staying Healthy-Asthma Responsible & Prepared students demonstrated increased improvement in episode management and risk reduction/prevention behaviors. PRACTICE IMPLICATIONS Working with schoolteachers, nurses can improve the use of effective asthma self-care behaviors.
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Affiliation(s)
- Eileen K Kintner
- The University of Texas at Austin School of Nursing, Austin, Texas, USA
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