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Vinjimoor S, Vieira C, Rogerson C, Owora A, Mendonca EA. Social risk factors for pediatric asthma exacerbations: A systematic review. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.19.23295732. [PMID: 37790526 PMCID: PMC10543039 DOI: 10.1101/2023.09.19.23295732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Objective This systematic review aims to identify social risk factors that influence pediatric asthma exacerbations. Methods Cohort studies published between 2010 and 2020 were systematically searched on the OVID Medline, Embase, and PsycInfo databases. Using our established phased inclusion and exclusion criteria, studies that did not address a pediatric population, social risk factors, and asthma exacerbations were excluded. Out of a total of 707 initially retrieved articles, 3 prospective cohort and 6 retrospective cohort studies were included. Results Upon analysis of our retrieved studies, two overarching domains of social determinants, as defined by Healthy People 2030, were identified as major risk factors for pediatric asthma exacerbations: Social/Community Context and Neighborhood/Built Environment. Social/Community factors including African American race and inadequate caregiver perceptions were associated with increased risk for asthma exacerbations. Patients in high-risk neighborhoods, defined by lower levels of education, housing, and employment, had higher rates of emergency department readmissions and extended duration of stay. Additionally, a synergistic interaction between the two domains was found such that patients with public or no health insurance and residence in high-risk neighborhoods were associated with excess hospital utilization attributable to pediatric asthma exacerbations. Conclusion Social risk factors play a significant role in influencing the frequency and severity of pediatric asthma exacerbations.
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Affiliation(s)
- Shriya Vinjimoor
- Indiana University School of Medicine
- Regenstrief Institute for Biomedical Informatics
| | - Caroline Vieira
- Indiana University Bloomington
- Regenstrief Institute for Biomedical Informatics
| | - Colin Rogerson
- Indiana University School of Medicine
- Regenstrief Institute for Biomedical Informatics
| | - Arthur Owora
- Regenstrief Institute for Biomedical Informatics
- Indiana University School of Public Health
| | - Eneida A Mendonca
- Indiana University School of Medicine
- Regenstrief Institute for Biomedical Informatics
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Balkissoon R. Journal Club: The Intersection of Racial/Ethnic Disparities in Coronavirus Disease 2019 and COPD. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2021; 8:292-302. [PMID: 33909967 DOI: 10.15326/jcopdf.2021.0227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Zheang M, Rodriguez E, Alvarado C, Correa R, Kahlor LA, Matsui EC. Exploring low-income African American and Latinx caregiver perspectives on asthma control in their children and reactions to messaging materials. J Asthma 2021; 59:1269-1275. [PMID: 33722170 DOI: 10.1080/02770903.2021.1903918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND African-American and Latinx children suffer from higher rates of uncontrolled asthma and poorer outcomes compared to white children. Sociocultural factors play a prominent role in how caregivers navigate asthma control for their children. OBJECTIVES (1) Explore the knowledge, perceptions and behaviors of Latinx and African-American caregivers related to their children's asthma and identify barriers to achieving asthma control; and (2) Elicit caregiver responses to messaging materials intended to help them better recognize uncontrolled asthma and seek timely medical treatment. METHODS Study participants were recruited and screened to meet the following inclusion criteria: African-American or Latinx race/ethnicity, household income at or below 185% of the federal poverty line, and at least one child diagnosed with asthma with symptom frequency consistent with uncontrolled asthma according to national guidelines. Participants attended one of three moderator-led focus groups. The transcripts were qualitatively analyzed using a thematic analysis approach. RESULTS Themes emerged among the nineteen participants related to asthma assessment, management, emotion, support, and trust. Caregivers exhibited gaps in their asthma knowledge, especially pertaining to the term "asthma control." Caregivers generally worried about asthma emergencies more than the daily impairments caused by uncontrolled asthma. Many were uncomfortable using daily controller medications, citing issues of provider trust and side effect concerns. Caregivers did not recognize uncontrolled asthma in their own child, even after viewing messaging materials informing them of symptom frequency criteria. CONCLUSION Culturally tailored interventions, including public asthma messaging, should address low trust in provider recommendations and caregiver concerns about controller medications.
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Affiliation(s)
- Michelle Zheang
- Dell Medical School, The University of Texas, Austin, TX, USA
| | - Erin Rodriguez
- Department of Educational Psychology, The University of Texas, Austin, TX, USA
| | - Cinthia Alvarado
- Department of Educational Psychology, The University of Texas, Austin, TX, USA
| | - Rebecca Correa
- Department of Population Health, Dell Medical School, The University of Texas, Austin, TX, USA
| | - Lee Ann Kahlor
- School of Advertising and Public Relations, Moody College of Communication, The University of Texas, Austin, TX, USA
| | - Elizabeth C Matsui
- Department of Population Health, Dell Medical School, The University of Texas, Austin, TX, USA.,Department of Pediatrics, Dell Medical School, The University of Texas, Austin, TX, USA
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McClure N, Catrambone C, Carlson E, Phillippi J. Maximizing the Role of the Nurse: Strategies to Address Gaps in Asthma Care in Schools. J Pediatr Nurs 2020; 53:52-56. [PMID: 32446213 DOI: 10.1016/j.pedn.2020.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this project was to describe differences in the numbers of children with a diagnosis of asthma identified through two methods, determine barriers to receiving asthma interventions in elementary school settings, and make recommendations for action and advocacy for school nurses to increase the number of children with access to asthma medications at school. DESIGN AND METHODS The authors conducted a review of the asthma diagnosis process from the initial identification of a diagnosis to the delivery of interventions with 349 enrolled students in one large, urban public school in Tennessee. RESULTS Sixty children were identified using the school's existing parent identification process and 91 children who participated in a concurrent asthma education program self-identified or were referred by a teacher, staff, or administrator. Only seven students identified through the combined methods had access to asthma medication (albuterol) at school. CONCLUSION Missing asthma action plans, medication forms and inhalers emerged as major barriers to intervention even when a child's diagnosis is documented. PRACTICE IMPLICATIONS The Asthma School Readiness Process (ASRP) was developed, which describes recommendations for nurses in school and community settings to promote safety and access to asthma medication in schools.
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Affiliation(s)
- Natasha McClure
- Vanderbilt University School of Nursing, TN, United States of America.
| | | | | | - Julia Phillippi
- Vanderbilt University School of Nursing, TN, United States of America
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Gergen PJ. Rethinking Access to Care. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:853-854. [PMID: 29747988 DOI: 10.1016/j.jaip.2017.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/06/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Peter J Gergen
- National Institute of Allergy and Infectious Diseases, National Institute of Health, Bethesda, Md.
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Butz AM, Tsoukleris M, Elizabeth Bollinger M, Jassal M, Bellin MH, Kub J, Mudd S, Ogborn CJ, Lewis-Land C, Thompson RE. Association between second hand smoke (SHS) exposure and caregiver stress in children with poorly controlled asthma. J Asthma 2019; 56:915-926. [PMID: 30307351 PMCID: PMC6551304 DOI: 10.1080/02770903.2018.1509989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 10/28/2022]
Abstract
Objective: Urban children with asthma experience high rates of second hand smoke (SHS) exposure. The objective was to examine whether SHS exposure is associated with symptom frequency in children with poorly controlled asthma. Methods: Children were enrolled in a RCT to test the efficacy of an environmental control behavioral intervention versus an attention control group and followed over 12 months. SHS exposure assessed using salivary cotinine measurement. Frequency of child asthma symptoms, healthcare utilization, household smoking and caregiver daily life stress were obtained via caregiver report. Time of enrollment was recorded to assess seasonal factors. Symptom days and nights were the primary outcomes. Multivariable models and odds ratios examined factors that best predicted increased frequency of daytime/nighttime symptoms. Results: Children (n = 222) with a mean age of 6.3 (SD 2.7) years, were primarily male (65%), African American (94%), Medicaid insured (94%), and had poorly controlled asthma (54%). The final multivariable model indicated symptoms in the fall (OR 2.78; 95% CI 1.16, 6.52) and increased caregiver daily life stress (OR 1.13, 95% CI 1.02, 1.25) were significantly associated with increased symptom days when controlling for cotinine level, intervention status, child age and home and car smoking restrictions. Conclusions: There was no impact of SHS exposure on increased symptom frequency. High caregiver daily life stress and symptoms in fall season may place children with asthma at risk for increased day/nighttime symptoms. Close monitoring of symptoms and medication use during the fall season and intervening on caregiver life stress may decrease asthma morbidity in children with poorly controlled asthma.
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Affiliation(s)
- Arlene M Butz
- a Department of Pediatrics, The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Mona Tsoukleris
- b The Univeristy of Maryland School of Pharmacy , Baltimore , MD , USA
| | - Mary Elizabeth Bollinger
- c Department of Pediatrics, The University of Maryland School of Medicine , Baltimore , MD , USA
| | - Mandeep Jassal
- a Department of Pediatrics, The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Melissa H Bellin
- d The University of Maryland School of Social Work , Baltimore , MD , USA
| | - Joan Kub
- e Department of Nursing, The USC Suzanne Dworak-Peck School of Social Work , Los Angeles , CA , USA
| | - Shawna Mudd
- f The Johns Hopkins University School of Nursing , Baltimore , MD , USA
| | - C Jean Ogborn
- g Department of Pediatric Emergency Medicine, The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Cassia Lewis-Land
- a Department of Pediatrics, The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Richard E Thompson
- h Biostatistics Department, The Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA
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Butz AM, Morphew T, Bellin M, Bollinger ME, Tsoukleris M. Pattern of medication use in children with very poorly controlled asthma. Ann Allergy Asthma Immunol 2019; 122:412-413. [PMID: 30685563 PMCID: PMC6451871 DOI: 10.1016/j.anai.2019.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/16/2019] [Accepted: 01/18/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Arlene M Butz
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; The Johns Hopkins University School of Nursing, Baltimore, Maryland.
| | | | - Melissa Bellin
- School of Social Work, University of Maryland, Baltimore, Maryland
| | | | - Mona Tsoukleris
- School of Pharmacy, University of Maryland, Baltimore, Maryland
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Schatz M, Sicherer SH, Khan D, Zeiger RS. The Journal of Allergy and Clinical Immunology: In Practice 2018 Highlights. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:393-411. [PMID: 30557718 DOI: 10.1016/j.jaip.2018.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 12/12/2022]
Abstract
A large number of clinically impactful studies and reviews were published in this journal in 2018. This article provides highlights of the original research published in 2018 issues of The Journal of Allergy and Clinical Immunolgy: In Practice on the subjects of anaphylaxis, asthma, dermatitis, drug allergy, eosinophilic disorders, food allergy, immune deficiency, rhinitis, and urticaria/angioedema and mast cell disorders. Within each topic, practical aspects of diagnosis and management are emphasized. Treatments discussed include lifestyle modifications, allergen avoidance therapy, positive and negative effects of pharmacologic therapy, and various forms of immunologic and desensitization management. We hope this review will help readers consolidate and use this extensive and practical knowledge for the benefit of patients.
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Affiliation(s)
- Michael Schatz
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif.
| | - Scott H Sicherer
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, Calif
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