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Kaviany P, Shah A. Current Practices in Pediatric Asthma Care. Clin Chest Med 2024; 45:611-623. [PMID: 39069325 DOI: 10.1016/j.ccm.2024.02.028] [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] [Indexed: 07/30/2024]
Abstract
This article is a comprehensive review of the latest knowledge and developments on pediatric asthma. It serves as a guide for general practitioners and subspecialists who treat asthma. The pathophysiology and critical features of asthma that should be addressed and the latest therapies available are discussed. The areas where further investigation is needed are also highlighted.
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Affiliation(s)
- Parisa Kaviany
- Division of Pulmonary & Sleep Medicine, Children's National Hospital, George Washington University School of Medicine, 111 Michigan Avenue Northwest, Washington, DC 20010, USA
| | - Avani Shah
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 155 East Superior Street, Box #48, Chicago, IL 60611, USA.
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Khalili R, Legaspi JM, Fabian MP, Levy JI, Korrick SA, Vieira VM. Multiple prenatal exposures and acute-care clinical encounters for asthma among children born to mothers living near a Superfund site. Am J Epidemiol 2024; 193:1088-1096. [PMID: 38576180 DOI: 10.1093/aje/kwae032] [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: 04/27/2023] [Revised: 02/06/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024] Open
Abstract
Prenatal exposures are associated with childhood asthma, and risk may increase with simultaneous exposures. Pregnant women living in lower-income communities tend to have elevated exposures to a range of potential asthma risk factors, which may interact in complex ways. We examined the association between prenatal exposures and the risk of childhood acute-care clinical encounters for asthma (hospitalizations, emergency department visits, observational stays) using conditional logistic regression with a multivariable smoothing term to model the interaction between continuous variables, adjusted for maternal characteristics and stratified by sex. All births near the New Bedford Harbor (NBH) Superfund site (2000-2006) in New Bedford, Massachusetts, were followed through 2011 using the Massachusetts Pregnancy to Early Life Longitudinal (PELL) Data System to identify children aged 5-11 years with acute-care clinical asthma encounters (265 cases among 7787 children with follow-up). Hazard ratios (HRs) were higher for children living closer to the NBH site with higher umbilical cord blood lead levels than in children living further away from the NBH site with lower lead levels (P <.001). HRs were higher for girls (HR = 4.17; 95% CI, 3.60-4.82) than for boys (HR = 1.72; 95% CI, 1.46-2.02). Our results suggest that prenatal lead exposure in combination with residential proximity to the NBH Superfund site is associated with childhood asthma acute-care clinical encounters. This article is part of a Special Collection on Environmental Epidemiology.
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Gabbay JM, Mayourian J, Bajaj BVM, Wu AC, Graham RJ, Perez JM. Child opportunity and outcomes in pediatric critical asthma: A multicenter analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:2187-2189. [PMID: 38703821 DOI: 10.1016/j.jaip.2024.04.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Jonathan M Gabbay
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
| | - Joshua Mayourian
- Division of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Benjamin V M Bajaj
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Mass
| | - Ann Chen Wu
- Department of Population Medicine, Harvard Medical School, Boston, Mass
| | - Robert J Graham
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Jennifer M Perez
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Mass
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Aguilar R, Knudsen-Robbins C, Ehwerhemuepha L, Feaster W, Kamath S, Heyming TW. Pediatric Asthma Exacerbations: 14-Day Emergency Department Return Visit Risk Factors. J Emerg Med 2024; 67:e22-e30. [PMID: 38824038 DOI: 10.1016/j.jemermed.2024.02.002] [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: 09/11/2023] [Revised: 01/10/2024] [Accepted: 02/02/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Asthma, the most common chronic disease of childhood, can affect a child's physical and mental health and social and emotional development. OBJECTIVE The aim of this study was to identify factors associated with emergency department (ED) return visits for asthma exacerbations within 14 days of an initial visit. METHODS This was a retrospective review from Cerner Real-World Data for patients aged from 5 to 18 years and seen at an ED for an asthma exacerbation and discharged home at the index ED visit. Asthma visits were defined as encounters in which a patient was diagnosed with asthma and a beta agonist, anticholinergic, or systemic steroid was ordered or prescribed at that encounter. Return visits were ED visits for asthma within 14 days of an index ED visit. Data, including demographic characteristics, ED evaluation and treatment, health care utilization, and medical history, were collected. Data were analyzed via logistic regression mixed effects model. RESULTS A total of 80,434 index visits and 17,443 return visits met inclusion criteria. Prior ED return visits in the past year were associated with increased odds of a return visit (odds ratio [OR] 2.12; 95% CI 2.07-2.16). History of pneumonia, a concomitant diagnosis of pneumonia, and fever were associated with increased odds of a return visit (OR 1.19; 95% CI 1.10-1.29; OR 1.15; 95% CI 1.04-1.28; OR 1.20; 95% CI 1.11-1.30, respectively). CONCLUSIONS Several variables seem to be associated with statistically significant increased odds of ED return visits. These findings indicate a potentially identifiable population of at-risk patients who may benefit from additional evaluation, planning, or education prior to discharge.
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Affiliation(s)
- Ricardo Aguilar
- Research Computational and Data Science, Research Institute, Children's Hospital of Orange County, Orange, California
| | - Chloe Knudsen-Robbins
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Louis Ehwerhemuepha
- Research Computational and Data Science, Research Institute, Children's Hospital of Orange County, Orange, California; School of Computational and Data Sciences, Chapman University, Orange, California
| | | | - Sunil Kamath
- Children's Hospital of Orange County, Orange, California
| | - Theodore W Heyming
- Children's Hospital of Orange County, Orange, California; Department of Emergency Medicine, University of California, Irvine, Orange, California.
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5
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Skeen EH, Moore CM, Federico MJ, Seibold MA, Liu AH, Hamlington KL. The Child Opportunity Index 2.0 and exacerbation-prone asthma in a cohort of urban children. Pediatr Pulmonol 2024; 59:1894-1904. [PMID: 38558492 DOI: 10.1002/ppul.26998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
RATIONALE Social determinants of health underlie disparities in asthma. However, the effects of individual determinants likely interact, so a summary metric may better capture their impact. The Child Opportunity Index 2.0 (COI) is one such tool, yet its association with exacerbation-prone (EP) asthma is unknown. OBJECTIVE To investigate the association between the COI and EP asthma and clinical measures of asthma severity in children. METHODS We analyzed data from two prospective observational pediatric asthma cohorts (n = 193). Children were classified as EP (≥1 exacerbation in the past 12 months) or exacerbation-null (no exacerbations in the past 5 years). Spirometry, exhaled nitric oxide, IgE, and Composite Asthma Severity Index (CASI) were obtained. The association between COI and EP status was assessed with logistic regression. We fit linear and logistic regression models to test the association between COI and each clinical measure. RESULTS A 20-point COI decrease conferred 40% higher odds of EP asthma (OR 1.4; 95%CI 1.1-1.76). The effect was similar when adjusted for age and sex (OR 1.38, 95%CI 1.1-1.75) but was attenuated with additional adjustment for race and ethnicity (OR 1.19, 95%CI 0.92-1.54). A similar effect was seen for the Social/Economic and Education COI domains but not the Health/Environment Domain. A 20-point COI decrease was associated with an increase in CASI of 0.34. COI was not associated with other clinical measures. CONCLUSIONS Lower COI was associated with greater odds of EP asthma. This highlights the potential use of the COI to understand neighborhood-level risk and identify community targets to reduce asthma disparities.
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Affiliation(s)
- Emily H Skeen
- Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Camille M Moore
- Center for Genes, Environment and Health, National Jewish Health, Denver, Colorado, USA
| | - Monica J Federico
- Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Max A Seibold
- Center for Genes, Environment and Health, National Jewish Health, Denver, Colorado, USA
| | - Andrew H Liu
- Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Katharine L Hamlington
- Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Chang AB, Kovesi T, Redding GJ, Wong C, Alvarez GG, Nantanda R, Beltetón E, Bravo-López M, Toombs M, Torzillo PJ, Gray DM. Chronic respiratory disease in Indigenous peoples: a framework to address inequity and strengthen respiratory health and health care globally. THE LANCET. RESPIRATORY MEDICINE 2024; 12:556-574. [PMID: 38677306 DOI: 10.1016/s2213-2600(24)00008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 04/29/2024]
Abstract
Indigenous peoples around the world bear a disproportionate burden of chronic respiratory diseases, which are associated with increased risks of morbidity and mortality. Despite the imperative to address global inequity, research focused on strengthening respiratory health in Indigenous peoples is lacking, particularly in low-income and middle-income countries. Drivers of the increased rates and severity of chronic respiratory diseases in Indigenous peoples include a high prevalence of risk factors (eg, prematurity, low birthweight, poor nutrition, air pollution, high burden of infections, and poverty) and poor access to appropriate diagnosis and care, which might be linked to colonisation and historical and current systemic racism. Efforts to tackle this disproportionate burden of chronic respiratory diseases must include both global approaches to address contributing factors, including decolonisation of health care and research, and local approaches, co-designed with Indigenous people, to ensure the provision of culturally strengthened care with more equitable prioritisation of resources. Here, we review evidence on the burden of chronic respiratory diseases in Indigenous peoples globally, summarise factors that underlie health disparities between Indigenous and non-Indigenous people, propose a framework of approaches to improve the respiratory health of Indigenous peoples, and outline future directions for clinical care and research.
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Tom Kovesi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Gregory J Redding
- School of Medicine, University of Washington, Seattle, WA, USA; Pediatric Pulmonary Division, Seattle Children's Hospital, Seattle, WA, USA
| | - Conroy Wong
- Department of Respiratory Medicine, Te Whatu Ora Counties Manukau, Auckland, New Zealand; School of Medicine, University of Auckland, Auckland, New Zealand
| | - Gonzalo G Alvarez
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Nantanda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edgar Beltetón
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala
| | - Maynor Bravo-López
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala; Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Maree Toombs
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Paul J Torzillo
- Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Nganampa Health Council, Alice Springs, NT, Australia
| | - Diane M Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Lee CM, Kaplan RM, Nelson SC, Horvitz-Lennon M. Financing the "Village": Establishing a Sustainable Financial System for Child Behavioral Health. Child Adolesc Psychiatr Clin N Am 2024; 33:457-470. [PMID: 38823817 PMCID: PMC11153862 DOI: 10.1016/j.chc.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
An increased need for child and adolescent behavioral health services compounded by a long-standing professional workforce shortage frames our discussion on how behavioral health services can be sustainably delivered and financed. This article provides an overview of different payment models, such as traditional fee-for-service and alternatives like provider salary, global payments, and pay for performance models. It discusses the advantages and drawbacks of each model, emphasizing the need to transition toward value-based care to improve health care quality and control costs.
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Affiliation(s)
- Chuan Mei Lee
- Department of Psychiatry and Behavioral Sciences, UCSF, 675 18th Street, Box 3132, San Francisco, CA 94143, USA; Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA.
| | - Robert M Kaplan
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Suzie C Nelson
- Department of Psychiatry, Wright State University, 2555 University Boulevard, Dayton, OH 45324, USA
| | - Marcela Horvitz-Lennon
- RAND Corporation, 20 Park Plaza, Suite 910, Boston, MA 02116, USA; Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, USA
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Conway AE, Lieberman J, Codispoti CD, Mahdavinia M, Anagnostou A, Hsu Blatman KS, Lang DM, Oppenheimer J, Mosnaim GS, Bukstein D, Shaker M. Pharmacoequity and Biologics in the Allergy Clinic: Providing the Right Care, at the Right Time, Every Time, to Everyone. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1170-1180. [PMID: 38458435 DOI: 10.1016/j.jaip.2024.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/10/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
Pharmacoequity refers to equity in access to pharmacotherapy for all patients and is an especially large barrier to biologic agents in patients with allergic diseases. Value-based care models can prompt clinicians to address social determinants of health, promoting pharmacoequity. Pharmacoequity is influenced by numerous factors including socioeconomic status, which may be mediated through insurance status, educational attainment, and access to specialist care. In addition to lower socioeconomic status, race and ethnicity, age, locations isolated from care systems, and off-label indications for biologic agents all constitute barriers to pharmacoequity. Whereas pharmaco-inequity is more apparent for expensive biologics, it also affects many other allergy treatments including epinephrine autoinjectors and SMART for asthma. Current programs aimed at alleviating cost barriers are imperfect. Patient assistance programs, manufacturer-sponsored free drug programs, and rebates often increase the complexity of care, with resultant inequity, particularly for patients with lower health literacy. Ultimately, single silver-bullet solutions are elusive. Long-term improvement instead requires a combination of research, advocacy, and creative problem-solving to design more intelligent and efficient systems that provide timely access to necessary care for every patient, every time.
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Affiliation(s)
| | - Jay Lieberman
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tenn
| | - Christopher D Codispoti
- Department of Internal Medicine, Division of Allergy, Rush University Medical Center, Chicago, Ill
| | - Mahboobeh Mahdavinia
- Department of Internal Medicine, Division of Allergy, Rush University Medical Center, Chicago, Ill
| | | | - Karen S Hsu Blatman
- Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Lebanon, NH; Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - David M Lang
- Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio
| | | | - Giselle S Mosnaim
- Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Evanston, Ill
| | - Don Bukstein
- Allergy, Asthma, and Sinus Center, Milwaukee, Wis
| | - Marcus Shaker
- Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Lebanon, NH; Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH.
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Bush A, Byrnes CA, Chan KC, Chang AB, Ferreira JC, Holden KA, Lovinsky-Desir S, Redding G, Singh V, Sinha IP, Zar HJ. Social determinants of respiratory health from birth: still of concern in the 21st century? Eur Respir Rev 2024; 33:230222. [PMID: 38599675 PMCID: PMC11004769 DOI: 10.1183/16000617.0222-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/20/2024] [Indexed: 04/12/2024] Open
Abstract
Respiratory symptoms are ubiquitous in children and, even though they may be the harbinger of poor long-term outcomes, are often trivialised. Adverse exposures pre-conception, antenatally and in early childhood have lifetime impacts on respiratory health. For the most part, lung function tracks from the pre-school years at least into late middle age, and airflow obstruction is associated not merely with poor respiratory outcomes but also early all-cause morbidity and mortality. Much would be preventable if social determinants of adverse outcomes were to be addressed. This review presents the perspectives of paediatricians from many different contexts, both high and low income, including Europe, the Americas, Australasia, India, Africa and China. It should be noted that there are islands of poverty within even the highest income settings and, conversely, opulent areas in even the most deprived countries. The heaviest burden of any adverse effects falls on those of the lowest socioeconomic status. Themes include passive exposure to tobacco smoke and indoor and outdoor pollution, across the entire developmental course, and lack of access even to simple affordable medications, let alone the new biologicals. Commonly, disease outcomes are worse in resource-poor areas. Both within and between countries there are avoidable gross disparities in outcomes. Climate change is also bearing down hardest on the poorest children. This review highlights the need for vigorous advocacy for children to improve lifelong health. It also highlights that there are ongoing culturally sensitive interventions to address social determinants of disease which are already benefiting children.
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Affiliation(s)
- Andrew Bush
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
| | - Catherine A Byrnes
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Starship Children's Health and Kidz First Hospital, Auckland, New Zealand
| | - Kate C Chan
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anne B Chang
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane and Menzies School of Health Research, Darwin, Australia
| | - Juliana C Ferreira
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Karl A Holden
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Stephanie Lovinsky-Desir
- Department of Pediatrics and Environmental Health Sciences, Columbia University Medical Center, New York, NY, USA
| | - Gregory Redding
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Varinder Singh
- Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Ian P Sinha
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Pan D, Diaz JL, Weidman K, Graham J, Goyal P, Rajan M, Lau J, Pinheiro L, Rachid L, Simmons W, Schenck EJ, Safford MM, Lief L. Social Networks as a Key Health Determinant in Acute Illness Recovery: A Lesson from the COVID-19 Pandemic. Am J Med 2024:S0002-9343(24)00236-5. [PMID: 38677397 DOI: 10.1016/j.amjmed.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND The COVID-19 pandemic highlighted the importance of considering social determinants of health in health outcomes. Within this spectrum of determinants, social networks garnered attention as the pandemic highlighted the negative effects of social isolation in the context of social distancing measures. Postpandemic, examining the role social networks play in COVID-19 recovery can help guide patient care and shape future health policies. This study aimed to investigate the relationship between social networks and self-rated health change, as well as physical function, in patients recovering from COVID-19 pneumonia. METHODS This was a retrospective cohort study utilizing clinical data from 2 New York City hospitals and a 9-month follow-up survey of COVID-19 pneumonia survivors. We evaluated a composite Social Network Score from the 6-item Lubben Social Network Scale and its association with 2 outcomes: 1) self-rated health change and 2) physical function. RESULTS A total of 208 patients were included in this study. A 1-point increase in the Social Network Score was associated with greater odds of both same or improved self-rated health change (odds ratio [OR] 1.07, 95% CI 1.02-1.12, P = .01), as well as unimpaired physical function (OR 1.08, 95% CI 1.03-1.14, P < .01). CONCLUSION This study emphasized the importance of social networks as a social determinant of health among patients recovering from COVID-19 hospitalization. Targeted interventions to enhance social networks may benefit not only COVID-19 patients but also individuals recovering from other acute illnesses.
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Affiliation(s)
- Di Pan
- Division of Pulmonary and Critical Care, Department of Medicine, Weill Cornell Medical College, New York, N.Y..
| | - Jihui L Diaz
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Penn
| | - Karissa Weidman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, N.Y
| | - Julia Graham
- Division of Pulmonary and Critical Care, Department of Medicine, Weill Cornell Medical College, New York, N.Y
| | - Parag Goyal
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, N.Y
| | - Mangala Rajan
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, N.Y
| | - Jennifer Lau
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, N.Y
| | - Laura Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, N.Y
| | - Leena Rachid
- Stritch School of Medicine at Loyola University Chicago, Maywood, Ill
| | - Will Simmons
- Department of Population Health Sciences, Weill Cornell Medical College, New York, N.Y
| | - Edward J Schenck
- Division of Pulmonary and Critical Care, Department of Medicine, Weill Cornell Medical College, New York, N.Y
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, N.Y
| | - Lindsay Lief
- Division of Pulmonary and Critical Care, Department of Medicine, Weill Cornell Medical College, New York, N.Y
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11
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Goff SL, Shieh MS, Lindenauer PK, Ash AS, Krishnan JA, Geissler KH. Differences in Health Care Utilization for Asthma by Children with Medicaid versus Private Insurance. Popul Health Manag 2024; 27:105-113. [PMID: 38574325 PMCID: PMC11001504 DOI: 10.1089/pop.2023.0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Asthma is the most common chronic disease in children, disproportionately affects families with lower incomes, and is a leading reason for acute care visits and hospitalizations. This retrospective cohort study used the Massachusetts All Payer Claims Database (2014-2018) to examine differences in acute care utilization and quality of care for asthma between Medicaid- and privately insured children in Massachusetts. Outcomes included acute care use (emergency department [ED] or hospitalization), ED visits with asthma, routine asthma visits, and filled prescriptions for asthma medications. Multivariable logistic regression was used to account for differences in demographics, ZIP codes, health status, and asthma severity. Overall, 10.0% of Medicaid-insured children and 5.6% of privately insured were classified as having asthma. Among 317,596 child-year observations for children with asthma, 64.4% were insured by Medicaid. Medicaid-insured children had higher rates of any acute care use (50.4% vs. 30.0%) and ED visits with an asthma diagnosis (27.2% vs. 13.3%) compared to privately insured children. Only 65.4% of Medicaid enrollees had at least one routine asthma visit compared to 74.3% of privately insured children. Most children received at least one asthma medication (88.6% Medicaid vs. 83.3% privately insured), but a higher percentage of Medicaid-insured children received at least one rescue medication (84.0% vs. 73.7%), and a lower percentage of Medicaid-insured (46.1% vs. 49.2%) received a controller medication. These results suggest that opportunities for improvement in childhood asthma persist, particularly for children insured by Medicaid.
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Affiliation(s)
- Sarah L. Goff
- Department of Health Promotion and Policy, School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Meng-Shiou Shieh
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts-Chan Medical School—Baystate, Springfield, Massachusetts, USA
| | - Peter K. Lindenauer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts-Chan Medical School—Baystate, Springfield, Massachusetts, USA
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
| | - Arlene S. Ash
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Jerry A. Krishnan
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois Chicago, Chicago, Illinois, USA
- Institute for Healthcare Delivery Design, University of Illinois Chicago, Chicago, Illinois, USA
| | - Kimberley H. Geissler
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts-Chan Medical School—Baystate, Springfield, Massachusetts, USA
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Rezaeiahari M, Brown CC, Eyimina A, Perry TT, Goudie A, Boyd M, Mick Tilford J, Jefferson AA. Predicting pediatric severe asthma exacerbations: an administrative claims-based predictive model. J Asthma 2024; 61:203-211. [PMID: 37725084 PMCID: PMC11195303 DOI: 10.1080/02770903.2023.2260881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/14/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Previous machine learning approaches fail to consider race and ethnicity and social determinants of health (SDOH) to predict childhood asthma exacerbations. A predictive model for asthma exacerbations in children is developed to explore the importance of race and ethnicity, rural-urban commuting area (RUCA) codes, the Child Opportunity Index (COI), and other ICD-10 SDOH in predicting asthma outcomes. METHODS Insurance and coverage claims data from the Arkansas All-Payer Claims Database were used to capture risk factors. We identified a cohort of 22,631 children with asthma aged 5-18 years with 2 years of continuous Medicaid enrollment and at least one asthma diagnosis in 2018. The goal was to predict asthma-related hospitalizations and asthma-related emergency department (ED) visits in 2019. The analytic sample was 59% age 5-11 years, 39% White, 33% Black, and 6% Hispanic. Conditional random forest models were used to train the model. RESULTS The model yielded an area under the curve (AUC) of 72%, sensitivity of 55% and specificity of 78% in the OOB samples and AUC of 73%, sensitivity of 58% and specificity of 77% in the training samples. Consistent with previous literature, asthma-related hospitalization or ED visits in the previous year (2018) were the two most important variables in predicting hospital or ED use in the following year (2019), followed by the total number of reliever and controller medications. CONCLUSIONS Predictive models for asthma-related exacerbation achieved moderate accuracy, but race and ethnicity, ICD-10 SDOH, RUCA codes, and COI measures were not important in improving model accuracy.
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Affiliation(s)
- Mandana Rezaeiahari
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Clare C. Brown
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Arina Eyimina
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Tamara T. Perry
- Department of Pediatrics, Allergy & Immunology Division, University of Arkansas for Medical Sciences
- Arkansas Children’s Research Institute, Little Rock, Arkansas
| | - Anthony Goudie
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Melanie Boyd
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - J. Mick Tilford
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Akilah A. Jefferson
- Department of Pediatrics, Allergy & Immunology Division, University of Arkansas for Medical Sciences
- Arkansas Children’s Research Institute, Little Rock, Arkansas
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Chen M, Bacong AM, Feng C, Kikuta NT, Datir RR, Chen S, Srinivasan M, Camargo CA, Palaniappan L, Arroyo AC. Asthma heterogeneity among Asian American children: The California Health Interview Survey. Ann Allergy Asthma Immunol 2024; 132:368-373.e2. [PMID: 37949352 PMCID: PMC10922489 DOI: 10.1016/j.anai.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The Asian American (AsA) population is heterogenous and rapidly growing; however, little is known regarding childhood asthma burden among AsA ethnic groups. The relation between obesity and asthma in AsA ethnic groups also remains unclear. OBJECTIVE To evaluate asthma prevalence and the relation of obesity to asthma risk among children in 7 AsA ethnic groups. METHODS We analyzed data from the California Health Interview Survey from 2011 to 2020. AsA ethnicities were self-reported. Body mass index z-scores, calculated from self-reported height/weight, were used to categorize children by obesity status, based on body mass index-for-age growth charts. Prevalence of self-reported lifetime doctor-diagnosed asthma and asthma attack in the last 12 months was calculated. We performed multivariable logistic regressions adjusting for age and sex. RESULTS Of 34,146 survey respondents, 12.2% non-Hispanic White and 12.5% AsA children reported lifetime asthma. Among AsA ethnic groups, however, lifetime asthma ranged from 5.1% (Korean American) to 21.5% (Filipino American). Non-Hispanic White children and AsA children had a similar lifetime asthma prevalence (adjusted odds ratio [aOR], 1.05; 95% CI, 0.71-1.55; P = .81), but prevalence was lower in Korean American children (aOR, 0.37; 95% CI, 0.19-0.73; P = .004) and higher in Filipino American children (aOR, 1.97; 95% CI, 1.22-3.17; P = .006). The lifetime asthma prevalence of different AsA ethnic groups persisted even when stratified by obesity status. CONCLUSION Childhood lifetime asthma prevalence varied among AsA ethnic groups, with lowest prevalence in Korean American children and highest prevalence in Filipino American. Further characterization of asthma burden among AsA ethnic groups may help guide asthma screening and prevention measures and offer new insights into asthma pathogenesis.
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Affiliation(s)
- Meng Chen
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; Stanford Center for Asian Health Research and Education, Stanford, California.
| | - Adrian Matias Bacong
- Stanford Center for Asian Health Research and Education, Stanford, California; Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Charles Feng
- Division of Allergy/Immunology, Palo Alto Medical Foundation, Mountain View, California
| | | | - Rohan Rahul Datir
- Stanford Center for Asian Health Research and Education, Stanford, California
| | - Shihua Chen
- Stanford Center for Asian Health Research and Education, Stanford, California
| | - Malathi Srinivasan
- Stanford Center for Asian Health Research and Education, Stanford, California; Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Carlos A Camargo
- Department of Emergency Medicine and Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Latha Palaniappan
- Stanford Center for Asian Health Research and Education, Stanford, California; Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Epidemiology and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Anna Chen Arroyo
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; Stanford Center for Asian Health Research and Education, Stanford, California
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14
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Le A, Bui V, Chu R, Arroyo AC, Chen M, Bacong AM. Social Determinants of Health and Allergic Disease Prevalence Among Asian American Children. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01918-0. [PMID: 38315290 DOI: 10.1007/s40615-024-01918-0] [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: 09/18/2023] [Revised: 12/20/2023] [Accepted: 01/20/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Although racial and ethnic disparities in allergic diseases have previously been observed, the relationship between social determinants of health (SDoH) and allergic disease prevalence among disaggregated Asian American (AsA) subgroups is poorly understood. OBJECTIVE To examine the association of SDoH with allergic disease prevalence among disaggregated AsA subgroups. METHODS Using the 2011-2018 National Health Interview Survey, we examined caregiver-reported race and ethnicity, SDoH, and allergic diseases. We compared survey-weighted allergic disease prevalence by AsA subgroup. Subgroup-stratified multivariable logistic regression accounting for age, sex, child/parent nativity, and survey year modeled the association between SDoH and allergic disease prevalence. We provide predicted probabilities of having each allergic disease based on exposure to each SDoH. RESULTS We examined data from 5042 non-Hispanic AsA children representing 3,264,768 AsA children. Approximately 25% of all AsA children reported at least one allergic disease, ranging from 20% of Asian Indian children to 30% of Filipino/a children. The number of unfavorable SDoH was lowest among Asian Indian and Chinese children (mean 0.7) and highest among "other Asian" children (mean 1.2). In stratified analyses, financial instability and inaccessible healthcare were associated with greater probability of allergic diseases among some, but not all AsA subgroups. Lower parent education level, food insecurity, and rent/other housing arrangement were associated with lower probability of allergic disease among some AsA children. CONCLUSION There was heterogeneity in the association of SDoH and allergic disease prevalence among AsA children. Further study of SDoH may inform modifiable environmental factors for allergic disease among AsA children.
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Affiliation(s)
- Austin Le
- Division of Environmental Health Sciences, University of California, Berkeley, School of Public Health, Berkeley, USA
| | - Vivian Bui
- Division of Epidemiology, University of California, Berkeley, School of Public Health, Berkeley, USA
| | - Richie Chu
- Department of Community Health Sciences, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, USA
- Asian American Studies Department, University of California, Los Angeles, Los Angeles, USA
| | - Anna Chen Arroyo
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, 1265 Welch Road, Room X200, Palo Alto, CA, 94305, USA
| | - Meng Chen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, 1265 Welch Road, Room X200, Palo Alto, CA, 94305, USA
| | - Adrian Matias Bacong
- Center for Asian Health Research and Education, Stanford University School of Medicine, Stanford, 1265 Welch Road, Room X200, Palo Alto, CA, 94305, USA.
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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15
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Perry TT, Marko A, Russell AF, Cooke AT, Bingemann TA, Ross KR, Young MC. How Schools Can Help Address Social Determinants of Health in Asthma Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:316-326. [PMID: 37839577 DOI: 10.1016/j.jaip.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
Schools are in a unique position to address social determinants of health (SDOHs) in pediatric asthma management because of their potential to provide resources and facilitate collaboration with health care providers and services for children at risk within their community. SDOHs include economic factors, educational attainment and health literacy, neighborhood factors and the built environment, social and community aspects including discrimination and racism, and health care access and quality. These factors have a significant impact on asthma health in children, and certain populations such as minoritzed populations and those living in high-poverty environments have been shown to be at greater risk for adverse effects of SDOHs on asthma outcomes. School-based asthma programs address several SDOHs including health literacy, the built environment, and health care quality and access and have been shown to improve asthma outcomes. Key components include connection between the school and the health care team, self-management education, and directly observed therapy. School nurses play a key role in directing and managing effective programs because they can evaluate and support a student's health while considering the effect of SDOHs at interpersonal, institutional, community, and policy levels.
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Affiliation(s)
- Tamara T Perry
- Division of Allergy and Immunology, College of Medicine, Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Angela Marko
- Division of Pediatric Pulmonology and Sleep Medicine, UH Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio.
| | - Anne F Russell
- School of Nursing and Health Sciences, Spring Arbor University, Spring Arbor, Mich; Food Allergy and Anaphylaxis Michigan Association, Ann Arbor, Mich
| | - Abigail T Cooke
- Allergy and Asthma Specialists, Durango, Colo; Colorado State University-Pueblo: Graduate School of Nursing, Pueblo, Colo
| | - Theresa A Bingemann
- Departments of Allergy, Immunology and Rheumatology and Pediatric Allergy and Immunology, University of Rochester School of Medicine, Rochester, NY
| | - Kristie R Ross
- Division of Pediatric Pulmonology and Sleep Medicine, UH Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Michael C Young
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
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Perry TT, Grant TL, Dantzer JA, Udemgba C, Jefferson AA. Impact of socioeconomic factors on allergic diseases. J Allergy Clin Immunol 2024; 153:368-377. [PMID: 37967769 PMCID: PMC10922531 DOI: 10.1016/j.jaci.2023.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/13/2023] [Accepted: 10/25/2023] [Indexed: 11/17/2023]
Abstract
Allergic and immunologic conditions, including asthma, food allergy, atopic dermatitis, and allergic rhinitis, are among the most common chronic conditions in children and adolescents that often last into adulthood. Although rare, inborn errors of immunity are life-altering and potentially fatal if unrecognized or untreated. Thus, allergic and immunologic conditions are both medical and public health issues that are profoundly affected by socioeconomic factors. Recently, studies have highlighted societal issues to evaluate factors at multiple levels that contribute to health inequities and the potential steps toward closing those gaps. Socioeconomic disparities can influence all aspects of care, including health care access and quality, diagnosis, management, education, and disease prevalence and outcomes. Ongoing research, engagement, and deliberate investment of resources by relevant stakeholders and advocacy approaches are needed to identify and address the impact of socioeconomics on health care disparities and outcomes among patients with allergic and immunologic diseases.
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Affiliation(s)
- Tamara T Perry
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark.
| | - Torie L Grant
- Johns Hopkins University School of Medicine, Baltimore, Md
| | | | - Chioma Udemgba
- National Institute of Allergic and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Akilah A Jefferson
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark
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17
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Gabbay JM, Abrams EM, Nyenhuis SM, Wu AC. Housing Insecurity and Asthma Outcomes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:327-333. [PMID: 37871647 DOI: 10.1016/j.jaip.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/03/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023]
Abstract
Asthma is a chronic respiratory disease with widespread prevalence that affects children, adolescents, and adults. Asthma morbidity and mortality can be exacerbated in the setting of housing insecurity. In this Grand Rounds Review article, we present a case and discuss the implications that housing insecurity has on asthma outcomes in the United States. We then highlight ways in which providers can advocate for patients with asthma and housing insecurity.
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Affiliation(s)
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada
| | - Sharmilee M Nyenhuis
- Department of Pediatrics, Section of Allergy and Immunology, University of Chicago, Chicago, Ill
| | - Ann Chen Wu
- Department of Medicine, Boston Children's Hospital, Boston, Mass; Division of Child Health Research and Policy, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
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18
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Sellitto T, Fraser-Thomas J, Bassett-Gunter RL, Lee V, Lunsky Y, Balogh R, Weiss JA. The role of thriving in mental health among people with intellectual and developmental disabilities during the COVID-19 pandemic in Canada. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13177. [PMID: 37987194 DOI: 10.1111/jar.13177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 09/20/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The COVID-19 pandemic has had a negative impact on the mental health of people with intellectual and developmental disabilities. Numerous pandemic-related stressors experienced by people with intellectual and developmental disabilities may have impacted their ability to thrive, which has been linked to mental health outcomes. The current study examined the associations among COVID-19 stressors, thriving, and mental health problems among youth and adults with intellectual and developmental disabilities. METHOD Caregivers of 159 people with intellectual and developmental disabilities between 12 and 35 years of age from Canada completed an online questionnaire. RESULTS A mediation analysis revealed that COVID-19 stressors were positively associated with mental health problems, and that thriving partially mediated this association. CONCLUSION Our findings suggest that experiences of thriving may be an important target for mental health support for people with intellectual and developmental disabilities.
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Affiliation(s)
- Teresa Sellitto
- Department of Psychology, York University, Toronto, Ontario, Canada
| | | | | | - Vivian Lee
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert Balogh
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Jonathan A Weiss
- Department of Psychology, York University, Toronto, Ontario, Canada
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19
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Crocker ME, Stout JW. A qualitative study of perspectives on the acceptability and feasibility of "virtual home visits" for asthma. BMC Public Health 2023; 23:2546. [PMID: 38124054 PMCID: PMC10734151 DOI: 10.1186/s12889-023-17485-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Asthma home-visit programs delivered by community health workers (CHWs) are an effective way to improve asthma outcomes and cost of care, through performing home environmental inspections, delivering education and hands-on demonstrations, and providing personalized behavior change support. During the COVID-19 pandemic, many in-person asthma CHW programs have been adapted to be delivered virtually, but it is unclear whether this is acceptable or feasible for clients with asthma. This qualitative study sought to identify perspectives of prior clients of the Public Health-Seattle & King County Asthma Program on acceptability and feasibility of a hypothetical virtual asthma program. METHODS We performed semi-structured interviews with participants speaking English, Spanish, and Somali. An a priori codebook was developed based on the Theoretical Framework of Acceptability and was revised iteratively during coding. Intra-rater reliability was established, and thematic analysis was used to determine major themes. RESULTS A total of 19 individuals participated (9 speaking English, 8 Spanish, and 2 Somali). Krippendorf's alpha was 0.848, indicating high intra-rater reliability. Our results demonstrated that many participants felt positively about the prospect of completing the program virtually, but they also expected a variety of challenges, the most important of which were lack of engagement with the CHW and lack of confidence in the accuracy of a virtual home inspection. Participants also varied widely in their comfort level with videoconferencing platforms and their access to adequate internet connectivity. CONCLUSIONS Acceptability and feasibility of virtual programming varies widely between participants, indicating that there may be no "one-size-fits-all" approach. We present several recommendations for adapting in-person asthma home visit programs to a virtual format, including considering a hybrid approach to delivery, making concerted efforts to build rapport when using videoconferencing, and deliberately evaluating the effectiveness of new adaptations, especially if a virtual environmental assessment is attempted.
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Affiliation(s)
- Mary E Crocker
- Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, WA, USA.
- Division of Pulmonary & Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA.
| | - James W Stout
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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20
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Das K, Onwuka AJ, Chisolm DJ. Social Determinants of Health Are Associated With Visits for Ambulatory Care Sensitive Conditions. Pediatr Emerg Care 2023; 39:934-939. [PMID: 37205847 DOI: 10.1097/pec.0000000000002971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Population health experts have described the link between social factors and health, but few studies link specific social needs to disease processes. Nationwide Children's Hospital implemented a universal, annual screener for social determinants of health (SDH) in 2018. Early analyses have shown that patients identifying an SDH need were more likely to have an emergency department (ED) or inpatient stay. The objective of this study is to identify links between SDH and ED presentation for ambulatory care sensitive conditions (ACSCs). METHODS This was a retrospective observational study of children aged 0-21 years receiving care at Nationwide Children's Hospital from 2018 to 2021 that were screened for SDH. Acute care utilization within 6 months of screener completion, sociodemographic, and clinical data were collected via EPIC data extraction. Patients that completed screening tool for the first time in the ED were excluded to minimize selection bias. Logistic regression was used to analyze the association between ED presentation for ACSCs and SDH needs. RESULTS A total of 108,346 social determinants screeners were included with 9% of screeners identifying a need. Five percent of the population expressed food needs, 4% transportation needs, 3% utility needs, and 1% housing needs. Eighteen percent of patients had an ED visit for ACSC, with the most common complaints being upper respiratory infections and asthma. Having any SDH need was associated with ED visits for ACSCs (odds ratio, 1.12; 95% confidence interval, 1.06-1.18). Needs in all domains were significantly associated with increased visits for ACSCs; however, patients with housing needs had the highest odds of utilization (odds ratio, 1.25; confidence interval, 1.11-1.41). CONCLUSIONS The odds of ED presentation for ACSCs are higher in patients with expressed social needs. Further delineating the connections between specific SDH and health outcomes can inform timely and appropriate interventions.
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Affiliation(s)
- Kristol Das
- From the Nationwide Children's Hospital, Columbus, OH
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21
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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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22
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Pate CA, Qin X, Johnson C, Zahran HS. Asthma disparities among U.S. children and adults. J Asthma 2023; 60:2214-2223. [PMID: 37366607 PMCID: PMC10760409 DOI: 10.1080/02770903.2023.2228915] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To assess factors that are associated with asthma prevalence and asthma attacks among children (0-17 years) and adults (18 years and over) in the United States of America. METHODS The 2019-2021 National Health Interview Survey data were analyzed using multivariable logistic regression models to determine associations between health outcomes (i.e. current asthma and asthma attacks) and demographic and socioeconomic factors. Each health outcome was regressed over each characteristic variable, adjusting for age, sex, and race/ethnicity for adults and sex and race/ethnicity for children. RESULTS Asthma was more common among children who were male, blacks, parental education less than bachelor's, or had public health insurance, and among adults who had less than a bachelor's degree, do not own a home, or not in the workforce. Persons in families facing difficulty paying medical bills were more likely to have current asthma (children: aPR = 1.62[1.40-1.88]; adults: aPR = 1.67[1.55-1.81]) and asthma attacks (children: aPR = 1.34[1.15-1.56]; adults: aPR = 1.31[1.20-1.43]). Persons with family income <100% federal poverty threshold (FPT) (children: aPR = 1.39[1.17-1.64]; adults: aPR = 1.64[1.50-1.80]) or adults 100-199% FPT (aPR = 1.28[1.19-1.39]) were more likely to have current asthma. Children and adults with family income <100% FPT and adults 100-199% FPT were also more likely to have asthma attacks. Having asthma attacks was common among adults not in the workforce as well (aPR = 1.17[1.07-1.27]). CONCLUSIONS Asthma affects certain groups disproportionately. The findings of this paper suggesting asthma disparities continue to persist may increase public health programs awareness to better deliver effective and evidence-based interventions.
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Affiliation(s)
- Cynthia A Pate
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xiaoting Qin
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carol Johnson
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hatice S Zahran
- Asthma and Community Health Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Niebur H, Rookwood A, Karki B, Abresch C. Toward a new model of childhood asthma care: community needs assessment in an underserved urban population. J Asthma 2023; 60:2064-2073. [PMID: 37171134 DOI: 10.1080/02770903.2023.2213351] [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: 02/02/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES The objective of this study was to utilize a community-engaged research approach to better understand gaps and opportunities for improving asthma care from the perspectives of patients, caregivers, community organization representatives, and healthcare providers in a predominantly minority community. METHODS Forty-one participants from four groups (patients, caregivers, community organization representatives, healthcare providers) participated in interviews or focus groups. A phenomenological approach to this qualitative research allowed the research team to better understand the lived experiences of families seeking asthma care in this community. RESULTS Five gaps and five corresponding opportunities were identified. The gaps identified were unequal healthcare resource distribution; underrepresentation of health professionals from diverse backgrounds; experiences of environmental racism; mistrust, bias, and discrimination in healthcare encounters; and systemic marginalization of communities. The opportunities identified include increasing healthcare infrastructure and accessibility; increasing racially, culturally, and linguistically congruent healthcare; implementing equitable improvements to the built environment; building relationships with communities and individuals; and acknowledging communities' strengths and resilience. CONCLUSION This study identified systemic gaps to asthma care that are of prominent concern to the community.
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Affiliation(s)
- Hana Niebur
- Department of Pediatrics, University of NE Medical Center, Omaha, USA
| | - Aislinn Rookwood
- Department of Pediatrics, University of NE Medical Center, Omaha, USA
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, USA
| | - Bibhusha Karki
- Division of Nursing, Midwifery and Social work, University of Manchester, Manchester, UK
| | - Chad Abresch
- Department of Pediatrics, University of NE Medical Center, Omaha, USA
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Rogerson C, Owora A, He T, Carroll A, Schleyer T, AbuSultaneh S, Tu W, Mendonca E. High flow nasal cannula use is associated with increased hospital length of stay for pediatric asthma. Pediatr Pulmonol 2023; 58:3046-3053. [PMID: 37530483 DOI: 10.1002/ppul.26617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND High flow nasal cannula (HFNC) is a respiratory device increasingly used to treat asthma. Recent mechanistic studies have shown that nebulized medications may have reduced delivery with HFNC, which may impair asthma treatment. This study evaluated the association between HFNC use for pediatric asthma and hospital length of stay (LOS). METHODS This was a retrospective matched cohort study. Cases included patients aged 2-18 years hospitalized between January 2010 and December 2021 with asthma and received HFNC treatment. Controls were selected using logistic regression propensity score matching based on demographics, vital signs, medications, imaging, and social and environmental determinants of health. The primary outcome was hospital LOS. RESULTS A total of 23,659 encounters met eligibility criteria, and of these 1766 cases included HFNC treatment with a suitable matched control. Cases were well-matched in demographics, social and environmental determinants of health, and clinical characteristics including use of adjunctive asthma therapies. The median hospital LOS for study cases was significantly higher at 87 h (interquartile range [IQR]: 61-145) compared to 66 h (IQR: 43-105) in the matched controls (p < 0.01). There was no significant difference in the rate of intubation and mechanical ventilation (8.9% vs. 7.6%, p = .18); however, the use of NIV was significantly higher in the cases than the control group (21.3% vs. 6.7%, p < .01). CONCLUSION In this study of children hospitalized for asthma, HFNC use was associated with increased hospital LOS compared to matched controls. Further research using more granular data and additional relevant variables is needed to validate these findings.
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Affiliation(s)
- Colin Rogerson
- Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Biostatistics, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | - Arthur Owora
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tian He
- Regenstrief Institute, Center for Biomedical Informatics, Indianapolis, Indiana, USA
| | - Aaron Carroll
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Titus Schleyer
- Department of Biostatistics, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | | | - Wanzhu Tu
- Regenstrief Institute, Center for Biomedical Informatics, Indianapolis, Indiana, USA
| | - Eneida Mendonca
- Indiana University School of Medicine, Indianapolis, Indiana, USA
- Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, USA
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Smith BM, Smith TK, Holve S, Connor KA, Coleman C, Tschudy MM. Defining and Promoting Pediatric Pulmonary Health: Equitable Family and Community Partnerships. Pediatrics 2023; 152:e2023062292G. [PMID: 37656028 PMCID: PMC10484323 DOI: 10.1542/peds.2023-062292g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 09/02/2023] Open
Abstract
Optimizing pulmonary health across the lifespan begins from the earliest stages of childhood and requires a partnership between the family, pulmonologist, and pediatrician to achieve equitable outcomes. The Community Pediatrics session of the Defining and Promoting Pediatric Pulmonary Health workshop weaved together 4 community-based pillars with 4 research principles to set an agenda for future pediatric pulmonary research in optimizing lung and sleep health for children and adolescents. To address diversity, equity, and inclusion, both research proposals and workforce must purposefully include a diverse set of participants that reflects the community served, in addition to embracing nontraditional, community-based sites of care and social determinants of health. To foster inclusive, exploratory, and innovative research, studies must be centered on community priorities, with findings applied to all members of the community, particularly those in historically marginalized and minoritized groups. Research teams should also foster meaningful partnerships with community primary care and family members from study conceptualization. To achieve these goals, implementation and dissemination science should be expanded in pediatric pulmonary research, along with the development of rapid mechanisms to disseminate best practices to community-based clinicians. To build cross-disciplinary collaboration and training, community-academic partnerships, family research partnerships, and integrated research networks are necessary. With research supported by community pillars built on authentic partnerships and guided by inclusive principles, pediatric lung and sleep health can be optimized for all children and adolescents across the full lifespan in the community in which they live and thrive.
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Affiliation(s)
- Brandon M. Smith
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tyler K. Smith
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine and Children’s Mercy Kansas City, Kansas City, Missouri
| | - Steve Holve
- Tuba City Regional Health Care, Indian Health Service, Tuba City, Arizona
| | - Katherine A. Connor
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Megan M. Tschudy
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Gabbay JM, Wu AC. Housing Mobility Intervention and the Impact on Pediatric Asthma Morbidity: A Novel Asthma-Directed Therapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2622-2623. [PMID: 37558365 DOI: 10.1016/j.jaip.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 08/11/2023]
Affiliation(s)
| | - Ann Chen Wu
- Department of Medicine, Boston Children's Hospital, Boston, Mass; Division of Child Health Research and Policy, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
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Oyegbile-Chidi T, Harvey D, Jones J, Byars A, Austin J, Hermann B, Dunn D. Impact of sociodemographic disadvantage on neurobehavioral outcomes in children with newly diagnosed seizures and their unaffected siblings over 36 months. Epilepsia 2023; 64:2172-2185. [PMID: 37264778 PMCID: PMC10526637 DOI: 10.1111/epi.17672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This study was undertaken to determine the short-term and longer term impact of sociodemographic disadvantage on the emotional-behavioral status of youths with new onset epilepsy and their unaffected siblings at the time of diagnosis and the subsequent 3 years. METHODS Three hundred twelve youths with newly diagnosed epilepsies and 223 unaffected siblings, aged 6-16 years, were independently assessed regarding their emotional and behavioral status by their parents and teachers at baseline, and at 18 at 36 months later; youths with seizures also completed self-report measures of depression, anxiety, and hostility at those three time points. A sociodemographic disadvantage score was computed for each family (children with newly diagnosed seizures and their siblings), and families were separated into four categories from most disadvantaged to least disadvantaged. RESULTS In both children and siblings, the least disadvantaged group exhibited the lowest level of neurobehavioral problems, whereas the most disadvantaged group showed a higher level of neurobehavioral problems across all the same behavior metrics. Findings remained stable and significant across all informants (parent, teacher, child) and across all time periods (throughout the 3-year period). Furthermore, both corrected and uncorrected linear regression analyses indicated that disadvantage was a more constant and stable predictor of behavioral and emotional problems over time compared to clinical seizure characteristics and abnormalities in magnetic resonance imaging and electroencephalographic testing. SIGNIFICANCE Sociodemographic disadvantage bears a strong relationship to youths with emotional and behavioral problems both at the time of diagnosis as well as prospectively. The relationship is robust and reflected in reports from multiple informants (parent, teacher, child self-report), evident in siblings as well, and possibly more explanatory than traditional clinical seizure variables. Future studies will be needed to determine whether this disadvantage factor is modifiable with early intervention.
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Affiliation(s)
| | - Danielle Harvey
- Public Health Sciences, University of California, Davis, Davis, California, USA
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Anna Byars
- Department of Neurology, Cincinnati, Cincinnati Children's Hospital, University of Cincinnati, Ohio, USA
| | - Joan Austin
- Department of Environments for Health, Indiana University, Indianapolis, Indiana, USA
| | - Bruce Hermann
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - David Dunn
- Department of Psychiatry and Neurology, Indiana University, Indianapolis, Indiana, USA
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Jefferson AA, Brown CC, Eyimina A, Goudie A, Rezaeiahari M, Perry TT, Tilford JM. Asthma Quality Measurement and Adverse Outcomes in Medicaid-Enrolled Children. Pediatrics 2023; 152:e2022059812. [PMID: 37497577 PMCID: PMC10389769 DOI: 10.1542/peds.2022-059812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVES To determine the association between the asthma medication ratio (AMR) quality measure and adverse outcomes among Medicaid-enrolled children with asthma in Arkansas, given concerns regarding the utility of the AMR in evaluating pediatric risk of asthma-related adverse events (AAEs). METHODS We used the Arkansas All-Payer Claims Database to identify Medicaid-enrolled children with asthma using a nonrestrictive case definition and additionally using the standard Healthcare Effectiveness Data and Information Set (HEDIS) persistent asthma definition. We assessed the AMR using the traditional dichotomous HEDIS AMR categorization and across 4 expanded AMR categories. Regression models assessed associations between AMR and AAE including hospitalization and emergency department utilization, with models conducted overall and by race and ethnicity. RESULTS Of the 22 788 children in the analysis, 9.0% had an AAE (6.7% asthma-related emergency department visits; 3.0% asthma-related hospitalizations). We found poor correlation between AMR and AAE, with higher rates of AAE (10.5%) among children with AMR ≥0.5 compared with AMR <0.5 (8.5%; P < .001), and similar patterns stratified by racial and ethnic subgroups. Expanded AMR categorization revealed notable differences in associations between AMR and AAEs, compared with traditional dichotomous categorization, with worse performance in Black children. CONCLUSIONS The AMR performed poorly in identifying risk of adverse outcomes among Medicaid-enrolled children with asthma. These findings underscore concerns of the utility of the AMR in population health management and reliance on restrictive HEDIS definitions. New population health frameworks incorporating broader considerations that accurately identify at-risk children are needed to improve equity in asthma management and outcomes.
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Affiliation(s)
- Akilah A. Jefferson
- Department of Pediatrics, Allergy & Immunology Division
- Arkansas Children’s Research Institute, Little Rock, Arkansas
| | - Clare C. Brown
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Arina Eyimina
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Anthony Goudie
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mandana Rezaeiahari
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Tamara T. Perry
- Department of Pediatrics, Allergy & Immunology Division
- Arkansas Children’s Research Institute, Little Rock, Arkansas
| | - J. Mick Tilford
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Grande M, Eldeirawi KM, Huntington-Moskos L, Polivka B, Nyenhuis SM. The Association of Food Insecurity With Asthma Control in Adults During COVID-19. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2144-2149. [PMID: 37146886 PMCID: PMC10845761 DOI: 10.1016/j.jaip.2023.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/16/2023] [Accepted: 04/10/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Food insecurity has been associated with poorer asthma control in children, but research lacks in adults. OBJECTIVE To assess the frequency of food insecurity and its association with asthma control in adults during the coronavirus disease 2019 pandemic. METHODS An online cross-sectional survey study was conducted in US adults with asthma. Survey questions included how worried or concerned participants were about food security since the pandemic. Asthma control was assessed using the Asthma Control Test, with uncontrolled asthma defined as Asthma Control Test score less than or equal to 19. Self-report of food insecurity since the pandemic was assessed. Food insecurity variables were dichotomized into high insecurity (≥3) or low insecurity (<3). Descriptive statistics and bivariate analyses were performed. RESULTS Of the total participants (N = 866), 82.79% were female; mean age of participants was 44 ± 15.05 years, their mean Asthma Control Test score was 19.25 ± 4.54, and 18.48% had high food insecurity. Participants with high food insecurity were more likely to have uncontrolled asthma (74.38%) compared with those with lower food insecurity (34.99%; P < .01). The relationship between asthma control and food insecurity remained significant after adjusting for age, education, sex, race, anxiety, and living stability concerns due to the pandemic. CONCLUSIONS Food insecurity exists in adults with asthma and is associated with uncontrolled asthma. Providers should consider screening their patients for food insecurity when treating individuals with uncontrolled asthma.
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Affiliation(s)
- Matthew Grande
- College of Medicine, University of Illinois, Chicago, Ill
| | - Kamal M Eldeirawi
- Department of Population Health Nursing Science, University of Illinois, Chicago, Ill
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Bickel S, Cohen RT, Needleman JP, Volerman A. Appropriate inhaler use in children with asthma: barriers and opportunities through the lens of the socio-ecological model. J Asthma 2023; 60:1269-1279. [PMID: 36420559 PMCID: PMC10192155 DOI: 10.1080/02770903.2022.2152352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 11/25/2022]
Abstract
Objective: Proper use of inhaled medications is essential for management of asthma, as inhaled therapies are recommended as first-line for both prevention and treatment of asthma symptoms. Optimizing adherence requires identifying and understanding multiple layers of systemic complexity to obtaining and using these therapies and offering specific solutions to address these barriers. Bronfenbrenner's socio-ecological model provides a framework for examining multilevel systems - both internal and external - that contribute to the management of childhood asthma. The four levels in this model consist of factors related to the individual, interpersonal relationships, organizational entities, and societal structures and rules. This narrative review identifies influences and factors related to asthma inhaler adherence by each level and offers evidence-based solutions to each obstacle.Data Sources: We conducted PubMed searches to identify relevant articles for barriers and solutions impacting asthma control at each level of the socio-ecological model.Study Selection: Common barriers to asthma control at each model level were identified. Pertinent studies for each barrier were identified and reviewed by the writing group for inclusion into the narrative review.Results: For each level of the socio-ecological model, three primary issues were identified based on the literature review. Approaches for addressing each issue in an evidence-based, systematic fashion are presented.Conclusion: Understanding the obstacles and potential interventions to achieve proper use of inhaled medications is a critical step necessary to develop and implement systematic solutions aimed at improving asthma control and morbidity for the more than 6 million affected children in the United States.
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Affiliation(s)
- Scott Bickel
- Division of Pediatric Pulmonology, Allergy & Immunology, Norton Children’s and University of Louisville School of Medicine, Louisville, KY, USA
| | - Robyn T. Cohen
- Division of Pediatric Pulmonary and Allergy, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Joshua P. Needleman
- Division of Pediatric Pulmonology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Anna Volerman
- Department of Medicine and Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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Antoñón M, Pernía-Sánchez JV, Cancho-Soto T, Segovia-Molina I, Díez-Monge N, Cano A. Asthma control in children, socioeconomic inequality and health care. An Pediatr (Barc) 2023; 98:353-361. [PMID: 37055301 DOI: 10.1016/j.anpede.2022.12.005] [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: 10/09/2022] [Accepted: 12/29/2022] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION Socioeconomic inequality (SEI) can adversely affect asthma control. The aim of this study was to establish the association of SEI with asthma control in children and caregiver quality of life. METHODS We assessed socioeconomic status based on the area of residence, according to the at risk of poverty rate (ARPR). After stratifying the paediatric population of Castilla y León (Spain) in ARPR tertiles, we selected participants by stratified random sampling, and identified children with asthma aged 6-14 years from the health records of primary care centres. We collected data through questionnaires completed by parents. The primary outcomes were asthma control and caregiver quality of life. We assessed their association with SEI, health care quality measures and individual factors (such as parental educational attainment) by means of multivariate regression models. RESULT The ARPR tertile was not associated with asthma control, quality of life or health care quality. A medium or high maternal educational attainment was associated with a lower risk of making an unscheduled or urgent visit (OR = .50; 95% CI, .27-.95; P = .034) and paternal educational attainment was associated with a lower risk of uncontrolled asthma (OR = 0.51; 95% CI, .28-.94; P = .030). CONCLUSION In the sample under study, SEI assessed at the local level was not associated with asthma control in children. Other factors, such as parental educational attainment, may have a protective effect.
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Affiliation(s)
- Miguel Antoñón
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | - Teresa Cancho-Soto
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Inés Segovia-Molina
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Nuria Díez-Monge
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain; Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Alfredo Cano
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain; Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain.
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Nakano K, Kuraoka S, Oda M, Ohba T, Mitsubuchi H, Nakamura K, Katoh T. Relationship between the Mediterranean Diet Score in Pregnancy and the Incidence of Asthma at 4 Years of Age: The Japan Environment and Children's Study. Nutrients 2023; 15:nu15071772. [PMID: 37049612 PMCID: PMC10096633 DOI: 10.3390/nu15071772] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
Several scoring methods for the Mediterranean diet, which is considered as a healthy diet, are available, but studies that have compared more than one of these scores are rare. In addition, the applicability of Mediterranean diet scoring has not been sufficiently examined outside of Mediterranean regions. We collected data on the Mediterranean diet during pregnancy and the incidence of type 1 allergies in offspring from the Japan Environment and Children's Study. Using multiple Mediterranean diet scoring methods, we analyzed the effect of adherence to the Mediterranean diet in pregnancy on the allergies of the offspring. Overall, 46,532 pairs of mothers and children were analyzed. In Japan, a high adherence to the Mediterranean diet during pregnancy was associated with a lower incidence of asthma in the offspring (odds ratio: 0.896, 95% confidence interval: 0.835, 0.962). Furthermore, we found that the selection of the Mediterranean diet scoring method and the setting of the reference value significantly altered the results. Our findings suggest that an appropriate selection of scoring methods and a reference value for food items are important to analyze the effects of adherence to the Mediterranean diet inside and outside of Mediterranean regions.
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Affiliation(s)
- Kaita Nakano
- The South Kyushu Okinawa Unit Center, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Shohei Kuraoka
- The South Kyushu Okinawa Unit Center, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Masako Oda
- The South Kyushu Okinawa Unit Center, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Takashi Ohba
- The South Kyushu Okinawa Unit Center, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
- Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Hiroshi Mitsubuchi
- The South Kyushu Okinawa Unit Center, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
- Department of Neonatology, Kumamoto University Hospital, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Kimitoshi Nakamura
- The South Kyushu Okinawa Unit Center, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
- Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Takahiko Katoh
- The South Kyushu Okinawa Unit Center, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
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Sferra SR, Salvi PS, Penikis AB, Weller JH, Canner JK, Guo M, Engwall-Gill AJ, Rhee DS, Collaco JM, Keiser AM, Solomon DG, Kunisaki SM. Racial and Ethnic Disparities in Outcomes Among Newborns with Congenital Diaphragmatic Hernia. JAMA Netw Open 2023; 6:e2310800. [PMID: 37115544 PMCID: PMC10148194 DOI: 10.1001/jamanetworkopen.2023.10800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/02/2023] [Indexed: 04/29/2023] Open
Abstract
Importance There is some data to suggest that racial and ethnic minority infants with congenital diaphragmatic hernia (CDH) have poorer clinical outcomes. Objective To determine what patient- and institutional-level factors are associated with racial and ethnic differences in CDH mortality. Design, Setting, and Participants Multicenter cohort study of 49 US children's hospitals using the Pediatric Health Information System database from January 1, 2015, to December 31, 2020. Participants were patients with CDH admitted on day of life 0 who underwent surgical repair. Patient race and ethnicity were guardian-reported vs hospital assigned as Black, Hispanic (White or Black), or White. Data were analyzed from August 2021 to March 2022. Exposures Patient race and ethnicity: (1) White vs Black and (2) White vs Hispanic; and institutional-level diversity (as defined by the percentage of Black and Hispanic patients with CDH at each hospital): (1) 30% or less, (2) 31% to 40%, and (3) more than 40%. Main Outcomes and Measures The primary outcomes were in-hospital and 60-day mortality. The study hypothesized that hospitals managing a more racially and ethnically diverse population of patients with CDH would be associated with lower mortality among Black and Hispanic infants. Results Among 1565 infants, 188 (12%), 306 (20%), and 1071 (68%) were Black, Hispanic, and White, respectively. Compared with White infants, Black infants had significantly lower gestational ages (mean [SD], White: 37.6 [2] weeks vs Black: 36.6 [3] weeks; difference, 1 week; 95% CI for difference, 0.6-1.4; P < .001), lower birthweights (White: 3.0 [1.0] kg vs Black: 2.7 [1.0] kg; difference, 0.3 kg; 95% CI for difference, 0.2-0.4; P < .001), and higher extracorporeal life support use (White: 316 patients [30%] vs Black: 69 patients [37%]; χ21 = 3.9; P = .05). Black infants had higher 60-day (White: 99 patients [9%] vs Black: 29 patients [15%]; χ21 = 6.7; P = .01) and in-hospital (White: 133 patients [12%] vs Black: 40 patients [21%]; χ21 = 10.6; P = .001) mortality . There were no mortality differences in Hispanic patients compared with White patients. On regression analyses, institutional diversity of 31% to 40% in Black patients (hazard ratio [HR], 0.17; 95% CI, 0.04-0.78; P = .02) and diversity greater than 40% in Hispanic patients (HR, 0.37; 95% CI, 0.15-0.89; P = .03) were associated with lower mortality without altering outcomes in White patients. Conclusions and Relevance In this cohort study of 1565 who underwent surgical repair patients with CDH, Black infants had higher 60-day and in-hospital mortality after adjusting for disease severity. Hospitals treating a more racially and ethnically diverse patient population were associated with lower mortality in Black and Hispanic patients.
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Affiliation(s)
- Shelby R. Sferra
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pooja S. Salvi
- Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Annalise B. Penikis
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennine H. Weller
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph K. Canner
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Matthew Guo
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Abigail J. Engwall-Gill
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel S. Rhee
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph M. Collaco
- Division of Pediatric Pulmonology, Department of Pediatrics, Johns Hopkins Children’s Center, Baltimore, Maryland
| | - Amaris M. Keiser
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Johns Hopkins Children’s Center, Baltimore, Maryland
| | - Daniel G. Solomon
- Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Shaun M. Kunisaki
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Luke MJ, Vasan A. Understanding and Addressing Racial and Ethnic Inequities in Pediatric Length of Stay. Hosp Pediatr 2023; 13:e92-e94. [PMID: 36911918 PMCID: PMC10087104 DOI: 10.1542/hpeds.2023-007146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Affiliation(s)
- Michael J Luke
- PolicyLab and Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aditi Vasan
- PolicyLab and Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Sara ŻS, Joanna J, Daniela P, Kinga P, Agnieszka B. The Effect of Environmental Factors on Immunological Pathways of Asthma in Children of the Polish Mother and Child Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4774. [PMID: 36981683 PMCID: PMC10049367 DOI: 10.3390/ijerph20064774] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
The FOXP3 transcription factor is a marker of regulatory T cells (Tregs), and is essential in the process of their activation and proper expression by promoting immune homeostasis. To assess the influence of the environment on the development of asthma, we hypothesized that in our cohort, exposure to environmental factors is associated with asthma risk in children, and that FOXP3 levels vary with their incidence and are negatively correlated with developing asthma. This prospective study conducted in Poland uses a cohort of 85 children (42 with and 43 without asthma diagnosis) aged 9 to 12 years recruited for the Polish Mother and Child Cohort Study. We collected questionnaires and organized visits to assess patients' clinical condition (skin prick tests, lung function assessments). Blood samples were taken to determine immune parameters. Breastfed children had lower risk of asthma. Asthma risk was higher in children who live in the city, with antibiotic course before the age of 2 and antibiotic therapy more than twice a year. Environmental factors were associated with childhood asthma. Breastfeeding, the coexistence of other allergic diseases, and the frequency of housekeeping affect FOXP3 levels, which are negatively correlated with the risk of asthma.
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Affiliation(s)
- Żywiołowska-Smuga Sara
- Department of Pediatrics and Allergy, Copernicus Memorial Hospital, Medical University of Lodz, Pabianicka Street 62, 93-513 Lodz, Poland
| | - Jerzyńska Joanna
- Department of Pediatrics and Allergy, Copernicus Memorial Hospital, Medical University of Lodz, Pabianicka Street 62, 93-513 Lodz, Poland
| | - Podlecka Daniela
- Department of Pediatrics and Allergy, Copernicus Memorial Hospital, Medical University of Lodz, Pabianicka Street 62, 93-513 Lodz, Poland
| | - Polańska Kinga
- Department of Pediatrics and Allergy, Copernicus Memorial Hospital, Medical University of Lodz, Pabianicka Street 62, 93-513 Lodz, Poland
- Department of Environmental and Occupational Health Hazards, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland
| | - Brzozowska Agnieszka
- Department of Pediatrics and Allergy, Copernicus Memorial Hospital, Medical University of Lodz, Pabianicka Street 62, 93-513 Lodz, Poland
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Lohr KD, Everhart RS, Greenlee JL, Winter MA. Caregiver Expressed Emotion and Pediatric Asthma: A Call for Culturally Specific Adaptations. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2023; 36:1-4. [PMID: 36577054 PMCID: PMC10024584 DOI: 10.1089/ped.2022.0156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/26/2022] [Indexed: 12/29/2022]
Abstract
Background: Expressed emotion is the affective attitudes and behaviors of an individual toward another. In this preliminary study, we described expressed emotion among caregivers of children with asthma living in low-income urban area and evaluated its association with child asthma control. Methods: Forty-one children (90.2% African American/Black) and their caregivers participated. Measures included the Childhood Asthma Control Test and the Five-Minute Speech Sample coded for overall expressed emotion, emotional over-involvement, and criticism. Results: Most caregivers were rated borderline (31.7%) or high (48.8%) for expressed emotion, borderline (31.7%) or high (39.0%) for emotional overinvolvement, and low for criticism (73.2%). The association between criticism and asthma control neared statistical significance [U(Nlow = 30, NB/high = 11) = 100, z = -1.922, P = 0.055]. Conclusion: Findings suggest an examination into expressed emotion coding procedures for caregivers in low-income urban areas, and culturally specific adaptations may be necessary. Future research should confirm findings in a larger sample and consider how parental criticism affects children's asthma management.
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Affiliation(s)
- Katherine D. Lohr
- Psychology Department, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Robin S. Everhart
- Psychology Department, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Marcia A. Winter
- Psychology Department, Virginia Commonwealth University, Richmond, Virginia, USA
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Mainardi AS, Harris D, Rosenthal A, Redlich CA, Hu B, Fenick AM. Reducing asthma exacerbations in vulnerable children through a medical-legal partnership. J Asthma 2023; 60:262-269. [PMID: 35188437 DOI: 10.1080/02770903.2022.2045307] [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: 10/19/2022]
Abstract
BACKGROUND Asthma health disparities are widely recognized, with worse outcomes in children from low income families. In a Medical-Legal Partnership (MLP), an attorney is embedded in a healthcare setting to address social determinants of health. We studied whether an MLP could impact asthma exacerbation rates in a vulnerable urban population at an academic children's hospital. METHODS The study population comprised children with asthma who were referred to the MLP between 2013 and 2017. We compared healthcare utilization for asthma exacerbations managed in primary care, emergency department and inpatient settings in the year before and year after MLP intervention. RESULTS 98 children with asthma were included in the study. The mean total encounters per person per year decreased from 1.16 to 0.66 (relative reduction 44.2%, p < 0.01). The largest effect was on hospitalizations, with a reduction from 0.33 to 0.10 hospitalizations per patient per year (relative reduction 69.7%, p < 0.01). Encounters for asthma exacerbations in the primary care office and emergency department also decreased but these changes did not meet statistical significance. CONCLUSION In a pediatric population with asthma, an MLP intervention was associated with a significant reduction in asthma exacerbation encounters and hospitalizations comparing the year before and after MLP intervention. Further studies are needed to better understand which interventions are most effective, and for which patient groups MLP referral would be particularly useful. MLPs may be an important way to reduce health disparities in patients with asthma and other chronic illnesses.
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Affiliation(s)
- Anne S Mainardi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of MedicineNew Haven, CT
| | - Drew Harris
- Division of Pulmonary and Critical Care, University of Virginia School of Medicine, Charlottesville, VR
| | - Alice Rosenthal
- Center for Children's Advocacy at Yale, New Haven Hospital, New Haven, CT
| | - Carrie A Redlich
- Occupational and Environmental Medicine Program, Yale University School of MedicineNew HavenCT
| | - Buqu Hu
- Division of Pulmonary and Critical Care, Yale University School of Medicine, New Haven, CT
| | - Ada M Fenick
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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Findley PA, Wiener RC, Mitra S, Wang H, Shen C, Sambamoorthi U. Whole Health in Parts: Omissions from National Data Sets. Popul Health Manag 2023; 26:22-28. [PMID: 36799933 PMCID: PMC10081708 DOI: 10.1089/pop.2022.0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Background: The Whole Health model is a holistic approach to facilitate whole health practices by addressing (1) the physical, mental, and social health of individuals and (2) associated support systems. Several national organizations such as the Institute for Healthcare Improvement's (IHI) Age-Friendly Health Systems (AFHS) movement and, the U.S. Department of Veterans Affairs have implemented whole health frameworks with many common elements and promoted whole health practice and skills. However, implementing a Whole Health model across communities and health systems will require evidence of effectiveness. Generating evidence on the effectiveness of the Whole Health model's effect on health outcomes requires data-driven intelligence. Methods: We identified the national public-use data sets that are most often used in health research with a machine-assisted literature search of PubMed and Scopus for peer-reviewed journal articles published from 2010 through the end of 2021, including preprints, using Python [3.7]. We then assessed if the 8 most commonly used datasets include variables associated with whole health. Results: The number of publications examining whole health has increased annually in the last decade, with more than 2800 publications in 2020 alone. Since 2010, 24,811 articles have been published using 1 of these data sets. However, we also found a lack of data (ie, data set includes all of the whole health variables) to examine whole health in national data sets. Conclusions: We support a call to expand data collection and standardization of critical measures of whole health.
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Affiliation(s)
| | - R. Constance Wiener
- Department of Dental Public Health and Professional Practice, West Virginia University, Morgantown, West Virginia, USA
| | - Sophie Mitra
- Department of Economics, Research Consortium on Disability, Fordham University, Bronx, New York, USA
| | - Hao Wang
- Department of Emergency Medicine, JPS Health Network, Integrative Emergency Services, Fort Worth, Texas, USA
| | - Chan Shen
- Department of Surgery, Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, “Vashisht” Professor for Health Disparities, HEARD Scholar, Texas Center for Health Disparities, University of North Texas Health Science Center, Fort Worth, Texas, USA
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Lucas JA, Kaufmann J, Jones M, Garg A, Ezekiel-Herrera D, Puro J, Marino M, Heintzman J. Role of ethnicity/language in documented rates of pediatric asthma prescription refills. J Asthma 2023; 60:360-367. [PMID: 35259312 PMCID: PMC9485292 DOI: 10.1080/02770903.2022.2051545] [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: 10/18/2022]
Abstract
OBJECTIVE Medication maintenance is critical in the management of asthma. We investigated the differences in electronic health record (EHR) documentation of medication refills for Spanish- and English-speaking Latino children and non-Hispanic white children by examining rates of albuterol rescue inhaler refills from 2005 to 2017, and and inhaled corticosteroid refills from 2015 to 2017 in a multi-state network of community health centers (CHCs). METHODS We used data from the ADVANCE network of CHCs. Our sample consisted of children aged 3-17, with a diagnosis of asthma and either albuterol or inhaled corticosteroid prescriptions (n = 39,162; n = 4,738 children, respectively). Negative binomial regression was used to calculate rates of refills per prescription adjusted for relevant patient-level covariates. Analyses stratified by asthma severity were also conducted. RESULTS English-speaking Latino children had lower rates of albuterol refills compared with non-Hispanic white children (rate ratio [RR] = 0.88, 95% confidence interval [CI]: 0.80-0.98), a trend that persisted among children with moderate/severe persistent asthma severity (RR = 0.85, 95% CI: 0.76-0.95). Spanish-speaking Latino and non-Hispanic white children had similar albuterol refills. Inhaled corticosteroid refill rates were comparable between all groups. CONCLUSIONS In a multi-state network, these findings suggest that CHCs deliver equitable asthma care related to prescription refills between their Latino and white patients, but there is still opportunity for providers to ensure that their English-speaking Latino patients have access to necessary emergency asthma medication.
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Affiliation(s)
- Jennifer A. Lucas
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Jorge Kaufmann
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | - David Ezekiel-Herrera
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA;,Division of Biostatistics, School of Public Health, Oregon Health & Science University—Portland State University, Portland, OR, USA
| | - John Heintzman
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA;,OCHIN, Inc, Portland, OR, USA
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Control del asma en niños, desigualdad socioeconómica y asistencia sanitaria. An Pediatr (Barc) 2023. [DOI: 10.1016/j.anpedi.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Nanda A, Siles R, Park H, Louisias M, Ariue B, Castillo M, Anand MP, Nguyen AP, Jean T, Lopez M, Altisheh R, Pappalardo AA. Ensuring equitable access to guideline-based asthma care across the lifespan: Tips and future directions to the successful implementation of the new NAEPP 2020 guidelines, a Work Group Report of the AAAAI Asthma, Cough, Diagnosis, and Treatment Committee. J Allergy Clin Immunol 2023; 151:869-880. [PMID: 36720288 DOI: 10.1016/j.jaci.2023.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/08/2023] [Accepted: 01/19/2023] [Indexed: 01/29/2023]
Abstract
The most recent recommendations from the 2020 National Asthma Education and Prevention Program Update and Global Initiative for Asthma 2021 guide evidence-based clinical decision making. However, given the present state of health disparities by age, income, and race, the equitable implementation and dissemination of these guidelines will be unlikely without further guidance. This work group report reviews the current state of the new asthma guideline implementation; presents updated evidence-based therapeutic options with attention to specific patient populations; and addresses barriers to the implementation of these guidelines in minoritized, historically marginalized, and underresourced communities. Allergists and immunologists can use practical ways to accomplish the goals of improved asthma care access and advanced asthma care across the life span, with specific considerations to historically marginalized populations. Modifiable barriers to guideline implementation include financial barriers, environmental factors, and allergy subspecialty access and care coordination. Various programs to improve access to guideline-based asthma care include community programs, school-based asthma programs, and digital health solutions, with an emphasis on reducing disparities by race.
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Affiliation(s)
- Anil Nanda
- Asthma and Allergy Center, Lewisville-Flower Mound; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas
| | - Roxana Siles
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland
| | - Henna Park
- Department of Pediatrics, University of Illinois Hospital, Chicago
| | - Margee Louisias
- Department of Medicine, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Cleveland; Department of Immunology, Boston Children's Hospital, Boston; Harvard Medical School, Boston
| | - Barbara Ariue
- Department of Pediatrics, Division of Allergy/Immunology, Loma Linda Children's Hospital, Loma Linda
| | - Maria Castillo
- Department of Medical Education at Driscoll Children's Hospital, Corpus Christi
| | - Mahesh Padukudru Anand
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore
| | - Anh P Nguyen
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, School of Medicine, University of California Davis, Sacramento
| | - Tiffany Jean
- Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange
| | - Michael Lopez
- Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange
| | - Roula Altisheh
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland
| | - Andrea A Pappalardo
- Department of Pediatrics, Department of Medicine, University of Illinois at Chicago, Chicago
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Brown ES, Palka JM, Lehman HK, Kulikova A, Khan DA, Lopez J, Antony A, Persaud D, Tiro J, Ivleva EI, Nakamura A, Patel Z, Holmes T, Humayun Q, Lloyd T, Allen K, Kaur S, Owitz MS, Pak RJ, Zablonski KG, Adragna MS, Chankalal R, Wood BL, Miller BD. The Impact of Caregiver Depression on Child Asthma Outcomes: Pathways and Mechanisms. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:200-209. [PMID: 36610757 DOI: 10.1016/j.jaip.2022.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/02/2022] [Accepted: 09/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Depression is common in caregivers of children with asthma and is associated with poor outcomes in their child. No prior studies have longitudinally examined caregiver depression remission as a predictor of improvement in child asthma control. OBJECTIVE This 2-site study examined whether the proportion of time a caregiver was in depression remission predicted subsequent child asthma control at exit. METHOD Caregivers (n = 205) with current major depressive disorder and their children, ages 7 to 17, with persistent asthma were observed every 4 weeks for 52 weeks. Caregiver depressive symptoms were measured using the 17-item Hamilton Rating Scale for Depression (HRSD). Child asthma was assessed with the (Childhood) Asthma Control Test (cACT/ACT) and spirometry, and depression with the Children's Depression Inventory (CDI). Linear regression analyses were conducted with change in cACT/ACT, CDI, and forced expiratory volume in 1 second (FEV1)% predicted as outcomes and proportion of time the caregiver was in remission (HRSD score ≤ 7) as the predictor. Multilevel mediation analyses examined the role of child depressive symptoms and asthma controller medication adherence. RESULTS Children were, on average, 54.1% female and 11 years old. Caregiver proportion of time in HRSD-assessed remission of depression was a significant predictor of improvement in cACT/ACT, CDI, and FEV1% predicted. Child CDI score, but not medication adherence, mediated the relationship between caregiver HRSD scores and child asthma control scores. CONCLUSIONS Improvement in caregiver depression positively influences child asthma outcomes partially through improvement in child depressive symptom severity. Caregiver depression screening and treatment might lead to improvement in child asthma outcomes.
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Affiliation(s)
- E Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Jayme M Palka
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Heather K Lehman
- Department of Allergy and Immunology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Alexandra Kulikova
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - David A Khan
- Division of Allergy & Immunology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Josseline Lopez
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anna Antony
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Jasmine Tiro
- Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Elena I Ivleva
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alyson Nakamura
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Zena Patel
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Traci Holmes
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Quratulain Humayun
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Tressa Lloyd
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Karen Allen
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Savitoj Kaur
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - M Seth Owitz
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Ray J Pak
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Kevin G Zablonski
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Michael S Adragna
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Raymond Chankalal
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Beatrice L Wood
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
| | - Bruce D Miller
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY
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Asthma Management in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:9-18. [PMID: 36334702 DOI: 10.1016/j.jaip.2022.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/05/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
Asthma is a common, complex heterogeneous disease often beginning in early life and is characterized by reversible airflow obstruction. The phenotypic differences that exist in children with asthma may impact underlying comorbid conditions and pharmacologic treatment choices. Prenatal factors for increased risk of asthma could include maternal diet and the maternal microbiome. Evidence also suggests that postnatal microbial exposures and colonization contribute to the risk of allergic diseases and asthma. After confirming the diagnosis, asthma management in children centers on 3 broad areas: pharmacologic treatment, treatment of underlying comorbidities, and education of the patient and caregivers on the importance of adherence and device technique. Moreover, social determinants of health significantly impact on symptom burden and treatment response.
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Busse WW, Castro M, Casale TB. Asthma Management in Adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:21-33. [PMID: 36283607 DOI: 10.1016/j.jaip.2022.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/14/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
Management of asthma in adults has advanced in the past 10 years. Central to these advances has been further clarification of type (T) 2 mechanisms of airway inflammation and utilization of T2 biomarkers, that is, eosinophils and fractional exhaled nitric oxide. In addition, epithelial cells are emerging as significant contributors to inflammation through generation of alarmins to initiate local injury as well as downstream pathways. Five new biologics, mepolizumab, benralizumab, reslizumab, dupilumab, and tezepelumab, were approved to join omalizumab and revolutionize severe asthma treatment. These biologics significantly prevent exacerbations to spare systemic corticosteroids use and their side effects. Guidelines attest to the effectiveness of inhaled corticosteroids/long-acting β-agonists (formoterol) for both maintenance and rescue therapy. Focused updates to the Expert Panel Report addressed limited but specific questions relevant to asthma control. Future guidelines should include phenotype/endotype-directed therapeutics to gain more precision-directed treatment.
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Affiliation(s)
- William W Busse
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas, Kansas City, Kan
| | - Thomas B Casale
- Division of Allergy and Immunology, University of South Florida, Tampa, Fla
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Ray A, Das J, Wenzel SE. Determining asthma endotypes and outcomes: Complementing existing clinical practice with modern machine learning. Cell Rep Med 2022; 3:100857. [PMID: 36543110 PMCID: PMC9798025 DOI: 10.1016/j.xcrm.2022.100857] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/24/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
There is unprecedented opportunity to use machine learning to integrate high-dimensional molecular data with clinical characteristics to accurately diagnose and manage disease. Asthma is a complex and heterogeneous disease and cannot be solely explained by an aberrant type 2 (T2) immune response. Available and emerging multi-omics datasets of asthma show dysregulation of different biological pathways including those linked to T2 mechanisms. While T2-directed biologics have been life changing for many patients, they have not proven effective for many others despite similar biomarker profiles. Thus, there is a great need to close this gap to understand asthma heterogeneity, which can be achieved by harnessing and integrating the rich multi-omics asthma datasets and the corresponding clinical data. This article presents a compendium of machine learning approaches that can be utilized to bridge the gap between predictive biomarkers and actual causal signatures that are validated in clinical trials to ultimately establish true asthma endotypes.
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Affiliation(s)
- Anuradha Ray
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, MUH 628 NW, Pittsburgh, PA 15213, USA; Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Jishnu Das
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Center for Systems Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sally E Wenzel
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, MUH 628 NW, Pittsburgh, PA 15213, USA; Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Environmental Medicine and Occupational Health, School of Public Health, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Pappalardo AA, Martin MA, Weinstein S, Pugach O, Mosnaim GS. Improving Adherence in Urban Youth With Asthma: Role of Community Health Workers. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3186-3193. [PMID: 36058514 PMCID: PMC10091238 DOI: 10.1016/j.jaip.2022.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The Asthma Action at Erie Trial is a comparative effectiveness trial comparing a community health worker (CHW) versus certified asthma educator (AE-C) intervention in low-income minority children. OBJECTIVES Determine whether asthma medication possession, adherence, technique, and triggers differ in children receiving an asthma CHW compared with an AE-C intervention. METHODS Children with uncontrolled asthma were randomized to receive 10 CHW home visits or 2 AE-C sessions in a clinic over 1 year. Asthma medication possession and inhaler technique were observed; adherence was measured using self-report, dose counters, and electronic monitors. Environmental triggers were captured by self-report, observation, and objective measurement. Mixed effects linear and logistic regression models were estimated for continuous and binary outcomes. RESULTS Children (n = 223) were mainly Hispanic (85%) and ages 5 to 16 years. Quick-relievers (82%), spacers (72%), and inhaled corticosteroid (ICS)-containing medications (44%) were tracked. Of those with uncontrolled asthma, 35% lacked an ICS prescription (n = 201). Children in the CHW arm were more likely to have an ICS prescription at 12 months (odds ratio 2.39; 95% CI 0.99-5.79). Inhaler technique improved 9.8% in the CHW arm at 6 months (95% CI 4.20-15.32). The ICS adherence improved in the CHW arm at 12 months, with a 16.0% (95% CI 2.3-29.7; P = .02) difference between arms. Differences in trigger exposure over time were not observed between arms. CONCLUSIONS The CHW services were associated with improved ICS adherence and inhaler technique, compared with AE-C services. More information is needed to determine the necessary dosage of intervention to sustain adherence.
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Affiliation(s)
- Andrea A Pappalardo
- Department of Medicine and Pediatrics, University of Illinois at Chicago of Medicine, Chicago, Ill.
| | - Molly A Martin
- Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, Ill
| | - Sally Weinstein
- Department of Psychiatry, University of Illinois at Chicago College of Medicine, Chicago, Ill
| | - Oksana Pugach
- Department of Biostatistics, Corevitas, LLC, Waltham, Mass
| | - Giselle S Mosnaim
- Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Evanston, Ill
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Marra M, Strippoli E, Zengarini N, Costa G. Inequalities in the Health Impact of the First Wave of the COVID-19 Pandemic in Piedmont Region, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14791. [PMID: 36429508 PMCID: PMC9690941 DOI: 10.3390/ijerph192214791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
(1) Introduction: Several studies observe a social gradient in the incidence and health consequences of SARS-CoV-2 infection, but they rely mainly on spatial associations because individual-level data are lacking. (2) Objectives: To assess the impact of social inequalities in the health outcomes of COVID-19 during the first epidemic wave in Piedmont Region, Italy, evaluating the role of the unequal social distribution of comorbidities and the capacity of the healthcare system to promote equity. (3) Methods: Subjects aged over 35, resident in Piedmont on 22 February 2020, were followed up until 30 May 2020 for access to swabs, infection, hospitalization, admission to intensive care unit, in-hospital death, COVID-19, and all-cause death. Inequalities were assessed through an Index of Socioeconomic Disadvantage composed of information on education, overcrowding, housing conditions, and neighborhood deprivation. Relative incidence measures and Relative Index of Inequality were estimated through Poisson regression models, stratifying by gender and age groups (35-64 years; ≥65 years), adjusting for comorbidity. (4) Results: Social inequalities were found in the various outcomes, in the female population, and among elderly males. Inequalities in ICU were lower, but analyses only on in-patients discount the hypothesis of preferential access by the most advantaged. Comorbidities contribute to no more than 30% of inequalities. (5) Conclusions: Despite the presence of significant inequities, the pandemic does not appear to have further exacerbated health inequalities, partly due to the fairness of the healthcare system. It is necessary to reduce inequalities in the occurrence of comorbidities that confer susceptibility to COVID-19 and promote prevention policies that limit inequalities in the mechanisms of contagion and improve out-of-hospital timely treatment.
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Affiliation(s)
- Michele Marra
- Epidemiology Department, Local Health Unit TO3, 10095 Grugliasco, Italy
| | - Elena Strippoli
- Epidemiology Department, Local Health Unit TO3, 10095 Grugliasco, Italy
| | - Nicolás Zengarini
- Epidemiology Department, Local Health Unit TO3, 10095 Grugliasco, Italy
| | - Giuseppe Costa
- Epidemiology Department, Local Health Unit TO3, 10095 Grugliasco, Italy
- Department of Clinical and Biological Sciences, University of Turin, 10126 Torino, Italy
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Cushing AM, Khan MA, Kysh L, Brakefield WS, Ammar N, Liberman DB, Wilson J, Shaban-Nejad A, Espinoza J. Geospatial data in pediatric asthma in the United States: a scoping review protocol. JBI Evid Synth 2022; 20:2790-2798. [PMID: 36081367 PMCID: PMC9669090 DOI: 10.11124/jbies-21-00284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this scoping review is to identify and describe the literature on the use of geospatial data in pediatric asthma research. INTRODUCTION Asthma is one of the most common pediatric chronic diseases in the United States, disproportionately affecting low-income patients. Asthma exacerbations may be triggered by local environmental factors, such as air pollution or exposure to indoor allergens. Geographic information systems are increasingly recognized as tools that use geospatial data to enhance understanding of the link between environmental exposure, social determinants of health, and clinical outcomes. Geospatial data in pediatric asthma may help inform risk factors for asthma severity, and guide targeted clinical and social interventions. INCLUSION CRITERIA This review will consider studies that utilize geospatial data in the evaluation of pediatric patients with asthma, ages 2 to 18 years, in the United States. Mixed samples of adults and children will also be considered. Geospatial data will include any external non-clinical geographic-based data source that uses a patient's environment or context. METHODS The following databases will be searched: PubMed, Embase, Cochrane CENTRAL, CINAHL, ERIC, Web of Science, and IEEE. Gray literature will be searched in DBLP, the US Environmental Protection Agency, Google Scholar, Google search, and a hand search of recent abstracts from relevant conferences. Articles published in English, Spanish, and French from 2010 to the present will be included. Study screening and selection will be performed independently by 2 reviewers. Data extraction will be performed by a trained research team member following pilot testing.
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Affiliation(s)
- Anna M. Cushing
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Masrur A. Khan
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Lynn Kysh
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Whitney S. Brakefield
- Bredesen Center for Data Science and Engineering, University of Tennessee, Knoxville, TN, United States
- Oak Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Nariman Ammar
- Oak Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Danica B. Liberman
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - John Wilson
- Spatial Sciences Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, United States
| | - Arash Shaban-Nejad
- Oak Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Juan Espinoza
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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49
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Justvig SP, Haynes L, Karpowicz K, Unsworth F, Petrosino S, Peltz A, Jones BL, Hickingbotham M, Cox J, Wu AC, Holder-Niles FF. The Role of Social Determinants of Health in the Use of Telemedicine for Asthma in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2543-2549. [PMID: 35863670 DOI: 10.1016/j.jaip.2022.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
Asthma is the most common chronic health condition among children in the United States. The adverse impacts of social determinants of health often manifest in unmet health-related social needs, potentially contributing to worse asthma outcomes. With the onset and rapid spread of coronavirus disease 2019 (COVID-19) and the identification of asthma as a potential risk factor for more severe disease, our asthma program quickly pivoted to a remote-access telemedicine asthma population management platform to best meet the needs of our most at-risk patients. Our practice provides care to a large proportion of Black and Latino/a/e children in urban areas insured by the State Medicaid Program and impacted by unmet social needs. As we pivoted to telemedicine, we consistently reached a greater number of patients and families than prepandemic and observed decreased emergency department visits and hospitalizations. About 1 in 5 families received resource touch points spanning categories of transportation, food and supplies, clothing, utilities, and rent. Overall, families reported positive experiences with telemedicine, including the ability to connect remotely with our social work and resource teams. Telemedicine may be an effective strategy for addressing both the medical and the social needs of children with asthma at risk for worse outcomes.
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Affiliation(s)
- Sarah P Justvig
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass
| | - Linda Haynes
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass
| | - Kristin Karpowicz
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass
| | - Fiona Unsworth
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass
| | - Sheila Petrosino
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass
| | - Alon Peltz
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Bridgette L Jones
- Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Mo
| | - Madison Hickingbotham
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Joanne Cox
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass
| | - Ann Chen Wu
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass.
| | - Faye F Holder-Niles
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass.
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50
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Pappalardo AA, Wang T, Martin MA. CHECK: Multi-level Real-World Pediatric Asthma Care Coordination: Results and Lessons Learned. J Asthma 2022; 60:1061-1071. [PMID: 36151882 DOI: 10.1080/02770903.2022.2129063] [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: 10/17/2022]
Abstract
OBJECTIVE Because asthma health disparities in children remain common, innovative approaches to obtain asthma health equity are essential. Comprehensive care coordination programs may address the social determinants of health that influence these disparities. This analysis aims to ascertain if receipt of Coordination of Healthcare for Complex Kids (CHECK) program services was associated with changes in school absence, cost, healthcare utilization, and controller prescription in children with asthma. METHODS The CHECK program ran from December 1st, 2014 through August 31st, 2017. Engagement with Community Health Workers (CHW) was rolling and targeted based on risk level (low, medium or high determined by healthcare utilization). This analysis included school-aged children with asthma (n = 2,629) and sufficient Chicago Public Schools attendance data (n = 430). RESULTS Children engaged in CHECK were more likely to be female (p = 0.046) and to identify as Black and/or Hispanic/Latino than enrolled-only children. School absence was not different between the groups. Average total cost for engaged children was 21.3% more than enrolled-only children the first year (p = 0.027) but did not differ by the second year (p = 0.948). At baseline, 68.1% of the cohort had at least one ED visit 12-months prior to CHECK, this reduced to 49.5% post-1 and 41.9% post-2. Engaged children were 21% more likely to visit an ED (p = 0.010) and 40% more likely to have a controller. CONCLUSIONS CHECK program receipt was associated with reduced costs and improved healthcare utilization, and controller prescriptions. School attendance did not change. The CHECK model offers potential pathways to support low-income children with asthma.
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Affiliation(s)
- A A Pappalardo
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL.,Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - T Wang
- Institute of Research and Health Policy, University of Illinois at Chicago, Chicago, IL
| | - M A Martin
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL.,Institute of Research and Health Policy, University of Illinois at Chicago, Chicago, IL
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