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Wunderlich W, Schulte A, Schleiss MR, Vacquier M, Sidebottom A. Disparities in Congenital Cytomegalovirus (cCMV) Postpartum Newborn Screening Research Participation. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02123-9. [PMID: 39138801 DOI: 10.1007/s40615-024-02123-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/22/2024] [Accepted: 08/02/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE The objective of this study is to evaluate if racial and other demographic disparities exist between patients who enrolled or declined participation in a congenital cytomegalovirus (cCMV) newborn universal screening research study. METHODS We examined characteristics for patients approached over a 2-year period to participate in a cCMV newborn screening study. Maternal characteristics included age, race, ethnicity, preferred language, interpreter need, insurance type, and number of living children. Recruitment period was also examined (pre-pandemic January 1 to December 31, 2019, and during COVID-19 July 1, 2021 to June 30, 2022). Characteristics were compared for patients who enrolled in the study and those who declined participation using descriptive statistics and logistic regression. RESULTS Of the study sample (n = 4156), 3148 (75.7%) patients enrolled and 1008 (24.3%) declined. Declined participation rates were 47.2% among non-Hispanic (NH) Black patients and 15.7% among NH White patients. In the final adjusted model, NH Black patients (OR 3.14, 95% CI 2.53-3.90), those with public insurance (OR 1.81, 95% CI 1.48-2.22), and those with four or more children (OR for 4 + children 1.45, 95% CI 1.11-1.90) were the most likely to decline research participation. CONCLUSIONS NH Black and NH multiracial patients were among the most likely patient groups to decline study participation. These groups have previously been identified to be at increased risk for cCMV. This differential participation in cCMV research could result in underreported estimates of prevalence. Future cCMV research, including surveillance studies, should include documentation of differential participation to both address efforts to improve research participation and document and address potential bias in results.
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Affiliation(s)
| | - Anna Schulte
- Allina Health, 800 E 28th Street, Minneapolis, MN, 55407, USA
| | - Mark R Schleiss
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Minnesota, 2001 6th Street SE, Minneapolis, MN, 55455, USA
| | - Marc Vacquier
- Allina Health, 800 E 28th Street, Minneapolis, MN, 55407, USA
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Chang TM, Chen Y, Yang KD, Wang JY, Lin CY, Chang YJ, Chen CH, Tsai YG. Asthma control associated with anxiety and depression in asthmatic children following post-acute COVID-19. Pediatr Allergy Immunol 2024; 35:e14168. [PMID: 38873913 DOI: 10.1111/pai.14168] [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: 02/27/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Poor asthma control may adversely affect mental health. Our study investigates the correlation between inadequate asthma control, exhaled nitric oxide (FENO) levels, and anxiety and depression among pediatric asthma patients with COVID-19. METHODS This prospective case-control study enrolled 520 asthmatic children (8-15 years), including 336 patients diagnosed with COVID-19 after rapid antigen testing at home and 184 age-matched asthmatic patients without COVID-19 infection. FENO and spirometry were performed 1 month after COVID-19 infection. Scores for Child Anxiety-Related Disorders (SCARED) and depression screen derived from Patient Health Questionnaire-9 (PHQ-9) to assess their mental health status. Childhood asthma control test (C-ACT), FENO levels, and spirometry were correlated with the SCARED and PHQ-9 questionnaires. RESULTS SCARED subscales, including generalized anxiety disorder, social anxiety disorder, school avoidance, and depression scores from PHQ-9, exhibited a significant increase in asthmatic patients diagnosed with COVID-19 (p < .05). Among asthmatic children with SARS-CoV-2 infection, the poor asthma control group exhibited the highest SCARED and PHQ-9 measurements (p < .01). Multiple linear regression analysis indicated that reduced C-ACT scores and elevated FENO levels in asthmatic children with COVID-19 were significant risk factors for both anxiety and depression scores (p < .05). Lower C-ACT scales were associated with high scores of SCARED (r = -0.471) and PHQ-9 (r = -0.329) in asthmatic children (p < .001). CONCLUSIONS The current study emphasizes the need for healthcare professionals to closely monitor asthma control in asthmatic children to prevent heightened risks of depression and anxiety during the ongoing COVID-19 pandemic.
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Affiliation(s)
- Tung-Ming Chang
- Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan
- Child Development Center, Changhua Christian Children's Hospital, Changhua, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yun Chen
- Child Development Center, Changhua Christian Children's Hospital, Changhua, Taiwan
| | - Kuender D Yang
- Department of Pediatrics, Mackay Memorial Hospital, New Taipei City, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jiu-Yao Wang
- Allergy, Immunology, and Microbiome (A.I.M.) Research Center, China Medical University, Taichung, Taiwan
- Department of Allergy, Immunology and Rheumatology, China Medical University Children's Hospital, Taichung, Taiwan
| | - Ching-Yuang Lin
- Department of Allergy, Immunology and Rheumatology, China Medical University Children's Hospital, Taichung, Taiwan
- Clinical Immunological Center, Division of Pediatric Nephrology, China Medical University Children's Hospital, Taichung, Taiwan
| | - Yu-Jun Chang
- Epidemiology and Biostatistics and Big Data Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Chang-Hua Chen
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Internal Medicine, Division of Infectious Diseases, Changhua Christian Hospital, Changhua, Taiwan
| | - Yi-Giien Tsai
- Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- School of Medicine, Kaohsiung Medical University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Kattih M, Lee H, Jo H, Jeong J, Kim H, Park J, Yang H, Nguyen A, Kim HJ, Lee H, Kim M, Lee M, Kwon R, Kim S, Koyanagi A, Kim MS, Rahmati M, López Sánchez GF, Dragioti E, Kim JH, Woo S, Cho SH, Smith L, Yon DK. National prevalence of atopic dermatitis in Korean adolescents from 2009 to 2022. Sci Rep 2024; 14:12391. [PMID: 38811655 PMCID: PMC11137070 DOI: 10.1038/s41598-024-62475-4] [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: 11/15/2023] [Accepted: 05/17/2024] [Indexed: 05/31/2024] Open
Abstract
Previous studies have examined the prevalence of allergic diseases in adolescents 1-2 years after the emergence of the COVID-19 pandemic. However, more data is needed to understand the long-term impact of COVID-19 on allergic diseases. Thus, we aimed to examine the trend of the atopic dermatitis prevalence in Korean adolescents before and during the COVID-19 pandemic across 14 years. Additionally, we analyze the risk factors of atopic dermatitis (AD) based on the results. The Korean Disease Control and Prevention Agency conducted the Korea Youth Risk Behavior Web-based Survey from 2009 to 2022, from which the data for this study were obtained. Prevalence trends were compared across subgroups, and the β difference (βdiff) was calculated. We computed odds ratios to examine changes in the disease prevalence before and during the pandemic. This study included a total of 917,461 participants from 2009 to 2022. The prevalence of atopic dermatitis increased from 6.79% (95% CI 6.66-6.91) in 2009-2011 to 6.89% (95% CI 6.72-7.05) in 2018-2019, then decreased slightly to 5.82% (95% CI 5.60-6.04) in 2022. Across the 14 years, middle school student status, low parent's highest education level, low household income, non-alcohol consumption, non-smoker smoking status, no suicidal thoughts, and no suicide attempts were associated with increased risk of atopic dermatitis, while female sex, rural residence, high BMI, low school performance, low household income, and no feelings of sadness and despair was associated with a small increase. This study examined the prevalence of atopic dermatitis across an 18-year, and found that the prevalence increased in the pre-pandemic then decreased during the start of the pandemic and remained constant throughout the pandemic. This trend could be explained mainly by the large scale social and political changes that occurred during the COVID-19 pandemic.
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Affiliation(s)
- Mafaz Kattih
- Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Hojae Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hyesu Jo
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Jinyoung Jeong
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyejun Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Applied Information Engineering, Yonsei University, Seoul, South Korea
| | - Jaeyu Park
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hwi Yang
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Ann Nguyen
- Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Hyeon Jin Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hyeri Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Minji Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Myeongcheol Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Rosie Kwon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Min Seo Kim
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Masoud Rahmati
- Health Service Research and Quality of Life Center (CEReSS), Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Guillermo F López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain
| | - Elena Dragioti
- Department of Medical and Health Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden
- Research Laboratory Psychology of Patients, Families, and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ju Hee Kim
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea
| | - Selin Woo
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Seong H Cho
- Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
- Division of Allergy and Immunology, Department of Internal Medicine, USF Morsani College of Medicine, Tampa, FL, USA.
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, CB1 1PT, UK.
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea.
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea.
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea.
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
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Smolinska S, Popescu FD, Izquierdo E, Antolín-Amérigo D, Price OJ, Alvarez-Perea A, Eguíluz Gracia I, Papadopoulos NG, Pfaar O, Fassio F, Hoffmann-Sommergruber K, Dramburg S, Agache I, Jutel M, Brough HA, Fonseca JA, Angier E, Boccabella C, Bonini M, Dunn Galvin A, Gibson PG, Gawlik R, Hannachi F, Kalayci Ö, Klimek L, Knibb R, Matricardi P, Chivato T. Telemedicine with special focus on allergic diseases and asthma-Status 2022: An EAACI position paper. Allergy 2024; 79:777-792. [PMID: 38041429 DOI: 10.1111/all.15964] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
Efficacious, effective and efficient communication between healthcare professionals (HCP) and patients is essential to achieve a successful therapeutic alliance. Telemedicine (TM) has been used for decades but during the COVID-19 pandemic its use has become widespread. This position paper aims to describe the terminology and most important forms of TM among HCP and patients and review the existing studies on the uses of TM for asthma and allergy. Besides, the advantages and risks of TM are discussed, concluding that TM application reduces costs and time for both, HCP and patients, but cannot completely replace face-to-face visits for physical examinations and certain tests that are critical in asthma and allergy. From an ethical point of view, it is important to identify those involved in the TM process, ensure confidentiality and use communication channels that fully guarantee the security of the information. Unmet needs and directions for the future regarding implementation, data protection, privacy regulations, methodology and efficacy are described.
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Affiliation(s)
- Sylwia Smolinska
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
| | - Florin-Dan Popescu
- Department of Allergology, Nicolae Malaxa Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Elena Izquierdo
- Department of Basic Medical Sciences, Facultad de Medicina, Institute of Applied Molecular Medicine Instituto de Medicina Molecular Aplicada Nemesio Díez (IMMA), Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Madrid, Spain
| | - Darío Antolín-Amérigo
- Servicio de Alergia, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Oliver J Price
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Alberto Alvarez-Perea
- Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Ibon Eguíluz Gracia
- Allergy Department, Hospital Regional Universitario de Malaga and Allergy Research Group, Instituto de Investigacion Biomedica de Malaga (IBIMA-Plataforma BIONAND). RICORS "Inflammatory Diseases", Malaga, Spain
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National Kapodistrian University of Athens, Athens, Greece
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | | | | | - Stephanie Dramburg
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Ioana Agache
- Allergy and Clinical Immunology at Transylvania University, Brasov, Romania
| | - Marek Jutel
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
- "ALL-MED" Medical Research Institute, Wroclaw, Poland
| | - Helen A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital, London, UK
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - João A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Elizabeth Angier
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Cristina Boccabella
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Bonini
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Clinical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | | | - Peter G Gibson
- John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Radoslaw Gawlik
- Department of Internal Medicine, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland
| | - Farah Hannachi
- Immuno-Allergology Unit, Hospital Centre of Luxembourg, Luxembourg City, Luxembourg
| | - Ömer Kalayci
- Hacettepe University School of Medicine, Ankara, Turkey
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Rebecca Knibb
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Paolo Matricardi
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Tomás Chivato
- Department of Clinical Medical Sciences, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Madrid, Spain
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Aggelidis X, Kritikou M, Makris M, Miligkos M, Papapostolou N, Papadopoulos NG, Xepapadaki P. Tele-Monitoring Applications in Respiratory Allergy. J Clin Med 2024; 13:898. [PMID: 38337592 PMCID: PMC10856055 DOI: 10.3390/jcm13030898] [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: 01/10/2024] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Respiratory allergic diseases affect over 500 million people globally and pose a substantial burden in terms of morbidity, mortality, and healthcare costs. Restrictive factors such as geographical disparities, infectious pandemics, limitations in resources, and shortages of allergy specialists in underserved areas impede effective management. Telemedicine encompasses real-time visits, store-and-forward option triage, and computer-based technologies for establishing efficient doctor-patient communication. Recent advances in digital technology, including designated applications, informative materials, digital examination devices, wearables, digital inhalers, and integrated platforms, facilitate personalized and evidence-based care delivery. The integration of telemonitoring in respiratory allergy care has shown beneficial effects on disease control, adherence, and quality of life. While the COVID-19 pandemic accelerated the adoption of telemedicine, certain concerns regarding technical requirements, platform quality, safety, reimbursement, and regulatory considerations remain unresolved. The integration of artificial intelligence (AI) in telemonitoring applications holds promise for data analysis, pattern recognition, and personalized treatment plans. Striking the balance between AI-enabled insights and human expertise is crucial for optimizing the benefits of telemonitoring. While telemonitoring exhibits potential for enhancing patient care and healthcare delivery, critical considerations have to be addressed in order to ensure the successful integration of telemonitoring into the healthcare landscape.
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Affiliation(s)
- Xenofon Aggelidis
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (X.A.); (M.M.); (N.P.)
| | - Maria Kritikou
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
| | - Michael Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (X.A.); (M.M.); (N.P.)
| | - Michael Miligkos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
| | - Niki Papapostolou
- Allergy Unit, 2nd Department of Dermatology and Venereology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece; (X.A.); (M.M.); (N.P.)
| | - Nikolaos G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, 15772 Athens, Greece; (M.M.); (N.G.P.); (P.X.)
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Özata MC, Dikici Ü, Özdemir Ö. COVID-19 frequency and clinical course in children with asthma. World J Virol 2023; 12:272-285. [PMID: 38187499 PMCID: PMC10768388 DOI: 10.5501/wjv.v12.i5.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/13/2023] [Accepted: 11/30/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND The epidemic of severe acute respiratory syndrome coronavirus 2 infection, known as the coronavirus disease 2019 (COVID-19), has caused a global health concern. Since its emergence, numerous studies have focused on various clinical manifestations and outcomes in different populations. However, studies are ongoing as the consequences and impact of COVID-19 in children with chronic diseases such as asthma are controversial. AIM To fill this research gap by retrospectively evaluating the course, laboratory, and clinical findings of COVID-19 among 414 asthmatic children followed up from the pediatric allergy outpatient clinic and known to have had COVID-19. METHODS The data of 5510 patients over the age of 5 diagnosed with asthma in our hospital's data were retrospectively scanned with specific parameters using protocol numbers from the hospital filing system. The data included retrospective evaluation of pulmonary function test results before and after COVID-19, routine hematological and biochemical parameters, sensitization states (total IgE, specific IgE, and skin prick test results), and radiological (computed tomography) findings. To inquire about the course and symptoms of COVID-19, asthma patients or their parents were then called and evaluated with a questionnaire. RESULTS As a result of retrospectively scanning the data of 5510 asthma patients over the age of 5, it was determined that 414 (7.5%) patients had COVID-19. The mean age of 414 patients was 17.18 ± 4.08 (min: 6; max: 28) years. Two hundred and three of our 414 patients are male, and 211 are female. When their vaccination status was questioned, 21.5% were vaccinated. When the symptoms of our 290 patients were questioned, it was stated that 59.0% had fever symptoms. The rate of using regular prophylactic asthma medications was 19%. The rate of using salbutamol in asthma was found to be 22%. The rate of patients using methylprednisolone was 1%. Emergency service admission was 17.2%, and hospitalization was found to be 4.8%. Leukopenia (< 4000) was found in 14.1% of patients, and 8.08% of our patients had neutropenia (< 1500). Lymphopenia (< 1500) was detected in 44.4% of patients, and lymphocytosis (> 4000) was found in 5.05% of patients. In 65% of our patients, the C-reactive protein value was elevated. A high aspartate aminotransferase and alanine aminotransferase value was detected in 3.2% and 5.4% of patients were found, respectively. 31% of patients had an elevated lactate dehydrogenase value. Typical radiological findings for COVID-19 were detected in 3/309 of patients. CONCLUSION According to our study, there is a correlation between the severity of COVID-19 and asthma symptoms and the course of the disease. However, it is worth noting that the retrospective nature of the study and the differences in sample size, age, and demographic characteristics between the two groups do not allow for an optimal comparison. Therefore, further investigation is needed to explore the relationship between COVID-19 and asthma, and it can be suggested that COVID-19 may trigger asthma attacks and asthma may impact the course of COVID-19.
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Affiliation(s)
| | - Ümmügülsüm Dikici
- Department of Pediatric Allergy and Immunology, Sakarya University, Adapazarı 54100, Sakarya, Türkiye
| | - Öner Özdemir
- Department of Pediatric Allergy and Immunology, Sakarya University, Adapazarı 54100, Sakarya, Türkiye
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Zhang L, Liu H, Ai T, Chen Z, Tang W, Hu S, Hu J. Epidemiology of asthma exacerbation in children before and after the COVID-19 pandemic: a retrospective study in Chengdu, China. BMC Pediatr 2023; 23:588. [PMID: 37993873 PMCID: PMC10664380 DOI: 10.1186/s12887-023-04364-9] [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: 09/01/2023] [Accepted: 10/14/2023] [Indexed: 11/24/2023] Open
Abstract
PURPOSE To examine the numbers and characteristics of children affected by asthma exacerbation in Chengdu, China, before and after the COVID-19 pandemic to inform efforts to manage childhood asthma in the post epidemic era. METHODS Data were retrospectively collected from children admitted for asthma exacerbation to Chengdu Women and Children's Central Hospital between January 2017 and December 2022. Rates of hospitalization, ages of the affected children, comorbidities and infections, and relationships between hospitalization and seasonal or environmental factors were examined before and after the epidemic. RESULTS Fewer children were hospitalized for asthma exacerbation, yet more hospitalized children had severe exacerbation after the epidemic than before. Rates of hospitalization varied considerably with time of year, and the timing of peak hospitalizations differed before and after the epidemic. Only before the epidemic, rates of hospitalization for asthma exacerbation were positively correlated with humidity. Infants made up a smaller proportion of hospitalized children after the epidemic than before, with preschool children accounting for most hospitalizations after the epidemic. The proportion of children hospitalized for asthma exacerbation who also had pneumonia was significantly smaller after the epidemic than before. Conversely, the proportion of children hospitalized for asthma exacerbation who also had allergic diseases was significantly greater after the epidemic than before. CONCLUSION The epidemiology of asthma exacerbation in children changed after the epidemic. Future efforts to manage the condition in the paediatric population should focus on severe asthma exacerbation, prevention and management of allergic diseases, and the influence of meteorological and environmental factors.
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Affiliation(s)
- Lei Zhang
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, China
| | - Hanmin Liu
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital, Sichuan University, Chengdu, China.
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Ministry of Education, Sichuan University, Chengdu, China.
- The Joint Laboratory for Lung Development and Related Diseases of West China Second University Hospital, Sichuan University, Chengdu, China.
- Sichuan Birth Defects Clinical Research Center, West China Second University Hospital, Sichuan University, Chengdu, China.
| | - Tao Ai
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Zijin Chen
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Wei Tang
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Shuai Hu
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jie Hu
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
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Alimani GS, Ananth S, Boccabella C, Khaleva E, Roberts G, Papadopoulos NG, Kosmidis C, Vestbo J, Papageorgiou E, Beloukas A, Mathioudakis AG. Prevalence and clinical implications of respiratory viruses in asthma during stable disease state and acute attacks: Protocol for a meta-analysis. PLoS One 2023; 18:e0294416. [PMID: 37967134 PMCID: PMC10651012 DOI: 10.1371/journal.pone.0294416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/31/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION Viruses are detected in over 50% of acute asthma attacks and in a notable proportion of patients with asthma during stable disease state They are associated with worse outcomes. We will conduct a series of systematic reviews and meta-analyses to quantify the prevalence and clinical burden of various respiratory viruses in stable asthma and acute asthma attacks. In addition, we will assess the viral loads of respiratory viruses during stable and acute asthma, to explore whether viral load could differentiate attacks triggered by viruses versus those where viruses are present as "innocent bystanders". MATERIALS AND METHODS Based on a prospectively registered protocol (PROSPERO, ID: CRD42023375108) and following standard methodology recommended by Cochrane, we will systematically search Medline/PubMed, EMBASE, the Cochrane Library and relevant conference proceedings for studies assessing the prevalence or clinical burden of respiratory viruses in asthma. Methodological rigour of the included studies will be appraised using a tool specific for prevalence studies and the Newcastle-Ottawa Scale respectively. In anticipation of significant clinical and methodological heterogeneity, we will conduct random effect meta-analyses. For evaluating the prevalence of viruses, we will perform meta-analyses of proportions using the inverse variance method, and the Freeman-Tukey transformation. We will conduct meta-regression analyses for exploring heterogeneity. CONCLUSION We envisage that these systematic reviews and meta-analyses will quantify the prevalence and burden of respiratory viruses in stable and acute asthma and will drive future research and clinical practice.
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Affiliation(s)
| | - Sachin Ananth
- London North West University Healthcare Trust, London, United Kingdom
| | - Cristina Boccabella
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario "A Gemelli"—IRCCS, University of the Sacred Heart, Rome, Italy
| | - Ekaterina Khaleva
- Faculty of Medicine, Clinical and Experimental Sciences and Human Development in Health, University of Southampton, Southampton, United Kingdom
| | - Graham Roberts
- Faculty of Medicine, Clinical and Experimental Sciences and Human Development in Health, University of Southampton, Southampton, United Kingdom
- Paediatric Allergy and Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Nikolaos G. Papadopoulos
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Chris Kosmidis
- Division of Evolution, Infection and Genomics, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Jørgen Vestbo
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Effie Papageorgiou
- Department of Biomedical Sciences, University of West Attica, Athens, Greece
| | - Apostolos Beloukas
- Department of Biomedical Sciences, University of West Attica, Athens, Greece
- National AIDS Reference Centre of Southern Greece, University of West Attica, Athens, Greece
| | - Alexander G. Mathioudakis
- Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Kouis P, Lemonaris M, Xenophontos E, Panayiotou A, Yiallouros PK. The impact of COVID-19 lockdown measures on symptoms control in children with asthma: A systematic review and meta-analysis of observational cohort studies. Pediatr Pulmonol 2023; 58:3213-3226. [PMID: 37606188 DOI: 10.1002/ppul.26646] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Reported reductions in emergency department visits and hospitalizations for asthma in previous studies have suggested a beneficial effect of the coronavirus disease of 2019 (COVID-19) lockdown measures on asthma morbidity. Nevertheless, studies relying on administrative data may overestimate the true impact of lockdowns due to changes in health-seeking behavior and reduced availability of pediatric asthma services during the pandemic. In this study, we systematically reviewed the literature and identified observational cohort studies that focused on nonadministrative data to assess the true impact of COVID-19 lockdowns on symptom control in children with asthma. METHODS A systematic literature search was conducted between January 2020 and August 2022 (International Prospective Register of Systematic Reviews ID: CRD42022354369). The impact of COVID-19 lockdowns across studies was expressed as a standardized mean difference (SMD) for continuous outcomes and as a summary relative risk (RR) for binary outcomes. RESULTS During the lockdown periods, the pooled asthma symptoms control test score (SMD: 1.99, 95% confidence interval [CI]: 0.75, 3.24, I2 : 98.4%) and the proportion of children with well-controlled asthma (RR: 1.35, 95% CI: 1.06, 1.71, I2 : 77.6%) were significantly increased. On the other hand, the pooled proportion of children with poorly controlled asthma (RR: 0.47, 95% CI: 0.38, 0.57, I2 : 0.0%) was significantly decreased. CONCLUSIONS During COVID-19 lockdowns, asthma symptoms and breakthrough disease exacerbations were significantly reduced in children with asthma. Further research is warranted on potential interventions aiming to enhance asthma control after the pandemic while taking into consideration their acceptability and potential tradeoffs.
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Affiliation(s)
- Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Marios Lemonaris
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
- Medical School, University of Nicosia, Nicosia, Cyprus
| | - Eleana Xenophontos
- Cyprus International Institute for Environmental and Public Health, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Andrie Panayiotou
- Cyprus International Institute for Environmental and Public Health, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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Yong SB, Gau SY, Li CJ, Tseng CW, Wang SI, Wei JCC. Associations between COVID-19 outcomes and asthmatic patients with inhaled corticosteroid. Front Pharmacol 2023; 14:1204297. [PMID: 38027036 PMCID: PMC10646298 DOI: 10.3389/fphar.2023.1204297] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background: The impact of inhaled corticosteroid (ICS) in the interaction between asthma, COVID-19 and COVID-19 associated outcomes remain largely unknown. The objective of this study is to investigate the risk of COVID-19 and its related outcomes in patients with asthma using and not using inhaled corticosteroid (ICS). Methods: We used the TriNetX Network, a global federated network that comprises 55 healthcare organizations (HCO) in the United States, to conduct a retrospective cohort study. Patients with a diagnosis of asthma with and without ICS between January 2020 and December 2022 were included. Propensity score matching was used to match the case cohorts. Risks of COVID-19 incidence and medical utilizations were evaluated. Results: Out of 64,587 asthmatic patients with ICS and without ICS, asthmatic patients with ICS had a higher incidence of COVID-19 (Hazard ratio, HR: 1.383, 95% confidence interval, CI: 1.330-1.437). On the contrary, asthmatic patients with ICS revealed a significantly lower risk of hospitalization (HR: 0.664, 95% CI: 0.647-0.681), emergency department visits (HR: 0.774, 95% CI: 0.755-0.793), and mortality (HR:0.834, 95% CI:0.740-0.939). In addition, subgroup or sensitivity analyses were also conducted to examine the result of different vaccination status, disease severity, or COVID-19 virus variants. Conclusion: For asthmatic patients using ICS, risk of COVID-19 was significantly higher than non-users. The observed association could provide potential guidance for primary care physicians regarding the risk of COVID-19 in asthmatic patients.
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Affiliation(s)
- Su-Boon Yong
- Department of Allergy and Immunology, China Medical University Children’s Hospital, Taichung, Taiwan
- Research Center for Allergy, Immunology, and Microbiome (A.I.M.), China Medical University Hospital, Taichung, Taiwan
| | - Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chia-Jung Li
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chih-Wei Tseng
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Public Health, Collage of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shiow-Ing Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Center for Health Data Science, Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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11
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Lohr KD, Everhart RS, Holder RL, Boutté R, Corona R, Mazzeo SE. Changes in caregiver mental health and pediatric asthma control during COVID-19. J Asthma 2023; 60:1741-1750. [PMID: 36857047 PMCID: PMC10363228 DOI: 10.1080/02770903.2023.2185892] [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: 10/10/2022] [Revised: 02/10/2023] [Accepted: 02/25/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE This study evaluated caregivers' stress and depressive symptoms, and children's asthma control, before COVID-19 began and after its onset among families in the RVA Breathes program. METHODS The RVA Breathes intervention, which took place in an urban city in the United States, includes asthma education delivered by a community health worker (CHW), a home assessment, and school nurse components. Participants included 125 children (5-11 years) with asthma and their caregivers (48% household income <$25,000) enrolled prior to the pandemic. Families were randomized to an active intervention arm (full intervention or intervention without school nurse component) or the control group. Caregivers completed the Center for Epidemiological Studies Depression Scale (CES-D) and the Perceived Stress Scale (PSS); children and caregivers completed the Childhood Asthma Control Test (cACT). Assessments pre-COVID-19 were compared to those completed after the pandemic's onset. RESULTS Children in both intervention groups had better cACT scores after the start of COVID-19 compared to before (t(55) = -2.131, p = .019; t(28) = -2.893, p = .004). Caregivers in the intervention groups had lower PSS scores after the start of COVID-19 compared to pre-COVID-19 (t(53) = 3.928, p < .001; t(28) = 2.568, p = .008). Furthermore, CES-D scores improved among caregivers in the full intervention (t(48) = 1.789, p = .040). Caregivers in the control condition did not report significant changes in stress or depressive symptoms. CONCLUSIONS Findings suggest that support from interventionists, including CHWs, might have alleviated stress and depressive symptoms during COVID-19, as well as improved asthma control during the pandemic.
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Affiliation(s)
| | | | | | - Rachel Boutté
- Department of Family and Preventative Medicine, Rush University Medical Center
| | - Rosalie Corona
- Department of Psychology, Virginia Commonwealth University
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12
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Domínguez-Martín C, Cano A, Díez-Monge N. Clinical performance of spirometry and respiratory oscillometry for prediction of severe exacerbations in schoolchildren with asthma. An Pediatr (Barc) 2023:S2341-2879(23)00109-6. [PMID: 37246048 DOI: 10.1016/j.anpede.2023.05.003] [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: 02/08/2023] [Accepted: 04/04/2023] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE To determine the performance of spirometry and respiratory oscillometry (RO) in the prediction of severe asthma exacerbations (SAEs) in children. METHODS In a prospective study, 148 children (age 6-14 years) with asthma were assessed with RO, spirometry and a bronchodilator (BD) test. Based on the findings of spirometry and the BD test, they were classified into three phenotypes: air trapping (AT), airflow limitation (AFL) and normal. Twelve weeks later, they were re-evaluated in relation to the occurrence of SAEs. We analysed the performance of RO, spirometry and AT/AFL phenotypes for prediction of SAEs by means of positive and negative likelihood ratios, ROC curves with the corresponding areas under the curve (AUCs) and a multivariate analysis adjusted for potential confounders. RESULTS During the follow-up, 7.4% of patients had SAEs, and there were differences between phenotypes (normal, 2.4%; AFL, 17.9%; AT, 22.2%, P = .005). The best AUC corresponded to the forced expiratory flow between 25% and 75% of vital capacity (FEF25-75): 0.787; 95% confidence interval, 0.600-0.973. Other significant AUCs were those for the reactance area (AX), forced expiratory volume in the first second (FEV1), the post-BD change in forced vital capacity (FVC), and the FEV1/FVC ratio. All of the variables had a low sensitivity for prediction of SAEs. The AT phenotype had the best specificity (93.8%; 95% CI, 87.9-97.0), but the positive and negative likelihood ratios were both significant only for the FEF25-75. In the multivariate analysis, only some spirometry parameters were significative for prediction of SAEs (AT phenotype, FEF25-75 and FEV1/FVC). CONCLUSIONS Spirometry performed better than RO for prediction of SAEs in the medium term in schoolchildren with asthma.
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Affiliation(s)
- Clara Domínguez-Martín
- 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.
| | - Nuria Díez-Monge
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain; Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
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Papadopoulos NG, Mathioudakis AG, Custovic A, Deschildre A, Phipatanakul W, Wong G, Xepapadaki P. Current and Optimal Practices in Childhood Asthma Monitoring Among Multiple International Stakeholders. JAMA Netw Open 2023; 6:e2313120. [PMID: 37171821 PMCID: PMC10182430 DOI: 10.1001/jamanetworkopen.2023.13120] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Importance Childhood asthma control largely depends on rigorous and regular monitoring. Although various clinical parameters, biomarkers, and patient-reported outcomes are helpful for monitoring purposes, there is no consensus on the minimum and/or optimal set of parameters and their relative priority. Objective To assess actual and perceived optimal childhood asthma monitoring practices used globally. Design, Setting, and Participants This international, multistakeholder survey study surveyed health care professionals and clinical academics with a professional interest in and exposure to childhood asthma between April 12 and September 3, 2021, to test for differences between the frequency that different techniques are actually used in practice vs optimal practice, between-group differences, and differences across medical settings and country economies. Main Outcomes and Measures Outcomes were frequency of duration of asthma monitoring visits as well as actual and perceived optimal use and importance of monitoring tools and domains. Results A total of 1319 participants with expertise in childhood asthma from 88 countries completed the survey. Participants included 1228 health care professionals with a balanced distribution across different care settings (305 [22.7%] primary care, 401 [29.9%] secondary, and 522 [38.9%] tertiary care) and 91 researchers. Children with mild to moderate asthma attended regular monitoring visits at a median (IQR) of 5.0 (2.5-8.0) months, with visits lasting a median (IQR) of 25 (15-25) minutes, whereas severe asthma required more frequent visits (median [IQR], 2.5 [1.0-2.5] months; median [IQR] duration, 25 [25-35] minutes). Monitoring of symptoms and control, adherence, comorbidities, lung function, medication adverse effects, and allergy were considered to be very high or high priority by more than 75% of the respondents. Different patterns emerged when assessing differences between actual and perceived optimal use of monitoring tools. For some tools, current and optimal practices did not differ much (eg, spirometry), whereas in others, there was considerable space for improvement (eg, standardized control and adherence tests). The largest gap was observed for between-visit monitoring with electronic trackers, apps, and smart devices. Differences across country economies, care settings, and medical specialties were modest. Conclusions and Relevance These survey results suggest that pediatric asthma monitoring is performed generally homogeneously worldwide, in most cases following evidence-based standards. Wider use of standardized instruments and the intensification of continuous between-visit monitoring, supported by electronic devices, is needed for further improvement of disease outcomes. The results of this survey, in conjunction with the available evidence base, can inform recommendations toward further optimization.
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Affiliation(s)
- Nikolaos G Papadopoulos
- Allergy Department, Second Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
- Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty or Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
| | - Alexander G Mathioudakis
- Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty or Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
- North West Lung Centre, Wythenshawe Hospital, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Antoine Deschildre
- Center for Infection and Immunity of Lille, Institut Pasteur de Lille, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Université de Lille, Lille, France
| | - Wanda Phipatanakul
- Department of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts
| | - Gary Wong
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Paraskevi Xepapadaki
- Allergy Department, Second Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
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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 A, Maeta A, Takaoka Y, Saeki K, Hamada M, Hiraguchi Y, Kawakami T, Okafuji I, Takemura Y, Takahashi K, Kameda M. Parents' Fears about Hospital Visits and Trait Anxiety in the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:healthcare11081080. [PMID: 37107913 PMCID: PMC10137802 DOI: 10.3390/healthcare11081080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Anxiety in parents of children with allergic diseases during the COVID-19 pandemic may impact hospital visits. This study explored the effect of the pandemic on parents' fears about hospital visits and their relationship with their personality traits. A cross-sectional, questionnaire-based study was conducted between September 2020 and March 2021, with parents of children aged 0-15 years, who regularly visited 24 outpatient facilities for allergic disease. The survey included patient information, fears about hospital visits, desired information, and the State-Trait Anxiety Inventory. Responses were compared between parents with high and low trait anxiety. The response rate was 97.6% (2439/2500). The most common fear was "Fear of getting medical care as usual (85.2%)" and "Fear of COVID-19 infection during hospital visits (87.1%)". High trait anxiety showed a significant association with "Fear of worsening of children's allergies" (adjusted OR: 1.31, 95%CI: 1.04 to 1.65, p = 0.022), and "Fear of worsening of COVID-19 due to allergy" (adjusted OR: 1.52, 95%CI: 1.27 to 1.80, p < 0.01). Healthcare professionals should share updates on COVID-19 and healthcare system to reduce parents' fear. Subsequently, they should communicate the importance of continuing treatment to prevent worsening of COVID-19 and avoid emergency visits, considering parental trait anxiety.
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Affiliation(s)
- Atsuko Nakano
- Department of Pediatrics, Kokuho Central Hospital, Nara 6360302, Japan
| | - Akihiro Maeta
- Department of Food Science and Nutrition, School of Food Science and Nutrition, Mukogawa Women's University, Hyogo 6638558, Japan
| | - Yuri Takaoka
- Department of Pediatrics, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka 5830872, Japan
| | - Keigo Saeki
- Department of Epidemiology, Nara Medical University School of Medicine, Nara 6348522, Japan
| | - Masaaki Hamada
- Department of Pediatrics, Yao Municipal Hospital, Osaka 5810069, Japan
| | - Yukiko Hiraguchi
- Department of Pediatrics, Osaka Saiseikai Nakatsu Hospital, Osaka 5300012, Japan
| | - Tomoko Kawakami
- Department of Pediatrics, Sumitomo Hospital, Osaka 5300005, Japan
| | - Ikuo Okafuji
- Department of Pediatrics, Kobe City Hospital Organization Kobe City Medical Center General Hospital, Hyogo 6500047, Japan
| | - Yutaka Takemura
- Department of Pediatrics, Kindai University Hospital, Osaka 5898511, Japan
| | - Kyoko Takahashi
- Department of Food Science and Nutrition, School of Food Science and Nutrition, Mukogawa Women's University, Hyogo 6638558, Japan
| | - Makoto Kameda
- Department of Pediatrics, Osaka Prefectural Hospital Organization Osaka Habikino Medical Center, Osaka 5830872, Japan
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Lawrence J, Truong D, Dao A, Bryant PA. Virtual hospital-level care—feasibility, acceptability, safety and impact of a pilot Hospital-In-The-Home model for COVID-19 infection. Front Digit Health 2023; 5:1068444. [PMID: 37090066 PMCID: PMC10113639 DOI: 10.3389/fdgth.2023.1068444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/22/2023] [Indexed: 04/08/2023] Open
Abstract
BackgroundHospital-in-the-Home (HITH) delivers hospital level care to patients in the comfort of their own home. Traditionally HITH involves clinicians travelling to patients' homes. We designed and implemented a virtual model of care leveraging a combination of virtual health modalities for children with COVID-19 in response to rising patient numbers, infection risk and pressures on protective equipment. In contrast to other models for COVID-19 infection in Australia at the time, our HITH service catered only for children who were unwell enough to meet criteria for hospitalisation (ie bed-replacement).AimsTo measure the feasibility, acceptability, safety and impact of a virtual model of care for managing children with COVID-19 infection requiring hospital-level care.MethodsRetrospective study of a new virtual model of care for all children admitted to the Royal Children's HITH service with COVID-19 infection between 7th October 2021 and 28th April 2022. The model consisted of at least daily video consultations, remote oximetry, symptom tracking, portal messaging and 24 h phone and video support. Patients were eligible if they met a certain level of severity (work of breathing, dehydration, lower oxygen saturations) without requiring intravenous fluids, oxygen support or intensive care. Online surveys were distributed to staff and consumers who experienced the model of care.Results331 patients were managed through the virtual HITH program with a mean length of stay of 3.5 days. Of these, 331 (100%) engaged in video consultations, 192 (58%) engaged in the patient portal and completed the symptom tracker a total of 634 times and communicated via a total of 783 messages. Consumer satisfaction (n = 31) was high (4.7/5) with the most useful aspect of the model rated as video consultation. Clinician satisfaction (n = 9) was also high with a net promoter score of 8.9. There were no adverse events at home. Eight children (2.4%) represented to hospital, 7 (2.1%) of whom were readmitted. The impact is represented by a total of 1,312 hospital bed-days saved in the seven-month period (2,249 bed-days per year). In addition, 1,480 home visits (travel time/ protective equipment/ infection risk) were avoided.ConclusionA virtual HITH program for COVID-19 in children is feasible, acceptable and safe and has a substantial impact on bed-days saved and nursing travel time. The implications for management of other acute respiratory viral illnesses that contribute to hospital bed pressure during winter months is immense. Virtual HITH is likely to be a key enabler of a sustainable healthcare system.
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Affiliation(s)
- J. Lawrence
- Electronic Medical Record Team, Royal Children’s Hospital, Melbourne, VIC, Australia
- Hospital-in-the-Home Department, Royal Children’s Hospital, Melbourne, VIC, Australia
- Health Services Research Unit, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Correspondence: J. Lawrence
| | - D. Truong
- Electronic Medical Record Team, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - A. Dao
- Electronic Medical Record Team, Royal Children’s Hospital, Melbourne, VIC, Australia
- Radiology Department, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - P. A. Bryant
- Hospital-in-the-Home Department, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Infectious Disease Unit, Royal Children’s Hospital, Melbourne, VIC, Australia
- Clinical Paediatrics Group, Murdoch Children’s Research Institute, Melbourne, Australia
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17
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Panesar R, Grossman J, Nachman S. Antibiotic use among admitted pediatric patients in the United States with status asthmaticus before and during the COVID-19 pandemic. J Asthma 2023; 60:647-654. [PMID: 35634914 DOI: 10.1080/02770903.2022.2083636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Hospital admission trends of children with status asthmaticus diminished during the Coronavirus-19 (COVID-19) pandemic of 2020, possibly secondary to several factors such as school closures and use of face masks. What effect this had on antibiotic prescribing practices has yet to be described. The objective of our study was to evaluate the use of antibiotics in hospitalized children with a diagnosis of status asthmaticus before and during the COVID pandemic.Methods: A retrospective cross-sectional analysis was conducted using the TriNetX® cloud-based program with a national and institutional database. Each database was queried for all inpatient pediatric encounters from 3 to 18 years old, admitted with a diagnosis of status asthmaticus in the spring seasons of 2017-2019. Admission data and antibiotic usage were queried during the COVID-19 pandemic year of 2020 from both databases and compared amongst all study years.Results: In 2020, there was an overall decrease in the number of admissions as compared to the average number from 2017-2019, by 76.9% in the national database (p < 0.05) and 91.2% in the institutional database. The rates of antibiotic prescriptions significantly dropped among the national database (p < 0.001, z = 3.39) and remained non-significantly changed among the institutional database (p = 0.944 and z = 0.073).Conclusions: Our study demonstrates that the COVID-19 pandemic year of 2020 coincided with a significant decrease in hospital admissions and antibiotic prescribing prevalence among children with status asthmaticus on a national level. Nonetheless, our reported trends in antibiotic prescribing are still grossly similar to that of pre-pandemic times and may demonstrate a continued need for antimicrobial stewardship.
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Affiliation(s)
- Rahul Panesar
- Department of Pediatric Critical Care Medicine, Stony Brook University Children's Hospital, Stony Brook, NY, USA
| | - Jeremy Grossman
- Department of Internal Medicine-Pediatrics, Stony Brook University Children's Hospital, Stony Brook, NY, USA
| | - Sharon Nachman
- Department of Pediatric Infectious Disease, Stony Brook University Children's Hospital, Stony Brook, NY, USA
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18
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Feldman JM, Serebrisky D, Starr S, Castaño K, Greenfield N, Silverstein G, Fruchter N, Mammen J, McGovern C, Arcoleo K. Reduced asthma morbidity during COVID-19 in minority children: is medication adherence a reason? J Asthma 2023; 60:468-478. [PMID: 35341432 PMCID: PMC9532462 DOI: 10.1080/02770903.2022.2059510] [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: 11/02/2021] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Asthma control improved during the COVID-19 pandemic. This study examined objectively measured medication adherence, asthma morbidity and quality of life (QoL) outcomes in Black and Latinx children by month for January-June 2019 (pre-COVID) compared to January-June 2020 (including first peak of COVID). METHODS Secondary analyses of 94 children with asthma (ages 10-17 years, 64% Latinx, 36% Black) and their caregivers assigned to the comparison group of a longitudinal RCT intervention trial. Outcomes included mean aggregate electronic adherence for controller medications, oral steroid bursts, acute healthcare utilization, caregiver asthma QoL, and the Asthma Control Test. Repeated measures analyses were conducted due to multiple observations. RESULTS Adherence to controller medications declined 48% from 2019 to 2020 (LS Mean = 33.9% vs. 17.6%, p=.0004, f=.92) with levels reaching a low in May 2020. A reduction in steroid bursts was observed over the same timeframe, 1.29 vs. 0.61, p = 0.006, f=.63. Caregiver QoL increased from 2019 to 2020 on total score (5.18 vs. 5.85, p = 0.002, f=.72), activity limitations (5.04 vs. 5.95), and emotional functioning (5.26 vs. 5.80). Although not statistically significant, a clinically meaningful 62% reduction in acute healthcare visits (p = 0.15) was reported in 2020. Children reported better asthma control (OR = 1.47, 95% CI 1.24, 1.73, p < 0.0001) in 2020 versus 2019 driven by improvements from May to June 2020. CONCLUSIONS Decreased asthma morbidity in minority children during COVID was coupled with decreased adherence to controller medications. This observed decrease in morbidity is not explained by improvements in adherence.
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Affiliation(s)
- Jonathan M. Feldman
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Department of Pediatrics, Division of Academic General Pediatrics, Bronx, NY
| | | | - Sheena Starr
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | - Katerina Castaño
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | - Naomi Greenfield
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | | | - Natalie Fruchter
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | | | - Colleen McGovern
- University Of North Carolina at Greensboro School of Nursing, Greensboro, NC
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19
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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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20
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Guo S, Chen D, Chen J, Zhu C, Huang L, Chen Z. Relationship between meteorological and environmental factors and acute exacerbation for pediatric bronchial asthma: Comparative study before and after COVID-19 in Suzhou. Front Public Health 2023; 11:1090474. [PMID: 36778545 PMCID: PMC9911831 DOI: 10.3389/fpubh.2023.1090474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Objective Climate and environmental change is a well-known factor causing bronchial asthma in children. After the outbreak of coronavirus disease (COVID-19), climate and environmental changes have occurred. The present study investigated the relationship between climate changes (meteorological and environmental factors) and the number of hospitalizations for pediatric bronchial asthma in Suzhou before and after the COVID-19 pandemic. Methods From 2017 to 2021, data on daily inpatients diagnosed with bronchial asthma at Children's Hospital of Soochow University were collected. Suzhou Meteorological and Environmental Protection Bureau provided daily meteorological and environmental data. To assess the relationship between bronchial asthma-related hospitalizations and meteorological and environmental factors, partial correlation and multiple stepwise regression analyses were used. To estimate the effects of meteorological and environmental variables on the development of bronchial asthma in children, the autoregressive integrated moving average (ARIMA) model was used. Results After the COVID-19 outbreak, both the rate of acute exacerbation of bronchial asthma and the infection rate of pathogenic respiratory syncytial virus decreased, whereas the proportion of school-aged children and the infection rate of human rhinovirus increased. After the pandemic, the incidence of an acute asthma attack was negatively correlated with monthly mean temperature and positively correlated with PM2.5. Stepwise regression analysis showed that monthly mean temperature and O3 were independent covariates (risk factors) for the rate of acute asthma exacerbations. The ARIMA (1, 0, 0) (0, 0, 0) 12 model can be used to predict temperature changes associated with bronchial asthma. Conclusion Meteorological and environmental factors are related to bronchial asthma development in children. The influence of meteorological and environmental factors on bronchial asthma may be helpful in predicting the incidence and attack rates.
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Affiliation(s)
| | | | | | | | - Li Huang
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Zhengrong Chen
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
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21
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Thanik E, Harada K, Garland E, Bixby M, Bhatia J, Lopez R, Galvez S, Dayanov E, Vemuri K, Bush D, DeFelice NB. Impact of COVID-19 on pediatric asthma-related healthcare utilization in New York City: a community-based study. BMC Pediatr 2023; 23:41. [PMID: 36691011 PMCID: PMC9868511 DOI: 10.1186/s12887-023-03845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 01/10/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND COVID-19 disproportionately affects families of low socioeconomic status and may worsen health disparities that existed prior to the pandemic. Asthma is a common chronic disease in children exacerbated by environmental exposures. METHODS A cross-sectional survey was conducted to understand the impact of the initial stage of the pandemic on environmental and social conditions, along with access to care for children with asthma in New York City (NYC). Participants were recruited from a community-based organization in East Harlem and a nearby academic Pediatric Pulmonary clinic and categorized as having either public or private insurance (n = 51). RESULTS Factors significantly associated with public compared to private insurance respectively were: increased reports of indoor asthma triggers (cockroach 76% vs 23%; mold 40% vs 12%), reduced income (72% vs 27%), and housing insecurity (32% vs 0%). Participants with public insurance were more likely to experience conditions less conducive to social distancing compared to respondents with private insurance, such as remaining in NYC (92% vs 38%) and using public transportation (44% vs 4%); families with private insurance also had greater access to remote work (81% vs 8%). Families with public insurance were significantly more likely to test positive for SARS-CoV-2 (48% vs 15%) but less likely to have gotten tested (76% vs 100%). Families with public insurance also reported greater challenges accessing office medical care and less access to telehealth, although not statistically significant (44% vs 19%; 68% vs 85%, respectively). CONCLUSIONS Findings highlight disproportionate burdens of the pandemic, and how these disparities affect children with asthma in urban environments.
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Affiliation(s)
- Erin Thanik
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA.
| | - Kaoru Harada
- Department of Medicine, Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth Garland
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA
| | - Moira Bixby
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA
| | - Jasmine Bhatia
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA
| | - Ray Lopez
- LSA Family Health Service, New York, NY, USA
| | | | - Elan Dayanov
- Graduate Program in Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Krishna Vemuri
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA
| | - Douglas Bush
- Department of Pediatrics, Division of Pulmonary, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicholas B DeFelice
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA
- Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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22
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Silva TM, Pinto BS, Cunha I, Roque F, Figueiras A, Fonseca J, Herdeiro MT, Gomes ER. Impact of the COVID-19 Pandemic on the Prescribing of Antiasthmatic Treatments in Portugal: A Nationwide Study. Clin Ther 2023; 45:e89-e99.e2. [PMID: 36775690 PMCID: PMC9841074 DOI: 10.1016/j.clinthera.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/22/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023]
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on everyday life, the environment, and health care services. A shift from in-person medical appointments to telemedicine was a main adjustment. Such changes can have repercussions on the control and management of chronic respiratory diseases, such as asthma. The available data suggest that there was an overall decrease in asthma-related morbidities during the first year of the pandemic. Therefore, the goal of this study was to quantify the effects of the pandemic on the prescribing of antiasthmatic treatments in outpatient care (public and private health care). METHODS This before-after study used a time series approach based on data from monthly prescriptions of antiasthmatic drugs (anti-inflammatory drugs and bronchodilators) dated between April 2018 and March 2021. An interrupted time series (ITS) design was used for assessing changes in antiasthmatic prescribing patterns in the short and long terms after COVID-19 was recognized as a pandemic. The results are complemented with seasonal autoregressive integrated moving average (sARIMA) models. FINDINGS The ITS analysis showed a non-significant increase in antiasthmatic prescribing in the short term. In the long term, after the pandemic was declared, a statistically significant decrease was observed in the prescribing of antiasthmatics (in anti-inflammatory drugs and, more pronounced, in bronchodilators). In the sARIMA model, the mean monthly volume of antiasthmatic prescriptions was 18.1% lower than predicted. The numbers of months outside of the 95% CIs were different between anti-inflammatory drugs (1 month) and bronchodilators (7 months). IMPLICATIONS The prescribing of antiasthmatic drugs in the long term was significantly decreased with the COVID-19 pandemic, with a greater effect in the case of bronchodilators.
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Affiliation(s)
- Tânia Magalhães Silva
- Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
| | - Bernardo Sousa Pinto
- Faculty of Medicine, Center for Health Technology and Services Research, and the Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal
| | - Inês Cunha
- Allergy and Clinical Immunology Service, University Hospital Center of Porto, Porto, Portugal
| | - Fátima Roque
- Research Unit for Inland Development, Guarda Polytechnic Institute, Guarda, Portugal; Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, and the Health Research Institute of Santiago de Compostela, University of Santiago de Compostela, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public Health, Santiago de Compostela, Spain
| | - João Fonseca
- Faculty of Medicine, Center for Health Technology and Services Research, and the Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal
| | - Maria Teresa Herdeiro
- Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Eva Rebelo Gomes
- Allergy and Clinical Immunology Service, University Hospital Center of Porto, Porto, Portugal.
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23
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To T, Zhang K, Terebessy E, Zhu J, Licskai C. Healthcare utilization in Canadian children and young adults with asthma during the COVID-19 pandemic. PLoS One 2023; 18:e0280362. [PMID: 36638144 PMCID: PMC9838850 DOI: 10.1371/journal.pone.0280362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023] Open
Abstract
Literature is limited regarding the COVID-19 pandemic's impact on health services use in younger Canadian populations with asthma. We utilized health administrative databases from January 2019-December 2021 for a population-based cross-sectional study to identify Ontario residents 0-25 years old with physician-diagnosed asthma and calculate rates of healthcare use. Multivariable negative binomial regression analysis was used to adjust for confounders. We included 716,690 children and young adults ≤25 years. There was a sharp increase of ICS and SABA prescription rates at the start of the pandemic (March 2020) of 61.7% and 54.6%, respectively. Monthly virtual physician visit rates increased from zero to 0.23 per 100 asthma population during the pandemic. After adjusting for potential confounders, rate ratios (RR) with 95% confidence intervals (CI) showed that the pandemic was associated with significant decrease in hospital admissions (RR = 0.21, 95% CI: 0.18-0.24), emergency department visits (RR = 0.35, 95% CI: 0.34-0.37), and physician visits (RR = 0.61, 95% CI: 0.60-0.61). ICS and SABA prescriptions filled also significantly decreased during the pandemic (RR = 0.58, 95% CI: 0.57-0.60 and RR = 0.47, 95% CI: 0.46-0.48, respectively). This Canadian population-based asthma study demonstrated a dramatic decline in physician and emergency department visits, hospitalizations, and medication prescriptions filled during the COVID-19 pandemic. An extensive evaluation of the factors contributing to an 80% reduction in the risk of hospitalization may inform post-pandemic asthma management.
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Affiliation(s)
- Teresa To
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- * E-mail:
| | - Kimball Zhang
- The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Jingqin Zhu
- The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Christopher Licskai
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- London Health Sciences, Victoria Hospital, London, Ontario, Canada
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24
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Pogge G, Waters EA, Webster GD, Prabhakaran S, Hunleth JM, Fedele DA, Shepperd JA. Caregiver Perceptions of Change in Pediatric Asthma Control During the COVID-19 Pandemic. J Asthma Allergy 2022; 15:1795-1804. [PMID: 36573182 PMCID: PMC9789706 DOI: 10.2147/jaa.s385891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/15/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose Although several indicators suggest that pediatric asthma control in the United States improved early in the pandemic, other indicators suggest not. Missing are reports from caregivers of the experiences of their children with asthma early in the pandemic. Methods Using the PP-ACT and other measures that we specifically constructed for our research, we conducted a cross-sectional national survey of US caregivers of children with asthma (N=595) to examine perceived change in their child's asthma control and changes in reports of ED visits and use of emergency relief medicine and controller medicine pre-pandemic (January to March 2020) versus early-pandemic (June to September 2020). Results Caregivers fell into three groups: most caregivers perceived that their child's asthma control was improved (50.3%) or unchanged (41.2%), and few reported worse control (8.5%). Surprisingly, all three groups of caregivers reported similar frequencies of early-pandemic and pre-pandemic ED visits and use of emergency relief medicine. Also surprising, caregivers who perceived their child's asthma as more controlled (compared with the other two groups) reported more frequent ED visits and use of emergency relief medicine, yet also more use of controller medicine at both early-pandemic and pre-pandemic. Conclusion The mismatch between caregivers' perceptions of their child's early-pandemic asthma control and their reports of ED visits and use of emergency relief medicine suggests that caregivers may rely on a gist (a global evaluation that can include nonbiomedical evidence) when estimating their child's asthma control. Caregivers and their families could benefit from help from clinicians in understanding the discrepancy between subjective asthma control and asthma control indicators and in understanding what well-controlled asthma looks and feels like.
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Affiliation(s)
- Gabrielle Pogge
- University of Florida, Department of Psychology, Gainesville, FL, 32603, USA
| | - Erika A Waters
- Washington University School of Medicine, Department of Surgery – Public Health Sciences, Saint Louis, MO, USA
| | - Gregory D Webster
- University of Florida, Department of Psychology, Gainesville, FL, 32603, USA
| | | | - Jean M Hunleth
- Washington University School of Medicine, Department of Surgery – Public Health Sciences, Saint Louis, MO, USA
| | - David A Fedele
- University of Florida, Department of Clinical and Health Psychology, Gainesville, FL, 32603, USA
| | - James A Shepperd
- University of Florida, Department of Psychology, Gainesville, FL, 32603, USA
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25
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Xepapadaki P, Adachi Y, Pozo Beltrán CF, El-Sayed ZA, Gómez RM, Hossny E, Filipovic I, Le Souef P, Morais-Almeida M, Miligkos M, Nieto A, Phipatanakul W, Pitrez PM, Wang JY, Wong GW, Papadopoulos NG. Utility of biomarkers in the diagnosis and monitoring of asthmatic children. World Allergy Organ J 2022; 16:100727. [PMID: 36601259 PMCID: PMC9791923 DOI: 10.1016/j.waojou.2022.100727] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Abstract
Asthma imposes a heavy morbidity burden during childhood; it affects over 10% of children in Europe and North America and it is estimated to exceed 400 million people worldwide by the year 2025. In clinical practice, diagnosis of asthma in children is mostly based on clinical criteria; nevertheless, assessment of both physiological and pathological processes through biomarkers, support asthma diagnosis, aid monitoring, and further lead to better treatment outcomes and reduced morbidity. Recently, identification and validation of biomarkers in pediatric asthma has emerged as a top priority across leading experts, researchers, and clinicians. Moreover, the implementation of non-invasive biomarkers for the assessment and monitoring of paediatric patients with asthma, has been prioritized; however, only a proportion of them are currently included in the clinical practise. Although, the use of non-invasive biomarkers is highly supported in recent asthma guidelines for documenting diagnosis and supporting monitoring of asthmatic patients, data on the Pediatric population are limited. In the present report, the Pediatric Asthma Committee of the World Allergy Organization (WAO), aims to summarize and discuss available data for the implementation of non-invasive biomarkers in the diagnosis and monitoring in children with asthma. Information on the most studied biomarkers, including spirometry, oscillometry, markers of allergic sensitization, fractional exhaled nitric oxide, and the most recent exhaled breath markers and "omic" approaches, will be reviewed. Practical limitations and considerations based on both experts' opinion and critical review of the literature, on the utility of all "well-known" and newly introduced non-invasive biomarkers will be presented. A critical commentary on biomarkers' use in diagnosing and monitoring asthma during the COVID-19 pandemic, cost and availability of biomarkers in different settings and in developing countries, the differences on the biomarkers use between Primary Practitioners, Pediatricians, and Specialists and their role on the longitudinal aspect of asthma is provided.
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Affiliation(s)
- Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
- Corresponding author.
| | - Yuichi Adachi
- Department of Pediatrics, Faculty of Medicine, University of Toyam, Japan
| | | | - Zeinab A. El-Sayed
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | | | - Elham Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Ivana Filipovic
- University Hospital Center Dr Dragiša Mišović Hospital Pediatric Department, Serbia
| | - Peter Le Souef
- Faculty of Health and Medical Sciences, Dept of Respiratory Medicine, Child and Adolescent Health Service, University of Western Australia, Perth, Australia
| | | | - Michael Miligkos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Antonio Nieto
- Pediatric Pulmonology & Allergy Unit Children's. Health Research Institute. Hospital La Fe, 46026, Valencia, Spain
| | - Wanda Phipatanakul
- Pediatric Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Paulo M. Pitrez
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Jiu-Yao Wang
- Center for Allergy and Clinical Immunology Research, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Gary W.K. Wong
- Department of Paediatrics, The Chinese University of Hong Kong, China
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26
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El-Sayed ZA, El-Owaidy RH, Harb WN, Shousha GA. COVID-19 in a group of children with asthma: presentation, severity, and outcome. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL IMMUNOLOGY 2022; 11:92-102. [PMID: 36660141 PMCID: PMC9845840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/05/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND There are insufficient data concerning COVID-19 severity among asthmatic children. AIM to evaluate the impact of asthma on COVID-19 severity and outcome. PATIENTS AND METHODS We carried out an observational study that comprised 2 matched groups of children with confirmed/probable COVID-19: 30 with and 32 without asthma aged 6-18 years, who were enrolled consecutively from Children's Hospital, Ain Shams University, Egypt. COVID-19 clinical presentations, laboratory and radiological abnormalities, severity and outcome were compared between the 2 groups. Asthma severity and control were assessed based on GINA 2020. RESULTS The asthmatic COVID-19 children were 9 boys and 21 girls, with median age 9 years, IQR: 8-12 years. The non-asthmatic COVID-19 group included 18 males and 14 females with median age 9.5 years, IQR: 7-12.5 years. Clinical manifestations of COVID-19 were comparable among the 2 groups, except for wheezes which were more frequently encountered as a COVID-19 manifestation among the asthmatics (p=0.001). Multisystem inflammatory syndrome (MIS-c) was diagnosed in one asthmatic and 3 non-asthmatic patients. The asthmatic group had higher frequency of serum ferritin, LDH and D-dimer elevations compared to the non-asthmatic peers (p values 0.014, 0.001, and 0.015 respectively). Based on CO-RAD classification, 70% of the asthmatic patients had CO-RAD score of 5 versus 6.3 % among the non-asthmatic group with significant differences between the 2 groups in their CO-RAD scores (P=0.002). COVID-19 severity was comparable among the studied groups (P=0.775), as well as COVID-19 outcome and duration of hospital stay (p values 0.999, and 0.655, respectively). CONCLUSION From our limited sample sized study, childhood asthma did not pose a significant impact on COVID-19 severity and outcome. Further longitudinal studies are warranted to validate our conclusion and investigate the relation of COVID-19 severity and outcome to allergen immunotherapy and the use of biologicals for asthma treatment.
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Affiliation(s)
- Zeineb A El-Sayed
- Pediatric Allergy, Immunology and Rheumatology Unit, Children’s Hospital, Ain Shams UniversityCairo, Egypt
| | - Rasha H El-Owaidy
- Pediatric Allergy, Immunology and Rheumatology Unit, Children’s Hospital, Ain Shams UniversityCairo, Egypt
| | - Waleed N Harb
- Fever Hospital of Al-Mahalla Al-KubraAl-Gharbya Governate, Egypt
| | - Ghada A Shousha
- Pediatric Allergy, Immunology and Rheumatology Unit, Children’s Hospital, Ain Shams UniversityCairo, Egypt
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27
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Wong KL, Wong WHS, Yau YS, Lee SL, Chiu SSS. Asthma admission among children in Hong Kong during the first year of the COVID-19 pandemic. Pediatr Pulmonol 2022; 57:3104-3110. [PMID: 36097891 DOI: 10.1002/ppul.26141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/17/2022] [Accepted: 09/11/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Multiple nonpharmaceutical interventions (NPIs) had been introduced in Hong Kong during coronavirus disease 2019 (COVID-19) pandemic. The impact on asthma admission, which was closely related to viral infection, was of concern. OBJECTIVE The study aimed to identify the impact of NPIs on pediatric asthma admissions and their association with respiratory viruses. METHODS We conducted a retrospective observational study to compare the difference in pediatric asthma hospital admission rates between pre-COVID-19 and COVID-19 periods. Information on demographics, nasopharyngeal specimen results, ventilatory support, intensive care admission, hospital stay duration, asthma control therapy, and previous admission episodes was collected. Weather parameters including temperature, rainfall, humidity, and air quality data that was reflected by the air quality health index were recorded. RESULTS A total of 1808 pediatric asthma admissions were recorded during the pre-COVID-19 period while there were 62 admissions during COVID-19 period, among which 54 admissions from the pre-COVID-19 period and 4 admissions from COVID-19 period were excluded. Weekly pediatric asthma admissions per total pediatric admissions during COVID-19 was one-third of that during the pre-COVID-19 period (0.3% vs. 0.9%, p < 0.001). During COVID-19 period, a significantly lower percentage of respiratory virus isolates was noted (58.6% vs. 72.6%, p = 0.019). Poisson regression analysis showed that the COVID-19 period (odds ratio [OR] = 0.202, 95% confidence interval [CI, 0.16-0.26]; p ≤ 0.001), summer vacation period (OR = 0.512, 95% CI [0.43-0.62]; p ≤ 0.001), and humidity (OR = 0.99, 95% CI [0.98-1.00]; p = 0.004) were independent protective factors for asthma admission. CONCLUSIONS There was a significant reduction in pediatric asthma hospitalizations and respiratory virus isolates in the first year of COVID-19 pandemic in Hong Kong with the implementation of NPIs. Rhinovirus remained the key respiratory virus isolate. Incorporation of appropriate NPIs in long run could reduce virus infection-related pediatric asthma admission.
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Affiliation(s)
- K L Wong
- Department of Paediatrics, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Wilfred H S Wong
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
| | - Y S Yau
- Department of Paediatrics, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - S L Lee
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Susan S S Chiu
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
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Yi M, Bao J, Wang J, Zhang Z, Jia Y, Zhao B, Fang J, Chen O. What caregivers believe affected the quality of implementation of asthma-related family management models (AFMM) during COVID-19: A phenomenological qualitative study. Pediatr Pulmonol 2022; 57:2815-2823. [PMID: 35960691 PMCID: PMC9538381 DOI: 10.1002/ppul.26107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/15/2022] [Accepted: 07/23/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE The recurrent COVID-19 epidemic in China has disrupted many aspects of daily life for children with asthma and their caregivers, while negatively impacting their asthma family management models (AFMM). This phenomenological qualitative study identifies what affects the quality of implementation of AFMM in this population and outlines potential coping strategies for the caregivers. METHODS We used purposive sampling to conduct semistructured interviews with primary caregivers of school-age children with asthma from community healthcare centers (CHCs), which focused on understanding what factors influenced caregivers' implementation of AFMM during quarantine. The Colaizzi seven-step method was used to independently code and categorize the transcript and to generate themes and identify associated key subthemes. RESULTS Twenty-four caregivers were interviewed, and they provided greater insight into barriers and motivators to implement AFMM. The three themes and nine relevant subthemes generated, (a) the "individual-family" internal-level factors: weak health literacy and beliefs, quietly changing family relationships, the dramatic increase in the care burden, gradual adjustment of negative psychology; (b) the "hospital-community" external-level factors: the endless power of peer support, strict community quarantine policy; and (c) the "health system-public" social-level factors: the enormous potential of internet-based telemedicine, improved public awareness of prevention, government's prompt assistance. CONCLUSIONS This qualitative study reveals that the quality of AFMM implementation during pandemic is impacted by three different levels. Therefore, a targeted and comprehensive caring model that provides caregivers with the necessary coping strategies around these three levels is needed to achieve better asthma control outcomes.
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Affiliation(s)
- Mo Yi
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jingxian Bao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Pediatric Respiratory, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jingjing Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zeyi Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yuanmin Jia
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Baosheng Zhao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jinxia Fang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ou Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Munblit D, Greenhawt M, Brough HA, Pushkareva A, Karimova D, Demidova A, Warner JO, Kalayci O, Sediva A, Untersmayr E, Rodriguez Del Rio P, Vazquez-Ortiz M, Arasi S, Alvaro-Lozano M, Tsabouri S, Galli E, Beken B, Eigenmann PA. Allergic diseases and immunodeficiencies in children, lessons learnt from COVID-19 pandemic by 2022: A statement from the EAACI-section on pediatrics. Pediatr Allergy Immunol 2022; 33:e13851. [PMID: 36282136 PMCID: PMC9538373 DOI: 10.1111/pai.13851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022]
Abstract
By the April 12, 2022, the COVID-19 pandemic had resulted in over half a billion people being infected worldwide. There have been 6.1 million deaths directly due to the infection, but the pandemic has had many more short- and long-term pervasive effects on the physical and mental health of the population. Allergic diseases are among the most prevalent noncommunicable chronic diseases in the pediatric population, and health-care professionals and researchers were seeking answers since the beginning of pandemic. Children are at lower risk of developing severe COVID-19 or dying from infection. Allergic diseases are not associated with a higher COVID-19 severity and mortality, apart from severe/poorly controlled asthma. The pandemic disrupted routine health care, but many mitigation strategies, including but not limited to telemedicine, were successfully implemented to continue delivery of high-standard care. Although children faced a multitude of pandemic-related issues, allergic conditions were effectively treated remotely while reduction in air pollution and lack of contact with outdoor allergens resulted in improvement, particularly respiratory allergies. There is no evidence to recommend substantial changes to usual management modalities of allergic conditions in children, including allergen immunotherapy and use of biologicals. Allergic children are not at greater risk of multisystem inflammatory syndrome development, but some associations with Long COVID were reported, although the data are limited, and further research is needed. This statement of the EAACI Section on Pediatrics provides recommendations based on the lessons learnt from the pandemic, as available evidence.
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Affiliation(s)
- Daniel Munblit
- Inflammation, Repair and Development Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Helen A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital, London, UK
- Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Anna Pushkareva
- European Academy of Allergy and Clinical Immunology (EAACI), Zurich, Switzerland
| | - Diana Karimova
- European Academy of Allergy and Clinical Immunology (EAACI), Zurich, Switzerland
| | - Anastasia Demidova
- European Academy of Allergy and Clinical Immunology (EAACI), Zurich, Switzerland
| | - John O Warner
- Inflammation, Repair and Development Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Omer Kalayci
- Pediatric Allergy and Asthma, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Anna Sediva
- Department of Immunology, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | | | - Marta Vazquez-Ortiz
- Inflammation, Repair and Development Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Stefania Arasi
- Translational Research in Pediatric Specialities Area, Division of Allergy, IRCCS, Bambino Gesù Children's Hospital, Rome, Italy
| | - Montserrat Alvaro-Lozano
- Allergology and Clinical Immunology Department, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Sophia Tsabouri
- Child Health Department, University of Ioannina School of Medicine, Ioannina, Greece
| | - Elena Galli
- Pediatric Allergology Unit, Department of Pediatric Medicine, S.Pietro Hospital Fatebenefratelli, Rome, Italy
| | - Burcin Beken
- Department of Pediatric Allergy and Immunology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Philippe A Eigenmann
- Pediatric Allergy Unit, Department of Woman, Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
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Ferraro VA, Zanconato S, Carraro S. Impact of COVID-19 in Children with Chronic Lung Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11483. [PMID: 36141755 PMCID: PMC9517525 DOI: 10.3390/ijerph191811483] [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: 08/13/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND since December 2019, the world has become victim of the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The aim of our narrative review is to analyze the impact of COVID-19 in children suffering from chronic lung disease (CLD). METHODS we searched the MEDLINE/Pubmed database using the terms "SARS-CoV-2" or "COVID-19" or "Coronavirus Diseases 2019"; AND "chronic lung diseases" or "chronic respiratory diseases" or "asthma" or "cystic fibrosis" or "primary ciliary dyskinesia" or "bronchopulmonary dysplasia"; and limiting the search to the age range 0-18 years. RESULTS AND CONCLUSIONS although COVID-19 rarely presents with a severe course in children, CLD may represent a risk factor; especially when already severe or poorly controlled before SARS-CoV-2 infection. On the other hand, typical features of children with CLD (e.g., the accurate adoption of prevention measures, and, in asthmatic patients, the regular use of inhaled corticosteroids and T2 inflammation) might have a role in preventing SARS-CoV-2 infection. Moreover, from a psychological standpoint, the restrictions associated with the pandemic had a profound impact on children and adolescents with CLD.
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Goldbloom EB, Buba M, Bhatt M, Suntharalingam S, King WJ. La prestation de soins virtuels et novateurs dans un centre pédiatrique canadien de soins tertiaires. Paediatr Child Health 2022; 27:S88-S94. [PMID: 36092293 PMCID: PMC9455648 DOI: 10.1093/pch/pxac022] [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: 07/31/2021] [Accepted: 01/24/2022] [Indexed: 11/14/2022] Open
Abstract
Les systèmes de santé et les travailleurs de la santé se sont rapidement adaptés à la prestation des soins virtuels pendant cette période sans précédent. Les programmes cliniques ont adopté divers modèles de soins virtuels pour maintenir l’accès, économiser l’équipement de protection individuelle et limiter la propagation des maladies infectieuses. Dans le présent article, les auteurs décrivent d’abord le contexte de prestation des soins pédiatriques pendant la pandémie de COVID-19 au Canada, laquelle a propulsé la prestation des soins virtuels. Ils résument ensuite la préparation, la mise en œuvre et les effets bénéfiques des programmes de soins virtuels utilisés actuellement au Centre hospitalier pour enfants de l’est de l’Ontario (CHEO), tant pour les patients hospitalisés que non hospitalisées, notamment dans les cliniques ambulatoires, aux urgences et au sein du programme de santé mentale. Ils soulignent les moyens transférables et particuliers qu’a retenus le CHEO pour intégrer la prestation des soins virtuels, que ce soit au moyen de sa structure de gouvernance, de la participation des intervenants – y compris les patients, les proches, les travailleurs de la santé et le personnel –, de la préparation et de l’utilisation des outils de télésanté et des approches novatrices de soins aux patients qui ont besoin d’une évaluation physique. Ils concluent en présentant leur vision de l’avenir des soins virtuels, qui feront partie de l’arsenal des soins pédiatriques après la pandémie de COVID-19, mais qui devront être soumis à un cadre commun d’évaluation. Fait important, la mise en œuvre rapide d’un modèle de soins principalement virtuels au CHEO a favorisé le maintien d’un volume élevé de soins pédiatriques de qualité. Selon les auteurs, bon nombre de ces programmes devraient être conservés et le seront bel et bien après la pandémie. Il est essentiel d’adopter une approche exhaustive et unifiée de l’évaluation pour obtenir des résultats constructifs qui inspireront des modèles de prestation des soins pérennes, incluant les soins virtuels, et qui contribueront à garantir le meilleur pronostic possible pour les patients.
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Affiliation(s)
- Ellen B Goldbloom
- Département de pédiatrie, CHEO, Ottawa (Ontario)Canada
- Institut de recherche du CHEO, Ottawa (Ontario)Canada
- Faculté de médecine, Université d’Ottawa, Ottawa (Ontario)Canada
| | - Melanie Buba
- Département de pédiatrie, CHEO, Ottawa (Ontario)Canada
- Institut de recherche du CHEO, Ottawa (Ontario)Canada
- Faculté de médecine, Université d’Ottawa, Ottawa (Ontario)Canada
| | - Maala Bhatt
- Département de pédiatrie, CHEO, Ottawa (Ontario)Canada
- Institut de recherche du CHEO, Ottawa (Ontario)Canada
- Faculté de médecine, Université d’Ottawa, Ottawa (Ontario)Canada
| | - Sinthuja Suntharalingam
- Faculté de médecine, Université d’Ottawa, Ottawa (Ontario)Canada
- Département de psychiatrie, CHEO, Ottawa (Ontario)Canada
| | - W James King
- Département de pédiatrie, CHEO, Ottawa (Ontario)Canada
- Institut de recherche du CHEO, Ottawa (Ontario)Canada
- Faculté de médecine, Université d’Ottawa, Ottawa (Ontario)Canada
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Filip R, Gheorghita Puscaselu R, Anchidin-Norocel L, Dimian M, Savage WK. Global Challenges to Public Health Care Systems during the COVID-19 Pandemic: A Review of Pandemic Measures and Problems. J Pers Med 2022; 12:1295. [PMID: 36013244 PMCID: PMC9409667 DOI: 10.3390/jpm12081295] [Citation(s) in RCA: 106] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/21/2022] [Accepted: 08/05/2022] [Indexed: 12/15/2022] Open
Abstract
Beginning in December 2019, the world faced a critical new public health stressor with the emergence of SARS-CoV-2. Its spread was extraordinarily rapid, and in a matter of weeks countries across the world were affected, notably in their ability to manage health care needs. While many sectors of public structures were impacted by the pandemic, it particularly highlighted shortcomings in medical care infrastructures around the world that underscored the need to reorganize medical systems, as they were vastly unprepared and ill-equipped to manage a pandemic and simultaneously provide general and specialized medical care. This paper presents modalities in approaches to the pandemic by various countries, and the triaged reorganization of medical sections not considered first-line in the pandemic that was in many cases transformed into wards for treating COVID-19 cases. As new viruses and structural variants emerge, it is important to find solutions to streamline medical care in hospitals, which includes the expansion of digital network medicine (i.e., telemedicine and mobile health apps) for patients to continue to receive appropriate care without risking exposure to contagions. Mobile health app development continues to evolve with specialized diagnostics capabilities via external attachments that can provide rapid information sharing between patients and care providers while eliminating the need for office visits. Telemedicine, still in the early stages of adoption, especially in the developing world, can ensure access to medical information and contact with care providers, with the potential to release emergency rooms from excessive cases, and offer multidisciplinary access for patients and care providers that can also be a means to avoid contact during a pandemic. As this pandemic illustrated, an overhaul to streamline health care is essential, and a move towards greater use of mobile health and telemedicine will greatly benefit public health to control the spread of new variants and future outbreaks.
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Affiliation(s)
- Roxana Filip
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- BK Laboratory, SuceavaCounty Emergency Hospital, 720224 Suceava, Romania
| | - Roxana Gheorghita Puscaselu
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- Integrated Center for Research, Development and Innovation in Advanced Materials, Nanotechnologies, and Distributed Systems for Fabrication and Control, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
| | - Liliana Anchidin-Norocel
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
| | - Mihai Dimian
- Integrated Center for Research, Development and Innovation in Advanced Materials, Nanotechnologies, and Distributed Systems for Fabrication and Control, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- Department of Computers, Electronics and Automation, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
| | - Wesley K. Savage
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- Integrated Center for Research, Development and Innovation in Advanced Materials, Nanotechnologies, and Distributed Systems for Fabrication and Control, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
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Factors Associated with Arkansans' First Use of Telehealth during the COVID-19 Pandemic. Int J Telemed Appl 2022; 2022:5953027. [PMID: 35775023 PMCID: PMC9237707 DOI: 10.1155/2022/5953027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To examine the factors associated with the first use of telehealth during the COVID-19 pandemic using Andersen's Model of Healthcare Utilization. Andersen's Model of Healthcare Utilization allowed the categorization of the independent variables into the following: (1) predisposing factors, including sociodemographic variables and health beliefs; (2) enabling factors, including socioeconomic status and access to care; and (3) need for care, including preexisting or newly diagnosed conditions and reasons to seek out care or to utilize a new mode of care. Methods Potential respondents (n = 4,077) were identified for recruitment from a volunteer registry in Arkansas. Recruitment emails provided a study description, the opportunity to verify meeting the study's inclusion criteria and to consent for participation, and a link to follow to complete the survey online. The online survey responses were collected between July and August of 2020 (n = 1,137). Results Telehealth utilization included two categories: (1) utilizers reported the first use of telehealth services during the pandemic, and (2) nonutilizers reported they had never used telehealth. Lower odds of reporting telehealth utilization during the pandemic were associated with race (Black; OR = 0.57, CI [0.33, 0.96]) and education (high School or less; OR = 0.45, CI [0.25, 0.83]). Higher odds of reporting telehealth utilization included having more than one provider (OR = 2.33, CI [1.30, 4.18]), more physical (OR = 1.12, CI [1.00, 1.25]) and mental (OR 1.53, CI [1.24, 1.88]) health conditions, and changes in healthcare delivery during the pandemic (OR = 3.49, CI [2.78, 4.38]). Conclusions The results illustrate that disparities exist in Arkansans' utilization of telehealth services during the pandemic. Future research should explore the disparities in telehealth utilization and how telehealth may be used to address disparities in care for Black Arkansans and those with low socioeconomic status.
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Bianchi FP, Stefanizzi P, Brescia N, Lattanzio S, Martinelli A, Tafuri S. COVID-19 vaccination hesitancy in Italian healthcare workers: a systematic review and meta-analysis. Expert Rev Vaccines 2022; 21:1289-1300. [PMID: 35757890 DOI: 10.1080/14760584.2022.2093723] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION As for other vaccines, vaccination hesitancy may be a determining factor in the success (or otherwise) of the COVID-19 immunization campaign in healthcare workers (HCWs). AREAS COVERED To estimate the proportion of HCWs in Italy who expressed COVID-19 vaccine hesitancy, we conducted a systematic review of the relevant literature and a meta-analysis. Determinants of vaccine compliance and options suggested by these studies to address vaccine hesitancy among HCWs were also analyzed. Seventeen studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar and Scopus databases between January 1, 2020 and January 25, 2022. The vaccine hesitancy rate among HCWs was 13.1% (95%CI: 6.9-20.9%). The vaccine hesitancy rate among HCWs investigated before and during the vaccination campaign was 18.2% (95%CI=12.8-24.2%) and 8.9% (95%CI=3.4-16.6%), respectively. That main reasons for vaccine hesitation were lack of information about vaccination, opinion that the vaccine is unsafe, and fear of adverse events. EXPERT OPINION Despite strategies to achieve a greater willingness to immunize in this category, mandatory vaccination appears to be one of the most important measures that can guarantee the protection of HCWs and the patients they care for.
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Affiliation(s)
| | - Pasquale Stefanizzi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari
| | - Nazario Brescia
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari
| | - Sabrina Lattanzio
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari
| | - Andrea Martinelli
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari
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Daoud Pérez Z, Rázquin Arias M, López‐Escobar A, Díaz‐Conradi A, Arce A, Ruggeri N, Romero Blanco I, Díaz‐Delgado B, Ventura Wichner PS. The impact of COVID-19 lockdown on children with recurrent wheezing and asthma in Spain. J Paediatr Child Health 2022; 58:1635-1641. [PMID: 35748401 PMCID: PMC9350390 DOI: 10.1111/jpc.16068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/29/2022] [Accepted: 05/29/2022] [Indexed: 12/13/2022]
Abstract
AIM The rapid spread of a novel human coronavirus SARS-CoV-2 led to drastic measures world-wide. Most countries were forced to declare a national lockdown. We studied the effect of lockdown measures on the level of asthma control and maintenance treatment in children with recurrent wheezing and asthma during the first wave of COVID-19 in Spain. METHODS We analysed children with recurrent wheezing or asthma before and after the implementation of the lockdown, by using a questionnaire aimed to examine pre-existing respiratory disorders, step treatment and level of asthma control before/after lockdown, COVID history and laboratory testing including IgG SARS-CoV-2. RESULTS We enrolled 475 asthmatic and pre-school wheezers (60.6% males), mean age 5.6 years. There were no differences in asthma treatment comparing both periods: 81.7% maintained the same treatment (P = 0.103). According to child asthma-control questionnaire, 87.7% remained well controlled during confinement. Nearly, a third of children (34.9%) needed reliever treatment, mainly in older children. Determination of IgG SARS-CoV-2 was performed in 233 children (49.1%) of whom 17 (7.3%) tested positive. Seven patients positive to IgG SARS-CoV-2 were assisted in the emergency department and two required hospital admission. CONCLUSIONS During COVID-19 lockdown in Spain, most children with recurrent wheezing and asthma remained well controlled from their underlying disease and did not modify greatly their maintenance treatments. Unexpectedly, we also observed that those children who tested positive to SARS-CoV-2 IgG showed a significant increase in paediatric hospital admissions and attendances to urgent care settings.
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Affiliation(s)
- Zarife Daoud Pérez
- Pediatrics Pulmonology DepartmentHM HospitalsMadridSpain,Pediatrics DepartmentEmirates Speciality Hospital DubaiDubaiUnited Arab Emirates
| | | | - Alejandro López‐Escobar
- Pediatrics DepartmentHospital Vithas Madrid La MilagrosaMadridSpain,Clinical Research UnitFundación Vithas, Grupo VithasMadridSpain
| | | | - Amalia Arce
- Pediatrics DepartmentHM Nens, HM HospitalsBarcelonaSpain
| | - Nora Ruggeri
- Pediatrics Pulmonology DepartmentHM Nens, HM HospitalsBarcelonaSpain
| | | | | | - Paula S Ventura Wichner
- Pediatrics DepartmentHM Nens, HM HospitalsBarcelonaSpain,Pediatrics DepartmentFundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP)BadalonaSpain
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Goldbloom EB, Buba M, Bhatt M, Suntharalingam S, King WJ. Innovative virtual care delivery in a Canadian paediatric tertiary-care centre. Paediatr Child Health 2022; 27:S9-S14. [PMID: 35620564 PMCID: PMC9126280 DOI: 10.1093/pch/pxab104] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/24/2022] [Indexed: 11/14/2022] Open
Abstract
Health care systems and providers have rapidly adapted to virtual care delivery during this unprecedented time. Clinical programs initiated a variety of virtual care delivery models to maintain access to care, preserve personal protective equipment, and minimize infectious disease spread. Herein, we first describe the context within paediatric health delivery during the COVID-19 pandemic in Canada that fueled the rise of virtual care delivery. We then summarize the development, implementation, and beneficial impact of the innovative virtual care delivery programs currently in use at Children's Hospital of Eastern Ontario (CHEO) for both inpatient and outpatient care, specifically in our ambulatory clinics, emergency department, and mental health program. We highlight the transferable unique ways CHEO has integrated virtual care delivery through our governance structure, stakeholder engagement including patient, caregivers and health care providers and staff, development, and use of eHealth tools and novel approaches for patient care requiring physical assessment. We conclude with our vision for the future of virtual care, one component of paediatric care delivery in the post-COVID-19 era, which requires a common framework for virtual care evaluation. Importantly, rapid implementation of a primarily virtual care model at CHEO sustained high volume quality paediatric care. We believe many of these programs should and will remain in the post-pandemic era. A comprehensive, unified approach to evaluation is essential to yield meaningful results that inform sustainable care delivery models that integrate virtual care, and ultimately help ensure the best health outcomes for our patients.
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Affiliation(s)
- Ellen B Goldbloom
- Department of Pediatrics, CHEO, Ottawa, Ontario, Canada.,CHEO Research Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Melanie Buba
- Department of Pediatrics, CHEO, Ottawa, Ontario, Canada.,CHEO Research Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Maala Bhatt
- Department of Pediatrics, CHEO, Ottawa, Ontario, Canada.,CHEO Research Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sinthuja Suntharalingam
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Psychiatry, CHEO, Ottawa, Ontario, Canada
| | - W James King
- Department of Pediatrics, CHEO, Ottawa, Ontario, Canada.,CHEO Research Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Lin CH, Cerrone DA. Shifts in Asthma Evaluation and Management During COVID-19. CURRENT TREATMENT OPTIONS IN ALLERGY 2022; 9:42-51. [PMID: 35582628 PMCID: PMC9099326 DOI: 10.1007/s40521-022-00304-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/03/2022]
Abstract
Purpose of Review The comprehensive management of asthma has historically relied on in-person visits to obtain a detailed history, thorough physical exam, and diagnostic and monitoring tools such as pulmonary function testing. The COVID-19 pandemic has posed numerous challenges to adequately utilizing these strategies. Despite these limitations, telemedicine has provided an important means to deliver asthma care. In this review, we discuss how these challenges have created paradigm shifts in not only the clinical aspects of asthma management, but also in patient attitudes and physician-patient relationships. Recent Findings Different strategies have been suggested to address asthma during COVID-19. Telemedicine has taken on an important role during the pandemic. The emphasis on asthma questionnaire use, education regarding lapsed asthma control, and as-needed oral corticosteroid courses have proven to be important instruments in the remote management of asthma. Overall, asthma exacerbations have decreased during this time. This is thought to be due to a variety of factors such as decreased exposure to common triggers. Summary Although the COVID-19 pandemic significantly limited an allergist's ability to provide conventional comprehensive asthma management, we also found that patient outcomes have actually improved. In addition to the decreased exposure to asthma triggers, this may also be an effect of increased patient ownership of their asthma, and subsequent improved therapeutic alliance.
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Affiliation(s)
- Connie H. Lin
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Allergy and Clinical Immunology, University of California, Los Angeles, 1245 16th Street, Suite 303, Santa Monica, CA 90404 USA
| | - Daniel A. Cerrone
- Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, University of California, Davis, Davis, CA USA
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COVID-19 Mental Health Impacts Among Parents of Color and Parents of Children with Asthma. J Racial Ethn Health Disparities 2022; 10:1259-1269. [PMID: 35505151 PMCID: PMC9063870 DOI: 10.1007/s40615-022-01311-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES This study investigated whether select social determinants of health and worries about COVID-19 resource losses mediated the relations between four parent groups: [1) non-Hispanic White (NHW) parents of children with asthma; 2) Black, Indigenous, or other Persons of Color (BIPOC) parents of healthy children; 3) BIPOC parents of children with asthma; and 4) NHW parents of healthy children (referent)] and parent anxiety and depression symptoms during COVID-19. METHODS Parents (N = 321) completed online questionnaires about discrimination, anxiety, depression, and COVID-19 impacts on employment/income and access to food and health care. Mediation analyses were conducting using nonparametric bootstrapping procedures. RESULTS BIPOC parents of children with and without asthma experienced greater anxiety and depression symptoms through greater discrimination compared to NHW parents of healthy children. BIPOC parents of children with asthma experienced greater anxiety symptoms, and both BIPOC groups experienced greater depression symptoms, through greater COVID-19 income losses. NHW parents of children with asthma and both BIPOC groups experienced greater anxiety and depression symptoms through greater worries about COVID-19 resource losses. CONCLUSIONS The suffering of BIPOC parents, especially BIPOC parents of children with asthma, necessitates multi-level COVID-19 responses to address key drivers of health inequities.
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The impact of the COVID‐19 pandemic on pediatric chronic illness groups. THE BROWN UNIVERSITY CHILD AND ADOLESCENT BEHAVIOR LETTER 2022. [PMCID: PMC9083819 DOI: 10.1002/cbl.30623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The COVID‐19 pandemic has had profound impacts on children and families, with widescale disruptions in many aspects of individual, family, school, and peer functioning. For children and adolescents, the pandemic has contributed to increased prevalence of depression, anxiety, eating disorders, and suicidality, particularly among adolescents.
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40
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Galant SP, Morphew T, Ehwerhemuepha L. Reduced exposure to respiratory viral triggers may explain less health care utilization for children with asthma. Ann Allergy Asthma Immunol 2022; 128:486-487. [PMID: 35489799 PMCID: PMC9045739 DOI: 10.1016/j.anai.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Stanley Paul Galant
- Department of Pediatrics, Children's Hospital of Orange County, Orange, California,Department of Pediatrics, University of California, Orange, California,Corresponding author
| | | | - Louis Ehwerhemuepha
- Department of Research Administration, Children's Hospital of Orange County, Orange, California
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Özer M, Başkaya N, Bostancı İ. Attitudes towards influenza and pneumococcal vaccines in parents of asthmatic children during the COVID-19 pandemic. Pediatr Pulmonol 2022; 57:871-877. [PMID: 34997997 DOI: 10.1002/ppul.25818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/11/2021] [Accepted: 01/01/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study aimed to determine the differences in attitudes and views towards influenza and pneumococcal vaccines in parents of children with asthma during the COVID-19 pandemic. MATERIALS AND METHODS Asthmatic children in the 6-18 age group who were admitted to the pediatric allergy clinic of our hospital between October 1, 2020 and February 31, 2021 were included in the study. The parents were given a questionnaire asking about their demographics and medical history. Their attitudes and thoughts towards these two vaccines, both before and during the pandemic, and their COVID-19 stories were questioned. RESULTS A total of 78 patients diagnosed with asthma were included in this study. While the rate of influenza vaccination before the pandemic was 29.5%, the rate of those who received or wanted to receive influenza vaccine during the pandemic was 71.8% (p = 0.001). It was observed that the rate of influenza vaccination during the pandemic increased with the regular use of asthma medication, the presence of atopy, and a history of COVID-19 infection in the family/close environment. In total, 69.2% of the parents stated that their child's pneumococcal vaccination was incomplete or they were unaware of their child's vaccination status. CONCLUSION This study demonstrated that there was an increase in the rate and willingness of parents of asthmatic children to have their children vaccinated against influenza during the COVID-19 pandemic. As for the pneumococcal vaccine, the majority of the parents did not have enough information or they were unaware of the vaccination status of their children.
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Affiliation(s)
- Murat Özer
- Department of Pediatric Immunology and Allergy, Dr. Sami Ulus, Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Nevzat Başkaya
- Department of Pediatric Immunology and Allergy, Dr. Sami Ulus, Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - İlknur Bostancı
- Department of Pediatric Immunology and Allergy, Dr. Sami Ulus, Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Pediatric head and neck burns increased during early COVID-19 pandemic. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:528-532. [PMID: 35660365 PMCID: PMC8959658 DOI: 10.1016/j.oooo.2022.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 12/24/2022]
Abstract
Objective The purpose of this study was to describe patterns of burns to the head and neck in children during the early COVID-19 pandemic. Study design This cross-sectional study reviewed pediatric patients in the Burn Care Quality Platform Registry. Patients were included if they were ≤17.9 years old and had sustained burns to the head and neck. Patients were separated into the following groups: March 13 to September 13, 2019 (before COVID-19 pandemic, BC) or March 13 to September 13, 2020 (during the initial 6 months of the COVID-19 pandemic, C19). The study team collected patient-related variables, details regarding burn injury, burn severity, and hospital course. Univariate and bivariate analyses were calculated. The chi-squared test was used for categorical variables. Statistical significance was P < .05. Results Fifty-five children with head and neck burn injuries were included. There was a 200% increase in burns to the head and neck region in children in April 2021 compared with previous year. Burns to head and neck in White children occurred more often during C19 (P = .03). The study revealed differences in timing of presentation (time of burn injury to emergency department admission) in different racial groups during (White children [P = .05]), and after the pandemic (African American children [P = .02]). Conclusions There was a transient increase in burns to the head and neck region in children during the early pandemic compared with the historic cohort.
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ONAY ZR, MAVI D, AYHAN Y, CAN OKSAY S, BILGIN G, GIRIT S. Did Hospital Admissions Caused by Respiratory Infections and Asthma Decrease During the COVID-19 Pandemic? Medeni Med J 2022; 37:92-98. [PMID: 35306795 PMCID: PMC8939444 DOI: 10.4274/mmj.galenos.2022.02779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/01/2022] [Indexed: 12/01/2022] Open
Abstract
Objective Despite maximum isolation measures taken during the coronavirus disease-2019 (COVID-19) pandemic, the workload of health institutions has increased. Consequently, changes in the number of admissions in clinics and emergency departments by disease groups have been observed. We aimed to quantitatively investigate the changes in the frequency of respiratory infections and asthma in the pediatric population during the COVID-19 pandemic. Methods We analyzed electronic medical record data of patients who were admitted to the emergency department (ED), outpatient and inpatient clinics, and pediatric intensive care unit (PICU) because of influenza, upper and lower respiratory tract infections (URTI, LRTI), acute bronchiolitis, and asthma during the two-year period (one year pre-COVID period and first year of the pandemic). Results There were 96,648 admissions in the pre-COVID period and 15,848 during the pandemic. We observed a decline in ED admissions (-73%), outpatient clinic visits (-70%), hospitalizations (-41.5%), and PICU admissions (-42%). While the admission rates of patients with influenza [from 4.26% to 0.37% (p=0.0001)] and URTI [from 81.54% to 75.62% (p=0.0001)] decreased, the ratio of the number of admissions to the total number of admissions due to LRTI [from 8.22% to 10.01% (p=0.0001)], acute bronchiolitis [from 2.76% to 3.07% (p=0.027)], and asthma [from 5.96% to 14% (p=0.0001)] increased. Conclusions The decrease in viruses that cause acute bronchiolitis and asthma attacks lead to a reduction in admissions to ED of this patient group. The fact that parents preferred not to admit their child in ED during this period may have paved the way for the development of more severe LRTIs.
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Affiliation(s)
- Zeynep Reyhan ONAY
- Istanbul Medeniyet University Faculty of Medicine, Department of Pediatric Pulmonology, Istanbul, Turkey
| | - Deniz MAVI
- Istanbul Medeniyet University Faculty of Medicine, Department of Pediatric Pulmonology, Istanbul, Turkey
| | - Yetkin AYHAN
- Istanbul Medeniyet University Faculty of Medicine, Department of Pediatric Pulmonology, Istanbul, Turkey
| | - Sinem CAN OKSAY
- Istanbul Medeniyet University Faculty of Medicine, Department of Pediatric Pulmonology, Istanbul, Turkey
| | - Gulay BILGIN
- Istanbul Medeniyet University Faculty of Medicine, Department of Pediatric Pulmonology, Istanbul, Turkey
| | - Saniye GIRIT
- Istanbul Medeniyet University Faculty of Medicine, Department of Pediatric Pulmonology, Istanbul, Turkey
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COVID-19 Infections and Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:658-663. [PMID: 34838708 PMCID: PMC8613003 DOI: 10.1016/j.jaip.2021.10.072] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/30/2021] [Indexed: 12/15/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19), has infected more than 200 million and led to the deaths of more than 4.3 million people. Although there are known risk factors for severe disease, asthma was initially hypothesized to be a risk factor for severe disease given the association between asthma exacerbations and respiratory viral illnesses in general. Fortunately, clinical outcomes for patients with asthma overall are similar to those for patients without asthma, without convincing evidence that asthma is a risk factor for severe disease. This may be explained in part by the decreasing gradient of angiotensin-converting enzyme-2 receptor from the upper to lower respiratory epithelium and that aeroallergen-sensitized patients with asthma can have up to 50% reduction in angiotensin-converting enzyme-2 receptor expression. Vaccination for patients with asthma is recommended for all without clear contraindications. COVID-19–specific treatment options are available depending on the severity of disease. We caution the use of systemic corticosteroids in patients with asthma not requiring supplemental oxygen given an association with worse outcomes. Postacute COVID-19 syndrome or long-haul COVID does not appear to be more prevalent in the population with asthma, and a multidisciplinary approach to care is a reasonable option.
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Sancakli O, Tuncel T, Eren Akarcan S, Kanık A, Özyurt G, Ozdogru EE. Anxiety Levels and Changes in Health and Hygiene Behaviors in Mothers of Children with Asthma in Early COVID-19 Lockdown in Turkey. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2022; 35:27-35. [PMID: 35290751 DOI: 10.1089/ped.2021.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: The restrictions imposed by the coronavirus disease 2019 (COVID-19) pandemic have caused significant changes in people's lives. This study aimed to investigate anxiety levels and changes in health and hygiene behaviors in mothers of children with asthma in early COVID-19 lockdown in Turkey. Materials and Methods: This study was a cross-sectional survey conducted on children with asthma, 6 to 11 years of age, between June 1 and 30, 2020, in Turkey. A sociodemographic data form, health and hygiene behavior form, childhood asthma control test, and state-trait anxiety inventory were administered to the mothers of the children. Results: The asthma group included 123 children (Female: 39.0%) and median age, interquartile range (IQR) [minimum-maximum]: 8.0 (6) [6-12] years; the control group included 88 children (Female: 47.7%) median age, IQR [minimum-maximum]: 8.0 (7) [5-12] years. Increased hygiene behaviors and high compliance with social isolation measures were recorded in the early lockdown, with no difference between the groups. Before the pandemic, the most frequently used cleaning products were general-purpose cleaners. During the early lockdown, however, the most frequently used product was disinfectants and was similar in both groups. In both groups, the rate of using nutritional supplements increased during the pandemic period, but the rate was higher in children with asthma both before and during the early lockdown (P < 0.001). The anxiety levels of the mothers in asthma and control groups were similar. Conclusion: This study is the first in Turkey demonstrating that, in mothers of children with asthma, lifestyle changes related to health and hygiene and anxiety levels are similar to those of other children and their mothers during the early lockdown period of COVID-19 pandemic.
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Affiliation(s)
- Ozlem Sancakli
- Department of Pediatric Allergy Immunology, Başkent University, Izmir, Turkey
| | - Tuba Tuncel
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Izmir University of Health Sciences Izmir Tepecik Training and Research Hospital, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Sanem Eren Akarcan
- Department of Pediatric Allergy and Immunology, Izmir University of Health Sciences Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ali Kanık
- Department of Pediatrics, Izmir University of Health Sciences Izmir Tepecik Training and Research Hospital, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Gonca Özyurt
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Emine Ece Ozdogru
- Department of Pediatric Allergy and Immunology, Izmir University of Health Sciences Izmir Tepecik Training and Research Hospital, Izmir, Turkey
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Bartha I, Bernaola M, Escudero C, Rodríguez Del Río P, Bazire R, Ibáñez Sandín MD. COVID-19 and childhood asthma: Analysis of a pediatric referral hospital. Pediatr Allergy Immunol 2022; 33:e13757. [PMID: 35338727 PMCID: PMC9115475 DOI: 10.1111/pai.13757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Irene Bartha
- Allergy Derpartment, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Marta Bernaola
- Allergy Derpartment, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Carmelo Escudero
- Allergy Derpartment, Hospital Infantil Universitario Niño Jesús, Madrid, España.,FibHNJ, ARADyAL-RETICs RD16/RD16/0006/0026 Instituto de Salud Carlos III, Madrid, España.,IIS La Princesa, Madrid, España
| | - Pablo Rodríguez Del Río
- Allergy Derpartment, Hospital Infantil Universitario Niño Jesús, Madrid, España.,FibHNJ, ARADyAL-RETICs RD16/RD16/0006/0026 Instituto de Salud Carlos III, Madrid, España.,IIS La Princesa, Madrid, España
| | - Raphaëlle Bazire
- Allergy Derpartment, Hospital Infantil Universitario Niño Jesús, Madrid, España.,FibHNJ, ARADyAL-RETICs RD16/RD16/0006/0026 Instituto de Salud Carlos III, Madrid, España.,IIS La Princesa, Madrid, España.,Contrato Río Hortega CM20/00253, Instituto de Salud Carlos III, Fondo Social Europeo, Madrid, Spain
| | - Maria Dolores Ibáñez Sandín
- Allergy Derpartment, Hospital Infantil Universitario Niño Jesús, Madrid, España.,FibHNJ, ARADyAL-RETICs RD16/RD16/0006/0026 Instituto de Salud Carlos III, Madrid, España.,IIS La Princesa, Madrid, España
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Factors Impacting Video Telehealth Appointment Completion During COVID-19 Pandemic Among People Living with HIV in a Community-Based Health System. AIDS Behav 2022; 26:407-414. [PMID: 34312740 PMCID: PMC8313002 DOI: 10.1007/s10461-021-03394-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 11/25/2022]
Abstract
As the threat of COVID-19 on vulnerable populations continues, mitigation protocols have escalated the use of telehealth platforms, secure 2-way video platforms with audio capabilities. The goal of the current study was to examine factors associated with successful completion of video telehealth appointments in HIV care. We utilized a random effects logistic model to assess characteristics of patient encounters that predicted completed telehealth visits. Results show that factors such as identifying as black (AOR = 0.30, 95% CI 0.23–0.40, p < 0.01), identifying as heterosexual (AOR = 0.40, 95% CI, 0.29–0.55, p < 0.01), identifying as Hispanic/Latinx (AOR = 0.67, 95% CI, 0.48–0.95), having public insurance (e.g., Ryan White funding, Medicare/Medicaid) (AOR = .25, 95% CI 0.19–0.33, p < .001), and having detectable viral load (AOR = .049, 95% CI, 0.31–0.76) are negatively associated with completion of telehealth appointments. Results suggest that greater efforts to address the digital divide are needed to increase access to video telehealth.
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Haapanen M, Renko M, Artama M, Kuitunen I. Systemic antibiotics and asthma medicines dispensed to 0-12 year olds significantly decreased during the COVID-19 pandemic in 2020. Acta Paediatr 2022; 111:376-382. [PMID: 34626007 PMCID: PMC8652669 DOI: 10.1111/apa.16144] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 12/24/2022]
Abstract
Aim Nationwide lockdowns and social restrictions during the COVID‐19 pandemic have reduced childhood infections. We assessed how many items of systemic antibiotics and asthma medicines were dispensed to children aged 0−12 years in Finland before and during the pandemic and analysed the reimbursement costs. Methods The data came from the national Finnish register of reimbursable prescriptions, which is maintained by the country's Social Insurance Institution. It included all prescriptions for antibiotics and asthma medicines dispensed to children aged 0−12 years in 2019 and 2020. Prescription rates per 1000 children were calculated for each quarter and compared using rate ratios and 95% confidence intervals (95% CI). Results Overall dispensing for antibiotics decreased by 55.3% and was most prominent for macrolides for children aged 0−5 years (59.6%, 95% CI 60.9%−58.2%). Asthma medicines decreased by 19.8%, and the most prominent reduction was in short‐acting beta‐agonists for children aged 0−5 years (35.2%, 95% CI 36.1%−34.2%). These reduced reimbursement costs by 3.4 million Euros from 2019 to 2020. Conclusion This nationwide study showed that the number of antibiotics and asthma medicines decreased by 59.6% and 19.8% respectively from 2019 to 2020, generating a cost saving of 3.4 million Euros.
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Affiliation(s)
- Marjut Haapanen
- Department of Pediatrics Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
| | - Marjo Renko
- Department of Pediatrics Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
- Department of Pediatrics Kuopio University Hospital Kuopio Finland
- University of Oulu PEDEGO Research Unit Oulu Finland
| | - Miia Artama
- Faculty of Social Sciences Tampere University Tampere
- Finnish Institute of Health and Welfare Tampere
| | - Ilari Kuitunen
- Department of Pediatrics Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
- Department of Pediatrics Mikkeli Central Hospital Mikkeli Finland
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McAndrew T, Cambeiro J, Besiroglu T. Aggregating human judgment probabilistic predictions of the safety, efficacy, and timing of a COVID-19 vaccine. Vaccine 2022; 40:2331-2341. [PMID: 35292162 PMCID: PMC8882426 DOI: 10.1016/j.vaccine.2022.02.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/15/2022]
Abstract
Safe, efficacious vaccines were developed to reduce the transmission of SARS-CoV-2 during the COVID-19 pandemic. But in the middle of 2020, vaccine effectiveness, safety, and the timeline for when a vaccine would be approved and distributed to the public was uncertain. To support public health decision making, we solicited trained forecasters and experts in vaccinology and infectious disease to provide monthly probabilistic predictions from July to September of 2020 of the efficacy, safety, timing, and delivery of a COVID-19 vaccine. We found, that despite sparse historical data, a linear pool—a combination of human judgment probabilistic predictions—can quantify the uncertainty in clinical significance and timing of a potential vaccine. The linear pool underestimated how fast a therapy would show a survival benefit and the high efficacy of approved COVID-19 vaccines. However, the linear pool did make an accurate prediction for when a vaccine would be approved by the FDA. Compared to individual forecasters, the linear pool was consistently above the median of the most accurate forecasts. A linear pool is a fast and versatile method to build probabilistic predictions of a developing vaccine that is robust to poor individual predictions. Though experts and trained forecasters did underestimate the speed of development and the high efficacy of a SARS-CoV-2 vaccine, linear pool predictions can improve situational awareness for public health officials and for the public make clearer the risks, rewards, and timing of a vaccine.
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Abstract
Asthma is common in children and exacerbations are usually triggered by respiratory viruses. There was considerable concern about the impact of COVID-19 on children with asthma. It was expected that children with asthma would fare poorly during the pandemic. However, the reported effect of the COVID-19 pandemic on pediatric asthma including acute asthma admissions, does not appear to be significant, but this needs careful follow-up. The socioeconomic effects of the pandemic and reduced healthcare access could potentially impact on ongoing delivery of health care in chronic respiratory conditions including asthma, especially in resource-poor settings. Children with chronic asthma need to be treated as per internationally published guidelines with innovative models of disease monitoring and ongoing care during the pandemic. During the pandemic, children with acute asthma need to be managed carefully based on local guidelines and using strict infection control policies. The use of technology such as telehealth and various tools of asthma management including questionnaires and digital monitoring will play an important role in asthma management during the pandemic. Medical professionals, healthcare administrators, and governments should be sensitive to the evolving needs of the community and work closely to continue to provide services in a challenging yet unresolved pandemic.
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