1
|
Rogers NT, Cummins S, Jones CP, Mytton OT, Roberts CH, Shaheen SO, Shah SA, Sheikh A, White M, Adams J. The UK Soft Drinks Industry Levy and childhood hospital admissions for asthma in England. Nat Commun 2024; 15:4934. [PMID: 38858369 PMCID: PMC11164966 DOI: 10.1038/s41467-024-49120-4] [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: 11/06/2023] [Accepted: 05/24/2024] [Indexed: 06/12/2024] Open
Abstract
Sugar sweetened beverage consumption has been suggested as a risk factor for childhood asthma symptoms. We examined whether the UK Soft Drinks Industry Levy (SDIL), announced in March 2016 and implemented in April 2018, was associated with changes in National Health Service hospital admission rates for asthma in children, 22 months post-implementation of SDIL. We conducted interrupted time series analyses (2012-2020) to measure changes in monthly incidence rates of hospital admissions. Sub-analysis was by age-group (5-9,10-14,15-18 years) and neighbourhood deprivation quintiles. Changes were relative to counterfactual scenarios where the SDIL wasn't announced, or implemented. Overall, incidence rates reduced by 20.9% (95%CI: 29.6-12.2). Reductions were similar across age-groups and deprivation quintiles. These findings give support to the idea that implementation of a UK tax intended to reduce childhood obesity may have contributed to a significant unexpected and additional public health benefit in the form of reduced hospital admissions for childhood asthma.
Collapse
Affiliation(s)
- Nina T Rogers
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK.
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Catrin P Jones
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Oliver T Mytton
- Great Ormond Street Institute of Child Health, 30 Guilford Street, London, UK
| | - Chrissy H Roberts
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Seif O Shaheen
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Syed Ahmar Shah
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Martin White
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jean Adams
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| |
Collapse
|
2
|
Darsha Jayamini WK, Mirza F, Asif Naeem M, Chan AHY. Investigating Machine Learning Techniques for Predicting Risk of Asthma Exacerbations: A Systematic Review. J Med Syst 2024; 48:49. [PMID: 38739297 PMCID: PMC11090925 DOI: 10.1007/s10916-024-02061-3] [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: 10/13/2023] [Accepted: 04/04/2024] [Indexed: 05/14/2024]
Abstract
Asthma, a common chronic respiratory disease among children and adults, affects more than 200 million people worldwide and causes about 450,000 deaths each year. Machine learning is increasingly applied in healthcare to assist health practitioners in decision-making. In asthma management, machine learning excels in performing well-defined tasks, such as diagnosis, prediction, medication, and management. However, there remain uncertainties about how machine learning can be applied to predict asthma exacerbation. This study aimed to systematically review recent applications of machine learning techniques in predicting the risk of asthma attacks to assist asthma control and management. A total of 860 studies were initially identified from five databases. After the screening and full-text review, 20 studies were selected for inclusion in this review. The review considered recent studies published from January 2010 to February 2023. The 20 studies used machine learning techniques to support future asthma risk prediction by using various data sources such as clinical, medical, biological, and socio-demographic data sources, as well as environmental and meteorological data. While some studies considered prediction as a category, other studies predicted the probability of exacerbation. Only a group of studies applied prediction windows. The paper proposes a conceptual model to summarise how machine learning and available data sources can be leveraged to produce effective models for the early detection of asthma attacks. The review also generated a list of data sources that other researchers may use in similar work. Furthermore, we present opportunities for further research and the limitations of the preceding studies.
Collapse
Affiliation(s)
- Widana Kankanamge Darsha Jayamini
- School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, 1010, New Zealand.
- Department of Software Engineering, Faculty of Computing and Technology, University of Kelaniya, Kelaniya, 11300, Sri Lanka.
| | - Farhaan Mirza
- School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, 1010, New Zealand
| | - M Asif Naeem
- Department of Data Science & Artificial Intelligence, National University of Computer and Emerging Sciences (NUCES), Islamabad, 44000, Pakistan
| | - Amy Hai Yan Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, 1142, New Zealand
| |
Collapse
|
3
|
Bowman WS, Schmidt RJ, Sanghar GK, Thompson Iii GR, Ji H, Zeki AA, Haczku A. "Air That Once Was Breath" Part 2: Wildfire Smoke and Airway Disease - "Climate Change, Allergy and Immunology" Special IAAI Article Collection: Collegium Internationale Allergologicum Update 2023. Int Arch Allergy Immunol 2024; 185:617-630. [PMID: 38527432 DOI: 10.1159/000536576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/23/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Population growth and climate change have led to more frequent and larger wildfires, increasing the exposure of individuals to wildfire smoke. Notably, asthma exacerbations and allergic airway sensitization are prominent outcomes of such exposure. SUMMARY Key research questions relate to determining the precise impact on individuals with asthma, including the severity, duration, and long-term consequences of exacerbations. Identifying specific risk factors contributing to vulnerability, such as age, genetics, comorbidities, or environmental factors, is crucial. Additionally, reliable biomarkers for predicting severe exacerbations need exploration. Understanding the long-term health effects of repeated wildfire smoke exposures in individuals with asthma and addressing healthcare disparities are important research areas. KEY MESSAGES This review discusses the need for comprehensive research efforts to better grasp wildfire smoke-induced respiratory health, particularly in vulnerable populations such as farmworkers, firefighters, pregnant women, children, the elderly, and marginalized communities. Effective mitigation would require addressing the current limitations we face by supporting research aimed at a better understanding of wildfire smoke-induced airway disease.
Collapse
|
4
|
Sharrad KJ, Sanwo O, Cuevas-Asturias S, Kew KM, Carson-Chahhoud KV, Pike KC. Psychological interventions for asthma in children and adolescents. Cochrane Database Syst Rev 2024; 1:CD013420. [PMID: 38205864 PMCID: PMC10782779 DOI: 10.1002/14651858.cd013420.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND Rates of asthma are high in children and adolescents, and young people with asthma generally report poorer health outcomes than those without asthma. Young people with asthma experience a range of challenges that may contribute to psychological distress. This is compounded by the social, psychological, and developmental challenges experienced by all people during this life stage. Psychological interventions (such as behavioural therapies or cognitive therapies) have the potential to reduce psychological distress and thus improve behavioural outcomes such as self-efficacy and medication adherence. In turn, this may reduce medical contacts and asthma attacks. OBJECTIVES To determine the efficacy of psychological interventions for modifying health and behavioural outcomes in children with asthma, compared with usual treatment, treatment with no psychological component, or no treatment. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register (including CENTRAL, CRS, MEDLINE, Embase, PsycINFO, CINAHL EBSCO, AMED EBSCO), proceedings of major respiratory conferences, reference lists of included studies, and online clinical databases. The most recent search was conducted on 22 August 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing psychological interventions of any duration with usual care, active controls, or a waiting-list control in male and female children and adolescents (aged five to 18 years) with asthma. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. symptoms of anxiety and depression, 2. medical contacts, and 3. asthma attacks. Our secondary outcomes were 1. self-reported asthma symptoms, 2. medication use, 3. quality of life, and 4. adverse events/side effects. MAIN RESULTS We included 24 studies (1639 participants) published between 1978 and 2021. Eleven studies were set in the USA, five in China, two in Sweden, three in Iran, and one each in the Netherlands, UK, and Germany. Participants' asthma severity ranged from mild to severe. Three studies included primary school-aged participants (five to 12 years), two included secondary school-aged participants (13 to 18 years), and 18 included both age groups, while one study was unclear on the age ranges. Durations of interventions ranged from three days to eight months. One intervention was conducted online and the rest were face-to-face. Meta-analysis was not possible due to clinical heterogeneity (interventions, populations, outcome tools and definitions, and length of follow-up). We tabulated and summarised the results narratively with reference to direction, magnitude, and certainty of effects. The certainty of the evidence was very low for all outcomes. A lack of information about scale metrics and minimal clinically important differences for the scales used to measure anxiety, depression, asthma symptoms, medication use, and quality of life made it difficult to judge clinical significance. Primary outcomes Four studies (327 participants) reported beneficial or mixed effects of psychological interventions versus controls for symptoms of anxiety, and one found little to no difference between groups (104 participants). Two studies (166 participants) that evaluated symptoms of depression both reported benefits of psychological interventions compared to controls. Three small studies (92 participants) reported a reduction in medical contacts, but two larger studies (544 participants) found little or no difference between groups in this outcome. Two studies (107 participants) found that the intervention had an important beneficial effect on number of asthma attacks, and one small study (22 participants) found little or no effect of the intervention for this outcome. Secondary outcomes Eleven studies (720 participants) assessed asthma symptoms; four (322 participants) reported beneficial effects of the intervention compared to control, five (257 participants) reported mixed or unclear findings, and two (131 participants) found little or no difference between groups. Eight studies (822 participants) reported a variety of medication use measures; six of these studies (670 participants) found a positive effect of the intervention versus control, and the other two (152 participants) found little or no difference between the groups. Across six studies (653 participants) reporting measures of quality of life, the largest three (522 participants) found little or no difference between the groups. Where findings were positive or mixed, there was evidence of selective reporting (2 studies, 131 participants). No studies provided data related to adverse effects. AUTHORS' CONCLUSIONS Most studies that reported symptoms of anxiety, depression, asthma attacks, asthma symptoms, and medication use found a positive effect of psychological interventions versus control on at least one measure. However, some findings were mixed, it was difficult to judge clinical significance, and the evidence for all outcomes is very uncertain due to clinical heterogeneity, small sample sizes, incomplete reporting, and risk of bias. There is limited evidence to suggest that psychological interventions can reduce the need for medical contact or improve quality of life, and no studies reported adverse events. It was not possible to identify components of effective interventions and distinguish these from interventions showing no evidence of an effect due to substantial heterogeneity. Future investigations of evidence-based psychological techniques should consider standardising outcomes to support cross-comparison and better inform patient and policymaker decision-making.
Collapse
Affiliation(s)
- Kelsey J Sharrad
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | | | | | | | | | | |
Collapse
|
5
|
Sarikloglou E, Fouzas S, Paraskakis E. Prediction of Asthma Exacerbations in Children. J Pers Med 2023; 14:20. [PMID: 38248721 PMCID: PMC10820562 DOI: 10.3390/jpm14010020] [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: 11/26/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Asthma exacerbations are common in asthmatic children, even among those with good disease control. Asthma attacks result in the children and their parents missing school and work days; limit the patient's social and physical activities; and lead to emergency department visits, hospital admissions, or even fatal events. Thus, the prompt identification of asthmatic children at risk for exacerbation is crucial, as it may allow for proactive measures that could prevent these episodes. Children prone to asthma exacerbation are a heterogeneous group; various demographic factors such as younger age, ethnic group, low family income, clinical parameters (history of an exacerbation in the past 12 months, poor asthma control, poor adherence to treatment, comorbidities), Th2 inflammation, and environmental exposures (pollutants, stress, viral and bacterial pathogens) determine the risk of a future exacerbation and should be carefully considered. This paper aims to review the existing evidence regarding the predictors of asthma exacerbations in children and offer practical monitoring guidance for promptly recognizing patients at risk.
Collapse
Affiliation(s)
| | - Sotirios Fouzas
- Department of Pediatrics, University of Patras Medical School, 26504 Patras, Greece;
| | - Emmanouil Paraskakis
- Paediatric Respiratory Unit, Paediatric Department, University of Crete, 71500 Heraklion, Greece
| |
Collapse
|
6
|
Rodriguez-Martinez CE, Sossa-Briceño MP. Disparities in prevalence and outcomes of respiratory disease in low- and middle-income countries. Pediatr Pulmonol 2023. [PMID: 37378459 DOI: 10.1002/ppul.26573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/18/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVES To provide a comprehensive overview of disparities in prevalence and outcomes of respiratory diseases and notable challenges for providing optimal treatment to pediatric patients with respiratory diseases living in low- and middle-income countries (LMICs), as an input to help better understand the roots of respiratory health disparities. METHODS We conducted a narrative review of relevant literature published in electronic databases from inception to February 2023 that present data on disparities in prevalence and outcomes of respiratory disease in LMICs. Additionally, we included studies that describe and discuss challenges for providing optimal treatment to pediatric patients with respiratory diseases living in LMICs. RESULTS A number of early life exposures have been associated with adverse respiratory outcomes in later life. Several studies have shown marked geographical variations in the prevalence and burden of pediatric asthma, with consistently lower prevalence rates but significantly higher burdens and worse outcomes in LMICs. There is a wide range of challenges that adversely affect the efficient care of children with respiratory diseases that can be classified into three categories: patient-related factors, social/environmental factors, and factors related to healthcare providers or the healthcare system. CONCLUSIONS Respiratory health disparities in children living in LMICs represent a global public health issue mainly explained by an unequal distribution of preventable and modifiable risk factors for respiratory diseases across different demographic groups.
Collapse
Affiliation(s)
- Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
- Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia
| | | |
Collapse
|
7
|
Matsumura Y. Inadequate therapeutic responses to glucocorticoid treatment in bronchial asthma. J Int Med Res 2023; 51:3000605231175746. [PMID: 37296513 DOI: 10.1177/03000605231175746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Bronchial asthma (BA) is a heterogeneous disease. Some patients benefit greatly from glucocorticoid (GC) treatment, whereas others are non-responders. This could be attributable to differences in pathobiology. Thus, predicting the responses to GC treatment in patients with BA is necessary to increase the success rates of GC therapy and avoid adverse effects. The sustained inflammation in BA decreases glucocorticoid receptor (GR, NR3C1) function. Meanwhile, GRβ overexpression might contribute to GC resistance. Important factors in decreased GR function include p38 mitogen-activated protein kinase-dependent GR phosphorylated at Ser226, reduced expression of histone deacetylase 2 following activation of the phosphatidylinositol 3-kinase-δ signaling pathway, and increased nuclear factor-kappa B activity. MicroRNAs, which are involved in GC sensitivity, are considered biomarkers of the response to inhaled GCs. Some studies revealed that inflammatory phenotypes and disease-related modifiable factors, including infections, the airway microbiome, mental stress, smoking, and obesity, regulate individual sensitivity to GCs. Therefore, future investigations are warranted to improve treatment outcomes.
Collapse
Affiliation(s)
- Yasuhiro Matsumura
- Department of Internal Medicine, Sasaki Foundation Kyoundo Hospital, Tokyo, Japan
| |
Collapse
|
8
|
Sedentary behaviour, but not moderate-to-vigorous physical activity, is associated with respiratory responses to acute psychological stress. Biol Psychol 2023; 177:108510. [PMID: 36716988 DOI: 10.1016/j.biopsycho.2023.108510] [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: 02/07/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND Acute psychological stress induces respiratory responses, and stress-induced respiratory changes can be used to non-invasively reflect metabolic regulation. Respiratory and cardiovascular responses to stress are both driven by sympathetic mechanisms. Higher volumes of sedentary behaviour and lower volumes of physical activity are associated with elevated sympathetic tone and larger cardiovascular responses to stress. The aim of this study was to test whether these associations translate to measures of respiratory stress reactivity. METHODS Daily hours of sedentary behaviour (thigh-mounted activPAL) and moderate-to-vigorous physical activity (MVPA; wrist-mounted ActiGraph) were assessed across seven days. Breath-by-breath respiratory (e.g., breathing frequency [BF], end-tidal carbon dioxide partial pressure [PetCO2], carbon dioxide output [V̇CO2] and respiratory exchange ratio [RER]) responses to an 8-min Paced Auditory Serial Addition Test were then measured using a Cortex MetaLyzer3B. RESULTS Healthy participants (N = 61, mean age ± SD = 25.7 ± 8.9 years) recorded high volumes of sedentary behaviour (9.96 ± 1.48 h/day) and MVPA (1.70 ± 0.71 h/day). In adjusted models (with the inclusion of sedentary behaviour, MVPA, and other a priori selected covariates) hours of daily sedentary behaviour were associated with baseline to stress changes in BF (Β = 0.695, 95% CI = 0.281 - 1.109, p = .014), VT (Β = -0.042, 95% CI = -0.058 - -0.026, p = .014), PetCO2 (Β = -0.537, 95% CI = -0.829 - -0.245, p = .014), V̇CO2 (Β = -0.008, 95% CI = -0.014 - -0.003, p = .030), and RER (Β = -0.013, 95% CI = -0.021 - -0.005, p = .022). Daily hours of MVPA were not linked with respiratory responses to stress. DISCUSSION Sedentary behaviour, but not MVPA, is associated with respiratory stress reactivity. Future work should untangle the underlying mechanisms of these findings and explore the consequences for cardiometabolic disease.
Collapse
|
9
|
Akuthota P. Asthma Exacerbations: Patient Features and Potential Long-Term Implications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1426:253-263. [PMID: 37464125 DOI: 10.1007/978-3-031-32259-4_12] [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: 07/20/2023]
Abstract
Asthma exacerbations occur in the context of a complex interplay between external exposures and host factors. Respiratory tract viral infections, in particular rhinovirus, are dominant initiators of exacerbations, with allergens and other inhalation exposures as additional key contributors. The presence of underlying type II inflammation, with associated biomarker elevations, is a major driver of exacerbation risk and mechanism, as evidenced by the consistent reduction of exacerbations seen with biologics targeting these pathways. Several genetic polymorphisms are associated with exacerbations, and while they may individually have small effects, they are cumulatively important and magnified by environmental exposures. A history of exacerbations predicts future exacerbations with potentially negative implications on long-term lung health.
Collapse
Affiliation(s)
- Praveen Akuthota
- Division of Pulmonary, Critical Care, Sleep Medicine, & Physiology, University of California San Diego, La Jolla, CA, USA.
| |
Collapse
|
10
|
Shahunja KM, Sly PD, Huda MM, Mamun A. Trajectories of neighborhood environmental factors and their associations with asthma symptom trajectories among children in Australia: evidence from a national birth cohort study. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2022; 20:835-847. [PMID: 36406622 PMCID: PMC9672149 DOI: 10.1007/s40201-022-00824-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE This study aims to investigate the prospective associations of neighborhood environmental exposure trajectories with asthma symptom trajectories during childhood developmental stages. METHODS We considered asthma symptom, neighborhood environmental factors, and socio-demographic data from the "Longitudinal Study of Australian Children (LSAC)". Group-based trajectory modeling was applied to identify the trajectories of asthma symptom, neighborhood traffic conditions, and neighborhood livability scales (considered for safety and facilities). We used multivariable logistic regression models to assess associations between various neighborhood environmental factors and asthma symptom trajectories. RESULTS We included 4,174 children from the LSAC cohort in our study. Three distinct trajectories for asthma symptom were the outcome variables of this study. Among the neighborhood environmental factors, we identified two distinct trajectories for the prevalence of heavy traffic on street, and two trajectories of neighborhood liveability scale. Compared to the 'Low/no' asthma symptoms trajectory group, children exposed to a 'persistently high' prevalence of heavy traffic on street was also significantly associated with both 'transient high' [relative risk ratio (RRR):1.40, 95% CI:1.25,1.58) and 'persistent high' (RRR: 1.33, 95% CI:1.17,1.50)] asthma symptom trajectory groups. Trajectory of moderate and static neighborhood liveability score was at increased risk of being classified as 'transient high' (RRR:1.16, 95% CI:1.07,1.25) and 'persistent high' (RRR:1.38, 95% CI:1.27,1.50) trajectories of asthma symptom. CONCLUSION Exposure to heavy traffic and poor neighborhood liveability increased the risk of having an unfavourable asthma symptom trajectory in childhood. Reducing neighborhood traffic load and improving neighborhood safety and amenities may facilitate a favorable asthma symptom trajectory among these children. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40201-022-00824-z.
Collapse
Affiliation(s)
- K M Shahunja
- UQ Poche Centre for Indigenous Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia
- The Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Brisbane, Australia
| | - Peter D Sly
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - M Mamun Huda
- UQ Poche Centre for Indigenous Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia
| | - Abdullah Mamun
- UQ Poche Centre for Indigenous Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia
- The Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Brisbane, Australia
| |
Collapse
|
11
|
Nayak SS, Borkar R, Ghozy S, Agyeman K, Al-Juboori MT, Shah J, Ulrich MT. Social vulnerability, medical care access and asthma related emergency department visits and hospitalization: An observational study. Heart Lung 2022; 55:140-145. [PMID: 35588567 DOI: 10.1016/j.hrtlng.2022.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/22/2022] [Accepted: 04/27/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Social Vulnerability Index (SVI) is a publicly available dataset to identify communities in greatest need of resources. OBJECTIVE To examine the utility of using the county-level SVI as predictors of asthma-related outcomes. METHODS We used the American Community Survey-derived SVI and the National Environmental Public Health Tracking Network - Query Tool to retrieve data for all counties with available SVI data and at least one matched outcome of interest. Then, we tested SVI as a predictor for emergency department visits (EDV) and hospitalizations, with investigating disparities in primary care physician (PCP) density and emergency department physicians (EDP) density. Linear and logistic regression models were used. RESULTS Compared to counties of the lowest SVI quartile, counties of mid-low, mid-high, and highest SVI quartiles had 1%, 4%, and 5% higher odds of asthma-related EDV per 10,000 population, respectively, and 4%, 21%, and 24% higher odds of asthma-related hospitalization per 10,000 population, respectively. Moreover, the data showed an apparent resources mismatch between the EDP densities per 10,000 populations and the SVI quartiles, and the effect of the county level SVI on the asthma-related EDV and hospitalization is not strongly affected by PCP or EDP densities. CONCLUSION The counties with the highest SVI -and the most vulnerable to asthma hazards- have a lower coverage of PCP and EDP. Interventions directed to address persistent social vulnerability would offer the opportunity of primary prevention with less exhaustion for the medical resources.
Collapse
Affiliation(s)
- Sandeep S Nayak
- Department of Internal Medicine, NYC Health + Hospitals/Metropolitan, NY 10029, USA; Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, CT 06610, USA.
| | - Rachana Borkar
- Department of Internal Medicine, NYC Health + Hospitals/Metropolitan, NY 10029, USA.
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; Nuffield Department of Primary Care Health Sciences and Department for Continuing Education (EBHC program), Oxford University, UK.
| | - Kwame Agyeman
- Department of Internal Medicine, Loma Linda University Medical Center, CA 92354, USA.
| | - Mohammed T Al-Juboori
- Department of Internal Medicine, NYC Health + Hospitals/Metropolitan, NY 10029, USA.
| | - Jaffer Shah
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
| | - Michael T Ulrich
- Department of Internal Medicine, Loma Linda University Medical Center, CA 92354, USA; Department of Internal Medicine, Riverside University Health System, CA 92555, USA.
| |
Collapse
|
12
|
Individual Experiences with Being Pushed to Limits and Variables That Influence the Strength to Which These Are Felt: A Cross-Sectional Survey Study. J 2022. [DOI: 10.3390/j5030024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In a 2021 survey, we found that “limit or suppression experiences” were related to a willingness to use enhancement technologies. However, the concept of “limit or suppression experiences” is vague and difficult to interpret in relation to neuroethics/enhancement. Thus, we aimed to better understand “limit or suppression experiences” and establish a robust philosophical concept of the topic. To do so, we exploratively investigated the concept to determine individual experiences with the presence or absence of sensing limits, investigate different ways in which limits can be sensed (factors of the sense of limits: “FSLs”), and identify factors that correlate with the strength of FSLs. Data from an Internet survey investigating respondents’ experiences with limits (1258 respondents) were analyzed using exploratory factor analysis and a linear regression model. Five variables were extracted as the FSLs. The highest regression coefficients were found between physical FSL and sports activities and between cognitive FSL and academics. The lowest regression coefficients were found between relational FSL and academics, sports activities, and arts and cultural activities. The results facilitate a detailed discussion of the motivations of enhancement users, and the extraction of the suppression experience opens new enhancement directions. Further normative and empirical studies are required.
Collapse
|
13
|
Be'er M, Amirav I, Cahal M, Rochman M, Lior Y, Rimon A, Lavy RG, Lavie M. Unforeseen changes in seasonality of pediatric respiratory illnesses during the first COVID-19 pandemic year. Pediatr Pulmonol 2022; 57:1425-1431. [PMID: 35307986 PMCID: PMC9088630 DOI: 10.1002/ppul.25896] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/01/2022] [Accepted: 03/10/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate whether the three nationwide coronavirus disease 2019 (COVID-19) lockdowns imposed in Israel during the full first pandemic year altered the traditional seasonality of pediatric respiratory healthcare utilization. METHODS Month by month pediatric emergency department (ED) visits and hospitalizations for respiratory diagnoses during the first full COVID-19 year were compared to those recorded for the six consecutive years preceding the pandemic. Data were collected from the patients' electronic files by utilizing a data extraction platform (MDClone© ). RESULTS A significant decline of 40% in respiratory ED visits and 54%-73% in respiratory hospitalizations during the first COVID-19 year compared with the pre-COVID-19 years were observed (p < 0.001 and p < 0.001, respectively). The rate of respiratory ED visits out of the total monthly visits, mostly for asthma, peaked during June 2020, compared with proceeding years (109 [5.9%] versus 88 [3.9%] visits; p < 0.001). This peak occurred 2 weeks after the lifting of the first lockdown, resembling the "back-to-school asthma" phenomenon of September. CONCLUSIONS This study demonstrates important changes in the seasonality of pediatric respiratory illnesses during the first COVID-19 year, including a new "back-from-lockdown" asthma peak. These dramatic changes along with the recent resurgence of respiratory diseases may indicate the beginnings of altered seasonality in pediatric pulmonary pathologies as collateral damage of the pandemic.
Collapse
Affiliation(s)
- Moria Be'er
- Pediatric Pulmonology Unit, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Amirav
- Pediatric Pulmonology Unit, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Cahal
- Pediatric Pulmonology Unit, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mika Rochman
- Pediatric Pulmonology Unit, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yotam Lior
- Division of Anesthesia, Intensive Care, and Pain Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Rimon
- Department of Pediatric Emergency, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roni G Lavy
- Department of Pediatric, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Lavie
- Pediatric Pulmonology Unit, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
14
|
Corallo KL, Lyle SM, Carlock MA, Ross TM, Ehrlich KB. Emotional Distress, Targeted Rejection, and Antibody Production After Influenza Vaccination in Adolescence. Psychosom Med 2022; 84:429-436. [PMID: 35100185 PMCID: PMC9064924 DOI: 10.1097/psy.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to explore how both ongoing emotional distress and the experience of a targeted rejection over the past 6 months are associated with adolescents' antibody response to influenza virus vaccination. We predicted that experiencing a targeted rejection would amplify the hypothesized negative association between emotional distress and antibody response after vaccination. METHODS Adolescent participants (N = 148) completed two study visits (mean [standard deviation] days between visits = 27.4 [1.8]). At the first visit, they provided blood samples, were administered the seasonal (2018-2019) quadrivalent influenza vaccine (Fluzone, Sanofi Pasteur), completed questionnaires, and participated in a semistructured interview. At the second visit, they provided another blood sample. Hemagglutination-inhibition assays were conducted to determine prevaccination and postvaccination antibody titers. Targeted rejection experiences were coded from adolescents' interviews. RESULTS The emotional distress by targeted rejection interaction predicted antibody response to the two A strains and the composite of all vaccine strains (b values = -0.451 to -0.843, p values < .05), but not the two B strains. Results suggested that, among adolescents who experienced a targeted rejection over the past 6 months, emotional distress was negatively associated with vaccine response (however, this finding did not reach statistical significance). Conversely, among adolescents who did not experience a targeted rejection, emotional distress was positively associated with vaccine response (b = 0.173, p = .032). CONCLUSIONS The current study highlights the importance of evaluating both acute life events and ongoing distress as they relate to adaptive immune functioning in adolescence.
Collapse
Affiliation(s)
| | | | | | - Ted M. Ross
- Center for Vaccines and Immunology and Department of Infectious Diseases, University of Georgia
| | | |
Collapse
|
15
|
Wang E, Zahid S, Moudgal AN, Demaestri S, Wamboldt FS. Intimate partner violence and asthma in pediatric and adult populations. Ann Allergy Asthma Immunol 2022; 128:361-378. [PMID: 34995784 DOI: 10.1016/j.anai.2021.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/15/2021] [Accepted: 12/28/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the relationship between intimate partner violence (IPV) and adult and childhood asthma outcomes. DATA SOURCES We conducted a systematic literature review using 4 databases (PubMed, Ovid MEDLINE, Ovid Embase, and Ovid PsycINFO) with asthma and IPV-associated terms. STUDY SELECTIONS We included published studies, available in English, to October 2021, which included IPV as an exposure and asthma as an outcome. Both adult and pediatric populations were included in the following settings: community, health care, and home. RESULTS There were 37 articles identified. There was evidence among multiple studies to support increased prevalence of asthma in adults exposed to IPV and prevalence and incidence in children with parental IPV exposure. There were fewer studies evaluating IPV exposure and adult asthma morbidity, but they found statistically significant associations between IPV and increased rate of asthma exacerbations and worsened asthma control. There was sparse evidence evaluating a relationship between IPV and adult asthma mortality. There were no studies identified evaluating IPV and childhood asthma morbidity or mortality. CONCLUSION The association between IPV and increased asthma prevalence, incidence, and worsened morbidity merits recognition and further investigation into potential mechanisms. Health care providers can implement practical strategies to help mitigate the negative effects of IPV on health and asthma. These include addressing potential impactful biopsychosocial factors and comorbidities, implementing routine screening and referrals, and partnering with community advocacy organizations. Given their positions of respect and power in society, health care providers can have lasting impacts on the lives of pediatric and adult patients affected by IPV.
Collapse
Affiliation(s)
- Eileen Wang
- National Jewish Health, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado.
| | | | | | - Sabrina Demaestri
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri
| | | |
Collapse
|
16
|
Hochgerner M, Sturm EM, Schnoegl D, Kwapiszewska G, Olschewski H, Marsh LM. Low oxygen levels decrease adaptive immune responses and ameliorate experimental asthma in mice. Allergy 2022; 77:870-882. [PMID: 34309864 PMCID: PMC9290649 DOI: 10.1111/all.15020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/09/2021] [Accepted: 07/13/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND High-altitude therapy has been used as add-on treatment for allergic asthma with considerable success. However, the underlying mechanisms remain unclear. In order to investigate the possible therapeutic effects of high-altitude therapy on allergic asthma, we utilized a new in vivo mouse model. METHODS Mice were treated with house dust mite (HDM) extract over 4 weeks and co-exposed to 10% oxygen (Hyp) or room air for the final 2 weeks. Experimental asthma was assessed by airway hyper-responsiveness, mucus hypersecretion and inflammatory cell recruitment. Isolated immune cells from mouse and allergic patients were stimulated in vitro with HDM under Hyp and normoxia in different co-culture systems to analyse the adaptive immune response. RESULTS Compared to HDM-treated mice in room air, HDM-treated Hyp-mice displayed ameliorated mucosal hypersecretion and airway hyper-responsiveness. The attenuated asthma phenotype was associated with strongly reduced activation of antigen-presenting cells (APCs), effector cell infiltration and cytokine secretion. In vitro, hypoxia almost completely suppressed the HDM-induced adaptive immune response in both mouse and human immune cells. While hypoxia did not affect effector T-cell responses per-se, it interfered with antigen-presenting cell (APC) differentiation and APC/effector cell crosstalk. CONCLUSIONS Hypoxia-induced reduction in the Th2-response to HDM ameliorates allergic asthma in vivo. Hypoxia interferes with APC/T-cell crosstalk and confers an unresponsive phenotype to APCs.
Collapse
Affiliation(s)
| | - Eva M. Sturm
- Division of Pharmacology, Otto Loewi Research Center Medical University of Graz Graz Austria
| | - Diana Schnoegl
- Ludwig Boltzmann Institute for Lung Vascular Research Graz Austria
| | - Grazyna Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular Research Graz Austria
- Division of Physiology Otto Loewi Research Center, Medical University of Graz Graz Austria
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research Graz Austria
- Division of Pulmonology, Department of Internal Medicine Medical University of Graz Graz Austria
| | - Leigh M. Marsh
- Ludwig Boltzmann Institute for Lung Vascular Research Graz Austria
| |
Collapse
|
17
|
Kawakami K, Miyasaka T, Nakamura Y, Metoki H, Miyata S, Sato M, Sora I, Yamauchi K, Kawakami K, Blendy JA, Kawano T, Shimokawa H, Takayanagi M, Ohno I, Takahashi T. The A118G single-nucleotide polymorphism in OPRM1 is a risk factor for asthma severity. Allergol Int 2022; 71:55-65. [PMID: 34688555 DOI: 10.1016/j.alit.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although population studies have implicated emotional burden in asthma severity, the underlying genetic risk factors are not completely understood. We aimed to evaluate the genetic influence of a functional single-nucleotide polymorphism (SNP) in the stress-related μ-opioid receptor gene (OPRM1; A118G SNP, rs1799971) on asthma severity. METHODS We initially assessed disease severity in asthmatic outpatients carrying A118G. Using an ovalbumin-induced experimental asthma rodent model harboring the functionally equivalent SNP, we investigated the mechanism by which this SNP influences the allergic immune response. RESULTS Among 292 outpatients, 168 underwent airway hyperresponsiveness (AHR) to methacholine testing. Compared with patients carrying the AA and AG genotypes, those carrying the GG genotype exhibited enhanced AHR. The stress levels were presumed to be moderate among patients and were comparable among genotypes. Compared with Oprm1 AA mice, GG mice demonstrated aggravated asthma-related features and increased pulmonary interleukin-4+CD4+ effector and effector memory T cells under everyday life stress conditions. Intraperitoneal naloxone methiodide injection reduced effector CD4+ T cell elevation associated with increased eosinophil numbers in bronchoalveolar lavage fluid of GG mice to the levels in AA mice, suggesting that elevated Th2 cell generation in the bronchial lymph node (BLN) of GG mice induces enhanced eosinophilic inflammation. CONCLUSIONS Without forced stress exposure, patients with asthma carrying the OPRM1 GG genotype exhibit enhanced AHR, attributable to enhanced Th2 cell differentiation in the regional lymph node. Further research is necessary to elucidate the role of the OPRM1 A118G genotype in the Th2 cell differentiation pathway in the BLN.
Collapse
Affiliation(s)
- Kaori Kawakami
- Division of Pathophysiology, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tomomitsu Miyasaka
- Division of Pathophysiology, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
| | - Yutaka Nakamura
- Division of Pulmonary Medicine, Allergy, and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Satoshi Miyata
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Miki Sato
- Division of Pathophysiology, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Ichiro Sora
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kohei Yamauchi
- Division of Pulmonary Medicine, Allergy, and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Kazuyoshi Kawakami
- Department of Medical Microbiology, Mycology and Immunology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Intelligent Network for Infection Control, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Julie A Blendy
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Medical School, Philadelphia, PA, USA
| | - Tasuku Kawano
- Division of Pathophysiology, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Motoaki Takayanagi
- Division of Pathophysiology, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Isao Ohno
- Center for Medical Education, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tomoko Takahashi
- Division of Pathophysiology, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| |
Collapse
|
18
|
Bierstetel SJ, Jiang Y, Slatcher RB, Zilioli S. Parent-child conflict and physical health trajectories among youth with asthma. J Psychosom Res 2021; 150:110606. [PMID: 34560405 PMCID: PMC8559307 DOI: 10.1016/j.jpsychores.2021.110606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the role of caregiver- and youth-reports of parent-child conflict on trajectories of asthma-related health outcomes over 2 years. METHODS In a sample of 193 youth with asthma (42.7% female; M age = 12.78) and their primary caregivers, we used a multi-method and multi-informant approach to assess self-reported parent-child conflict from youth and caregivers at both the daily and global levels at baseline. Next, we annually assessed subjective (i.e., youth self-reported asthma symptoms) and clinical (i.e., peak flow) asthma health outcomes for 2 years. RESULTS Latent growth curve models revealed an effect of baseline youth-reported global family conflict on peak flow trajectories such that youth who reported greater parent-child conflict at baseline experienced less of an increase in peak flow over time than youth who reported less parent-child conflict at baseline (standardized β = -0.27, p = .003). CONCLUSIONS Youth with asthma who perceive greater overall conflict with their caregivers experience less improvement in peak flow as they age. The research and clinical implications of these findings are discussed.
Collapse
|
19
|
Jenkins BN, Moskowitz J, Halterman JS, Kain ZN. Applying theoretical models of positive emotion to improve pediatric asthma: A positive psychology approach. Pediatr Pulmonol 2021; 56:3142-3147. [PMID: 34379892 DOI: 10.1002/ppul.25600] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 02/05/2023]
Abstract
Positive emotion, encompassing feelings such as joy and happiness, has been shown to predict a multitude of health outcomes. However, the role of positive emotion in pediatric asthma is not understood. No work to date has examined how positive emotion may offer benefits to children and adolescents with asthma. Based on theory and models of positive emotion and health, we hypothesize that positive emotion may improve asthma outcomes through mediators such as health behaviors and health-relevant physiological functioning. Moreover, boosting positive emotion during times of stress may be particularly relevant in mitigating asthma symptoms. In the present commentary, we elaborate on the hypothesized mechanisms behind such associations grounded within positive emotion theoretical frameworks. Additionally, we summarize the methodologically rigorous work of positive emotion interventions in other clinical settings to propose that positive emotion could be a useful tool in the management of pediatric asthma.
Collapse
Affiliation(s)
- Brooke N Jenkins
- Department of Psychology, Chapman University, Orange, California, USA.,Center on Stress & Health, University of California, Irvine, California, USA.,Department of Anesthesiology and Perioperative Care, University of California, Irvine, California, USA
| | - Judith Moskowitz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jill S Halterman
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | - Zeev N Kain
- Center on Stress & Health, University of California, Irvine, California, USA.,Department of Anesthesiology and Perioperative Care, University of California, Irvine, California, USA
| |
Collapse
|
20
|
Intimate Partner Violence and Adult Asthma Morbidity: A Population-Based Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:4300-4309.e7. [PMID: 34364825 DOI: 10.1016/j.jaip.2021.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/01/2021] [Accepted: 06/16/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The etiologies for difficult-to-control asthma are complex and incompletely understood. Intimate partner violence (IPV) is a pervasive problem and may play a role in difficult-to-control asthma. IPV is associated with increased prevalence of asthma. There are no prior studies evaluating IPV's association with adult asthma exacerbations. OBJECTIVE This study hypothesized that IPV exposure would be associated with increased asthma exacerbations, higher symptom burden, and poorer asthma control among adults. METHODS Analyses are based on 2634 adults who participated in the 2005 Behavioral Risk Factor Surveillance System survey, reported active asthma, and completed the asthma and IPV questions. We used multivariate logistic regression to examine the association of IPV with asthma morbidity outcomes while controlling for the following potential confounders: sex, race, education, health care coverage, smoking status, age, and body mass index. RESULTS The prevalence of IPV was 32.4%. IPV was associated with increased odds of an asthma exacerbation (adjusted odds ratio [AOR] = 1.75, 95% confidence interval [CI] = 1.26-2.43), higher symptom burden (AOR = 2.33, 95% CI = 1.53-3.55), and lack of asthma control (AOR = 2.23, 95% CI = 1.22-4.09) when using composite measures for these outcomes. When using single-item measures for outcomes, IPV was also associated with increased asthma-related emergency department or urgent care visits (AOR = 2.35, 95% CI = 1.56-3.54), other urgent provider visits (AOR = 1.84, 95% CI = 1.28-2.64), perceived asthma attacks (AOR = 1.53, 95% CI = 1.12-2.09), limitations (AOR = 2.07, 95% CI = 1.49-2.89), daytime symptoms (AOR = 1.92, 95% CI = 1.35-2.72), and nocturnal awakenings (AOR = 1.88, 95% CI = 1.32-2.69). CONCLUSIONS IPV is prevalent in adult asthmatics and consistently and significantly associated with worsened adult asthma morbidity, even after adjusting for key confounders. Further research is needed to more fully understand the mechanisms underlying these relationships.
Collapse
|
21
|
Loucks EB, Rosenkranz MA, Creswell JD. Harnessing Life's Slings and Arrows: The Science and Opportunities for Mindfulness Meditation During a Global Pandemic and Beyond. Psychosom Med 2021; 83:497-502. [PMID: 34117158 PMCID: PMC8740951 DOI: 10.1097/psy.0000000000000961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
ABSTRACT We are at a difficult time in history with societal increases in stress, loneliness, and psychopathology, along with high rates of obesity, sedentary lifestyles, and chronic pain. Mindfulness interventions offer promise to address these societal issues. However, in order to make best use of the opportunities revealed by our current challenges, we must: (1) tackle these issues head-on with inclusive, innovative, and creative experimental designs and interventions, and (2) collectively adhere to rigorous, high quality methods so as to provide an evidence-based integration of mindfulness interventions into mainstream medicine and public health.We find there are several areas for which important advances are happening, including sampling socially diverse populations, examining mechanisms of action, pain management, and health behaviors. Furthermore, rigorous methods, including measurement, causal inference from control groups, delivery and scalability of mindfulness interventions, and effect modifiers to determine who mindfulness programs work best for are also gaining traction. This special issue on Mindfulness: Biobehavioral Mechanisms and Health Outcomes attends to many of these issues, several of which are highlighted in this editorial perspective.
Collapse
Affiliation(s)
- Eric B Loucks
- From the Department of Epidemiology, Brown University School of Public Health (Loucks); Mindfulness Center at Brown University (Loucks); Department of Psychiatry, University of Wisconsin-Madison (Rosenkranz); Center for Healthy Minds, University of Wisconsin-Madison (Rosenkranz); and Department of Psychology, Carnegie Mellon University (Creswell)
| | | | | |
Collapse
|
22
|
Gherlone N, Hill DR, Feinn R, Hollenbach JP. Hair cortisol concentrations among urban and rural-dwelling mother-child dyads, La Romana, Dominican Republic. Stress 2021; 24:413-420. [PMID: 33222576 DOI: 10.1080/10253890.2020.1846028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Hair cortisol concentrations (HCC) were studied in mother-child dyads of La Romana, Dominican Republic (DR), a low-income city, and of the surrounding bateyes, sugarcane plantation villages with inhabitants frequently of Haitian descent. Populations of low socioeconomic status (SES) experience hypothalamic-pituitary-adrenal (HPA) axis dysregulation. Urban communities may be increasingly exposed to stressors such as crime and concentrated poverty whereas rural communities may be devoid of important community resources. As a result, the experience of stress in poverty may differ by place of residence. The goal of this study was to examine differences in HCC among urban and rural-dwelling mother-child dyads in socioeconomically disadvantaged communities surrounding La Romana, DR. Forty-five mother/child dyads were enrolled in La Romana and 45 at several bateyes surrounding La Romana. Mothers were ≥18 years and children were between 7 and 14 years. Mothers self-reported perceived stress and demographic factors. Hair samples were collected from mothers and children, and HCC was assessed using enzyme-linked immunosorbent assays. General linear models examined associations between socioeconomic factors and HCC, and between maternal and child HCC. HCC were measured in 88 maternal and 87 child samples (N = 175). Mothers living in a batey had higher HCC than those living in La Romana (p = 0.001). HCC was positively associated among maternal-child dyads (p = 0.001). Further, Haitian-born mothers as a population who frequently live in a rural batey experienced higher HCC (p = 0.025) that may partially be explained by discriminatory practices in the DR. This research helps to elucidate the impact of urban and rural environmental settings on HCC.Lay summaryThis study focuses on chronic stress, measured by hair cortisol levels, among a low-income population of Dominican and Haitian mother-child pairs who live in urban and rural settings. We found that Haitian-born mothers, who frequently live in a rural batey, had higher hair cortisol levels than Dominican born mothers. Hair cortisol levels between mothers and their children were positively associated. This study addresses the impact of urban and rural environments on the stress response among socioeconomically disadvantaged persons living in an upper middle income country who bear an excessive burden of psychosocial stress.
Collapse
Affiliation(s)
- Nicole Gherlone
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - David R Hill
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Richard Feinn
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Jessica P Hollenbach
- Department of Pediatrics, UConn Health, Farmington, CT, USA
- Asthma Center, Connecticut Children's Medical Center, Hartford, CT, USA
| |
Collapse
|
23
|
Resztak JA, Farrell AK, Mair-Meijers H, Alazizi A, Wen X, Wildman DE, Zilioli S, Slatcher RB, Pique-Regi R, Luca F. Psychosocial experiences modulate asthma-associated genes through gene-environment interactions. eLife 2021; 10:e63852. [PMID: 34142656 PMCID: PMC8282343 DOI: 10.7554/elife.63852] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 06/16/2021] [Indexed: 01/04/2023] Open
Abstract
Social interactions and the overall psychosocial environment have a demonstrated impact on health, particularly for people living in disadvantaged urban areas. Here, we investigated the effect of psychosocial experiences on gene expression in peripheral blood immune cells of children with asthma in Metro Detroit. Using RNA-sequencing and a new machine learning approach, we identified transcriptional signatures of 19 variables including psychosocial factors, blood cell composition, and asthma symptoms. Importantly, we found 169 genes associated with asthma or allergic disease that are regulated by psychosocial factors and 344 significant gene-environment interactions for gene expression levels. These results demonstrate that immune gene expression mediates the link between negative psychosocial experiences and asthma risk.
Collapse
Affiliation(s)
- Justyna A Resztak
- Center for Molecular Medicine and Genetics, Wayne State UniversityDetroitUnited States
| | | | | | - Adnan Alazizi
- Center for Molecular Medicine and Genetics, Wayne State UniversityDetroitUnited States
| | - Xiaoquan Wen
- Department of Biostatistics, University of MichiganAnn ArborUnited States
| | - Derek E Wildman
- College of Public Health, University of South FloridaTampaUnited States
| | - Samuele Zilioli
- Department of Psychology, Wayne State UniversityDetroitUnited States
- Department of Family Medicine and Public Health Sciences, Wayne State UniversityDetroitUnited States
| | | | - Roger Pique-Regi
- Center for Molecular Medicine and Genetics, Wayne State UniversityDetroitUnited States
- Department of Obstetrics and Gynecology, Wayne State UniversityDetroitUnited States
| | - Francesca Luca
- Center for Molecular Medicine and Genetics, Wayne State UniversityDetroitUnited States
- Department of Obstetrics and Gynecology, Wayne State UniversityDetroitUnited States
| |
Collapse
|
24
|
Pavón-Romero GF, Serrano-Pérez NH, García-Sánchez L, Ramírez-Jiménez F, Terán LM. Neuroimmune Pathophysiology in Asthma. Front Cell Dev Biol 2021; 9:663535. [PMID: 34055794 PMCID: PMC8155297 DOI: 10.3389/fcell.2021.663535] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/15/2021] [Indexed: 12/26/2022] Open
Abstract
Asthma is a chronic inflammation of lower airway disease, characterized by bronchial hyperresponsiveness. Type I hypersensitivity underlies all atopic diseases including allergic asthma. However, the role of neurotransmitters (NT) and neuropeptides (NP) in this disease has been less explored in comparison with inflammatory mechanisms. Indeed, the airway epithelium contains pulmonary neuroendocrine cells filled with neurotransmitters (serotonin and GABA) and neuropeptides (substance P[SP], neurokinin A [NKA], vasoactive intestinal peptide [VIP], Calcitonin-gene related peptide [CGRP], and orphanins-[N/OFQ]), which are released after allergen exposure. Likewise, the autonomic airway fibers produce acetylcholine (ACh) and the neuropeptide Y(NPY). These NT/NP differ in their effects; SP, NKA, and serotonin exert pro-inflammatory effects, whereas VIP, N/OFQ, and GABA show anti-inflammatory activity. However, CGPR and ACh have dual effects. For example, the ACh-M3 axis induces goblet cell metaplasia, extracellular matrix deposition, and bronchoconstriction; the CGRP-RAMP1 axis enhances Th2 and Th9 responses; and the SP-NK1R axis promotes the synthesis of chemokines in eosinophils, mast cells, and neutrophils. In contrast, the ACh-α7nAChR axis in ILC2 diminishes the synthesis of TNF-α, IL-1, and IL-6, attenuating lung inflammation whereas, VIP-VPAC1, N/OFQ-NOP axes cause bronchodilation and anti-inflammatory effects. Some NT/NP as 5-HT and NKA could be used as biomarkers to monitor asthma patients. In fact, the asthma treatment based on inhaled corticosteroids and anticholinergics blocks M3 and TRPV1 receptors. Moreover, the administration of experimental agents such as NK1R/NK2R antagonists and exogenous VIP decrease inflammatory mediators, suggesting that regulating the effects of NT/NP represents a potential novel approach for the treatment of asthma.
Collapse
Affiliation(s)
| | | | | | | | - Luis M. Terán
- Department of Immunogenetics and Allergy, Instituto Nacional Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| |
Collapse
|
25
|
Keller W, Vogel M, Prenzel F, Genuneit J, Jurkutat A, Hilbert C, Hiemisch A, Kiess W, Poulain T. Atopic diseases in children and adolescents are associated with behavioural difficulties. BMC Pediatr 2021; 21:197. [PMID: 33892662 PMCID: PMC8063387 DOI: 10.1186/s12887-021-02663-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/05/2021] [Indexed: 11/21/2022] Open
Abstract
Background Atopic diseases and behavioural difficulties in children have both been on the rise in recent decades. This study seeks to assess associations between atopic diseases and behavioural difficulties, examining the differences considering child age and how behavioural difficulties were reported (via self-report or parent-report). Methods Data on behavioural difficulties, assessed through the Strengths and Difficulties Questionnaire (SDQ), and on atopic diseases, assessed through the participant’s medical history, were available for 2701 study participants aged 3 to 18 years. Associations between atopic diseases and behavioural difficulties were evaluated using linear regression analyses. We split the study sample into two groups. I: 3-to 10-year-olds/parent-reported SDQ (n = 1764), II: 11- to 18-year-olds/parent-reported SDQ (n = 937) and self-reported SDQ (n = 915). All analyses were adjusted for age, gender, and socioeconomic status. Results In younger children, atopic dermatitis was strongly associated with higher total difficulties scores, more emotional problems and conduct problems, and more symptoms of hyperactivity/inattention. Parents reported higher total difficulties scores, more emotional problems, and more peer-relationship problems for adolescents with bronchial asthma and other allergies, whereas the adolescents themselves reported more peer relationship problems. Conclusion In younger children, atopic dermatitis is associated with internalizing and externalizing problems. In adolescents, bronchial asthma and other allergies are associated with a greater level of internalizing problems only. The findings further suggest that parents of adolescents are more likely to perceive associations between atopic diseases and behavioural difficulties than the adolescents themselves.
Collapse
Affiliation(s)
- Wiebke Keller
- Department of Women and Children's Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany.,LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Mandy Vogel
- Department of Women and Children's Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany.,LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Freerk Prenzel
- Department of Women and Children's Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Anne Jurkutat
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Cornelia Hilbert
- LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Andreas Hiemisch
- Department of Women and Children's Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany.,LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Wieland Kiess
- Department of Women and Children's Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany.,LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Tanja Poulain
- Department of Women and Children's Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Liebigstrasse 20a, 04103, Leipzig, Germany. .,LIFE Leipzig Research Center for Civilization Diseases, Leipzig University, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.
| |
Collapse
|
26
|
Hao S, Yuan F, Pang P, Yang B, Jiang X, Yan A. Early childhood traffic-related air pollution and risk of allergic rhinitis at 2-4 years of age modification by family stress and male gender: a case-control study in Shenyang, China. Environ Health Prev Med 2021; 26:48. [PMID: 33865319 PMCID: PMC8053259 DOI: 10.1186/s12199-021-00969-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/04/2021] [Indexed: 01/12/2023] Open
Abstract
Background Few studies have explored the modifications by family stress and male gender in the relationship between early exposure to traffic-related air pollution (TRAP) and allergic rhinitis (AR) risk in preschool children. Methods We conducted a case-control study of 388 children aged 2–4 years in Shenyang, China. These children AR were diagnosed by clinicians. By using measured concentrations from monitoring stations, we estimated the exposures of particulate matter less than 10 μm in diameter (PM10), nitrogen dioxide (NO2), ozone (O3), carbon monoxide (CO), and sulfur dioxide (SO2) in preschool children aged 2–4 years. After adjusted potential confounding factors, we used logistic regression model to evaluate the odds ratio (OR) and 95% confidence interval (CI) for childhood AR with exposure to different air pollutants according to the increasing of the interquartile range (IQR) in the exposure level. Results The prevalence of AR in children aged 2–4 years (6.4%) was related to early TRAP exposure. With an IQR (20 μg/m3) increase in PM10 levels, an adjusted OR was significantly elevated by 1.70 (95% CI, 1.19 to 2.66). Also, with an IQR (18 μg/m3) increase in NO2, an elevated adjusted OR was 1.85 (95% CI, 1.52 to 3.18). Among children with family stress and boys, PM10 and NO2 were positively related to AR symptoms. No significant association was found among children without family stress and girls. Conclusions Family stress and male gender may increase the risk of AR in preschool children with early exposure to PM10 and NO2.
Collapse
Affiliation(s)
- Shuai Hao
- Department of Otolaryngology, First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, China.
| | - Fang Yuan
- Department of Otolaryngology, First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Pai Pang
- Department of Otolaryngology, First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Bo Yang
- Department of Otolaryngology, First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Xuejun Jiang
- Department of Otolaryngology, First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, China
| | - Aihui Yan
- Department of Otolaryngology, First Affiliated Hospital of China Medical University, No. 155, Nanjing North Street, Heping District, Shenyang, 110001, China.
| |
Collapse
|
27
|
Doan SN. Allostatic load: Developmental and conceptual considerations in a multi-system physiological indicator of chronic stress exposure. Dev Psychobiol 2021; 63:825-836. [PMID: 33650132 DOI: 10.1002/dev.22107] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/14/2020] [Accepted: 01/08/2021] [Indexed: 12/26/2022]
Abstract
Developmental researchers studying how stress affects health have often focused on specific, individual, physiological parameters such as cortisol. Yet, recent theories of stress biology emphasize that the stress response is multi-faceted and engages distinct yet interconnected physiological systems, including metabolic, immune, and cardiovascular systems that respond to one another. Moreover, advocates of a systems approach also argue that the confluence of changes across several physiological systems presents a health risk, even when one indicator alone is not predictive of health outcomes. Allostatic load is one potential multi-system indicator of stress, capturing the cumulative, physiological burden of chronic stress exposure on the body. At the same time, studying allostatic load during early development raises several issues, including how allostatic load is operationalized, the clinical importance of commonly used biomarkers during distinct periods of development, and the fundamental role of timing. In this review paper, we discuss the potential of allostatic load in the context of studies of stress in developmental science, review developmental studies that have assessed allostatic load, and articulate critical conceptual questions regarding the study of allostatic load during the childhood years.
Collapse
Affiliation(s)
- Stacey N Doan
- Claremont McKenna College & City of Hope National Medical Center, Claremont, CA, USA
| |
Collapse
|
28
|
Tieskens KF, Milando CW, Underhill LJ, Vermeer K, Levy JI, Fabian MP. The impact of energy retrofits on pediatric asthma exacerbation in a Boston multi-family housing complex: a systems science approach. Environ Health 2021; 20:14. [PMID: 33583411 PMCID: PMC7883428 DOI: 10.1186/s12940-021-00699-x] [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] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pediatric asthma is currently the most prevalent chronic disease in the United States, with children in lower income families disproportionately affected. This increased health burden is partly due to lower-quality and insufficient maintenance of affordable housing. A movement towards 'green' retrofits that improve energy efficiency and increase ventilation in existing affordable housing offers an opportunity to provide cost-effective interventions that can address these health disparities. METHODS We combine indoor air quality modeling with a previously developed discrete event model for pediatric asthma exacerbation to simulate the effects of different types of energy retrofits implemented at an affordable housing site in Boston, MA. RESULTS Simulation results show that retrofits lead to overall better health outcomes and healthcare cost savings if reduced air exchange due to energy-saving air tightening is compensated by mechanical ventilation. Especially when exposed to indoor tobacco smoke and intensive gas-stove cooking such retrofit would lead to an average annual cost saving of over USD 200, while without mechanical ventilation the same children would have experienced an increase of almost USD 200/year in health care utilization cost. CONCLUSION The combination of indoor air quality modeling and discrete event modeling applied in this paper can allow for the inclusion of health impacts in cost-benefit analyses of proposed affordable housing energy retrofits.
Collapse
Affiliation(s)
- Koen F. Tieskens
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
| | - Chad W. Milando
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
| | - Lindsay J. Underhill
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
| | - Kimberly Vermeer
- Urban Habitat Initiatives Inc, 328A Tremont Street, Boston, MA 02116 USA
| | - Jonathan I. Levy
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
| | - M. Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118 USA
| |
Collapse
|
29
|
Zhang C, Kong Y, Shen K. The Age, Sex, and Geographical Distribution of Self-Reported Asthma Triggers on Children With Asthma in China. Front Pediatr 2021; 9:689024. [PMID: 34540763 PMCID: PMC8448385 DOI: 10.3389/fped.2021.689024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/27/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Asthma can be exacerbated by many triggers, and the heterogeneity of asthma triggers is clear among children with asthma. This study describes asthma triggers using a large-scale electronic dataset from the smartphone-based Chinese Children's Asthma Action Plan (CCAAP) app and aims to examine the difference in asthma triggers among different subgroups of children with asthma. Methods: Data from the smartphone-based CCAAP app between February 22, 2017, and November 23, 2020, were reviewed, and children with asthma who reported their asthma triggers were enrolled. Eight common asthma triggers were listed in the software: upper respiratory infection (URI), allergen sensitization, exercise, emotional disturbances, pungent odors, air pollution/smog, weather change, and tobacco smoke. We compared the incidence of asthma triggers among different subgroups (<6 years vs. 6-17 years; boy vs. girl; eastern region vs. central region vs. western region). Results: We enrolled 6,835 patients with self-reported asthma triggers. When compared by sex, boys had a higher proportion of exercise-triggered asthma than girls (boys vs. girls, 22.5 vs. 19.7%, p < 0.05). The proportion of patients <6 years of age with URI-triggered asthma was higher than that of patients 6-17 years of age (<6 vs. 6-17 years, 80.9 vs. 74.9%, p < 0.001). Patients 6-17 years of age were more likely than patients <6 years of age to report five of the asthma triggers: allergen sensitization (<6 vs. 6-17 years, 26.6 vs. 35.8%, p < 0.001), exercise (<6 vs. 6-17 years, 19.3 vs. 23.7%, p < 0.001), pungent odors (<6 vs. 6-17 years, 8.8 vs. 12.7%, p < 0.001), air pollution/smog (<6 vs. 6-17 years, 9.4 vs. 16.2%, p < 0.001), and tobacco smoke (<6 vs. 6-17 years, 3.5 vs. 5.3%, p < 0.001). In subgroups based on geographical distribution, asthma triggering of allergen sensitization was reported to be the most common in patients from the eastern region (eastern region vs. central region vs. western region, 35.0 vs. 24.6 vs. 28.0%, p < 0.001). Exercise-triggered asthma was found to be the most prevalent among patients from the central region (eastern region vs. central region vs. western region, 21.6 vs. 24.8 vs. 20.4%, p < 0.05). However, the proportion of patients with air pollution/smog as an asthma trigger was the lowest among those from the western region (eastern region vs. central region vs. western region, 14.1 vs. 14.1 vs. 10.8%, p < 0.05). Conclusion: Children with asthma present different types of asthma triggers, both allergenic and nonallergenic. Age, sex, and geographical distribution affect specific asthma triggers. Preventive measures can be implemented based on a patient's specific asthma trigger.
Collapse
Affiliation(s)
- Changhao Zhang
- Department of Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Clinical Research Center of Respiratory Diseases, National Center for Children's Health, Beijing, China
| | - Yan Kong
- Department of Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Clinical Research Center of Respiratory Diseases, National Center for Children's Health, Beijing, China
| | - Kunling Shen
- Department of Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Clinical Research Center of Respiratory Diseases, National Center for Children's Health, Beijing, China
| |
Collapse
|
30
|
Kumari MV, Amarasiri L, Rajindrajith S, Devanarayana NM. Functional abdominal pain disorders and asthma: two disorders, but similar pathophysiology? Expert Rev Gastroenterol Hepatol 2021; 15:9-24. [PMID: 32909837 DOI: 10.1080/17474124.2020.1821652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Functional abdominal pain disorders (FAPDs) and asthma are common ailments affecting both children and adults worldwide. Multiple studies have demonstrated an association between these two disorders. However, the exact reason for this observed association is not apparent. AREAS COVERED The current review has explored available literature and outlined multiple underlying pathophysiological mechanisms, common to both asthma and FAPDs, as possible reasons for this association. EXPERT OPINION Smooth muscle dysfunction, hypersensitivity and hyper-responsiveness, mucosal inflammation, and barrier dysfunction involving gastrointestinal and respiratory tracts are the main underlying pathophysiological mechanisms described for the generation of symptoms in FAPDs and asthma. In addition, alterations in neuroendocrine regulatory functions, immunological dysfunction, and microbial dysbiosis have been described in both disorders. We believe that the pathophysiological processes that were explored in this article would be able to expand the mechanisms of the association. The in-depth knowledge is needed to be converted to therapeutic and preventive strategies to improve the quality of care of children suffering from FAPDs and asthma.
Collapse
Affiliation(s)
- Manori Vijaya Kumari
- Department of Physiology, Faculty of Medicine & Allied Sciences, Rajarata University of Sri Lanka , Anuradhapura, Sri Lanka
| | - Lakmali Amarasiri
- Department of Physiology, Faculty of Medicine, University of Colombo , Colombo, Sri Lanka
| | | | | |
Collapse
|
31
|
Gieler U, Gieler T, Peters EMJ, Linder D. Haut und Psychosomatik – Psychodermatologie heute. J Dtsch Dermatol Ges 2020; 18:1280-1300. [PMID: 33251743 DOI: 10.1111/ddg.14328_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Uwe Gieler
- Universitäts-Hautklinik, Universitätsklinikum Gießen
| | - Tanja Gieler
- Kinder- und Jugendpsychosomatik, Universitäts-Kinderklinik, Universitätsklinikum Gießen
| | - Eva Milena Johanne Peters
- Psychoneuroimmunologie Labor, Klinik für Psychosomatik und Psychotherapie, Universitätsklinikum Gießen, Gießen in Kooperation mit der Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin - Charité, Berlin
| | - Dennis Linder
- Universitäts-Hautklinik, Universität Padua, Italien, Institut für Medizinische Psychologie und Psychotherapie, Medizinische Universität Graz, Österreich
| |
Collapse
|
32
|
Marquez-Velarde G. The paradox does not fit all: Racial disparities in asthma among Mexican Americans in the U.S. PLoS One 2020; 15:e0242855. [PMID: 33253243 PMCID: PMC7703920 DOI: 10.1371/journal.pone.0242855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 11/10/2020] [Indexed: 12/02/2022] Open
Abstract
Mexican Americans have a lower prevalence of asthma than White Americans, Black Americans, and Other Hispanics. This is concordant with the Hispanic Paradox, which posits that Hispanics have good health and lower mortality than White Americans despite their relative socioeconomic disadvantages. However, the research is limited in relation to the effects of race on health, independent of ethnicity, among this population. In this study, the author disaggregated Mexican Americans, foreign-born and U.S.-born into two categories, White and Black Mexicans, in order to assess their likelihood of having an asthma diagnosis, compared to White Americans and to each other. This study used harmonized data from the National Health Interview Survey from 2000–2018 with a final analytic sample of N = 1,094,516. The analysis was conducted using binary logistic regression, controlling for acculturation and health behavior-related variables, as well as sociodemographic characteristics. In the results, Black Mexicans had a significant disadvantage in relation to their White counterparts and White Americans. The findings suggest there is an intra-ethnic racial disparity in asthma and the Hispanic paradox is not applicable across racial lines for Mexican Americans. These findings also suggest Black Mexicans’ poor asthma outcomes are the byproduct of various mechanisms of racial inequality.
Collapse
Affiliation(s)
- Guadalupe Marquez-Velarde
- Department of Sociology, Social Work and Anthropology, Utah State University, Logan, UT, United States of America
- * E-mail:
| |
Collapse
|
33
|
Parents' Acceptance of Learning about Mindfulness for Managing Pediatric Asthma. CHILDREN-BASEL 2020; 7:children7120262. [PMID: 33260496 PMCID: PMC7760491 DOI: 10.3390/children7120262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/17/2020] [Accepted: 11/26/2020] [Indexed: 12/04/2022]
Abstract
Background: Emerging research suggests mindfulness may reduce stress and asthma symptoms in children, yet there is a gap in understanding parental views towards learning about mindfulness. Objective: This study aimed to compare the perceived acceptance to learn about mindfulness among parents of children with and without asthma, and to understand differences across income levels. Methods: This was a national, cross-sectional, online survey of parents of children 0–18 years. Acceptance was measured with questions on whether parents believe mindfulness could be beneficial while parenting, and if they would be willing to learn about mindfulness. Comparisons of mindfulness acceptance between income level were conducted using chi-square and Fisher’s exact test. Results: Parents of children with asthma were more likely to be interested in learning about mindfulness from their health care provider compared to those without asthma (46% vs. 38%, p < 0.0001). At all income levels examined in the study, parents (63–75%) of children with asthma indicated that they agreed or strongly agreed that mindfulness can be beneficial when parenting. Conclusion: Findings suggest an opportunity to incorporate mindfulness teaching into asthma care for pediatric patients of all income levels.
Collapse
|
34
|
Miyahara N. [The role of neuropeptide Y for the development of allergic airway responses]. Nihon Yakurigaku Zasshi 2020; 155:360-363. [PMID: 33132250 DOI: 10.1254/fpj.20036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Neuropeptide Y (NPY) is a neurotransmitter that is widely expressed in the brain and peripheral nervous system. Various immune cells express the receptor for NPY, Y1 receptor. NPY modulates these cells via its Y1 receptor, and involvement of NPY in the pathophysiology of bronchial asthma, has been reported. Increased plasma levels of NPY in asthmatic patients have been reported. NPY polymorphisms are associated with an increased risk for asthma in overweight subjects and young adults. We and other researchers have reported that using murine models of allergic airway responses, NPY and Y1 receptor play critical roles for the development of allergic airway inflammation and airway hyperresponsiveness. Therefore, manipulating NPY-Y1 pathway represents a novel therapeutic target to control allergic airway responses, and might be beneficial for treatment of bronchial asthma.
Collapse
Affiliation(s)
- Nobuaki Miyahara
- Department of Medical Technology, Okayama University Graduate School of Health Sciences.,Department of Allergy and Respiratory Medicine, Okayama University Hospital
| |
Collapse
|
35
|
Gieler U, Gieler T, Peters EMJ, Linder D. Skin and Psychosomatics - Psychodermatology today. J Dtsch Dermatol Ges 2020; 18:1280-1298. [PMID: 33251751 PMCID: PMC7756276 DOI: 10.1111/ddg.14328] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 02/06/2023]
Abstract
Modern psychodermatology relies on the bio-psycho-social disease model in psychosomatics, according to which biological, psychological and social factors (on various levels, from molecules to the biosphere) play a major role in the disease pathogenesis through complex, non-linear interactions over the entire disease course. It is nowadays experimentally proven that "emotions get into the skin". Recent research shows close anatomical, physiological and functional connections between skin and nervous system, already known to be ontogenetically related. These connections are reflected in many skin diseases where psychological and somatic etiological factors are closely intertwined. A holistic approach by the physician should do justice to this interdependence; biological, psychological and social factors should be adequately taken into account when taking anamnesis, making a diagnosis and choosing a therapy. The "visibility" of the skin organ bestows dermatology a special position among the various other clinical subjects, and renders a holistic, psychosomatic approach to the patient that is particularly important. The life course belongs also to modern psychodermatological approaches. Based on the modern psychodermatology concept, other corresponding sub-areas such as psychogastroenterology, psychocardiology etc. have emerged. After the theoretical part of this article, some selected skin diseases are discussed in more detail from the psychosomatic point of view.
Collapse
Affiliation(s)
- Uwe Gieler
- Department of DermatologyUniversity Hospital Gießen
| | - Tanja Gieler
- Psychosomatic Medicine for Children and AdolescentsDepartment of PediatricsUniversity Hospital Gießen
| | - Eva Milena Johanne Peters
- Laboratory for PsychoneuroimmunologyDepartment of Psychosomatic Medicine and PsychotherapyUniversity Hospital Gießen in cooperation with the Department of Psychosomatic Medicine and PsychotherapyUniversity Hospital – CharitéBerlin
| | - Dennis Linder
- Department of DermatologyUniversity of PaduaItalyInstitute for Medical Psychology and PsychotherapyMedical University GrazAustria
| |
Collapse
|
36
|
Cameron L, Palikhe NS, Laratta C, Vliagoftis H. Elevated Circulating Th2 Cells in Women With Asthma and Psychological Morbidity: A New Asthma Endotype? Clin Ther 2020; 42:1015-1031. [PMID: 32482491 DOI: 10.1016/j.clinthera.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Psychological stress shifts the immune system toward the production of T-helper (Th)-2-mediated cytokines and eosinophilia, increases the risks for both asthma and depression, and can precipitate asthma exacerbations. Th2-mediated inflammation is a characteristic of allergic asthma. We have shown that the levels of CD4+ Th2 cells in the peripheral blood of patients with asthma are associated with severity and/or control of the disease. To improve our understanding of the interactions between stress and asthma symptoms, we evaluated the effects of psychological comorbidity on Th2-mediated inflammation in patients with asthma. METHODS Sixty-six asthmatic patients were recruited from the University of Alberta Asthma Clinic after they gave informed consent. Stress-related effects on asthma and psychological morbidity were assessed using the Asthma Control Questionnaire, completed by the patients at recruitment. Venous blood was collected at recruitment and Th2-mediated immunity evaluated by flow cytometry, quantitative real-time reverse-transcription polymerase chain reaction and enzyme-linked immunosorbent assay. FINDINGS Patients with stress-triggered asthma (n = 12) had higher percentage of CD4+ T cells (P = 0.006) and Th2 cells (CD4+CRTh2+ T cells; P = 0.002) in peripheral blood compared to patients with asthma who did not experience stress-related worsening of disease (n = 54). The same was true when we analyzed patients with any form of psychological comorbidity (n = 19) compared to those without psychological comorbidities (n = 47). These differences were evident among women, but not among men. Women with psychological comorbidity also required higher doses of inhaled and oral corticosteroids compared to those without psychological comorbidity. IMPLICATIONS Asthma involving psychological morbidity associates with an elevated level of circulating Th2 cells and increased corticosteroid usage, and may be more prevalent in women. Larger-scale prospective studies are required for assessing whether these women constitute a new endotype of Th2-high asthma responsive to treatments aimed to improve psychological comorbidities.
Collapse
Affiliation(s)
- Lisa Cameron
- Department of Pathology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Alberta Respiratory Centre, University of Alberta, Edmonton, Alberta, Canada.
| | - Nami Shrestha Palikhe
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Alberta Respiratory Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Cheryl Laratta
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Alberta Respiratory Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Harissios Vliagoftis
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Alberta Respiratory Centre, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
37
|
Parekh TM, Cherrington AL, Bhatia S, Turan B, Patel SB, Kim YI, Turan JM, Dransfield MT. The Association of Low Income and High Stress with Acute Care Use in COPD Patients. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2020; 7:107-117. [PMID: 32324982 PMCID: PMC7454020 DOI: 10.15326/jcopdf.7.2.2019.0165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/04/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Low-income chronic obstructive pulmonary disease (COPD) individuals are known to have higher rates of COPD-related hospitalizations and readmissions. Levels of psychological stress are also higher in low-income populations and may be associated with acute care use. We sought to: (1) determine the association between stress and acute care use in COPD, (2) evaluate the social determinants of health (SDH) in low and high stress individuals, and (3) determine the association between low income and high stress with acute care use. MATERIALS AND METHODS Using results from a survey-based study of individuals with COPD at the University of Alabama (UAB), we used multivariable regression modeling to evaluate the association of high stress with acute care use (COPD-related emergency department [ED] visits or hospitalizations). We then compared SDH between low and high stress groups and evaluated the association of low income + high stress with acute care use in a secondary model. RESULTS We included 126 individuals in our study. The high stress group was more likely to be < 65 years old and female. No differences in race, smoking, years of smoking, body mass index, dyspnea, or lung function (forced expiratory volume in 1 second [FEV1]%) by stress group were observed. The high stress group had a 2.5-fold increased adjusted odds of acute care use (adjusted odds ratio [AOR]95% confidence interval [CI], 2.51, 1.06-5.98) compared to the low stress group, while the low-income + high stress group had a 4-fold increased adjusted odds of acute care use (AOR, 95% CI, 4.38, 1.25-15-45) compared to high-income + low-stress group. CONCLUSIONS Acute care use and stress are associated in COPD. These associations are more pronounced in the low-income + high stress population who disproportionately contribute to health care utilization and frequently lack the resources needed to cope with stress.
Collapse
Affiliation(s)
- Trisha M Parekh
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Alabama at Birmingham
| | - Andrea L Cherrington
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham
| | - Bulent Turan
- Department of Psychology, University of Alabama at Birmingham
| | | | - Young-Il Kim
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Alabama at Birmingham
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham
| | - Mark T Dransfield
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Alabama at Birmingham
- Birmingham VA Medical Center, Birmingham, Alabama
| |
Collapse
|
38
|
Abstract
Several factors have been associated with the development of asthma and asthma-related morbidity and mortality. Exposures in the environment such as allergens and air pollutants have traditionally been linked to the risk of asthma and asthma outcomes. More recent literature has identified chronic psychosocial stress as an additional environmental exposure to consider in relation to asthma. Adverse childhood events (ACEs) and chronic and toxic stress have been associated with chronic diseases such as cardiovascular disease, cancer, and chronic obstructive pulmonary disease. Chronic stress has also been shown to result in biological changes such as expression of immunologic genes, changes in expression of the beta-adrenergic (B2AR) and the glucocorticoid receptor (GR-α) genes, cytokine regulation, and alterations in the hypothalamic pituitary axis and cortisol levels which all may affect asthma pathophysiology and therapeutic response among patients exposed to chronic stress. Recent research has revealed associations between ACEs and chronic and toxic stress and asthma risk in pre-conception to early childhood as well as morbidity and response to asthma treatments among pediatric and adult age groups. As some populations are more significantly impacted by asthma such as racial and ethnic minority groups, the influence of psychosocial stress has also been explored as a potential factor responsible for observed disparities in asthma prevalence and outcomes among these groups which also experience higher rates of psychosocial stress. Racial discrimination has specifically been shown to affect asthma-related outcomes among minority groups. Interventions to address the impact of chronic and toxic stress such as yoga and meditation have been shown to improve asthma outcome measures. Chronic and toxic stress is an important environmental exposure to further consider as we continue to explore the differences in underlying asthma pathophysiology leading to various disease phenotypes among patients and clinical/therapeutic response to interventions and treatments.
Collapse
|
39
|
Palumbo ML, Prochnik A, Wald MR, Genaro AM. Chronic Stress and Glucocorticoid Receptor Resistance in Asthma. Clin Ther 2020; 42:993-1006. [PMID: 32224031 DOI: 10.1016/j.clinthera.2020.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Chronic and persistent exposure to negative stress can lead to adverse consequences on health. Particularly, psychosocial factors were found to increase the risk and outcome of respiratory diseases like asthma. Glucocorticoids (GCs) are the most efficient anti-inflammatory therapy for asthma. However, a significant proportion of patients don't respond adequately to GC administration. GC sensitivity is modulated by genetic and acquired disease-related factors. Additionally, it was proposed that endogenous corticosteroids may limit certain actions of synthetic GCs, contributing to insensitivity. Psychological and physiological stresses activate the hypothalamic-pituitary-adrenal axis, increasing cortisol levels. Here, we review the mechanism involved in altered GC sensitivity in asthmatic patients under stressful situations. Strategies for modulation GC sensitivity and improving GC therapy are discussed. METHODS PubMed was searched for publications on psychological chronic stress and asthma, GC resistance in asthma, biological mechanisms for GC resistance, and drugs for steroid-resistant asthma, including highly potent GCs. FINDINGS GC resistance in patients with severe disease remains a major clinical problem. In asthma, experimental and clinical evidence suggests that chronic stress induces inflammatory changes, contributing to a worse GC response. GC resistant patients can be treated with other broad-spectrum anti-inflammatory drugs, but these generally have major side effects. Different mechanisms of GC resistance have been described and might be useful for developing new therapeutic strategies against it. Novel drugs, such as highly potent GCs, phosphoinositide 3-kinase-delta inhibitors that reestablish histone deacetylase-2 function, decrease of GC receptor phosphorylation by p38 mitogen-activated protein kinase inhibitors, or phosphatase activators, are currently in clinical development and might be combined with GC therapy in the future. Furthermore, microRNAs (small noncoding RNA molecules) operate as posttranscriptional regulators, providing another level of control of GC receptor levels. Empirical results allow postulating that the detection and study of microRNAs might be a promising approach to better characterize and treat asthmatic patients. IMPLICATIONS Many molecular and cellular pathobiological mechanisms are responsible of GC resistance. Therefore detecting specific biomarkers to help identify patients who would benefit from new therapies is crucial. Stress consitutes a negative aspect of current lifestyles that increase asthma morbidity and mortality. Adequate stress management could be an important and positive intervention.
Collapse
Affiliation(s)
- María Laura Palumbo
- Centro de Investigaciones y Transferencia del Noroeste de la Provincia de Buenos Aires (UNNOBA-UNSADA-CONICET), Junín, Argentina
| | - Andrés Prochnik
- Instituto de Investigaciones Biomédicas (UCA-CONICET), Buenos Aires, Argentina
| | - Miriam Ruth Wald
- Instituto de Investigaciones Biomédicas (UCA-CONICET), Buenos Aires, Argentina
| | - Ana María Genaro
- Instituto de Investigaciones Biomédicas (UCA-CONICET), Buenos Aires, Argentina; Departamento de Farmacología, Facultad de Medicina, UBA Paraguay, Buenos Aires, Argentina.
| |
Collapse
|
40
|
Meuret AE, Tunnell N, Roque A. Anxiety Disorders and Medical Comorbidity: Treatment Implications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:237-261. [PMID: 32002933 DOI: 10.1007/978-981-32-9705-0_15] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anxiety disorders are debilitating psychological disorders characterized by a wide range of cognitive and somatic symptoms. Anxiety sufferers have a higher lifetime prevalence of various medical problems. Chronic medical conditions furthermore increase the likelihood of psychiatric disorders and overall dysfunction. Lifetime rates of cardiovascular, respiratory, gastrointestinal, and other medical problems are disproportionately high in anxiety and panic/fear sufferers. The heightened comorbidity is not surprising as many symptoms of anxiety and panic/fear mimic symptoms of medical conditions. Panic disorder specifically is strongly linked to medical conditions due to its salient somatic symptoms, such as dyspnea, dizziness, numbness, chest pain, and heart palpitations, all of which can signal danger and deterioration for chronic disease sufferers. This chapter identifies shared correlates of medical illness and anxiety disorders and evidence for misinterpretation of symptoms as medically relevant and offers an analysis of implications for treatment of both types of conditions. We will concentrate on medical conditions with high associations for anxiety and panic by aspects of symptomatology, specifically neurological disorders (fibromyalgia, epilepsy, cerebral palsy), diabetes, gastrointestinal illness (irritable bowel syndrome, gastroesophageal reflux disease), and cardiovascular and respiratory illnesses (asthma).
Collapse
Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, Dallas, TX, USA.
| | - Natalie Tunnell
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Andres Roque
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| |
Collapse
|
41
|
Akcan N, Bahceciler NN. Headliner in Physiology and Management of Childhood Asthma: Hypothalamic-Pituitary-Adrenal Axis. Curr Pediatr Rev 2020; 16:43-52. [PMID: 31738144 DOI: 10.2174/1573396315666191026100643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/23/2019] [Accepted: 10/23/2019] [Indexed: 02/06/2023]
Abstract
Asthma is the most common chronic inflammatory disease of children. Inhaled corticosteroids (ICS) are the cornerstone of asthma therapy which are the most effective, commonly used treatment of persistent asthma. Mostly, studies on the relationship between asthma and cortisol have focused on side effects of treatment. Recently, asthmatic patients not treated with ICS have been reported to have an attenuated activity and/or responsiveness of their Hypothalamic-Pituitary- Adrenal (HPA) axis. Moreover, it has been proposed that asthma worsening with stress may be due to a dysfunctional HPA axis, or cortisol insensitivity due to chronic psychological stress through impaired glucocorticoid receptor expression or function. Although long-term ICS treatment might produce adrenal suppression or iatrogenic Cushing syndrome, improvement of adrenal function has also been detected in some of asthmatic cases. Thus, the response scheme of HPA axis still contains undiscovered features in asthma. The management of asthma can be improved by increasing knowledge on the role of HPA axis in asthma pathophysiology. The risk for side effects of ICS can be minimized through increased awareness, early recognition of at-risk patients and regular patient follow-up. This review was written to draw attention to the role of HPA axis in both asthma and its treatment and to illustrate a follow up algorithm of HPA axis in the management of asthma.
Collapse
Affiliation(s)
- Nese Akcan
- Department of Pediatric Endocrinology, Faculty of Medicine, Near East University, Nicosia, Cyprus
| | - Nerin N Bahceciler
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Near East University, Nicosia, Cyprus
| |
Collapse
|
42
|
Kariuki SM, Gray DM, Newton CRJC, Vanker A, MacGinty RP, Koen N, Barnett W, Chibnik L, Koenen KC, Stein DJ, Zar HJ. Association between maternal psychological adversity and lung function in South African infants: A birth cohort study. Pediatr Pulmonol 2020; 55:236-244. [PMID: 31571431 PMCID: PMC7154702 DOI: 10.1002/ppul.24532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/16/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The association of perinatal psychological adversity (ie, stressors and distress) with infant lung function (ILF) and development is not well studied in Africa and elsewhere. We determined the association between maternal perinatal psychological adversity and ILF in African infants. DESIGN Prospective longitudinal follow up of the Drakenstein Child Health Study birth cohort. PARTICIPANTS Seven hundred and sixty-two infants aged 6 to 10 weeks and 485 infants who had data for both maternal perinatal psychological adversity and ILF (measured at 6 to 10 weeks and 12 months). METHODS The main analyses were based on cross-sectional measures of ILF at each assessment (6 to 10 weeks or 12 months), using generalized linear models, and then on the panel-data of both longitudinal ILF assessments, using generalised estimating equations, that allowed specification of the within-group correlation structure. RESULTS Prenatal intimate partner violence (IPV) exposure was associated with reduced respiratory resistance at 6 to 10 weeks (beta coefficient [β] = -.131, P = .023); postnatal IPV with reduced ratio of time to peak tidal expiratory flow over total expiratory time (tPTEF /tE ) at 12 months (β = -.206, P = .016); and prenatal depression with lower respiratory rate at 6 to 10 weeks (β = -.044, P = .032) and at 12 months (β = -.053, P = .021). Longitudinal analysis found an association of prenatal IPV with reduced tPTEF /tE (β = -.052, P < .0001); postnatal IPV with decreased functional residual capacity (FRC; β = -.086, P < .0001); prenatal posttraumatic stress disorder with increased FRC (β = .017, P < .0001); prenatal depression with increased FRC (β = .026, P < .0001) and postnatal depression with increased FRC (β = .021, P < .0001). CONCLUSION Screening for psychological adversity and understanding the mechanisms involved may help identify children at risk of altered lung development and inform approaches to treatment.
Collapse
Affiliation(s)
- Symon M. Kariuki
- Department of Clinical Research (Neurosciences)KEMRI‐Wellcome Trust Research ProgrammeKilifiKenya
- Department of PsychiatryUniversity of OxfordOxfordEngland
| | - Diane M. Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
- Department of Paediatrics and Child HealthSouth African Medical Research Council (SAMRC) Unit on Child and Adolescent HealthCape TownSouth Africa
| | - Charles R. J. C. Newton
- Department of Clinical Research (Neurosciences)KEMRI‐Wellcome Trust Research ProgrammeKilifiKenya
- Department of PsychiatryUniversity of OxfordOxfordEngland
| | - Aneesa Vanker
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
- Department of Paediatrics and Child HealthSouth African Medical Research Council (SAMRC) Unit on Child and Adolescent HealthCape TownSouth Africa
| | - Rae P. MacGinty
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
- Department of Paediatrics and Child HealthSouth African Medical Research Council (SAMRC) Unit on Child and Adolescent HealthCape TownSouth Africa
| | - Nastassja Koen
- Department of Psychiatry & Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Department of Psychiatry and Mental HealthSouth African Medical Research Council (SAMRC) Unit on Anxiety and Stress DisordersCape TownSouth Africa
| | - Whitney Barnett
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
- Department of Paediatrics and Child HealthSouth African Medical Research Council (SAMRC) Unit on Child and Adolescent HealthCape TownSouth Africa
| | - Lori Chibnik
- Harvard TH Chan School of Public HealthHarvard UniversityBostonMassachusetts
| | - Karestan C. Koenen
- Harvard TH Chan School of Public HealthHarvard UniversityBostonMassachusetts
| | - Dan J. Stein
- Department of Psychiatry & Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Department of Psychiatry and Mental HealthSouth African Medical Research Council (SAMRC) Unit on Anxiety and Stress DisordersCape TownSouth Africa
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
- Department of Paediatrics and Child HealthSouth African Medical Research Council (SAMRC) Unit on Child and Adolescent HealthCape TownSouth Africa
| |
Collapse
|
43
|
Boonpiyathad T, Capova G, Duchna H, Croxford AL, Farine H, Dreher A, Clozel M, Schreiber J, Kubena P, Lunjani N, Mirer D, Rückert B, Satitsuksanoa P, Tan G, Groenen PMA, Bersuch E, Akdis M, Strasser DS, Renner ED, Akdis CA. Impact of high-altitude therapy on type-2 immune responses in asthma patients. Allergy 2020; 75:84-94. [PMID: 31267528 DOI: 10.1111/all.13967] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 04/30/2019] [Accepted: 05/30/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Asthma patients present with distinct immunological profiles, with a predominance of type 2 endotype. The aim of this study was to investigate the impact of high-altitude treatment on the clinical and immunological response in asthma. METHODS Twenty-six hospitalized asthma patients (nine eosinophilic allergic; EA, nine noneosinophilic allergic; NEA and eight noneosinophilic nonallergic; NN) and nine healthy controls in high altitude for 21 days were enrolled in the study. We assessed eosinophils, T cells, Tregs, and innate lymphoid cells (ILC) from peripheral blood using flow cytometry. RESULTS The number of eosinophils (both resting and activated) and chemoattractant receptor homolog expressed on Th2 cells (CRTH2)-expressing CD4+ and CD8+ T cells decreased significantly in EA patients after altitude treatment. The frequency of CRTH2+ Tregs as decreased significantly in all the asthma phenotypes as well as the frequency of ILC2 was significantly reduced in EA after altitude treatment. After 21 days of altitude therapy, CRTH2-expressing ILC2, CD4+ and CD8+ T cells and Treg cells showed attenuated responses to exogenous PGD2. Furthermore, PGD2 signaling via CRTH2 was found to diminish the suppressive function of CRTH2+ Tregs which partially normalized during high-altitude treatment. Improved asthma control was particularly evident in allergic asthma patients and correlated with decreased frequencies of CRTH2+ Treg cells in EA patients. Serum IL-5 and IL-13 decreased during climate treatment in asthma patients with high baseline levels. CONCLUSIONS Asthma treatment in high altitude reduced the type 2 immune response, corrected the increased CRTH2 expression and its dysregulated functions.
Collapse
Affiliation(s)
- Tadech Boonpiyathad
- Swiss Institute of Allergy and Asthma Research University of Zurich Davos Switzerland
- Department of Medicine Phramongkutklao Hospital Bangkok Thailand
- Christine Kühne Center for Allergy Research and Education Davos Switzerland
| | - Gertruda Capova
- Christine Kühne Center for Allergy Research and Education Davos Switzerland
- Hochgebirgsklinik Davos Davos Switzerland
| | - Hans‐Werner Duchna
- Christine Kühne Center for Allergy Research and Education Davos Switzerland
- Hochgebirgsklinik Davos Davos Switzerland
| | | | - Herve Farine
- Drug Discovery Idorsia Pharmaceuticals Ltd. Allschwil Switzerland
| | - Anita Dreher
- Swiss Institute of Allergy and Asthma Research University of Zurich Davos Switzerland
- Hochgebirgsklinik Davos Davos Switzerland
| | - Martine Clozel
- Drug Discovery Idorsia Pharmaceuticals Ltd. Allschwil Switzerland
| | | | | | - Nonhlanhla Lunjani
- Swiss Institute of Allergy and Asthma Research University of Zurich Davos Switzerland
- Christine Kühne Center for Allergy Research and Education Davos Switzerland
| | - David Mirer
- Swiss Institute of Allergy and Asthma Research University of Zurich Davos Switzerland
| | - Beate Rückert
- Swiss Institute of Allergy and Asthma Research University of Zurich Davos Switzerland
| | - Pattraporn Satitsuksanoa
- Swiss Institute of Allergy and Asthma Research University of Zurich Davos Switzerland
- Christine Kühne Center for Allergy Research and Education Davos Switzerland
| | - Ge Tan
- Swiss Institute of Allergy and Asthma Research University of Zurich Davos Switzerland
| | | | - Eugen Bersuch
- Christine Kühne Center for Allergy Research and Education Davos Switzerland
- Hochgebirgsklinik Davos Davos Switzerland
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research University of Zurich Davos Switzerland
| | | | - Ellen D. Renner
- Christine Kühne Center for Allergy Research and Education Davos Switzerland
- Hochgebirgsklinik Davos Davos Switzerland
- Chair and Institute of Environmental Medicine – UNIKA‐T TU Munich and Helmholtz Zentrum Munich Munich Germany
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research University of Zurich Davos Switzerland
- Christine Kühne Center for Allergy Research and Education Davos Switzerland
| |
Collapse
|
44
|
Denlinger LC, Heymann P, Lutter R, Gern JE. Exacerbation-Prone Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:474-482. [PMID: 31765853 DOI: 10.1016/j.jaip.2019.11.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/28/2019] [Accepted: 11/12/2019] [Indexed: 02/07/2023]
Abstract
Patients who are prone to exacerbations of asthma experience significant costs in terms of missed work and school, acute care visits, and hospitalizations. Exacerbations are largely driven by environmental exposures including pollutants, stress, and viral and bacterial pathogens. These exposures are most likely to induce acute severe "asthma attacks" in high-risk patients. These personal risk factors for exacerbations can vary with the phenotype of asthma and age of the patient. In children, allergic sensitization is a strong risk factor, especially for those children who develop sensitization early in life. Airway inflammation is an important risk factor, and biomarkers are under evaluation for utility in detecting eosinophilic and type 2 inflammation and neutrophilic inflammation as indicators of risk for recurrent exacerbations. Insights into inflammatory mechanisms have led to new approaches to prevent exacerbations using mAb-based biologics that target specific type 2 pathways. Challenges remain in developing an evidence base to support precision interventions with these effective yet expensive therapies, and in determining whether these treatments will be safe and effective in young children. Unfortunately, there has been less progress in developing treatments for acute exacerbations. Hopefully, greater understanding of mechanisms relating airway viruses, bacteria, mucin production, and neutrophilic inflammatory responses will lead to additional treatment options for patients experiencing acute exacerbations.
Collapse
Affiliation(s)
- Loren C Denlinger
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis.
| | - Peter Heymann
- Department of Pediatrics, University of Virginia, Charlottesville, Va
| | - Rene Lutter
- Departments of Respiratory Medicine and Experimental Immunology, Amsterdam University Centers, University of Amsterdam, Amsterdam Infection and Immunity Institute, Amsterdam, The Netherlands
| | - James E Gern
- Department of Pediatrics, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, Wis
| |
Collapse
|
45
|
Sharrad KJ, Sanwo O, Carson-Chahhoud KV, Pike KC. Psychological interventions for asthma in children and adolescents. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2019. [DOI: 10.1002/14651858.cd013420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Kelsey J Sharrad
- University of South Australia; School of Health Sciences; Adelaide Australia
| | - Olatokunbo Sanwo
- William Harvey Hospital; East Kent Hospitals University NHS Foundation Trust; Ashford UK
| | | | - Katharine C Pike
- UCL Great Ormond Street Institute of Child Health; Respiratory, Critical Care & Anaesthesia; London UK
| |
Collapse
|
46
|
Bundle N, Verlander NQ, Morbey R, Edeghere O, Balasegaram S, de Lusignan S, Smith G, Elliot AJ. Monitoring epidemiological trends in back to school asthma among preschool and school-aged children using real-time syndromic surveillance in England, 2012-2016. J Epidemiol Community Health 2019; 73:825-831. [PMID: 31262728 DOI: 10.1136/jech-2018-211936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/12/2019] [Accepted: 05/14/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND : Back to school (BTS) asthma has been previously reported in children; however, its epidemiology and associated healthcare burden are unclear. We aimed to describe the timing and magnitude of BTS asthma using surveillance data from different health services in England. METHODS : Asthma morbidity data from emergency department attendances and general practitioner (GP) consultations between April 2012 and December 2016 were used from national syndromic surveillance systems in England. Age-specific and sex-specific rates and time series of asthma peaks relative to school term dates were described. The timing of a BTS excess period and adjusted rates of asthma relative to a baseline period were estimated using cumulative sum control chart plots and negative binomial regression. RESULTS : BTS asthma among children aged below 15 years was most pronounced at the start of the school year in September. This effect was not present among those aged 15 years and above. After controlling for sex and study year, the adjusted daily rate of childhood GP in-hours asthma consultations was 2.5-3 times higher in the BTS excess period, with a significantly higher effect among children aged 0-4 years. A distinct age-specific pattern of sex differences in asthma presentations was present, with a higher burden among males in children and among females aged over 15 years. CONCLUSION: We found evidence of a BTS asthma peak in children using surveillance data across a range of healthcare systems, supporting the need for further preventative work to reduce the impact of BTS asthma in children.
Collapse
Affiliation(s)
- Nick Bundle
- United Kingdom Field Epidemiology Training Programme, Public Health England, London, UK.,Field Epidemiology South East and London, Field Service, National Infection Service, Public Health England, London, UK
| | - Neville Q Verlander
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
| | - Roger Morbey
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, West Midlands, UK
| | - Obaghe Edeghere
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, West Midlands, UK
| | - Sooria Balasegaram
- Field Epidemiology South East and London, Field Service, National Infection Service, Public Health England, London, UK
| | - Simon de Lusignan
- Research & Surveillance Centre, Royal College of General Practitioners, London, UK.,Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK
| | - Gillian Smith
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, West Midlands, UK
| | - Alex J Elliot
- Real-time Syndromic Surveillance Team, Field Service, National Infection Service, Public Health England, Birmingham, West Midlands, UK
| |
Collapse
|
47
|
Gjelsvik A, Rogers ML, Garro A, Sullivan A, Koinis-Mitchell D, McQuaid EL, Smego R, Vivier PM. Neighborhood Risk and Hospital Use for Pediatric Asthma, Rhode Island, 2005-2014. Prev Chronic Dis 2019; 16:E68. [PMID: 31146802 PMCID: PMC6549429 DOI: 10.5888/pcd16.180490] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Studies consistently show that children living in poor neighborhoods have worse asthma outcomes. The objective of our study was to assess the association between negative neighborhood factors (ie, neighborhood risk) and pediatric asthma hospital use. METHODS This retrospective study used data from children aged 2 to 17 years in a statewide (Rhode Island) hospital network administrative database linked to US Census Bureau data. We defined an asthma visit as an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code of 493 in any diagnosis field. We used 8 highly correlated measures for each census-block group to construct an index of neighborhood risk. We used maps and linear regression to assess the association of neighborhood risk with average annual census-block-group rates of asthma emergency department visits and hospitalizations. We used multivariable analyses to identify child characteristics and neighborhood risk associated with an asthma revisit, accounting for the child's sociodemographic information, season, and multiple measurements per child. RESULTS From 2005 through 2014, we counted 359,195 visits for 146,889 children. Of these, 12,699 children (8.6%) had one or more asthma visits. Linear regression results showed 1.18 (95% confidence interval, 1.06-1.30) more average annual emergency departments visits per 100 children and 0.41 (95% confidence interval, 0.34-0.47) more average annual hospitalizations per 100 children in neighborhoods in the highest-risk index quintile than in neighborhoods in the lowest-risk index quintile. CONCLUSION Interventions to improve asthma outcomes among children should move beyond primary care or clinic settings and involve a careful evaluation of social context and environmental triggers.
Collapse
Affiliation(s)
- Annie Gjelsvik
- Department of Epidemiology, Brown University, Providence, Rhode Island
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
- Brown University, Box G-121S, Providence, RI 02912.
| | - Michelle L Rogers
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
| | - Aris Garro
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Pediatrics, Brown University Warren Alpert Medical School, Providence, Rhode Island
| | - Adam Sullivan
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
- Department of Biostatistics, Brown University, Providence, Rhode Island
| | - Daphne Koinis-Mitchell
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
- Department of Pediatrics, Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
| | - Elizabeth L McQuaid
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
| | - Raul Smego
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
| | - Patrick M Vivier
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
- Department of Pediatrics, Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island
| |
Collapse
|
48
|
Barry V, Stout ME, Lynch ME, Mattis S, Tran DQ, Antun A, Ribeiro MJ, Stein SF, Kempton CL. The effect of psychological distress on health outcomes: A systematic review and meta-analysis of prospective studies. J Health Psychol 2019; 25:227-239. [PMID: 30973027 DOI: 10.1177/1359105319842931] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Distress effects are widely examined in cross-sectional studies with less known about effects on future health. This review summarizes distress impacts on health among adults in prospective studies and describes available distress measurement tools. Four inter-disciplinary databases were searched. Effects of distress on mortality and other outcomes were reviewed and estimated in a meta-analysis. A total of 19 studies were assessed which incorporated 10 distress tools. Distress had a detrimental effect on health regardless of the population studied, distress tool used, and health outcome examined. There was an increased mortality risk among those reporting high versus low distress (pooled hazard ratio (95% confidence interval) = 1.29 (1.15-1.46)).
Collapse
Affiliation(s)
| | | | | | | | | | | | - Maria Ja Ribeiro
- Emory University, USA.,Atlanta Veterans Affairs Medical Center, USA
| | | | | |
Collapse
|
49
|
Abstract
PURPOSE OF REVIEW Asthma attacks are frequent in children with asthma and can lead to significant adverse outcomes including time off school, hospital admission and death. Identifying children at risk of an asthma attack affords the opportunity to prevent attacks and improve outcomes. RECENT FINDINGS Clinical features, patient behaviours and characteristics, physiological factors, environmental data and biomarkers are all associated with asthma attacks and can be used in asthma exacerbation prediction models. Recent studies have better characterized children at risk of an attack: history of a severe exacerbation in the previous 12 months, poor adherence and current poor control are important features which should alert healthcare professionals to the need for remedial action. There is increasing interest in the use of biomarkers. A number of novel biomarkers, including patterns of volatile organic compounds in exhaled breath, show promise. Biomarkers are likely to be of greatest utility if measured frequently and combined with other measures. To date, most prediction models are based on epidemiological data and population-based risk. The use of digital technology affords the opportunity to collect large amounts of real-time data, including clinical and physiological measurements and combine these with environmental data to develop personal risk scores. These developments need to be matched by changes in clinical guidelines away from a focus on current asthma control and stepwise escalation in drug therapy towards inclusion of personal risk scores and tailored management strategies including nonpharmacological approaches. SUMMARY There have been significant steps towards personalized prediction models of asthma attacks. The utility of such models needs to be tested in the ability not only to predict attacks but also to reduce them.
Collapse
|
50
|
McKelvey LM, Saccente JE, Swindle TM. Adverse Childhood Experiences in Infancy and Toddlerhood Predict Obesity and Health Outcomes in Middle Childhood. Child Obes 2019; 15:206-215. [PMID: 30762431 PMCID: PMC7001385 DOI: 10.1089/chi.2018.0225] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Adverse Childhood Experiences (ACEs) study articulated the negative effects of childhood trauma on adult weight and health. The purpose of the current study is to examine the associations between ACEs in infancy and toddlerhood and obesity and related health indicators in middle childhood. METHODS We used data collected from a sample of low-income families enrolled in the national evaluation of Early Head Start (EHS). Data come from 1335 demographically diverse families collected at or near children's ages 1, 2, 3, and 11. An EHS-ACE index was created based on interview and observation items from data collected at ages 1, 2, and 3, which were averaged to represent exposure across infancy and toddlerhood. At age 11, children's height and weight were measured and parents were asked about their child's health. RESULTS Children were exposed at rates of 30%, 28%, 15%, and 8% to one, two, three, and four or more EHS-ACEs, respectively. Logistic regressions revealed significant associations between EHS-ACEs in infancy/toddlerhood and obesity, respiratory problems, taking regular nonattention-related prescriptions, and the parent's global rating of children's health at age 11. Across all outcomes examined, children with four or more ACEs had the poorest health. Compared with children with no ACE exposure, the odds of each of the examined health outcomes were over twice as high for children who experienced four or more ACEs. CONCLUSIONS Findings highlight that ACEs experienced very early in development are associated with children whose health is at risk later in childhood.
Collapse
Affiliation(s)
- Lorraine M. McKelvey
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Jennifer E. Saccente
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Taren M. Swindle
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| |
Collapse
|