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Renneberg CK, Brund RBK, Heuckendorff S, Gunaseelan A, Kruse LV, Fonager K. Preschool children from lower household incomes experience inequality in asthma treatment: findings from a Danish nationwide cohort study. Eur J Public Health 2024; 34:85-90. [PMID: 37862429 PMCID: PMC10843934 DOI: 10.1093/eurpub/ckad187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The obligation to pay for asthma medication in a country with universal healthcare might lead to increased asthma exacerbations and inequitable healthcare access for children from low-income households. Thus, the aim of this study was to examine the association between household income and childhood/preschool asthma regarding hospitalization and medication receipt. METHODS In this nationwide register-based cohort study, we encompassed all 3-year-old children residing in Denmark, born between 2000 and 2014, along with their linked parents and followed them until their sixth birthday. Household income was divided into quartiles. Asthma was categorized in two mutually exclusive groups as either the redemption of two prescriptions for asthma medication or receiving a hospital diagnosis. We utilized Poisson regression to estimate the risk ratio (RR). RESULTS The analysis included 834 422 preschool children. The prevalence of asthma dependent on medication alone was 7.3%, while 1.8% of children necessitated asthma-related hospitalization. Income inequality was evident across all income quartiles. Notably, children from the lowest income quartile had a RR of 0.95 (95% CI: 0.92-0.98) of redeeming asthma medication and conversely a RR of 1.18 (95% CI: 1.14-1.23) of asthma-related hospitalization. CONCLUSIONS Despite universal healthcare, income inequality has a dual impact on children from low-income households. They face a diminished risk of redeeming asthma medication and a higher susceptibility to asthma-related hospitalizations indicating an unequal access to healthcare. Prioritizing efforts to reduce childhood health inequalities is crucial. However, further research, particularly qualitative studies, is needed to better comprehend the underlying mechanisms to address the complexities of income inequality.
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Affiliation(s)
| | | | - Signe Heuckendorff
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
- Psychiatry Region North Jutland, Aalborg, Denmark
| | - Artika Gunaseelan
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Lisbeth Venø Kruse
- Department of Paediatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Al-Qerem W, Jarab A, Jarrar Y, Al-Zayadneh E, Al-Iede M, Ling J, Abu Hammour K, S Alabdullah S, Saad Alabdullah A, Al Refaie Y, Lubbad D, Alassi A, Ibrahim S, Al-Ibadah M, Al Bawab AQ. Correlation of vitamin D receptor genotypes, specific IgE levels and other variables with asthma control in children. J Asthma 2024; 61:105-118. [PMID: 37530048 DOI: 10.1080/02770903.2023.2244580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 07/17/2023] [Accepted: 08/01/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Asthma is a common condition affecting millions of children globally. The main goal of this study is to assess factors related to asthma management, particularly atopy level and the impact of genetic variants of the vitamin D receptor (VDR) gene. METHODS Asthmatic children were enrolled in an outpatient respiratory clinic. Information on patients' medication adherence, medical and medication factors, and sociodemographic were gathered. Spirometry FEV1% and FVC% measurements, and the asthma control test were used to evaluate the severity of asthma, and genotyping of the VDR gene and radioallergosorbent test (RAST) were conducted. Regression analyses were conducted to evaluate variables associated with asthma control and spirometry measures. RESULTS A total of 313 participants (67.4% males) were recruited in the current study. The mean age was 9.37 (±3.45) years. The mean score for adherence was 4.26 (±2.52), and only 46% of the participants had controlled asthma. Forward conditional stepwise binary regression showed that low and moderate Inhaled corticosteroids (ICS) dose (OR= 0.42 (95% CI 0.20-0.90), p = 0.026; OR = 0.371 (95% CI 0.2-0.72), p = 0.003, respectively) decreased the odds of being in the controlled asthma group, while higher inhaler score (OR = 2.75 (95% CI 2.17-3.49, p < 0.001)) increased the odds of being in the controlled asthma group. However, results found no association between VDR genotype and asthma control, spirometry values or hospitalization due to asthma. CONCLUSIONS The results indicated that many of the asthma patients had poorly controlled asthma. Factors that were associated with poor asthma control included poor inhaler technique.
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Affiliation(s)
- Walid Al-Qerem
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Anan Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
- College of Pharmacy, Al Ain University, Abu Dhabi, UAE
| | - Yazun Jarrar
- Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied University, As-salt, Jordan
| | - Enas Al-Zayadneh
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan
| | - Montaha Al-Iede
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan
| | - Jonathan Ling
- Faculty of Science and Wellbeing, University of Sunderland, Sunderland, UK
| | | | | | | | - Yamam Al Refaie
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Dina Lubbad
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan
| | - Ameen Alassi
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Sarah Ibrahim
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan
| | - Mahmood Al-Ibadah
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
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Schacter HL, D Ehrhardt A, MacDonell KE. Associations between peer experiences and health outcomes among adolescents and young adults with asthma. J Asthma 2023; 60:1359-1368. [PMID: 36369912 DOI: 10.1080/02770903.2022.2147080] [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: 03/30/2022] [Revised: 10/20/2022] [Accepted: 11/09/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Although peer relationships become increasingly important across adolescence and early adulthood, research examining links between peer relationships and the health outcomes of young people with asthma is scarce. Using a large sample of adolescents and young adults (AYAs) with asthma, the current study assessed whether positive and negative peer experiences are associated with AYAs' asthma control, asthma self-efficacy, and internalizing symptoms. METHODS In this cross-sectional study, a national sample of 440 diverse adolescents and young adults with asthma completed an online survey. Questionnaires assessed general and asthma-specific peer experiences (i.e. peer victimization; peer support; asthma-related peer problems) and health indicators (i.e. asthma control; asthma self-efficacy; internalizing symptoms). Regression analyses were performed to examine associations between peer experiences and health while controlling for participant age, gender, race/ethnicity, and age of asthma diagnosis. RESULTS Results from separate regression models indicated that adolescents who experienced greater peer victimization, less peer support, and more asthma-related peer problems also reported worse asthma control, lower asthma self-efficacy, and more severe internalizing symptoms. Follow-up exploratory analyses indicated that peer victimization and asthma-related peer problems were the strongest predictors of asthma control and internalizing, whereas peer support and asthma-related peer problems were the strongest predictors of asthma self-efficacy. CONCLUSIONS This study underscores connections between peer relationships and health outcomes among AYAs with asthma. Interventions that leverage peer support and mitigate peer stress may offer a developmentally appropriate approach for mitigating physical and psychological distress among adolescents and young adults with asthma.
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Affiliation(s)
| | | | - Karen E MacDonell
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, USA
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Aggarwal S, Cepalo T, Gill S, Thipse M, Clifton KL, Higginson A, Vu J, Bijelić V, Barrowman N, Giangioppo S, Radhakrishnan D. Factors associated with future hospitalization among children with asthma: a systematic review. J Asthma 2023; 60:425-445. [PMID: 35522051 DOI: 10.1080/02770903.2022.2070762] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Asthma is a leading cause of emergency department (ED) visits and hospitalizations in children, though many could be prevented. Our study objective was to identify factors from the published literature that are associated with future hospitalization for asthma beyond 30 days following an initial asthma ED visit. DATA SOURCES We searched CINAHL, CENTRAL, MEDLINE, and Embase for all studies examining factors associated with asthma-related hospitalization in children from January 1, 1992 to February 7, 2022.Selecting Studies: All citations were reviewed independently by two reviewers and studies meeting inclusion criteria were assessed for risk of bias. Data on all reported variables were extracted from full text and categorized according to identified themes. Where possible, data were pooled for meta-analysis using random effects models. RESULTS Of 2262 studies, 68 met inclusion criteria. We identified 28 risk factors and categorized these into six themes. Factors independently associated with future hospitalization in meta-analysis include: exposure to environmental tobacco smoke (OR = 1.94 95%CI 0.67-5.61), pets exposure (OR = 1.67 95%CI 1.17-2.37), and previous asthma hospitalizations (OR = 3.47 95% CI 2.95-4.07). Additional related factors included previous acute care visits, comorbid health conditions (including atopy), allergen exposure, severe-persistent asthma phenotype, inhaled steroid use prior to ED visit, poor asthma control, higher severity symptoms at ED presentation, warmer season at admission, longer length of stay or ICU admission, and African-American race/ethnicity. CONCLUSIONS We identified multiple factors that are consistently associated with future asthma hospitalization in children and could be used to identify those who would benefit from targeted preventative interventions.
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Affiliation(s)
| | - Tanita Cepalo
- Faculty of Science, Carleton University, Ottawa, Canada
| | - Sana Gill
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Madhura Thipse
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Kerry-Lee Clifton
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | | | - James Vu
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Vid Bijelić
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Sandra Giangioppo
- University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Dhenuka Radhakrishnan
- Children's Hospital of Eastern Ontario, Ottawa, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Canada.,ICES, Ottawa, ON, Canada
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Batra M, Dharmage SC, Newbigin E, Tang M, Abramson MJ, Erbas B, Vicendese D. Grass pollen exposure is associated with higher readmission rates for pediatric asthma. Pediatr Allergy Immunol 2022; 33:e13880. [PMID: 36433858 DOI: 10.1111/pai.13880] [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: 06/26/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pediatric asthma hospital readmission is a burden on the individual and costly for Australian hospitals. Grass pollen's role, a known trigger for asthma admissions, is unexamined in readmissions. We examined the association between grass pollen and pediatric asthma readmission. METHODS The Victorian Admitted Episodes Dataset was used to identify all primary admissions with a principal diagnosis of asthma in children aged 2-18 years between 1997 and 2009. Readmissions were defined as subsequent admissions within 28 days of index admission discharge. Generalized additive models were used to assess associations between readmission, grass pollen season, and daily grass pollen counts, lagged and cumulative. Models were further stratified by sex and age group. RESULTS Mean daily readmission was higher during grass pollen season than other times of the year, incidence rate ratio (IRR) 1.44 (95% CI, 1.03, 2.02) and for children aged 2-5 years, IRR 1.99 (1.26, 3.14). Same day grass pollen was nonlinearly associated with daily readmission for the 13-18 age group between 110 and 256 grains/m3 , p < .01. Lag 2 grass pollen was nonlinearly associated with daily readmissions overall (p = .03), boys (p = .01), and younger age groups 2-5 (p = .02) and 6-12 (p < .001). CONCLUSIONS Grass pollen exposure was associated with higher readmission rates for pediatric asthma. Treatment plans prior to discharge could be implemented to reduce the likelihood of readmission by younger children during the pollen season.
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Affiliation(s)
- Mehak Batra
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Edward Newbigin
- School of BioSciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mimi Tang
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, The Royal Children's Hospital Victoria, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bircan Erbas
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.,Violet Vines Marshman Centre for Rural Health Research, La Trobe University, Bendigo, Victoria, Australia
| | - Don Vicendese
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,School of Engineering & Mathematical Science, La Trobe University, Bundoora, Victoria, Australia
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Morrison B, Lim E, Jun Ahn H, Chen JJ. Factors Related to Pediatric Readmissions of Four Major Diagnostic Categories in Hawai`i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:108-114. [PMID: 35415615 PMCID: PMC8995857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Readmissions are a key quality measure for health care decision making and understanding variables associated with readmissions has become a crucial research area. This study identified patient-level factors that might be associated with pediatric readmissions using a database that included inpatient data from 2008 to 2017 from Hawai`i. Four major diagnostic categories with the most pediatric readmissions in the state were identified: respiratory, digestive, mental, and nervous system diseases and disorders. The associations between readmission and patient-level variables, such as age, sex, race/ethnicity, insurance status, and Charlson Comorbidity Index (CCI), were determined for each diagnosis and for overall readmissions. CCI and insurance were the strongest predictors when all diagnoses were combined. However, for some diagnoses, there was weak or no association between CCI, insurance, and readmission. This suggests that diagnosis-specific analysis of predictors of readmission may be more useful than looking at predictors of readmission for all diagnoses combined. While this study focused on patient variables, future studies should also incorporate how hospital variables may also be related to diagnosis.
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Affiliation(s)
- Breanna Morrison
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai`i, Honolulu, HI
| | - Eunjung Lim
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai`i, Honolulu, HI
| | - Hyeong Jun Ahn
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai`i, Honolulu, HI
| | - John J. Chen
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai`i, Honolulu, HI
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Aschalew A, Kebed RA, Demie TG, Weldetsadik AY. Assessment of level of asthma control and related factors in children attending pediatric respiratory clinics in Addis Ababa, Ethiopia. BMC Pulm Med 2022; 22:70. [PMID: 35197032 PMCID: PMC8865488 DOI: 10.1186/s12890-022-01865-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background Asthma is a common airways disease with significant morbidity and mortality in all ages. Studies of pediatric asthma control and its determinants yielded variable results across settings. However, there is paucity of data on asthma control and its factors in Ethiopian children. We aimed to assess the level of asthma control and the related factors in children attending pediatric respiratory clinics at three tertiary hospitals in Addis Ababa.
Methods We conducted a cross-sectional study from March 1 to August 30, 2020 using standardized questionnaires and review of patient’s charts. Data was analyzed using SPSS software for window version 26. Results A total of 105 children (56.2% male) were included in the study. The mean age (± SD) and age at Asthma diagnosis (± SD) were 6 (± 3.3) and 4 (± 2.8) respectively. Uncontrolled asthma was present in 33 (31%) of children. Comorbidities (Atopic dermatitis and allergic Rhinitis (AOR = 4.56; 95% CI 1.1–18.70; P = 0.035), poor adherence to controller medications (AOR = 3.23; 95% CI 1.20–10.20; P = 0.045), inappropriate inhaler technique (AOR = 3.48; 95% CI 1.18–10.3; P = 0.024), and lack of specialized care (AOR = 4.72; 95% CI 1.13–19.80; P = 0.034) were significantly associated with suboptimal asthma control. Conclusion One-third of children attending pediatric respiratory clinics in Addis Ababa had uncontrolled Asthma. Treatment of comorbidities, training of appropriate inhaler techniques, optimal adherence to controllers, and proper organization of clinics should be emphasized to improve asthma control among children.
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Affiliation(s)
| | - Rahel Argaw Kebed
- Pediatric Pulmonary and Critical Care, Addis Ababa University, Addis Ababa, Ethiopia
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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.
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Hogan AH, Carroll CL, Iverson MG, Hollenbach JP, Philips K, Saar K, Simoneau T, Sturm J, Vangala D, Flores G. Risk Factors for Pediatric Asthma Readmissions: A Systematic Review. J Pediatr 2021; 236:219-228.e11. [PMID: 33991541 DOI: 10.1016/j.jpeds.2021.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To systematically review the literature on pediatric asthma readmission risk factors. STUDY DESIGN We searched PubMed/MEDLINE, CINAHL, Scopus, PsycINFO, and Cochrane Central Register of Controlled Trials for published articles (through November 2019) on pediatric asthma readmission risk factors. Two authors independently screened titles and abstracts and consensus was reached on disagreements. Full-text articles were reviewed and inclusion criteria applied. For articles meeting inclusion criteria, authors abstracted data on study design, patient characteristics, and outcomes, and 4 authors assessed bias risk. RESULTS Of 5749 abstracts, 74 met inclusion criteria. Study designs, patient populations, and outcome measures were highly heterogeneous. Risk factors consistently associated with early readmissions (≤30 days) included prolonged length of stay (OR range, 1.1-1.6) and chronic comorbidities (1.7-3.2). Risk factors associated with late readmissions (>30 days) included female sex (1.1-1.6), chronic comorbidities (1.5-2), summer discharge (1.5-1.8), and prolonged length of stay (1.04-1.7). Across both readmission intervals, prior asthma admission was the most consistent readmission predictor (1.3-5.4). CONCLUSIONS Pediatric asthma readmission risk factors depend on the readmission interval chosen. Prior hospitalization, length of stay, sex, and chronic comorbidities were consistently associated with both early and late readmissions. TRIAL REGISTRATION CRD42018107601.
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Affiliation(s)
- Alexander H Hogan
- Division of Hospital Medicine, Connecticut Children's Medical Center, Hartford, CT; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT.
| | - Christopher L Carroll
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT; Division of Critical Care, Connecticut Children's Medical Center, Hartford, CT
| | | | - Jessica P Hollenbach
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT; Asthma Center, Connecticut Children's Medical Center, Hartford, CT
| | - Kaitlyn Philips
- Children's Hospital at Montefiore, Bronx, NY; Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Katarzyna Saar
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
| | - Tregony Simoneau
- Boston Children's Medical Center, Boston, MA; Department of Pediatrics, Harvard University, Cambridge, MA
| | - Jesse Sturm
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT; Department of Emergency Medicine, Connecticut Children's Medical Center, Hartford, CT
| | - Divya Vangala
- Department of Pediatrics, Duke University, Durham, NC
| | - Glenn Flores
- Department of Pediatrics, University of Miami Miller School of Medicine, and Holtz Children's Hospital, Jackson Health System, Miami, FL
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Radhakrishnan D, Bota SE, Price A, Ouédraogo A, Husein M, Clemens KK, Shariff SZ. Comparison of childhood asthma incidence in 3 neighbouring cities in southwestern Ontario: a 25-year longitudinal cohort study. CMAJ Open 2021; 9:E433-E442. [PMID: 33947701 PMCID: PMC8101639 DOI: 10.9778/cmajo.20200130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Air pollution is a known trigger for exacerbations among individuals with asthma, but its role in the development of new-onset asthma is unclear. We compared the rate of new asthma cases in Sarnia, a city with high pollution levels, with the rates in 2 neighbouring regions in southwestern Ontario, Canada. METHODS Using a population-based birth cohort design and linked health administrative data, we compared the hazard of incident asthma among children 0 to 10 years of age between those born in Lambton (Sarnia) and those born in Windsor and London-Middlesex, for the period Apr. 1, 1993, to Mar. 31, 2009. We used Cox proportional hazards models to adjust for year of birth and exposure to air pollutants (nitrogen dioxide, sulphur dioxide [SO2], ozone and small particulate matter [PM2.5]), as well as maternal, geographic and socioeconomic factors. RESULTS Among 114 427 children, the highest incidence of asthma was in Lambton, followed by Windsor and London-Middlesex (30.3, 24.4 and 19.8 per 1000 person-years, respectively; p < 0.001). Relative to Lambton, the hazard of asthma, adjusted for socioeconomic and perinatal factors, was lower in Windsor (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.67-0.77) and London-Middlesex (HR 0.65, 95% CI 0.61-0.69). Inclusion of air pollutants attenuated this relative difference in both Windsor (HR 0.79, 95% CI 0.62-1.01) and London-Middlesex (HR 0.89, 95% CI 0.64-1.24). INTERPRETATION We identified a higher incidence of asthma among children born in Lambton (Sarnia) relative to 2 other regions in southwestern Ontario. Higher levels of air pollution (particularly SO2 and PM2.5) in this region, as experienced by children in their first year of life, may be contributory.
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Affiliation(s)
- Dhenuka Radhakrishnan
- Children's Hospital of Eastern Ontario Research Institute (Radhakrishnan); Department of Pediatrics (Radhakrishnan), University of Ottawa; ICES uOttawa (Radhakrishnan), Ottawa, Ont.; ICES Western (Bota, Ouédraogo, Clemens, Shariff); London Health Sciences Centre (Price, Husein); Departments of Pediatrics (Price), of Surgery (Husein), of Medicine (Clemens), and of Epidemiology and Biostatistics (Clemens), Western University; Lawson Health Research Institute (Price, Husein, Shariff), London, Ont.
| | - Sarah E Bota
- Children's Hospital of Eastern Ontario Research Institute (Radhakrishnan); Department of Pediatrics (Radhakrishnan), University of Ottawa; ICES uOttawa (Radhakrishnan), Ottawa, Ont.; ICES Western (Bota, Ouédraogo, Clemens, Shariff); London Health Sciences Centre (Price, Husein); Departments of Pediatrics (Price), of Surgery (Husein), of Medicine (Clemens), and of Epidemiology and Biostatistics (Clemens), Western University; Lawson Health Research Institute (Price, Husein, Shariff), London, Ont
| | - April Price
- Children's Hospital of Eastern Ontario Research Institute (Radhakrishnan); Department of Pediatrics (Radhakrishnan), University of Ottawa; ICES uOttawa (Radhakrishnan), Ottawa, Ont.; ICES Western (Bota, Ouédraogo, Clemens, Shariff); London Health Sciences Centre (Price, Husein); Departments of Pediatrics (Price), of Surgery (Husein), of Medicine (Clemens), and of Epidemiology and Biostatistics (Clemens), Western University; Lawson Health Research Institute (Price, Husein, Shariff), London, Ont
| | - Alexandra Ouédraogo
- Children's Hospital of Eastern Ontario Research Institute (Radhakrishnan); Department of Pediatrics (Radhakrishnan), University of Ottawa; ICES uOttawa (Radhakrishnan), Ottawa, Ont.; ICES Western (Bota, Ouédraogo, Clemens, Shariff); London Health Sciences Centre (Price, Husein); Departments of Pediatrics (Price), of Surgery (Husein), of Medicine (Clemens), and of Epidemiology and Biostatistics (Clemens), Western University; Lawson Health Research Institute (Price, Husein, Shariff), London, Ont
| | - Murad Husein
- Children's Hospital of Eastern Ontario Research Institute (Radhakrishnan); Department of Pediatrics (Radhakrishnan), University of Ottawa; ICES uOttawa (Radhakrishnan), Ottawa, Ont.; ICES Western (Bota, Ouédraogo, Clemens, Shariff); London Health Sciences Centre (Price, Husein); Departments of Pediatrics (Price), of Surgery (Husein), of Medicine (Clemens), and of Epidemiology and Biostatistics (Clemens), Western University; Lawson Health Research Institute (Price, Husein, Shariff), London, Ont
| | - Kristin K Clemens
- Children's Hospital of Eastern Ontario Research Institute (Radhakrishnan); Department of Pediatrics (Radhakrishnan), University of Ottawa; ICES uOttawa (Radhakrishnan), Ottawa, Ont.; ICES Western (Bota, Ouédraogo, Clemens, Shariff); London Health Sciences Centre (Price, Husein); Departments of Pediatrics (Price), of Surgery (Husein), of Medicine (Clemens), and of Epidemiology and Biostatistics (Clemens), Western University; Lawson Health Research Institute (Price, Husein, Shariff), London, Ont
| | - Salimah Z Shariff
- Children's Hospital of Eastern Ontario Research Institute (Radhakrishnan); Department of Pediatrics (Radhakrishnan), University of Ottawa; ICES uOttawa (Radhakrishnan), Ottawa, Ont.; ICES Western (Bota, Ouédraogo, Clemens, Shariff); London Health Sciences Centre (Price, Husein); Departments of Pediatrics (Price), of Surgery (Husein), of Medicine (Clemens), and of Epidemiology and Biostatistics (Clemens), Western University; Lawson Health Research Institute (Price, Husein, Shariff), London, Ont
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Dhaliwal C, Haji T, Leung G, Thipse M, Giangioppo S, Radhakrishnan D. Predictors of future acute asthma visits among children receiving guideline recommended emergency department discharge management. J Asthma 2020; 58:1024-1031. [PMID: 32336173 DOI: 10.1080/02770903.2020.1761383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Asthma emergency department (ED) visits remain frequent among children, prompting ongoing pursuit of preventative strategies. OBJECTIVE We identified factors associated with future acute asthma ED visits among children who had already received guideline recommended discharge management following a prior asthma ED visit. METHODS We performed a retrospective cohort study of children ages 1-17 years with a first asthma ED visit to the Children's Hospital of Eastern Ontario in Canada between September 2014-August 2015. Children who received recommended discharge management including an inhaled corticosteroids prescription and/or an asthma action plan were included. We used multivariable logistic regression to identify factors associated with a future acute asthma visits one year following the first ED visit. RESULTS Among 909 children with a first asthma ED visit, 24% had a future acute asthma visit within one year. Future acute asthma visits were more likely in children with a nut/peanut allergy (OR 1.76, 95% CI: 1.15, 2.70), higher severity symptoms (OR 2.04, 95% CI: 1.23, 3.39), a primary care physician (OR 2.23, 95% CI: 1.26, 3.93), or a prior diagnosis of asthma (OR 1.53, 95% CI: 1.03, 2.28). CONCLUSION Children at risk for repeat acute asthma ED visits despite having a primary care provider and receiving recommended discharge management at their first ED visit can be identified by factors such as having a nut/peanut allergy, a prior asthma diagnosis, and higher severity symptoms at ED presentation. These factors can be used to target more intensive preventative interventions to those most in need.
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Affiliation(s)
- Cara Dhaliwal
- Department of Family Medicine, Western University, London, ON, Canada
| | - Tahereh Haji
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Garvin Leung
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Madhura Thipse
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Sandra Giangioppo
- Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Dhenuka Radhakrishnan
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada
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12
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ST2 Predicts Risk of Unplanned Readmission Within 1 Year After Pediatric Congenital Heart Surgery. Ann Thorac Surg 2020; 110:2070-2075. [PMID: 32246937 DOI: 10.1016/j.athoracsur.2020.02.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Approximately 10% to 20% of children are readmitted after congenital heart surgery. Very little is known about biomarkers as predictors of risk of unplanned readmission after pediatric congenital heart surgery. Novel cardiac biomarker ST2 may be associated with risk of unplanned readmission. ST2 concentrations are believed to reflect cardiovascular stress and fibrosis. Our objective was to explore the relationship between pre- and postoperative ST2 biomarker levels and risk of readmission within 1 year after congenital heart surgery. METHODS We prospectively enrolled pediatric patients aged < 18 years who underwent at least 1 congenital heart operation at Johns Hopkins Hospital from 2010 to 2014. Plasma samples were collected immediately before surgery and at the end of bypass. We used Kaplan-Meier survival analysis and multivariable Cox regression models to adjust for variables used in The Society of Thoracic Surgeons Congenital Heart Surgery Database mortality risk model. RESULTS Of our cohort of 145 patients, we found 39 children with readmissions within 365 days. The median time to unplanned readmission was 54 days (interquartile range, 10-153). Kaplan-Meier analysis demonstrated a significant difference across terciles of pre- and postoperative ST2 biomarker levels. After adjustment, elevated serum levels of ST2 measured preoperatively and postoperatively were associated with increased risk of readmission (hazard ratio, 2.5-3.7; all P < .05). CONCLUSIONS Elevated levels of ST2 are significantly associated with increased risk of unplanned readmission within 1 year after pediatric congenital heart surgery. Novel serum biomarker ST2 can be used for risk stratification or estimating postsurgical prognosis.
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13
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Weinstein SM, Pugach O, Rosales G, Mosnaim GS, Walton SM, Martin MA. Family Chaos and Asthma Control. Pediatrics 2019; 144:peds.2018-2758. [PMID: 31289192 PMCID: PMC6855822 DOI: 10.1542/peds.2018-2758] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Asthma is a highly prevalent childhood chronic disease, with particularly high rates among poor and minority youth. Psychosocial factors have been linked to asthma severity but remain poorly understood. This study examined (1) relationships between parent and child depression and posttraumatic stress disorder (PTSD) symptoms, family functioning, and child asthma control in a sample of urban minority youth with uncontrolled asthma and (2) family functioning as a pathway linking parent depression and asthma outcomes. METHODS Data were drawn from the baseline cohort of a randomized trial testing community interventions for children aged 5 to 16 with uncontrolled asthma (N = 223; mean age = 9.37, SD = 3.02; 85.2% Hispanic). Asthma control was defined by using the Asthma Control Test and Childhood Asthma Control Test, activity limitation, and previous-12-month asthma severity. Psychosocial measures included parent and child depression and PTSD symptoms, family chaos, and parent social support. RESULTS Parent and child depression symptoms, but not PTSD, were associated with worse asthma control (β = -.20 [SE = 0.06] and β = -.12 [SE = -.03]; P < .001). Family chaos corresponded to worse asthma control, even when controlling for parent and child depression (β = -.33; [SE = 0.15]; P < .05), and was a mediator of the parent depression-asthma path. Emotional triggers of asthma also mediated the parent depression-asthma relationship. CONCLUSIONS Findings highlight family chaos as a mechanism underlying the relationship between parent depression and child asthma control. Addressing parent and child depression, family routines, and predictability may optimize asthma outcomes.
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Affiliation(s)
| | | | | | | | - Surrey M. Walton
- Pharmacy Systems Outcomes and Policy, University of Illinois at Chicago, Chicago, Illinois; and
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14
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Novel Biomarkers Improve Prediction of 365-Day Readmission After Pediatric Congenital Heart Surgery. Ann Thorac Surg 2019; 109:164-170. [PMID: 31323208 DOI: 10.1016/j.athoracsur.2019.05.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the association between preoperative biomarker levels and 365-day readmission or mortality after pediatric congenital heart surgery. METHODS Children aged 18 years or younger undergoing congenital heart surgery (n = 145) at Johns Hopkins Hospital from 2010 to 2014 were enrolled in the prospective cohort. Novel biomarkers suppression of tumorgenicity 2, galectin-3, N-terminal prohormone brain natriuretic peptide, and glial fibrillary acidic protein were measured. The composite study endpoint was unplanned readmission within 365 days after discharge or mortality either in hospital during the surgical admission or within 365 days after discharge. A clinical model based on covariates used in The Society of Thoracic Surgeons Congenital Heart Surgery Database mortality risk model and an augmented model using the clinical model in conjunction with a novel biomarker panel were evaluated. RESULTS Readmission or mortality within 365 days of surgery occurred among 39 pediatric patients (27%). The clinical model alone resulted in a c-statistic of 0.719 (95% confidence interval, 0.63 to 0.81). The clinical model in conjunction with the log-transformed biomarkers improved the c-statistic to 0.805 (95% confidence interval, 0.73 to 0.88). The addition of biomarkers resulted in a significant improvement to the clinical model alone (P value = 0.035). CONCLUSIONS Novel biomarkers may add predictive value when assessing the likelihood of 365-day readmission or mortality after pediatric congenital heart surgery. After adjusting for clinical and novel biomarkers, preoperative and postoperative suppression of tumorgenicity 2 remained associated with 365-day readmission or mortality. Currently, The Society of Thoracic Surgeons clinical congenital mortality risk model can be applied to identify children with increased risk of repeat hospitalizations and postdischarge mortality and may inform preventative care interventions that aim to reduce these adverse events.
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15
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Lam HCY, Hajat S, Chan EYY, Goggins WB. Different sensitivities to ambient temperature between first- and re-admission childhood asthma cases in Hong Kong - A time series study. ENVIRONMENTAL RESEARCH 2019; 170:487-492. [PMID: 30641275 DOI: 10.1016/j.envres.2018.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/07/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Asthma can be triggered by various factors due to different etiologies. Environmental factors remain a common trigger of asthma, especially amongst children, and such ambient exposures can be harder to avoid compared to behavioral triggers. As such, the contribution of environmental factors may be enhanced when considering repeat asthma cases compared to initial presentations. To test this hypothesis, we assessed associations between ambient temperature and hospital admissions for asthma in Hong Kong and stratified admission records into first and repeat asthma hospitalizations. METHODS The daily number of asthma hospitalizations among children aged 0-5 years in Hong Kong during 2007-2011 was regressed on daily mean temperature using distributed lagged nonlinear models, with adjustment for seasonal patterns, day-of-week effects, and other meteorological factors and air-pollutants. Analyses were stratified by summer/winter and by type of admission (first admission and repeated admission). RESULTS About 33% of the 12284 asthma hospitalizations were repeat admissions. Repeat admissions demonstrated higher sensitivity to high temperature in the summer. During this period, high temperatures were associated with increased risk of repeat admission but not with first admissions: RR (95% CI) comparing 31 °C vs. 29 °C across lags 0-15 days was 3.40 (1.26, 9.18) and 0.74 (0.31, 1.77) for repeat and first admissions respectively. In the cold season, all admissions increased with falls in temperature, with slightly stronger associations apparent for repeat admissions compared to first admission: 1.20 (1.00, 1.44) vs. 1.10 (0.96, 1.26) respectively comparing risk at 15 °C vs. 12 °C across lags 0-5 days. CONCLUSIONS To our knowledge, this is the first study to show stronger associations between ambient temperature and repeat asthma admissions compared to first admissions. The higher sensitivity among those experiencing repeat admissions may allow for more personalized disease management. Given the substantial differences in associations by admission type, future studies of ambient exposures on asthma should consider analyzing the two groups separately.
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Affiliation(s)
- Holly Ching Yu Lam
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Shakoor Hajat
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, University of London, United Kingdom
| | - Emily Ying Yang Chan
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - William Bernard Goggins
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
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16
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Ghriwati NA, Everhart RS, Winter MA. Interactive effects of family functioning and sleep experiences on daily lung functioning in pediatric asthma: An ecological momentary assessment approach. J Asthma 2019; 57:262-270. [PMID: 30669891 DOI: 10.1080/02770903.2019.1568453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objectives: Children living in urban, underserved settings are at risk for experiencing sleep difficulties as well as poor asthma outcomes. The family is important for both asthma management and ensuring children are getting the necessary amount of sleep, but how family functioning and sleep patterns influence children's asthma remains unclear. Methods: Fifty-nine children (7-12 years old; 90% African American) diagnosed with asthma, and their primary caregivers, participated in this study. In a single research session, caregivers rated overall family functioning via the Family Assessment Device. Caregivers also completed daily diaries delivered via smartphone for a two-week period rating their children's daily sleep quantity and quality; a home-based spirometer (AM2) was used to assess children's pulmonary functioning across that same period. Two-level multilevel models tested associations among overall family functioning, children's sleep quality/quantity, and pulmonary functioning. Results: Child sleep quality, quantity, and general family functioning did not predict child pulmonary functioning directly. Family functioning and sleep quality interacted to predict children's pulmonary functioning; children with poor family functioning and bad/very bad sleep quality had the poorest levels of lung functioning. Conclusions: These findings highlight a subset of children who are at higher risk for poor lung functioning based on sleep quality and family functioning. Results may inform routine monitoring of family functioning and sleep difficulties at pediatric asthma visits and intervention strategies to augment children's lung functioning.
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17
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Ardura-Garcia C, Stolbrink M, Zaidi S, Cooper PJ, Blakey JD. Predictors of repeated acute hospital attendance for asthma in children: A systematic review and meta-analysis. Pediatr Pulmonol 2018; 53:1179-1192. [PMID: 29870146 PMCID: PMC6175073 DOI: 10.1002/ppul.24068] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Asthma attacks are common and have significant physical, psychological, and financial consequences. Improving the assessment of a child's risk of subsequent asthma attacks could support front-line clinicians' decisions on augmenting chronic treatment or specialist referral. We aimed to identify predictors for emergency department (ED) or hospital readmission for asthma from the published literature. METHODS We searched MEDLINE, EMBASE, AMED, PsycINFO, and CINAHL with no language, location, or time restrictions. We retrieved observational studies and randomized controlled trials (RCT) assessing factors (personal and family history, and biomarkers) associated with the risk of ED re-attendance or hospital readmission for acute childhood asthma. RESULTS Three RCTs and 33 observational studies were included, 31 from Anglophone countries and none from Asia or Africa. There was an unclear or high risk of bias in 14 of the studies, including 2 of the RCTs. Previous history of emergency or hospital admissions for asthma, younger age, African-American ethnicity, and low socioeconomic status increased risk of subsequent ED and hospital readmissions for acute asthma. Female sex and concomitant allergic diseases also predicted hospital readmission. CONCLUSION Despite the global importance of this issue, there are relatively few high quality studies or studies from outside North America. Factors other than symptoms are associated with the risk of emergency re-attendance for acute asthma among children. Further research is required to better quantify the risk of future attacks and to assess the role of commonly used biomarkers.
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Affiliation(s)
| | | | - Seher Zaidi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Philip J Cooper
- Facultad de Ciencias Medicas, de la Salud y la Vida, Universidad Internacional del Ecuador, Quito, Ecuador.,Institute of Infection and Immunity, St George's University of London, London, UK
| | - John D Blakey
- Respiratory Medicine, Royal Liverpool Hospital, Liverpool, UK.,Health Services Research, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
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18
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Ehrlich KB, Miller GE, Shalowitz M, Story R, Levine C, Williams D, Le V, Chen E. Secure Base Representations in Children With Asthma: Links With Symptoms, Family Asthma Management, and Cytokine Regulation. Child Dev 2018; 90:e718-e728. [PMID: 29873065 DOI: 10.1111/cdev.13098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Children's perceptions of caregivers as a secure base have been linked with socioemotional outcomes, but little is known about connections to physical health. We examined whether secure base representations are associated with children's symptoms, family management strategies, and inflammatory processes in children with asthma. Participants included 308 children (ages 8-17) and one parent. Children completed a blood draw to measure asthma-related immune functions and reported on perceptions of their mothers as a secure base and their asthma symptoms. Dyads completed interviews about asthma management. Analyses revealed that children's secure base perceptions were associated with better family asthma management and lower Type 2 T-helper cell cytokine production. These findings suggest that secure base representations may be protective for children with asthma.
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19
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Krupp NL, Fiscus C, Webb R, Webber EC, Stanley T, Pettit R, Davis A, Hollingsworth J, Bagley D, McCaskey M, Stevens JC, Weist A, Cristea AI, Warhurst H, Bauer B, Saysana M, Montgomery GS, Howenstine MS, Davis SD. Multifaceted quality improvement initiative to decrease pediatric asthma readmissions. J Asthma 2017; 54:911-918. [PMID: 28118056 DOI: 10.1080/02770903.2017.1281294] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Asthma is the most common chronic disease of childhood and a leading cause of hospitalization in children. A primary goal of asthma control is prevention of hospitalizations. A hospital admission is the single strongest predictor of future hospital admissions for asthma. The 30-day asthma readmission rate at our institution was significantly higher than that of other hospitals in the Children's Hospital Association. As a result, a multifaceted quality improvement project was undertaken with the goal of reducing the 30-day inpatient asthma readmission rate by 50% within two years. METHODS Analysis of our institution's readmission patterns, value stream mapping of asthma admission, discharge, and follow-up processes, literature review, and examination of comparable successful programs around the United States were all utilized to identify potential targets for intervention. Interventions were implemented in a stepwise manner, and included increasing inhaler availability after discharge, modifying asthma education strategies, and providing in-home post-discharge follow-up. The primary outcome was a running 12-month average 30-day inpatient readmission rate. Secondary outcomes included process measures for individual interventions. RESULTS From a peak of 7.98% in January 2013, a steady decline to 1.65% was observed by July 2014, which represented a 79.3% reduction in 30-day readmissions. CONCLUSION A significant decrease in hospital readmissions for pediatric asthma is possible, through comprehensive, multidisciplinary quality improvement that spans the continuum of care.
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Affiliation(s)
- Nadia L Krupp
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Cindy Fiscus
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Russell Webb
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Emily C Webber
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA.,b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Teresa Stanley
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Rebecca Pettit
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Ashley Davis
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Judy Hollingsworth
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Deborah Bagley
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Marjorie McCaskey
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - John C Stevens
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Andrea Weist
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - A Ioana Cristea
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Heather Warhurst
- b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Benjamin Bauer
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA.,b Riley Hospital for Children at Indiana University Health , Indianapolis , IN , USA
| | - Michele Saysana
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Gregory S Montgomery
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Michelle S Howenstine
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Stephanie D Davis
- a Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
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20
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Finkelstein J, Jeong IC. Machine learning approaches to personalize early prediction of asthma exacerbations. Ann N Y Acad Sci 2016; 1387:153-165. [PMID: 27627195 DOI: 10.1111/nyas.13218] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/29/2016] [Accepted: 08/03/2016] [Indexed: 12/15/2022]
Abstract
Patient telemonitoring results in an aggregation of significant amounts of information about patient disease trajectory. However, the potential use of this information for early prediction of exacerbations in adult asthma patients has not been systematically evaluated. The aim of this study was to explore the utility of telemonitoring data for building machine learning algorithms that predict asthma exacerbations before they occur. The study dataset comprised daily self-monitoring reports consisting of 7001 records submitted by adult asthma patients during home telemonitoring. Predictive modeling included preparation of stratified training datasets, predictive feature selection, and evaluation of resulting classifiers. Using a 7-day window, a naive Bayesian classifier, adaptive Bayesian network, and support vector machines were able to predict asthma exacerbation occurring on day 8, with sensitivity of 0.80, 1.00, and 0.84; specificity of 0.77, 1.00, and 0.80; and accuracy of 0.77, 1.00, and 0.80, respectively. Our study demonstrated that machine learning techniques have significant potential in developing personalized decision support for chronic disease telemonitoring systems. Future studies may benefit from a comprehensive predictive framework that combines telemonitoring data with other factors affecting the likelihood of developing acute exacerbation. Approaches implemented for advanced asthma exacerbation prediction may be extended to prediction of exacerbations in patients with other chronic health conditions.
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Affiliation(s)
- Joseph Finkelstein
- Department of Biomedical Informatics, Columbia University, New York, New York
| | - In Cheol Jeong
- Chronic Disease Informatics Program, Johns Hopkins University, Baltimore, Maryland
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21
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Lushaj EB, Nelson K, Amond K, Kenny E, Badami A, Anagnostopoulos PV. Timely Post-discharge Telephone Follow-Up is a Useful Tool in Identifying Post-discharge Complications Patients After Congenital Heart Surgery. Pediatr Cardiol 2016; 37:1106-10. [PMID: 27064092 DOI: 10.1007/s00246-016-1398-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/05/2016] [Indexed: 11/25/2022]
Abstract
The objective of this study was to evaluate the effect of structured post-discharge telephone follow-up (TFU) on the time to the first postoperative clinic visit and early unplanned hospital readmissions in patients after congenital heart surgery. Structured phone calls delivered by senior surgical practitioners were made 1-4 days post-discharge. Demographics and clinical outcomes of pediatric patients receiving a TFU from 2012 to 2014 were assessed. In total, 196 phone calls were made in 165 patients. Thirty-four health problems were identified in 32 (19 %) patients (15 infants, 9 children, 8 neonates). Sixty-nine percent (n = 22) of the patients with problems identified at TFU were males. Fifty-three percent (n = 17) of the patients with problems identified at TFU were RACHS 2. Most of the problems (53 %) were identified in middle-class economic families. Gastrointestinal and incision site complications were the most common problems identified. Eighteen (56 %) patients had adjustments of medications. Six (19 %) TFUs resulted in earlier than scheduled post-op clinic visits. Overall incidence of unplanned readmissions was 16 % and similar between the patients that had problems during TFU (13 %) and patients that did not have problems identified at TFU (18 %; p = 0.50). Our study demonstrates the potential impact of the timely and structured post-discharge TFU in identifying post-discharge complications and modifying discharge instructions. When TFU identifies a problem, the interventions may be successful in preventing readmissions before first postoperative clinic visit. TFUs may be helpful, as a supplement standard of care with specific focus on patients <1 year of age to help identify adverse events that could otherwise escalate.
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Affiliation(s)
- Entela B Lushaj
- Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Kari Nelson
- Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Kate Amond
- Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Eugene Kenny
- Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Abbasali Badami
- Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Petros V Anagnostopoulos
- Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
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22
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Islam S, Yasui Y, Kaul P, Mackie AS. Hospital Readmission of Patients With Congenital Heart Disease in Canada. Can J Cardiol 2016; 32:987.e7-987.e14. [DOI: 10.1016/j.cjca.2015.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/01/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022] Open
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Beck AF, Huang B, Auger KA, Ryan PH, Chen C, Kahn RS. Explaining Racial Disparities in Child Asthma Readmission Using a Causal Inference Approach. JAMA Pediatr 2016; 170:695-703. [PMID: 27182793 PMCID: PMC5503118 DOI: 10.1001/jamapediatrics.2016.0269] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Childhood asthma is characterized by disparities in the experience of morbidity, including the risk for readmission to the hospital after an initial hospitalization. African American children have been shown to have more than 2 times the hazard of readmission when compared with their white counterparts. OBJECTIVE To explain why African American children are at greater risk for asthma-related readmissions than white children. DESIGN, SETTING, AND PARTICIPANTS This study was completed as part of the Greater Cincinnati Asthma Risks Study, a population-based, prospective, observational cohort. From August 2010 to October 2011, it enrolled 695 children, aged 1 to 16 years, admitted for asthma or wheezing who identified as African American (n = 441) or white (n = 254) in an inpatient setting of an urban, tertiary care children's hospital. MAIN OUTCOMES AND MEASURES The main outcome was time to asthma-related readmission and race was the predictor. Biologic, environmental, disease management, access, and socioeconomic hardship variables were measured; their roles in understanding racial readmission disparities were conceptualized using a directed acyclic graphic. Inverse probability of treatment weighting balanced African American and white children with respect to key measured variables. Racial differences in readmission hazard were assessed using weighted Cox proportional hazards regression and Kaplan-Meier curves. RESULTS The sample was 65% male (n = 450), and the median age was 5.4 years. African American children were 2.26 times more likely to be readmitted than white children (95% CI, 1.56-3.26). African American children significantly differed with respect to nearly every measured biologic, environmental, disease management, access, and socioeconomic hardship variable. Socioeconomic hardship variables explained 53% of the observed disparity (hazard ratio, 1.47; 95% CI, 1.05-2.05). The addition of biologic, environmental, disease management, and access variables resulted in 80% of the readmission disparity being explained. The difference between African American and white children with respect to readmission hazard no longer reached the level of significance (hazard ratio, 1.18; 95% CI, 0.87-1.60; Cox P = .30 and log-rank P = .39). CONCLUSIONS AND RELEVANCE A total of 80% of the observed readmission disparity between African American and white children could be explained after statistically balancing available biologic, environmental, disease management, access to care, and socioeconomic and hardship variables across racial groups. Such a comprehensive, well-framed approach to exposures that are associated with morbidity is critical as we attempt to better understand and lessen persistent child asthma disparities.
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Affiliation(s)
- Andrew F. Beck
- Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio2Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohi
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Katherine A. Auger
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Patrick H. Ryan
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Chen Chen
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Robert S. Kahn
- Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Harsh parent-child conflict is associated with decreased anti-inflammatory gene expression and increased symptom severity in children with asthma. Dev Psychopathol 2016; 27:1547-54. [PMID: 26535943 DOI: 10.1017/s0954579415000930] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Asthma is a chronic respiratory disorder that affects over 7 million children in the United States. Evidence indicates that family stressors are associated with worsening of asthma symptoms, and some research suggests that these stressful experiences engender changes in children's immune systems in ways that exacerbate airway inflammation and contribute to both acute and chronic asthma symptoms. We examined the association between observed experiences of parent-child conflict and the expression of signaling molecules involved in the transduction of anti-inflammatory signals that regulate airway inflammation and obstruction. Fifty-seven children and their parents participated in a conflict task, and coders rated interactions for evidence of harsh and supportive behaviors. Children reported on their perceptions of parental support and reported on their daily asthma symptoms for 2 weeks. We collected peripheral blood in children to measure leukocyte expression of messenger RNA for the glucocorticoid receptor and the β2-adrenergic receptor. Analyses revealed that harsh conflict behaviors were associated with decreased expression of both messenger RNAs and more severe asthma symptoms. Neither supportive behaviors nor perceived parental support was associated with gene expression or asthma symptoms. These findings suggest that harsh interactions with parents are associated with downregulation of key anti-inflammatory signaling molecules and difficulties breathing in children with asthma. Children with asthma who are also victims of maltreatment may be particularly susceptible to transcriptional changes in immune cells that could worsen asthma over time.
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Leeman J, Crandell JL, Lee A, Bai J, Sandelowski M, Knafl K. Family Functioning and the Well-Being of Children With Chronic Conditions: A Meta-Analysis. Res Nurs Health 2016; 39:229-43. [PMID: 27128982 DOI: 10.1002/nur.21725] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 11/11/2022]
Abstract
For children with chronic conditions, well-being is closely related to how well their families function. Most prior research syntheses on family functioning and child well-being have focused on children with a single condition, thereby limiting the potential to aggregate and build on what is known across conditions. To address this challenge, research reports were reviewed and meta-analyses conducted of findings on the relationship between family functioning and child well-being across a range of chronic physical conditions. The sample was derived from a larger systematic review study that included 1,028 reports published between January 1, 2000 and March 31, 2014. The current review includes 53 studies in which a relationship between family functioning and child well-being was analyzed using one of four family measures: Family Adaptability and Cohesion Evaluation Scales, Family Environment Scale, Family Relationship Index, or Family Assessment Device. Most studies were cross-sectional and observational (n = 43, 81%). The most frequently studied conditions were diabetes, cancer, sickle cell disease, and asthma. In 37 studies, findings were sufficiently comparable to conduct meta-analyses. Significant correlations were identified between children's psychological health and seven of nine dimensions of family functioning. Significant correlations also were found between dimensions of family functioning and children's problem behaviors, social competence, quality of life, and, to a lesser extent, adherence and physical health. Of the family dimensions, cohesion and conflict were associated most strongly with child outcomes. Understanding the specific family variables, such as conflict, linked to varied child outcomes is key for intervention development. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jennifer Leeman
- Assistant Professor, School of Nursing, University of North Carolina, 5004 Carrington Hall, CB 7460, Chapel Hill, NC, 27599-7460
| | - Jamie L Crandell
- Assistant Professor, School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Anna Lee
- Doctoral Candidate, School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Jinbing Bai
- Doctoral Candidate, School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Margarete Sandelowski
- Cary C. Boshamer Distinguished Professor, School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Kathleen Knafl
- Frances Hill Fox Distinguished Professor, School of Nursing, University of North Carolina, Chapel Hill, NC
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Nabors LA, Meerianos AL, Vidourek RA, King KA, Rosen BL, Zhang J, Swoboda C. Predictors of flourishing for adolescents with asthma. J Asthma 2015; 53:146-54. [PMID: 26312650 DOI: 10.3109/02770903.2015.1072722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to examine well-being or flourishing of adolescents with asthma as well as factors influencing flourishing for these adolescents. METHODS A secondary analysis of data collected for the 2011-2012 National Survey of Children's Health was conducted. Flourishing of adolescents with and without asthma was compared. Parent coping and anger, child sex and age and child flourishing were examined for adolescents with asthma. RESULTS Youth with asthma had lower flourishing than those without this disease. Positive parent coping was related to flourishing, while parent anger negatively influenced flourishing of adolescents with asthma. Interaction terms were significant, indicating that the aforementioned variables interacted with adolescent age and sex. CONCLUSIONS Study results point to a complex relationship between parent- and adolescent-level factors and adolescent well-being. Further research is needed to examine relations among flourishing and health outcomes in youth with asthma.
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Affiliation(s)
| | | | | | | | | | - Jiaqi Zhang
- b Quantitative and Mixed Methods Research Methodologies, University of Cincinnati , Cincinnati , OH , USA
| | - Christopher Swoboda
- b Quantitative and Mixed Methods Research Methodologies, University of Cincinnati , Cincinnati , OH , USA
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Wood BL, Miller BD, Lehman HK. Review of family relational stress and pediatric asthma: the value of biopsychosocial systemic models. FAMILY PROCESS 2015; 54:376-389. [PMID: 25683472 DOI: 10.1111/famp.12139] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Asthma is the most common chronic disease in children. Despite dramatic advances in pharmacological treatments, asthma remains a leading public health problem, especially in socially disadvantaged minority populations. Some experts believe that this health gap is due to the failure to address the impact of stress on the disease. Asthma is a complex disease that is influenced by multilevel factors, but the nature of these factors and their interrelations are not well understood. This paper aims to integrate social, psychological, and biological literatures on relations between family/parental stress and pediatric asthma, and to illustrate the utility of multilevel systemic models for guiding treatment and stimulating future research. We used electronic database searches and conducted an integrated analysis of selected epidemiological, longitudinal, and empirical studies. Evidence is substantial for the effects of family/parental stress on asthma mediated by both disease management and psychobiological stress pathways. However, integrative models containing specific pathways are scarce. We present two multilevel models, with supporting data, as potential prototypes for other such models. We conclude that these multilevel systems models may be of substantial heuristic value in organizing investigations of, and clinical approaches to, the complex social-biological aspects of family stress in pediatric asthma. However, additional systemic models are needed, and the models presented herein could serve as prototypes for model development.
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Affiliation(s)
- Beatrice L Wood
- Psychiatry and Pediatrics, University at Buffalo, Buffalo, NY
| | - Bruce D Miller
- Psychiatry and Pediatrics, University at Buffalo, Buffalo, NY
| | - Heather K Lehman
- Allergy and Immunology, Woman and Children's Hospital of Buffalo, Buffalo, NY
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Chung HS, Hathaway DK, Lew DB. Risk factors associated with hospital readmission in pediatric asthma. J Pediatr Nurs 2015; 30:364-84. [PMID: 25289769 DOI: 10.1016/j.pedn.2014.09.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 09/06/2014] [Accepted: 09/22/2014] [Indexed: 11/18/2022]
Abstract
Asthma is a leading cause of hospitalization among children, and about 15-50% of pediatric patients are readmitted after an index admission. The purpose of this integrative review is to explore contemporary scientific findings on the association between pediatric asthma readmission and various demographic, environmental, psychosocial and clinical risk factors. An electronic database search resulted in a sample of 29 studies. African American, public or no insurers, previous admission and complex chronic comorbidity were identified as risk factors associated with pediatric asthma readmission. However, more interdisciplinary and well-designed investigations are warranted to further explicate the spectrum of environmental and psychosocial correlates.
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Affiliation(s)
- Hoi Sing Chung
- Loewenberg School of Nursing, The University of Memphis, Memphis, TN.
| | - Donna K Hathaway
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN
| | - Dukhee B Lew
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN; Allergy and Immunology, LeBonheur Children's Hospital, Memphis, TN
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29
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Spanier AJ, Beck AF, Huang B, McGrady ME, Drotar DD, Peake RWA, Kellogg MD, Kahn RS. Family hardships and serum cotinine in children with asthma. Pediatrics 2015; 135:e416-23. [PMID: 25583915 PMCID: PMC4306794 DOI: 10.1542/peds.2014-1748] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE A better understanding of how poverty-related hardships affect child health could highlight remediable intervention targets. Tobacco smoke exposure may be 1 such consequence of family hardship. Our objective was to explore the relationship between family hardships and tobacco exposure, as measured by serum cotinine, a tobacco metabolite, among children hospitalized for asthma. METHODS We prospectively enrolled a cohort of 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing. The primary outcome was detectable serum cotinine. We assessed family hardships, including 11 financial and social variables, through a survey of the child's caregiver. We used logistic regression to evaluate associations between family hardship and detectable cotinine. RESULTS We had complete study data for 675 children; 57% were African American, and 74% were enrolled in Medicaid. In total, 56% of children had detectable cotinine. More than 80% of families reported ≥ 1 hardship, and 41% reported ≥ 4 hardships. Greater numbers of hardships were associated with greater odds of having detectable cotinine. Compared with children in families with no hardships, those in families with ≥ 4 hardships had 3.7-fold (95% confidence interval, 2.0-7.0) greater odds of having detectable serum cotinine in adjusted analyses. Lower parental income and educational attainment were also independently associated with detectable serum cotinine. CONCLUSIONS Family hardships are prevalent and associated with detectable serum cotinine level among children with asthma. Family hardships and tobacco smoke exposure may be possible targets for interventions to reduce health disparities.
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Affiliation(s)
- Adam J Spanier
- Department of Pediatrics, Penn State Milton S. Hershey Children's Hospital, Hershey, Pennsylvania;
| | - Andrew F Beck
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and
| | - Bin Huang
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and
| | - Meghan E McGrady
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and
| | - Dennis D Drotar
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and
| | - Roy W A Peake
- Clinical Epidemiologic Research Laboratory, Boston Children's Hospital, Boston, Massachusetts
| | - Mark D Kellogg
- Clinical Epidemiologic Research Laboratory, Boston Children's Hospital, Boston, Massachusetts
| | - Robert S Kahn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and
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Rodríguez-Martínez CE, Sossa-Briceño MP, Castro-Rodriguez JA. Predictors of hospitalization for asthma in children: results of a 1-year prospective study. Pediatr Pulmonol 2014; 49:1058-64. [PMID: 24376022 DOI: 10.1002/ppul.22936] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 08/30/2013] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Although hospital admissions for pediatric asthma constitute a significant problem in high-income countries, they are an even greater health problem in low- and middle-income countries (LMIC). However, previous studies that aimed to identify predictors of hospital admission for asthma in children have mainly been conducted in high-income countries, and these findings might not be applicable to LMIC. METHODS In a prospective cohort study, we aimed to identify predictors of hospital admission for asthma, including measures of parental knowledge about asthma and maternal depression level, in a population of children aged 1-18 years living in urban Bogota, Colombia hospitalized for acute asthma symptoms, over a 6-month period. RESULTS Out of the total of 101 included patients, 37 (36.6%) had at least one hospital admission for asthma during the year following admission. After controlling for the age of the patients, dog ownership in the previous 12 months, asthma severity variables in the previous 6 months, maternal allergic rhinitis, level of maternal education, and measures of parental knowledge about asthma and maternal depression level, we found that maternal smoking (IRR, 3.12; 95% confidence interval [95% CI], 1.12-8.68; P = 0.029) was the only independent predictor of hospital admissions due to asthma exacerbations in the year following admission to the study. CONCLUSIONS In a population of asthmatic Latino children admitted to hospital for an asthma exacerbation, approximately one-third of the patients had at least one hospital admission for asthma during the year following admission, and maternal smoking was the only independent predictor of these hospitalizations.
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Affiliation(s)
- Carlos E Rodríguez-Martínez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia; Research Unit, Military Hospital of Colombia, Bogota, Colombia
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Central nervous system influences in asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 795:309-19. [PMID: 24162917 DOI: 10.1007/978-1-4614-8603-9_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Asthma is a biomedical disorder whose presentation can be markedly influenced by neurological and psychological factors. This chapter describes several approaches that provide insight into the role of psychological factors and brain function in asthma. These include the study of placebo responses and recent explorations using functional neuroimaging during the onset of asthma symptoms. Although the specific mechanisms involved remain uncertain, we are gaining an appreciation for some of the neurocircuitry that is involved. The insula and ACC may modulate inflammatory processes by their influence on neuroendocrine responses to stress, including highly studied effects on the HPA axis and its physiologic responses. However much we have recently learned, it is clear that further study of this topic is critical to fully explicate the role of the brain in asthma.
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Beck AF, Huang B, Simmons JM, Moncrief T, Sauers HS, Chen C, Ryan PH, Newman NC, Kahn RS. Role of financial and social hardships in asthma racial disparities. Pediatrics 2014; 133:431-9. [PMID: 24488745 PMCID: PMC3934338 DOI: 10.1542/peds.2013-2437] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Health care reform offers a new opportunity to address child health disparities. This study sought to characterize racial differences in pediatric asthma readmissions with a focus on the potential explanatory role of hardships that might be addressed in future patient care models. METHODS We enrolled 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing in a population-based prospective observational cohort. The outcome was time to readmission. Child race, socioeconomic status (measured by lower income and caregiver educational attainment), and hardship (caregivers looking for work, having no one to borrow money from, not owning a car or home, and being single/never married) were recorded. Analyses used Cox proportional hazards. RESULTS The cohort was 57% African American, 33% white, and 10% multiracial/other; 19% were readmitted within 12 months. After adjustment for asthma severity classification, African Americans were twice as likely to be readmitted as whites (hazard ratio: 1.98; 95% confidence interval: 1.42 to 2.77). Compared with whites, African American caregivers were significantly more likely to report lower income and educational attainment, difficulty finding work, having no one to borrow money from, not owning a car or home, and being single/never married (all P ≤ .01). Hardships explained 41% of the observed racial disparity in readmission; jointly, socioeconomic status and hardship explained 49%. CONCLUSIONS African American children were twice as likely to be readmitted as white children; hardships explained >40% of this disparity. Additional factors (eg, pollution, tobacco exposure, housing quality) may explain residual disparities. Targeted interventions could help achieve greater child health equity.
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Affiliation(s)
- Andrew F. Beck
- Divisions of General and Community Pediatrics,,Hospital Medicine, and
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Hadley S. Sauers
- Divisions of General and Community Pediatrics,,Hospital Medicine, and
| | - Chen Chen
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Patrick H. Ryan
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Allred E, An S, Leviton A, Loddenkemper T, McCrave J, Nichol SM. Should readmission within 30 days after discharge of children hospitalized for a neurologic disorder be considered a quality assurance failure? J Child Neurol 2013; 28:758-61. [PMID: 23529907 DOI: 10.1177/0883073813481404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The Affordable Care Act penalizes hospitals with high readmission rates. Children's hospitals are not yet among these hospitals, although that is likely to change. Because chronic neurologic conditions represent a sizable proportion of all children's hospitals costs, and because some/many of the readmissions might not be easily prevented, children's hospitals and neurologists who care for children might be inappropriately penalized for some readmissions. We encourage more study to identify the correlates of readmission of children who have a neurologic disorder.
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Affiliation(s)
- Elizabeth Allred
- Quality Improvement Team, Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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34
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Walker VG. Minority caregivers' emotional responses and perceptions of the emotional responses of their children to asthma: comparing boys and girls. Issues Ment Health Nurs 2013; 34:325-34. [PMID: 23663019 DOI: 10.3109/01612840.2012.753559] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Approximately 7.1 million children in the US suffer from asthma. An exploratory qualitative study using a stratified purposive sampling method was conducted. The sample included four Latina and four African American female caregivers of children (ages 6-12) who had asthma. Caregivers were asked open-ended questions about perceptions of their children's emotional responses to asthma. Major themes and subthemes were identified with content analysis. Sons were reported as quiet when experiencing asthma. Daughters were described as being verbal, worried, excited. A question from the study was whether the children's responses were related to caregivers' (a) actions, (b) responses to asthma, and/or(c) race/ethnicity.
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35
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Gupta RS, Lau CH, Springston EE, Warren CM, Mears CJ, Dunford CM, Sharp LK, Holl JL. Perceived Factors Affecting Asthma Among Adolescents. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/2150129712472342] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To describe the development, implementation, and findings of a participatory media-based asthma afterschool program. Methods: A pilot study was conducted during the 2010/2011 school year in an inner-city Chicago high school with high asthma rates and poor asthma morbidity. Students met after school twice a week over 10 weeks. Students were given basic training in research and media production using photovoice participatory research technique and were instructed to identify personally relevant factors affecting asthma through photography and journaling. Students’ journal entries and photographs were qualitatively coded. Relative frequencies of codes were calculated to determine common themes among identified factors. Students worked with a videographer to compile their findings into informational videos, which were used to educate peers and community members about asthma. Results: Fifteen students aged 13 to 18 attended a mean of 11 sessions (out of 20). One hundred eighty photographs (mean = 12 per student) and 112 journal entries (mean = 7.5 per student) were reviewed, with 4 predominant positive and negative factors identified. Reported factors influencing students’ health and asthma included social support (22% of student photos and journal entries), neighborhood environment (17%), and lifestyle (28%), in addition to well-established asthma factors (43%). Conclusions: Results from the Student Asthma Research Team pilot demonstrate that adolescent students, given appropriate instruction and opportunity, are able to identify factors affecting their asthma. Interventions engaging adolescents via self-directed identification and participatory media production techniques hold promise as vehicles for enabling students to own and share health-related experiences through research and peer/community outreach.
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Affiliation(s)
- Ruchi S. Gupta
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Claudia H. Lau
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Elizabeth E. Springston
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Christopher M. Warren
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Cynthia J. Mears
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Christine M. Dunford
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Lisa K. Sharp
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Jane L. Holl
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
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Goodwin RD, Bandiera FC, Steinberg D, Ortega AN, Feldman JM. Asthma and mental health among youth: etiology, current knowledge and future directions. Expert Rev Respir Med 2013; 6:397-406. [PMID: 22971065 DOI: 10.1586/ers.12.34] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Asthma and mental health problems, such as depression, anxiety and behavior disorders, are common among youth and are significant sources of morbidity. There is a consistent association between asthma and anxiety/depression and a less consistent association between asthma and behavior disorders. Possible biological and psychological mechanisms may include inflammatory processes as well as the stress of having to live with a life-threatening condition. Future studies are warranted with longitudinal designs to establish temporality as well as measures of potential confounds. Biological and psychological measures would complement the longitudinal design to further establish causality. In addition, more information on the degree to which asthma and mental health have reciprocal influences on each other over time - and the mechanisms of these relationships - are needed in order to develop more effective intervention strategies to improve asthma control and mental health among those with both.
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Affiliation(s)
- Renee D Goodwin
- Department of Psychology, Queens College, City University of New York, Flushing, NY 11367, USA.
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Beck AF, Simmons JM, Huang B, Kahn RS. Geomedicine: area-based socioeconomic measures for assessing risk of hospital reutilization among children admitted for asthma. Am J Public Health 2012; 102:2308-14. [PMID: 23078500 DOI: 10.2105/ajph.2012.300806] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed whether geographic information available at the time of asthma admission predicts time to reutilization (readmission or emergency department revisit). METHODS For a prospective cohort of children hospitalized with asthma in 2008 and 2009 in Cincinnati, Ohio, we constructed a geographic social risk index from geocoded home addresses linked to census tract extreme poverty and high school graduation rates and median home values. We examined geographic risk associations with reutilization and caregiver report of hardship. RESULTS Thirty-nine percent of patients reutilized within 12 months. Compared with those in the lowest geographic risk stratum, those at medium and high risk had 1.3 (95% confidence interval [CI] = 0.9, 1.9) and 1.8 (95% CI = 1.4, 2.4) the risk of reutilization, respectively. Caregivers of children at highest geographic risk were 5 times as likely to report more than 2 financial hardships (P < .001) and 3 times as likely to report psychological distress (P = .001). CONCLUSIONS A geographic social risk index may help identify asthmatic children likely to return to the hospital. Targeting social risk assessments and interventions through geographic information may help to improve outcomes and reduce disparities.
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Affiliation(s)
- Andrew F Beck
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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38
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Risk Factors Associated With Readmission After Pediatric Cardiothoracic Surgery. Ann Thorac Surg 2012; 94:865-73. [DOI: 10.1016/j.athoracsur.2012.04.025] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 04/06/2012] [Accepted: 04/10/2012] [Indexed: 11/19/2022]
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39
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Maternal familism predicts birthweight and asthma symptoms three years later. Soc Sci Med 2012; 76:28-38. [PMID: 23142569 DOI: 10.1016/j.socscimed.2012.07.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Revised: 06/21/2012] [Accepted: 07/30/2012] [Indexed: 11/21/2022]
Abstract
There are marked ethnic and socioeconomic differences in birthweight and childhood asthma, conditions which may be linked causally or via a third variable. Cultural resources are often credited with diminished health disparities in infancy and childhood among subsets of poor and minority populations; yet direct empirical tests of this hypothesis are needed. In this study, ethnicity, lifespan family socioeconomic position (FSEP), and the cultural resource of familism were compared as predictors of birthweight and expression of asthma symptoms (AE) by age three. Familism and lifespan FSEP were assessed in 4633 socioeconomically disadvantaged African Americans, White Americans, and Latinas upon giving birth, as was offspring birthweight. AE was assessed in offspring through age three. Asthma diagnosis by age three was likelier in very low (≤ 1500 g) and low (≤ 2500 g) birthweight infants compared to infants born at average (2501-3999 g) or larger (≥ 4000 g) birthweights. Asthma risk associated with lower birthweight was higher for Latinos (17-35%) and African Americans (19-23%) than for White Americans (13-14%). As predicted, maternal familism was higher among White Americans than among African Americans and Latinas, an effect that was largely driven by ethnic disparities in lifespan FSEP. Familism predicted continuous birthweight (p = .003) and AE (p = .001) by age three independently of ethnicity and lifespan FSEP accounting for appropriate control variables, including maternal biomedical risk, maternal acculturation, parental marital status, and infant sex. There was a 71-g gain in birthweight for every one-unit increase in familism. The protective effect of familism on AE by age three was strongest for participants of lower lifespan FSEP. Maternal familism is one cultural resource that may reduce reproductive and intergenerational health disparities in both U.S.- and foreign-born Americans. Consistent with our previous work, familism and other nonmaterial resources covary with material resources. Nevertheless, culture is distinguishable from lifespan FSEP and ethnicity, and has health implications beyond associations to ethnicity, lifespan FSEP, and related biomedical and sociodemographic factors.
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Abstract
A systematic review of the literature was performed to answer the following questions (a) What factors contribute to the emotional responses of school-age children who have asthma? (b) What are the potential gaps in the literature regarding the emotional responses of school-age children (ages 6-12) who have asthma? (c) Are children with a lower socioeconomic status (SES) and those who are minorities represented in the literature proportionate to their prevalence? Two main focus areas regarding emotional responses were identified: (a) factors related to children who have asthma and (b) factors related to caregivers of children who have asthma. Internalizing disorders were reported consistently for children and caregivers of children who have asthma. Negative consequences of asthma for children included panic and asthma attacks, missed school days, and behavioral problems. Issues for caregivers included higher levels of anxiety and depressive symptoms, asthma management deficits, and lower caregiver warmth and involvement. Gaps in the literature included separated studies for children ages 6-12, a lack of a standardized method to define SES, studies that were of a more experimental nature, and a disparate number of studies of minority children and caregivers relative to their asthma prevalence.
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Morawska A, Gregory C, Burgess S. Parental beliefs about behaviour problems of their asthmatic children and interventions to support parenting. J Child Health Care 2012; 16:75-90. [PMID: 22247183 DOI: 10.1177/1367493511426278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to explore parents' attributions for their children's behaviour and their beliefs about treatment efficacy, and to investigate the specific topics and strategies parents believe would be most beneficial in a parenting intervention. A survey of 165 parents and qualitative interviews with 13 parents were conducted, assessing child behaviour, parental attributions and intervention characteristics. The findings indicated that parents were confident in their ability to manage the challenges of asthma, and in general, believed that five key asthma treatment recommendations were at least moderately helpful in managing their child's asthma. Many parents believed that asthma medications were related to behavioural difficulties including hyperactivity, disruptiveness, and disobedience. Nearly half of the parents were concerned about how to best manage their child's asthma, and a number of themes were identified as important intervention elements. The implications of these findings for intervention development are discussed.
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Affiliation(s)
- Alina Morawska
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Australia.
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Fiese BH, Winter MA, Botti JC. The ABCs of family mealtimes: observational lessons for promoting healthy outcomes for children with persistent asthma. Child Dev 2011; 82:133-45. [PMID: 21291433 DOI: 10.1111/j.1467-8624.2010.01545.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Family mealtimes have the potential to promote healthy child development. This observational study of 200 family mealtimes examined the relation between child health in a group of children (ages 5 to 12) with persistent asthma and 3 dimensions of mealtime interaction: Action, Behavior Control, and Communication. Percent time spent in Action and Positive Communication varied by asthma severity, child quality of life, and sociodemographic variables. Positive communication during mealtimes predicted child quality of life. Significant interactions between demographic variables and behavior control suggested that higher levels of behavior control affected child quality of life in the context of lower maternal education. Guidance is offered for practitioners and policy makers toward promoting healthy family mealtimes as a public health priority.
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Affiliation(s)
- Barbara H Fiese
- The University of Illinois at Urbana-Champaign, The Family Resiliency Center, Urbana, IL 61801-3811, USA.
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43
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Long KA, Ewing LJ, Cohen S, Skoner D, Gentile D, Koehrsen J, Howe C, Thompson AL, Rosen RK, Ganley M, Marsland AL. Preliminary evidence for the feasibility of a stress management intervention for 7- to 12-year-olds with asthma. J Asthma 2011; 48:162-70. [PMID: 21332379 DOI: 10.3109/02770903.2011.554941] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Evidence supports a bidirectional relationship between stress and asthma exacerbations in children, suggesting that interventions to reduce stress may improve both psychosocial quality of life and disease course. Here, we examine the feasibility of a stress management intervention for 7- to 12-year-olds with asthma. METHODS Two trials were conducted. Cohort 1 (n = 11) was recruited from the community and attended intervention sessions at an urban university. Cohort 2 (n = 7) was school based and recruited from an African American charter school. Six individual intervention sessions focused on psychoeducation about asthma, stress, and emotions; problem-solving and coping skills training; and relaxation training paired with physiological feedback. Pre- and post-intervention stress, mood, and lung function data were collected. Satisfaction surveys were administered after intervention completion. RESULTS The intervention was rated as highly acceptable by participating families. Feasibility was much stronger for the school-based than the university-based recruitment mechanism. Initial efficacy data suggest that both cohorts showed pre- to post-intervention improvements in lung function, perceived stress, and depressed mood. CONCLUSION Findings provide evidence for the feasibility of offering asthma-related stress management training in a school setting. Initial findings offer support for future, large-scale efficacy studies.
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Affiliation(s)
- Kristin A Long
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA.
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Rhee H, Belyea MJ, Brasch J. Family support and asthma outcomes in adolescents: barriers to adherence as a mediator. J Adolesc Health 2010; 47:472-8. [PMID: 20970082 PMCID: PMC2963868 DOI: 10.1016/j.jadohealth.2010.03.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 02/01/2010] [Accepted: 03/09/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE Asthma morbidity in children is associated with family psychosocial functioning. Although the family plays a pivotal role in maintaining optimal asthma care, the mechanism of how family support influences asthma outcomes is not well understood. The purpose of this study was to examine the role of barriers to adherence in mediating the effect of family support on asthma outcomes in adolescents. METHODS The sample included 126 adolescents with asthma aged 13-20 years, living in the Northeast United States. The sample consisted of 49% Whites and 51% minorities, including primarily Blacks (38%) followed by Hispanic (11%). Adolescents provided self-reported data. Structural equation modeling was performed to examine the direct and indirect relationships between family support and asthma outcomes. RESULTS Family support was positively associated with asthma control and quality of life. These significant associations were mediated by barriers to adherence. Particularly, family support was found to reduce barriers concerning adolescents' negative attitudes toward medication and healthcare providers, which in turn improved asthma control and quality of life symptoms, emotional functioning, and activity domains. Adolescents' cognitive difficulty also tended to mediate the relationship between family support and emotional functioning. CONCLUSION This study highlights the beneficial effects of family support in improving asthma outcomes in adolescents. Family support exerts the positive effect by ameliorating barriers to treatment adherence in adolescents, particularly the barriers associated with negative attitudes and cognitive challenges. The findings underscore the importance of incorporating family assessment and intervention in caring for adolescents with asthma.
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Affiliation(s)
- Hyekyun Rhee
- University of Rochester, School of Nursing, Rochester, New York 14642, USA.
| | - Michael J. Belyea
- Arizona State University College of Nursing and Health Care Innovation, Phoenix, Arizona
| | - Judith Brasch
- University of Rochester, School of Nursing, Rochester, New York
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Kaptein AA, Klok T, Moss-Morris R, Brand PLP. Illness perceptions: impact on self-management and control in asthma. Curr Opin Allergy Clin Immunol 2010; 10:194-9. [PMID: 20386435 DOI: 10.1097/aci.0b013e32833950c1] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Outcome in asthma is determined not only by pulmonary function or other biomedical characteristics. An important determinant of asthma outcome is illness perceptions: patients' subjective beliefs and emotional responses to their illness. Illness perceptions influence patients' coping and self-management behavior, and thereby outcome. RECENT FINDINGS We review recent studies on associations between illness perceptions and outcome in patients with asthma, with a range of respondents and caregivers, with varying degree of asthma severity, and in different settings of medical care. Most studies pertain to substantial numbers of patients, and have been performed in different countries, adding to the external validity of the findings. All studies report substantial effects of illness perceptions on various categories of outcome: illness perceptions reflecting personal control over the illness are associated with a positive outcome, that is, asthma control. Findings point at the importance and clinical relevance of addressing patients' illness perceptions, and suggest that this may improve outcome in asthma care. Well conducted intervention studies on this topic are called for in order to improve outcomes and quality of life in asthma patients. SUMMARY Illness perceptions influence the way in which patients with asthma cope and their self-management of the illness. Illness perceptions can be assessed quite easily and directly, they inform healthcare providers about the psychosocial responses of patients towards their asthma, they are responsive to change in the clinical encounter or via self-management intervention training. Exploring patient's illness perceptions, therefore, is a crucial component of good clinical care.
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Affiliation(s)
- Ad A Kaptein
- Medical Psychology, Leiden University Medical Center (LUMC), Leiden, The Netherlands. a.a.kaptein@ lumc.nl
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Lien L, Green K, Thoresen M, Bjertness E. Atopic conditions and mental health problems: a 3-year follow-up study. Eur Child Adolesc Psychiatry 2010; 19:705-13. [PMID: 20358235 DOI: 10.1007/s00787-010-0106-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 03/17/2010] [Indexed: 12/21/2022]
Abstract
The aim of this study was to test the hypothesis that atopic conditions at 15/16 years of age affect both internalized and externalized mental health problems 3 years later. Combined school and postal survey was conducted in urban and rural settings. A total of 3,674 adolescents (70.1% response rate) were followed at two time points and interviewed with similar questionnaires at baseline and follow-up. Hopkins Symptoms Checklist (HSCL-10) was used to assess internalized problems, and two subscales (conduct problems and hyperactivity) from the Strength and Difficulties Questionnaire to measure externalized mental health problems. The atopic conditions investigated were asthma, hay fever and eczema by asking the adolescents whether these conditions were present or not. There was an increase in the prevalence of internalized mental health problems from about 17-25% and a decrease in externalized mental health problems and number of atopic conditions in the follow-up period. Of the atopic conditions, hay fever was most prevalent with about 34% at 15 years of age and 20% at 18. The asthma prevalence was at 10 and 5% and eczema at 25 and 10%, respectively. Internalized mental health problems among girls were significantly associated with atopic conditions 3 years earlier, also after controlling for confounding variables. To live with atopic conditions seem to affect the mood and level of anxiety among adolescent girls. This should be kept in mind by health professionals treating young girls with atopic conditions.
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Affiliation(s)
- Lars Lien
- Institute of Psychiatry, University of Oslo, Blindern, Oslo, Norway.
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Feudtner C, Pati S, Goodman DM, Kahn MG, Sharma V, Hutto JH, Levin JE, Slonim AD, Hall M, Shah SS. State-level child health system performance and the likelihood of readmission to children's hospitals. J Pediatr 2010; 157:98-102.e1. [PMID: 20304421 DOI: 10.1016/j.jpeds.2010.01.049] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 12/07/2009] [Accepted: 01/27/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the relationship between children's hospital readmission and the performance of child health systems in the states in which hospitals are located. STUDY DESIGN We conducted a retrospective cohort study of 197,744 patients 2 to 18 years old from 39 children's hospitals located in 24 states in the United States in 2005. Subjects were observed for a year after discharge for readmission to the same hospital. The odds of readmission were modeled on the basis of patient-level characteristics and state child health system performance as ranked by the Commonwealth Fund. RESULTS A total of 1.8% of patients were readmitted within a week, 4.8% within a month, and 16.3% within 365 days. After adjustment for patient-level characteristics, the probability of readmission varied significantly between states (P=.001), and the likelihood of readmission during the ensuing year increased as the states' health system performance ranking improved. States in the best ranking quartile had a 2.03% higher readmission rate than states in the lowest quartile (P=.02); the same directional relationship was observed for readmission intervals from 1 to 365 days after discharge. CONCLUSIONS Hospital readmission rates are significantly related to the performance of the surrounding health care system.
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Affiliation(s)
- Chris Feudtner
- PolicyLab, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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48
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Adams SK, Koinis-Mitchell D. Perspectives on complementary and alternative therapies in asthma. Expert Rev Clin Immunol 2010; 4:703-11. [PMID: 20477120 DOI: 10.1586/1744666x.4.6.703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Asthma is a chronic disease that affects millions of individuals living in the USA. Proper asthma management is essential for controlling asthma symptoms and exacerbations. In recent years, however, there has been increased recognition of individuals using complementary and alternative medicine (CAM) to treat asthma. This article reviews the status of the current literature on various cultural factors that influence CAM use. In addition, current research of two widely used forms of CAM, herbal remedies and relaxation techniques, is presented. Future directions and recommendations to increase the methodological rigor of CAM research are discussed, particularly as they pertain to herbal remedies and relaxation strategies. The importance of well-designed research studies, including observational studies and randomized controlled trials, is highlighted.
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Affiliation(s)
- Sue K Adams
- University of Rhode Island, Department of Human Development and Family Studies, 2 Lower College Road, Transition Center 210, Kingston, RI 02881, USA.
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Everhart RS, Fiese BH. Development and initial validation of a pictorial quality of life measure for young children with asthma. J Pediatr Psychol 2009; 34:966-76. [PMID: 19168502 DOI: 10.1093/jpepsy/jsn145] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To develop and assess the psychometric properties of a pictorial version of the Pediatric Asthma Quality of Life Questionnaire (PAQLQ). METHODS A pictorial PAQLQ was administered to 101 children with mild to severe asthma between 5 and 7 years of age. A subgroup of 48 children followed longitudinally completed the established version of the PAQLQ. RESULTS A confirmatory factor analysis with modifications supported the factor structure of the established PAQLQ. The pictorial measure exhibited internal consistency reliability and convergent, discriminant, and predictive validity. CONCLUSIONS Results suggest that the pictorial version of the PAQLQ has an underlying factor structure that is similar to that of the established PAQLQ. Future research with larger and diverse samples is needed to confirm the factor structure of the pictorial PAQLQ.
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50
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Liu SY, Pearlman DN. Hospital readmissions for childhood asthma: the role of individual and neighborhood factors. Public Health Rep 2009; 124:65-78. [PMID: 19413029 PMCID: PMC2602932 DOI: 10.1177/003335490912400110] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study used a Cox proportional hazards model to determine whether neighborhood characteristics are associated with risk of readmission for childhood asthma independently of individual characteristics. METHODS Rhode Island Hospital Discharge Data from 2001 to 2005 were used to identify children younger than 19 years of age at the time of the index (i.e., first) asthma admission, defined as a primary diagnosis of asthma or a primary diagnosis of respiratory illness with a secondary or tertiary diagnosis of asthma (n=2,919). Hazard ratios of repeat hospitalizations for childhood asthma from 2001 to 2005 were estimated, controlling for individual- and neighborhood-level variables. RESULTS During the study period, 15% of the sample was readmitted for asthma (n=451). In the unadjusted cumulative hazard curves, children residing in the census tracts with the highest proportion of crowded housing conditions, racial minority residents, or neighborhood-level poverty had higher cumulative hospital readmission rates as compared with children who resided in less disadvantaged neighborhoods. In the fully adjusted models, children insured by Medicaid at the time of their index admission had readmission rates that were 33% higher than children who were privately insured. CONCLUSION Our findings suggest that differences in health-care coverage are associated with higher readmission rates for pediatric asthma, but the relationship between neighborhood inequality and repeat hospitalizations for pediatric asthma requires further exploration. Social indicators such as minority race, Medicaid health insurance, and neighborhood markers of economic disadvantage are tightly interwoven in the U.S. and teasing these relationships apart is important in asthma disparities research.
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Affiliation(s)
- Sze Yan Liu
- Program in Public Health, Brown University, Providence, RI
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