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Mayoral K, Garin O, Caballero-Rabasco MA, Praena-Crespo M, Bercedo A, Hernandez G, Castillo J, Lizano Barrantes C, Pardo Y, Ferrer M. Smartphone App for monitoring Asthma in children and adolescents. Qual Life Res 2021; 30:3127-3144. [PMID: 33387290 DOI: 10.1007/s11136-020-02706-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE The asthma stepwise treatment approach recommended is based on monitoring patients' symptoms. The Asthma Research in Children and Adolescents (ARCA) cohort was created to provide evidence about the evolution of persistent asthma. This manuscript describes the development of an electronic health tool, comprising a mobile health application for patients with asthma and its associated online platform for pediatricians to monitor them. METHODS The development process followed 7 phases: the first 5 (Conceptualization, Preparation, Assessment scheduling, Image and user interface, and Technical development) defined and designed the tool, followed by a testing phase (functionality assessment and pilot test with ARCA patients), and a last phase which evaluated usability. Since the target population was aged 6-16 years, three versions were designed within the same smartphone application: parents/proxy, children, and adolescents. The online platform for pediatricians provides real-time information from the application: patients' responses over time with color-coded charts (red/amber/green, as in traffic lights). RESULTS The pilot test through semi-structured phone interviews of the first 50 participants included in the ARCA study (n = 53) detected their misunderstandings. Pediatricians were trained to emphasize that the application is free of charge and requires monthly answers. Median of the System Usability Scale scores (n = 85), ranging 0 (negative)-100 (positive), was > 93 in the three age versions of the application. CONCLUSIONS Technology has the capability of transforming the use of patient-reported outcomes. Describing all the development phases of a mobile health application for monitoring children and adolescents with asthma may increase the knowledge on how to design applications for young patients.
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Affiliation(s)
- K Mayoral
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, Madrid, Spain
| | - O Garin
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, Madrid, Spain. .,Pompeu Fabra University UPF, Barcelona, Spain.
| | - M A Caballero-Rabasco
- Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Pediatric Allergy and Pulmonology Unit, Pediatric Service, Hospital del Mar, Barcelona, Spain
| | - M Praena-Crespo
- Centro de Salud la Candelaria, Servicio Andaluz de Salud, Seville, Spain.,Grupo de Vías Respiratorias de la Asociación Española de Pediatras de Atención Primaria (AEPAP), Madrid, Spain
| | - A Bercedo
- Grupo de Vías Respiratorias de la Asociación Española de Pediatras de Atención Primaria (AEPAP), Madrid, Spain.,Centro de Salud Dobra, Servicio Cántabro de Salud, Cantabria, Spain
| | - G Hernandez
- Grupo de Vías Respiratorias de la Asociación Española de Pediatras de Atención Primaria (AEPAP), Madrid, Spain.,CAP Vila Olimpica, Parc Sanitari Pere Virgili, Barcelona, Spain
| | - J Castillo
- Grupo de Vías Respiratorias de la Asociación Española de Pediatras de Atención Primaria (AEPAP), Madrid, Spain.,Pediatric Pneumology Unit, Pediatric Service, Hospital Infantil Universitario Miguel Servet, Zaragoza, Spain
| | - C Lizano Barrantes
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,Pompeu Fabra University UPF, Barcelona, Spain.,University of Costa Rica, San José, Costa Rica
| | - Y Pardo
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, Madrid, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Ferrer
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain. .,Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública CIBERESP, Madrid, Spain.
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Dooley AA, Jackson JH, Gatti ML, Fanous H, Martinez C, Prue DC, Phull G, Richmond M, Weinstein NA, Chorvinsky E, Shukla PJ, Pillai DK. Pediatric sleep questionnaire predicts more severe sleep apnea in children with uncontrolled asthma. J Asthma 2020; 58:1589-1596. [PMID: 32878527 DOI: 10.1080/02770903.2020.1818775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE While up to 35% of children with asthma have evidence of sleep disordered breathing (SDB), it is unclear if nocturnal symptoms stem from asthma itself or SDB. The Pediatric Sleep Questionnaire (PSQ) is a validated tool for identifying SDB in childhood asthma. We hypothesize children with asthma and abnormal PSQ demonstrate decreased asthma control and are at higher risk of obstructive sleep apnea (OSA). METHODS We performed a retrospective, chart review of children and young adults referred to our tertiary children's hospital severe asthma clinic. Data collection included age, gender, BMI percentile, spirometry, PSQ, asthma control questionnaires, asthma severity, control, and impairment. These data were evaluated in the context of polysomnography, when available. RESULTS 205 inner-city children were included; 37.2% female, median age 6.4 y, and mean BMI of 71.3%ile. Rhinitis (p = 0.028), eczema (p = 0.002), and reflux (p = 0.046) were associated with abnormal PSQ; however, overweight/obese status, spirometry, asthma severity, and serologic markers were not. After correcting for comorbidities, abnormal PSQ score was associated with poor asthma control based on validated measures (p < 0.001). In patients with polysomnography, we confirmed abnormal PSQ was associated with increased OSA severity (apnea-hypopnea index 9.1/hr vs. 3.6/hr; p = 0.027). CONCLUSIONS In pediatric asthma, positive PSQ was associated with significantly decreased asthma control. Additionally, children with normal PSQ demonstrated mild OSA, while children with abnormal PSQ had increased severity of OSA. This demonstrates that PSQ can be used to screen children for more severe sleep apnea.
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Affiliation(s)
- Amy A Dooley
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - J Hunter Jackson
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Meagan L Gatti
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Hani Fanous
- Division of Pediatric Pulmonology, University of Miami, Miami, FL, USA
| | - Claudia Martinez
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Dominique C Prue
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Gurpreet Phull
- Division of Pulmonary and Sleep Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Miller Richmond
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Noa A Weinstein
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Elizabeth Chorvinsky
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Prateek J Shukla
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Dinesh K Pillai
- Division of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA.,Department of Genomics and Precision Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Abstract
PURPOSE Social determinants of health (SDoHs) influence how well a family manages children's asthma. The aim of this study was to examine the influence of SDoHs on family asthma management. DESIGN A cross-sectional exploratory study was conducted with 292 children in grades 2 to 5 who had current asthma and their parents to examine associations between SDoHs and the families' asthma management, quality of life, and healthcare utilization. METHODS Data were collected from both child and parent. Social determinants of health include the child's race/ethnic group, age, gender, and asthma severity and the family's socioeconomic status and language spoken in the home, and the school was the community-level variable. Parents and children completed asthma management and quality-of-life scales and parents reported on the children's emergency department visits and hospitalizations for asthma. RESULTS Worse quality of life was reported by families with lower socioeconomic status and African American children. Asthma severity was associated with parents' asthma management but not children's asthma self-management. Families who spoke Spanish at home had the lowest socioeconomic status yet performed significantly more asthma management than English-speaking families. CONCLUSIONS The findings highlight factors the clinical nurse specialist should address in educational interventions.
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Bi C, Maestre JP, Li H, Zhang G, Givehchi R, Mahdavi A, Kinney KA, Siegel J, Horner SD, Xu Y. Phthalates and organophosphates in settled dust and HVAC filter dust of U.S. low-income homes: Association with season, building characteristics, and childhood asthma. ENVIRONMENT INTERNATIONAL 2018; 121:916-930. [PMID: 30347374 DOI: 10.1016/j.envint.2018.09.013] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 05/20/2023]
Abstract
Phthalates and organophosphates are ubiquitous indoor semi-volatile organic contaminants (SVOCs) that have been widely used as plasticizers and flame retardants in consumer products. Although many studies have assessed their levels in house dust, only a few used dust samples captured by filters of building heating, ventilation, and air conditioning (HVAC) systems. HVAC filters collect particles from large volumes of air over a long period of time (potentially known) and thus provide a spatially and temporally integrated concentration. This study measured concentrations of phthalates and organophosphates in HVAC filter dust and settled floor dust collected from low-income homes in Texas, United States, in both the summer and winter seasons. The most frequently detected compounds were benzyl butyl phthalate (BBzP), di-(2-ethylhexyl) phthalate (DEHP), di-n-octyl phthalate (DnOP), tris (1-chloro-2-propyl) phosphate (TCIPP), triphenyl phosphate (TPHP), and tris (1,3-dichloroisopropyl) phosphate (TDCIPP). The median level of TCIPP in settled dust was 3- to 180-times higher than levels reported in other studies of residential homes. Significantly higher concentrations were observed in HVAC filter dust as compared to settled dust for most of the frequently detected compounds in both seasons, except for several phthalates in the winter. SVOC concentrations in settled dust in winter were generally higher than in summer, while different seasonality patterns were found for HVAC filter dust. Settled dust samples from homes with vinyl flooring contained significantly higher levels of BBzP and DEHP as compared to homes with other types of floor material. The concentration of DEHP and TDCIPP in settled dust also significantly associated with the presence of carpet in homes. Cleaning activities to remove dust from furniture actually increased the levels of certain compounds in HVAC filter dust, while frequent vacuuming of carpet helped to decrease the concentrations of some compounds in settled dust. Additionally, the size and age of a given house also correlated with the levels of some pollutants in dust. A statistically significant association between DEHP concentration in HVAC filter dust in summer and the severity of asthma in children was observed. These results suggest that HVAC filter dust represents a useful sampling medium to monitor indoor SVOC concentrations with high sensitivity; in contrast, when using settled dust, in addition to consideration of seasonal influences, it is critical to know the sampling location because the type and level of SVOCs may be related to local materials used there.
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Affiliation(s)
- Chenyang Bi
- Department of Civil, Architectural and Environmental Engineering, The University of Texas at Austin, TX, USA
| | - Juan P Maestre
- Department of Civil, Architectural and Environmental Engineering, The University of Texas at Austin, TX, USA
| | - Hongwan Li
- Department of Civil, Architectural and Environmental Engineering, The University of Texas at Austin, TX, USA
| | - Ge Zhang
- Department of Civil, Architectural and Environmental Engineering, The University of Texas at Austin, TX, USA; Department of Building Environment and Energy Application Engineering, University of Science and Technology Beijing, Beijing, China
| | - Raheleh Givehchi
- Department of Civil and Mineral Engineering, University of Toronto, Toronto, Canada
| | - Alireza Mahdavi
- Department of Civil and Mineral Engineering, University of Toronto, Toronto, Canada
| | - Kerry A Kinney
- Department of Civil, Architectural and Environmental Engineering, The University of Texas at Austin, TX, USA
| | - Jeffrey Siegel
- Department of Civil and Mineral Engineering, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sharon D Horner
- School of Nursing, The University of Texas at Austin, TX, USA
| | - Ying Xu
- Department of Civil, Architectural and Environmental Engineering, The University of Texas at Austin, TX, USA; Department of Building Science, Tsinghua University, Beijing, China.
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Horner SD, Timmerman GM, McWilliams BC. Feasibility study of a combined lifestyle behaviors and asthma self-management intervention for school-aged children. J SPEC PEDIATR NURS 2018; 23:e12224. [PMID: 29972278 PMCID: PMC6202196 DOI: 10.1111/jspn.12224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/10/2018] [Accepted: 06/18/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of this study is to test the feasibility of delivering an intervention that combines healthy lifestyle behaviors related to weight management with asthma self-management, the Living Healthy with Asthma intervention, to children who have asthma. METHODS AND DESIGN Using a mixed design, the feasibility study of the 12-week Living Healthy with Asthma intervention was conducted with a single group of children diagnosed with asthma. Pretest and posttest data were collected on asthma-related (self-management, metered dose inhaler [MDI] skill, asthma severity, quality of life [QOL]), and healthy lifestyle variables (body mass index [BMI], dietary quality). A matched comparison sample was drawn from a separate study that tested the same asthma self-management component (single intervention) used in the feasibility study to determine if the Living Healthy with Asthma intervention worked as well as the single intervention for improving children's asthma self-management. RESULTS Thirteen school-aged children were enrolled in the feasibility study. There were significant reductions in BMI z-scores (P = 0.007), and improvements in vegetable servings (P = 0.03), MDI skill (P = 0.005), children's QOL (P < 0.001), and parents' QOL (P = 0.03). When comparing the feasibility group with the matched comparison group (n = 13), there were no significant differences in asthma self-management, MDI skill, or asthma severity after the interventions. PRACTICE IMPLICATIONS Findings supported the feasibility of implementing the combined intervention, and it was not inferior to the single intervention-which supports nurses' efforts to help families manage multiple health problems.
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Affiliation(s)
- Sharon D. Horner
- Associate Dean for Research, The University of Texas at Austin School of Nursing
| | - Gayle M. Timmerman
- Associate Dean for Academic Affairs, The University of Texas at Austin School of Nursing
| | - Bennie C. McWilliams
- Director, Pediatric Pulmonary, Dell Children’s Medical Center of Central Texas, Associate Professor, The University of Texas at Austin Dell Medical School
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Brunwasser SM, Gebretsadik T, Gold DR, Turi KN, Stone CA, Datta S, Gern JE, Hartert TV. A new model of wheezing severity in young children using the validated ISAAC wheezing module: A latent variable approach with validation in independent cohorts. PLoS One 2018; 13:e0194739. [PMID: 29664908 PMCID: PMC5903664 DOI: 10.1371/journal.pone.0194739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 03/08/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The International Study of Asthma and Allergies in Children (ISAAC) Wheezing Module is commonly used to characterize pediatric asthma in epidemiological studies, including nearly all airway cohorts participating in the Environmental Influences on Child Health Outcomes (ECHO) consortium. However, there is no consensus model for operationalizing wheezing severity with this instrument in explanatory research studies. Severity is typically measured using coarsely-defined categorical variables, reducing power and potentially underestimating etiological associations. More precise measurement approaches could improve testing of etiological theories of wheezing illness. METHODS We evaluated a continuous latent variable model of pediatric wheezing severity based on four ISAAC Wheezing Module items. Analyses included subgroups of children from three independent cohorts whose parents reported past wheezing: infants ages 0-2 in the INSPIRE birth cohort study (Cohort 1; n = 657), 6-7-year-old North American children from Phase One of the ISAAC study (Cohort 2; n = 2,765), and 5-6-year-old children in the EHAAS birth cohort study (Cohort 3; n = 102). Models were estimated using structural equation modeling. RESULTS In all cohorts, covariance patterns implied by the latent variable model were consistent with the observed data, as indicated by non-significant χ2 goodness of fit tests (no evidence of model misspecification). Cohort 1 analyses showed that the latent factor structure was stable across time points and child sexes. In both cohorts 1 and 3, the latent wheezing severity variable was prospectively associated with wheeze-related clinical outcomes, including physician asthma diagnosis, acute corticosteroid use, and wheeze-related outpatient medical visits when adjusting for confounders. CONCLUSION We developed an easily applicable continuous latent variable model of pediatric wheezing severity based on items from the well-validated ISAAC Wheezing Module. This model prospectively associates with asthma morbidity, as demonstrated in two ECHO birth cohort studies, and provides a more statistically powerful method of testing etiologic hypotheses of childhood wheezing illness and asthma.
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Affiliation(s)
- Steven M. Brunwasser
- Vanderbilt University Medical Center, Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, T-1218 Medical Center North, Nashville, TN, United States of America
- Vanderbilt University Medical Center, Department of Obstetrics and Gynecology, B-1118 MCN, Nashville, TN, United States of America
- * E-mail:
| | - Tebeb Gebretsadik
- Vanderbilt University Medical Center, Department of Biostatistics, West End, Nashville, TN, United States of America
| | - Diane R. Gold
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Department of Environmental Health, Boston, MA, United States of America
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Kedir N. Turi
- Vanderbilt University Medical Center, Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, T-1218 Medical Center North, Nashville, TN, United States of America
| | - Cosby A. Stone
- Vanderbilt University Medical Center, Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, T-1218 Medical Center North, Nashville, TN, United States of America
| | - Soma Datta
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - James E. Gern
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Pediatrics, K4/918 CSC, Madison, WI, United States of America
| | - Tina V. Hartert
- Vanderbilt University Medical Center, Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, T-1218 Medical Center North, Nashville, TN, United States of America
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Walker VG. Exploration of the Influence of Factors Identified in the Literature on School-aged Children's Emotional Responses to Asthma. J Pediatr Nurs 2017; 33:54-62. [PMID: 28065421 PMCID: PMC5376515 DOI: 10.1016/j.pedn.2016.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/09/2016] [Accepted: 11/28/2016] [Indexed: 01/16/2023]
Abstract
Approximately 6.3 million US children suffer from asthma. The purpose of this study was to explore factors on school-aged children's emotional responses to asthma, N=85, ages 6-12. Correlations included Asthma related child emotional functioning QOL and (a) asthma severity, r=-0.30, p<0.01, (b) child internalizing behaviors, r=-0.26, p<0.05, (c) child externalizing behaviors r=-0.43, p<0.001; Caregiver emotional functioning QOL and (a) asthma severity, r=-0.39, p<0.001, (b) child internalizing behaviors, r=-0.22, p<0.05, (c) child externalizing behaviors, r=-0.25; p<0.05. Multiple regression analysis revealed that asthma severity and child externalizing problems accounted for 26% of the variance in asthma related child emotional functioning QOL, F (4, 79)=7.051, p<0.001 (asthma severity, β=-0.31, p<0.01; child externalizing problem behaviors, β=-0.43, p<0.001). Findings imply that asthma research should consider problem behaviors of school-aged children when addressing asthma related emotional functioning QOL.
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Horner SD, Brown A, Brown SA, Rew DL. Enhancing Asthma Self-Management in Rural School-Aged Children: A Randomized Controlled Trial. J Rural Health 2015; 32:260-8. [PMID: 26431213 DOI: 10.1111/jrh.12150] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To test the effects of 2 modes of delivering an asthma educational intervention on health outcomes and asthma self-management in school-aged children who live in rural areas. METHODS Longitudinal design with data collected 4 times over 12 months. The target sample was composed of children in grades 2-5 who had a provider diagnosis of asthma. Elementary schools were stratified into high or low socioeconomic status based on student enrollment in the free or reduced-cost lunch program. Schools were then randomly assigned to 1 of 3 treatment arms: in-school asthma class, asthma day camp, or the attention-control group. FINDINGS Sample retention was good (87.7%) and equally distributed by study arm. Improvements in emergency department visits and office visits were related to attending either the asthma class or asthma day camp. Asthma severity significantly decreased in both asthma treatment groups. Other factors such as hospitalizations, parent asthma management, and child asthma management improved for all groups. CONCLUSIONS Both asthma class and asthma day camp yielded significant reductions in asthma severity. There were reductions in the emergency department and office visits for the 2 asthma arms, and hospitalizations declined significantly for all groups. Asthma self-management also improved in all groups, while it was somewhat higher in the asthma arms. This may be due to the attention being drawn to asthma management by study participation and the action of completing questionnaires about asthma management, asthma symptoms, and health outcomes.
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Affiliation(s)
- Sharon D Horner
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | - Adama Brown
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | - Sharon A Brown
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | - D Lynn Rew
- School of Nursing, The University of Texas at Austin, Austin, Texas
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Horner SD, Brown A. An exploration of parent-child dyadic asthma management influences on quality of life. ISSUES IN COMPREHENSIVE PEDIATRIC NURSING 2015; 38:85-104. [PMID: 25822510 PMCID: PMC4433571 DOI: 10.3109/01460862.2015.1017668] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Most studies of childhood asthma management use data from a single family reporter and fail to capture the parent-child dyadic influences. In this descriptive exploratory study with 183 parent-child dyads, data were collected from both parents and children. Using structural equation modeling, the relationships of parents' and children's asthma knowledge, self-efficacy to manage asthma, and asthma management on the child's quality of life were examined. Direct significant relationships from knowledge to self-efficacy to asthma management were found for each member of the dyad. The associations between parents' and children's self-efficacy and asthma management were not statistically significant. Only the children's self-efficacy to manage asthma was significantly associated with children's asthma-related quality of life.
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Affiliation(s)
- Sharon D. Horner
- The University of Texas at Austin, School of Nursing, 1700 Red River, Austin, TX 78701-1499
| | - Adama Brown
- The University of Texas at Austin, School of Nursing, 1700 Red River, Austin, TX 78701-1499
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da Silva CM, Barros L. Pediatric Asthma Management: Study of the Family Asthma Management System Scale with a Portuguese Sample. CHILDRENS HEALTH CARE 2014. [DOI: 10.1080/02739615.2013.837822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Silva CM, Barros L. Asthma knowledge, subjective assessment of severity and symptom perception in parents of children with asthma. J Asthma 2013; 50:1002-9. [PMID: 23859138 DOI: 10.3109/02770903.2013.822082] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES This study aimed to confirm the tendency for parents to underestimate the severity of symptoms and the poor consistency between parents' reports of symptoms and the physicians' evaluation of asthma control. Additionally, the relationship between parents' asthma knowledge and their report of symptoms and estimation of asthma severity was explored. METHODS Fifty children (M = 10.5 years) and their caregivers were recruited from two Portuguese hospitals. A measure of asthma symptoms report (Severity of Chronic Asthma, SCA) and a subjective evaluation of asthma severity were collected and compared with physicians' ratings of asthma control, as well as parents' knowledge about asthma (Asthma Knowledge Questionnaire, AKQ) and emotional disturbance (Brief Symptom Inventory, BSI). RESULTS Although parents' evaluation of perceived asthma severity was moderately correlated to symptoms reported, results confirm an inconsistency between parents' reports of symptoms, their subjective rating of asthma severity and the physician's rating of clinical control, revealing a tendency for parents to underestimate disease severity and to underreport asthma symptoms. Asthma knowledge was not significantly correlated to SCA or to parents' subjective evaluation of asthma severity. Parents with poorer knowledge reported fewer symptoms. CONCLUSIONS Portuguese parents revealed a tendency to overestimate their child's level of asthma control and a low level of asthma knowledge. Parents' education, psychological disturbance and time since diagnosis were associated with asthma knowledge. Parents' knowledge was not related to the child's asthma outcomes or to their subjective evaluation of asthma severity or symptoms reports. Parents' asthma knowledge deficits, underreporting of symptoms and underestimation of asthma severity, may affect parent-provider communication and impede asthma control.
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Affiliation(s)
- Cláudia Mendes Silva
- Department of Psychology and Education, University of Beira Interior , Covilhã , Portugal and
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Horner SD, Brown SA, Walker VG. Is rural school-aged children's quality of life affected by their responses to asthma? J Pediatr Nurs 2012; 27:491-9. [PMID: 22920660 PMCID: PMC3428597 DOI: 10.1016/j.pedn.2011.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 06/11/2011] [Accepted: 06/21/2011] [Indexed: 11/24/2022]
Abstract
The unpredictable nature of asthma makes it stressful for children and can affect their quality of life (QOL). An exploratory analysis of 183 rural school-aged children's data was conducted to determine relationships among demographic factors, children's responses to asthma (coping and asthma self-management), and their QOL. Coping frequency, asthma severity, and race/ethnicity significantly predicted children's asthma-related QOL. Children reported more frequent coping as asthma-related QOL worsened (higher scores). Children with more asthma severity had worse asthma-related QOL. Post hoc analyses showed that racial/ethnic minorities reported worse asthma-related QOL scores than did non-Hispanic Whites.
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Affiliation(s)
- Sharon D Horner
- The University of Texas, Austin School of Nursing, Austin, TX, USA.
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Kintner E, Cook G, Allen A, Meeder L, Bumpus J, Lewis K. Feasibility and benefits of a school-based academic and counseling program for older school-age students with asthma. Res Nurs Health 2012; 35:507-17. [PMID: 22644890 DOI: 10.1002/nur.21490] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2012] [Indexed: 11/06/2022]
Abstract
An asthma education program for older school-age students with asthma was developed in collaboration with school personnel, healthcare professionals, and community partners. Feasibility and benefits were evaluated using a single-group, prospective, quasi-experimental design. The convenience sample, consisting of 28 grade 6 and 7 students with asthma, had 50% males, a diverse racial background, and a wide range of incomes. Feasibility and benefits were demonstrated by comparing pre-intervention to 1- and 12-month post-intervention evaluation of students who completed more than 70% of the 10 sessions. Statistically significant improvements in cognitive, behavioral, psychosocial, and quality of life outcomes were seen from pre-intervention to 1-month post-intervention (all p < .03). Severity of asthma significantly improved from 1- to 12-month post-intervention (p= .04).
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Affiliation(s)
- Eileen Kintner
- The University of Texas at Austin School of Nursing, Austin, TX 8701-1499, USA
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Spanier AJ, Kahn RS, Hornung R, Lierl M, Lanphear BP. Associations of Fraction of Exhaled Nitric Oxide with Beta Agonist Use in Children with Asthma. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2011; 24:45-50. [PMID: 22276224 PMCID: PMC3255503 DOI: 10.1089/ped.2010.0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 02/10/2011] [Indexed: 12/16/2022]
Abstract
The fraction of exhaled nitric oxide (FeNO), a measure of airway inflammation, is a potential noninvasive tool to guide asthma management in children. It remains unclear, however, if FeNO adds any information beyond clinical assessment of asthma control. We evaluated the associations of FeNO level with short acting beta agonist use and compared it with other clinical asthma assessments. We examined a prospective cohort study of 225 tobacco-smoke-exposed children aged 6-12 years with doctor-diagnosed asthma, including measures of FeNO, reported days of short acting beta agonist use, and unscheduled asthma visits. FeNO was analyzed in relation to current and future (3 months later) short acting beta agonist use. Mean FeNO at baseline, 6, and 12 months was 15.5, 15.7, and 16.8 ppb. In multivariable analyses, higher FeNO level was associated with increased short acting beta agonist use but only among children who were not on inhaled corticosteroids. Among those not on an inhaled steroid, there was a 12% increase in current and 15% increase in future days of short acting beta agonist use for every 10 ppb increase in FeNO level. FeNO levels remained associated with current short acting beta agonist use even after adjusting for unscheduled asthma visits. FeNO levels remained associated with future short acting beta agonist use even after adjusting for current short acting beta agonist use or unscheduled asthma visits. We conclude that FeNO levels are associated with short acting beta agonist use but only among children who are not on an inhaled corticosteroid.
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Moonie S, Cross CL, Guillermo CJ, Gupta T. Grade retention risk among children with asthma and other chronic health conditions in a large urban school district. Postgrad Med 2010; 122:110-5. [PMID: 20861594 DOI: 10.3810/pgm.2010.09.2207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Asthma accounts for 12.8 million missed school days for children nationwide. Whether this excess absenteeism contributes to poor outcomes such as grade retention is of interest. The Clark County School District in Las Vegas, NV has incorporated the Federal "No Child Left Behind Act," which states that absences per individual in excess of 10 per school year are considered unapproved and may put a child at risk for repeating a grade. The purpose of this study was to determine if children with asthma are at increased risk for absenteeism associated with grade retention. Secondary data were obtained for students in attendance for the 2006-2007 school year. Days absent were weighted for enrollment time. Frequencies were obtained using descriptive statistics, and multivariate logistic regression was used to model the odds of absenteeism > 10 days per year. Of 300 881 students, 27 299 (9.1%) reported having asthma, as determined by school health records. The population was 52% male, 37% white, and 39% Hispanic. Significant predictors of missing > 10 days per school year included ethnicity, gender, grade, and health status (P < 0.0001). Students with asthma (adjusted odds ratio [aOR], 1.5) or asthma plus another health condition (aOR, 1.6) were at significantly increased odds of missing > 10 school days per year compared with healthy students or those with a medical condition other than asthma (P < 0.0001). Lastly, some disparities were found in current grade point average by race, gender, and asthma status. Children with asthma have a greater risk of absenteeism associated with grade retention. Therefore, improved asthma management and tailored education is necessary to identify and eliminate asthma triggers in the home and school setting for school-aged children.
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Affiliation(s)
- Sheniz Moonie
- Department of Environmental and Occupational Health, Unit of Epidemiology and Biostatistics, University of Nevada, Las Vegas School of Community Health Sciences, Las Vegas, NV 89154-3064, USA.
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Everhart RS, Fiese BH. Asthma severity and child quality of life in pediatric asthma: a systematic review. PATIENT EDUCATION AND COUNSELING 2009; 75:162-168. [PMID: 19036553 DOI: 10.1016/j.pec.2008.10.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 08/18/2008] [Accepted: 10/06/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To systematically review evidence of asthma severity as a correlate of child quality of life (QOL) in pediatric asthma. METHODS Online bibliographic databases (PsycINFO, PsycARTICLES, and MEDLINE) were used to identify relevant studies that specifically considered the relationship between asthma severity and child QOL. RESULTS Fourteen studies matching inclusion and exclusion criteria were reviewed. Asthma severity was significantly related to child QOL in nine of these studies. Informant of QOL and type of QOL measure were found to influence the strength of the relationship between severity and child QOL in pediatric asthma. CONCLUSIONS Findings suggest that asthma severity is a correlate of child QOL. Children whose asthma symptoms are not well-managed are likely to experience an impaired level of QOL. Findings also suggest the need to utilize asthma-specific QOL measures and an informant of QOL other than the child's parent in order to receive the most accurate information about the child's level of functioning. PRACTICE IMPLICATIONS Researchers and healthcare providers basing clinical outcomes on QOL assessments should consider asthma severity in their evaluations. Further, researchers and healthcare providers should recognize the continued need to reduce asthma severity and improve asthma symptom control in their attempts to improve the QOL of children with asthma.
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Affiliation(s)
- Robin S Everhart
- Syracuse University, Department of Psychology, 430 Huntington Hall, Syracuse, NY 13244, United States
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Childhood asthma in a rural environment: implications for clinical nurse specialist practice. CLIN NURSE SPEC 2008; 22:192-8; quiz 199-200. [PMID: 18596488 DOI: 10.1097/01.nur.0000311708.40190.ca] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to identify factors that impact asthma morbidity in rural school-aged children. DESIGN Exploratory analysis of baseline data collected in a longitudinal intervention study was performed. SETTING Four rural school districts that served small towns and unincorporated areas participated in this study. SAMPLE Participants were children in grades 2 to 5 who had current asthma and who spoke English or Spanish. There were 183 children (108 boys, 75 girls) with an average age of 8.78 years and who were Hispanic (46%), white (31%), or African American (22%). METHODS Associations between asthma risk factors (gender, ethnicity/race, socioeconomic status, asthma severity), asthma resources (access to care, health insurance), family asthma management, and asthma morbidity (absenteeism, emergency department visits, hospitalizations) were analyzed. FINDINGS Children with more severe asthma had higher absenteeism and more hospitalizations, and their parents performed more asthma management behaviors. Families who had difficulty accessing care had more hospitalizations and emergency department visits and were more likely to be poor. More boys, more Hispanic and African American children, and more children from poorer families were hospitalized for asthma than were middle-class and non-Hispanic white children. CONCLUSIONS Asthma is a chronic condition that is fairly easy for some families to manage, whereas other families are having higher asthma morbidity that needs to be addressed through targeted interventions.
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A Danish population-based cohort study of newly diagnosed asthmatic children's care pathway - adherence to guidelines. BMC Health Serv Res 2008; 8:130. [PMID: 18549494 PMCID: PMC2440738 DOI: 10.1186/1472-6963-8-130] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Accepted: 06/12/2008] [Indexed: 11/19/2022] Open
Abstract
Background Asthma is the most common chronic disease in childhood. Large variations exist concerning the number of children being treated by general practitioners and by specialists. Consequently, health related costs due to this disease vary as care by specialists is more expensive compared with care by general practitioners. Little is known of the consequences of these variations concerning the quality of care. The aim of the study was to analyse associations between care providers and adherence to guidelines concerning frequency of contacts with the health service due to asthma. Methods A cohort study was performed of 36,940 incident asthmatic children's (aged 6–14) contacts with the health service using the unique personal registration number to link data from five national registries. The prevalence ratios were calculated for associations between provider (general practitioner, primary care specialist, hospital specialist or both GP and specialist) and adherence with guidelines concerning three indicators of quality of care pathway: 1) diagnostic examination of lung function at start of medical treatment 2) follow-up the first six months and 3) follow-up the next six months. The associations were adjusted for sex, age, socioeconomic status, county, and severity of disease. Results Most children (70.3%) had only been seen by their GP. About 80% of the children were treated with inhaled steroids, 70% were treated with inhaled steroids as well as inhaled beta2agonists and 13% were treated with inhaled beta2agonists only. A total of 12,650 children (34.2%) had no registered asthma-related contacts with the health service except when redeeming prescriptions. Care was in accordance with guidelines in all three indicators of quality in 7% of the cases (GPs only: 3%, primary care specialists only: 16%, hospital specialists: 28%, and both GP and specialists: 13%). Primary care specialists had a 5.01, hospital specialists a 8.81 and both GP and specialists a 4.32 times higher propensity to provide a clinical pathway according to guidelines compared to GPs alone. Conclusion The majority of the children were seen in general practice. Hospital specialists provided care in accordance with guidelines nine times more often compared with GPs, but still only one quarter of these children had pathways in accordance with guidelines. It is relevant to study further if these lacks of adherence to guidelines have implications for the asthmatic children or if guidelines are too demanding concerning frequency of follow-up or if asthmatic children should be stratified to different care pathways.
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Bibliography. Current world literature. Outcome measures. Curr Opin Allergy Clin Immunol 2007; 7:288-90. [PMID: 17489050 DOI: 10.1097/aci.0b013e3281fbd52a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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