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Gorina LG, Krylova NA, Rakovskaya IV, Geppe NA, Gamova NA, Barkhatova OI. Mechanisms of Long-Term Persistence of Mycoplasmas in Children with Asthma. Microorganisms 2023; 11:1683. [PMID: 37512855 PMCID: PMC10383847 DOI: 10.3390/microorganisms11071683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Improving the management of children with asthma associated with mycoplasma infection is important. Aim: To study the duration of the persistence of antigens, and DNA in a free state, in the structures of circulating immune complexes (CICs) and living cells of Mycoplasma pneumoniae (Mpn) and Mycoplasma hominis (Mh) in children with asthma. In total, 205 children with asthma from 1 to 14 years were observed. The reaction of aggregate-hemagglutination (AHAA), the direct immunofluorescence reaction (DIF), the reaction of the polymerase chain reaction (PCR), and the culture method were used. In addition, 47 children were re-examined 1.5 months after the treatment of mycoplasma infection with azithromycin. The number of samples positive for antigens and DNA in the free state and in the structures of CICs significantly decreased. Then, 50 blood serum samples containing Mh antigens, and 50 samples containing Mpn antigens were analyzed by culture method. Mh was isolated in 21 (65.5%) of 32 samples containing DNA. Mpn was isolated from antigen-positive samples in nine cases. The presented data indicate the long-term persistence of antigens, and DNA of mycoplasma cells in the free state, in the structure of CICs, as well as in the form of "microcolonies". A high level of CICs can be used to predict the course of the disease and the response to therapy.
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Affiliation(s)
- Luisa G Gorina
- Gamaleya National Research Center of Epidemiology and Microbiology, 123098 Moscow, Russia
| | - Natalya A Krylova
- Department of Childhood Diseases Sechenov, First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Irina V Rakovskaya
- Gamaleya National Research Center of Epidemiology and Microbiology, 123098 Moscow, Russia
| | - Natalia A Geppe
- Department of Childhood Diseases Sechenov, First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Natalia A Gamova
- Gamaleya National Research Center of Epidemiology and Microbiology, 123098 Moscow, Russia
| | - Olga I Barkhatova
- Gamaleya National Research Center of Epidemiology and Microbiology, 123098 Moscow, Russia
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Chen KY, Chu W, Jones R, Vuillermin P, Fuller D, Tran D, Sanci L, Shanthikumar S, Carlin J, Hiscock H. Modifiable factors associated with pediatric asthma readmissions: a multi-center linked cohort study. J Asthma 2023; 60:708-717. [PMID: 35748560 DOI: 10.1080/02770903.2022.2089996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To (a) identify rates of hospital readmission and emergency department (ED) re-presentation for asthma within a 12-month period, (b) estimate the effects of modifiable hospital, general practitioner (GP) and home environmental factors on hospital readmission, ED re-presentations and rescue oral corticosteroid use. METHODS We recruited 767 children aged 3-18 years who were admitted to 3 hospitals in Victoria, Australia between 2017 and 2018 with a validated diagnosis of asthma on chart review. Primary outcome was hospital readmission with asthma within 12 months of index admission. Secondary outcomes were ED re-presentation for asthma and rescue oral corticosteroid use. All outcomes were identified through linked administrative datasets. Their caregivers and 277 nominated GPs completed study surveys regarding the home environment and their usual asthma management practices respectively. RESULTS Within 12 months of an index admission for asthma 263 (34.3%) participants were readmitted to a hospital for asthma, with participants between the ages of 3-5 years accounting for 69.2% of those readmitted. The estimated effect of GP reported guideline discordant care on the odds of readmission was OR 1.57, 95% CI 1.00-2.47, p = 0.05. None of the hospital or home environmental factors appeared to be associated with hospital readmissions. CONCLUSIONS Hospital readmissions among Australian children with asthma are increasing, and linked datasets are important for objectively identifying the health services burden of asthma. They also confirm the important role of the GP in the management of pediatric asthma.
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Affiliation(s)
- Katherine Yh Chen
- Health Services Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of General Medicine, The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Wanyu Chu
- Health Services Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Renee Jones
- Health Services Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Peter Vuillermin
- School of Medicine, Deakin University, Geelong, VIC, Australia
- Department of Paedatrics, University Hospital Geelong, Geelong, VIC, Australia
| | - David Fuller
- School of Medicine, Deakin University, Geelong, VIC, Australia
- Department of Paedatrics, University Hospital Geelong, Geelong, VIC, Australia
| | - David Tran
- Department of Pediatrics, Northern Health, Epping, VIC, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, Parkville, VIC, Australia
| | - Shivanthan Shanthikumar
- Department of Pediatrics, The University of Melbourne, Parkville, VIC, Australia
- Department of Respiratory and Sleep Medicine, The Royal Children's Hospital, Parkville, VIC, Australia
- Respiratory Diseases Research Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - John Carlin
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute and The University of Melbourne, Parkville, VIC, Australia
| | - Harriet Hiscock
- Health Services Group, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, VIC, Australia
- Centre for Community and Child Health, The Royal Children's Hospital, Parkville, VIC, Australia
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Gao H, Miao C, Li H, Bai M, Zhang H, Wu Z, Li W, Liu W, Xu L, Liu G, Zhu Y. The effects of different parity and delivery mode on wheezing disorders in the children-a retrospective cohort study in Fujian, China. J Asthma 2021; 59:1989-1996. [PMID: 34587470 DOI: 10.1080/02770903.2021.1988104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The relationship between childbirth delivery methods and the risk of wheezing in children remains controversial. Few studies have explored it under different maternal conditions. OBJECTIVE To explore the influence of childbirth delivery method on the onset of wheezing in children of different parity. METHODS A total of 21716 patients were included in this retrospective observational study. Multivariable logistic regression was used to analyze the relationship between childbirth delivery method and wheezing in children under 18 years of age in Fujian Province. RESULTS Wheezing differed statistically based on the child's sex, age, season of onset, parity, jaundice history, and feeding patterns (P < 0.05). After adjusting for confounding factors, in cases of parity greater than two, the risk of wheezing in cesarean section deliveries was higher than that in vaginal deliveries (OR: 1.107; 95% CI 1.010-1.214). In girls with parity greater than two (OR: 1.179; 95% CI 1.003-1.387) and normal-weight infants with parity greater than two (OR: 1.106; 95% CI 1.003-1.220), the risk of wheezing in cesarean section deliveries was higher. The interaction term between the mode of childbirth and parity was significant in girls (P = 0.014). CONCLUSION The method of childbirth delivery and parity are related to the risk of wheezing and may be relevant to gender and birth weight. Parity and gender have synergistic effects on wheezing.
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Affiliation(s)
- Haiyan Gao
- Fujian Obstetrics and Gynecology Hospital, Fuzhou, China.,Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Chong Miao
- Department of Computer Technology, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Haibo Li
- Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Meng Bai
- Fujian Obstetrics and Gynecology Hospital, Fuzhou, China.,Department of Computer Technology, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Huijie Zhang
- Department of Pediatrics, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Zhengqin Wu
- Fujian Obstetrics and Gynecology Hospital, Fuzhou, China.,Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Wei Li
- Fujian Obstetrics and Gynecology Hospital, Fuzhou, China.,Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Wenjuan Liu
- Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Fujian Children's Hospital, Fuzhou, China
| | - Libo Xu
- Department of Computer Technology, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Guanghua Liu
- Department of Pediatrics, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Yibing Zhu
- Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, Fuzhou, China
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Jones R, Turner B, Perera P, Hiscock H, Chen K. Understanding caregiver perspectives on challenges and solutions to pediatric asthma care for children with a previous hospital admission: a multi-site qualitative study. J Asthma 2021; 59:1973-1980. [PMID: 34569896 DOI: 10.1080/02770903.2021.1984528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Pediatric hospital admissions for asthma provide an opportunity to trigger a review of the current management with an aim of preventing readmissions. However, caregiver voices on how best to improve care are missing. METHODS As part of a larger, mixed methods cohort study, we identified caregivers of children aged 3-18 years who had an index hospital admission to a tertiary pediatric, mixed adult and pediatric, or regional hospital in Victoria, Australia, between 1st September 2017 and 31st August 2018 with a discharge diagnosis of "Asthma" or "Wheeze" based on International Classification of Disease-10 coding. We conducted qualitative semi-structured interviews with a purposive sample of 39 caregivers. We used content analysis to identify themes from the data. RESULTS Caregivers identified both challenges associated with asthma care for children with a previous hospital admission as well as solutions to improve care and potentially reduce readmissions. Key challenges included: unclear pathways for follow up care, inconsistent advice, lack of personalized management, delays in getting a diagnosis, delays in the prescription of a preventer medication, and difficulty accessing primary care during exacerbations. Follow up with an "asthma specialist", early access to a trial of preventer medication, personalized Written Asthma Action Plans and increased access to and quality of community-based asthma support services were identified as key solutions. CONCLUSIONS Caregivers have identified several potential solutions that could be implemented to improve care and possibly reduce pediatric asthma hospital readmissions. The challenge now is to co-design, embed and evaluate these in healthcare systems. Supplemental data for this article can be accessed at publisher's website.
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Affiliation(s)
- Renee Jones
- Health Services, Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Brittany Turner
- Health Services, Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Prescilla Perera
- Health Services, Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Harriet Hiscock
- Health Services, Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Katherine Chen
- Health Services, Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of General Medicine, The Royal Children's Hospital, Melbourne, Australia
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