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Uhm JY, Choi MY. School Health Teachers as Partners in Diabetes Caring: Maternal Perspectives. West J Nurs Res 2023; 45:942-952. [PMID: 37599455 DOI: 10.1177/01939459231193725] [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] [Indexed: 08/22/2023]
Abstract
BACKGROUND The absence of primary care providers' participation in school health care may require close collaboration between school health teachers and parents. This study explores maternal perspectives on obstacles and improvements in partnerships with school health teachers of children with type 1 diabetes. METHODS Participants were recruited using purposive sampling through an online type 1 diabetes self-help group in South Korea. Twenty-two mothers whose children were aged between 7 and 13 and had been diagnosed with type 1 diabetes at least 1 year ago were included. Individual interviews were conducted based on a semi-structured interview guide from February to June 2019. Qualitative data were analyzed using inductive content analysis comprising open coding, coding sheets, grouping, categorization, and abstraction. RESULTS Mothers recognized obstacles in eight categories and improvements in nine categories under institutional, interpersonal, and intrapersonal aspects of the partnership with school health teachers. Respondents recognized insufficient legal coverage and guidelines, and also health teacher shortage and workload as obstacles in the institutional dimension. Mothers perceived building trust, compromising to balance responsibilities, and constant and open communication as improvements in the interpersonal dimension. They recognized practical competency and tailored care for ordinary school life as school health teacher-related improvements. CONCLUSIONS The findings indicate that school health teachers should compromise to balance responsibilities to improve partnerships with parents in the school health care setting. Institutional improvements, such as establishing robust laws and clear guidelines and increasing the number of school health teachers, should be prioritized.
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Affiliation(s)
- Ju-Yeon Uhm
- Department of Nursing, Pukyong National University, Busan, Republic of Korea
| | - Mi-Young Choi
- Department of Nursing Science, Chungbuk National University, Cheongju, Republic of Korea
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March CA, Siminerio LM, Kazmerski TM, Albanese-O'Neill A, Miller E, Libman I. School-based diabetes care: A national survey of U.S. pediatric diabetes providers. Pediatr Diabetes 2023; 2023:4313875. [PMID: 37929230 PMCID: PMC10624000 DOI: 10.1155/2023/4313875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Objectives To understand the practices, attitudes, and beliefs of type 1 diabetes (T1D) providers towards school-based diabetes care (SBDC), including counseling families and communicating with schools, and explore the barriers and facilitators which affect their support of SBDC. Research Design and Methods We conducted a national survey of pediatric T1D providers about their perceived support of SBDC, including family counseling and school communication. We used descriptive statistics to analyze results and explored differences by practice size (<500, 500-999, and ≥1000 patients) and environment (academic vs non-academic). Results A total of 149 providers completed the survey. Nearly all (95%) indicated SBDC was very important. Though most (63%) reported counseling families about SBDC multiple times per year, few (19%) spoke with school staff routinely, reporting that was a shared responsibility among different providers. Close to 90% agreed school feedback on T1D management plans would be helpful, yet only 31% routinely requested this input. Moderate to extremely significant barriers to SBDC communication included internal factors, such as staff resources (67%) and time (82%), and external factors, such as school nurse education needs (62%) and differing school district policies (70%). Individuals from large or academic practices reported more barriers in their knowledge of SBDC, including federal/state laws. Desired facilitators for SBDC included a designated school liaison (84%), electronic transmission for school forms (90%), and accessible school staff education (95%). Conclusions Though providers universally agree that SBDC is important, there are multilevel internal (practice) and external (policy) barriers to facilitating a bidirectional relationship between schools and health teams.
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Affiliation(s)
- Christine A March
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | | | - Traci M Kazmerski
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Anastasia Albanese-O'Neill
- Department of Family, Community, and Health System Science, University of Florida College of Nursing, Gainesville, FL
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Ingrid Libman
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
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Abstract
PURPOSE OF REVIEW School-based asthma management is an important component of pediatric asthma care that has the potential to provide more universal evidence-based asthma care to children and mitigate asthma-related health inequities. The purpose of this review is to highlight relevant developments in school-based asthma management over the past 2 years. RECENT FINDINGS There have been considerable recent scientific advances in school-based asthma management including robust clinical trials of environmental interventions in the classroom setting, school-nurse led interventions, stock albuterol policy changes, school-based telemedicine approaches and innovative methods to engage community stakeholders in research that have pushed the frontiers of school-based asthma care. SUMMARY Recent scientific work in school-based asthma management demonstrates the potential power of schools in providing access to guideline-based asthma care for all children with asthma and in improving their health outcomes. Future work should focus on the evaluation of methods to promote the adoption of school-based asthma management strategies in real-world practice and support evidence-based policy change and strategic partnerships to improve asthma health outcomes and produce meaningful public health impact for diverse children and families.
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Affiliation(s)
- Ashley A. Lowe
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
- Asthma & Airway Disease Research Center, University of Arizona Health Sciences, University of Arizona, Tucson, Arizona, USA
| | - Ina St Onge
- Department of Pediatrics, Division of Pulmonary Medicine, University of Massachusetts Chan Medical School, UMass Memorial Children’s Medical Center, Worcester, MA, USA
| | - Michelle Trivedi
- Department of Pediatrics, Division of Pulmonary Medicine, University of Massachusetts Chan Medical School, UMass Memorial Children’s Medical Center, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical Center, Worcester, MA, USA
- Child Health Equity Center, Department of Pediatrics, UMass Chan Medical School, UMass Memorial Children’s Medical Center, Worcester, MA, USA
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Uhm JY, Choi MY. School Nurse-Parent Partnership in School Health Care for Children with Type 1 Diabetes: A Hybrid Method Concept Analysis. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:282-291. [PMID: 36375806 DOI: 10.1016/j.anr.2022.11.001] [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: 06/27/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To define school nurse-parent partnerships in school health care for children with type 1 diabetes (T1D) and determine its attributes using a hybrid model. METHODS This method involves a three-phase process: theoretical, fieldwork, and analytical. A literature review was conducted during the theoretical phase. A literature search of articles from January 1991 to February 2020 was conducted using relevant electronic databases. Eighty-three articles that met the inclusion criteria were completely read. Fieldwork data were collected through individual interviews from February to July 2019 in South Korea. In the fieldwork phase, interviews were conducted individually with 22 mothers of students with T1D and 20 school nurses recruited by purposeful sampling. Inductive content analysis was conducted. The findings from the theoretical phase were integrated with those from the fieldwork phase, and the final concept was derived. RESULTS School nurse-parent partnership in school health care for children with T1D has been defined as an interactive process of maintaining a balanced responsibility and providing tailored care to meet needs by establishing trusting relationships and communicating transparently and openly. This analysis yielded four attributes: trusting relationships, transparent and open communication, balanced responsibility, and providing tailored care to meet needs-this entails providing nursing actions by advocating for students and performing a negotiated role together or individually for student and family. CONCLUSION The findings of this study add to the importance of an attribute of balancing responsibility for partnership in school health care. The results show that this partnership could contribute to the development of a scale, theory, and nursing intervention in school health care for children with T1D.
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Affiliation(s)
- Ju-Yeon Uhm
- Department of Nursing, Pukyong National University, Republic of Korea
| | - Mi-Young Choi
- Department of Nursing Science, Chungbuk National University, Republic of Korea.
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Shillan HN, Luther JP, Ryan GW, Hoque S, Spano MA, Lessard DM, Gerald LB, Pbert L, Phipatanakul W, Goldberg RJ, Trivedi MK. School-supervised Asthma Therapy is Associated with Improved Long-Term Asthma Outcomes for Underrepresented Minority Children. J Sch Nurs 2022:10598405221100470. [PMID: 35548948 PMCID: PMC9808969 DOI: 10.1177/10598405221100470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Asthma morbidity disproportionately impacts children from low-income and racial/ethnic minority communities. School-supervised asthma therapy improves asthma outcomes for up to 15 months for underrepresented minority children, but little is known about whether these benefits are sustained over time. We examined the frequency of emergency department (ED) visits and hospital admissions for 83 children enrolled in Asthma Link, a school nurse-supervised asthma therapy program serving predominantly underrepresented minority children. We compared outcomes between the year preceding enrollment and years one-four post-enrollment. Compared with the year prior to enrollment, asthma-related ED visits decreased by 67.9% at one year, 59.5% at two years, 70.2% at three years, and 50% at four years post-enrollment (all p-values< 0.005). There were also significant declines in mean numbers of total ED visits, asthma-related hospital admissions, and total hospital admissions. Our results indicate that school nurse-supervised asthma therapy could potentially mitigate racial/ethnic and socioeconomic inequities in childhood asthma.
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Affiliation(s)
- Holly N Shillan
- 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Janki P Luther
- Department of Medicine, 12275Washington University School of Medicine, St. Louis, MO, USA
| | - Grace W Ryan
- Department of Population and Quantitative Health Sciences, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Shushmita Hoque
- Department of Medicine, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Michelle A Spano
- Division of Pulmonary Medicine, Department of Pediatrics, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Darleen M Lessard
- Department of Population and Quantitative Health Sciences, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Lynn B Gerald
- Department of Health Promotion Sciences, 48710University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
- Asthma and Airway Disease Research Center, 577409University of Arizona, Tucson, AZ USA
| | - Lori Pbert
- Department of Population and Quantitative Health Sciences, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Wanda Phipatanakul
- Department of Asthma, Allergy, and Immunology, 1862Boston Children's Hospital, Boston, MA, USA
| | - Robert J Goldberg
- Department of Population and Quantitative Health Sciences, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Michelle K Trivedi
- Department of Population and Quantitative Health Sciences, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
- Division of Pulmonary Medicine, Department of Pediatrics, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
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6
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Slas E, Nguyen Y, McIltrot K. Communication Between Schools Nurses and Health Care Providers on Students with Asthma: An Integrative Review. J Sch Nurs 2021; 38:48-60. [PMID: 34617825 DOI: 10.1177/10598405211045693] [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: 11/17/2022] Open
Abstract
School-based asthma programs have been proven to lessen the burden of pediatric asthma. There is a lack of successful care coordination between school nurses and primary care providers. This review examined strategies to increase communication and identified gaps in the literature. Databases, including PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and The Cochrane Library, were searched to identify relevant articles. This review included 12 articles consisting of randomized controlled trials, quasi-experimental studies, mixed method studies, qualitative studies, and other non-research articles. Four key findings emerged, including limited availability of asthma action plans, inclusion of parents in the communication triad, school nurse outreach to providers, and improved communication leads to positive outcomes for students with asthma including decreased use of emergency medication and increased self-management of asthma. Further research is needed to develop evidence-based interventions that can be implemented to improve communication between school nurses and primary care providers.
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Affiliation(s)
- Emma Slas
- 15851Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Yen Nguyen
- 15851Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Kimberly McIltrot
- 15851Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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7
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Cao H, Gu J, Dai J, Yang G, Tang H, Ding A. Comparison of the effect of fluticasone combined with salmeterol and fluticasone alone in the treatment of pediatric asthma: review and meta-analysis. Minerva Pediatr (Torino) 2021; 73:452-459. [PMID: 33988019 DOI: 10.23736/s2724-5276.21.05939-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A systematic review and meta-analysis was performed to investigate the effect of fluticasone + salmeterol and fluticasone alone in the treatment of pediatric asthma. METHODS Studies meeting specific selection criteria were selected from online databases, including Pubmed, Embase, and the Cochrane Library. The quality of randomized controlled trials was assessed using the Cochrane Library. Weighted mean difference (WMD) and 95% CI were used to evaluate the effect size of continuous variables, while rate ratio (RR) and 95% CI were used for dichotomous variables. RESULTS A total of 11 studies, including 8,272 pediatric asthma patients, were included in this meta-analysis. Among these, 4,133 patients were in the salmeterol + fluticasone group. The changes in forced expiratory volume in 1 second in children with asthma in the salmeterol + fluticasone and fluticasone alone groups were significantly different (fixed effects model, WMD = 3.26, 95% CI: 1.52-5.00, P = 0.0002). Asthma exacerbation between two groups were significantly different (fixed effects model, RR = 0.85, 95% CI: 0.73-0.98, Z = 2.18, P = 0.03). There was no difference in the incidence of adverse events between salmeterol + fluticasone and fluticasone alone in the treatment of pediatric asthma (P > 0.05). When the control group was treated with double dose fluticasone, the difference of changes in FEV1 and asthma exacerbation in children with asthma between the two groups were not significant. CONCLUSIONS The efficacy of salmeterol + fluticasone is better than fluticasone alone, and the efficacy of salmeterol + fluticasone is equal to doubling the dose of fluticasone in the treatment of pediatric asthma.
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Affiliation(s)
- Huling Cao
- Pediatric Ward, the Second Affiliated Hospital of Nantong University, Nantong City, China
| | - Junhua Gu
- Department of Radioiogy, the Second Affiliated Hospital of Nantong University, Nantong City, China
| | - Juan Dai
- Pediatric Ward, the Second Affiliated Hospital of Nantong University, Nantong City, China
| | - Guihong Yang
- Pediatric Ward, the Second Affiliated Hospital of Nantong University, Nantong City, China
| | - Hui Tang
- Pediatric Ward, the Second Affiliated Hospital of Nantong University, Nantong City, China
| | - Aiming Ding
- Department of Nursing, the Second Affiliated Hospital of Nantong University, Nantong City, China -
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8
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Kotcherlakota S, Pelish P, Hoffman K, Kupzyk K, Rejda P. Augmented Reality Technology as a Teaching Strategy for Learning Pediatric Asthma Management: Mixed Methods Study. JMIR Nurs 2020; 3:e23963. [PMID: 34406970 PMCID: PMC8373372 DOI: 10.2196/23963] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 01/26/2023] Open
Abstract
Background Asthma is a major chronic disease affecting 8.6% of children in the United States. Objective The purpose of this research was to assess the use of clinical simulation scenarios using augmented reality technology to evaluate learning outcomes for nurse practitioner students studying pediatric asthma management. Methods A mixed-methods pilot study was conducted with 2 cohorts of graduate pediatric nurse practitioner students (N=21), with each cohort participating for 2 semesters. Results Significant improvements in pediatric asthma test scores (P<.001) of student learning were found in both cohorts at posttest in both semesters. Student satisfaction with the augmented reality technology was found to be high. The focus group discussions revealed that the simulation was realistic and helpful for a flipped classroom approach. Conclusions The study results suggest augmented reality simulation to be valuable in teaching pediatric asthma management content in graduate nursing education.
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Affiliation(s)
| | - Peggy Pelish
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, United States
| | - Katherine Hoffman
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, United States
| | - Kevin Kupzyk
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, United States
| | - Patrick Rejda
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, United States
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9
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Stern J, Chen M, Jusko TA, Fagnano M, Järvinen KM, Halterman JS. Food allergy in at-risk adolescents with asthma: A key area for focus. Ann Allergy Asthma Immunol 2020; 125:405-409.e1. [PMID: 32534023 PMCID: PMC9881432 DOI: 10.1016/j.anai.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/09/2020] [Accepted: 06/01/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Asthma affects more than 6.2 million children in the United States and is a major source of chronic disease burden. Concurrent food allergy (FA) may be a risk factor for worse asthma outcomes. OBJECTIVE To estimate the prevalence of FA among a cohort of adolescents with persistent asthma and assess whether FA is an independent risk factor for asthma morbidity. METHODS We included 342 adolescents aged 12 to 16 years with persistent asthma from the Rochester city school district who participated in the School-Based Asthma Care for Teens trial between 2014 and 2018. Multivariable models were used to estimate the association between FA and asthma morbidity. RESULTS Overall, 29% of adolescents with asthma reported having a FA. Although there were no statistically significant differences in daytime asthma symptoms, teens with FA had higher fractional exhaled nitric oxide (47.5 vs 33.9 P = .002) and reported more days with activity limitation owing to asthma (3.1 vs 2.3 days/2 weeks, P = .03) compared with teens without FA. Less than half (42%) of adolescents with FA had an epinephrine autoinjector. CONCLUSION This study found FA to be common among this cohort of adolescents with asthma. Although FA was not related to asthma symptom severity, adolescents with FA had higher fractional exhaled nitric oxide and more activity limitation, and most did not have epinephrine autoinjectors. A history of FA and lack of epinephrine autoinjector may increase near-fatal outcomes in adolescents with asthma. Preventive measures in addition to standard asthma treatments are warranted for these teens.
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Affiliation(s)
- Jessica Stern
- Division of Pediatric Allergy and Immunology and Center for Food Allergy, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Michael Chen
- Departments of Public Health Sciences and Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Todd A. Jusko
- Departments of Public Health Sciences and Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Maria Fagnano
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Kirsi M. Järvinen
- Division of Pediatric Allergy and Immunology and Center for Food Allergy, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jill S. Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
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10
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Abrams EM. The Impact of Caregiver Health Literacy on Pediatric Asthma: An Integrative Review. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2020; 33:110-116. [DOI: 10.1089/ped.2020.1192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Elissa M. Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba Winnipeg, Canada
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11
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Rehman N, Morais-Almeida M, Wu AC. Asthma Across Childhood: Improving Adherence to Asthma Management from Early Childhood to Adolescence. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:1802-1807.e1. [PMID: 32112922 PMCID: PMC7275896 DOI: 10.1016/j.jaip.2020.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/24/2020] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
Abstract
Asthma affects nearly 6 million US children. Throughout childhood, children undergo a series of biological, developmental, and psychosocial changes. Thus, factors influencing a child's asthma management differ across 3 essential stages-early childhood (0-5 years), school-aged years (5-12 years), and adolescence (12-18 years)-and require varied intervention by parents, school personnel, clinicians, and the children themselves. Because asthma care in children is characterized by fluctuations in severity and coordination among many stakeholders, optimal asthma control is difficult to achieve in this young population. Challenges in childhood asthma management are reflected in the low rates of children's adherence to medication regimes. Although pharmacological and biological factors addressing age in physicians' treatment choices are well outlined, age-specific approaches to patient-provider communication and asthma-related interventions are also important in improving quality of life for patients with pediatric asthma.
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Affiliation(s)
- Narmeen Rehman
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass
| | - Mário Morais-Almeida
- Allergy Center, CUF Descobertas Hospital, CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Ann Chen Wu
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass.
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12
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Ruvalcaba E, Callaghan-Koru J, Rand CS, Eakin MN. Integrating asthma management and care in Maryland Head Start Programs: A qualitative assessment of opportunities and needs. EVALUATION AND PROGRAM PLANNING 2019; 77:101684. [PMID: 31394433 PMCID: PMC6815253 DOI: 10.1016/j.evalprogplan.2019.101684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/24/2019] [Accepted: 07/24/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE To understand the role of Maryland Head Start (HS) programs in asthma care and identify resources and needs to improve health outcomes. METHODS A qualitative needs assessment was conducted with Maryland HS staff (n = 35) and parents/caregivers of enrolled children with asthma (n = 16) from all 14 grantee programs in Maryland. Focus group discussions and interviews addressed strengths and challenges in current asthma control and opportunities for integration of an asthma care program into HS services. Transcripts were thematically analyzed using a modified Framework approach. RESULTS HS programs actively communicate with families about asthma management and facilitate communication between families and primary care providers (PCPs). Both HS staff and families reported a strong trusting relationship allowing HS staff to provide asthma management support. HS needs strong linkages with supportive services and PCP offices to engage families, address environmental triggers, and educate staff. While families across the state report interest in peer education on asthma through HS, there were some region-specific asthma care barriers for urban and rural programs. CONCLUSION This needs assessment confirmed interest among all stakeholders in integrating asthma care through HS and identified communication strategies, supportive infrastructure, and addressing regional access to care as key elements for program design.
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Affiliation(s)
- Elizabeth Ruvalcaba
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, USA
| | - Jennifer Callaghan-Koru
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore County, USA
| | - Cynthia S Rand
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, USA
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, USA.
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13
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McCabe EM, McDonald C, Connolly C, Lipman TH. Factors Associated With School Nurses' Self-Efficacy in Provision of Asthma Care and Performance of Asthma Management Behaviors. J Sch Nurs 2019; 37:353-362. [PMID: 31570029 DOI: 10.1177/1059840519878866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Asthma is a chronic disease affecting nearly 6 million children in the United States and accounts for nearly 14 million missed school days. School nurses' performance of asthma management behaviors (AMBs) may reduce exacerbations, thereby decreasing emergency visits and hospitalizations and increasing attendance at school. Self-efficacy can have a positive effect on AMBs. More research is needed on the interplay between environmental factors in school nurses' work setting, self-efficacy in providing asthma care (hereafter "self-efficacy in asthma care"), and performance of AMBs. This study used a descriptive cross-sectional online survey design with practicing registered school nurses in Pennsylvania (N = 231). Data analysis included descriptive statistics, correlation tests, and multiple regression. In separate models, self-efficacy in asthma care and student-nurse ratio were significantly associated with performance of AMBs. Schools and school nurses need stronger efforts to strengthen self-efficacy in asthma care, with the goal of increasing nurses' performance of AMBs.
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Affiliation(s)
- Ellen M McCabe
- Hunter-Bellevue School of Nursing, Hunter College, The City University of New York, NY, USA
| | | | - Cynthia Connolly
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Terri H Lipman
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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14
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Pham MN, Wang J. Management of food allergies and asthma in schools. Ann Allergy Asthma Immunol 2019; 121:391-399. [PMID: 30290894 DOI: 10.1016/j.anai.2018.07.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/23/2018] [Accepted: 07/23/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Michele N Pham
- Division of Allergy and Immunology, Department of Pediatrics, The Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, New York
| | - Julie Wang
- Division of Allergy and Immunology, Department of Pediatrics, The Elliot and Roslyn Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, New York.
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15
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Kocaaslan EN, Akgün Kostak M. Effect of disease management education on the quality of life and self-efficacy levels of children with asthma. J SPEC PEDIATR NURS 2019; 24:e12241. [PMID: 30887669 DOI: 10.1111/jspn.12241] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 01/26/2019] [Accepted: 02/22/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to determine the effects of disease management education provided to children with asthma on their quality of life and self-efficacy levels. METHODS AND DESIGN The study design was a quasi-experimental design with The One Group Pretest-Posttest design. This study was conducted on 60 children with asthma between 10 and 18 years of age. Data were collected by "Information Form", "Pediatric Asthma Quality of Life Questionnaire", and "Self-Efficacy Scale for Children and Adolescents with Asthma". Children's quality of life and self-efficacy levels were assessed before receiving an individual asthma education intervention and then children were informed with an asthma management education book individually. Two months after the education intervention, the quality of life and self-efficacy levels of the children were re-evaluated. RESULTS The children's quality of life and self-efficacy levels increased significantly after education (p = 0.014). Maternal age, number of siblings, number of family members living in the same house, activity status, the frequency of experiencing symptoms, and the ability to use the inhalers on their own affected children quality of life. Child's age, knowledge about factors causing asthma, and ability to use medication on their own affected their self-efficacy ( p < 0.05). PRACTICE IMPLICATIONS According to these results, planned asthma education program and provided continuity of this education by nurses would be effective to improve the quality of life and levels of self-efficacy. Asthma management education for children with asthma by nurses after diagnosis is beneficial for improving the quality of life and levels of self-efficacy.
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Affiliation(s)
- Esra Nur Kocaaslan
- Department of Child Health Nursing, Trakya University Faculty of Health Sciences, Balkan Campus, Edirne, Turkey
| | - Melahat Akgün Kostak
- Department of Child Health Nursing, Trakya University Faculty of Health Sciences, Balkan Campus, Edirne, Turkey
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16
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Pediatric asthma - moving ahead faster than ever. Curr Opin Allergy Clin Immunol 2019; 17:96-98. [PMID: 28225363 DOI: 10.1097/aci.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Langton CR, Hollenbach JP, Simoneau T, Cloutier MM. Asthma management in school: parents' and school personnel perspectives. J Asthma 2019; 57:295-305. [PMID: 30676162 DOI: 10.1080/02770903.2019.1568455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Effective asthma management at school can help students with asthma stay healthy, learn better and participate fully during their school day. This study sought to understand school-based asthma care from the perspective of parents and school personnel to improve asthma care at school. Methods: A cross-sectional study was conducted in Hartford, CT. School personnel from 59 schools and 322 parents/guardians were invited to participate. Four cross-sectional surveys using Likert-type scales assessed parental and school personnel satisfaction, confidence in managing asthma, policy awareness, management of asthma during physical activity, and perceived gaps surrounding school-based asthma care. Results: 263/322 (82%) eligible parents of children with asthma (mean age 8.5 ± 4.3, 56% Hispanic, 30% African American) completed surveys. Thirty six school nurses (62%), 131 teachers (8%), 14 coaches (14%), and 17 school principals (29%) participated. 90% of parents were satisfied with asthma management in school. School nurses were more aware of asthma policies than teachers (74% vs. 24%, p < 0.001). 34% of school nurses, 30% of teachers and 36% of coaches were unaware of asthma-related absences. 14% of physical education teachers/coaches reported no asthma training. Conclusion: In this convenience sample of parents and school personnel, parents reported overall satisfaction regarding the asthma care their children receive at school, yet a number of gaps pertaining to school-based asthma care were identified. Increased asthma training and enhanced communication among school personnel is needed to address these gaps. National guidelines and resources are readily available to improve asthma care at school.
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Affiliation(s)
| | - Jessica P Hollenbach
- Asthma Center, Connecticut Children's Medical Center, Hartford, CT, USA.,Department of Pediatrics, UCONN Health, Farmington, CT, USA
| | - Tregony Simoneau
- Asthma Center, Connecticut Children's Medical Center, Hartford, CT, USA.,Department of Pediatrics, UCONN Health, Farmington, CT, USA
| | - Michelle M Cloutier
- Asthma Center, Connecticut Children's Medical Center, Hartford, CT, USA.,Department of Pediatrics, UCONN Health, Farmington, CT, USA.,Department of Medicine, UCONN Health, Farmington, CT, USA
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18
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Louisias M, Phipatanakul W. Managing Asthma in Low-Income, Underrepresented Minority, and Other Disadvantaged Pediatric Populations: Closing the Gap. Curr Allergy Asthma Rep 2017; 17:68. [PMID: 28914405 DOI: 10.1007/s11882-017-0734-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW In this article, we review current understanding of the epidemiology and etiology of disparities in asthma. We also highlight current and emerging literature on solutions to tackle disparities while underscoring gaps and pressing future directions. RECENT FINDINGS Tailored, multicomponent approaches including the home, school, and clinician-based interventions show great promise. Managing asthma in disadvantaged populations can be challenging as they tend to have disproportionately worse outcomes due to a multitude of factors. However, multifaceted, innovative interventions that are sustainable and scalable are key to improving outcomes.
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Affiliation(s)
- Margee Louisias
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.,Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA. .,Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
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