The effectiveness of school-based family asthma educational programs on the quality of life and number of asthma exacerbations of children aged five to 18 years diagnosed with asthma: a systematic review protocol

Hydroxyurea Adherence for Personal Best in Sickle Cell Treatment (HABIT) efficacy trial: Community health worker support may increase hydroxyurea adherence of youth with sickle cell disease

Despite disease-modifying effects of hydroxyurea on sickle cell disease (SCD), poor adherence among affected youth commonly impedes treatment impact. Following our prior feasibility trial, the "Hydroxyurea Adherence for Personal Best in Sickle Cell Treatment (HABIT)" multi-site randomized controlled efficacy trial aimed to increase hydroxyurea adherence for youth with SCD ages 10-18 years. Impaired adherence was identified primarily through flagging hydroxyurea-induced fetal hemoglobin (HbF) levels compared to prior highest treatment-related HbF. Eligible youth were enrolled as dyads with their primary caregivers for the 1-year trial. This novel semi-structured supportive, multidimensional dyad intervention led by community health workers (CHW), was augmented by daily tailored text message reminders, compared to standard care during a 6-month intervention phase, followed by a 6-month sustainability phase. Primary outcomes from the intervention phase were improved Month 6 HbF levels compared to enrollment and proportion of days covered (PDC) for hydroxyurea versus pre-trial year. The secondary outcome was sustainability of changes up to Month 12. The 2020-2021 peak coronavirus disease 2019 (COVID-19) pandemic disrupted enrollment and clinic-based procedures; CHW in-person visits shifted to virtual scheduled interactions. We enrolled 50 dyads, missing target enrollment. Compared to enrollment levels, both HbF level and PDC significantly - but not sustainably - improved within the intervention group (p = .03 and .01, respectively) with parallel increased mean corpuscular volume (MCV) (p = .05), but not within controls. No significant between-group differences were found at Months 6 or 12. These findings suggest that our community-based, multimodal support for youth-caregiver dyads had temporarily improved hydroxyurea usage. Durability of impact should be tested in a trial with longer duration of CHW-led and mobile health support.

Development and Utilization of a Diagnostic Support Tool for Asthma within the Electronic Medical Record

Asthma in childhood is a common and costly chronic disease. Quality asthma care can lead to better control of asthma thus decreasing use of health services. The gold standard for pediatric asthma diagnosis and management is the National Heart, Lung and Blood Institute (NHLBI) guidelines for Diagnosis and Management of Asthma which center on precisely establishing the severity of asthma, as this precise classification delineates appropriate therapy. However, navigating these guidelines is a challenge for primary care providers that creates a barrier to providing quality care. We aim to improve precision in asthma severity classification in the community healthcare setting through the development of an electronic asthma decision support tool (eADST) incorporating NHLBI guidelines embedded within the electronic health record system. We developed an algorithm for the eADST to guide the health care provider to the appropriate classification and subsequent therapy. We engaged our health system's electronic health record informatics team and together developed and revised the tool. We launched the tool in three academic community clinics and measured precision in asthma classification in the twelve months prior to the availability of the tool and the twelve months following the launch. We found a significant improvement in precision of asthma severity classification following the launch, a necessary first step in improvement of asthma care. The next step will be to evaluate the impact of the tool on asthma outcomes.

2022 Prevention of chronic non-communicable diseases in Of the Russian Federation. National guidelines

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Food and Nutrition Education Using Intuitive Method and NOVA Food Classification: Implications for Food Practices of Children and Adolescents Intuitive Method in Food and Nutrition Education

PURPOSE

To evaluate the impact of food and nutrition education interventions based on the intuitive method (IM) proposed by Johaan Henrich Pestalozzi (1746-1827) at different time periods on the food practices of children and adolescents.

DESIGN

This was a prospective comparative intervention program assessed by a pre-post survey at shorter term (3 months) and longer term (6 months).

SETTING

Two institutions that provide extracurricular social support for children and adolescents with social and economic vulnerabilities in the city of Lavras, Minas Gerais, Brazil. The shorter-term intervention was conducted in Institution A and the longer term one conducted in Institution B.

SUBJECTS

The sample consisted of 245 students aged between 5 and 14 years who attended the institutions. For each institution, they were divided into two groups (control and IM).

INTERVENTION

We compared the effectiveness of the interventions performed by the IM or by expository actions (control) in both institutions. Interventions were focused on the guidelines of the Food Guide for the Brazilian Population and dealt with food choices, meal preparation, commensality, and obstacles to healthy eating.

MEASURES

The assessed outcomes were food consumption according to NOVA food classification, cooking self-efficacy, and knowledge about food and nutrition.

ANALYSIS

Paired t-tests were used to compare food consumption before and after interventions. Adjusted logistic regression models were used to analyze the outcomes on food and nutrition knowledge and cooking self-efficacy.

RESULTS

Subjects receiving IM interventions decreased mean intake of ultra-processed food (3.56 to 1.50 portions; P< .001) and had greater odds of increasing self-efficacy with cooking (OR = 2,33-4,17). Both methods were effective regarding teaching about food and nutrition. Intervention period did not homogeneously impact these outcomes.

CONCLUSIONS

The use of food and nutrition education interventions presented positive outcomes on the food practices of the participants. The IM is an alternative method to educate children and adolescents about healthy eating practices.

[Medical rehabilitation of children with bronchial asthma]

Medical rehabilitation of children suffering from bronchial asthma is based on the complex use of natural therapeutic factors, drug, non-drug therapy and other methods in order to achieve control over the disease and long-term remission. The use of non-drug technologies is necessary taking into account the pathogenesis of the bronchial asthma development and is aimed at relieving bronchospasm, reducing the activity of allergic inflammation in the bronchi, improving their drainage function, strengthening the respiratory muscles and increasing exercise tolerance. When carrying out rehabilitation measures it is important to observe the basic principles of medical rehabilitation. An individual medical rehabilitation program is drawn up taking into account the assessment of the child's clinical condition at each stage with the diagnosis of the initial rehabilitation status, the establishment of a rehabilitation diagnosis and an assessment of the rehabilitation potential. The article presents the data of the analysis of scientific publications and our own research allowing to draw up an algorithm for the formation of an individual program of medical rehabilitation for children with bronchial asthma.

Video-based Pain Education in Schools: A Study With Adolescents

OBJECTIVE

School-based educational programs have shown positive changes in health-related behaviors among adolescents. The aim of this study was to analyze the changes in pain-related knowledge among adolescents and in the use of positive responses to their peers' pain behaviors after watching a brief educational video.

METHODS

One hundred and thirty-five adolescents (mean age=13.27; SD=1.17) participated and provided demographic and pain-related information. They also responded to a pain-related knowledge questionnaire before (T1), after (T2), and 1 month after (T3) watching a brief pain educational video, and to a modified version of the Inventory of Parent/Caregiver Responses to the Children's Pain Experience at T1 and at T3.

RESULTS

There was a significant increase in pain knowledge for all participants between T1 and T2 (η2p=0.73) and between T1 and T3 (η2p=0.62). An increase in responses considered to be positive to peers' pain behaviors (ie, the promotion of well-behaviors and coping responses) 1 month after watching the educational video was also found. Interestingly, these results were not associated with the chronic pain status of the participant.

DISCUSSION

The findings showed that a brief and inexpensive educational video-based intervention in schools helps to increase pain-related knowledge and change responses to students with chronic pain. This has the potential to prevent chronic pain and related disability among students, and decrease bullying-like behaviors toward students with chronic pain.

Assessment of Quality of Life of Primary Caregivers of Egyptian Asthmatic Children and Adolescents

Background:

Asthma as a serious public health problem worldwide exerts a serious load on children's health-related quality of life (HRQOL) and their families.

Objective:

We assess the HRQOL of the primary caregivers of Egyptian asthmatic children and adolescents and its relation to HRQOL of their children and asthma severity.

Materials and Methods:

A cross-sectional study was conducted on 128 pairs of asthmatic children (7–16 years) and their primary caregivers. Pediatric asthma quality of life (QOL) questionnaire, pediatric asthma caregiver's QOL questionnaire, and asthma control questionnaire were used.

Results:

Uncontrolled asthmatic patients had statistically significantly lower mean caregiver score compared to controlled asthmatic (P < 0.005). There was a statistically significant positive correlation between caregiver's individual and overall QOL scores and their children (individual and overall QOL scores) (P < 0.05). A statistically significant negative correlation between asthma severity and QOL scores of the caregivers of asthmatic children and adolescents was found (P < 0.05).

Conclusion:

The QOL of the primary caregivers of asthmatic children is significantly adversely affected by their children's illness severity.

Impact of a self-monitoring application on pediatric asthma disparities

OBJECTIVES

We previously reported improved outcomes after implementing the electronic-AsthmaTracker (e-AT), a self-monitoring tool for children with asthma, at 11 ambulatory pediatric clinics. This study assesses e-AT adherence and impact across race/ethnicity subgroups.

STUDY DESIGN

Secondary data analysis of a prospective cohort study of children ages 2-17 years with persistent asthma, enrolled from January 2014 to December 2015 to use the e-AT for 1 year. Survival analysis was used to compare e-AT use adherence and generalized estimating equation models to compare outcomes pre- and post e-AT initiation, between race/ethnicity subgroups.

RESULTS

Data from 318 children with baseline measurements were analyzed: 76.4 % white, 11.3 % Hispanic, 7.8 % "other", and 4.4 % unknown race/ethnicity subgroups. Mean e-AT adherence was 82 % (95 %CI: 79-84 %, reference) for whites, 73 % (64-81 %, p = 0.025) for Hispanics, and 78 % (69-86 %, p = 0.373) for other minorities. Compared to whites, Cox proportional hazard ratio for study dropout risk was 2.14 (1.31-3.77, p = 0.001) for Hispanics and 0.95 (0.60-1.50, p = 0.834) for other minorities. Disparities existed at baseline, with lower QOL (74.9 vs 80.6; p = 0.025) and asthma control (18.4 vs 19.7; p = 0.027) among Hispanics, compared to whites. After e-AT initiation, disparities disappeared at 3 months for QOL (87.2 vs 90.5; p = 0.159) and asthma control (23.1 vs 22.4; p = 0.063), persisting until study end. Disparities also existed at baseline, with lower QOL (74.6 vs. 80.6; p = 0.042) and asthma control (18.2 vs. 19.7, p = 0.024) among "other" minorities, compared to whites, and disappeared at 3 months for QOL (92.7 vs. 90.5, p = 0.432) and asthma control (22.7 vs 22.4; p = 0.518), persisting until study end. Subgroup analysis was underpowered to detect a difference in oral steroid use or ED/hospital admissions.

CONCLUSIONS

Our study shows improved asthma control and QOL among minorities and disparity elimination after e-AT implementation. Future adequately powered studies will explore the impact on oral steroid and ED/hospital use disparities.

The short-chain free fatty acid receptor FFAR3 is expressed and potentiates contraction in human airway smooth muscle

Emerging evidence suggests that gut microbiota-derived short-chain fatty acids (SCFAs; acetate, propionate, and butyrate) are important modulators of the inflammatory state in diseases such as asthma. However, the functional expression of the G_i protein-coupled free fatty acid receptors (FFAR2/GPR43 and FFAR3/GPR41) has not been identified on airway smooth muscle (ASM). Classically, acute activation of G_i-coupled receptors inhibits cyclic AMP (cAMP) synthesis, which impairs ASM relaxation and can also induce crosstalk between G_i- and G_q-signaling pathways, potentiating increases in intracellular Ca²⁺ concentration ([Ca²⁺]_i), favoring ASM contraction. In contrast, chronic activation of G_i-coupled receptors can sensitize adenylyl cyclase resulting in increased cAMP synthesis favoring relaxation. We questioned whether the G_i-coupled FFAR2 or FFAR3 is expressed in human ASM, whether they modulate cAMP and [Ca²⁺]_i, and whether SCFAs modulate human ASM tone. We detected the protein expression of FFAR3 but not FFAR2 in native human ASM and primary cultured human airway smooth muscle (HASM) cells. In HASM cells, acute activation of FFAR3 with SCFAs inhibited forskolin-stimulated cAMP accumulation, but chronic activation did not sensitize cAMP synthesis. SCFAs induced [Ca²⁺]_i increases that were attenuated by pertussis toxin, gallein, U73122, or xestospongin C. Acute treatment with SCFAs potentiated acetylcholine-stimulated [Ca²⁺]_i increases and stress fiber formation in cells and contraction of ex vivo human airway tissues. In contrast, chronic pretreatment of human ASM with propionate did not potentiate airway relaxation. Together, these findings demonstrate that FFAR3 is expressed in human ASM and contributes to ASM contraction via reduced cAMP and increased [Ca²⁺]_i.

Update in Pediatric Asthma: Selected Issues

Asthma is a complex condition that affects 14% of the world's children and the approach to management includes both pharmacologic as well as non-pharmacologic strategies including attention to complex socioeconomic status phenomena. After an historical consideration of asthma, allergic and immunologic aspects of asthma in children and adolescents are presented. Concepts of socioeconomic aspects of asthma are considered along with environmental features and complications of asthma disparities. Also reviewed are links of asthma with mental health disorders, sleep disturbances and other comorbidities. A stepwise approach to asthma management is discussed that includes pharmacologic and non-pharmacologic strategies in the pediatric population. The role of immunotherapy and use of various immunomodulators are considered as well.

Ambulatory Management of Childhood Asthma Using a Novel Self-management Application

BACKGROUND AND OBJECTIVES

Pediatric ambulatory asthma control is suboptimal, reducing quality of life (QoL) and causing emergency department (ED) and hospital admissions. We assessed the impact of the electronic-AsthmaTracker (e-AT), a self-monitoring application for children with asthma.

METHODS

Prospective cohort study with matched controls. Participants were enrolled January 2014 to December 2015 in 11 pediatric clinics for weekly e-AT use for 1 year. Analyses included: (1) longitudinal changes for the child (QoL, asthma control, and interrupted and missed school days) and parents (interrupted and missed work days and satisfaction), (2) comparing ED and hospital admissions and oral corticosteroid (OCS) use pre- and postintervention, and (3) comparing ED and hospital admissions and OCS use between e-AT users and matched controls.

RESULTS

A total of 327 children and parents enrolled; e-AT adherence at 12 months was 65%. Compared with baseline, participants had significantly (P < .001) increased QoL, asthma control, and reduced interrupted and missed school and work days at all assessment times. Compared with 1 year preintervention, they had reduced ED and hospital admissions (rate ratio [RR]: 0.68; 95% confidence interval [CI]: 0.49-0.95) and OCS use (RR: 0.74; 95% CI: 0.61-0.91). Parent satisfaction remained high. Compared with matched controls, participants had reduced ED and hospital admissions (RR: 0.41; 95% CI: 0.22-0.75) and OCS use (RR: 0.65; 95% CI: 0.46-0.93).

CONCLUSIONS

e-AT use led to high and sustained participation in self-monitoring and improved asthma outcomes. Dissemination of this care model has potential to broadly improve pediatric ambulatory asthma care.

Up-regulation of Rac1 in the bronchial smooth muscle of murine experimental asthma

There has been considerable research on the involvement of RhoA/Rho kinase signalling in smooth muscle contractions. However, only a few reports have addressed the specific role of Rac1, which is a member of the Rho GTPase superfamily. Therefore, this study investigated the role of Rac1-related pathways in bronchial smooth muscle (BSM) contractions. Bronchial rings isolated from mice were suspended in an organ bath, and the isometric contractions of circular smooth muscles were monitored. The phosphorylation of myosin light chains (MLCs) was analysed by immunoblotting. The Rac1 inhibitor EHT1864 inhibited carbachol (CCh)-induced BSM contractions, although high K⁺ depolarization-induced BSM contractions were not significantly attenuated by EHT1864. Moreover, high K⁺ - and phorbol 12,13-dibutyrate (PDBu; PKC activator)-induced contractions were not attenuated by Rac1 inhibition, whereas sodium fluoride (NaF)-induced force development was inhibited by EHT1864. The gene and protein expression of Rac1 was increased in the BSM of a murine model with antigen-induced airway hyper-responsiveness (AHR). In addition, an increased force of the BSM contractions in AHR was suppressed by EHT1864 treatment, suggesting that the up-regulation of Rac1 is involved in AHR. These findings suggest that an increase in Rac1-mediated signalling is involved in the augmented contractions of BSMs in antigen-induced AHR mice.

School and Community-based Nurse-led Asthma Interventions for School-aged Children and Their Parents: A Systematic Literature Review

PROBLEM

Asthma is one of the most prevalent chronic diseases in the world. Lack of asthma knowledge can lead to asthma exacerbations, more emergency room visits, school absences, and decreased quality of life. This systematic review examines the effectiveness of educational intervention programs on asthma management for school-aged children and their parents beyond inpatient clinic settings.

ELIGIBILITY CRITERIA

Educational asthma interventions for school-aged children and their parents with comparison with usual asthma care and the outcome related to asthma management. Studies included were peer-reviewed and published in English within the last five years.

SAMPLE

The eight study articles were identified in ProQuest, Medline, CINAHL, and PubMed databases.

RESULTS

The review demonstrated that educational asthma interventions for children and their parents significantly improved knowledge and skills related to asthma self-management.

CONCLUSIONS

School and community-based asthma educational intervention programs are key components for good management of asthma condition. Well-planned asthma education programs are valuable and should go beyond inpatient clinic settings for promoting and maintaining health for children with asthma and their parents.

IMPLICATIONS

School nurses are well-positioned to assume a more prominent role in asthma care to improve child health and academic outcomes. School nurses have an opportunity to establish a trusting relationship that is foundational for collaborating with parents and students for better asthma management.

Can interactive parental education impact health care utilization in pediatric asthma: A study in rural Texas

Objective It is well known that parent/patient education helps to reduce the burden of asthma in urban areas, but data are scarce for rural areas. This study explored the impact of asthma education in Ector County, a rural part of Health Services Region 9 in Texas, which has one of the highest prevalence rates of asthma in the state. Methods This prospective study investigated an interactive asthma education intervention in pediatric patients aged 2-18 years and their caregivers. Change in parental/caregiver knowledge about their child's asthma along with frequency of missed school days, emergency department (ED) visits and hospital admissions was obtained via telephone surveys before and after the educational intervention was delivered. Results The study enrolled 102 pediatric patients and their parents/caregivers. Asthma education was associated with significantly fewer school absences, ED visits and hospitalizations. Parents/caregivers reported feeling better educated, knowing what triggers an asthma exacerbation, identifying the signs of a severe asthma attack in their child, feeling confident about managing asthma and feeling that the asthma was under control. Conclusion Asthma education of caregivers and children was associated with better symptom management and fewer acute exacerbations, pointing to the relevance and importance of asthma education among pediatric patients in rural areas.

Prevalence and Associated Risk Factors of Bronchial Asthma in Children in Santo Domingo, Dominican Republic

Background

Bronchial asthma is an important health problem worldwide. There is insufficient data on the prevalence of bronchial asthma among school children in Santo Domingo, Dominican Republic.

Objective

The objective of this study is to assess the prevalence of asthma and its related risk factors among school children in Santo Domingo, Dominican Republic.

Materials and methods

A cross-sectional study using a modified questionnaire was conducted in Santo Domingo among 600 children aged three to 11 eleven years. The prevalence of asthma and its associated risk factors such as birth order, family history of asthma, family history of allergy, exposure to pets at home, exposure to tobacco smoke, and source of fuel used at home were collected. The relevant data collected was analyzed using the Statistical Package for the Social Sciences (SPSS) 24.0. (IBM Corp., Armonk, NY) software.

Results

The prevalence of asthma was found to be 22.0%. Age, family history of asthma, family history of allergy, exposure to tobacco smoke, and birth order showed statistical significance. The source of fuel used at home, gender, and exposure to pets were not statistically significant to be considered as risk factors associated with asthma in the population studied.

Conclusion

With an asthma prevalence of 22.0% in the pediatric population, the Dominican Republic has one of the highest national rates of asthma in the pediatric population in Latin America. Proper education, screening, and prevention can help lower the burden of this disease economically and socially.

Effectiveness of school-based family asthma educational programs in quality of life and asthma exacerbations in asthmatic children aged five to 18: a systematic review

BACKGROUND

Asthma is a common, chronic, non-communicable respiratory disease that affects millions of children worldwide. Asthma exacerbations can range from mild to severe and can have an unfavorable impact on the quality of life of children and their caregivers. Asthma exacerbations often result in absenteeism from school or work, activity intolerance and emergency hospital visits. One strategy to address this health issue in an attempt to improve health outcomes is school-based asthma educational programs. A review of the literature revealed that previous systematic reviews have examined similar topics on the effectiveness of school-based asthma educational programs that have included collaborative efforts between parents and schools. No systematic reviews were found that examined the effectiveness of school-based asthma educational programs that exclusively included children and their caregivers. Research has not been systematically reviewed to determine the effectiveness of a school-based asthma educational program within a familial context.

OBJECTIVES

To identify the best available evidence on the effectiveness of school-based family asthma educational programs that exclusively included both children and caregivers on the quality of life and number of asthma exacerbations of children aged five to 18 years with a clinical diagnosis of asthma.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

Children aged five to 18 years of any gender, race or ethnicity with a clinical diagnosis of asthma and their caregivers.

TYPES OF INTERVENTION(S)

School-based family asthma educational programs.

TYPES OF STUDIES

Randomized controlled trials.

OUTCOMES

Quality of life and the number of asthma exacerbations measured by either missed days from school or work, and/or physical activity intolerance, and/or emergency hospital visits.

SEARCH STRATEGY

The search strategy aimed to find both published and unpublished studies from inception of the database to August 21, 2015.

METHODOLOGICAL QUALITY

Quantitative papers selected for retrieval were assessed by two independent reviewers for methodological validity before inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute.

DATA EXTRACTION

Data were extracted from articles included in the review using the standardized data extraction tool from the Joanna Briggs Institute. The data extracted included specific details about the populations, interventions, study methods and outcomes of significance to the review question and its specific objectives.

DATA SYNTHESIS

Due to the heterogeneity among the included studies, statistical pooling and meta-analysis was not possible. Results are presented in narrative form.

RESULTS

Six studies examining the intervention were included in this review. All six of the included studies were randomized controlled trials (RCTs). All six studies compared the effects of school-based asthma education to no school-based asthma education/usual care on quality of life and number of asthma exacerbations. Three out of four RCTs showed that children who participated in school-based family asthma educational programs demonstrated a statistically significant improvement in overall quality of life (P < 0.05). All six studies showed improvement in the number of asthma exacerbations that resulted in one or all of the measured outcomes of either missed days from school or work, physical activity intolerance and/or decreased emergency hospital visits.

CONCLUSION

School-based family asthma educational programs for children that include caregivers can have a positive impact on the quality of life and asthma management of children with asthma. Other outcomes that can be positively affected by school-based family asthma educational programs include absenteeism from school or work, physical activity intolerance and emergency hospital visits as result of asthma exacerbations.

How Do Student Prior Achievement and Homework Behaviors Relate to Perceived Parental Involvement in Homework?

This study investigated how students' prior achievement is related to their homework behaviors (i.e., time spent on homework, homework time management, and amount of homework), and to their perceptions of parental involvement in homework (i.e., parental control and parental support). A total of 1250 secondary students from 7 to 10th grade participated in the study. Structural equation models were fitted to the data, compared, and a partial mediation model was chosen. The results indicated that students' prior academic performance was significantly associated with both of the students' homework variables, with direct and indirect results linking achievement and homework behaviors with perceived parental control and support behaviors about homework. Low-achieving students, in particular, perceived more parental control of homework in the secondary grades. These results, together with those of previous research, suggest a recursive relationship between secondary school students' achievement and their perceptions of parental involvement in homework, which represents the process of student learning and family engagement over time. Study limitations and educational implications are discussed.

Asthma heterogeneity and severity

Asthma is a common, chronic inflammatory airways disease characterized by a clinical syndrome of bronchial hyperresponsiveness, inflammation, and reversible airflow obstruction. Individuals with asthma can vary widely in clinical presentation, severity, and pathobiology. The incident factors, pathogenesis, prognosis, and treatment of asthma remain incompletely understood. Utilizing measurable characteristics of asthmatic patients, including demographic, physiologic, and biologic markers, can however identify meaningful phenotypic categories in asthma. Identification of these phenotypes may help improve precision therapeutics targeted toward an individual’s’ disease, and may identify strategies for preventing progression of disease severity.