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Nayak SS, Borkar R, Ghozy S, Agyeman K, Al-Juboori MT, Shah J, Ulrich MT. Social vulnerability, medical care access and asthma related emergency department visits and hospitalization: An observational study. Heart Lung 2022; 55:140-145. [PMID: 35588567 DOI: 10.1016/j.hrtlng.2022.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/22/2022] [Accepted: 04/27/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Social Vulnerability Index (SVI) is a publicly available dataset to identify communities in greatest need of resources. OBJECTIVE To examine the utility of using the county-level SVI as predictors of asthma-related outcomes. METHODS We used the American Community Survey-derived SVI and the National Environmental Public Health Tracking Network - Query Tool to retrieve data for all counties with available SVI data and at least one matched outcome of interest. Then, we tested SVI as a predictor for emergency department visits (EDV) and hospitalizations, with investigating disparities in primary care physician (PCP) density and emergency department physicians (EDP) density. Linear and logistic regression models were used. RESULTS Compared to counties of the lowest SVI quartile, counties of mid-low, mid-high, and highest SVI quartiles had 1%, 4%, and 5% higher odds of asthma-related EDV per 10,000 population, respectively, and 4%, 21%, and 24% higher odds of asthma-related hospitalization per 10,000 population, respectively. Moreover, the data showed an apparent resources mismatch between the EDP densities per 10,000 populations and the SVI quartiles, and the effect of the county level SVI on the asthma-related EDV and hospitalization is not strongly affected by PCP or EDP densities. CONCLUSION The counties with the highest SVI -and the most vulnerable to asthma hazards- have a lower coverage of PCP and EDP. Interventions directed to address persistent social vulnerability would offer the opportunity of primary prevention with less exhaustion for the medical resources.
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Affiliation(s)
- Sandeep S Nayak
- Department of Internal Medicine, NYC Health + Hospitals/Metropolitan, NY 10029, USA; Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, CT 06610, USA.
| | - Rachana Borkar
- Department of Internal Medicine, NYC Health + Hospitals/Metropolitan, NY 10029, USA.
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; Nuffield Department of Primary Care Health Sciences and Department for Continuing Education (EBHC program), Oxford University, UK.
| | - Kwame Agyeman
- Department of Internal Medicine, Loma Linda University Medical Center, CA 92354, USA.
| | - Mohammed T Al-Juboori
- Department of Internal Medicine, NYC Health + Hospitals/Metropolitan, NY 10029, USA.
| | - Jaffer Shah
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
| | - Michael T Ulrich
- Department of Internal Medicine, Loma Linda University Medical Center, CA 92354, USA; Department of Internal Medicine, Riverside University Health System, CA 92555, USA.
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Mitchell RJ, McMaugh A, Herkes G, Homaira N, Hng T, Cameron CM, Lystad RP. Hospital service use for young people with chronic health conditions: A population-based matched retrospective cohort study. J Paediatr Child Health 2022; 58:1439-1446. [PMID: 35638474 PMCID: PMC9545431 DOI: 10.1111/jpc.16028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/11/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022]
Abstract
AIM This study aims to identify the hospitalised morbidity associated with three common chronic health conditions among young people using a population-based matched cohort. METHODS A population-level matched case-comparison retrospective cohort study of young people aged ≤18 years hospitalised with asthma, type 1 diabetes (T1D) or epilepsy during 2005-2018 in New South Wales, Australia using linked birth, health and mortality records. The comparison cohort was matched on age, sex and residential postcode. Adjusted rate ratios (ARR) were calculated by sex and age group. RESULTS There were 65 055 young people hospitalised with asthma, 6648 with epilepsy, and 2209 with T1D. Young people with epilepsy (ARR 10.95; 95% confidence interval (CI) 9.98-12.02), T1D (ARR 8.64; 95% CI 7.72-9.67) or asthma (ARR 4.39; 95% CI 4.26-4.53) all had a higher risk of hospitalisation than matched peers. Admission risk was highest for males (ARR 11.00; 95% CI 9.64-12.56) and females with epilepsy (ARR 10.83; 95% CI 9.54-12.29) compared to peers. The highest admission risk by age group was for young people aged 10-14 years (ARR 5.50; 95% CI 4.77-6.34) living with asthma, children aged ≤4 years (ARR 12.68; 95% CI 11.35-14.17) for those living with epilepsy, and children aged 5-9 years (ARR 9.12; 95% CI 7.69-10.81) for those living with T1D compared to peers. CONCLUSIONS The results will guide health service planning and highlight opportunities for better management of chronic health conditions, such as further care integration between acute, primary and community health services for young people.
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Affiliation(s)
- Rebecca J Mitchell
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Anne McMaugh
- The Macquarie School of EducationMacquarie UniversitySydneyNew South WalesAustralia
| | - Geoffrey Herkes
- Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia,Department of NeurologyRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Nusrat Homaira
- School of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia,Respiratory DepartmentSydney Children's HospitalSydneyNew South WalesAustralia
| | - Tien‐Ming Hng
- Department of Diabetes and EndocrinologyBlacktown and Mount Druitt HospitalSydneyNew South WalesAustralia,School of MedicineWestern Sydney UniversitySydneyNew South WalesAustralia
| | - Cate M Cameron
- Jamieson Trauma InstituteRoyal Brisbane & Women's Hospital, Metro North HealthBrisbaneQueenslandAustralia,Queensland University of Technology (QUT), Centre for Healthcare TransformationAustralian Centre for Health Services Innovation (AusHSI)BrisbaneQueenslandAustralia
| | - Reidar P Lystad
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
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3
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Mitchell RJ, McMaugh A, Homaira N, Lystad RP, Badgery-Parker T, Cameron CM. The impact of childhood asthma on academic performance: A matched population-based cohort study. Clin Exp Allergy 2021; 52:286-296. [PMID: 34564913 DOI: 10.1111/cea.14022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/25/2021] [Accepted: 09/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is inconclusive evidence of the effect of asthma on the academic performance of young people. This study aims to compare scholastic performance and high school completion of young people hospitalized with asthma compared to matched peers not hospitalized with asthma. METHOD A population-based matched case-comparison cohort study of young people aged ≤18 years hospitalized for asthma during 2005-2018 in New South Wales, Australia using linked birth, health, education and mortality records. The comparison cohort was matched on age, gender and residential postcode. Generalized linear mixed-modelling examined risk of school performance below the national minimum standard (NMS) and generalized linear regression examined risk of not completing high school for young people hospitalized with asthma compared to matched peers. RESULTS Young males hospitalized with asthma had a 13% and 15% higher risk of not achieving the NMS for numeracy (95%CI 1.04-1.22) and reading (95%CI 1.07-1.23), respectively, compared to peers. Young males hospitalized with asthma had a 51% (95%CI 1.22-1.86) higher risk of not completing year 10, and around a 20% higher risk of not completing year 11 (ARR: 1.25; 95%CI 1.15-1.36) or year 12 (ARR: 1.27; 95%CI 1.17-1.39) compared to peers. Young females hospitalized with asthma showed no difference in achieving numeracy or reading NMSs, but did have a 21% higher risk of not completing year 11 (95%CI 1.09-1.36) and a 33% higher risk of not completing year 12 (95%CI 1.19-1.49) compared to peers. CONCLUSIONS Educational attainment is worse for young people hospitalized with asthma compared to matched peers. Early intervention and strategies for better management of asthma symptoms may enhance academic performance for students.
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Affiliation(s)
- Rebecca J Mitchell
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Anne McMaugh
- The Macquarie School of Education, Macquarie University, Sydney, New South Wales, Australia
| | - Nusrat Homaira
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Reidar P Lystad
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Tim Badgery-Parker
- Faculty of Medicine, Health and Human Sciences, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Cate M Cameron
- Jamieson Trauma Institute, Royal Brisbane & Women's Hospital, Metro North Hospital and Health Services District, Brisbane, Queensland, Australia.,Centre for Healthcare Transformation, Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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4
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Pound CM, Knight BD, Webster R, Benchimol EI, Radhakrishnan D. Predictors of Hospitalization for Children With Croup, a Population-Based Cohort Study. Hosp Pediatr 2020; 10:1068-1077. [PMID: 33203748 DOI: 10.1542/hpeds.2020-001362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES We sought to determine predictors of hospitalization for children presenting with croup to emergency departments (EDs), as well as predictors of repeat ED presentation and of hospital readmissions within 18 months of index admission. We also aimed to develop a practical tool to predict hospitalization risk upon ED presentation. METHODS Multiple deterministically linked health administrative data sets from Ontario, Canada, were used to conduct this population-based cohort study between April 1, 2006 and March 31, 2017. Children born between April 1, 2006, and March 31, 2011, were eligible if they had 1 ED visit with a croup diagnosis. Multivariable logistic regression was used to determine factors associated with hospitalization, subsequent ED visits, and subsequent croup hospitalizations. A multivariable prediction tool and associated scoring system were created to predict hospitalization risk within 7 days of ED presentation. RESULTS Overall, 1811 (3.3%) of the 54 981 eligible children who presented to an Ontario ED were hospitalized. Significant hospitalization predictors included age, sex, Canadian Triage and Acuity Scale score, gestational age at birth, and newborn distress. Younger patients and boys were more likely to revisit the ED for croup. Our multivariable prediction tool could forecast hospitalization up to a 32% probability for a given patient. CONCLUSIONS This study is the first population-based study in which predictors of hospitalization for croup based on demographic and historical factors are identified. Our prediction tool emphasized the importance of symptom severity on ED presentation but will require refinement before clinical implementation.
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Affiliation(s)
- Catherine M Pound
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada;
- Divisions of Pediatrics
- Department of Pediatrics and
| | - Braden D Knight
- ICES uOttawa, Ottawa, Canada
- Clinical Research Unit
- Ontario Child Health Support Unit, Ontario, Canada; and
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Richard Webster
- Clinical Research Unit
- Ontario Child Health Support Unit, Ontario, Canada; and
| | - Eric I Benchimol
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Department of Pediatrics and
- ICES uOttawa, Ottawa, Canada
- Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Dhenuka Radhakrishnan
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- Department of Pediatrics and
- ICES uOttawa, Ottawa, Canada
- Respirology, and
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Regional Variation of Hospitalization Rates for Asthma in Korea: Association with Ambient Carbon Monoxide and Health Care Supply. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041244. [PMID: 32075169 PMCID: PMC7068567 DOI: 10.3390/ijerph17041244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/03/2020] [Accepted: 02/11/2020] [Indexed: 11/16/2022]
Abstract
This study was performed to investigate the relationship between the hospitalization rate for asthma and the ambient carbon monoxide (CO) by examining regional variation of the hospitalization rates for asthma in Korea and its factors. The hospital inpatient claims for asthma were acquired from the National Health Insurance database in 2015. A multivariate linear regression was performed with the hospitalization rate for asthma as a dependent variable. The annual ambient concentration of CO showed a negative association with the hospitalization rates for asthma while that of sulfur dioxide showed a positive association. The number of primary care physicians showed a negative association with the hospitalization rates for asthma while the number of beds in hospitals with less than 300 beds showed a positive association. The negative association of the ambient concentration of CO with the hospitalization rates for asthma showed results upon further investigation.
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Lim CAE, Oh J, Eiting E, Coughlin C, Calderon Y, Barnett B. Development of a combined paediatric emergency department and observation unit. BMJ Open Qual 2020. [PMCID: PMC7011886 DOI: 10.1136/bmjoq-2019-000688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Recent trends towards more cost-efficient and patient-centred treatment are converging to provide opportunities to improve the care of children. Observation units are hospital areas dedicated to the ongoing evaluation and management of patients for a brief period of time for well-defined conditions. We describe the implementation of a paediatric observation unit (POU) adjacent to a paediatric emergency department (PED) in an urban, academic, community hospital. Methods Staffing models were designed to provide paediatric services to patients in both the PED and POU. Admission criteria, workflow and transfer guidelines were developed. Quality improvement initiatives were undertaken and evaluated. Unit throughput, patient outcomes and patient satisfaction data were collected and analysed. Results Over a 2-year period, there were 24 038 patient visits to the PED. Of these, 1215 (5.1%) patients required admission. Seven hundred and seventy-seven (64.0%) of these children were admitted to the POU. One hundred and nineteen (15.3%) of these patients were subsequently converted to inpatient hospitalisation. The average length of stay (LOS) was 25.7 hours in 2017 and 26.5 hours in 2018. Ten patients returned to the PED within 72 hours of discharge from the POU and four were readmitted. Patient satisfaction scores regarding ‘likelihood to recommend’ improved from the 36th to the 92nd percentile rank over a 1-year period. Close monitoring of patient outcomes allowed for the adjustment of admission guidelines, increased unit census and optimised utilisation. Conclusion A combined PED-POU has been successful at our institution in meeting benchmark goals set for LOS and conversion rates. In addition, quality improvement interventions increased patient census and improved patient satisfaction scores while reducing the inpatient burden on the referring children’s hospital.
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Affiliation(s)
- Czer Anthoney Enriquez Lim
- Department of Emergency Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Pediatrics, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julie Oh
- Department of Emergency Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Pediatrics, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erick Eiting
- Department of Emergency Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Catherine Coughlin
- Department of Emergency Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yvette Calderon
- Department of Emergency Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Barbara Barnett
- Department of Emergency Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Azmeh R, Greydanus DE, Agana MG, Dickson CA, Patel DR, Ischander MM, Lloyd RD. Update in Pediatric Asthma: Selected Issues. Dis Mon 2019; 66:100886. [PMID: 31570159 DOI: 10.1016/j.disamonth.2019.100886] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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.
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Affiliation(s)
- Roua Azmeh
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Marisha G Agana
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Cheryl A Dickson
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States; Health Equity and Community Affairs, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, United States
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Mariam M Ischander
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Robert D Lloyd
- Pacific Northwest University of Health Sciences College of Osteopathic Medicine, Yakima, Washington, United States
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Dionne A, Bucholz EM, Gauvreau K, Gould P, Son MBF, Baker AL, de Ferranti SD, Fulton DR, Friedman KG, Newburger JW. Impact of Socioeconomic Status on Outcomes of Patients with Kawasaki Disease. J Pediatr 2019; 212:87-92. [PMID: 31229318 DOI: 10.1016/j.jpeds.2019.05.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the association of neighborhood socioeconomic status (SES) with time to intravenous immunoglobulin treatment, length of stay (LOS), and coronary artery aneurysms (CAAs) in patients with Kawasaki disease. STUDY DESIGN We examined the relationship of SES in 915 patients treated at a large academic center between 2000 and 2017. Neighborhood SES was measured using a US census-based score derived from 6 measures related to income, education, and occupation. Linear and logistic regression were used to examine the association of SES with number of days of fever at time of treatment, LOS, and CAA. RESULTS Patients in the lowest SES quartile were treated later than patients with greater SES (7 [IQR 5, 9] vs 6 [IQR 5, 8] days, P = .01). Patients in the lowest SES quartile were more likely to be treated after 10 days of illness, with an OR 1.9 (95% CI 1.3-2.8). In multivariable analysis, SES remained an independent predictor of the number of days of fever at time of treatment (P = .01). Patients in the lowest SES quartile had longer LOS than patients with greater SES (3 [IQR 2, 5] vs 3 [IQR 2, 4], P = .007). In subgroup analysis of white children, those in the lowest SES quartile vs quartiles 2-4 were more likely to develop large/giant CAA 17 (12%) vs 30 (6%), P = .03. CONCLUSIONS Lower SES is associated with delayed treatment, prolonged LOS, and increased risk of large/giant CAA. Novel approaches to diagnosis and education are needed for children living in low-SES neighborhoods.
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Affiliation(s)
- Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Emily M Bucholz
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Patrick Gould
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Mary Beth F Son
- Department of Pediatrics, Harvard Medical School, Boston, MA; Division of Immunology, Boston Children's Hospital, Boston, MA
| | - Annette L Baker
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Sarah D de Ferranti
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - David R Fulton
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kevin G Friedman
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
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Irani F, Barbone JM, Beausoleil J, Gerald L. Is asthma associated with cognitive impairments? A meta-analytic review. J Clin Exp Neuropsychol 2017; 39:965-978. [PMID: 28325118 DOI: 10.1080/13803395.2017.1288802] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Asthma is a chronic disease with significant health burden and socioeconomic and racial/ethnic disparities related to diagnosis and treatment. Asthma primarily affects the lungs, but can impact brain function through direct and indirect mechanisms. Some studies have suggested that asthma negatively impacts cognition, while others have failed to identify asthma-related cognitive compromise. We aimed to conduct a meta-analysis of cognition in individuals with asthma compared to that in healthy controls. We also examined the impact of some key potential moderators. METHOD Data on cognitive outcome measures and sociodemographic, illness-related, and study-related variables were extracted from studies reporting cognitive test performance in individuals with asthma compared to that in controls. RESULTS There was no evidence of publication bias. A random-effects model examining differences in task performance between 2017 individuals with asthma and 2131 healthy controls showed significant effects in the small to medium range. Cognitive deficits associated with asthma were global, with strongest effects on broader measures involving academic achievement and executive functioning, but with additional impact on processing speed, global intellect, attention, visuospatial functioning, language, learning, and memory. Severity of asthma was a key moderator, with greatest cognitive deficits associated with severe asthma. Cognitive burden was also greatest in asthma patients who were younger, males, from low socioeconomic backgrounds, and from racial/ethnic minorities. Effects were independent of type of population (child versus adult), type of study (norm-referenced versus control-referenced), or reported use of oral or inhaled corticosteroid medications. CONCLUSIONS There is cognitive burden associated with asthma, particularly among vulnerable groups with severe asthma. This could be due to increased risk of intermittent cerebral hypoxia in severe asthma. The clinical need to assess cognition in individuals with asthma is underscored.
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Affiliation(s)
- Farzin Irani
- a Department of Psychology , West Chester University of Pennsylvania , West Chester , PA , USA
| | - Jordan Mark Barbone
- a Department of Psychology , West Chester University of Pennsylvania , West Chester , PA , USA
| | - Janet Beausoleil
- b Division of Allergy and Immunology , The Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - Lynn Gerald
- c Mel and Enid Zuckerman College of Public Health , University of Arizona , Tucson , AZ , USA.,d Asthma and Airways Disease Research Center , University of Arizona , Tucson , AZ , USA
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Ronis SD, McConnochie KM, Wang H, Wood NE. Urban Telemedicine Enables Equity in Access to Acute Illness Care. Telemed J E Health 2017; 23:105-112. [DOI: 10.1089/tmj.2016.0098] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sarah D. Ronis
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Case Western Reserve University School of Medicine, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | | | - Hongyue Wang
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
| | - Nancy E. Wood
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
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11
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A scoping review of female disadvantage in health care use among very young children of immigrant families. Soc Sci Med 2016; 152:50-60. [PMID: 26840770 DOI: 10.1016/j.socscimed.2016.01.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/05/2015] [Accepted: 01/18/2016] [Indexed: 11/21/2022]
Abstract
Preference for sons culminates in higher mortality and inadequate immunizations and health care visits for girls compared to boys in several countries. It is unknown if the negative consequences of son-preference persist among those who immigrate to Western, high-income countries. To review the literature regarding gender inequities in health care use among children of parents who migrate to Western, high-income countries, we completed a scoping literature review using Medline, Embase, PsycINFO and Scopus databases. We identified studies reporting gender-specific health care use by children aged 5 years and younger whose parents had migrated to a Western country. Two independent reviewers conducted data extraction and a quality assessment tool was applied to each included study. We retrieved 1547 titles, of which 103 were reviewed in detail and 12 met our inclusion criteria. Studies originated from the United States and Europe, using cross-sectional or registry-based designs. Five studies examined gender differences in health care use within immigrant groups, and only one study explored the female health disadvantage hypothesis. No consistent gender differences were observed for routine primary care visits however immunizations and prescriptions were elevated for boys. Greater use of acute health services, namely emergency department visits and hospitalizations, was observed for boys over girls in several studies. Studies did not formally complete gender-based analyses or assess for acculturation factors. Health care use among children in immigrant families may differ between boys and girls, but the reasons for why this is so are largely unexplored. Further gender-based research with attention paid to the diversity of immigrant populations may help health care providers identify children with unmet health care needs.
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12
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Vasbinder EC, Belitser SV, Souverein PC, van Dijk L, Vulto AG, van den Bemt PMLA. Non-adherence to inhaled corticosteroids and the risk of asthma exacerbations in children. Patient Prefer Adherence 2016; 10:531-8. [PMID: 27110103 PMCID: PMC4835125 DOI: 10.2147/ppa.s92824] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Non-adherence to inhaled corticosteroids (ICSs) is a major risk factor for poor asthma control in children. However, little is known about the effect of adherence to ICS on the incidence of asthma exacerbations. The objective of this study was to examine the effect of poor adherence to ICS on the risk of exacerbations in children with asthma. METHODS In this nested case-control study using data from the Dutch PHARMO Record Linkage System, children aged 5-12 years who had an asthma exacerbation needing oral corticosteroids or hospital admission were matched to patients without exacerbations. Refill adherence was calculated as medication possession ratio from ICS-dispensing records. Data were analyzed using a multivariable multiplicative intensity regression model. RESULTS A total of 646 children were included, of whom 36 had one or more asthma exacerbations. The medication possession ratio was 67.9% (standard deviation [SD] 30.2%) in children with an exacerbation versus 54.2% (SD 35.6%) in the control group. In children using long-acting beta-agonist, good adherence to ICS was associated with a higher risk of asthma exacerbations: relative risk 4.34 (95% confidence interval: 1.20-15.64). CONCLUSION In children with persistent asthma needing long-acting beta-agonist, good adherence to ICS was associated with an increased risk of asthma exacerbations. Possible explanations include better motivation for adherence to ICS in children with more severe asthma, and reduced susceptibility to the consequences of non-adherence to ICS due to overprescription of ICS to children who are in clinical remission. Further study into the background of the complex interaction between asthma and medication adherence is needed.
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Affiliation(s)
- Erwin C Vasbinder
- Erasmus University Medical Center, Department of Hospital Pharmacy, Rotterdam, the Netherlands
| | - Svetlana V Belitser
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands
| | | | - Arnold G Vulto
- Erasmus University Medical Center, Department of Hospital Pharmacy, Rotterdam, the Netherlands
| | - Patricia MLA van den Bemt
- Erasmus University Medical Center, Department of Hospital Pharmacy, Rotterdam, the Netherlands
- Correspondence: Patricia MLA van den Bemt, Erasmus University Medical Center, Department of Hospital Pharmacy, Nc-212, PO Box 2040, 3000 CA Rotterdam, the Netherlands, Tel +31 10 703 3202, Fax +31 10 703 2400, Email
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13
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Kaiser SV, Bakel LA, Okumura MJ, Auerbach AD, Rosenthal J, Cabana MD. Risk Factors for Prolonged Length of Stay or Complications During Pediatric Respiratory Hospitalizations. Hosp Pediatr 2015; 5:461-73. [PMID: 26330245 DOI: 10.1542/hpeds.2014-0246] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Respiratory illnesses are the leading cause of pediatric hospitalizations in the United States, and a major focus of efforts to improve quality of care. Understanding factors associated with poor outcomes will allow better targeting of interventions for improving care. The objective of this study was to identify patient and hospital factors associated with prolonged length of stay (LOS) or complications during pediatric hospitalizations for asthma or lower respiratory infection (LRI). METHODS Cross-sectional study of hospitalizations of patients <18 years with asthma or LRI (bronchiolitis, influenza, or pneumonia) by using the nationally representative 2012 Kids Inpatient Database. We used multivariable logistic regression models to identify factors associated with prolonged LOS (>90th percentile) or complications (noninvasive ventilation, mechanical ventilation, or death). RESULTS For asthma hospitalizations(n = 85 320), risks for both prolonged LOS and complications were increased with each year of age (adjusted odds ratio [AOR] 1.06, 95% confidence interval [CI] 1.05-1.07; AOR 1.05, 95% CI 1.03-1.07, respectively for each outcome) and in children with chronic conditions (AOR 4.87, 95% CI 4.15-5.70; AOR 21.20, 95% CI 15.20-29.57, respectively). For LRI hospitalizations (n = 204 950), risks for prolonged LOS and complications were decreased with each year of age (AOR 0.98, 95% CI 0.97-0.98; AOR 0.95, 95% CI 0.94-0.96, respectively) and increased in children with chronic conditions (AOR 9.86, 95% CI 9.03-10.76; AOR 56.22, 95% CI 46.60-67.82, respectively). Risks for prolonged LOS for asthma were increased in large hospitals (AOR 1.67, 95% CI 1.32-2.11) and urban-teaching hospitals (AOR 1.62, 95% CI 1.33-1.97). CONCLUSIONS Older children with asthma, younger children with LRI, children with chronic conditions, and those hospitalized in large urban-teaching hospitals are more vulnerable to prolonged LOS and complications. Future research and policy efforts should evaluate and support interventions to improve outcomes for these high-risk groups (eg, hospital-based care coordination for children with chronic conditions).
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Affiliation(s)
| | - Leigh-Anne Bakel
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | - Michael D Cabana
- Departments of Pediatrics, Epidemiology and Biostatistics, and Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California; and
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Spencer NJ, Blackburn CM, Read JM. Disabling chronic conditions in childhood and socioeconomic disadvantage: a systematic review and meta-analyses of observational studies. BMJ Open 2015; 5:e007062. [PMID: 26338834 PMCID: PMC4563224 DOI: 10.1136/bmjopen-2014-007062] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 07/23/2015] [Accepted: 07/30/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the association of socioeconomic disadvantage with the prevalence of childhood disabling chronic conditions in high-income countries. STUDY DESIGN Systematic review and meta-analyses. DATA SOURCES 6 electronic databases, relevant websites, reference lists and experts in the field. STUDY SELECTION 160 observational studies conducted in high-income countries with data on socioeconomic status and disabling chronic conditions in childhood, published between 1 January 1991 and 31 December 2013. DATA EXTRACTION AND SYNTHESIS Abstracts were reviewed, full papers obtained, and papers identified for inclusion by 2 independent reviewers. Inclusion decisions were checked by a third reviewer. Where reported, ORs were extracted for low versus high socioeconomic status. For studies reporting raw data but not ORs, ORs were calculated. Narrative analysis was undertaken for studies without data suitable for meta-analysis. RESULTS 126 studies had data suitable for meta-analysis. ORs for risk estimates were: all-cause disabling chronic conditions 1.72 (95% CI 1.48 to 2.01); psychological disorders 1.88 (95% CI 1.68 to 2.10); intellectual disability 2.41 (95% CI 2.03 to 2.86); activity-limiting asthma 2.20 (95% CI 1.87 to 2.85); cerebral palsy 1.42 (95% CI 1.26 to 1.61); congenital abnormalities 1.41 (95% CI 1.24 to 1.61); epilepsy 1.38 (95% CI 1.20 to 1.59); sensory impairment 1.70 (95% CI 1.39 to 2.07). Heterogeneity was high across most estimates (I(2)>75%). Of the 34 studies without data suitable for meta-analysis, 26 reported results consistent with increased risk associated with low socioeconomic status. CONCLUSIONS The findings indicate that, in high-income countries, childhood disabling chronic conditions are associated with social disadvantage. Although evidence of an association is consistent across different countries, the review provides limited evidence to explain the association; future research, using longitudinal data, will be required to distinguish low socioeconomic status as the cause or consequence of childhood disabling chronic conditions and the aetiological pathways and mechanisms.
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Affiliation(s)
| | | | - Janet M Read
- Warwick Medical School, University of Warwick, Coventry, UK
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15
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Shah MN, Wasserman EB, Gillespie SM, Wood NE, Wang H, Noyes K, Nelson D, Dozier A, McConnochie KM. High-Intensity Telemedicine Decreases Emergency Department Use for Ambulatory Care Sensitive Conditions by Older Adult Senior Living Community Residents. J Am Med Dir Assoc 2015; 16:1077-81. [PMID: 26293419 DOI: 10.1016/j.jamda.2015.07.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 06/29/2015] [Accepted: 07/08/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs) are common among older adults. The high-intensity telemedicine model of care has been proposed as an innovative approach to expand access to acute illness care, thereby preventing ED visits. The aim of this study was to assess the effect of a high-intensity telemedicine program for senior living community (SLC) residents on the rate of ED use for ACSCs. METHODS We performed a prospective cohort study at a primary care geriatrics practice that provides care to 22 SLCs. Six SLCs selected as intervention facilities, with the remaining SLCs serving as controls. Consenting practice patients at intervention facilities could have patient-to-provider, real-time, or store-and-forward high-intensity telemedicine services to diagnose and treat illnesses. The primary outcome was the rate of ED visits for which the primary diagnosis was an "ambulatory-care-sensitive" condition by the Institute of Medicine, which we compared between control and intervention participants. RESULTS During the study period, control participants had 310 ED visits for ACSCs, for a rate of 0.195 visits/person-year. Intervention participants visited the ED for ACSCs 85 times, for a rate of 0.138 visits/person-year [unadjusted rate ratio (RR): 0.71, 95% confidence interval (CI): 0.53-0.94]. Among intervention participants, ED use for ACSCs decreased at an annual rate of 34% (RR: 0.661, 95% CI: 0.444-0.982), whereas, in the control group there was no statistically significant change in ED use over time (RR: 1.01, 95% CI: 0.90-1.14). CONCLUSIONS Providing acute illness care by high-intensity telemedicine to older adults residing in SLCs significantly decreases the rate of ED use for ACSCs over 1 year, compared with no change in the rate of ED use for ACSCs among the control group.
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Affiliation(s)
- Manish N Shah
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY; Division of Geriatrics and Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | - Erin B Wasserman
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Suzanne M Gillespie
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY; Division of Geriatrics and Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | - Nancy E Wood
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Hongyue Wang
- Department of Biostatistics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Katia Noyes
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Dallas Nelson
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Ann Dozier
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Kenneth M McConnochie
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
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16
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Abstract
A formal emergency care system for children in the United States began in the 1980s with the establishment of specialized training programs in academic children's hospitals. The ensuing three decades have witnessed the establishment of informal regional networks for clinical care and a federally funded research consortium that allows for multisite research on evidence-based practices. However, pediatric emergency care suffers from problems common to emergency departments (EDs) in general, which include misaligned incentives for care, overcrowding, and wide variation in the quality of care. In pediatric emergency care specifically, there are problems with low-volume EDs that have neither the experience nor the equipment to treat children, poor adherence to clinical guidelines, lack of resources for mental health patients, and a lack of widely accepted performance metrics. We call for policies to address these issues, including providing after-hours care in other settings and restructuring payment and reimbursement policies to better address patients' needs.
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17
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Pijnenburg MW, Baraldi E, Brand PLP, Carlsen KH, Eber E, Frischer T, Hedlin G, Kulkarni N, Lex C, Mäkelä MJ, Mantzouranis E, Moeller A, Pavord I, Piacentini G, Price D, Rottier BL, Saglani S, Sly PD, Szefler SJ, Tonia T, Turner S, Wooler E, Lødrup Carlsen KC. Monitoring asthma in children. Eur Respir J 2015; 45:906-25. [PMID: 25745042 DOI: 10.1183/09031936.00088814] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. To reach this goal in children with asthma, ongoing monitoring is essential. While all components of asthma, such as symptoms, lung function, bronchial hyperresponsiveness and inflammation, may exist in various combinations in different individuals, to date there is limited evidence on how to integrate these for optimal monitoring of children with asthma. The aims of this ERS Task Force were to describe the current practise and give an overview of the best available evidence on how to monitor children with asthma. 22 clinical and research experts reviewed the literature. A modified Delphi method and four Task Force meetings were used to reach a consensus. This statement summarises the literature on monitoring children with asthma. Available tools for monitoring children with asthma, such as clinical tools, lung function, bronchial responsiveness and inflammatory markers, are described as are the ways in which they may be used in children with asthma. Management-related issues, comorbidities and environmental factors are summarised. Despite considerable interest in monitoring asthma in children, for many aspects of monitoring asthma in children there is a substantial lack of evidence.
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Affiliation(s)
- Mariëlle W Pijnenburg
- Dept of Paediatrics/Paediatric Respiratory Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Eugenio Baraldi
- Women's and Children's Health Dept, Unit of Respiratory Medicine and Allergy, University of Padova, Padova, Italy
| | - Paul L P Brand
- Dept of Paediatrics/Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, The Netherlands
| | - Kai-Håkon Carlsen
- Dept of Paediatrics, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ernst Eber
- Respiratory and Allergic Disease Division, Dept of Paediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Frischer
- Dept of Paediatrics and Paediatric Surgery, Wilhelminenspital, Vienna, Austria
| | - Gunilla Hedlin
- Depart of Women's and Children's Health and Centre for Allergy Research, Karolinska Institutet and Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Neeta Kulkarni
- Leicestershire Partnership Trust and Dept of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Christiane Lex
- Dept of Paediatric Cardiology and Intensive Care Medicine, Division of Pediatric Respiratory Medicine, University Hospital Goettingen, Goettingen, Germany
| | - Mika J Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Eva Mantzouranis
- Dept of Paediatrics, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ian Pavord
- Dept of Respiratory Medicine, University of Oxford, Oxford, UK
| | - Giorgio Piacentini
- Paediatric Section, Dept of Life and Reproduction Sciences, University of Verona, Verona, Italy
| | - David Price
- Dept of Primary Care Respiratory Medicine, Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Bart L Rottier
- Dept of Pediatric Pulmonology and Allergology, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sejal Saglani
- Leukocyte Biology and Respiratory Paediatrics, National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter D Sly
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia
| | - Stanley J Szefler
- Children's Hospital Colorado and University of Colorado Denver School of Medicine, Denver, USA
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Steve Turner
- Dept of Paediatrics, University of Aberdeen, Aberdeen, UK
| | | | - Karin C Lødrup Carlsen
- Dept of Paediatrics, Women and Children's Division, Oslo University Hospital, Oslo, Norway Dept of Paediatrics, Faculty of Medicine, University of Oslo, Oslo, Norway
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18
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Harrington KF, Zhang B, Magruder T, Bailey WC, Gerald LB. The Impact of Parent's Health Literacy on Pediatric Asthma Outcomes. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2015; 28:20-26. [PMID: 25852967 DOI: 10.1089/ped.2014.0379] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 09/17/2014] [Indexed: 11/12/2022]
Abstract
Background: Health literacy has been associated with health disparities in many disease outcomes, including children's asthma. Parents are responsible for most of children's healthcare. Therefore, parents' health literacy may impact children's health outcomes, including asthma control. This study sought to determine the association between parent health literacy and children's asthma control among a cohort of predominately minority urban children aged between 6 and 12 years. Methods: This cross-sectional study assessed children with asthma and their parents at a single outpatient visit. English-speaking parents and their children, aged between 6 and 12 years with physician-diagnosed asthma, were eligible for this study. Healthcare providers assessed asthma control and severity, and parents completed demographic, health literacy, asthma control, and asthma knowledge measures. Children completed a pulmonary function test as part of the Asthma Control Questionnaire (ACQ) scoring. Results: A total of 281 parent-child dyads provided data, with the majority of parents being mothers and African American, with a high school level education or less. Lower parent health literacy was associated with worse asthma control as rated both by the provider (p=0.007) and the ACQ (p=0.013), despite only moderate concordance between ratings (ρ=0.408, p<0.0001). Lower parent health literacy also was associated with less asthma knowledge, which was associated with worse asthma control. Conclusions: Higher parent health literacy was associated with more parent asthma knowledge and better child asthma control. Pediatric providers should consider tailoring education or treatment plans or utilizing universal precautions for low health literacy.
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Affiliation(s)
- Kathleen F Harrington
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio
| | - Teresa Magruder
- Division of Pulmonary and Sleep Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - William C Bailey
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Lynn B Gerald
- Mel and Enid Zuckerman College of Public Health and the Arizona Respiratory Center, University of Arizona , Tucson, Arizona
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19
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Akinbami LJ, Moorman JE, Simon AE, Schoendorf KC. Trends in racial disparities for asthma outcomes among children 0 to 17 years, 2001-2010. J Allergy Clin Immunol 2014; 134:547-553.e5. [PMID: 25091437 PMCID: PMC4757843 DOI: 10.1016/j.jaci.2014.05.037] [Citation(s) in RCA: 214] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 05/23/2014] [Accepted: 05/30/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Racial disparities in childhood asthma have been a long-standing target for intervention, especially disparities in hospitalization and mortality. OBJECTIVES Describe trends in racial disparities in asthma outcomes using both traditional population-based rates and at-risk rates (based on the estimated number of children with asthma) to account for prevalence differences between race groups. METHODS Estimates of asthma prevalence and outcomes (emergency department [ED] visits, hospitalizations, and deaths) were calculated from national data for 2001 to 2010 for black and white children. Trends were calculated using weighted loglinear regression, and changes in racial disparities over time were assessed using Joinpoint. RESULTS Disparities in asthma prevalence between black and white children increased from 2001 to 2010; at the end of this period, black children were twice as likely as white children to have asthma. Population-based rates showed that disparities in asthma outcomes remained stable (ED visits and hospitalizations) or increased (asthma attack prevalence, deaths). In contrast, analysis with at-risk rates, which account for differences in asthma prevalence, showed that disparities in asthma outcomes remained stable (deaths), decreased (ED visits, hospitalizations), or did not exist (asthma attack prevalence). CONCLUSIONS Using at-risk rates to assess racial disparities in asthma outcomes accounts for prevalence differences between black and white children, and adds another perspective to the population-based examination of asthma disparities. An at-risk rate analysis shows that among children with asthma, there is no disparity for asthma attack prevalence and that progress has been made in decreasing disparities in asthma ED visit and hospitalization rates.
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Affiliation(s)
- Lara J Akinbami
- Infant, Child and Women's Health Statistics Branch, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md; US Public Health Service, Rockville, Md.
| | - Jeanne E Moorman
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Alan E Simon
- Infant, Child and Women's Health Statistics Branch, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md
| | - Kenneth C Schoendorf
- Infant, Child and Women's Health Statistics Branch, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md; US Public Health Service, Rockville, Md
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20
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Social disadvantage and asthma control in children. Paediatr Respir Rev 2014; 15:256-62; quiz 262-3. [PMID: 24928775 PMCID: PMC4146695 DOI: 10.1016/j.prrv.2014.04.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 12/22/2022]
Abstract
This review discusses various aspects of social disadvantage and their association with poor asthma control, including socioeconomic status, exposure to psychosocial stress and violence, minority affiliation, environmental concerns such as allergens and pollution, and poverty in rural settings. Each of these elements has been linked with worsened asthma outcomes in children. Known and hypothesized mechanisms behind these associations are described in an effort to further understand the complex entity of poorly controlled asthma among socially deprived children. Intervention studies to improve asthma outcomes in these vulnerable populations are also described.
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21
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A systematic review of validated methods to capture acute bronchospasm using administrative or claims data. Vaccine 2014; 31 Suppl 10:K12-20. [PMID: 24331069 DOI: 10.1016/j.vaccine.2013.06.091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 06/08/2013] [Accepted: 06/21/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE To identify and assess billing, procedural, or diagnosis code, or pharmacy claim-based algorithms used to identify acute bronchospasm in administrative and claims databases. METHODS We searched the MEDLINE database from 1991 to September 2012 using controlled vocabulary and key terms related to bronchospasm, wheeze and acute asthma. We also searched the reference lists of included studies. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria. Two reviewers independently extracted data regarding participant and algorithm characteristics. RESULTS Our searches identified 677 citations of which 38 met our inclusion criteria. In these 38 studies, the most commonly used ICD-9 code was 493.x. Only 3 studies reported any validation methods for the identification of bronchospasm, wheeze or acute asthma in administrative and claims databases; all were among pediatric populations and only 2 offered any validation statistics. Some of the outcome definitions utilized were heterogeneous and included other disease based diagnoses, such as bronchiolitis and pneumonia, which are typically of an infectious etiology. One study offered the validation of algorithms utilizing Emergency Department triage chief complaint codes to diagnose acute asthma exacerbations with ICD-9 786.07 (wheezing) revealing the highest sensitivity (56%), specificity (97%), PPV (93.5%) and NPV (76%). CONCLUSIONS There is a paucity of studies reporting rigorous methods to validate algorithms for the identification of bronchospasm in administrative data. The scant validated data available are limited in their generalizability to broad-based populations.
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22
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Chen JH. Asthma and child behavioral skills: does family socioeconomic status matter? Soc Sci Med 2014; 115:38-48. [PMID: 24937327 DOI: 10.1016/j.socscimed.2014.05.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
Abstract
Asthma is associated with poorer behavioral and psychological outcomes in children, yet little is known about whether and how the social stratification process affects the impacts of asthma on children's outcomes. Using data from the Early Childhood Longitudinal Study-Birth Cohort, this study considered the role of socioeconomic status in shaping the developmental consequences of children's asthma. Results showed that asthma was negatively associated with attention and social competence and positively associated with externalizing problem behaviors for children with low-educated mothers and children who lived in poor households. However, the adverse consequences of asthma disappeared for children with high-educated mothers and children who did not experience poverty. Additionally, the socioeconomic disparities were not fully explained by healthcare resources, family process, and exposure to environment risks and the disparities were found for both mild and severe cases. These findings suggest that, to fully understand the developmental consequences of illness in children, it is important to place socioeconomic status at the center of investigation.
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Affiliation(s)
- Jen-Hao Chen
- University of Missouri, Department of Health Sciences, Columbia, MO 65211, United States.
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Wilson S, Zhang H, Jiang C, Burwell K, Rehr R, Murray R, Dalemarre L, Naney C. Being overburdened and medically underserved: assessment of this double disparity for populations in the state of Maryland. Environ Health 2014; 13:26. [PMID: 24708780 PMCID: PMC4021052 DOI: 10.1186/1476-069x-13-26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 03/24/2014] [Indexed: 05/13/2023]
Abstract
BACKGROUND Environmental justice research has shown that many communities of color and low-income persons are differentially burdened by noxious land uses including Toxic Release Inventory (TRI) facilities. However, limited work has been performed to assess how these populations tend to be both overburdened and medically underserved. We explored this "double disparity" for the first time in Maryland. METHODS We assessed spatial disparities in the distribution of TRI facilities in Maryland across varying levels of sociodemographic composition using 2010 US Census Health Professional Shortage Area (HPSA) data. Univariate and multivariate regression in addition to geographic information systems (GIS) were used to examine relationships between sociodemographic measures and location of TRI facilities. Buffer analysis was also used to assess spatial disparities. Four buffer categories included: 1) census tracts hosting one or more TRI facilities; 2) tracts located more than 0 and up to 0.5 km from the closest TRI facility; 3) tracts located more than 0.5 km and up to 1 km from a TRI facility; and 4) tracts located more than 1 km and up to 5 km from a TRI facility. RESULTS We found that tracts with higher proportions of non-white residents and people living in poverty were more likely to be closer to TRI facilities. A significant increase in income was observed with an increase in distance between a census tract and the closest TRI facility. In general, percent non-white was higher in HPSA tracts that host at least one TRI facility than in non-HPSA tracts that host at least one TRI facility. Additionally, percent poverty, unemployment, less than high school education, and homes built pre-1950 were higher in HPSA tracts hosting TRI facilities than in non-HPSA tracts hosting TRI facilities. CONCLUSIONS We found that people of color and low-income groups are differentially burdened by TRI facilities in Maryland. We also found that both low-income groups and persons without a high school education are both overburdened and medically underserved. The results of this study provide insight into how state agencies can better address the double disparity of disproportionate environmental hazards and limited access to health care resources facing vulnerable communities in Maryland.
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Affiliation(s)
- Sacoby Wilson
- Community Engagement, Environmental Justice and Health, University of Maryland-College Park, College Park, MD 20742, USA
- Maryland Institute for Applied Environmental Health, University of Maryland-College Park, College Park, MD 20742, USA
| | - Hongmei Zhang
- Epidemiology, Biostatistics, and Environmental Health Science, School of Public Health, University of Memphis, Memphis, TN 38111, USA
| | - Chengsheng Jiang
- Community Engagement, Environmental Justice and Health, University of Maryland-College Park, College Park, MD 20742, USA
- Maryland Institute for Applied Environmental Health, University of Maryland-College Park, College Park, MD 20742, USA
| | - Kristen Burwell
- Community Engagement, Environmental Justice and Health, University of Maryland-College Park, College Park, MD 20742, USA
- Maryland Institute for Applied Environmental Health, University of Maryland-College Park, College Park, MD 20742, USA
| | - Rebecca Rehr
- Community Engagement, Environmental Justice and Health, University of Maryland-College Park, College Park, MD 20742, USA
- Maryland Institute for Applied Environmental Health, University of Maryland-College Park, College Park, MD 20742, USA
| | - Rianna Murray
- Community Engagement, Environmental Justice and Health, University of Maryland-College Park, College Park, MD 20742, USA
- Maryland Institute for Applied Environmental Health, University of Maryland-College Park, College Park, MD 20742, USA
| | - Laura Dalemarre
- Community Engagement, Environmental Justice and Health, University of Maryland-College Park, College Park, MD 20742, USA
- Maryland Institute for Applied Environmental Health, University of Maryland-College Park, College Park, MD 20742, USA
| | - Charles Naney
- Community Engagement, Environmental Justice and Health, University of Maryland-College Park, College Park, MD 20742, USA
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Sedaghat AR, Wilke CO, Cunningham MJ, Ishman SL. Socioeconomic disparities in the presentation of acute bacterial sinusitis complications in children. Laryngoscope 2013; 124:1700-6. [DOI: 10.1002/lary.24492] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 09/16/2013] [Accepted: 10/25/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Ahmad R. Sedaghat
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts
| | - Claus O. Wilke
- Department of Integrative Biology, Center for Computational Biology and Bioinformatics; Institute for Cellular and Molecular Biology, The University of Texas at Austin; Austin Texas
| | - Michael J. Cunningham
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts
| | - Stacey L. Ishman
- Division of Otolaryngology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- Division of Pulmonary Medicine; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- Department of Otolaryngology-Head & Neck Surgery; University of Cincinnati; Cincinnati Ohio U.S.A
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Delmas MC, Marguet C, Raherison C, Nicolau J, Fuhrman C. [Admissions for pediatric asthma in France]. Arch Pediatr 2013; 20:739-47. [PMID: 23731604 DOI: 10.1016/j.arcped.2013.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/08/2013] [Accepted: 04/20/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Most hospital admissions for asthma exacerbation are avoidable with adequate disease management. The objective of this study was to describe admissions for asthma in children in France using data from the French nationwide hospital database. METHODS We selected admissions having either a main diagnosis of asthma or a main diagnosis of acute respiratory failure (ARF) with asthma as an associated diagnosis, occurring in children (age<15years) between 2002 and 2010 in France (excluding French Guyana). RESULTS In 2010, 35,004 asthma admissions and 1381 cases of asthma-related ARF were recorded (crude admission rate, 30.1/10,000 children); the mean length of stay was 2days. The in-hospital lethality rate ranged from 0.01% to 0.03% depending on the year. The annual age-standardized admission rate increased between 2002 and 2010 (+2.5% per year on average in metropolitan France). In 2010, 11.8% of children admitted for asthma or asthma-related ARF were readmitted for asthma or asthma-related ARF at least once within the same calendar year, and 1.3% were readmitted within the week following admission. The proportion of children aged less than 5 years who were readmitted within the same calendar year increased between 2002 and 2010. CONCLUSION The increase in admission and readmission rates indicates non-optimal management of asthma in children in France.
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Affiliation(s)
- M-C Delmas
- Département des maladies chroniques, institut de veille sanitaire, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
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Abstract
OBJECTIVES To examine hospitalizations and length of stay (LOS) for infants aged <1 year in rural and urban counties, hypothesizing that infants living in rural counties experience significantly different hospital use compared with urban infants. METHODS Birth certificates for infants born in California hospitals between 1993 and 2005 and surviving to discharge were linked to hospital discharge records and death certificates during the first year of life, resulting in a study population of >6.4 million. Hospitalizations, cumulative LOS, readmission rates, and mortality were compared by using univariate and multivariable analysis for infants living in small rural, large rural, small urban, and large urban counties. Odds of hospitalization and cumulative LOS were also examined for common infant diagnoses. RESULTS Infants living in increasingly rural counties experienced decreasing rates of hospitalization and decreasing number of hospitalized days during the first year of life. Infants living in small rural counties experienced 370 hospital days per 1000 infants compared with 474 hospital days per 1000 infants living in large urban counties. In multivariable analysis, infants in large urban counties experienced increased odds of hospitalization (odds ratio: 1.20 [95% confidence interval: 1.06-1.36]) and increased hospitalized days (incidence risk ratio: 1.17 [95% confidence interval: 1.06-1.29]) compared with infants in small rural counties. For most common diagnoses, urban residence was associated with either increased odds of hospitalization or increased cumulative LOS. CONCLUSIONS Infants living in rural California counties experienced decreased hospital utilization, including decreased hospitalization and decreased LOS, compared with infants living in urban counties.
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Affiliation(s)
| | - Scott A. Lorch
- Division of Neonatology and Center for Outcomes Research, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and,Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
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Fuhlbrigge A, Peden D, Apter AJ, Boushey HA, Camargo CA, Gern J, Heymann PW, Martinez FD, Mauger D, Teague WG, Blaisdell C. Asthma outcomes: exacerbations. J Allergy Clin Immunol 2012; 129:S34-48. [PMID: 22386508 DOI: 10.1016/j.jaci.2011.12.983] [Citation(s) in RCA: 230] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 12/23/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND The goals of asthma treatment include preventing recurrent exacerbations. Yet there is no consensus about the terminology for describing or defining "exacerbation" or about how to characterize an episode's severity. OBJECTIVE National Institutes of Health institutes and other federal agencies convened an expert group to propose how asthma exacerbation should be assessed as a standardized asthma outcome in future asthma clinical research studies. METHODS We used comprehensive literature reviews and expert opinion to compile a list of asthma exacerbation outcomes and classified them as either core (required in future studies), supplemental (used according to study aims and standardized), or emerging (requiring validation and standardization). This work was discussed at a National Institutes of Health-organized workshop in March 2010 and finalized in September 2011. RESULTS No dominant definition of "exacerbation" was found. The most widely used definitions included 3 components, all related to treatment, rather than symptoms: (1) systemic use of corticosteroids, (2) asthma-specific emergency department visits or hospitalizations, and (3) use of short-acting β-agonists as quick-relief (sometimes referred to as "rescue" or "reliever") medications. CONCLUSIONS The working group participants propose that the definition of "asthma exacerbation" be "a worsening of asthma requiring the use of systemic corticosteroids to prevent a serious outcome." As core outcomes, they propose inclusion and separate reporting of several essential variables of an exacerbation. Furthermore, they propose the development of a standardized, component-based definition of "exacerbation" with clear thresholds of severity for each component.
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Pati S, Lorch SA, Lee GE, Sheffler-Collins S, Shah SS. Health insurance and length of stay for children hospitalized with community-acquired pneumonia. J Hosp Med 2012; 7:304-10. [PMID: 21972214 PMCID: PMC3877930 DOI: 10.1002/jhm.959] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 06/02/2011] [Accepted: 06/15/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND Disparities in patterns of care and outcomes for ambulatory-care sensitive childhood conditions such as community-acquired pneumonia (CAP) persist. However, the influence of insurance status on length of stay (LOS) for children hospitalized with CAP remains unexplored. METHODS Secondary analysis of children (<18 years) hospitalized with CAP sampled in the Kids' Inpatient Database (KID) for years 1997, 2000, 2003, and 2006. Insurance status (private, public, uninsured) was based on claims data. Hospital LOS was calculated in days. Taking into account the complex sampling design, negative binomial regression models produced adjusted estimates of incidence rate ratios (IRR) for hospital LOS for children by insurance status. RESULTS There was little variation in the categories of insurance status of children hospitalized with CAP between 1997 and 2006, with at least 40% privately insured, at least 40% publicly insured, and at least 5% uninsured in each sampled year. In all years, publicly insured children had a significantly longer hospital stay than privately insured children, and uninsured children had a significantly shorter hospital stay than privately insured children. These observed differences persisted after multivariate adjustment. CONCLUSIONS Differences in LOS between uninsured, publicly insured, and privately insured children with CAP raise concerns about potential differences in hospital discharge practices related to insurance status and type. As healthcare reform is implemented, policy makers should strengthen efforts to reduce these disparities in order to achieve health for the population.
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Affiliation(s)
- Susmita Pati
- Division of Primary Care Pediatrics, State University of New York at Stony Brook School of Medicine, and Stony Brook Long Island Children's Hospital, Stony Brook, New York 11794-8111, USA.
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Brouwer KC, Lozada R, Weeks JR, Magis-Rodríguez C, Firestone M, Strathdee SA. Intraurban mobility and its potential impact on the spread of blood-borne infections among drug injectors in Tijuana, Mexico. Subst Use Misuse 2012; 47:244-53. [PMID: 22136446 PMCID: PMC3979331 DOI: 10.3109/10826084.2011.632465] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We explored intraurban mobility of Tijuana, Mexico, injection drug users (IDUs). In 2005, 222 IDUs underwent behavioral surveys and infectious disease testing. Participants resided in 58 neighborhoods, but regularly injected in 30. From logistic regression, "mobile" IDUs (injecting ≥3 km from their residence) were more likely to cross the Mexico/U.S. border, share needles, and get arrested for carrying syringes-but less likely to identify hepatitis as an injection risk. Mobile participants lived in neighborhoods with less drug activity, treatment centers, or migrants, but higher marriage and home ownership rates. Mobile IDUs should be targeted for outreach and further investigation. The study's limitations are noted.
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Affiliation(s)
- Kimberly C Brouwer
- School of Medicine, University of California San Diego, La Jolla, California 92093, USA.
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Abstract
OBJECTIVES To outline the prevalence and disparities of asthma among school-aged urban minority youth, causal pathways through which poorly controlled asthma adversely affects academic achievement, and proven or promising approaches for schools to address these problems. METHODS Literature review. RESULTS Asthma is the most common chronic disease affecting youth in the United States; almost 10 million youth under 18 (14%) have received a diagnosis and 6.8 million (9%) have active asthma. Average annual prevalence estimates were approximately 45% higher for Black versus White children (12.8% vs. 8.8%), as were average annual estimates of asthma attacks (8.4% vs. 5.8%). Urban minority youth have highly elevated prevalence of poorly controlled asthma as evidenced by overuse of emergency departments and under-use of efficacious medications. Poorly controlled asthma has functional consequences on cognition, connectedness with school, and absenteeism. Exemplary asthma programs include management and support systems, school health and mental health services, asthma education, healthy school environments, physical education and activity, and coordination of school, family, and community efforts. CONCLUSIONS Asthma and, more importantly, poorly controlled asthma are highly and disproportionately prevalent among school-aged urban minority youth, has a negative impact on academic achievement through its effects on cognition, school connectedness, and absenteeism, and effective practices are available for schools to address this problem. To reduce the adverse effects of poorly controlled asthma on learning, a multifaceted approach to asthma control and prevention in which schools can and must play a central role is essential.
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Affiliation(s)
- Charles E Basch
- Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120th Street, New York, NY 10027, USA.
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The impact of socioeconomic factors on asthma hospitalization rates by rural classification. J Community Health 2011; 36:495-503. [PMID: 21107894 DOI: 10.1007/s10900-010-9333-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Asthma hospitalization rates have increased in the past decade. Research has shown that there are multiple correlates for this increase but that driving causal factors may differ for asthma hospitalization rates in rural and non-rural settings. Here we examine the socioeconomic correlates to asthma hospitalization rates in Maine for both rural and non-rural populations to examine the similarity and differences in causal factors. Findings indicate a clear SES gradient relative to asthma hospitalization rates; as population measured SES decreased, asthma hospitalization rates increased. The associated causal factors were found to differ in rural and non-rural areas. In non-rural areas, the presence of insurance was associated with increases in the asthma hospitalization rates while in rural areas, income, occupation and the percentage of non-English language speaking persons were associated with lower asthma hospitalization rates. Public policy should focus on targeted prevention strategies at the community level, especially in rural areas where cultural competency and socioeconomic factors are increasingly important.
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Economic value of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity a community guide systematic review. Am J Prev Med 2011; 41:S33-47. [PMID: 21767734 DOI: 10.1016/j.amepre.2011.05.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 04/19/2011] [Accepted: 05/09/2011] [Indexed: 11/22/2022]
Abstract
CONTEXT A recent systematic review of home-based, multi-trigger, multicomponent interventions with an environmental focus showed their effectiveness in reducing asthma morbidity among children and adolescents. These interventions included home visits by trained personnel to assess the level of and reduce adverse effects of indoor environmental pollutants, and educate households with an asthma client to reduce exposure to asthma triggers. The purpose of the present review is to identify economic values of these interventions and present ranges for the main economic outcomes (e.g., program costs, benefit-cost ratios, and incremental cost-effectiveness ratios). EVIDENCE ACQUISITION Using methods previously developed for Guide to Community Preventive Services economic reviews, a systematic review was conducted to evaluate the economic efficiency of home-based, multi-trigger, multicomponent interventions with an environmental focus to improve asthma-related morbidity outcomes. A total of 1551 studies were identified in the search period (1950 to June 2008), and 13 studies were included in this review. Program costs are reported for all included studies; cost-benefit results for three; and cost-effectiveness results for another three. Information on program cost was provided with varying degrees of completeness: six of the studies did not provide a list of components included in their program cost description (limited cost information), three studies provided a list of program cost components but not a cost per component (partial cost information), and four studies provided both a list of program cost components and costs per component (satisfactory cost information). EVIDENCE SYNTHESIS Program costs per participant per year ranged from $231-$14,858 (in 2007 U.S.$). The major factors affecting program cost, in addition to completeness, were the level of intensity of environmental remediation (minor, moderate, or major), type of educational component (environmental education or self-management), the professional status of the home visitor, and the frequency of visits by the home visitor. Benefit-cost ratios ranged from 5.3-14.0, implying that for every dollar spent on the intervention, the monetary value of the resulting benefits, such as averted medical costs or averted productivity losses, was $5.30-$14.00 (in 2007 U.S.$). The range in incremental cost-effectiveness ratios was $12-$57 (in 2007 U.S.$) per asthma symptom-free day, which means that these interventions achieved each additional symptom-free day for net costs varying from $12-$57. CONCLUSIONS The benefits from home-based, multi-trigger, multicomponent interventions with an environmental focus can match or even exceed their program costs. Based on cost-benefit and cost-effectiveness studies, the results of this review show that these programs provide a good value for dollars spent on the interventions.
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Gale SL, Magzamen SL, Radke JD, Tager IB. Crime, neighborhood deprivation, and asthma: a GIS approach to define and assess neighborhoods. Spat Spatiotemporal Epidemiol 2011; 2:59-67. [PMID: 22749585 DOI: 10.1016/j.sste.2011.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 12/22/2010] [Accepted: 01/04/2011] [Indexed: 10/18/2022]
Abstract
Exposure to neighborhood factors remains difficult to quantify when neighborhoods are often predefined and imprecisely measured. This study examines the association between neighborhood deprivation and participation in a community-based asthma case management (CM) program in Oakland, CA. We estimated neighborhoods by calculating walking distances of , and miles around each child's (n=2892) residence. The model assesses deprivation by the addition of weighted factors within a child's neighborhood-crime rates, alcohol outlets, and eight 2000 US Census characteristics. The results illustrate that neighborhood deprivation is weakly associated with greater levels of program participation, but neighborhood education level, measured by percentage of residents with less than a high school education, is strongly associated with greater program participation (OR: 4.43, 95% CI: [1.23, 15.99]). Neighborhood deprivation factors were significantly different between neighborhoods defined by walking distances and census blockgroups (Wilcoxon-signed rank test: p<0.05).
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Affiliation(s)
- Sara L Gale
- School of Public Health, University of California, Berkeley, CA 94704, USA.
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Claudio L, Stingone JA. Primary household language and asthma care among Latino children. J Health Care Poor Underserved 2009; 20:766-79. [PMID: 19648704 DOI: 10.1353/hpu.0.0164] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To determine if language barriers affect the level of asthma management and quality of health care in Latino children, a cross-sectional, parent-report survey was conducted in 26 randomly selected public elementary schools in New York City. The overall response rate was 76.9%, yielding a sample of 1,847 Latino children. The prevalence of asthma among Latinos from Spanish-speaking households was 20.8%, compared with 25.8% among Latino children from English-speaking households. Although asthmatics from Spanish-speaking families were less likely to have symptoms than children from English-speaking families, they were twice as likely to be hospitalized for asthma (9.4% vs. 4.4%, p<.02). Asthmatics from Spanish-speaking households were more likely to have public health insurance and to use a community/hospital clinic for care. Spanish-speaking parents were less likely to report having access to care on weekends or to have communicated with their child's physician about recommended components of an asthma management plan.
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Affiliation(s)
- Luz Claudio
- Department of Community Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Abstract
This article provides a survey on the concepts, methods, and applications of the study of unwarranted variation in health care with particular attention to children's medical services.
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Affiliation(s)
- David C. Goodman
- The Dartmouth Institute for Health Policy and Clinical Practice, 35 Centerra Parkway, Suite 202, Lebanon, NH 03766, USA,The Children's Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA,Dartmouth Medical School, Hanover, NH, USA
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Fagnano M, van Wijngaarden E, Connolly HV, Carno MA, Forbes-Jones E, Halterman JS. Sleep-disordered breathing and behaviors of inner-city children with asthma. Pediatrics 2009; 124:218-25. [PMID: 19564303 PMCID: PMC2704979 DOI: 10.1542/peds.2008-2525] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore the relationship between sleep-disordered breathing (SDB) and behavioral problems among inner-city children with asthma. METHODS We examined data for 194 children (aged 4-10 years) who were enrolled in a school-based asthma intervention program (response rate: 72%). SDB was assessed by using the Sleep-Related Breathing Disorder Questionnaire that contains 3 subscales: snoring, sleepiness, and attention/hyperactivity. For the current study, we modified the Sleep-Related Breathing Disorder Questionnaire by removing the 6 attention/hyperactivity items. A sleep score of >0.33 was considered indicative of SDB. To assess behavior, caregivers completed the Behavior Problem Index (BPI), which includes 8 behavioral subdomains. We conducted bivariate analyses and multiple linear regression to determine the association of SDB with BPI scores. RESULTS The majority of children (mean age: 8.2 years) were male (56%), black (66%), and insured by Medicaid (73%). Overall, 33% of the children experienced SDB. In bivariate analyses, children with SDB had significantly higher (worse) behavior scores compared with children without SDB on total BPI (13.7 vs 8.8) and the subdomains externalizing (9.4 vs 6.3), internalizing (4.4 vs 2.5), anxious/depressed (2.4 vs 1.3), headstrong (3.2 vs 2.1), antisocial (2.3 vs 1.7), hyperactive (3.0 vs 1.8), peer conflict (0.74 vs 0.43), and immature (2.0 vs 1.5). In multiple regression models adjusting for several important covariates, SDB remained significantly associated with total BPI scores and externalizing, internalizing, anxious/depressed, headstrong, and hyperactive behaviors. Results were consistent across SDB subscales (snoring, sleepiness). CONCLUSIONS We found that poor sleep was independently associated with behavior problems in a large proportion of urban children with asthma. Systematic screening for SDB in this high-risk population might help to identify children who would benefit from additional intervention.
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Affiliation(s)
- Maria Fagnano
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
| | - Edwin van Wijngaarden
- Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry
| | - Heidi V. Connolly
- Department of School of Nursing, University of Rochester School of Medicine and Dentistry
| | - Margaret A. Carno
- Department of School of Nursing, University of Rochester School of Medicine and Dentistry
| | - Emma Forbes-Jones
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry
| | - Jill S. Halterman
- Department of Pediatrics and Golisano Children’s Hospital at Strong, University of Rochester School of Medicine and Dentistry
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McConnochie KM, Wood NE, Herendeen NE, Ng PK, Noyes K, Wang H, Roghmann KJ. Acute illness care patterns change with use of telemedicine. Pediatrics 2009; 123:e989-95. [PMID: 19482750 DOI: 10.1542/peds.2008-2698] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Health-e-Access, a telemedicine service providing care for acute illnesses in children, has delivered >6500 telemedicine visits from 10 primary care practices in Rochester, New York, by using telemedicine access at 22 child care and school sites. The goal was to assess the hypotheses that children served by Health-e-Access received health care more often for acute illnesses but had fewer emergency department (ED) visits and lower health care expenditures than did children without access through this service. METHODS By using insurance claims, this case study compared utilization (starting in May 2001) of telemedicine, office, or ED care for children with versus without telemedicine access. Children included in analyses had > or =6 consecutive insurance-covered months through July 2007. Claims data captured all utilization. A total of 19 652 child-months from 1216 children with telemedicine access were matched with respect to age, gender, socioeconomic status, and season with child-months for children without telemedicine availability. RESULTS The mean age at utilization was 6.71 years, with 79% of all child-months being covered by Medicaid managed care. The overall utilization rate was 305.1 visits per 100 child-years. In multivariate analyses with adjustment for potential confounders, overall illness-related utilization rates (in-person or telemedicine visits per 100 child-years) for all sites were 23.5% greater for children with telemedicine access than for control children, but ED utilization was 22.2% less. CONCLUSION The Health-e-Access telemedicine model holds potential to reduce health care costs, mostly through replacement of ED visits for nonemergency problems.
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Affiliation(s)
- Kenneth M McConnochie
- Department of Pediatrics, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, USA.
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Magzamen S, Patel B, Davis A, Edelstein J, Tager IB. Kickin' Asthma: school-based asthma education in an urban community. THE JOURNAL OF SCHOOL HEALTH 2008; 78:655-665. [PMID: 19000242 DOI: 10.1111/j.1746-1561.2008.00362.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND In urban communities with high prevalence of childhood asthma, school-based educational programs may be the most appropriate approach to deliver interventions to improve asthma morbidity and asthma-related outcomes. The purpose of this study was to evaluate the implementation of Kickin' Asthma, a school-based asthma curriculum designed by health educators and local students, which teaches asthma physiology and asthma self-management techniques to middle and high school students in Oakland, CA. METHODS Eligible students were identified through an in-class asthma case identification survey. Approximately 10-15 students identified as asthmatic were recruited for each series of the Kickin' Asthma intervention. The curriculum was delivered by an asthma nurse in a series of four 50-minute sessions. Students completed a baseline and a 3-month follow-up survey that compared symptom frequency, health care utilization, activity limitations, and medication use. RESULTS Of the 8488 students surveyed during the first 3 years of the intervention (2003-2006), 15.4% (n = 1309) were identified as asthmatic; approximately 76% of eligible students (n = 990) from 15 middle schools and 3 high schools participated in the program. Comparison of baseline to follow-up data indicated that students experienced significantly fewer days with activity limitations and significantly fewer nights of sleep disturbance after participation in the intervention. For health care utilization, students reported significantly less frequent emergency department visits or hospitalizations between the baseline and follow-up surveys. CONCLUSIONS A school-based asthma curriculum designed specifically for urban students has been shown to reduce symptoms, activity limitations, and health care utilization for intervention participants.
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Affiliation(s)
- Sheryl Magzamen
- Division of Epidemiology, School of Public Health, 50 University Hall, #7360, Berkeley, CA 94720-7360, USA.
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Kruse LK, Deshpande S, Vezina M. Disparities in asthma hospitalizations among children seen in the emergency department. J Asthma 2008; 44:833-7. [PMID: 18097859 DOI: 10.1080/02770900701750163] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We examined the race/ethnicity variation in the risk of hospitalization among children seen in the emergency department (ED) for asthma. ED and hospitalization records for children 1 to 19 years of age in New Jersey for 2004 and 2005 were linked. The dataset identified 47,548 ED and hospitalizations among 37,216 children. ED and hospitalization rates indicated persistent disparities in pediatric asthma. ED admission rates were similar across race/ethnic groups, suggesting similar management of pediatric asthma patients once they are seen in the ED. Integrating existing ED and hospitalization records will enhance asthma surveillance and the targeting of interventions to reduce race/ethnicity disparities.
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Affiliation(s)
- Lakota K Kruse
- Division of Family Health Services, Public Health Services Branch, New Jersey Department of Health and Senior Services, Trenton, New Jersey 08625-0364, USA.
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Moin M, Aghamohammadi A, Gharavi MH, Ardestani A, Faghihimehr A, Kouhi A, Mazloumi M. Risk factors leading to hospital admission in Iranian asthmatic children. Int Arch Allergy Immunol 2007; 145:244-8. [PMID: 17914276 DOI: 10.1159/000109293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 06/18/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Asthma is one of the most common chronic diseases in the world, leading to an increased rate of hospitalization. We performed this study to better understand the factors leading to admission among asthmatic children. METHODS We performed a study among asthmatic children in a referral hospital for asthma and allergy in Tehran. Sixty-three cases were selected from asthmatic children admitted to the emergency room (ER) who still had an indication for ward or intensive care unit admission after primary treatment. Our control group was the asthmatic children discharged after primary treatment and patients who were referred to the asthma and allergy clinic (63 patients). Data were obtained by structured questionnaires filled out during clinical interviews. RESULTS There was a significant difference in mean age (5 years for cases vs. 6 years for controls; p = 0.049), personal and familial allergic history (69.8 and 57.1% for cases vs. 34.9 and 36.5% for controls; p < 0.01 and p = 0.02, respectively), history of recent respiratory infections (79.4% for cases vs. 49.2% for controls; p < 0.01), hospitalization history due to asthma (57.1% for cases vs. 23.8% for controls; p < 0.01) and regular use of inhaled corticosteroid (66.7% for cases vs. 33.3% for controls; p < 0.01). CONCLUSIONS Our findings confirm most previous observations, suggesting that recent respiratory infections, hospitalization, personal or familial allergy, disease severity and lower ages are important factors leading to hospitalization. We also found that regular clinical follow-up, regular use of inhaled corticosteroids, higher IgE levels and O2 saturation may lower the probability of hospitalization during asthmatic attacks.
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Affiliation(s)
- Mostafa Moin
- Immunology, Asthma and Allergy Research Institute, Department of Clinical Immunology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Nikièma B, Zunzunegui MV, Séguin L, Gauvin L, Potvin L. Poverty and cumulative hospitalization in infancy and early childhood in the Quebec birth cohort: a puzzling pattern of association. Matern Child Health J 2007; 12:534-44. [PMID: 17690962 DOI: 10.1007/s10995-007-0259-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 07/19/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We anticipate a negative gradient between income and hospitalization, since income is positively associated with good health. In a previous cross-sectional study, we reported an unexpected pattern of association between poverty and hospitalization for 5-month-old infants in Quebec. This study re-examines the poverty-hospitalization relationship within a longitudinal population study of the same birth cohort aged 3.5 years. METHOD Life table analysis, multivariable proportional hazard regression, and multivariable logistic regression were performed on data from the first four waves of the Quebec Longitudinal Study of Child Development (QLSCD). Probabilities of hospitalization were estimated by poverty status. The hazard ratios (HR) (Cox-regression) for duration of poverty (frequency of insufficient income) and severity of poverty (combining frequency and level of income insufficiency) were estimated, controlling for predisposing, enabling, and need determinants of hospitalization. RESULTS At 3.5 years, 31% of children had been hospitalized at least once. Compared with children whose families had constantly sufficient income, children with intermittent poverty exhibited higher hospitalization risks (HR = 1.30; 95%CI = 1.04-1.64) while chronically poor children exhibited comparable hospitalization hazards (HR = 0.97; 95%CI = 0.73-1.27). Hospitalization risks for children in the severest poverty group resembled that of the non-poor group (HR = 0.99; 95%CI = 0.66-1.49), while children in less severely poor families were more likely to be hospitalized (HR = 1.26; 95%CI = 0.99-1.60). CONCLUSION Results suggest hospitalization barriers for children living in chronic and severe poverty. If these barriers exist in a universal health care system, they may originate with primary care service organization or hospital care referral procedures.
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Affiliation(s)
- Béatrice Nikièma
- Groupe de Recherche Interdisciplinaire en Santé (GRIS), Département de Médecine Sociale et Préventive, Faculté de Médecine, Université de Montréal, Succursale Centre-Ville, CP 6128, Montreal, QC, Canada, H3C 3J7.
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Forbes L, Harvey S, Newson R, Jarvis D, Luczynska C, Price J, Burney P. Risk factors for accident and emergency (A&E) attendance for asthma in inner city children. Thorax 2007; 62:855-60. [PMID: 17456503 PMCID: PMC2094271 DOI: 10.1136/thx.2006.058362] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Inner city children make heavy use of accident and emergency (A&E) services for asthma. Developing strategies to reduce this requires a better understanding of the risk factors. METHODS A case-control study was carried out of children with asthma living in south-east London: 1018 children who attended A&E for asthma over 1 year and 394 children who had not attended A&E for asthma over the previous year. The main risk factors were socioeconomic status, home environment, routine asthma management and parents' psychological responses to and beliefs about the treatment of asthma attacks. RESULTS A&E attendance was more common in children living in poorer households. No associations were found with home environment or with measures of routine asthma care. Children who had attended outpatients were much more likely to attend A&E (odds ratio (OR) 13.17, 95% CI 7.13 to 24.33). Other risk factors included having a parent who reported feeling alone (OR 2.58, 95% CI 1.71 to 3.87) or panic or fear (OR 2.62. 95% CI 1.75 to 3.93) when the child's asthma was worse; and parental belief that the child would be seen more quickly in A&E than at the GP surgery (OR 2.48, 95% CI 1.62 to 3.79). Parental confidence in the GP's ability to treat asthma attacks reduced the risk of attending A&E (OR 0.30, 95% CI 0.17 to 0.54). CONCLUSIONS There is no evidence that passive smoking, damp homes or poor routine asthma care explains heavy inner city use of A&E in children with asthma. Reducing A&E use is unlikely to be achieved by improving these, but identifying appropriate settings for treating children with asthma attacks and communicating these effectively may do so.
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Affiliation(s)
- Lindsay Forbes
- Wandsworth Primary Care Trust, Springfield University Hospital, 61 Glenburnie Road, London SW17 7DJ, UK.
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Singleton RJ, Holman RC, Cobb N, Curns AT, Paisano EL. Asthma hospitalizations among American Indian and Alaska Native people and for the general US population. Chest 2006; 130:1554-62. [PMID: 17099037 DOI: 10.1378/chest.130.5.1554] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Asthma is one of the most common chronic diseases in the United States. High rates of asthma hospitalization have been reported for some ethnic minorities; however, asthma hospitalization rates for American Indian/Alaska Native (AI/AN) populations of all ages have not been studied. In this study, we examined and compared hospitalization rates for AI/AN populations and the general population in the United States. DESIGN Hospital discharge records with a first-listed diagnosis of asthma were evaluated for AI/AN populations and the US general population of all ages from 1988 to 2002. RESULTS The asthma hospitalization rate for AI/AN populations decreased from 17.8/10,000 per year in 1988 to 1990 to 12.9/10,000 per year in 2000 to 2002. The overall age-adjusted rate for 2000 to 2002 was slightly lower than that for the general US population (12.9/10,000 and 16.4/10,000, respectively). However, AI/AN populations living in the Southwest region (17.6/10,000) had the highest asthma hospitalization rate among the Indian Health Service regions and the rate from 2000 to 2002 was similar to that for the general US population. The 2000 to 2002 asthma hospitalization rate for AI/AN populations < 1 year of age (infants) was higher than that in US infants, and the rates for AI/AN age groups > or = 1 year were similar to or lower than those for the general US population. CONCLUSIONS While asthma was rarely reported among AI/AN populations before 1975, the average annual age-adjusted asthma hospitalization rate was only slightly lower for AI/AN populations than that for the US general population from 2000 to 2002. Furthermore, the asthma hospitalization rates for AI/AN populations living in the Southwest and East regions were similar to the rate for the general US population. Efforts to further increase asthma awareness and symptom recognition among AI/AN populations should be implemented to help to reduce asthma hospitalizations.
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Abstract
Structural violence refers to the social structures that put people in harm's way. Farmer and colleagues describe the impact of social violence upon people living with HIV in the US and Rwanda.
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Affiliation(s)
- Paul E Farmer
- Department of Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America.
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Stingone JA, Claudio L. Disparities in the use of urgent health care services among asthmatic children. Ann Allergy Asthma Immunol 2006; 97:244-50. [PMID: 16937759 DOI: 10.1016/s1081-1206(10)60021-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Urgent care composes one third of the total costs associated with asthma. Asthmatic children of African American and Latino backgrounds have higher rates of emergency department (ED) use and hospitalizations than white children, especially in urban settings. OBJECTIVE To evaluate the role of socioeconomic, disease-related, and access-to-care factors in utilization of the ED and inpatient services for urgent treatment of asthma. METHODS A parent-response questionnaire was systematically distributed in public elementary schools that serve children of different socioeconomic backgrounds in New York City. RESULTS The prevalence of current asthma was found to be 13.0% in 5- to 12-year-old children. Almost half of the current asthmatic patients had used urgent care in the ED or hospital in the previous 12 months. In univariate analysis, use of urgent care was strongly associated with race/ethnicity and income (P < .001). Adjusting for socioeconomic, disease-related, and access-to-care factors, including household income, symptom severity, type of health insurance, and usual source of asthma care, the racial/ethnic disparity persisted, with Latinos having 5 times the risk and African Americans having double the risk of using urgent care as whites. CONCLUSIONS There is a failure in asthma management in this urban population, demonstrated by the finding that almost half of all current asthmatic patients used urgent care. After controlling for different socioeconomic and disease-related factors, minority race/ethnicity, low household income, and frequent evening symptoms were found to be strong predictors of urgent care utilization. Insurance status, delaying care for any reason, and use of controller medications were found not to be associated with urgent care use.
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Affiliation(s)
- Jeanette A Stingone
- Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, New York 10029-6574, USA
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Fisher-Owens SA, Turenne WM, Chavanu K, Slonim AD. Racial Disparities in Children Hospitalized with Asthma at Academic Childrens' Hospitals. ACTA ACUST UNITED AC 2006. [DOI: 10.1089/pai.2006.19.162] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
OBJECTIVES The objective of this study is to construct an accurate and representative demographic profile of patients undergoing sinus surgery for chronic rhinosinusitis (CRS). This will enable future studies to enroll representative samples so that results can be more easily compared across studies and generalized to the U.S. population. METHODS The investigators interrogated the databases of the National Survey of Ambulatory Surgery to gather demographic data. Whenever the NSAS provided incomplete characterization, deficiencies were corrected using state-level data provided by the Health care Cost and Utilization Project. The constructed profile was compared with available profiles of patients with CRS and demographic data provided by the U.S. Census Bureau. RESULTS The demographic profile of patients undergoing sinus surgery is 52.7% female with a mean age of 38.5 years. A total of 93.5% of surgery is performed on an outpatient basis with 78.8% of patients having private insurance sources. No significant difference in occurrence of surgery was found between months of the year or between regions of the country. The constructed race profile is 85.7% white, 5% black, 1.2% Asian/Pacific Islander, 0.2% Native American, and 7.8% other. CONCLUSIONS A novel integration of national and state databases can be used to create a demographic profile of patients undergoing surgery for CRS. The creation of this profile enables further study of representative populations of patients with CRS and enables thoughtful analysis of the existing literature. The difficulty in creating the profile highlights the need for complete and accurate healthcare information collection by national and state agencies.
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Affiliation(s)
- Timothy J Martin
- Department of Otolaryngology and Communication Sciences, Division of Epidemiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Shanawani H. Health disparities and differences in asthma: concepts and controversies. Clin Chest Med 2006; 27:17-28, v. [PMID: 16543049 DOI: 10.1016/j.ccm.2005.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Asthma is one of the most common respiratory diseases, with immense social impact. Despite best efforts, asthma prevalence, morbidity, and mortality are increasing in the United States. This is especially the case in select communities which suffer an excess burden of asthma. Studying these groups and attempting to ameliorate the disease burden they suffer has an important moral and social imperative. It also may lend important insight into the complex factors that contribute to asthma outcomes. The factors that affect asthma interact in a complicated manner and require a comprehensive approach that addresses each of them. However, pursuing health disparities research is controversial, and important ethical and operative considerations need to be made by those to engage in health disparities research.
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Affiliation(s)
- Hasan Shanawani
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan School of Medicine, 3916 Taubman Box 0360, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0360, USA.
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Abstract
OBJECTIVES There are conflicting data regarding the impact of breastfeeding on the development of asthma in late childhood. Our aim with this study was to investigate the relationship between breastfeeding and the prevalence of asthma in children at 14 years. METHODS The Mater-University of Queensland Study of Pregnancy is a birth cohort of 7223 women and their infants recruited from a public antenatal clinic in Brisbane, Australia, between 1981 and 1984. Data regarding breastfeeding and the duration of breastfeeding were collected through the use of a questionnaire completed by the mother 6 months postdelivery, and the prevalence of asthma was determined through the use of a questionnaire completed by the mother 14 years postdelivery. RESULTS Data regarding both breastfeeding and asthma were available for 4964 children. The prevalence of asthma in children at 14 years was 28.4%. Breastfeeding for > or =4 months was not found to have a significant effect on the prevalence of asthma in 14-year-olds. The unadjusted odds ratio of developing asthma at 14 years if the child was breastfed for > or =4 months was 1.03. The odds ratio of developing asthma did not change appreciably when allowance was made for potential confounding factors. CONCLUSION Data from this study indicate that breastfeeding neither increases nor decreases the prevalence of asthma in children at 14 years.
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Affiliation(s)
- Scott W Burgess
- Department of Respiratory and Sleep Medicine, Mater Children's Hospital, South Brisbane, Queensland 4101, Australia.
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Halterman JS, Conn KM, Forbes-Jones E, Fagnano M, Hightower AD, Szilagyi PG. Behavior problems among inner-city children with asthma: findings from a community-based sample. Pediatrics 2006; 117:e192-9. [PMID: 16452328 DOI: 10.1542/peds.2005-1140] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Previous studies have suggested a relationship between childhood asthma and behavior problems. However, few studies have used community-based samples to assess the prevalence of behavior problems among urban children with asthma symptoms. The objective of this study was to evaluate the relationship between asthma symptoms and behavior among a population-based sample of inner-city children and to determine the prevalence of behavioral comorbidity among children with asthma symptoms. METHODS In 2003, parents of children who were entering kindergarten in the city of Rochester completed a detailed survey regarding the child's background, medical history (with specific questions about asthma symptoms), and behavior. We compared children with no asthma symptoms, intermittent symptoms, and persistent symptoms with regard to positive peer social skills (eg, makes friends easily), negative peer social skills (eg, fights with other children), task orientation (eg, concentrates well), and shy/anxious behavior (eg, is withdrawn) (validated scales; range: 1-4). We used multivariate regression to determine the independent association between symptom severity and behavioral outcomes. RESULTS A total of 1619 children were included (response rate: 80%; mean age: 5.1 year), and 15% had asthma symptoms (8% persistent, 7% intermittent). Average negative peer scores were worse for children with persistent asthma symptoms compared with children with intermittent and no symptoms (mean scores: 1.88, 1.70, and 1.65). Children with persistent symptoms also scored worse than children with no symptoms on the assessment of task orientation (2.85 vs 3.03) and shy/anxious behavior (2.11 vs 1.89). Among children with persistent asthma symptoms, >20% scored >1 SD below average on 2 or more scales, compared with 16% of children with intermittent symptoms and 10% with no symptoms. CONCLUSIONS Urban children with persistent asthma symptoms demonstrate more behavior problems across several domains compared with children with no symptoms. These findings suggest a clear need for an early biopsychosocial approach to care for vulnerable children with asthma.
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Affiliation(s)
- Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children's Hospital at Strong, Rochester, New York, USA.
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