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Bruzzese JM. Asthma and Adolescence: Unique Opportunities for Fostering Asthma Self-Management and Asthma Control. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2024; 37:68-73. [PMID: 39293037 DOI: 10.1089/ped.2024.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Abstract
Asthma is a significant worldwide concern among adolescents. Adolescents experience key cognitive and psychosocial developmental changes that they must negotiate as they transition from children to adults. Several of these changes have implications for their ability to effectively manage their asthma. When health care professionals (HCPs) understand these pivotal changes and their role in asthma management, they are better able to work with adolescents and help them become effective asthma self-managers. Therefore, this article reviews the cognitive changes that render adolescents ready to care for their asthma, as well as the following psychosocial changes that may hinder or facilitate self-management: independence from caregivers, reliance on peers, identity development, the role of social media in adolescents' lives, and risk-taking behaviors. Each developmental task is discussed in terms of asthma self-management and offers suggestions for HCPs that may help them work more effectively with adolescents with asthma.
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Han YY, Celedón JC. The effects of violence and related stress on asthma. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00479-4. [PMID: 39069155 DOI: 10.1016/j.anai.2024.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/10/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024]
Abstract
In the United States, people living in deprived urban areas and persons in certain minoritized groups are often exposed to violence and affected with asthma, and epidemiologic studies have shown a link between exposure to violence (ETV) and asthma throughout the lifespan. Indeed, ETV at the individual, intrafamilial and community levels has been linked to asthma in children and adults. In this review, we discuss the evidence for a causal relation between ETV and asthma, emphasizing findings published in the last five years. Interpretation of the available evidence is limited by variable quality of the assessment of ETV or asthma, potential recall and selection bias, inability to estimate the relative contribution of various types of violence to the observed associations, lack of objective biomarkers of asthma or asthma endotypes, and inconsistent consideration of potential confounders or modifiers of the ETV-asthma link. Despite such limitations, the aggregate evidence from studies conducted in different locations and populations suggests that ETV affects asthma and asthma outcomes, and that this is explained by direct physiologic effects of violence-related distress and indirect effects (e.g., through risky health behaviors or co-morbidities). Thus, large prospective studies with careful assessment of specific types of ETV, key covariates and comorbidities (including mental illness), and asthma are needed to advance this field. Such research efforts should not preclude screening for maltreatment in children with asthma and ETV-related depression and anxiety in adolescents and adults with asthma. Further, vigorous policies are needed to curtail violence, as such policies could benefit patients with asthma while saving lives.
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Affiliation(s)
- Yueh-Ying Han
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Juan C Celedón
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Weinstein SM, Lee HH, Dziak JJ, Berbaum ML, Zhang T, Avenetti D, Sandoval A, Martin MA. Examining Caregiver- and Family-Level Psychosocial Influences on Child Oral Health Behavioral Outcomes in Racially and Economically Minoritized Urban Families. CHILDREN (BASEL, SWITZERLAND) 2024; 11:882. [PMID: 39062331 PMCID: PMC11276087 DOI: 10.3390/children11070882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/10/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVES Understanding the pathways linking caregiver- and family-level psychosocial factors and child oral health behaviors is critical for addressing oral health disparities. The current study examined the associations between caregiver psychosocial functioning and family chaos and child toothbrushing behaviors in children at high risk for poor oral health outcomes. METHODS Data were drawn from the baseline wave of the CO-OP Chicago Cohort Study (U01DE030067), a longitudinal study on child/caregiver dyads exploring oral health behaviors and caries development in young children (N = 296 dyads; child mean age = 5.36, SD = 1.03; caregiver mean age = 33.8 years, SD = 6.70; caregiver race = 43% Black; caregiver ethnicity = 55% Latinx). The oral health behavioral outcomes included child toothbrushing frequency, child plaque levels, and caregiver assistance with child toothbrushing. The data included demographics; caregiver depression, anxiety, post-traumatic stress disorder (PTSD) symptoms, social functioning, social support, and resilience; and family-level household chaos. RESULTS Multiple regression models indicated that greater household chaos was significantly related to lower caregiver assistance with child toothbrushing (p = 0.0075). Additionally, caregiver anxiety and PTSD symptoms as well as number of children in the home significantly predicted higher levels of household chaos (p < 0.01). Notably, 18% of caregivers reported clinically significant PTSD. The relationships between caregiver-level psychosocial factors and child oral health behaviors were not significant. CONCLUSIONS The results suggest household chaos may play an important role in child oral health behaviors and highlight the importance of investigating family-level factors for understanding and addressing child oral health risk.
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Affiliation(s)
- Sally M. Weinstein
- Department of Psychiatry, College of Medicine, University of Illinois Chicago, 1747 W. Roosevelt Road, Chicago, IL 60608, USA;
| | - Helen H. Lee
- Department of Anesthesiology, College of Medicine, University of Illinois Chicago, 1740 W. Taylor Street, Chicago, IL 60612, USA
- Institute for Health Research and Policy, University of Illinois Chicago, 1747 W. Roosevelt Road, Chicago, IL 60608, USA; (J.J.D.); (M.L.B.); (T.Z.); (D.A.); (A.S.); (M.A.M.)
| | - John J. Dziak
- Institute for Health Research and Policy, University of Illinois Chicago, 1747 W. Roosevelt Road, Chicago, IL 60608, USA; (J.J.D.); (M.L.B.); (T.Z.); (D.A.); (A.S.); (M.A.M.)
| | - Michael L. Berbaum
- Institute for Health Research and Policy, University of Illinois Chicago, 1747 W. Roosevelt Road, Chicago, IL 60608, USA; (J.J.D.); (M.L.B.); (T.Z.); (D.A.); (A.S.); (M.A.M.)
| | - Tong Zhang
- Institute for Health Research and Policy, University of Illinois Chicago, 1747 W. Roosevelt Road, Chicago, IL 60608, USA; (J.J.D.); (M.L.B.); (T.Z.); (D.A.); (A.S.); (M.A.M.)
| | - David Avenetti
- Institute for Health Research and Policy, University of Illinois Chicago, 1747 W. Roosevelt Road, Chicago, IL 60608, USA; (J.J.D.); (M.L.B.); (T.Z.); (D.A.); (A.S.); (M.A.M.)
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois Chicago, 801 S. Paulina Street, Chicago, IL 60612, USA
| | - Anna Sandoval
- Institute for Health Research and Policy, University of Illinois Chicago, 1747 W. Roosevelt Road, Chicago, IL 60608, USA; (J.J.D.); (M.L.B.); (T.Z.); (D.A.); (A.S.); (M.A.M.)
| | - Molly A. Martin
- Institute for Health Research and Policy, University of Illinois Chicago, 1747 W. Roosevelt Road, Chicago, IL 60608, USA; (J.J.D.); (M.L.B.); (T.Z.); (D.A.); (A.S.); (M.A.M.)
- Department of Pediatrics, College of Medicine, University of Illinois Chicago, 840 S. Wood Street, Chicago, IL 60612, USA
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Lima VBD, Vazquez VS, Campos ACP, Santos LMD, Cruz ÁA. Exposure to intimate partner violence and lack of asthma control in adults: a cross-sectional study. SAO PAULO MED J 2023; 141:e2022336. [PMID: 37311135 DOI: 10.1590/1516-3180.2022.0336.r2.30032023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 03/29/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Asthma is a chronic airway disease that affects 339 million people worldwide. It is a heterogeneous disease with different risks, including in family environments, where intimate partner violence occurs. OBJECTIVE This study aimed to investigate the possible association between psychosocial factors and asthma control in adults exposed to intimate partner violence. DESIGN AND SETTING This cross-sectional study was conducted at a Brazilian public higher education institution in Salvador, Bahia, Brazil. METHODS The study population consisted of adults clinically diagnosed with severe asthma and those with mild/moderate asthma identified at an asthma referral outpatient clinic. The sample comprised 492 participants who underwent clinical evaluation and completed questionnaires to assess asthma control, depression, stress, and resilience. The Conflict Tactics Scale, which measures tactics for managing marital conflicts, was used to estimate the level of intimate partner violence. RESULTS Of the 492 participants, 76.2% were women and 91% self-referenced color black/brown, 37.8% reported low family income, 87.4% reported low education level, 71.7% reported high stress, 32.5% reported low resilience, 18.5% reported moderate or severe depression, 83.3% reported resolute negotiation, 49.4% reported major psychological aggression, 19.6% reported major physical aggression, 15.5% reported major injury, and 7.3% reported major sexual coercion. Regression analysis revealed that sex was an effect modifier. CONCLUSION Women in situations of social vulnerability, with low income and poor education, with depression, severe asthma, and those who used aggression to resolve marital conflicts had a profile associated with a lack of asthma control.
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Affiliation(s)
- Valmar Bião de Lima
- BSc. Statistician and Researcher, Programa de Controle da Asma na Bahia (ProAR), Salvador (BA), Brazil; and Doctoral Student, Postgraduate Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Vanessa Serva Vazquez
- PhD. Psychologist and Researcher, Programa de Controle da Asma na Bahia (ProAR),, Salvador (BA), Brazil
| | - Ana Clara Paixão Campos
- PhD. Doctoral Student, Centro de Integração de Dados e Conhecimentos para Saúde (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Letícia Marques Dos Santos
- PhD. Psychologist, Postgraduate Program in Collective Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil; and Associate Professor, Instituto de Humanidades Artes e Ciências (IHCA), Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Álvaro Augusto Cruz
- PhD. Physician, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil; CNPq Researcher 1 B, founder of the Program for the Control of Asthma in Bahia (ProAR) and Executive Director of the ProAR Foundation, Salvador (BA), Brazil
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Adolescents' reports of chaos within the family home environment: Investigating associations with lifestyle behaviours and obesity. PLoS One 2023; 18:e0280737. [PMID: 36701326 PMCID: PMC9879426 DOI: 10.1371/journal.pone.0280737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Disorganised and chaotic home environments may hinder the adoption of healthy lifestyle behaviours and contribute to excessive weight gain among adolescents. We examined whether self-reported level of chaos within the family home environment is associated with lifestyle behaviours and obesity in adolescent girls and boys. METHODS Cross-sectional data from the 3rd wave of the Québec Adipose and Lifestyle Investigation in Youth (QUALITY) study were analyzed. The sample consisted of n = 377 White adolescents with a history of parental obesity. Home environment chaos was measured using the Confusion, Hubbub, and Order Scale (CHAOS) analyzed both continuously and dichotomized as high vs. low chaos. Body Mass Index z-scores (zBMI) were computed using WHO standards from measured weight and height. Physical activity (7-day accelerometry), vegetable and fruit intake (three 24-hour diet recalls), and leisure screen time and sleep duration (questionnaire) were assessed. Sex-specific linear regression models were used to estimate associations between level of family home environment chaos, lifestyle behaviours and zBMI. RESULTS The overall level of chaos was low in our study sample, with higher reported levels among girls compared to boys. Among girls, high (vs low) chaos was associated with shorter sleep duration (hours/day) (B = - 0.44, 95% CI: -0.75, -0.14). No associations were observed for other lifestyle behaviours or for zBMI. CONCLUSION In this sample of adolescents with a parental history of obesity, higher household chaos was not associated with obesity or lifestyle behaviours, except for sleep duration among girls. Replication of findings in more diverse samples is indicated.
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Pappalardo AA, Martin MA, Weinstein S, Pugach O, Mosnaim GS. Improving Adherence in Urban Youth With Asthma: Role of Community Health Workers. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3186-3193. [PMID: 36058514 PMCID: PMC10091238 DOI: 10.1016/j.jaip.2022.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The Asthma Action at Erie Trial is a comparative effectiveness trial comparing a community health worker (CHW) versus certified asthma educator (AE-C) intervention in low-income minority children. OBJECTIVES Determine whether asthma medication possession, adherence, technique, and triggers differ in children receiving an asthma CHW compared with an AE-C intervention. METHODS Children with uncontrolled asthma were randomized to receive 10 CHW home visits or 2 AE-C sessions in a clinic over 1 year. Asthma medication possession and inhaler technique were observed; adherence was measured using self-report, dose counters, and electronic monitors. Environmental triggers were captured by self-report, observation, and objective measurement. Mixed effects linear and logistic regression models were estimated for continuous and binary outcomes. RESULTS Children (n = 223) were mainly Hispanic (85%) and ages 5 to 16 years. Quick-relievers (82%), spacers (72%), and inhaled corticosteroid (ICS)-containing medications (44%) were tracked. Of those with uncontrolled asthma, 35% lacked an ICS prescription (n = 201). Children in the CHW arm were more likely to have an ICS prescription at 12 months (odds ratio 2.39; 95% CI 0.99-5.79). Inhaler technique improved 9.8% in the CHW arm at 6 months (95% CI 4.20-15.32). The ICS adherence improved in the CHW arm at 12 months, with a 16.0% (95% CI 2.3-29.7; P = .02) difference between arms. Differences in trigger exposure over time were not observed between arms. CONCLUSIONS The CHW services were associated with improved ICS adherence and inhaler technique, compared with AE-C services. More information is needed to determine the necessary dosage of intervention to sustain adherence.
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Affiliation(s)
- Andrea A Pappalardo
- Department of Medicine and Pediatrics, University of Illinois at Chicago of Medicine, Chicago, Ill.
| | - Molly A Martin
- Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, Ill
| | - Sally Weinstein
- Department of Psychiatry, University of Illinois at Chicago College of Medicine, Chicago, Ill
| | - Oksana Pugach
- Department of Biostatistics, Corevitas, LLC, Waltham, Mass
| | - Giselle S Mosnaim
- Division of Allergy and Immunology, Department of Medicine, NorthShore University Health System, Evanston, Ill
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Huang Y, Pan Y, Chen M, Jiang H, Ren L, Wang Y, Zhang L, Dong C. The resilient process of the family after diagnosis of childhood chronic illness: a qualitative meta-synthesis. J Pediatr Nurs 2022; 67:e180-e190. [PMID: 35906113 DOI: 10.1016/j.pedn.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 12/14/2022]
Abstract
PROBLEM Childhood chronic illness has a serious effect on the whole family. As there is yet little known about how the families adjust to the diagnosis of childhood chronic illness, this qualitative meta-synthesis aims to further our knowledge regarding the resilient process. ELIGIBILITY CRITERIA A meta-synthesis review was conducted to explore the resilient process of the family after diagnosis of childhood chronic illness using nine electronic databases PubMed (MEDLINE), Web of Science, the Cochrane Library, SCOPUS, PsycINFO, CINAHL, Wan Fang, CBM, and CNKI from each database's inception to December 31,2020. Snowball sampling and manual search were performed to identify other relevant studies. SAMPLE Seventeen qualitative studies met the inclusion criteria and were analyzed into meta-synthesis. RESULTS Three key meta-themes were identified across the studies: (a) disintegration and vulnerability: emotional fluctuation and household chaos; (b) adjustment and adaptation: struggle with family needs; (c) recovery and reconstruction: growth and expectation. CONCLUSION Family adjustment to childhood chronic illness presents a complex, multifaceted and dynamic process. Identifying characteristics of family processes provides some practical interventions for families with a chronically ill child. IMPLICATIONS There is a need for all health professionals and social care services to be aware of the experience of family adjustment of children diagnosed with chronic illness. The specific intervention targeted at different periods of the family adjustment process is warranted to help families to recover from crises and deal better with challenges.
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Affiliation(s)
- Yingying Huang
- The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yinzhu Pan
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Meijia Chen
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Hao Jiang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Liya Ren
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Yuxin Wang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Liping Zhang
- The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Chaoqun Dong
- School of Nursing, Wenzhou Medical University, Wenzhou, China.
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Baker JA, Moore HM, Brinton JT, Federico MJ. Comprehensive In-Patient Education Consult for Asthma Exacerbations. Respir Care 2022; 67:682-687. [PMID: 35228306 PMCID: PMC9994195 DOI: 10.4187/respcare.08778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Asthma is the most common chronic disease leading to hospital admissions and readmissions in childhood. Bedside nurses and respiratory therapists are the primary asthma educators, but they may lack time or knowledge to provide comprehensive asthma education and identify barriers to care. Patients and their parent(s) may benefit from comprehensive education and assessment of barriers from a certified asthma educator. METHODS A team of certified asthma educators used a quality improvement method to create an in-patient asthma education consulting service. The in-patient pulmonary consult and medical teams referred subjects ≥ 1 y in age with a new or existing diagnosis of asthma who had been admitted to the ICU or identified as having concerns for poor medication adherence to the asthma consult. The asthma consult provided face-to-face education with the subject and parent(s), addressed barriers to the plan of care, and helped facilitate appointments to an asthma specialist after discharge. RESULTS There were 126 subjects eligible for the asthma consult pilot implemented October 1, 2018-April 30, 2020. The asthma consult saw 52 subjects. Subjects who received consults had a higher rate of previous health care utilization and existing specialist for asthma. After the in-patient stay, the odds of returning to the emergency department/urgent care (UC) or hospital within the following 12 months did not differ between asthma consult and control group. However, after adjusting for covariates of age, race, ethnicity, previous health care utilization, and existing specialist, there was a significant difference in the odds of readmission and revisits (adjusted odds ratio 0.39 [95% CI 0.16-0.98], P = .04) for the asthma consult group compared to the control group. CONCLUSIONS Providing comprehensive, face-to-face asthma education and working with subjects and their parent(s) to address barriers to medication adherence and facilitate specialty follow-up post discharge decreased health care utilization.
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Affiliation(s)
- Joyce A Baker
- The Breathing Institute at Children's Hospital Colorado, Aurora, Colorado.
| | - Heather M Moore
- The Breathing Institute at Children's Hospital Colorado, Aurora, Colorado
| | - John T Brinton
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Monica J Federico
- The Breathing Institute at Children's Hospital Colorado and Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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Schacter HL, Slatcher RB, Rodriguez-Stanley J, Houpt R, Zilioli S. Effects of daily peer problems on sleep and the severity of pediatric asthma symptoms. Health Psychol 2022; 41:409-416. [PMID: 35467897 PMCID: PMC9837798 DOI: 10.1037/hea0001177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Although psychosocial stressors in the home environment place children at risk for physical health problems, less is known about whether or how peer stressors contribute to health problems in youth. The current study investigated associations between daily peer problems and asthma symptoms among adolescents with asthma. The possible mediating role of nightly sleep disturbance and the moderating role of adolescent mental health were also examined. METHOD Adolescents (N = 297) with asthma reported on peer problems, nighttime awakenings, sleep quality, and asthma symptoms over 4 days. Youth also self-administered daily peak expiratory flow rate (PEFR) assessments, and parents reported on their children's anxious-depressive symptoms. RESULTS Adolescents encountering more daily peer problems experienced more severe asthma symptoms, but not lower PEFR. Mediation analyses demonstrated that associations between daily peer problems and subjective asthma symptoms were partially explained by more nighttime awakenings and lower sleep quality, even after accounting for potentially confounding demographic factors and adolescents' daily experiences of familial stress. However, these indirect pathways did not vary depending on youth anxious-depressive symptoms. CONCLUSIONS The findings provide novel evidence for everyday peer stress as a developmentally relevant health risk factor among adolescents with asthma. Insofar as daily peer problems were associated with elevated asthma symptoms via impaired sleep, psychosocial interventions focusing on the peer context may help mitigate maladaptive health behaviors and asthma morbidity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Samuele Zilioli
- Wayne State University, Department of Psychology,Wayne State University, Department of Family Medicine and Public Health Sciences
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Harshness and unpredictability: Childhood environmental links with immune and asthma outcomes. Dev Psychopathol 2022; 34:587-596. [PMID: 34924078 DOI: 10.1017/s0954579421001577] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The environment has pervasive impacts on human development, and two key environmental conditions - harshness and unpredictability - are proposed to be instrumental in tuning development. This study examined (1) how harsh and unpredictable environments related to immune and clinical outcomes in the context of childhood asthma, and (2) whether there were independent associations of harshness and unpredictability with these outcomes. Participants were 290 youth physician-diagnosed with asthma. Harshness was assessed with youth-reported exposure to violence and neighborhood-level murder rate. Unpredictability was assessed with parent reports of family structural changes. Youth also completed measures of asthma control as well as asthma quality of life and provided blood samples to assess immune profiles, including in vitro cytokine responses to challenge and sensitivity to inhibitory signals from glucocorticoids. Results indicated that harshness was associated with more pronounced pro-inflammatory cytokine production following challenge and less sensitivity to the inhibitory properties of glucocorticoids. Furthermore, youth exposed to harsher environments reported less asthma control and poorer quality of life. All associations with harshness persisted when controlling for unpredictability. No associations between unpredictability and outcomes were found. These findings suggest that relative to unpredictability, harshness may be a more consistent correlate of asthma-relevant immune and clinical outcomes.
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Holmes LC, Orom H, Lehman HK, Lampkin S, Halterman JS, Akiki V, Supernault-Sarker AA, Butler SB, Piechowski D, Sorrentino PM, Chen Z, Wilding GE. A pilot school-based health center intervention to improve asthma chronic care in high-poverty schools. J Asthma 2022; 59:523-535. [PMID: 33322963 PMCID: PMC8281495 DOI: 10.1080/02770903.2020.1864823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To test the feasibility and effectiveness of a multifaceted intervention administered through school-based health centers (SBHCs) to improve asthma control for children in high-poverty schools with not well controlled asthma. METHODS Students 4-14 years old with persistent asthma were enrolled from three SBHCs. The centers' advanced practice providers received training on evidence-based asthma guidelines. Students randomized to the intervention received directly observed therapy of their asthma controller medication, medication adjustments as needed by the centers' providers, and daily self-management support. Students randomized to usual care were referred back to their primary care provider (PCP) for routine asthma care. RESULTS We enrolled 29 students. Students in the intervention group received their controller medication 92% of days they were in school. Ninety-four percent of follow-up assessments were completed. During the study, 11 of 12 intervention students had a step-up in medication; 2 of 15 usual care students were stepped up by their PCP. Asthma Control Test scores did not differ between groups, although there were significant improvements from baseline to the 7 month follow-up within each group (both p < .01). Both FEV1% predicted and FEV1/FVC ratio significantly worsened in the usual care group (both p = .001), but did not change in the intervention group (p = .76 and .28 respectively). CONCLUSIONS Our pilot data suggest that a multifaceted intervention can be feasibly administered through SBHCs in communities with health disparities. Despite the small sample size, spirometry detected advantages in the intervention group. Further study is needed to optimize the intervention and evaluate outcomes. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03032744.
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Affiliation(s)
- Lucy C. Holmes
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA,Corresponding author: Lucy C. Holmes, Department of Pediatrics, 1001 Main Street, Buffalo, New York 14203, (716) 323-0034,
| | - Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
| | - Heather K. Lehman
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Stacie Lampkin
- Department of Pharmacy Practice, D’Youville College, Buffalo, NY, USA
| | - Jill S. Halterman
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, USA
| | - Vanessa Akiki
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Alicia A. Supernault-Sarker
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | | | - Denise Piechowski
- John R. Oishei Children’s Hospital, Kaleida Health, Buffalo, NY, USA
| | | | - Ziqiang Chen
- Department of Biostatistics, University at Buffalo School of Public Health and Health Professions, Buffalo, NY USA
| | - Gregory E. Wilding
- Department of Biostatistics, University at Buffalo School of Public Health and Health Professions, Buffalo, NY USA
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Lu MA, Eckmann T, Ruvalcaba E, McQuaid EL, Rand CS, Riekert KA, Eakin MN. Family management of asthma in Head Start preschool children. Ann Allergy Asthma Immunol 2022; 128:178-183. [PMID: 34774736 PMCID: PMC8810596 DOI: 10.1016/j.anai.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Urban minority preschool children are disproportionately affected by asthma with increased asthma morbidity and mortality. It is important to understand how families manage asthma in preschool children to improve asthma control. OBJECTIVE To evaluate family asthma management and asthma outcomes among a low-income urban minority population of Head Start preschool children. METHODS The family asthma management system scale (FAMSS) evaluates how families manage a child's asthma. A total of 388 caregivers completed the FAMSS at baseline. Asthma outcomes were evaluated at baseline and prospectively at 6 months, including asthma control (based on the Test for Respiratory and Asthma Control in Kids), courses of oral corticosteroids (OCSs) required, and caregiver health-related quality of life (Pediatric Asthma Caregiver's Quality of Life Questionnaire [PACQLQ]). Multiple regression models evaluated the relationship between the FAMSS total score, FAMSS subscales, and asthma outcomes. RESULTS Higher FAMSS total scores were associated with fewer courses of OCSs required (b = -0.23, P < .01) and higher PACQLQ scores (b = 0.07, P < .05). At baseline, higher integration subscale scores (b = -0.19, P < .05) were associated with fewer courses of OCSs required, and higher family response scores were associates with higher PACQLQ scores (b = 0.06, P < .05). Nevertheless, higher collaboration scores were associated with lower PACQLQ at baseline (b = -0.06, P < .05) and 6 months (b = -0.07, P < .05). CONCLUSION Among this population of low-income minority preschool children, understanding how a family manages their child's asthma may help identify gaps for education to possibly improve caregiver asthma-related quality of life and reduce courses of OCSs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01519453 (https://clinicaltrials.gov/ct2/show/NCT01519453); protocol available from meakin1@jhmi.edu.
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Affiliation(s)
- Monica A Lu
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas Eckmann
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth Ruvalcaba
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth L McQuaid
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island; Department of Pediatrics, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Cynthia S Rand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin A Riekert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Abstract
Asthma is common in children and exacerbations are usually triggered by respiratory viruses. There was considerable concern about the impact of COVID-19 on children with asthma. It was expected that children with asthma would fare poorly during the pandemic. However, the reported effect of the COVID-19 pandemic on pediatric asthma including acute asthma admissions, does not appear to be significant, but this needs careful follow-up. The socioeconomic effects of the pandemic and reduced healthcare access could potentially impact on ongoing delivery of health care in chronic respiratory conditions including asthma, especially in resource-poor settings. Children with chronic asthma need to be treated as per internationally published guidelines with innovative models of disease monitoring and ongoing care during the pandemic. During the pandemic, children with acute asthma need to be managed carefully based on local guidelines and using strict infection control policies. The use of technology such as telehealth and various tools of asthma management including questionnaires and digital monitoring will play an important role in asthma management during the pandemic. Medical professionals, healthcare administrators, and governments should be sensitive to the evolving needs of the community and work closely to continue to provide services in a challenging yet unresolved pandemic.
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Keeping Pace with Adolescent Asthma: A Practical Approach to Optimizing Care. Pulm Ther 2021; 8:123-137. [PMID: 34743311 PMCID: PMC8571974 DOI: 10.1007/s41030-021-00177-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/25/2021] [Indexed: 10/30/2022] Open
Abstract
Known for their pre-occupation with body image, self-identity creation, peer acceptance, and risk-taking behaviors, adolescents with asthma face unique challenges. Asthma is a heterogeneous disease and accurate diagnosis requires assessment through detailed clinical history, examination, and objective tests. Diagnostic challenges exist as many adolescents can present with asthma-like symptoms but do not respond to asthma treatment and risk being mis-diagnosed. Under-recognition of asthma symptoms and denial of disease severity must also be addressed. The over-reliance on short-acting beta-agonists in the absence of anti-inflammatory therapy for asthma is now deemed unsafe. Adolescents with mild asthma benefit from symptom-driven treatment with combination inhaled corticosteroids (ICS) and long-acting beta-agonist (LABA) on an as-required basis. For those with moderate-to-persistent asthma requiring daily controller therapy, maintenance and reliever therapy using the same ICS-LABA controller simplifies treatment regimes, while serving to reduce exacerbation risk. A developmentally staged approach based on factors affecting asthma control in early, middle, and late adolescence enables better understanding of the individual's therapeutic needs. Biological, psychological, and social factors help formulate a risk assessment profile in adolescents with difficult-to-treat and severe asthma. Smoking increases risks of developing asthma symptoms, lung function deterioration, and asthma exacerbations. Morbidity associated with e-cigarettes or vaping calls for robust efforts towards smoking and vaping cessation and abstinence. As adolescents progress from child-centered to adult-oriented care, coordination and planning are required to improve their self-efficacy to ready them for transition. Frequent flare-ups of asthma can delay academic attainment and adversely affect social and physical development. In tandem with healthcare providers, community and schools can link up to help shoulder this burden, optimizing care for adolescents with asthma.
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15
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Rodríguez EM, Pollack CE, Keet C, Peng RD, Balcer-Whaley S, Custer J, Cimbolic P, Matsui EC. Neighborhoods, Caregiver Stress, and Children's Asthma Symptoms. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:1005-1012.e1. [PMID: 34626856 DOI: 10.1016/j.jaip.2021.08.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/29/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neighborhood and caregiver characteristics have each been linked to children's asthma outcomes, but less is known about how caregiver psychosocial functioning may explain the link between neighborhood characteristics and asthma outcomes. OBJECTIVE To examine associations between neighborhood safety, caregiver stress and depressive symptoms, and children's asthma outcomes, and to evaluate whether caregiver stress and depressive symptoms mediate the relationship between neighborhood safety and asthma outcomes. METHODS We analyzed baseline data from a prospective cohort study of the effects of a housing mobility program on children's asthma-related outcomes. Age- and sex-adjusted models evaluated associations of neighborhood safety, and caregiver stress and depressive symptoms, with children's asthma symptoms and exacerbations. RESULTS Participants were 140 low-income children with persistent asthma (98% Black participants; 53% males; mean age, 9.0 years) with an average of 7.1 ± 5.3 maximum symptom days per 2 weeks. Lower neighborhood safety, and higher caregiver stress and depressive symptoms, were associated with higher asthma symptoms, but not exacerbations, in adjusted models (eg, for neighborhood safety, maximum symptom days: odds ratio, 1.41; 95% CI, 1.07-1.88; for caregiver stress, maximum symptom days: odds ratio, 1.08; 95% CI, 1.01-1.15; for depressive symptoms, maximum symptom days: odds ratio, 1.05; 95% CI, 1.00-1.11). Exploratory analyses suggested that caregiver stress partially mediated associations between neighborhood safety and asthma symptoms for children in unsafe neighborhoods. CONCLUSIONS Neighborhood safety was associated with children's asthma symptoms independent from caregiver stress and depressive symptoms, although for children in unsafe neighborhoods, caregiver stress may partially mediate this association. Findings suggest the importance of targeting multiple systems to improve children's asthma outcomes.
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Affiliation(s)
- Erin M Rodríguez
- Department of Educational Psychology, University of Texas at Austin, Austin, Texas
| | | | | | | | | | - James Custer
- Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Pete Cimbolic
- Baltimore Regional Housing Partnership, Baltimore, Md
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16
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Weinstein SM, Pugach O, Rosales G, Mosnaim GS, Orozco K, Pappalardo AA, Martin MA. Psychosocial Moderators and Outcomes of a Randomized Effectiveness Trial for Child Asthma. J Pediatr Psychol 2021; 46:673-687. [PMID: 33616185 PMCID: PMC8291673 DOI: 10.1093/jpepsy/jsab011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Psychosocial factors play a role in child asthma morbidity and disparities, but their impact on asthma intervention effectiveness is less understood. This study examined how child, parent, and family psychosocial factors moderated asthma response to, and changed in response to, 2 community asthma interventions among urban minority youth. METHODS Asthma Action at Erie was a randomized comparative effectiveness trial examining a community health worker (CHW) home intervention versus certified asthma educator (AE-C) services for children aged 5-16 with uncontrolled asthma (N = 223; mean age = 9.37, SD = 3.02; 85.2% Hispanic). Asthma control was assessed via the Asthma Control Test (ACT)/childhood ACT and activity limitation. Baseline child/parent depression and posttraumatic stress disorder (PTSD) symptoms, family chaos, and social support were examined as treatment moderators. We also tested intervention effects on psychosocial outcomes. RESULTS For parents with higher baseline depression symptoms, youth in the CHW group had greater ACT improvement by 24 months (7.49 points) versus AE-C (4.76 points) and 51% reduction in days of limitation by 6 months versus AE-C (ß = -0.118; p = .0145). For higher parent PTSD symptoms, youth in CHW had 68% fewer days of limitation at 24 months versus AE-C (ß = -0.091; p = .0102). Psychosocial outcomes did not vary by group, but parent depression, parent and child PTSD symptoms, and social support improved for all. CONCLUSIONS CHW intervention was associated with improved asthma control among families with higher parent strain. Findings have implications for utilizing tailored CHW home interventions to optimize asthma outcomes in at-risk families.
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Affiliation(s)
| | - Oksana Pugach
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - Genesis Rosales
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - Giselle S Mosnaim
- Department of Allergy, Immunology & Asthma, NorthShore University Health System
| | - Kimberly Orozco
- Institute for Health Research and Policy, University of Illinois at Chicago
| | - Andrea A Pappalardo
- Department of Pediatrics, University of Illinois at Chicago
- Department of Medicine, University of Illinois at Chicago
| | - Molly A Martin
- Institute for Health Research and Policy, University of Illinois at Chicago
- Department of Pediatrics, University of Illinois at Chicago
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Martin MA, Pugach O, Mosnaim G, Weinstein S, Rosales G, Roy A, Pappalardo AA, Walton S. Community Health Worker Asthma Interventions for Children: Results From a Clinically Integrated Randomized Comparative Effectiveness Trial (2016‒2019). Am J Public Health 2021; 111:1328-1337. [PMID: 34111359 PMCID: PMC8355214 DOI: 10.2105/ajph.2021.306272] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To compare asthma control for children receiving either community health worker (CHW) or certified asthma educator (AE-C) services. Methods. The Asthma Action at Erie Trial is a comparative effectiveness trial that ran from 2016 to 2019 in Cook County, Illinois. Participants (aged 5‒16 years with uncontrolled asthma) were randomized to 10 home visits from clinically integrated asthma CHWs or 2 in-clinic sessions from an AE-C. Results. Participants (n = 223) were mainly Hispanic (85%) and low-income. Both intervention groups showed significant improvement in asthma control scores over time. Asthma control was maintained after interventions ended. The CHW group experienced a greater improvement in asthma control scores. One year after intervention cessation, the CHW group had a 42% reduction in days of activity limitation relative to the AE-C group (b = 0.58; 95% confidence interval = 0.35, 0.96). Conclusions. Both interventions were associated with meaningful improvements in asthma control. Improvements continued for 1 year after intervention cessation and were stronger with the CHW intervention. Public Health Implications. Clinically integrated asthma CHW and AE-C services that do not provide home environmental remediation equipment may improve and sustain asthma control.
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Affiliation(s)
- Molly A Martin
- Molly A. Martin is with the Department of Pediatrics and the Institute for Health and Research Policy at the University of Illinois at Chicago. Oksana Pugach and Genesis Rosales are with the Institute for Health and Research Policy at the University of Illinois at Chicago. Giselle Mosnaim is with Northshore University Health System, Evanston, IL. Sally Weinstein is with the Department of Psychiatry at the University of Illinois at Chicago. Angkana Roy is with Erie Family Health Center, Chicago. Andrea A. Pappalardo is with the Department of Pediatrics at the University of Illinois at Chicago. Surrey Walton is with the College of Pharmacy at the University of Illinois at Chicago
| | - Oksana Pugach
- Molly A. Martin is with the Department of Pediatrics and the Institute for Health and Research Policy at the University of Illinois at Chicago. Oksana Pugach and Genesis Rosales are with the Institute for Health and Research Policy at the University of Illinois at Chicago. Giselle Mosnaim is with Northshore University Health System, Evanston, IL. Sally Weinstein is with the Department of Psychiatry at the University of Illinois at Chicago. Angkana Roy is with Erie Family Health Center, Chicago. Andrea A. Pappalardo is with the Department of Pediatrics at the University of Illinois at Chicago. Surrey Walton is with the College of Pharmacy at the University of Illinois at Chicago
| | - Giselle Mosnaim
- Molly A. Martin is with the Department of Pediatrics and the Institute for Health and Research Policy at the University of Illinois at Chicago. Oksana Pugach and Genesis Rosales are with the Institute for Health and Research Policy at the University of Illinois at Chicago. Giselle Mosnaim is with Northshore University Health System, Evanston, IL. Sally Weinstein is with the Department of Psychiatry at the University of Illinois at Chicago. Angkana Roy is with Erie Family Health Center, Chicago. Andrea A. Pappalardo is with the Department of Pediatrics at the University of Illinois at Chicago. Surrey Walton is with the College of Pharmacy at the University of Illinois at Chicago
| | - Sally Weinstein
- Molly A. Martin is with the Department of Pediatrics and the Institute for Health and Research Policy at the University of Illinois at Chicago. Oksana Pugach and Genesis Rosales are with the Institute for Health and Research Policy at the University of Illinois at Chicago. Giselle Mosnaim is with Northshore University Health System, Evanston, IL. Sally Weinstein is with the Department of Psychiatry at the University of Illinois at Chicago. Angkana Roy is with Erie Family Health Center, Chicago. Andrea A. Pappalardo is with the Department of Pediatrics at the University of Illinois at Chicago. Surrey Walton is with the College of Pharmacy at the University of Illinois at Chicago
| | - Genesis Rosales
- Molly A. Martin is with the Department of Pediatrics and the Institute for Health and Research Policy at the University of Illinois at Chicago. Oksana Pugach and Genesis Rosales are with the Institute for Health and Research Policy at the University of Illinois at Chicago. Giselle Mosnaim is with Northshore University Health System, Evanston, IL. Sally Weinstein is with the Department of Psychiatry at the University of Illinois at Chicago. Angkana Roy is with Erie Family Health Center, Chicago. Andrea A. Pappalardo is with the Department of Pediatrics at the University of Illinois at Chicago. Surrey Walton is with the College of Pharmacy at the University of Illinois at Chicago
| | - Angkana Roy
- Molly A. Martin is with the Department of Pediatrics and the Institute for Health and Research Policy at the University of Illinois at Chicago. Oksana Pugach and Genesis Rosales are with the Institute for Health and Research Policy at the University of Illinois at Chicago. Giselle Mosnaim is with Northshore University Health System, Evanston, IL. Sally Weinstein is with the Department of Psychiatry at the University of Illinois at Chicago. Angkana Roy is with Erie Family Health Center, Chicago. Andrea A. Pappalardo is with the Department of Pediatrics at the University of Illinois at Chicago. Surrey Walton is with the College of Pharmacy at the University of Illinois at Chicago
| | - Andrea A Pappalardo
- Molly A. Martin is with the Department of Pediatrics and the Institute for Health and Research Policy at the University of Illinois at Chicago. Oksana Pugach and Genesis Rosales are with the Institute for Health and Research Policy at the University of Illinois at Chicago. Giselle Mosnaim is with Northshore University Health System, Evanston, IL. Sally Weinstein is with the Department of Psychiatry at the University of Illinois at Chicago. Angkana Roy is with Erie Family Health Center, Chicago. Andrea A. Pappalardo is with the Department of Pediatrics at the University of Illinois at Chicago. Surrey Walton is with the College of Pharmacy at the University of Illinois at Chicago
| | - Surrey Walton
- Molly A. Martin is with the Department of Pediatrics and the Institute for Health and Research Policy at the University of Illinois at Chicago. Oksana Pugach and Genesis Rosales are with the Institute for Health and Research Policy at the University of Illinois at Chicago. Giselle Mosnaim is with Northshore University Health System, Evanston, IL. Sally Weinstein is with the Department of Psychiatry at the University of Illinois at Chicago. Angkana Roy is with Erie Family Health Center, Chicago. Andrea A. Pappalardo is with the Department of Pediatrics at the University of Illinois at Chicago. Surrey Walton is with the College of Pharmacy at the University of Illinois at Chicago
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18
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Zheang M, Rodriguez E, Alvarado C, Correa R, Kahlor LA, Matsui EC. Exploring low-income African American and Latinx caregiver perspectives on asthma control in their children and reactions to messaging materials. J Asthma 2021; 59:1269-1275. [PMID: 33722170 DOI: 10.1080/02770903.2021.1903918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND African-American and Latinx children suffer from higher rates of uncontrolled asthma and poorer outcomes compared to white children. Sociocultural factors play a prominent role in how caregivers navigate asthma control for their children. OBJECTIVES (1) Explore the knowledge, perceptions and behaviors of Latinx and African-American caregivers related to their children's asthma and identify barriers to achieving asthma control; and (2) Elicit caregiver responses to messaging materials intended to help them better recognize uncontrolled asthma and seek timely medical treatment. METHODS Study participants were recruited and screened to meet the following inclusion criteria: African-American or Latinx race/ethnicity, household income at or below 185% of the federal poverty line, and at least one child diagnosed with asthma with symptom frequency consistent with uncontrolled asthma according to national guidelines. Participants attended one of three moderator-led focus groups. The transcripts were qualitatively analyzed using a thematic analysis approach. RESULTS Themes emerged among the nineteen participants related to asthma assessment, management, emotion, support, and trust. Caregivers exhibited gaps in their asthma knowledge, especially pertaining to the term "asthma control." Caregivers generally worried about asthma emergencies more than the daily impairments caused by uncontrolled asthma. Many were uncomfortable using daily controller medications, citing issues of provider trust and side effect concerns. Caregivers did not recognize uncontrolled asthma in their own child, even after viewing messaging materials informing them of symptom frequency criteria. CONCLUSION Culturally tailored interventions, including public asthma messaging, should address low trust in provider recommendations and caregiver concerns about controller medications.
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Affiliation(s)
- Michelle Zheang
- Dell Medical School, The University of Texas, Austin, TX, USA
| | - Erin Rodriguez
- Department of Educational Psychology, The University of Texas, Austin, TX, USA
| | - Cinthia Alvarado
- Department of Educational Psychology, The University of Texas, Austin, TX, USA
| | - Rebecca Correa
- Department of Population Health, Dell Medical School, The University of Texas, Austin, TX, USA
| | - Lee Ann Kahlor
- School of Advertising and Public Relations, Moody College of Communication, The University of Texas, Austin, TX, USA
| | - Elizabeth C Matsui
- Department of Population Health, Dell Medical School, The University of Texas, Austin, TX, USA.,Department of Pediatrics, Dell Medical School, The University of Texas, Austin, TX, USA
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19
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Multivariate Association of Child Depression and Anxiety with Asthma Outcomes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2399-2405. [PMID: 33677079 DOI: 10.1016/j.jaip.2021.02.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/25/2021] [Accepted: 02/18/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pediatric asthma is associated with increased health services utilization, missed school days, and diminished quality of life. Children with asthma also report more frequent depressive and anxiety symptoms than children without asthma, which may further worsen asthma outcomes. OBJECTIVE The current study investigated the relationship between depressive and anxiety symptoms and 4 asthma outcomes (asthma control, asthma severity, lung function, and asthma-related quality of life) in children (N = 205) with moderate to severe persistent asthma. METHODS The data were analyzed using a canonical correlation analysis, a multivariate framework that allows examination of all variables of interest in the same model. RESULTS We found a statistically significant relationship between symptoms of depression and anxiety and asthma outcomes (1 - Λ = .372; P < .001). A large effect size suggests that 37.2% of variance is shared between depression and anxiety symptoms and 4 asthma outcomes (particularly asthma control and asthma-related quality of life) in the overall sample. Among girls (vs. boys), asthma control (measured by the Asthma Control Test) emerged as a stronger contributor to asthma outcomes compared with boys. CONCLUSIONS These results suggest that psychiatric symptoms, especially anxiety, are associated with poor asthma-related quality of life, and more negative perception of asthma control in girls compared with boys (with no observed sex difference in physiological lung function). Clinicians should consider incorporating questions about psychiatric symptoms as part of routine asthma management, and focus patient education on unique differences in which boys and girls perceive their asthma symptoms.
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20
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Corsi M, Orsini A, Pedrinelli V, Santangelo A, Bertelloni CA, Carli N, Buselli R, Peroni D, Striano P, Dell'Osso L, Carmassi C. PTSD in parents of children with severe diseases: a systematic review to face Covid-19 impact. Ital J Pediatr 2021; 47:8. [PMID: 33446246 PMCID: PMC7807213 DOI: 10.1186/s13052-021-00957-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022] Open
Abstract
CONTEXT The literature agrees on the impact of post-traumatic stress symptoms in parents of seriously ill children but there is less clarity about the real extent and gender differences of this psychopathological risk. The recent Covid-19 outbreak highlighted new burdens for researchers on Post Traumatic Stress Disorder (PTSD) and clear evidence-based knowledge on this issue is timely needed. OBJECTIVE In this review, we present a synthesis of the updated evidence on PTSD rates in parents of children with severe diseases. We also aim to try to understand if research in this field has been refined over time with the long-term intent to better face the new challenges of Covid-19 in the paediatric field. DATA SOURCES The PubMed database was searched. STUDY SELECTION Studies were included if they assessed PTSD in parents of children diagnosed with physical illnesses. DATA EXTRACTION Of 240 studies, 4 were included. RESULTS Analysis of the 4 studies revealed 2 studies with PTSD rates around 20% and in line with previous best-evidence. All 4 studies tried to provide more data on fathers, however, all the studies present the lack of a control group. LIMITATIONS The limited number of studies, which also differ widely in the methodology used. CONCLUSIONS Methodological errors evidenced in all the 4 studies limit their reliability, making the understanding of the paediatric caregiver's concern regarding PTSD still difficult. More sound research is needed.
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Affiliation(s)
- Martina Corsi
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
- Occupational Health Department, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Alessandro Orsini
- Department of Clinical and Experimental Medicine, Pediatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy.
- Pediatric Neurology, Pediatric Department, Azienda Ospedaliero- Universitaria Pisana, University of Pisa, Pisa, Italy.
| | - Virginia Pedrinelli
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Andrea Santangelo
- Department of Clinical and Experimental Medicine, Pediatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Carlo Antonio Bertelloni
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Niccolò Carli
- Department of Clinical and Experimental Medicine, Pediatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Rodolfo Buselli
- Occupational Health Department, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, Pediatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
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Parents' Acceptance of Learning about Mindfulness for Managing Pediatric Asthma. CHILDREN-BASEL 2020; 7:children7120262. [PMID: 33260496 PMCID: PMC7760491 DOI: 10.3390/children7120262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/17/2020] [Accepted: 11/26/2020] [Indexed: 12/04/2022]
Abstract
Background: Emerging research suggests mindfulness may reduce stress and asthma symptoms in children, yet there is a gap in understanding parental views towards learning about mindfulness. Objective: This study aimed to compare the perceived acceptance to learn about mindfulness among parents of children with and without asthma, and to understand differences across income levels. Methods: This was a national, cross-sectional, online survey of parents of children 0–18 years. Acceptance was measured with questions on whether parents believe mindfulness could be beneficial while parenting, and if they would be willing to learn about mindfulness. Comparisons of mindfulness acceptance between income level were conducted using chi-square and Fisher’s exact test. Results: Parents of children with asthma were more likely to be interested in learning about mindfulness from their health care provider compared to those without asthma (46% vs. 38%, p < 0.0001). At all income levels examined in the study, parents (63–75%) of children with asthma indicated that they agreed or strongly agreed that mindfulness can be beneficial when parenting. Conclusion: Findings suggest an opportunity to incorporate mindfulness teaching into asthma care for pediatric patients of all income levels.
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22
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Hunleth J, Spray J, Ruiz S, Maki J, Fedele DA, Prabhakaran S, Forsyth RB, Sykes C, Crepps K, Shepperd J, Bowen D, Waters EA. Situating household management of children's asthma in the context of social, economic, and environmental injustice. J Asthma 2020; 59:70-78. [PMID: 33107771 DOI: 10.1080/02770903.2020.1837159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Structural determinants of health are social, economic, and environmental forces that generate unequal opportunities for resources and unequally distribute exposure to risk. For example, economic constraint, racial discrimination and segregation, and environmental injustice shape population-level asthma prevalence and severity. Structural determinants are especially relevant to consider in clinical settings because they affect everyday household asthma management. OBJECTIVE To examine how structural determinants shape everyday household management of pediatric asthma and offer a framework for providers to understand asthma management in social context. DESIGN Qualitative interviews of caregivers for children with asthma. PARTICIPANTS Participants included 41 caregivers in two U.S. cities: St. Louis, Missouri (n = 25) and Gainesville, Florida (n = 16). Most caregivers were women (83%), Black (73%) and/or had low socioeconomic status (SES; 78%). Caregivers cared for children with asthma aged 0-4 (32%), 5-11 (68%) and 12-17 (54%). APPROACH We carried out narrative interviews with caregivers using an adapted McGill Illness Narrative Interview and using qualitative analysis techniques (e.g. inductive and deductive coding, constant comparison). KEY RESULTS Caregivers highlighted three ways that structural determinants complicated asthma management at home: 1) housing situations, 2) competing household illnesses and issues, and 3) multi-household care. CONCLUSIONS By connecting social, economic, and environmental injustices to the everyday circumstances of asthma management, our study can help providers understand how social contexts challenge asthma management and can open conversations about barriers to adherence and strategies for supporting asthma management at home. We offer recommendations for medical system reform, clinical interactions, and policy advocacy.
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Affiliation(s)
- Jean Hunleth
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Julie Spray
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Sienna Ruiz
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Julia Maki
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | | | - Rachel B Forsyth
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Cassidy Sykes
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Kaylah Crepps
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - James Shepperd
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Deb Bowen
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Erika A Waters
- Division of Public Health Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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23
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Masterson EE, Younglove LB, Perez A, Torres E, Krenz JE, Tchong French MI, Riederer AM, Sampson PD, Metwali N, Min E, Jansen KL, Aisenberg G, Babadi RS, Farquhar SA, Thorne PS, Karr CJ. The home air in agriculture pediatric intervention (HAPI) trial: Rationale and methods. Contemp Clin Trials 2020; 96:106085. [PMID: 32721578 PMCID: PMC7494646 DOI: 10.1016/j.cct.2020.106085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data addressing air quality effects on children with asthma in rural U.S. communities are rare. Our community engaged research partnership previously demonstrated associations between neighborhood NH3 and ambient PM2.5 and asthma in the agricultural lower Yakima Valley of Washington. As a next step, the partnership desired an intervention approach to address concerns about pediatric asthma in this largely Latino immigrant, farm worker community. OBJECTIVE The Home Air in Agriculture Pediatric Intervention (HAPI) sought to examine the effectiveness of enrichment of an existing asthma education program with portable high-efficiency particulate air (HEPA) cleaners designed to reduce PM2.5 and NH3. We investigated the effect of this enriched approach on these exposures and asthma health measures. DESIGN We randomized children with poorly controlled asthma to a control arm (current asthma education program) or an intervention arm (current asthma education program + placement of two indoor air cleaners in the family's home). Outcomes included (1) 14-day integrated samples of indoor air contaminants (PM2.5 and NH3) at baseline and one-year follow-up and (2) child asthma health metrics at baseline, midpoint (4-6 months) and one-year follow-up. These included the Asthma Control Test, symptoms days, clinical utilization, oral corticosteroid use, pulmonary function, fractional exhaled nitric oxide, and urinary leukotriene E4 concentration. DISCUSSION To our knowledge, this is the first randomized HEPA cleaner intervention designed to assess NH3 as well as PM2.5 and to evaluate health outcomes of children with asthma in an agricultural region.
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Affiliation(s)
- Erin E Masterson
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America.
| | - Lisa B Younglove
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Adriana Perez
- Yakima Valley Farm Worker's Clinic, Toppenish, WA, United States of America
| | - Elizabeth Torres
- Northwest Communities Education Center, Radio KDNA, Granger, WA, United States of America
| | - Jennifer E Krenz
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Maria I Tchong French
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Anne M Riederer
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Paul D Sampson
- Department of Statistics, University of Washington, Seattle, WA, United States of America
| | - Nervana Metwali
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, United States of America
| | - Esther Min
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Karen L Jansen
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Gino Aisenberg
- School of Social Work, University of Washington, Seattle, WA, United States of America
| | - Ryan S Babadi
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Stephanie A Farquhar
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America; Department of Health Services, University of Washington, Seattle, WA, United States of America
| | - Peter S Thorne
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, United States of America
| | - Catherine J Karr
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, United States of America; Department of Pediatrics, University of Washington, Seattle, WA, United States of America
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24
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Landeo-Gutierrez J, Celedón JC. Chronic stress and asthma in adolescents. Ann Allergy Asthma Immunol 2020; 125:393-398. [PMID: 32653405 DOI: 10.1016/j.anai.2020.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/20/2020] [Accepted: 07/06/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE First, to review and critically discuss published evidence on psychosocial stressors, stress, and asthma in adolescents and, then, discuss potential future directions in this field. DATA SOURCES The data source is the National Library of Medicine (PubMed database). STUDY SELECTIONS A literature search was conducted for human studies on stressors or stress and asthma between 2000 and 2020. Studies that were published in English, contained a full text, and included adolescents were considered for inclusion in this review. RESULTS Compared with the available body of evidence in children and adults, relatively few studies have been published in adolescents. Current evidence suggests that exposure to stressors (at the individual, family, and community levels) or stress (acute and chronic) is associated with asthma and worse asthma outcomes, but such evidence must be cautiously interpreted owing to limitations in the design or the analytical approach of the published studies. CONCLUSION Future large studies with a prospective design should determine whether and how stressors or stress causes or worsens asthma in adolescents. At present, clinicians should assess exposure to stressors (eg, violence or abuse) and screen for anxiety and depressive disorders when caring for adolescents with asthma in addition to providing referrals to social workers or mental health professionals when appropriate. Public health policies are needed to reduce psychosocial stressors, such as gun violence and racism, in adolescents.
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Affiliation(s)
- Jeremy Landeo-Gutierrez
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Juan C Celedón
- Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Fawcett M, Coughlan C, McGeorge E, Imran A, Bello F, Kneebone R, Watson M. Qualitative evaluation of asthma services for young people: a sequential simulation study. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:134-139. [PMID: 35518560 PMCID: PMC8936663 DOI: 10.1136/bmjstel-2020-000585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/27/2020] [Indexed: 11/04/2022]
Abstract
Background Asthma is the most common chronic disease of childhood and an important preventable cause of mortality in children and young people (CYP). Few studies have brought together CYP and health professionals to understand the patient perspective of routine asthma care. We sought to explore how young people engage with routine asthma care in North West London through sequential simulation. Method We designed a sequential simulation focusing on routine asthma management in young people aged 12-18. A 20 min simulation was developed with four young people to depict typical interactions with school nurses and primary care services. This was performed to a mixed audience of young people, general practitioners (GPs), paediatricians, school nurses and commissioners. Young people were invited to attend by their GPs and through social media channels. Attendees participated in audio-recorded, facilitated discussions exploring the themes arising from the simulation. Recordings were transcribed and subjected to thematic analysis. Results 37 people attended the sequential simulation. Themes arising from postsimulation discussions included recognition of chaotic family lifestyles as a key barrier to accessing care; the importance of strong communication between multidisciplinary team professionals and recognition of the role school nurses can play in delivering routine asthma care. Conclusion Sequential simulation allows healthcare providers to understand routine asthma care for CYP from the patient perspective. We propose improved integration of school nurses into routine asthma care and regular multidisciplinary team meetings to reduce fragmentation, promote interprofessional education and address the widespread professional complacency towards this lethal condition.
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Affiliation(s)
- Martha Fawcett
- Connecting Care for Children, Imperial College Healthcare NHS Trust, London, UK
| | - Charles Coughlan
- Connecting Care for Children, Imperial College Healthcare NHS Trust, London, UK
| | - Elizabeth McGeorge
- Connecting Care for Children, Imperial College Healthcare NHS Trust, London, UK
| | - Ambreen Imran
- Imperial College Centre for Engagement and Simulation Science, Imperial College London, London, UK
| | - Fernando Bello
- Imperial College Centre for Engagement and Simulation Science, Imperial College London, London, UK
| | - Roger Kneebone
- Imperial College Centre for Engagement and Simulation Science, Imperial College London, London, UK
| | - Mando Watson
- Connecting Care for Children, Imperial College Healthcare NHS Trust, London, UK
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26
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Emond JA. Household chaos: a risk factor for adverse child outcomes gains attention in public health. BMC Public Health 2020; 20:596. [PMID: 32357857 PMCID: PMC7193378 DOI: 10.1186/s12889-020-08680-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 01/08/2023] Open
Abstract
Household chaos, characterized by high levels of confusion, disorganization and hurriedness in the home, is increasingly recognized as an important risk factor for adverse child outcomes. Early research on household chaos and child well-being was largely within the field of developmental psychology, where greater levels of household chaos has been associated with greater behavioral, attention and learning problems in young children. The potential influence of household chaos on child health behaviors is more recently gaining attention within public health. A recent study by Marsh et al., entitled, the Relationship between Household Chaos and Child, Parent, and Family Outcomes: A Systematic Scoping Review, presents the findings from 112 studies that assessed the influence of household chaos on a wide range of child outcomes. Findings highlight the various adverse child health outcomes across multiple domains that may be negatively affected by greater levels of household chaos including a few that reflect child health behaviors such as sleep, diet and weight gain. The review additionally presents findings from mediation and moderation analyses. This commentary highlights key aspects of the Marsh et al. review and outlines the implications of the work within health behavior research. This commentary further identifies child screen media use as a critically understudied area when considering the interplay between household chaos and child well-being.
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Affiliation(s)
- Jennifer A Emond
- The Department of Biomedical Data Science and the Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
- One Medical Center Drive, Hinman Box 7920, Rubin 829, Hanover, NH, 03755, USA.
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27
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Martin MA, Bisarini R, Roy A, Mosnaim G, Rosales G, Weinstein S, Walton SM. Implementation Lessons From a Randomized Trial Integrating Community Asthma Education for Children. J Ambul Care Manage 2020; 43:125-135. [PMID: 32073501 PMCID: PMC8329939 DOI: 10.1097/jac.0000000000000326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study characterized and compared the implementation of clinically integrated community health workers (CHWs) to a certified asthma educator (AE-C) for low-income children with asthma. In the AE-C arm (N = 115), 51.3% completed at least one in-clinic education session. In the CHW arm (N = 108), 722 home visits were completed. The median number of visits was 7 (range, 0-17). Scheduled in-clinic asthma education may not be the optimal intervention for this patient population. CHW visit completion rates suggest that the schedule, location, and content of CHW asthma services better met patients' needs. Seven to 10 visits seemed to be the preferred CHW dose.
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Affiliation(s)
- Molly A Martin
- University of Illinois at Chicago (Drs Martin, Bisarini, Weinstein, and Walton and Ms Rosales); Erie Family Health Center, Chicago, Illinois (Dr Roy); and Northshore University Health System, Evanston, Illinois (Dr Mosnaim)
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28
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Weinstein SM, Orozco K, Pugach O, Rosales G, Songthangtham N, Martin MA. Parent Nativity and Child Asthma Control in Families of Mexican Heritage: The Effects of Parent Depression and Social Support. Acad Pediatr 2020; 20:967-974. [PMID: 32407888 PMCID: PMC7483789 DOI: 10.1016/j.acap.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Research has repeatedly demonstrated that parent foreign nativity has a protective effect on child asthma outcomes among Mexican Americans, but the mechanisms underlying this relationship are not well understood. The current study explored parent depression as a mediator and social support as a moderator of the parent nativity-child asthma control pathway. METHODS Data come from the baseline sample of a trial (NCT02481986) testing community interventions for 223 children aged 5 to 16 with uncontrolled asthma. We focused on parent/child dyads of Mexican heritage (N = 165; mean age = 9.08, standard deviation = 2.94; 57.3% with Mexico-born parent). Asthma control was defined using the child and adult versions of the Asthma Control Test (ACT). Psychosocial factors included parent depression symptoms and social (instrumental, informational, and emotional) support. RESULTS Mexican-born parents had fewer depressive symptoms (β^ = -2.03, SE^ = 0.24) and children with better asthma control (β^ = 1.78, SE^ = 0.24) than US-born parents, P < .0001. Analyses suggested partial mediation of the nativity-ACT path via parent depression (P < .001). An interaction between Instrumental Support and Nativity was marginally significant (β^ = -0.10, SE^ = 0.05, P = .07), with protective effects only observed at higher support levels. Last, among Mexico-born parents, the protective nativity effects on ACT declined with increasing residential years in the United States through 12 years. CONCLUSIONS This study is novel in identifying parent depression as one mechanism underlying the effects of parent nativity on child asthma control, but results suggest that the health advantages may depend on availability of support. Providing resources for parent depression and instrumental support (transportation, childcare) can optimize asthma interventions in this population.
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29
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Pappalardo AA, Weinstein S. The Anxiety-Asthma Relationship: Risk or Resilience? J Pediatr 2019; 214:8-10. [PMID: 31477380 DOI: 10.1016/j.jpeds.2019.07.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/24/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Andrea A Pappalardo
- Department of Pediatrics, Department of Medicine, University of Illinois at Chicago, Chicago, IL.
| | - Sally Weinstein
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
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30
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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: 19] [Impact Index Per Article: 3.8] [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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