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Kannoth S, Chung SE, Tamakloe KD, Albrecht SS, Azan A, Chambers EC, Sheffield PE, Thompson A, Woo Baidal JA, Lovinsky-Desir S, Stingone JA. Neighborhood environmental vulnerability and pediatric asthma morbidity in US metropolitan areas. J Allergy Clin Immunol 2023; 152:378-385.e2. [PMID: 36990323 PMCID: PMC10524145 DOI: 10.1016/j.jaci.2023.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Research suggests demographic, economic, residential, and health-related factors influence vulnerability to environmental exposures. Greater environmental vulnerability may exacerbate environmentally related health outcomes. We developed a neighborhood environmental vulnerability index (NEVI) to operationalize environmental vulnerability on a neighborhood level. OBJECTIVE We explored the relationship between NEVI and pediatric asthma emergency department (ED) visits (2014-19) in 3 US metropolitan areas: Los Angeles County, Calif; Fulton County, Ga; and New York City, NY. METHODS We performed separate linear regression analyses examining the association between overall NEVI score and domain-specific NEVI scores (demographic, economic, residential, health status) with pediatric asthma ED visits (per 10,000) across each area. RESULTS Linear regression analyses suggest that higher overall and domain-specific NEVI scores were associated with higher annual pediatric asthma ED visits. Adjusted R2 values suggest that overall NEVI scores explained at least 40% of the variance in pediatric asthma ED visits. Overall NEVI scores explained more of the variance in pediatric asthma ED visits in Fulton County. NEVI scores for the demographic, economic, and health status domains explained more of the variance in pediatric asthma ED visits in each area compared to the NEVI score for the residential domain. CONCLUSION Greater neighborhood environmental vulnerability was associated with greater pediatric asthma ED visits in each area. The relationship differed in effect size and variance explained across the areas. Future studies can use NEVI to identify populations in need of greater resources to mitigate the severity of environmentally related outcomes, such as pediatric asthma.
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Affiliation(s)
- Sneha Kannoth
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY.
| | - Sarah E Chung
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| | - Kelvin D Tamakloe
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| | - Sandra S Albrecht
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| | - Alexander Azan
- Department of Population Health, New York University Langone Health, New York City, NY
| | - Earle C Chambers
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Perry E Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Azure Thompson
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Jennifer A Woo Baidal
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY
| | - Stephanie Lovinsky-Desir
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY
| | - Jeanette A Stingone
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
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Zaibi H, Allouche A, Ben Jemia E, Ouertani H, Ferchichi M, Ben Amar J, Aouina H. Assessment of therapeutic compliance and its associated factors in tunisian adult asthmatic patients. LA TUNISIE MEDICALE 2023; 101:266-272. [PMID: 37682271 PMCID: PMC11138317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Despite therapeutic advances, morbidity attributed to asthma continues to increase. This seems partly to be due to poor adherence. AIM To assess therapeutic adherence and the association between poor compliance and asthma control. METHODS We carried out a descriptive cross-sectional study on a sample of 150 asthmatics, followed in the pneumology department of Charles Nicolle hospital for more than 6 months. The survey took place over 1 month. The 4-item Morisky questionnaire (MMAS-4) was used to assess adherence to therapy. RESULTS Our patients had a median age of 44.2 years and a sex ratio of 0.47. Asthma was severe in 48% of cases and poorly controlled in 34% of cases. Adherence was poor in 66% of patients. Factors significantly associated with adherence were educationlevel (p=0.02), socio- economic status (p = 0.01), treatment cost (p= 0.02), its availability (p=0.04) and its free cost (p = 0.001), consultation waiting time (p=0.03) and knowledge on asthma (p=0,04). We retained in multivariate analyze two factors determining therapeutic adherence, which are socio-economic status (OR = 2.02 ; [1.2-6.26]) and participation in the therapeutic choice (OR = 1.2 ; 95% CI [2.02-4.25]). CONCLUSIONS It appears that medication adherence is widely influenced by socio-economic status. So, improving these conditions would guarantee better treatment compliance.
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Affiliation(s)
- Haifa Zaibi
- Service de pneumologie, Hôpital Charles Nicolle Tunis / Université Tunis El Manar / Faculté de médecine de Tunis
| | - Asma Allouche
- Service de pneumologie, Hôpital Charles Nicolle Tunis / Université Tunis El Manar / Faculté de médecine de Tunis
| | - Emna Ben Jemia
- Service de pneumologie, Hôpital Charles Nicolle Tunis / Université Tunis El Manar / Faculté de médecine de Tunis
| | - Hend Ouertani
- Service de pneumologie, Hôpital Charles Nicolle Tunis / Université Tunis El Manar / Faculté de médecine de Tunis
| | - Meriem Ferchichi
- Service de pneumologie, Hôpital Charles Nicolle Tunis / Université Tunis El Manar / Faculté de médecine de Tunis
| | - Jihen Ben Amar
- Service de pneumologie, Hôpital Charles Nicolle Tunis / Université Tunis El Manar / Faculté de médecine de Tunis
| | - Hichem Aouina
- Service de pneumologie, Hôpital Charles Nicolle Tunis / Université Tunis El Manar / Faculté de médecine de Tunis
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Sangnimitchaikul W, Srisatidnarakul B, Ladores S. The Effectiveness of a Family-Based Asthma Self-Management Program in Enhancing the Asthma Health Outcomes in School-Age Children. Compr Child Adolesc Nurs 2021:1-15. [PMID: 33411567 DOI: 10.1080/24694193.2020.1837290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/08/2020] [Indexed: 10/22/2022]
Abstract
This quasi-experimental study aimed to evaluate a family-based asthma self-management program, based on the individual and family self-management theory and the McMaster model of family functioning. Children aged 7 to 12 with uncontrolled asthma and their families were recruited from an outpatient pulmonary department of a university hospital in Thailand. Thirty-seven child-parent pairs were randomly assigned to three sessions for a period of two months of the family-based asthma self-management program, while 37 child-parent pairs were assigned to the control group. Data were collected at baseline and after implementation at two months by using the Childhood Asthma Control Questionnaire and the Pediatric Asthma Quality of Life Questionnaire, and the measurement of pulmonary function was performed using peak flow meters. Multivariate analysis of covariance (MANCOVA) was employed to analyze the mean difference between the experimental and control groups. The results indicated significant increased asthma control status, pulmonary function, and quality of life in the children from baseline to after implementation in the experimental group that participated in the family-based asthma self-management program. Significant improvement in these three asthma health outcomes was also seen in the experimental group when compared to the control group. It was seen that the family-based asthma self-management program is useful for promoting the self-management of school-age children, enabling the control of symptoms, and enhancing health outcomes regarding asthma.
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Affiliation(s)
| | | | - Sigrid Ladores
- School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama
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Rangachari P. A framework for measuring self-management effectiveness and health care use among pediatric asthma patients and families. J Asthma Allergy 2017; 10:111-122. [PMID: 28442924 PMCID: PMC5396924 DOI: 10.2147/jaa.s133481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Asthma is associated with substantial health care expenditures, including an estimated US$56 billion per year in direct costs. A recurring theme in the asthma management literature is that costly asthma symptoms, including hospitalizations and multiple emergency department (ED)/outpatient visits, can often be prevented through patient/family adherence to the national (National Institutes of Health Expert Panel Report-3) guidelines for effective self-management of asthma, specifically 1) medication adherence and 2) environmental trigger avoidance, as outlined in the patient's personalized Asthma-Action Plan. It is important to note however that while effective self-management of asthma is known to reduce ED visits and hospitalizations, the relationship between asthma self-management effectiveness and outpatient visit frequency remains ambiguous, reflecting a gap in the literature. For instance, do patients/families who self-manage effectively visit outpatient clinics more frequently for asthma care (compared to those who do not self-manage effectively), after accounting for differences in asthma severity, demographic characteristics, and risk factors? Do patients/families who visit outpatient clinics more frequently for asthma care, in turn have fewer ED and inpatient encounters for asthma? On the other hand, do patients/families who do not revisit outpatient clinics regularly have higher ED visits and hospitalizations? It is important to address these gaps, in order to reduce the costs and public health burden of asthma. This paper provides a foundation for addressing these gaps, by conducting an integrative review of the asthma management literature, to develop a conceptual framework for measuring self-management effectiveness and health care use among pediatric asthma patients/families. In doing so, the paper lays the groundwork for future research seeking to explicate the relationship between asthma self-management effectiveness and health care use, which in turn has potential to engage asthma providers in promoting ideal self-management and optimal health care use for pediatric asthma, in accordance with national evidence-based guidelines for asthma management.
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Affiliation(s)
- Pavani Rangachari
- College of Allied Health Sciences, Augusta University, Augusta, GA, USA
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Zarei AR, Jahanpour F, Alhani F, Razazan N, Ostovar A. The Impact of Multimedia Education on Knowledge and Self-efficacy among Parents of Children with Asthma: A Randomized Clinical Trial. J Caring Sci 2014; 3:185-92. [PMID: 25276762 PMCID: PMC4171813 DOI: 10.5681/jcs.2014.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 06/08/2014] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Asthma is one of the most common chronic disease among children, and is considered as a global health problem. According to the guidelines of childhood Asthma, parental education in order to improve their knowledge and self-efficacy should be considered in clinical care. Therefore, this study was performed with the purpose of investigating the influence of multimedia education on knowledge and self-efficacy of the parents of children with Asthma. METHODS This study is a clinical trial which was carried out on 50 parents of children with Asthma. Data collection instrument included the demographic questionnaires, assessing knowledge and self-efficacy of the parents of children with Asthma. Reliability and validity of the instruments were assessed and the multimedia education was carried out for the experimental group. Data analysis was done using SPSS 13 and descriptive inferential statistical tests (independent t-test and Mann-Whitney). RESULTS History of Asthma was present in majority 52% of the families of the children and 54% reported smoking in their home. The average scores of knowledge and self-efficacy of the study samples in the experimental group showed an increase after multimedia education methods, so that there was a statistically significant difference between the experimental and control groups. CONCLUSION The results obtained in this study also demonstrate that educating parents through multimedia technology increase their knowledge and self-efficacy in their care of children.
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Affiliation(s)
- Ahmad Reza Zarei
- Departement of Nursing, Faculty of Nursing & Midwifery, Bushehr University of
Medical Sciences, Bushehr, Iran
| | - Faezeh Jahanpour
- Departement of Nursing, Faculty of Nursing & Midwifery, Bushehr University of
Medical Sciences, Bushehr, Iran
| | - Fatemeh Alhani
- Departement of Nursing, Faculty of Medicine, Tarbiat Modares University, Tehran,
Iran
| | - Najmeh Razazan
- Departement of Nursing, Faculty of Nursing & Midwifery, Bushehr University of
Medical Sciences, Bushehr, Iran
| | - Afshin Ostovar
- Departement of Epidemiology, Persian Gulf Tropical Medicine Research Center,
Bushehr University of Medical Sciences, Bushehr, Iran
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Indinnimeo L, Chiarotti F, De Vittori V, Baldini L, De Castro G, Zicari AM, Tancredi G, Leonardi L, Duse M. Risk factors affecting quality of life in a group of Italian children with asthma. Int J Immunopathol Pharmacol 2014; 27:235-44. [PMID: 25004835 DOI: 10.1177/039463201402700210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The measure of Quality of Life (QoL) has become one of the most important criteria used to assess the impact of chronic illness, such as asthma, on the patients daily life, in adults and children alike. The objective of our open observational study was to measure the QoL and analyze several factors that potentially affect QoL, such as symptoms and functional respiratory parameters, in a cohort of children with asthma. One hundred and twenty-seven children with asthma, 6 to 14 years of age, living in the city of Rome, were enrolled as outpatients. They were subjected to Skin Prick Tests (SPT), underwent spirometry and filled out the Pediatric Asthma Quality of Life Questionnaire (PAQLQ). One hundred and eleven children were diagnosed with intermittent asthma, 12 (10%) with mild asthma, and four with moderate persistent asthma. Ninety-six children had a positive SPT. The mean total score of QoL, obtained from the questionnaire, was 5.4 (∓1.2 SD). Two QoL groups were created. Children with total QoL score <5.5 were included in the Lower QoL score group while children with total QoL score ≥ 5.5 were included in the Higher QoL score group. Children in the Higher group and their mothers had a higher mean age, suffered from fewer asthma exacerbations during the year preceding the study, and showed a higher mean value of forced expiratory volume (FEV1) compared to the children in the Lower category. Using Logistic regression we identified the main factors that may affect QoL as FEV1, symptoms in the previous year and mothers age. QoL is correlated with the frequency of asthma exacerbations and FEV1 values. Furthermore, our research shows that a significant impairment of QoL may also occur in patients with normal lung function, pointing out the importance of evaluating QoL in all children with asthma.
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Affiliation(s)
- L Indinnimeo
- Center of Pediatric Immunology and Allergology, Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - F Chiarotti
- Department of Cellular Biology and Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - V De Vittori
- Center of Pediatric Immunology and Allergology, Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - L Baldini
- Deparment of Psychology of the Processes of Development and Socialization, Sapienza University of Rome, Rome, Italy
| | - G De Castro
- Center of Pediatric Immunology and Allergology, Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - A M Zicari
- Center of Pediatric Immunology and Allergology, Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - G Tancredi
- Center of Pediatric Immunology and Allergology, Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - L Leonardi
- Center of Pediatric Immunology and Allergology, Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
| | - M Duse
- Center of Pediatric Immunology and Allergology, Umberto 1 Hospital, Sapienza University of Rome, Rome, Italy
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7
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BinSaeed AA. Caregiver knowledge and its relationship to asthma control among children in Saudi Arabia. J Asthma 2014; 51:870-5. [PMID: 24654707 DOI: 10.3109/02770903.2014.906608] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study was to examine caregiver responses to individual questions of the asthma knowledge questionnaire and to compare the prevalence of uncontrolled asthma among children according to caregiver responses (correct vs. incorrect). METHODS We conducted an analytical cross-sectional study among 158 children with asthma aged 4-11 who were attending the pediatric primary care clinic of the King Khalid University Hospital in Riyadh, Saudi Arabia. The asthma knowledge questionnaire for use with parents or guardians of children with asthma was used to measure the knowledge of caregivers. Asthma control in the children was measured using an Arabic version of the childhood asthma control test. Pearson's chi-square or Fisher's exact tests were used to compare the prevalence of uncontrolled asthma according to the caregivers' responses. RESULTS This study showed substantial gaps in knowledge among caregivers of children with asthma. The answer to only one of 17 questions was well known (86.1%); this question involved the harm of smoking near a child with asthma. Answers on 11 of 17 questions were significantly (p < 0.05) associated with asthma control in children. Among the key questions explored, the prevalence of uncontrolled asthma was 3.0 (1.8-4.9), 2.5 (95% confidence interval = 1.7-3.9) and 1.8 (1.3-2.5) times higher among children of caregivers who did not disagree with the statements that it is not good for children to use an inhaler for too long, that inhalers can affect or damage the heart, and that children with asthma should use asthma medications only when they have symptoms. CONCLUSIONS Although innovations are needed to help patients improve their adherence to treatment and to effectively utilize the benefits of contemporary asthma medications, we observe substantial knowledge-related problems in the asthma management of children in Saudi Arabia.
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Affiliation(s)
- Abdulaziz A BinSaeed
- Prince Sattam Bin Abdul Aziz Research Chair of Epidemiology and Public Health, College of Medicine, King Saud University , Riyadh , Saudi Arabia and
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