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Dupuis R, Nowak-Wegrzyn A. The value of proactive management of food allergy. Ann Allergy Asthma Immunol 2024; 132:253-254. [PMID: 38432779 DOI: 10.1016/j.anai.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Roxanne Dupuis
- Department of Pediatrics, Hassenfeld Children's Hospital, New York University R. Grossman School of Medicine, New York, New York
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, Hassenfeld Children's Hospital, New York University R. Grossman School of Medicine, New York, New York; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
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Dupuis R, Block JP, Barrett JL, Long MW, Petimar J, Ward ZJ, Kenney EL, Musicus AA, Cannuscio CC, Williams DR, Bleich SN, Gortmaker SL. Cost Effectiveness of Calorie Labeling at Large Fast-Food Chains Across the U.S. Am J Prev Med 2024; 66:128-137. [PMID: 37586572 PMCID: PMC10840662 DOI: 10.1016/j.amepre.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Calorie labeling of standard menu items has been implemented at large restaurant chains across the U.S. since 2018. The objective of this study was to evaluate the cost effectiveness of calorie labeling at large U.S. fast-food chains. METHODS This study evaluated the national implementation of calorie labeling at large fast-food chains from a modified societal perspective and projected its cost effectiveness over a 10-year period (2018-2027) using the Childhood Obesity Intervention Cost-Effectiveness Study microsimulation model. Using evidence from over 67 million fast-food restaurant transactions between 2015 and 2019, the impact of calorie labeling on calorie consumption and obesity incidence was projected. Benefits were estimated across all racial, ethnic, and income groups. Analyses were performed in 2022. RESULTS Calorie labeling is estimated to be cost saving; prevent 550,000 cases of obesity in 2027 alone (95% uncertainty interval=518,000; 586,000), including 41,500 (95% uncertainty interval=33,700; 50,800) cases of childhood obesity; and save $22.60 in healthcare costs for every $1 spent by society in implementation costs. Calorie labeling is also projected to prevent cases of obesity across all racial and ethnic groups (range between 126 and 185 cases per 100,000 people) and all income groups (range between 152 and 186 cases per 100,000 people). CONCLUSIONS Calorie labeling at large fast-food chains is estimated to be a cost-saving intervention to improve long-term population health. Calorie labeling is a low-cost intervention that is already implemented across the U.S. in large chain restaurants.
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Affiliation(s)
- Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Jason P Block
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Jessica L Barrett
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Michael W Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Joshua Petimar
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Erica L Kenney
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Aviva A Musicus
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Carolyn C Cannuscio
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Ruran HB, Dupuis R, Herbert LJ, D'Anna RK, Dahlberg SE, Young MC, Sicherer SH, Bartnikas LM. Parental awareness and management of bullying in children with food allergies. J Allergy Clin Immunol Pract 2023; 11:3257-3259.e2. [PMID: 37406807 PMCID: PMC10592494 DOI: 10.1016/j.jaip.2023.06.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Hana B Ruran
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Case Western Reserve University, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Linda J Herbert
- Division of Psychology and Behavioral Health, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC
| | - Rachel K D'Anna
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Mass
| | - Suzanne E Dahlberg
- Harvard Medical School, Boston, Mass; Department of Pediatrics, Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Mass
| | - Michael C Young
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Scott H Sicherer
- Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lisa M Bartnikas
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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Dupuis R, Reiner JF, Silver S, Barrett JL, Daly JG, Lee RM, Gortmaker SL, Cradock AL. Use of Evidence-Based Interventions to Promote Healthy Weight, Nutrition, and Physical Activity in Community Health Improvement Plans from Large Local Health Departments. J Public Health Manag Pract 2023; 29:640-645. [PMID: 37350590 DOI: 10.1097/phh.0000000000001778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
We sought to identify evidence-based healthy weight, nutrition, and physical activity strategies related to obesity prevention in large local health department (LHD) Community Health Improvement Plans (CHIPs). We analyzed the content of the most recent, publicly available plans from 72 accredited LHDs serving a population of at least 500 000 people. We matched CHIP strategies to the County Health Rankings and Roadmaps' What Works for Health (WWFH) database of interventions. We identified 739 strategies across 55 plans, 62.5% of which matched a "WWFH intervention" rated for effectiveness on diet and exercise outcomes. Among the 20 most commonly identified WWFH interventions in CHIPs, 10 had the highest evidence for effectiveness while 4 were rated as likely to decrease health disparities according to WWFH. Future prioritization of strategies by health agencies could focus on strategies with the strongest evidence for promoting healthy weight, nutrition, and physical activity outcomes and reducing health disparities.
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Affiliation(s)
- Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts (Mss Dupuis, Reiner, Silver, and Barrett, Mr Daly, and Drs Lee, Gortmaker, and Cradock); and Evans Center for Implementation and Improvement Sciences, Boston University, Boston, Massachusetts (Ms Silver)
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Abstract
This JAMA Forum discusses the key food is medicine (FIM) actions being taken by the federal government and individual state governments and key nongovernmental actions that are advancing FIM.
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Affiliation(s)
- Sara N Bleich
- Department of Health Policy and Management, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Roxanne Dupuis
- Department of Social and Behavioral Sciences, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Hilary K Seligman
- Department of General Internal Medicine, University of California, San Francisco
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Dupuis R, Feuerstein-Simon R, Brown-Whitehorn TF, Spergel JM, Volpp KG, Marti XL, Troxel AB, Meisel ZF, Mollen CJ, Kenney EL, Block J, Gortmaker SL, Cannuscio CC. Food Allergy Management for Adolescents Using Behavioral Incentives: A Randomized Trial. Pediatrics 2023; 151:e2022058876. [PMID: 36683454 PMCID: PMC9890392 DOI: 10.1542/peds.2022-058876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE We sought to evaluate the use of behavioral economics approaches to promote the carrying of epinephrine auto-injectors (EAIs) among adolescents with food allergies. We hypothesized that adolescents who receive frequent text message nudges (Intervention 1) or frequent text message nudges plus modest financial incentives (Intervention 2) would be more likely to carry their epinephrine than members of the usual care control group. METHODS We recruited 131 adolescents ages 15 to 19 with a food allergy and a current prescription for epinephrine to participate in a cohort multiple randomized controlled trial. Participants were randomly assigned to participate in Intervention 1, Intervention 2, or to receive usual care. The primary outcome was consistency of epinephrine-carrying, measured as the proportion of checkpoints at which a participant could successfully demonstrate they were carrying their EAI, with photo-documentation of the device. RESULTS During Intervention 1, participants who received the intervention carried their EAI 28% of the time versus 38% for control group participants (P = .06). During Intervention 2, participations who received the intervention carried their EAI 45% of the time versus 23% for control group participants (P = .002). CONCLUSIONS Text message nudges alone were unsuccessful at promoting EAI-carrying but text message nudges combined with modest financial incentives almost doubled EAI-carriage rates among those who received the intervention compared with the control group. However, even with the intervention, adolescents with food allergies carried their EAI <50% of the time. Alternative strategies for making EAIs accessible to adolescents at all times should be implemented.
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Affiliation(s)
- Roxanne Dupuis
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | - Erica L. Kenney
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jason Block
- Harvard Pilgrim/Harvard Medical School, Boston, Massachusetts
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Ruran H, Dupuis R, Herbert L, Young M, Sicherer S, Bartnikas L. Parental Awareness and Management of Bullying in Children with Food Allergies. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Dupuis R, Phipatanakul W, Bartnikas LM. Social disparities in early childhood prevention and management of food allergy. J Allergy Clin Immunol 2023; 151:37-41. [PMID: 36608981 PMCID: PMC9830563 DOI: 10.1016/j.jaci.2022.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 01/05/2023]
Abstract
Food allergy (FA) affects 8% of US children. Navigating and managing FA permeates across multiple facets of childhood. In this article, we review research on social disparities in feeding practices, managing meals, and selecting childcare and schools. Key highlights include the following: (1) although preference for breast-feeding or formula feeding does not reduce FA risk, there are disparities in access to formula that may affect children with FA; (2) disparities likely exist in the early introduction to allergenic foods, though additional research is needed to identify barriers to following the most recent consensus guidelines on early introduction; (3) families with limited income face challenges in providing safe meals for their children; (4) disparities exist in early childcare options for preschool-age children, though there is a lack of research on FA practices in these settings; and (5) there is evidence that schools with different student demographics implement different types of FA policies. Further research is needed to better understand and characterize social disparities in FA prevention and management in early childhood and to develop evidence-based strategies to reduce them.
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Affiliation(s)
- Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Wanda Phipatanakul
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Lisa M Bartnikas
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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Bartnikas LM, Dupuis R, Wang J, Phipatanakul W. Food Allergies in Inner-City Schools: Addressing Disparities and Improving Management. Ann Allergy Asthma Immunol 2022; 129:430-439. [PMID: 35568300 DOI: 10.1016/j.anai.2022.04.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Food allergy (FA) affects approximately 8% of children in the United States. Management comprises both preventing and treating allergic reactions, which poses unique challenges in the inner-city school setting. In this article, we review the epidemiology of FA in school-aged children and management challenges and opportunities specific to the inner-city population. DATA SOURCES A literature search of the PubMed database was performed to identify published literature on FA epidemiology, FA management, school policies, disparities, inner-city, race, ethnicity, and socioeconomic status. STUDY SELECTIONS Relevant articles on FA management best practices and challenges in schools, with a particular emphasis on inner-city schools and populations and socioeconomic, racial, and ethnic disparities, were reviewed in detail. RESULTS Disparities in FA prevalence, management, and treatment exist. Additional research is needed to better characterize these disparities and elucidate the mechanisms leading to them. There is a lack of evidence-based interventions for the prevention and treatment of food allergic reactions in schools and specifically in inner-city schools, in which a greater proportion of students may rely on school food. CONCLUSION There are opportunities for partnership among health care providers, schools, and communities to address unmet needs in FA management and disparities in the inner-city school setting.
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Affiliation(s)
- Lisa M Bartnikas
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, Massachusetts
| | - Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Julie Wang
- Department of Pediatrics, Division of Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Wanda Phipatanakul
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, Massachusetts.
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Dupuis R, Herbert L, Young M, Sicherer S, Phipatanakul W, Bartnikas L. Disrupted Foodways: Food Allergies and Food Insecurity. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Feuerstein-Simon R, Lowenstein M, Dupuis R, Dolan A, Marti XL, Harvey A, Ali H, Meisel ZF, Grande DT, Lenstra N, Cannuscio CC. Substance Use and Overdose in Public Libraries: Results from a Five-State Survey in the US. J Community Health 2022; 47:344-350. [PMID: 35020100 PMCID: PMC8753323 DOI: 10.1007/s10900-021-01048-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/26/2022]
Abstract
In the U.S., overdoses have become a health crisis in both public and private places. We describe the impact of the overdose crisis in public libraries across five U.S. states, and the front-line response of public library workers. We conducted a cross-sectional survey, inviting one worker to respond at each public library in five randomly selected states (CO, CT, FL, MI, and VA), querying participants regarding substance use and overdose in their communities and institutions, and their preparedness to respond. We describe substance use and overdose patterns, as well as correlates of naloxone uptake, in public libraries. Participating library staff (N = 356) reported witnessing alcohol use (45%) and injection drug use (14%) in their libraries in the previous month. Across states surveyed, 12% of respondents reported at least one on-site overdose in the prior year, ranging from a low of 10% in MI to a high of 17% in FL. There was wide variation across states in naloxone uptake at libraries, ranging from 0% of represented libraries in FL to 33% in CO. Prior on-site overdose was associated with higher odds of naloxone uptake by the library (OR 2.5, 95% CI 1.1-5.7). Although 24% of respondents had attended a training regarding substance use in the prior year, over 90% of respondents wanted to receive additional training on the topic. Public health professionals should partner with public libraries to expand and strengthen substance use outreach and overdose prevention efforts.
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Affiliation(s)
- Rachel Feuerstein-Simon
- Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Anatomy and Chemistry Building, Room 148, Philadelphia, PA, 19104, USA.
| | - Margaret Lowenstein
- Department of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - Abby Dolan
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - Alexandra Harvey
- Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Anatomy and Chemistry Building, Room 148, Philadelphia, PA, 19104, USA
| | - Heba Ali
- Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, 3620 Hamilton Walk, Anatomy and Chemistry Building, Room 148, Philadelphia, PA, 19104, USA
| | - Zachary F Meisel
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - David T Grande
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Noah Lenstra
- Department of Library and Information Science School of Education, The University of North Carolina at Greensboro (UNCG), Greensboro, USA
| | - Carolyn C Cannuscio
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Lowenstein M, Feuerstein-Simon R, Dupuis R, Herens A, Hom J, Sharma M, Sheni R, Encarnacion L, Flaherty C, Cueller M, Cannuscio C. Overdose Awareness and Reversal Trainings at Philadelphia Public Libraries. Am J Health Promot 2020; 35:250-254. [PMID: 32662281 DOI: 10.1177/0890117120937909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate an overdose response training program in public libraries. DESIGN Mixed methods evaluation including pre- and post-intervention questionnaires and debriefing interviews. SETTING Ten Philadelphia public libraries. SAMPLE Overdose response training participants (library staff and community members). INTERVENTION Public, hour-long overdose response trainings run by the Philadelphia Department of Public Health, the Free Library of Philadelphia, and the University of Pennsylvania between March and December 2018. MEASURES Questionnaires assessed motivation for attending trainings, overdose response readiness, and intention to acquire and carry naloxone. Debriefing interviews elicited training feedback. ANALYSIS We assessed changes in overdose response readiness and intention to carry naloxone and performed thematic analysis on interview data. RESULTS At 29 trainings, 254 people attended, of whom 203 (80%) completed questionnaires and 23 were interviewed. 30% of participants had witnessed an overdose, but only 3% carried naloxone at baseline. Following training, overdose response readiness and intention to acquire/carry naloxone improved significantly (P < .01). Interviewees nonetheless noted that they experienced barriers to naloxone acquisition, including cost, stigma, and concern regarding future insurability. Trainings subsequently included naloxone distribution. Interviewees reported that public libraries were welcoming, nonstigmatizing venues. CONCLUSION In Philadelphia, library-based overdose response trainings were well-attended and reached a population with prior overdose encounters. Similar trainings could be deployed as a scalable overdose prevention strategy in the nation's 16 568 public libraries.
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Affiliation(s)
- Margaret Lowenstein
- National Clinician Scholars Program, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel Feuerstein-Simon
- Center for Public Health Initiatives, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Roxanne Dupuis
- Center for Public Health Initiatives, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Social and Behavioral Sciences, 1812Harvard University, Boston, MA, USA
| | - Allison Herens
- 6542Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Jeffrey Hom
- Leonard Davis Institute of Health Economics, 6572University of Pennsylvania, Philadelphia, PA, USA.,6542Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Meghana Sharma
- Center for Public Health Initiatives, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Risha Sheni
- Center for Public Health Initiatives, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lonard Encarnacion
- Center for Public Health Initiatives, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Carina Flaherty
- Center for Public Health Initiatives, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Maria Cueller
- Department of Criminology, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Carolyn Cannuscio
- Department of Family Medicine and Community Health, 14640University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Dupuis R, Kinsey EW, Spergel JM, Brown-Whitehorn T, Graves A, Samuelson K, Epstein C, Mollen C, Cannuscio CC. Food Allergy Management at School. J Sch Health 2020; 90:395-406. [PMID: 32124441 DOI: 10.1111/josh.12885] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 05/22/2019] [Accepted: 09/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Approximately 8% of schoolchildren in the United States experience potentially life-threatening food allergies. They must diligently avoid allergenic foods and have prompt access to epinephrine to treat anaphylaxis. These prevention strategies must be sustained without interruption, posing a range of challenges at school. METHODS We conducted semi-structured interviews with 178 participants about their experiences managing food allergies outside the home. Interviews were transcribed and analyzed using an iterative approach in NVivo 10. RESULTS Participants reported highly varied school experiences across the ecological model. They described the need to be proactive and self-sufficient to manage food allergies. Whereas food allergy-related social exclusion was common, participants also described positive peer interactions, including intensive peer engagement and support. They perceived that formal school policies were limited in scope and inconsistently implemented. Prevention-oriented policies were more common in lower grades than in higher grades. CONCLUSIONS Poorly defined and implemented policies disrupted students' social and educational experiences at school, families' relationships with school staff, and, ultimately, the safety and wellbeing of students with allergies. Given the high prevalence of food allergies among children, these findings demonstrate the need for multiple layers of support to facilitate safe, socially inclusive food allergy management at schools.
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Affiliation(s)
- Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02215
| | - Eliza Whiteman Kinsey
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032
| | - Jonathan M Spergel
- Clinical Pediatrics, Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, PA, 19104
| | - Terri Brown-Whitehorn
- Clinical Pediatrics, Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, PA, 19104
| | - Amy Graves
- Center for Public Health Initiatives, University of Pennsylvania, 3620 Hamilton Walk, Philadelphia, PA, 19104
| | - Kate Samuelson
- Center for Public Health Initiatives, University of Pennsylvania, 3620 Hamilton Walk, Philadelphia, PA, 19104
| | - Caleb Epstein
- Center for Public Health Initiatives, University of Pennsylvania, 3620 Hamilton Walk, Philadelphia, PA, 19104
| | - Cynthia Mollen
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104
| | - Carolyn C Cannuscio
- Department of Family Medicine and Community Health, Perelman School of Medicine, Center for Public Health Initiatives, University of Pennsylvania, Anatomy and Chemistry Building, Room 145, 3620 Hamilton Walk, Philadelphia, PA, 19104
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Feuerstein-Simon R, Lowenstein M, Sharma M, Dupuis R, Luna Marti X, Cannuscio CC. Local health departments and the implementation of evidence-based policies to address opioid overdose mortality. Subst Abus 2020; 41:468-474. [PMID: 32213045 DOI: 10.1080/08897077.2019.1709250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND In the context of the opioid overdose crisis, local health departments are on the front lines, coordinating programs and services and translating state and federal policies into community action. While media reports describe growth of Overdose Education and Naloxone Distribution (OEND) programs among local health departments, little is known about program features, scope, and target populations. Methods: We surveyed health departments in 180 United States counties with high overdose mortality rates. Results: Among health officials from 54 counties (30% response), many counties reported implementation of evidence-based practices, with a high degree of programmatic variation. The majority of responding health departments (94%) conducted overdose education and naloxone distribution (OEND) programs. Programs were heterogeneous in scale, with a reported median of 250 naloxone kits (range 1-25,000 kits) acquired for community distribution. In addition, four in five respondents were aware of their state's standing order policy for increasing naloxone access. While the majority of respondents reported county-level availability of at least one form of evidence-based medications to treat opioid use disorder (MOUD), many reported no availability of buprenorphine (33%) or methadone (43%). Conclusions: Local health departments are vital to reducing opioid overdose mortality, and many are implementing relevant evidence-based practices. To support further adoption of potentially life-saving strategies, health departments need adequate funding and staffing as well as policies and guidelines to support implementation.
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Affiliation(s)
- Rachel Feuerstein-Simon
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Margaret Lowenstein
- National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meghana Sharma
- Master of Public Health Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roxanne Dupuis
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Xochitl Luna Marti
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carolyn C Cannuscio
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Lowenstein M, Feuerstein-Simon R, Sheni R, Dupuis R, Kinsey EW, Luna Marti X, Cannuscio C. Public libraries as partners in confronting the overdose crisis: A qualitative analysis. Subst Abus 2019; 42:302-309. [DOI: 10.1080/08897077.2019.1691129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Margaret Lowenstein
- National Clinician Scholars Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel Feuerstein-Simon
- Center for Public Health Initiatives, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Risha Sheni
- Center for Public Health Initiatives, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Roxanne Dupuis
- Center for Public Health Initiatives, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Social and Behavioral Sciences, Harvard University, Boston, Massachusetts, USA
| | - Eliza Whiteman Kinsey
- Center for Public Health Initiatives, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Xochitl Luna Marti
- Center for Public Health Initiatives, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Carolyn Cannuscio
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Public Health Initiatives, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Feuerstein-Simon R, Dupuis R, Schumacher R, Cannuscio CC. A Randomized Trial to Encourage Healthy Eating Through Workplace Delivery of Fresh Food. Am J Health Promot 2019; 34:269-276. [PMID: 31840522 DOI: 10.1177/0890117119890804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aimed to increase the consumption of home-cooked meals among employees at a large urban worksite through a fully subsidized Community Supported Agriculture (CSA) program. DESIGN Randomized trial. SETTING Worksite in a large northeast city. PARTICIPANTS Employees were recruited through flyers, e-mail listservs, and outreach from departmental administrators (n = 60). INTERVENTION Intervention participants received 8 biweekly fresh food deliveries through a CSA program. They also received cooking education and support. Control participants received usual employee benefits. MEASURES Consumption of meals prepared at home was the primary end point. Increased consumption of fresh fruits and vegetables was the secondary end point, and food insecurity was an exploratory end point. ANALYSIS Poisson regression was used to assess mean differences in weekly consumption of home-cooked meals. To assess differences in fruit and vegetable consumption and food insecurity, binary logistic regression was used to estimate odds ratios. RESULTS Compared to the control group, intervention participants consumed 29% more home-cooked meals per week (P < .01). Fruit and vegetable consumption also increased among intervention participants. The odds of at least twice-daily fruit consumption were 3.8 times higher among intervention participants than among controls, and the odds of at least twice-daily vegetable consumption were 6.2 times higher among intervention participants than among controls. Compared to control participants, intervention participants experienced a statistically significant 89% reduction in the odds of reporting food insecurity at follow-up, when controlling for baseline food insecurity. Participants reported perceived intervention benefits, including the opportunity to experiment with new, healthful foods without financial risk, as well as the social value of sharing recipes, food, and related conversation with colleagues. CONCLUSION The study demonstrated the feasibility and potential positive effects of a subsidized workplace CSA program, augmented with cooking education and support.
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Affiliation(s)
| | - Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA
| | - Ryan Schumacher
- Penn Medicine Center for Health Care Innovation, Philadelphia, PA, USA
| | - Carolyn C Cannuscio
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Affiliation(s)
- Eliza Whiteman Kinsey
- All authors are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Eliza W. Kinsey is also with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Roxanne Dupuis is also with the Department of Social and Behavioral Sciences, T. H. Chan School of Public Health, Harvard University, Boston, MA. Carolyn C. Cannuscio is also with the Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jason Hammer
- All authors are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Eliza W. Kinsey is also with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Roxanne Dupuis is also with the Department of Social and Behavioral Sciences, T. H. Chan School of Public Health, Harvard University, Boston, MA. Carolyn C. Cannuscio is also with the Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Roxanne Dupuis
- All authors are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Eliza W. Kinsey is also with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Roxanne Dupuis is also with the Department of Social and Behavioral Sciences, T. H. Chan School of Public Health, Harvard University, Boston, MA. Carolyn C. Cannuscio is also with the Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rachel Feuerstein-Simon
- All authors are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Eliza W. Kinsey is also with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Roxanne Dupuis is also with the Department of Social and Behavioral Sciences, T. H. Chan School of Public Health, Harvard University, Boston, MA. Carolyn C. Cannuscio is also with the Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Carolyn C Cannuscio
- All authors are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Eliza W. Kinsey is also with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Roxanne Dupuis is also with the Department of Social and Behavioral Sciences, T. H. Chan School of Public Health, Harvard University, Boston, MA. Carolyn C. Cannuscio is also with the Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Kinsey E, Dupuis R, Oberle M, Hillier A, Cannuscio C. Chronic Disease Self-Management During the Monthly SNAP Cycle (P04-193-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz051.p04-193-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
This study explored chronic disease self-management over the monthly benefit cycle among primary food shoppers from households receiving Supplemental Nutrition Assistance Program (SNAP) benefits in Philadelphia, Pennsylvania.
Methods
In-depth interviews, participant observation and surveys were conducted with the primary food shopper of SNAP households (n = 18). Interviews and surveys were conducted in a clinical setting, at participants’ homes, and in food procurement settings including grocery stores, food pantries and soup kitchens.
Results
All households had at least one member with a chronic disease or condition; 5 with a diet-related chronic condition, 5 managing the chronic condition of a family member, and 13 with overweight or obesity. Households reported that the dietary demands of managing chronic illnesses were expensive and mentally taxing. Food and financial shortfalls at the end of the benefit cycle, as well as reliance on charitable food assistance programs, often had negative impacts on chronic disease self-management.
Conclusions
Drawing from nearly 50 hours of in-depth qualitative interviews with SNAP participants, this study highlights the dual cognitive burden of poverty and chronic disease and elucidates the particular challenges of food procurement and maintenance of diet quality throughout the benefit month faced by SNAP households with diet-related chronic diseases. Interventions targeted at reducing the cost of medically appropriate, healthy foods may help to improve chronic disease self-management within SNAP populations.
Funding Sources
This work was supported by the University of Pennsylvania Leonard Davis Institute of Health Economics, the University of Pennsylvania Graduate and Professional Student Assembly Provost Award for Interdisciplinary Innovation, the NIH NIDDK Pediatric Endocrine Fellowship Training in Diabetes Research, and the Investment for the Future Initiative in Community Practices, University of Pennsylvania School of Nursing. The sources of financial support had no role in the design, analysis, or writing of this abstract.
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Affiliation(s)
- Eliza Kinsey
- Columbia University Mailman School of Public Health
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Kinsey EW, Oberle M, Dupuis R, Cannuscio CC, Hillier A. Food and financial coping strategies during the monthly Supplemental Nutrition Assistance Program cycle. SSM Popul Health 2019; 7:100393. [PMID: 31016223 PMCID: PMC6468142 DOI: 10.1016/j.ssmph.2019.100393] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 11/24/2022] Open
Abstract
One in seven Americans participates in the Supplemental Nutrition Assistance Program (SNAP), making it the largest federally funded food assistance program. SNAP benefits are distributed once per month and both food spending and calorie consumption tend to decrease as time from benefit distribution increases. The monthly SNAP benefit cycle has serious implications for the health and financial stability of low-income families, a growing number of whom rely on SNAP as their sole source of income. Relatively little is known about the specific coping strategies households use to manage the SNAP cycle. The purpose of this study is to provide a critical exploration of the nature and timing of coping strategies for managing the SNAP cycle, including implications these coping mechanisms have for health and financial stability. This paper presents data from a prospective cohort study of mothers (n = 12) receiving SNAP benefits in Philadelphia between 2016 and 17. Both in-depth qualitative and survey methods were used. Participants reported on a variety of coping strategies they used to manage the SNAP cycle, including adjustments to shopping and eating patterns, mental accounting, emotional resilience, and social support. Instrumental social support was particularly vital in the final days of the benefit cycle, as were skipping meals and purchasing less expensive, energy-dense foods. Constant vigilance was required throughout the month to manage financial instability. The coping strategies for managing the SNAP cycle have short-term benefits, such as buffering against hunger and financial instability, however these survival strategies may have negative long-term repercussions for physical and financial health. Coping strategies included adjusting shopping/eating, mental accounting, and social support. SNAP was divided by trip type; first trip for essential food items, later trips for fill-in items. End-of-month diet changes included skipping meals and buying cheaper, more energy-dense foods. Instrumental social support was most critical in final days of the benefit cycle. Constant vigilance was required throughout the month to manage financial instability.
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Affiliation(s)
- Eliza Whiteman Kinsey
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Megan Oberle
- Division of Endocrinology and Diabetes, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Carolyn C Cannuscio
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy Hillier
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
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Schroeder K, Klusaritz H, Dupuis R, Bolick A, Graves A, Lipman TH, Cannuscio C. Reconciling opposing perceptions of access to physical activity in a gentrifying urban neighborhood. Public Health Nurs 2019; 36:461-468. [PMID: 30908690 DOI: 10.1111/phn.12602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 02/08/2019] [Accepted: 02/14/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to understand perspectives on access to physical activity in a gentrifying neighborhood. DESIGN This qualitative descriptive study used street intercept interviews and photo documentation. SAMPLE Participants included members (n = 19) of a gentrifying neighborhood in a northeastern city. RESULTS Participants held markedly different perceptions of opportunities for physical activity. Some participants, particularly area university students or those who are identified as White, perceived the neighborhood as favorable to physical activity, with high walkability and abundant resources. Other participants, particularly those who identified as Black or African-American, felt it was difficult to be physically active because neighborhood recreation facilities are scarce or unaffordable and parks are poorly maintained or unsafe. Multiple participants noted strategies to overcome neighborhood barriers to physical activity. Regardless of neighborhood perceptions, family and friends played an important role in influencing physical activity. CONCLUSIONS Nurses must consider how disparities in actual and perceived access to neighborhood resources influence participation in physical activity, particularly in gentrifying neighborhood. Public health nurses are embedded in the neighborhoods that they serve, providing a unique opportunity to understand and address the impact of neighborhood on health.
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Affiliation(s)
- Krista Schroeder
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.,University of Pennsylvania Center for Public Health Initiatives, Philadelphia, Pennsylvania
| | - Heather Klusaritz
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Roxanne Dupuis
- University of Pennsylvania Center for Public Health Initiatives, Philadelphia, Pennsylvania
| | - Ansley Bolick
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Amy Graves
- University of Pennsylvania Center for Public Health Initiatives, Philadelphia, Pennsylvania
| | - Terri H Lipman
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.,University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Carolyn Cannuscio
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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21
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Kinsey EW, Hammer J, Dupuis R, Feuerstein-Simon R, Cannuscio CC. Planning for Food Access During Emergencies: Missed Meals in Philadelphia. Am J Public Health 2019; 109:781-783. [PMID: 30896998 DOI: 10.2105/ajph.2019.304996] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To illustrate the effects that minor social or environmental disruptions could have on the food access of low-income households in Philadelphia, Pennsylvania, and provide suggestions for how cities can better incorporate food into emergency planning. METHODS Using publicly available data and stakeholder interviews (n = 8) in 2017, we projected the number of meals that would be missed during environmental and social disruptions in Philadelphia, a major US city with a high poverty rate. RESULTS As our projections in Philadelphia indicate, even just 3 days of school closures could result in as many as 405 600 missed meals for school-aged children. CONCLUSIONS These scenarios provide valuable lessons for other cities to proactively plan for food access continuity in times of uncertainty. Public Health Implications. City planners and other city agencies need to include food as a routine part of emergency planning and redefine the threshold at which emergency response protocols are triggered to better ensure protection of low-income and underserved populations.
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Affiliation(s)
- Eliza Whiteman Kinsey
- All authors are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Eliza W. Kinsey is also with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Roxanne Dupuis is also with the Department of Social and Behavioral Sciences, T. H. Chan School of Public Health, Harvard University, Boston, MA. Carolyn C. Cannuscio is also with the Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania
| | - Jason Hammer
- All authors are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Eliza W. Kinsey is also with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Roxanne Dupuis is also with the Department of Social and Behavioral Sciences, T. H. Chan School of Public Health, Harvard University, Boston, MA. Carolyn C. Cannuscio is also with the Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania
| | - Roxanne Dupuis
- All authors are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Eliza W. Kinsey is also with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Roxanne Dupuis is also with the Department of Social and Behavioral Sciences, T. H. Chan School of Public Health, Harvard University, Boston, MA. Carolyn C. Cannuscio is also with the Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania
| | - Rachel Feuerstein-Simon
- All authors are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Eliza W. Kinsey is also with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Roxanne Dupuis is also with the Department of Social and Behavioral Sciences, T. H. Chan School of Public Health, Harvard University, Boston, MA. Carolyn C. Cannuscio is also with the Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania
| | - Carolyn C Cannuscio
- All authors are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Eliza W. Kinsey is also with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Roxanne Dupuis is also with the Department of Social and Behavioral Sciences, T. H. Chan School of Public Health, Harvard University, Boston, MA. Carolyn C. Cannuscio is also with the Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania
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Abstract
In Philadelphia, over 40% of youth are overweight or obese. The objective in this assessment was to learn about urban residents' perspectives regarding the local food environment and its impact on eating behaviors. Using photo-elicitation, 20 adolescents reflected on their food environments through photographs and corresponding interviews. Without specific prompting from interviewers, every participant raised concerns about their school food environments, which they commonly found to be unhealthy and unappealing. Participants' responses reflected four themes: (1) mixed reviews regarding the healthfulness of school vending machines, (2) lunch from home versus lunch from school, (3) factors that influenced food choice at school, and (4) critiques of school food environments. Students embraced the photo-elicitation approach as a way to convey their concerns and to suggest opportunities for improvements. School nurses, who are trusted by students and school personnel, are well-positioned to solicit student input and advocate for healthier school food environments.
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Affiliation(s)
- Kelsey Gangemi
- Safety and Epidemiology, HealthCore, Inc., Wilmington, DE, USA
| | - Roxanne Dupuis
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Rosemary Frasso
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sara Solomon
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA
| | - Carolyn C Cannuscio
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA.,Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Abstract
INTRODUCTION Public libraries are free and accessible to all and are centers of community engagement and education, making them logical choices as partners for improving population health. Library staff members routinely assist patrons with unmet health and social needs. METHODS We used a 100-question, self-administered web survey sent to all library directors listed in the Pennsylvania Library Association database (N = 621), to investigate staff interactions with library patrons to address social determinants of health. We conducted statistical comparisons of quantitative responses and a content analysis of open-ended responses. RESULTS Respondents (N = 262) reported frequently interacting with patrons around health and social concerns - well beyond those related to literacy and education - including help with employment (94%), nutrition (70%), exercise (66%), and social welfare benefits (51%). Acute emergencies were not uncommon in Pennsylvania's public libraries, with nearly 12% of respondents having witnessed a drug overdose at the library in the past year. Most respondents felt that their professional training left them inadequately prepared to assist patrons with health and social issues. Although at least 40% of respondents offered some health programming at their library branch, their offerings did not meet the high level of need reflected in common patron inquiries. CONCLUSION The challenges library staff members experience in meeting their patrons' information needs suggest opportunities for public libraries to advance population health. Library staff members need additional training and resources and collaboration with public health and health care institutions to respond to community needs through effective, evidence-based public health programming.
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Affiliation(s)
- Eliza D Whiteman
- School of Design, University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania.,3620 Hamilton Walk, Anatomy and Chemistry Bldg, Room 145, Philadelphia, PA 19104.
| | - Roxanne Dupuis
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anna U Morgan
- Division of General Internal Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Bernadette D'Alonzo
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caleb Epstein
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heather Klusaritz
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carolyn C Cannuscio
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Ha YP, Seifu LD, Lewis LM, Dupuis R, Brawner BM, Cannuscio CC. Partnering Medical Students With Barbers to Cut Hypertension in Black Men. Am J Public Health 2018; 108:785-787. [PMID: 29741952 DOI: 10.2105/ajph.2018.304374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Yoonhee P Ha
- Yoonhee P. Ha, Roxanne Dupuis, and Carolyn C. Cannuscio are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Leah D. Seifu is with The Children's Hospital of Philadelphia. Lisa M. Lewis and Bridgette M. Brawner are with the Department of Family and Community Health, School of Nursing, University of Pennsylvania
| | - Leah D Seifu
- Yoonhee P. Ha, Roxanne Dupuis, and Carolyn C. Cannuscio are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Leah D. Seifu is with The Children's Hospital of Philadelphia. Lisa M. Lewis and Bridgette M. Brawner are with the Department of Family and Community Health, School of Nursing, University of Pennsylvania
| | - Lisa M Lewis
- Yoonhee P. Ha, Roxanne Dupuis, and Carolyn C. Cannuscio are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Leah D. Seifu is with The Children's Hospital of Philadelphia. Lisa M. Lewis and Bridgette M. Brawner are with the Department of Family and Community Health, School of Nursing, University of Pennsylvania
| | - Roxanne Dupuis
- Yoonhee P. Ha, Roxanne Dupuis, and Carolyn C. Cannuscio are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Leah D. Seifu is with The Children's Hospital of Philadelphia. Lisa M. Lewis and Bridgette M. Brawner are with the Department of Family and Community Health, School of Nursing, University of Pennsylvania
| | - Bridgette M Brawner
- Yoonhee P. Ha, Roxanne Dupuis, and Carolyn C. Cannuscio are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Leah D. Seifu is with The Children's Hospital of Philadelphia. Lisa M. Lewis and Bridgette M. Brawner are with the Department of Family and Community Health, School of Nursing, University of Pennsylvania
| | - Carolyn C Cannuscio
- Yoonhee P. Ha, Roxanne Dupuis, and Carolyn C. Cannuscio are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Leah D. Seifu is with The Children's Hospital of Philadelphia. Lisa M. Lewis and Bridgette M. Brawner are with the Department of Family and Community Health, School of Nursing, University of Pennsylvania
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Morgan AU, D’Alonzo BA, Dupuis R, Whiteman ED, Kallem S, McClintock A, Fein JA, Klusaritz H, Cannuscio CC. Public Library Staff as Community Health Partners: Training Program Design and Evaluation. Health Promot Pract 2017; 19:361-368. [DOI: 10.1177/1524839917735304] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | | | | | | | - Joel A. Fein
- University of Pennsylvania, Philadelphia, PA, USA
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Affiliation(s)
- Tigist Hailu
- Tigist Hailu and Jason Karlawish are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Carolyn C. Cannuscio is with the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia. Roxanne Dupuis is with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
| | - Carolyn C Cannuscio
- Tigist Hailu and Jason Karlawish are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Carolyn C. Cannuscio is with the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia. Roxanne Dupuis is with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
| | - Roxanne Dupuis
- Tigist Hailu and Jason Karlawish are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Carolyn C. Cannuscio is with the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia. Roxanne Dupuis is with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
| | - Jason Karlawish
- Tigist Hailu and Jason Karlawish are with the Perelman School of Medicine, University of Pennsylvania, Philadelphia. Carolyn C. Cannuscio is with the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia. Roxanne Dupuis is with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia
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Morgan AU, Dupuis R, D’Alonzo B, Johnson A, Graves A, Brooks KL, McClintock A, Klusaritz H, Bogner H, Long JA, Grande D, Cannuscio CC. Beyond Books: Public Libraries As Partners For Population Health. Health Aff (Millwood) 2016; 35:2030-2036. [DOI: 10.1377/hlthaff.2016.0724] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Anna U. Morgan
- Anna U. Morgan is a Robert Wood Johnson Foundation Clinical Scholar at the Perelman School of Medicine, University of Pennsylvania, in Philadelphia
| | - Roxanne Dupuis
- Roxanne Dupuis is a research program manager at the Center for Public Health Initiatives, University of Pennsylvania
| | - Bernadette D’Alonzo
- Bernadette D’Alonzo is a research assistant at the Center for Public Health Initiatives, University of Pennsylvania
| | - Andria Johnson
- Andria Johnson is a lecturer in the Department of History and Sociology of Science at the University of Pennsylvania
| | - Amy Graves
- Amy Graves is a research assistant at the Center for Public Health Initiatives, University of Pennsylvania
| | - Kiahana L. Brooks
- Kiahana L. Brooks is a research assistant at the Center for Public Health Initiatives, University of Pennsylvania
| | - Autumn McClintock
- Autumn McClintock is strategy coordinator for the Strategic Initiatives Department at the Free Library of Philadelphia
| | - Heather Klusaritz
- Heather Klusaritz is director of community engagement at the Center for Public Health Initiatives and associate director of the Center for Community and Population Health in the Department of Family Medicine and Community Health at the Perelman School of Medicine, University of Pennsylvania
| | - Hillary Bogner
- Hillary Bogner is an associate professor in the Department of Family Medicine and Community Health at the Perelman School of Medicine, University of Pennsylvania
| | - Judith A. Long
- Judith A. Long is a core investigator at the Veterans Affairs Center for Health Equity Research and Promotion and the Sol Katz Professor of Medicine at the Perelman School of Medicine, University of Pennsylvania
| | - David Grande
- David Grande is an assistant professor of medicine at the Perelman School of Medicine, University of Pennsylvania
| | - Carolyn C. Cannuscio
- Carolyn C. Cannuscio (
) is director of research at the Center for Public Health Initiatives and an assistant professor in the Department of Family Medicine and Community Health at the Perelman School of Medicine, University of Pennsylvania
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Abstract
The goal of this study was to understand safety climate in the United States (U.S.) fire service, which responded to more than 31 million calls to the 9-1-1 emergency response system in 2013. The majority of those calls (68 %) were for medical assistance, while only 4 % of calls were fire-related, highlighting that the 9-1-1 system serves as a critical public health safety net. We conducted focus groups and interviews with 123 firefighters from 12 fire departments across the United States. Using an iterative analytic approach supported by NVivo 10 software, we developed consensus regarding key themes. Firefighters concurred that the 9-1-1 system is strained and increasingly called upon to deliver Emergency Medical Services (EMS) in the community. Much like the hospital emergency department, EMS frequently assists low-income and elderly populations who have few alternative sources of support. Firefighters highlighted the high volume of low-acuity calls that occupy much of their workload, divert resources from true emergencies, and lead to unwarranted occupational hazards like speeding to respond to non-serious calls. As a result, firefighters reported high occupational stress, low morale, and desensitization to community needs. Firefighters' called for improvements to the 9-1-1 system-the backbone of emergency response in the U.S.-including better systems of triage, more targeted use of EMS resources, continuing education to align with job demands, and a strengthened social safety net to address the persistent needs of poor and elderly populations.
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Affiliation(s)
- Carolyn C Cannuscio
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Anatomy Chemistry Building, Room 145, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA.
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Andrea L Davis
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Amelia D Kermis
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Yasin Khan
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Roxanne Dupuis
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jennifer A Taylor
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Dupuis R, Meisel Z, Grande D, Strupp E, Kounaves S, Graves A, Frasso R, Cannuscio CC. Food allergy management among restaurant workers in a large U.S. city. Food Control 2016. [DOI: 10.1016/j.foodcont.2015.11.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Affiliation(s)
- Carolyn C Cannuscio
- Carolyn C. Cannuscio is with the Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Carolyn C. Cannuscio, Roxanne Dupuis, and Amy Graves are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Carlie Hanson is with the College of Public Health, Temple University, Philadelphia. Shari Hersh is with the City of Philadelphia Mural Arts Program
| | - Roxanne Dupuis
- Carolyn C. Cannuscio is with the Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Carolyn C. Cannuscio, Roxanne Dupuis, and Amy Graves are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Carlie Hanson is with the College of Public Health, Temple University, Philadelphia. Shari Hersh is with the City of Philadelphia Mural Arts Program
| | - Amy Graves
- Carolyn C. Cannuscio is with the Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Carolyn C. Cannuscio, Roxanne Dupuis, and Amy Graves are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Carlie Hanson is with the College of Public Health, Temple University, Philadelphia. Shari Hersh is with the City of Philadelphia Mural Arts Program
| | - Carlie Hanson
- Carolyn C. Cannuscio is with the Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Carolyn C. Cannuscio, Roxanne Dupuis, and Amy Graves are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Carlie Hanson is with the College of Public Health, Temple University, Philadelphia. Shari Hersh is with the City of Philadelphia Mural Arts Program
| | - Shari Hersh
- Carolyn C. Cannuscio is with the Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Carolyn C. Cannuscio, Roxanne Dupuis, and Amy Graves are with the Center for Public Health Initiatives, University of Pennsylvania, Philadelphia. Carlie Hanson is with the College of Public Health, Temple University, Philadelphia. Shari Hersh is with the City of Philadelphia Mural Arts Program
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Cannuscio CC, Dupuis R, Graves A, Seymour JW, Kounaves S, Strupp E, Leri D, Frasso R, Grande D, Meisel ZF. A behavioral economics intervention to encourage epinephrine-carrying among food-allergic adults: a randomized controlled trial. Ann Allergy Asthma Immunol 2015; 115:234-240.e1. [PMID: 26093776 DOI: 10.1016/j.anai.2015.05.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 05/05/2015] [Accepted: 05/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adolescents and young adults with food allergies are at increased risk of adverse events, including death from anaphylaxis. Epinephrine is the cornerstone of emergency response, yet few individuals with serious food allergies consistently carry their emergency medication. Behavioral economics offers promising, previously untapped opportunities for behavior change in this arena. OBJECTIVE To test the effectiveness of modest financial incentives in promoting the carrying of epinephrine and to evaluate the acceptability of text messaging for delivering reminders and key health messages to young adults with food allergies. METHODS A mixed-methods randomized controlled trial in young adults with food allergies investigated the carrying of epinephrine auto-injectors using financial incentives plus text message reminders vs text message reminders alone. Epinephrine carriage was assessed 10 times during the 49-day intervention using rapid-reply cell phone photographs plus daily code words. RESULTS The intervention (financial incentive) group had their epinephrine auto-injectors at 54% of check-ins vs 27% of check-ins in the control (text-only) group (P = .023). Participants in the 2 groups consistently reported favorable impressions of text messaging as a desirable, unobtrusive way to receive information and support for food allergy management. CONCLUSION Although the intervention and control groups reported favorable impressions of text message-based reminder systems, the intervention group performed significantly better than the control group on a photograph-based measurement of epinephrine carriage. There remained ample room for improvement in the 2 groups given the goal of consistent, uninterrupted epinephrine carriage by people with potentially life-threatening food allergies. TRIAL REGISTRATION https://clinicaltrials.gov; NCT02354729.
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Affiliation(s)
- Carolyn C Cannuscio
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Roxanne Dupuis
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amy Graves
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jane W Seymour
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah Kounaves
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Strupp
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Damien Leri
- Master of Public Health Program, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rosemary Frasso
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Grande
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zachary F Meisel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Mehmood A, Basset M, Orjuela R, Dupuis R, Drean JY. Modelling and experimental validation of Textile Pockets based active inflatable device. ISA Trans 2014; 53:1881-1891. [PMID: 25200116 DOI: 10.1016/j.isatra.2014.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 07/07/2014] [Accepted: 07/21/2014] [Indexed: 06/03/2023]
Abstract
This paper aims with the mathematical modelling of an active inflatable device. This device is composed of a compressor, an Electro-pneumatic Pressure Converter (EPC) and an Inflatable Textile fabric Pocket (ITP). The later has interesting mechanical properties and is fabricated using Jacquard knitting technique which allows automatic production of unlimited varieties of pattern weaving without any mould. Thanks to these features, these ITPs have provided a better alternative to the classical airbags made by stretchable polymer material. The proposed mathematical model is obtained by combining sub-models of two main parts of the whole system. In this way, a generalised and flexible model is obtained which can easily take into consideration the ITPs of different shapes. The pressure dynamics inside the ITP are considered by taking into account the air flow rate, variation of the volume of ITP and the length of pneumatic lines joining ITP with compressed air source. The parameters of the whole mathematical model are obtained via identification techniques. The effectiveness of the model is assessed through several experimental tests with the help of a servo hydraulic fatigue testing machine.
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Affiliation(s)
- A Mehmood
- MIPS Laboratory (EA 3223), University of Haute-Alsace, 12 rue des frères lumière F-68093 Mulhouse, France; COMSATS Institute of Information Technology, Park road Islamabad, Pakistan.
| | - M Basset
- MIPS Laboratory (EA 3223), University of Haute-Alsace, 12 rue des frères lumière F-68093 Mulhouse, France
| | - R Orjuela
- MIPS Laboratory (EA 3223), University of Haute-Alsace, 12 rue des frères lumière F-68093 Mulhouse, France
| | - R Dupuis
- MIPS Laboratory (EA 3223), University of Haute-Alsace, 12 rue des frères lumière F-68093 Mulhouse, France
| | - J Y Drean
- LPMT laboratory (EA 4365), University of Haute-Alsace, 11 rue Alfred Werner F-68093 Mulhouse, France
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Ju M, Jmal H, Dupuis R, Aubry E. Visco-hyperelastic constitutive model for modeling the quasi-static behavior of polyurethane foam in large deformation. POLYM ENG SCI 2014. [DOI: 10.1002/pen.24018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- M.L. Ju
- Laboratoire MIPS; Université de Haute Alsace; 68093 Mulhouse France
| | - H. Jmal
- Laboratoire MIPS; Université de Haute Alsace; 68093 Mulhouse France
| | - R. Dupuis
- Laboratoire MIPS; Université de Haute Alsace; 68093 Mulhouse France
| | - E. Aubry
- Laboratoire MIPS; Université de Haute Alsace; 68093 Mulhouse France
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Ju M, Mezghani S, Jmal H, Dupuis R, Aubry E. Parameter Estimation of a Hyperelastic Constitutive Model for the Description of Polyurethane Foam in Large Deformation. Cellular Polymers 2013. [DOI: 10.1177/026248931303200102] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Polyurethane foam is widely used in such areas as the automotive industry and sport, and in the field of packaging because of its low stiffness, high compressibility and its ability to absorb strain energy. The quasi-static behaviours of polyurethane foam are highly nonlinear and elastic. This paper demonstrates that the nonlinear elastic mechanical behaviour of compressible polyurethane foam during the loading and unloading quasi-static compression tests can be described by applying Ogden's modified model. The experimental data from a uniaxial compression of three types of polyurethane foam in three different strain rates are used for parameter identification. A nonlinear optimization method helps to ensure that the parameters are satisfied with stability conditions. Thanks to the optimized parameter results, the numerical simulations agree with the experimental data. Finally, the errors between the model results and the experimental results are analyzed and the unloading phases are discussed in detail.
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Affiliation(s)
- M.L. Ju
- Laboratoire MIPS, Université de Haute Alsace, 12 rue des frères Lumière, 68093 Mulhouse, France
| | - S. Mezghani
- Laboratoire MIPS, Université de Haute Alsace, 12 rue des frères Lumière, 68093 Mulhouse, France
- Research Unit U2MP, National Engineering School of Sfax (ENIS), B.P 1173. 3038-Sfax- Tunisia
| | - H. Jmal
- Laboratoire MIPS, Université de Haute Alsace, 12 rue des frères Lumière, 68093 Mulhouse, France
| | - R. Dupuis
- Laboratoire MIPS, Université de Haute Alsace, 12 rue des frères Lumière, 68093 Mulhouse, France
| | - E. Aubry
- Laboratoire MIPS, Université de Haute Alsace, 12 rue des frères Lumière, 68093 Mulhouse, France
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Jmal H, Dupuis R, Aubry E. Quasi-static behavior identification of polyurethane foam using a memory integer model and the difference-forces method. J CELL PLAST 2011. [DOI: 10.1177/0021955x11406101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Flexible polyurethane foam is widely used in numerous comfort applications such as automotive seat cushions and mattresses. It would be interesting to design a mechanical model which describes the behavior of this material in a series of test conditions. This study is devoted to the modeling of the quasi-static behavior of polyurethane foam using a memory integer model. Polyurethane foam undergoing large compressive deformation exhibits highly nonlinear elasticity and a viscoelastic behavior. The memory integer model describes the nonlinearity in a polynomial function and the viscoelasticity through a convolution function. Uniaxial compression tests help to identify the mechanical parameters of the model. The difference between the force responses of foam in load and unload phases constitute the base element of the method used in this article. Numerous precautions are taken into account to obtain accurate results which verify the thermodynamic conditions. Finally, the reliability as well as the limits of the memory integer model are discussed.
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Affiliation(s)
- H. Jmal
- Laboratoire MIPS, Université de Haute Alsace, 12 rue des frères Lumière, 68093 Mulhouse, France
| | - R. Dupuis
- Laboratoire MIPS, Université de Haute Alsace, 12 rue des frères Lumière, 68093 Mulhouse, France,
| | - E. Aubry
- Laboratoire MIPS, Université de Haute Alsace, 12 rue des frères Lumière, 68093 Mulhouse, France
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Alloway RR, Dupuis R, Gabardi S, Kaiser TE, Taber DJ, Tichy EM, Weimert-Pilch NA. Evolution of the role of the transplant pharmacist on the multidisciplinary transplant team. Am J Transplant 2011; 11:1576-83. [PMID: 21672154 DOI: 10.1111/j.1600-6143.2011.03601.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Transplant pharmacists have been recognized as an essential part of the transplant team by their colleagues along with several governing and professional organizations. The specific education, training and responsibilities of the transplant pharmacist have not been clearly delineated in the literature. Various pharmacists across the country have been called upon to serve on the transplant team necessitating standardization of their fundamental and desirable activities. Therefore, the purpose of this manuscript is to describe the training and role of a transplant pharmacist on the patient care team and provide a roadmap to implementation of novel transplant pharmacy services.
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Affiliation(s)
- R R Alloway
- Division of Hypertension/Nephrology, Section of Transplantation, Department of Medicine, University of Cincinnati, OH, USA
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Dupuis R, Harris M, Gillis K, Gerber D, Fair J, Watson R, Koslowski T, Andreoni K. Experience With Low-Dose Valganciclovir Prophylaxis in Adult Liver Transplant Recipients. Transplant Proc 2007; 39:3266-70. [DOI: 10.1016/j.transproceed.2007.09.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Accepted: 09/13/2007] [Indexed: 11/28/2022]
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Touboul P, Portal J, Vicaut E, Labreuche J, Kownator S, Belliard J, Cohen S, Dupuis R, Pithois-Merli I. 2P-0360 Influence of age, gender and cardiovascular risk factors on common carotid artery intima-media thickness: PARC Study results. ATHEROSCLEROSIS SUPP 2003. [DOI: 10.1016/s1567-5688(03)90503-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Champain N, Dupuis R, Pomero V, Mouilleseaux B, Dubousset J, Skalli W. Geometric and postural analysis of mild idiopathic scoliotic patients. Stud Health Technol Inform 2002; 91:267-71. [PMID: 15457735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Understanding the aggravation process of mild idiopathic scoliosis is still a challenge. The aim of this study is to investigate the spine and pelvis configuration with regard to gravity line using 3D reconstruction coupled with foot pressure measurements. The distance between each vertebral center and the gravity line is calculated in order to observe the global equilibrium of spine. A protocol has been set and used for 10 mild idiopathic scoliotic patients. 34 asymptomatic volunteers who were previously observed with the same protocol were used as reference for biomechanical comparisons. The first results showed differences between scoliotic and asymptomatic subjects and also among scoliotic patients. The proposed protocol should allow clinicians to follow up scoliotic patients with an innovative and efficient tool.
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Affiliation(s)
- N Champain
- Laboratoire de BioMécanique, ENSAM-CNRS, Paris, France
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Ciminelli AM, Dupuis R, Williams D, Hollar K, Fair JH, Johnson M, Gerber D. Patient education role of a pharmacist on a transplant service. Am J Health Syst Pharm 2000; 57:767-8. [PMID: 10786265 DOI: 10.1093/ajhp/57.8.767] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Savard P, Rouleau JL, Ferguson J, Poitras N, Morel P, Davies RF, Stewart DJ, Talajic M, Gardner M, Dupuis R, Lauzon C, Sussex B, Potvin L, Warnica W. Risk stratification after myocardial infarction using signal-averaged electrocardiographic criteria adjusted for sex, age, and myocardial infarction location. Circulation 1997; 96:202-13. [PMID: 9236435 DOI: 10.1161/01.cir.96.1.202] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The objectives were to investigate the factors influencing signal-averaged ECGs (SAECGs) recorded in patients after myocardial infarction (MI) and to develop criteria for predicting arrhythmic events (AEs) that account for these factors. METHODS AND RESULTS SAECGs were recorded 5 to 15 days after MI in 2461 patients without bundle-branch block. The duration (QRSd), terminal potential (VRMS), and terminal duration (LAS) of the filtered QRS were measured. During follow-up (17 +/- 8 months), AEs (arrhythmic death; ventricular tachycardia, VT; ventricular fibrillation, VF) occurred in 80 patients (3.3%). Receiver operating characteristic curves showed that QRSd discriminated patients with all types of AEs, but VRMS and LAS discriminated only VT patients; QRSd minus LAS also discriminated AE patients. Sex, age, and MI location significantly affected the SAECG; survivors without VT or VF were divided into subgroups (2 sex x 4 age x 2 MI), and QRSd values exceeding the 70th percentile in each subgroup predicted AEs with a sensitivity of 65.4%. An unadjusted QRSd criterion showed the same overall sensitivity and specificity but with less uniform values for each subgroup. A Cox model was constructed by use of multiple prognostic indicators, and in rank order, QRSd, previous MI, and Killip class were predictive of AEs. CONCLUSIONS SAECG adjustments for sex, age, and MI location did not improve sensitivity and specificity but produced a more uniform predictive performance. The proposed criteria are based only on QRSd, because late potentials (VRMS and LAS) did not discriminate patients with sudden death. Duration of high-level activity during QRS (QRSd-LAS) can predict AEs, suggesting that the arrhythmogenic substate involves a large mass of myocardium.
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Affiliation(s)
- P Savard
- Institut de génic biomédical, Ecole Polytechnique, Université de Montréal, Québec, Canada.
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Théroux P, Kouz S, Roy L, Knudtson ML, Diodati JG, Marquis JF, Nasmith J, Fung AY, Boudreault JR, Delage F, Dupuis R, Kells C, Bokslag M, Steiner B, Rapold HJ. Platelet membrane receptor glycoprotein IIb/IIIa antagonism in unstable angina. The Canadian Lamifiban Study. Circulation 1996; 94:899-905. [PMID: 8790023 DOI: 10.1161/01.cir.94.5.899] [Citation(s) in RCA: 125] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ligand binding to the platelet membrane receptor glycoprotein (GP) IIb/IIIa, the final and obligatory step to platelet aggregation, can now be inhibited by pharmacological agents. This study was designed to evaluate the potential of lamifiban, a novel nonpeptide antagonist of GP IIb/IIIa, for the management of unstable angina. METHODS AND RESULTS In a prospective, dose-ranging, double-blind study, 365 patients with unstable angina were randomized to an infusion of 1, 2, 4, or 5 micrograms/min of lamifiban or of placebo. Treatment was administered for 72 to 120 hours. Outcome events were measured during the infusion period and after 1 month. Concomitant aspirin was administered to all patients and heparin to 28% of patients. Lamifiban, all doses combined, reduced the risk of death, nonfatal myocardial infarction, or the need for an urgent revascularization during the infusion period from 8.1% to 3.3% (P = .04). The rates were 2.5%, 4.9%, 3.3%, and 2.4% with increasing doses. At 1 month, death or nonfatal infarction occurred in 8.1% of patients with placebo and in 2.5% of patients with the two high doses (P = .03). The highest dose of lamifiban additionally prevented the need for an urgent intervention. Lamifiban dose-dependently inhibited platelet aggregation. Bleeding times were significantly prolonged with platelet inhibition of > 80%. Major (but neither life-threatening nor intracranial) bleedings occurred in 0.8% of patients with placebo and 2.9% with lamifiban. CONCLUSIONS The nonpeptide GP IIb/IIIa antagonist lamifiban protected patients with unstable angina from severe ischemic events during a 3- to 5-day infusion and reduced the incidence of death and infarction at 1 month, suggesting considerable promise for this new therapeutic approach.
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Affiliation(s)
- P Théroux
- Department of Medicine, Montreal Heart Institute, Quebec, Canada
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Rouleau JL, Talajic M, Sussex B, Potvin L, Warnica W, Davies RF, Gardner M, Stewart D, Plante S, Dupuis R, Lauzon C, Ferguson J, Mikes E, Balnozan V, Savard P. Myocardial infarction patients in the 1990s--their risk factors, stratification and survival in Canada: the Canadian Assessment of Myocardial Infarction (CAMI) Study. J Am Coll Cardiol 1996; 27:1119-27. [PMID: 8609330 DOI: 10.1016/0735-1097(95)00599-4] [Citation(s) in RCA: 192] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES This study sought to evaluate the in-hospital and postdischarge mortality of patients with an acute myocardial infarction in the 1990s. BACKGROUND The widespread implementation of therapeutic interventions that modify the natural history of coronary artery disease has led to changes in the profile and survival of patients with an acute myocardial infarction. Although data exist for selected subsets of patients with an acute myocardial infarction, at this time there is little recent prospective information on all patients presenting with an acute myocardial infarction, particularly for survival after hospital discharge. METHODS All patients < or = 75 years old presenting with an acute myocardial infarction between July 1, 1990 and June 30, 1992 at nine Canadian hospitals were prospectively evaluated and followed up for 1 year. From November 1991, patients of all ages were included. In two centers, recruitment continued until December 31, 1992. A total of 3,178 patients were recruited. RESULTS The in-hospital mortality rate of patients < or = 75 years old was 8.4%, and that at 1 year after hospital discharge was 5.3%. For patients of all ages recruited after November 1, 1991, the in-hospital mortality rate was 9.9% and 7.1% for 1 year after hospital discharge. For patients < or = 75 years old, age carried an independent in-hospital but no post discharge risk. Female patients had a twofold greater risk of dying in hospital. After hospital discharge, only 1.7% of patients < or = 75 years old and 1.9% of patients of all ages died of a presumed arrhythmic death. Premature ventricular contractions had no independent prognostic value. The relatively low in-hospital (5.3%) and postdischarge (6.1%) reinfarction rate may have contributed to improved survival. A greater reinfarction rate in patients >75 years old (17.4% vs. 9.6%, p < 0.001) may have contributed to their poorer outcome. CONCLUSIONS One-year mortality after acute myocardial infarction continues to decrease, and changes in the prognostic value of traditional methods of risk stratification have occurred.
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Affiliation(s)
- J L Rouleau
- Department of Medicine, Montreal Heart Institute, Quebec, Canada
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Abstract
When mice are introduced into an open-field, they are inclined to explore mainly the peripheral zone of this open-field. This tendency to remain close the walls, called thigmotaxis, decreases gradually during the first minutes of exploration. We have considered the degree of thigmotaxis during this period of decrease as an index of anxiety in mice. This hypothesis has been validated with several reference anxiogenic drugs (dexamphetamine, pentylenetetrazole, yohimbine, idazoxan) which increased thigmotaxis; and with anxiolytic drugs (buspirone, phenobarbital), which reduced it. On this test the selective or non-selective indirect dopamine agonists GBR 12783, dexamphetamine and cocaine induced an increase of thigmotaxis. Finally, the simultaneous involvement of D1 and D2 dopamine receptors has been evidenced in the anxiogenic-like effect associated with an increase of dopaminergic transmissions.
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Affiliation(s)
- P Simon
- Unité de Neuropsychopharmacologie expérimentale, URA 1170 du CNRS, Faculté de Médecine et Pharmacie de Rouen, Saint Etienne du Rouvray, France
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Koh YY, Dupuis R, Pollice M, Albertine KH, Fish JE, Peters SP. Neutrophils recruited to the lungs of humans by segmental antigen challenge display a reduced chemotactic response to leukotriene B4. Am J Respir Cell Mol Biol 1993; 8:493-9. [PMID: 8386926 DOI: 10.1165/ajrcmb/8.5.493] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Allergic asthma is characterized by an infiltration of the lung with inflammatory cells including eosinophils and neutrophils. The mechanism by which inflammatory cells are recruited to the lung in IgE-mediated disorders is unknown. In order to explore the mechanism responsible for cell recruitment, ragweed-allergic volunteers underwent segmental (bronchoscopic) antigen challenge, followed 24 h later by bronchoalveolar lavage (BAL). Experimental conditions were chosen to favor neutrophil, rather than eosinophil, recruitment. Chemotactic responses of purified BAL neutrophils (under agarose) were then compared with blood neutrophils obtained from the same subjects. We hypothesized that neutrophils recruited to the lung would be desensitized to the chemotaxin(s) responsible for their recruitment. BAL neutrophils showed a profound inhibition of their chemotactic response to an optimal concentration of leukotriene B4 (LTB4) ex vivo (approximately 40% of the response of blood neutrophils) with a slightly reduced response to the anaphylatoxin C5a and to FMLP. In addition, they displayed a normal production of superoxide anion in response to phorbol myristate acetate. These results demonstrate that neutrophils recruited to the lung of humans by local antigen challenge display a marked inhibition of their chemotactic response to LTB4, and are consistent with the hypothesis that LTB4 is instrumental in recruiting neutrophils to the lung in IgE-mediated reactions.
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Affiliation(s)
- Y Y Koh
- Department of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania, 19107-5083
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Collins DS, Dupuis R, Gleich GJ, Bartemes KR, Koh YY, Pollice M, Albertine KH, Fish JE, Peters SP. Immunoglobulin E-mediated increase in vascular permeability correlates with eosinophilic inflammation. Am Rev Respir Dis 1993; 147:677-83. [PMID: 8442605 DOI: 10.1164/ajrccm/147.3.677] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
An increase in bronchovascular permeability is thought to play an important role in the pathogenesis of allergic asthma. We sought to determine whether the increase in permeability observed 24 h after segmental antigen challenge in ragweed-allergic human volunteers was associated with the infiltration and degranulation of a specific cell type. A 20,000-fold range of antigen concentrations was used to alter the number and type of inflammatory cells recruited to the lung by challenge. Although large numbers of inflammatory cells were recruited to lung air spaces over a large range of antigen concentrations, significant numbers of eosinophils (731.3 +/- 232.9 x 10(3)/ml) were recruited only when the concentration of antigen used for segmental challenge was > or = 100-fold higher than the concentration needed to produce an 8 to 10 mm wheal 20 min after intradermal skin testing. In addition, large increases in bronchoalveolar lavage (BAL) albumin concentration (636.3 +/- 170.5 micrograms/ml) were observed only in this same group of subjects. The correlation coefficient between the logarithms of the BAL eosinophil concentration and albumin concentration was +0.82 (p < 0.001), and between eosinophil-derived neurotoxin and albumin it was +0.88 (p < 0.001). In a stepwise, multiple regression analysis, eosinophils accounted for 67% of the variance in BAL albumin concentration, whereas no other cell type was a significant predictor of albumin flux into BAL fluid. We conclude that eosinophil recruitment and degranulation are associated with large increases in bronchovascular permeability after segmental antigen challenge in humans.
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Affiliation(s)
- D S Collins
- Department of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania 19107-5083
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Dupuis R, Collins DS, Koh YY, Pollice M, Albertine KH, Fish JE, Peters SP. Effect of antigen dose on the recruitment of inflammatory cells to the lung by segmental antigen challenge. J Allergy Clin Immunol 1992; 89:850-7. [PMID: 1560168 DOI: 10.1016/0091-6749(92)90441-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Bronchoscopic antigen challenge of atopic volunteers results in an immediate release of inflammatory mediators and, after a number of hours, the recruitment of inflammatory cells to the lung. The purpose of this work was to investigate the effect of antigen dose on the subsequent recruitment of inflammatory cells to the lung. Twenty-two volunteers without asthma, eight nonatopic control subjects, and 14 ragweed-allergic subjects underwent 25 local antigen-challenge procedures that consisted of a baseline lavage of a control segment, antigen challenge of another segment in the contralateral lung, and lavage of the challenged segment 24 hours later. A 25,000-fold range of antigen doses was used from 0.004 to 100 PNU/ml (0.02 to 500 ng/ml of ragweed antigen E [Amb a I]). Challenge of nonatopic control subjects resulted in the recruitment of only a small number of inflammatory cells, less than a twofold increase in comparison with the cells of control lavage; this increase was primarily due to an increase in neutrophils. Challenge of atopic subjects, in contrast, resulted in approximately a threefold to ninefold increase in inflammatory cells with more cells recruited at larger doses of antigen. Only subjects challenged with a "high" dose of antigen (greater than or equal to 1 PNU/ml) recruited significant quantities of eosinophils to the lung. In these subjects, a twofold increase in macrophages, a fourfold increase in lymphocytes, a 90-fold increase in neutrophils, and an 800-fold increase in eosinophils were observed; the number of neutrophils and eosinophils recruited averaged between 30 and 60 million.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- R Dupuis
- Jefferson Medical College, Department of Medicine, Philadelphia, Pa. 19107-5083
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Repetto M, Maziere JC, Citadelle D, Dupuis R, Meier M, Biade S, Quiec D, Roux C. Teratogenic effect of the cholesterol synthesis inhibitor AY 9944 on rat embryos in vitro. Teratology 1990; 42:611-8. [PMID: 1708171 DOI: 10.1002/tera.1420420605] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AY 9944 [trans-1,4-bis(2-chlorobenzylaminomethyl) cyclohexane dihydrochloride] is an amphiphilic cationic molecule. This chemical is an established inhibitor of cholesterol synthesis and is teratogenic in rats. The mechanisms of this teratogenicity remain to be clarified. This study used cultured rat whole embryos to ascertain whether AY 9944 had a direct effect on embryos, or whether its action was indirect, via the maternal cholesterol metabolism. Four experimental conditions were investigated: (A) controls; (B) 10 day untreated embryos were cultured in serum of treated rats; (C) 10 day untreated embryos were cultured in serum containing added AY 9944 (0-1,000 micrograms/ml); and (D) 10 day embryos from females treated on day 4 of gestation were cultured in normal serum. In group B there was no growth retardation; some slight nonspecific abnormalities were not significant. In group C, direct addition of AY 9944 to culture medium retarded growth and differentiation in a dose-dependent manner. No malformation was observed, but histological examinations showed numerous areas of cell necrosis, especially in the CNS. In group D, not only was growth retardation observed, but also characteristic malformations of AY 9944 teratogenesis, including pituitary agenesis. These results show that AY 9944 teratogenicity is initiated prior to day 10.
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Affiliation(s)
- M Repetto
- Laboratoire d'Embryologie, CHU Saint-Antoine, Paris, France
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Camarda AJ, Brosseau J, Dupuis R. The use of nuclear medicine in the diagnosis of Paget's disease of the mandible. Report of a case. J Can Dent Assoc 1989; 55:49-53. [PMID: 2643450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Traditionally, incisional bone biopsy has been required in order to establish and confirm a diagnosis of Paget's disease (Osteitis deformans) of the mandible and/or maxilla. This article presents a case report of a patient who refused such biopsy. The patient was referred with a three year history of intermittent mandibular pain, accompanied by occasional swelling of the adjacent soft tissues. Although several health professionals had been consulted, no diagnosis had been established. Furthermore, an incisional biopsy had apparently been performed in the area of the left mandible, as reported by the patient, with no conclusive results. On examination, the patient refused all proposed repeat biopsy, but did agree to a full laboratory workup which included: routine blood studies; nuclear medicine bone studies of total body regions including the head and neck, followed by sialography of the submandibular salivary glands. A definitive diagnosis of Paget's disease was reported on 99-m-MDP-technetium bone scans of the mandible. The patient was subsequently treated with the appropriate medication which resulted in a remission of the disease over the three year follow-up period. The histopathological diagnosis was never confirmed because of the patient's repeated refusal to be biopsied.
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Barbu V, Roux C, Lambert D, Dupuis R, Gardette J, Maziere JC, Maziere C, Elefant E, Polonovski J. Cholesterol prevents the teratogenic action of AY 9944: importance of the timing of cholesterol supplementation to rats. J Nutr 1988; 118:774-9. [PMID: 2453625 DOI: 10.1093/jn/118.6.774] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
These studies were conducted to determine whether dietary cholesterol supplementation could prevent fetal malformations induced by the amphipathic drug AY 9944, which is well known as a cholesterol biosynthesis inhibitor, and to investigate whether the plasma maternal sterol level and the nature of the sterols found in treated Wistar rats could explain this prevention. Pituitary agenesis was the most constant element of holoprosencephaly when AY 9944 was administered on d 4 of gestation at two dosages, 50 or 75 mg/kg. The rate of malformed fetuses was dose related. A strong negative correlation was established between maternal plasma sterol levels on d 10 of gestation (day of pituitary gland formation) and the rate of fetal anomalies (r = -0.97, P less than 0.01). Supplementation of AY 9944-treated rats with cholesterol had an obvious preventive action on fetal malformations. When cholesterol was added to the diet the same day as AY 9944 treatment and maintained until d 15, the prevention of malformations was almost complete. When the supplementation was initiated later, the prevention of anomalies decreased. The nature of plasma maternal sterols shows that the cholesterol supplementation modifies significantly the ratio of cholesterol to 7-dehydrocholesterol in treated rats. Therefore, maternal plasma sterol perturbations may play a role in the teratogenic action of AY 9944.
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Affiliation(s)
- V Barbu
- Laboratoire de Biochimie, Faculté de Médecine St. Antoine, Paris, France
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