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Xu S, Song Z, Cheng X, Wang J. An asthma self-management program based on WeChat to improve asthma control and quality of life: a randomized controlled trial. FRONTIERS IN ALLERGY 2025; 6:1503597. [PMID: 40109932 PMCID: PMC11919652 DOI: 10.3389/falgy.2025.1503597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Accepted: 02/20/2025] [Indexed: 03/22/2025] Open
Abstract
Background Few studies have tested the feasibility and efficacy of WeChat-based asthma self-management, which supports patients in managing their asthma via mobile phone. We developed an intervention program based on the WeChat Mini program to support self-management. We evaluated the effectiveness and feasibility of improving asthma control and quality of life in patients with asthma. Methods Fifty and 53 patients were randomized into the control and WeChat groups, respectively, to receive traditional interventions and interventions based on the WeChat Mini program. We conducted the intervention for three months and then observed for three months. Results At the end of the third month, the Asthma Control Test (ACT) scores of the WeChat group were greater than those of the control group (P = 0.003), and the ACT scores of the two groups were significantly higher than those at baseline (P = 0.028; P < 0.001). At the end of the sixth month, the control group was not significantly different from the baseline group (P = 1.000), but the WeChat group was significantly different (P < 0.001). The ACT scores of the WeChat group were higher than those of the control group (P = 0.001). The ACT scores of the WeChat group were lower than those of the third month, but the difference was insignificant (P = 0.214). For asthma self-management and quality of life, the WeChat group improved more at the end of the third and sixth months (all P < 0.001). Conclusion Implementing an asthma self-management program based on the WeChat application is effective in helping patients with asthma improve their asthma control and quality of life.
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Affiliation(s)
- Shanshan Xu
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhihui Song
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiao Cheng
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jiawei Wang
- Department of Pharmacy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Willis LD. Role of the Respiratory Therapist in Asthma Education. Respir Care 2025. [PMID: 39969942 DOI: 10.1089/respcare.12546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2025]
Abstract
The primary goal of asthma management is attainment of the best possible outcomes for symptom control and reduction of exacerbations. This can be accomplished through partnering with patients and families and providing education. Asthma self-management education empowers patients with the knowledge, confidence, and skills necessary to successfully manage their condition. Components of asthma education include basic facts about asthma, inhaled medications, self-monitoring, environmental control, and a written asthma action plan. Repetition, reinforcement, and good clinician communication skills are vital for successful self-management education. Teach back, teach-to-goal, and motivational interviewing are effective strategies that have demonstrated improved outcomes for adults and children with asthma. Respiratory therapists have positively impacted outcomes for patients with asthma through educational interventions. This paper reviews the published literature regarding asthma education and provides guidance for clinicians for effective asthma self-management education.
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Affiliation(s)
- L Denise Willis
- Ms. Willis is affiliated with Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas; and College of Health Professions, Respiratory Care, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Wang X, Chien WT, Chong YY. Effectiveness of psychosocial interventions for improving asthma symptoms and parental stress in families of school-age children with asthma: A systematic review and meta-analysis. Int J Nurs Stud 2024; 160:104905. [PMID: 39316993 DOI: 10.1016/j.ijnurstu.2024.104905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/07/2024] [Accepted: 09/03/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Asthma is a prevalent chronic disease affecting school-age children, with substantial psychosocial implications for children and their parents. OBJECTIVES This review aimed to synthesise current evidence on the effects of psychosocial interventions for families of school-age children with asthma and investigate the optimal features of effective interventions. METHODS Embase, MEDLINE, PsycINFO, CINAHL, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, Google Scholar, CNKI, and Wanfang Data were searched from inception to November 2023. Randomised controlled trials (RCTs) examining psychosocial interventions in children aged six to twelve with asthma on asthma symptoms and parental stress were included. Emergency department visits, hospitalisations, lung function, psychological symptoms and health-related quality of life in both children and parents were secondary outcomes. Data were pooled for short-term (≤ three months), medium-term (> three months and ≤ six months), and long-term (> six months) follow-ups. Risk of bias was appraised using version 2 of the Cochrane risk of bias tool for randomised trials. Meta-analysis was performed using RevMan 5.4.1. RESULTS Seven RCTs with 884 parent-child dyads from two countries were included. Meta-analyses found that psychosocial interventions improved asthma control (k = 2, n = 301, standardised mean difference [SMD] 0.35, 95 % confidence interval [CI] 0.12 to 0.58, P = 0.003), sleep problem (k = 2, n = 149, SMD -0.47, 95 % CI -0.79 to -0.14, P = 0.005), cough (k = 2, n = 149, SMD -0.97, 95 % CI -1.59 to -0.35, P = 0.002), wheezing (k = 2, n = 149, SMD -0.76, 95 % CI -1.09 to -0.42, P < 0.0001), and parental stress (k = 6, n = 813, SMD -0.32, 95 % CI -0.61 to -0.02, P = 0.03), compared to controls in the short term. Subgroup analysis revealed significant effects of psychoeducation, family empowerment interventions, and acceptance and commitment therapy-based interventions on reducing parental stress. No significant intervention effects were observed on parental symptoms of depression at any follow-up. Narrative synthesis indicated that psychosocial interventions may provide benefits in children's health-related quality of life in the short term, parental symptoms of anxiety in the medium term, and activity limitation, cough, and wheezing in the long term. The intervention effects for other reviewed outcomes were inconsistent. CONCLUSIONS Psychosocial interventions demonstrate possible benefits for families of school-aged children with asthma in asthma symptoms, parental stress, and children's health-related quality of life within three months post-intervention and parental symptoms of anxiety at six months post-intervention. Future research with rigorous design should investigate the optimal duration, frequency, and intervention approaches of psychosocial interventions. TWEETABLE ABSTRACT Psychosocial interventions improve asthma symptoms and parental stress within three months post-intervention for families of school-age children with asthma @ConnieChong1.
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Affiliation(s)
- Xu Wang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuen Yu Chong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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Skolnik N, Yawn BP, Correia de Sousa J, Vázquez MMM, Barnard A, Wright WL, Ulrich A, Winders T, Brunton S. Best practice advice for asthma exacerbation prevention and management in primary care: an international expert consensus. NPJ Prim Care Respir Med 2024; 34:39. [PMID: 39551807 PMCID: PMC11570618 DOI: 10.1038/s41533-024-00399-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 11/04/2024] [Indexed: 11/19/2024] Open
Abstract
Primary care clinicians play a key role in asthma and asthma exacerbation management worldwide because most patients with asthma are treated in primary care settings. The high burden of asthma exacerbations persists and important practice gaps remain, despite continual advances in asthma care. Lack of primary care-specific guidance, uncontrolled asthma, incomplete assessment of exacerbation and asthma control history, and reliance on systemic corticosteroids or short-acting beta2-agonist-only therapy are challenges clinicians face today with asthma care. Evidence supports the use of inhaled corticosteroids (ICS) + fast-acting bronchodilator treatments when used as needed in response to symptoms to improve asthma control and reduce rates of exacerbations, and the symptoms that occur leading up to an asthma exacerbation provide a window of opportunity to intervene with ICS. Incorporating patient perspectives and preferences when designing asthma regimens will help patients be more engaged in their therapy and may contribute to improved adherence and outcomes. This expert consensus contains 10 Best Practice Advice Points from a panel of primary care clinicians and a patient representative, formed in collaboration with the International Primary Care Respiratory Group (IPCRG), a clinically led charitable organization that works locally and globally in primary care to improve respiratory health. The panel met virtually and developed a series of best practice statements, which were drafted and subsequently voted on to obtain consensus. Primary care clinicians globally are encouraged to review and adapt these best practice advice points on preventing and managing asthma exacerbations to their local practice patterns to enhance asthma care within their practice.
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Affiliation(s)
- Neil Skolnik
- Thomas Jefferson University, Philadelphia, PA, USA
- Jefferson Health, Philadelphia, PA, USA
| | | | | | - María Mar Martínez Vázquez
- University of the Basque Country, Leioa, Spain
- International Primary Care Respiratory Group (IPCRG), Scotland, UK
| | - Amanda Barnard
- International Primary Care Respiratory Group (IPCRG), Scotland, UK
- Australian National University, Canberra, ACT, Australia
| | - Wendy L Wright
- Wright & Associates Family Healthcare, Amherst, MA, USA
- Partners in Healthcare Education, PLLC, Amherst, MA, USA
| | - Austin Ulrich
- Primary Care Education Consortium, Winnsboro, SC, USA.
| | - Tonya Winders
- Global Allergy & Airways Patient Platform, Vienna, Austria
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Rodríguez EM, Westcott S, Calderón MPY, Horner SD, Matsui EC, Dillard J, Fareed H, Camacho J. Study protocol for a randomized controlled trial of Adapt 2 Asthma (A2A), a culturally relevant coping skills and asthma management intervention for Latinx Families. Trials 2024; 25:706. [PMID: 39438915 PMCID: PMC11495093 DOI: 10.1186/s13063-024-08531-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 10/07/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND Latinx children in the United States experience disparities in asthma control and asthma-related functional outcomes compared to non-Latinx White children, including more school absences, emergency department visits, and hospitalizations for asthma. Stress appears to play a role in asthma control, but interventions designed to address the role of stress in asthma control for Latinx children are limited. METHOD The current randomized controlled trial tests the effects of Adapt 2 Asthma (A2A), a family-based coping skills and asthma management intervention tailored to the stressors, strengths, and cultural beliefs of Latinx families, compared to an asthma self-management control arm (the Asthma Plan for Kids; APK). Latinx families of children ages 8 to 14 years old with asthma (target N = 280) are identified and enrolled from primary care clinics and randomly assigned to either A2A or APK. The intervention is delivered by lay health workers trained and receiving ongoing consultation from the study team. The primary outcome is child- and parent-reported asthma control, while secondary outcomes are child's quality of life, lung function, school absences, and emergency department visits, and child and parent coping and family asthma management behaviors. Participants will be assessed at baseline, post-intervention, and at 6- and 12-month follow-up timepoints. DISCUSSION This study has the potential to provide new evidence regarding the effects of culturally relevant coping and asthma management intervention strategies for Latinx children with asthma. TRIAL REGISTRATION Clinicaltrials.gov NCT05118282 . Registered on 11 November 2021.
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Affiliation(s)
- Erin M Rodríguez
- Department of Educational Psychology, University of Texas at Austin, 1912 Speedway, Stop D5000, Austin, TX, 78712, USA.
| | - Spencer Westcott
- Department of Educational Psychology, University of Texas at Austin, 1912 Speedway, Stop D5000, Austin, TX, 78712, USA
| | - María Paula Yávar Calderón
- Department of Educational Psychology, University of Texas at Austin, 1912 Speedway, Stop D5000, Austin, TX, 78712, USA
| | - Sharon D Horner
- School of Nursing, University of Texas at Austin, 1710 Red River Street, Austin, TX, 78712, USA
| | - Elizabeth C Matsui
- Dell Medical School, University of Texas at Austin, 1601 Trinity St., Building B, Austin, TX, 78712, USA
| | - Jendayi Dillard
- Department of Educational Psychology, University of Texas at Austin, 1912 Speedway, Stop D5000, Austin, TX, 78712, USA
| | - Hadi Fareed
- Department of Educational Psychology, University of Texas at Austin, 1912 Speedway, Stop D5000, Austin, TX, 78712, USA
| | - Jennifer Camacho
- Department of Educational Psychology, University of Texas at Austin, 1912 Speedway, Stop D5000, Austin, TX, 78712, USA
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Thach C, Lafont C, Epaud R, Tahiri K, Sauvage F, Sagorin V, Sérabian V, Delestrain C. Effectiveness of pediatric asthma education program in the context of a general hospital in France: A retrospective real-life study. Heliyon 2024; 10:e35356. [PMID: 39170434 PMCID: PMC11337717 DOI: 10.1016/j.heliyon.2024.e35356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/21/2024] [Accepted: 07/26/2024] [Indexed: 08/23/2024] Open
Abstract
Objective To assess the feasibility and effectiveness of a pediatric asthma education program delivered in the context of a French suburban general hospital. Design Monocentric retrospective study including children with asthma in Melun, Île-de-France, from January to December 2019. Data collected concerned asthma management, symptoms, education, and knowledge. Results We included 262 patients with a median age of 4.5 years. Asthma education (AE) was taught to 226 (86 %) children, 36 with minimal education (ME), 155 (69 %) with an unstructured asthma education program (USEP) and 71 (31 %) a structured asthma education program (SEP). Patients with an SEP had better knowledge of the disease and its treatment as compared with those with a USEP or ME (p < 0.05). Lung function was evaluated for 70 % of children with ME, 90 % with a USEP (p = 0.144) and 77 % an SEP (p = 0.455). Allergy testing was assessed for 42 % of children with ME, 69 % a USEP (p = 0.020) and 57 % an SEP (p = 0.185). Almost all children with USEP (93 %) and SEP (94 %) also had a written asthma action plan as compared with 49 % of the children with ME (p < 0.001). Also, 76 % of children with ME did not have an asthma follow-up as compared with 37 % with a USEP and 52 % an SEP. Overall, 69 % of children with ME had at least one hospitalization within the year as compared with 32 % with a USEP (p = 0.001) and 59 % an SEP (p = 0.506). Conclusions An asthma education program delivered in a general hospital resulted in increased disease knowledge for children and their caregivers, together with reduced acute interventions.
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Affiliation(s)
- Caroline Thach
- Service de pédiatrie, Groupe hospitalier Sud Ile de France, 77000 Melun, France
| | - Charlotte Lafont
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- AP-HP, hôpital Henri-Mondor, Service de Santé Publique, F-94010, Créteil, France
| | - Ralph Epaud
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- Service de pédiatrie, Centre intercommunal de Créteil, 94010 Créteil Cedex, France
| | - Kenza Tahiri
- Service de pédiatrie, Centre intercommunal de Créteil, 94010 Créteil Cedex, France
| | - Floriane Sauvage
- Service de pédiatrie, Centre intercommunal de Créteil, 94010 Créteil Cedex, France
| | - Virginie Sagorin
- Unité transversale d’Education thérapeutique du Patient, Groupe hospitalier Sud Ile de France, 77000 Melun, France
| | - Virginie Sérabian
- Unité transversale d’Education thérapeutique du Patient, Groupe hospitalier Sud Ile de France, 77000 Melun, France
| | - Céline Delestrain
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- Service de pédiatrie, Centre intercommunal de Créteil, 94010 Créteil Cedex, France
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Shao M, Liu Z, Liu T. Effects of Family-Supported Healthcare on Children with Asthma. Ther Clin Risk Manag 2024; 20:427-436. [PMID: 39055744 PMCID: PMC11269404 DOI: 10.2147/tcrm.s464826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/30/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction Healthcare is essential for asthma control, however, whether family-supported healthcare improves therapeutic effects in childhood asthma remains unclear. Methods The enrolled patients were randomly divided into control and intervention groups. The pulmonary function was evaluated by forced expiratory volume in 1 s as a percentage of forced vital capacity (FEV1/FVC) and fractional exhaled nitric oxide (FeNO). Asthma control and life quality were assessed via a childhood asthma control test and pediatric asthma quality of life questionnaire. Inflammatory cytokines interleukin-6 (IL-6) and interleukin-17 (IL-17) were determined by enzyme-linked immunosorbent assay. Results No significant differences existed in the basic characteristics of asthma children and their parents among two groups. The increase of FEV1/FVC was higher in the intervention group versus the control group (76.47 ± 10.76% vs 69.76 ± 8.88%, p = 0.001 at the time of post-intervention), and the decrease of FeNO was greater in the intervention group (30.43 ± 6.85 bbp vs 35.64 ± 6.62 bbp, p = 0.003 at the time of post-intervention). Family-supported healthcare highly improved asthma control and quality of life in childhood asthma post-treatment. Meanwhile, the inflammatory cytokines IL-17 (118.14 ± 25.79 pg/mL in intervention group vs 142.86 ± 28.68 pg/mL in control group, p = 0.004 at the time of post-intervention) and IL-6 (103.76 ± 23.11 pg/mL in intervention group vs 119.73 ± 22.68 pg/mL in control group, p = 0.009 at the time of post-intervention) significantly decreased by family-supported healthcare intervention. Importantly, acute exacerbation (80.8% in intervention group vs 95.7% in control group, p = 0.030) and rehospitalization cases (88.5% in intervention group vs 100% in control group, p = 0.028) also decreased by family-supported healthcare intervention. Discussion Family-supported healthcare improves pulmonary function and quality of life while alleviates inflammation, acute exacerbation, and rehospitalization in childhood asthma post-routine treatment.
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Affiliation(s)
- Mingyu Shao
- Department of Child Health Care, Zibo Central Hospital, Zibo, Shandong, 255020, People’s Republic of China
| | - Zhaohong Liu
- Department of Child Health Care, Zibo Central Hospital, Zibo, Shandong, 255020, People’s Republic of China
| | - Tongtong Liu
- Department of Pediatrics, Zibo Central Hospital, Zibo, Shandong, 255020, People’s Republic of China
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Nguyen H, Nasir M. Management of Chronic Asthma in Adults. Med Clin North Am 2024; 108:629-640. [PMID: 38816107 DOI: 10.1016/j.mcna.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Asthma is characterized by chronic inflammation and respiratory symptoms such as wheezing and coughing. In the United States, it affects 25 million people annually. Chronic smokers, poor adherence to medications, incorrect use of inhalers, and overall poor asthma control are known risk factors that lead to poorly controlled chronic asthmatics. Although asthma is traditionally categorized by severity, treatment by primary care providers is guided by the Global Initiative for Asthma or the National Asthma Education and Prevention Program. As more research is available, shared decision-making between health care providers and patients will lead to improved outcomes in managing chronic asthma.
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Affiliation(s)
- Huong Nguyen
- Family and Community Medicine, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H154/C1613, Hershey, PA, USA.
| | - Munima Nasir
- Family and Community Medicine, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H154/C1613, Hershey, PA, USA
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Habte BM, Beyene KA, Patel SA, Fenta TG, Fitzpatrick AM. Asthma Control and Associated Factors Among Children with Current Asthma - Findings from the 2019 Child Behavioral Risk Factor Surveillance System - Asthma Call-Back Survey. J Asthma Allergy 2024; 17:611-620. [PMID: 38957434 PMCID: PMC11217140 DOI: 10.2147/jaa.s465550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/18/2024] [Indexed: 07/04/2024] Open
Abstract
Purpose This study aimed to determine the prevalence and correlates of uncontrolled asthma among children with current asthma in four US states. We also determined the rates and correlates of asthma-related hospitalization, urgent care center (UCC), or emergency department (ED) visits. Participants and Methods We analyzed the 2019 Behavioral Risk Factor Surveillance Survey (BRFSS) Asthma Call-back Survey (ACBS) datasets. Asthma control status was classified as well-controlled or uncontrolled asthma based on day- and night-time asthma symptoms, activity limitation or use of rescue medications. Multivariable logistic regression models were used to identify the correlates of uncontrolled asthma and asthma-related hospitalization or UCC/ED visits. Results Among 249 children with current asthma, 55.1% had uncontrolled asthma while 40% reported asthma-related hospitalization or UCC/ED visits in the past year. Non-Hispanic ethnicity, ages of 0-9 and 15-17 years, household income <$25,000, and not having a flu vaccination had higher odds of uncontrolled asthma. Conversely, asthma self-management education and households with two children compared to one were positively associated with uncontrolled asthma. For healthcare utilization, male and non-Hispanic children, along with those from households earning <$25,000 exhibited higher odds of asthma-related hospitalization and UCC/ED visits. Conclusion Uncontrolled asthma and asthma-related visits to UCC/ED and hospitalization are common among children with current asthma. These outcomes are influenced by low household income and male sex, among other factors which call for multi-faceted interventions by healthcare providers and policymakers. Targeted strategies to effectively manage asthma and reduce the need for emergency healthcare services are recommended.
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Affiliation(s)
- Bruck Messele Habte
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kebede A Beyene
- Department of Pharmaceutical and Administrative Sciences, University of Health Sciences and Pharmacy in St. Louis, St. Louis, MO, USA
| | - Shivani A Patel
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Teferi Gedif Fenta
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Waters EA, Pachur T, Pogge G, Hunleth J, Webster GD, Fedele DA, Shepperd JA. Managing children's asthma: what role do caregivers' mental representations of trigger and symptom management behaviors play? Psychol Health 2024:1-21. [PMID: 38682920 PMCID: PMC11518878 DOI: 10.1080/08870446.2024.2347657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 04/15/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Pediatric asthma management is challenging for parents and guardians (hereafter caregivers). We examined (1) how caregivers mentally represent trigger and symptom management strategies, and (2) how those mental representations are associated with actual management behavior. METHODS In an online survey, N = 431 caregivers of children with asthma rated 20 trigger management behaviors and 20 symptom management behaviors across 15 characteristics, and indicated how often they engaged in each behavior. RESULTS Principal components analysis indicated 4 dimensions for trigger management behaviors and 3 for symptom management behaviors. Bayesian mixed-effects models indicated that engagement in trigger management behavior was more likely for behaviors rated as affirming caregiver activities. However, trigger management behavior did not depend on how highly the behavior was rated as challenging for caregiver, burdensome on child, or routine caregiving. Engagement in symptom management behavior was more likely for behaviors rated as affirming and common and harmless to the child, but was unrelated to how highly a behavior was rated as challenging for caregivers. CONCLUSION These results suggest that interventions might be particularly useful if they focus on the affirming nature of asthma management behaviors. However, such interventions should acknowledge structural factors (e.g. poverty) that constrain caregivers' ability to act.
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Affiliation(s)
- Erika A. Waters
- Washington University in St. Louis, Saint Louis, Missouri, USA
| | - Thorsten Pachur
- Technical University of Munich, Munich , Germany
- Max Planck Institute for Human Development, Berlin, Germany
| | | | - Jean Hunleth
- Washington University in St. Louis, Saint Louis, Missouri, USA
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Juliá Benito JC, Moreno-Galarraga L, Bragado Alcaraz E, Asensi Monzó MT, Ortega Casanueva C, Moral L, Rodríguez Fernández-Oliva CR, Sanz Ortega J, Valdesoiro Navarrete L. Inhaled medications and inhalation chambers for childhood asthma. Spanish network of working groups on asthma in pediatrics (REGAP). An Pediatr (Barc) 2024; 100:123-131. [PMID: 38326156 DOI: 10.1016/j.anpede.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/26/2023] [Indexed: 02/09/2024] Open
Abstract
Asthma, the most prevalent chronic disease in pediatric age, continues to pose challenges in its management and treatment. National and international guidelines emphasize the importance of therapeutic education (TE) to achieve disease control. TE involves imparting knowledge and skills to the patient and their family, enhancing medication adherence, rectifying errors in inhalation technique, and tailoring treatment based on individual patient characteristics. It is essential for TE to be progressive, gradual, and personalized, spanning all levels of care. Training healthcare professionals in TE is crucial, particularly for pediatricians, who must also be aware of the extensive variability of available meds and inhalers and their respective age-specific indications. Addressing this need, the REGAP Group extensively reviewed inhalers currently available in Spain for pediatric asthma treatment. The review encompassed different inhalation systems and inhaled drugs used for pediatric asthma treatment. This review will be updated annually, providing information on medications, devices, inhalation chambers, indications, and financiation. The REGAP Group hopes that these tables will be a valuable help for pediatricians in their daily clinical practice and serve as an effective TE tool.
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Affiliation(s)
- Juan Carlos Juliá Benito
- Centro de Salud República Argentina, Valencia, Spain; Unidad de Alergia y Neumología Pediátrica, Hospital IMED, Valencia, Spain.
| | - Laura Moreno-Galarraga
- Neumología Infantil, Servicio de Pediatría, Hospital Universitario de Navarra, Pamplona, Spain
| | - Esther Bragado Alcaraz
- Unidad de Neumología y Alergia Pediátrica, Hospital Universitario Santa Lucia, Cartagena, Spain
| | | | | | - Luis Moral
- Unidad de Alergología y Neumología Pediátrica, Hospital General Universitario, Alicante, Spain
| | | | | | - Laura Valdesoiro Navarrete
- Unidad de Alergia, Neumología Pediátrica y Fibrosis Quística, Servicio de Pediatría, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
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Moreels T, Cruyt E, De Baets S, Andries L, Arts-Tielemans M, Rodriguez-Bailon M, Bergström A, Boete K, Bormans I, Costa U, Declercq H, Dekelver S, Dekyvere V, Delooz E, Engels C, Helderweirt S, Jarrey M, Lenaerts A, Leyman A, Lim KH, Meynen L, Satink T, Schoenmakers F, Senn D, Slembrouck L, Van Meensel E, Vangenechten D, Van Paepeghem B, De Vriendt P, Van de Velde D. Self-Management Analysis in Chronic Conditions (SMACC) checklist: an international consensus-based tool to develop, compare and evaluate self-management support programmes. BMJ Open 2023; 13:e075676. [PMID: 38128945 DOI: 10.1136/bmjopen-2023-075676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES The Self-Management Analysis in Chronic Conditions (SMACC) checklist was developed as a guidance tool to support the development, comparison and evaluation of self-management support programmes for persons with a chronic condition. The checklist was based on a previously performed concept analysis of self-management. The aim of this study was to validate its content using an international Delphi study and to deliver a final version. DESIGN A two-round Delphi study was conducted between October 2022 and January 2023. Using the researchers' networks, professionals with research or clinical expertise in self-management support and chronic conditions were recruited via online purposive snowball sampling. Participants were asked to score each item of the checklist (16 items total) on 3 content validity indicators: (1) clarity and comprehensibility, (2) relevance and importance and (3) degree of alignment with the overall goal of the checklist to promote adequate and comprehensive self-management support programmes. A consensus threshold of 75% agreement was used. The participants were also asked general questions about the checklist as a whole and were asked to provide feedback considering its refinement. RESULTS Fifty-four professionals with an average 14.5 years of experience participated in round 1, 48 with an average 12.5 years of experience participated in round 2. The majority of professionals were from Western Europe. For the majority of items consensus was reached after round 1. In round 2, 3 of the 4 remaining items reached consensus, 1 last item was retained based on highly recurring feedback. CONCLUSIONS The SMACC checklist was considered a valid and comprehensive tool to aid the development, evaluation and comparison of self-management support programmes. It was acknowledged as a useful instrument to supplement existing frameworks and was seen as feasible to implement in both research and clinical settings. Further validation in the field, with input from patients and peer experts, will be valuable.
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Affiliation(s)
- Timothy Moreels
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Ellen Cruyt
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Stijn De Baets
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
- Department of Gerontology and Frailty in Ageing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lore Andries
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Magelien Arts-Tielemans
- Department of Occupational Therapy, HAN University of Applied Science, Nijmegen, The Netherlands
| | | | - Aileen Bergström
- Karolinska Institutet Department of Neurobiology Care Sciences and Society, Stockholm, Sweden
| | - Kyara Boete
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Iris Bormans
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Ursula Costa
- Occupational Science, Health University of Applied Science Tyrol, Tyrol, Austria
| | - Hanne Declercq
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Sari Dekelver
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Virginie Dekyvere
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Eva Delooz
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Cynthia Engels
- Clinical Epidemiology and Ageing Unit, Université Paris Est Créteil (UPEC), Créteil, France
| | - Sam Helderweirt
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Mike Jarrey
- Occupational Therapy, Artevelde University College, Ghent, Belgium
| | - Anneleen Lenaerts
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Anneleen Leyman
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Kee Hean Lim
- Department of Health Sciences, St Mary's Hospital Medical School, London, UK
| | - Louise Meynen
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Ton Satink
- Department of Occupational Therapy, HAN University of Applied Science, Nijmegen, The Netherlands
| | | | - Daniela Senn
- Occupational Therapy, ZHAW School of Health Professions, Winterthur, Switzerland
| | - Lise Slembrouck
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Emma Van Meensel
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Dani Vangenechten
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | | | - Patricia De Vriendt
- Department of Gerontology and Frailty in Ageing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Occupational Therapy, Artevelde University College, Ghent, Belgium
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13
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Wientzek R, Brückner RM, Schönenberg A, Prell T. Instruments for measuring self-management and self-care in geriatric patients - a scoping review. Front Public Health 2023; 11:1284350. [PMID: 38192561 PMCID: PMC10773718 DOI: 10.3389/fpubh.2023.1284350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/22/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction With demographic changes, prioritizing effective care for geriatric patients to maintain functionality, independence, and quality of life is crucial. Well-developed self-management or self-care abilities, which can be maintained and improved through interventions, are of the utmost importance. To implement these interventions tailored and effectively, a thorough assessment of the individual's self-management and self-care abilities is required. Objective This scoping review aimed to identify self-management and self-care instruments suitable for geriatric patients, their underlying theories and definitions of self-management and self-care, and their similarities and differences in item content. Methods A systematic search of the PubMed and CINAHL databases was conducted to identify retrievable full-text articles published in English in the medical and nursing fields since the 1970s, which were validated on a sample with an average age of at least 70 years, used generic rather than disease-specific items, and addressed the broad range of self-management and self-care abilities. Results Of the 20 included articles, six instruments were identified that were based on different theories and offered varying definitions of self-management or self-care. Despite these differences, all emphasize empowered individuals taking an active role in their care. Most address actual behavior and abilities referring to lifestyle factors and (anticipated) adjustment behavior. However, crucial aspects, such as psychological factors, (instrumental) activities of daily living, and social environment are not fully addressed in these instruments, nor are the types of execution to which the items refer, such as wants, feelings, confidence, or attitudes. Conclusion To fully understand how geriatric patients implement daily self-management or self-care, a combination of instruments covering the important factors of self-management and self-care and addressing multiple types of item execution, such as behaviors, abilities, wants, or attitudes, is recommended. This review provides the first comprehensive overview of self-management and self-care instruments suitable for geriatric patients.
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Affiliation(s)
- Rebecca Wientzek
- Department of Geriatrics, Halle University Hospital, Halle (Saale), Germany
| | | | - Aline Schönenberg
- Department of Geriatrics, Halle University Hospital, Halle (Saale), Germany
| | - Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle (Saale), Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
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14
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Pogge G, Fedele DA, Waters EA, Maki J, Hunleth JM, Prabhakaran S, Bowen DJ, Shepperd JA. Exploring Caregiver Interest in and Preferences for Interventions for Children With Risk of Asthma Exacerbation: Web-Based Survey. JMIR Form Res 2023; 7:e46341. [PMID: 37531188 PMCID: PMC10433025 DOI: 10.2196/46341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Maintaining control of asthma symptoms is the cornerstone of asthma treatment guidelines in the United States. However, suboptimal asthma control and asthma exacerbations among young people are common and are associated with many negative outcomes. Interventions to improve asthma control are needed. For such interventions to be successful, it is necessary to understand the types of interventions that are appealing to caregivers of children with different levels of risk of exacerbation. OBJECTIVE This study aimed to evaluate whether caregivers of children with high (vs low) risk of asthma exacerbation show different levels of interest in and preferences for potential intervention programs and delivery methods. METHODS We contracted with Ipsos to administer a web-based survey to caregivers of children with asthma who were residing in the United States. Caregivers (N=394) reported their interest (1=not at all; 3=a lot) in 9 possible intervention programs and 8 possible intervention delivery methods. Caregivers also indicated their preferences by selecting the 3 intervention programs and 3 delivery methods that "most" interested them. Finally, caregivers completed 2 open-ended questions asking what other resources might be useful for managing their children's asthma. We classified children as having a high risk of exacerbation if they had an exacerbation in the past 3 months (n=116) and a low risk of exacerbation if otherwise (n=278). RESULTS Caregivers reported higher levels of interest in all intervention programs and delivery methods if they cared for a child with a high risk rather than a low risk of exacerbation. However, regardless of the child's risk status, caregivers expressed the highest levels of interest in programs to increase their child's self-management skills, to help pay for asthma care, and to work with the school to manage asthma. Caregivers expressed the highest levels of interest in delivery methods that maintained personal control over accessing information (websites, videos, printed materials, and smartphone apps). Caregivers' preferences were consistent with their interests; programs and delivery methods that were rated as high in interest were also selected as one of the 3 that "most" interested them. Although most caregivers did not provide additional suggestions for the open-ended questions, a few caregivers suggested intervention programs and delivery methods that we had not included (eg, education about avoiding triggers and medication reminders). CONCLUSIONS Similar interests and preferences among caregivers of children with high and low risk of exacerbation suggest a broad need for support in managing childhood asthma. Providers could help caregivers by directing them toward resources that make asthma care more affordable and by helping their children with asthma self-management. Interventions that accommodate caregivers' concerns about having personal control over access to asthma information are likely to be more successful than interventions that do not.
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Affiliation(s)
- Gabrielle Pogge
- Department of Psychology, University of Florida, Gainesville, FL, United States
| | - David A Fedele
- Department of Psychology, University of Florida, Gainesville, FL, United States
| | - Erika A Waters
- Division of Public Health Sciences, Washington University in St Louis, St Louis, MO, United States
| | - Julia Maki
- Division of Public Health Sciences, Washington University in St Louis, St Louis, MO, United States
| | - Jean M Hunleth
- Division of Public Health Sciences, Washington University in St Louis, St Louis, MO, United States
| | | | - Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle, WA, United States
| | - James A Shepperd
- Department of Psychology, University of Florida, Gainesville, FL, United States
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15
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de Dios JG, López-Pineda A, Juan GMP, Minagorre PJA, Guilabert M, Pérez-Jover V, Carrillo I, Mira JJ. Perceptions and attitudes of pediatricians and families with regard to pediatric medication errors at home. BMC Pediatr 2023; 23:380. [PMID: 37525101 PMCID: PMC10391897 DOI: 10.1186/s12887-023-04106-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 06/02/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE This study aimed to identify the perceptions and attitudes of pediatricians and parents/caregivers regarding medication errors at home, and to compare the findings from the two populations. METHODS This was a cross-sectional survey study. We designed a survey for working pediatricians and another one for parents or caregivers of children aged 14 years and younger. The survey's questions were designed to assess provider and parental opinions about the difficulty faced by parents providing medical treatment, specific questions on medication errors, and on a possible intervention program aimed at preventing pediatric medication errors. Pediatrician and parent responses to matching questions in both surveys were compared. RESULTS The surveys were administered in Spain from 2019 to 2021. In total, 182 pediatricians and 194 families took part. Most pediatricians (62.6%) and families (79.3%) considered that managing medical treatment was not among the main difficulties faced by parents in caring for their children. While 79.1% of pediatricians thought that parents consulted the internet to resolve doubts regarding the health of their children, most families (81.1%) said they consulted healthcare professionals. Lack of knowledge among parents and caregivers was one of the causes of medication errors most frequently mentioned by both pediatricians and parents. Most pediatricians (95.1%) said they would recommend a program designed to prevent errors at home. CONCLUSIONS Pediatricians and families think that medical treatment is not among the main difficulties faced by parents in caring for their children. Most pediatricians said they would recommend a medication error reporting and learning system designed for families of their patients to prevent medication errors that might occur in the home environment.
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Grants
- GV/2019/040 Ministry of innovation, universities, science and society of Valencia Region
- GV/2019/040 Ministry of innovation, universities, science and society of Valencia Region
- GV/2019/040 Ministry of innovation, universities, science and society of Valencia Region
- GV/2019/040 Ministry of innovation, universities, science and society of Valencia Region
- GV/2019/040 Ministry of innovation, universities, science and society of Valencia Region
- GV/2019/040 Ministry of innovation, universities, science and society of Valencia Region
- GV/2019/040 Ministry of innovation, universities, science and society of Valencia Region
- GV/2019/040 Ministry of innovation, universities, science and society of Valencia Region
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Affiliation(s)
- Javier González de Dios
- Pharmacology, Pediatrics and Organic Chemistry, Miguel Hernandez University, San Juan de Alicante, Spain
- Paediatrics Department, General University Hospital of Alicante, Alicante, Spain
- Institute of Health and Biomedical Research of Alicante, Alicante Spain General University Hospital of Alicante, Alicante, Spain
| | - Adriana López-Pineda
- Clinical Medicine Department, Miguel Hernández University, San Juan de Alicante, Spain
- Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, San Juan de Alicante, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), San Juan de Alicante, Spain
| | | | - Pedro J Alcalá Minagorre
- Paediatrics Department, General University Hospital of Alicante, Alicante, Spain
- Institute of Health and Biomedical Research of Alicante, Alicante Spain General University Hospital of Alicante, Alicante, Spain
| | - Mercedes Guilabert
- Health Psychology Department, Miguel Hernandez University, Elche, Spain.
| | - Virtudes Pérez-Jover
- Institute of Health and Biomedical Research of Alicante, Alicante Spain General University Hospital of Alicante, Alicante, Spain
- Health Psychology Department, Miguel Hernandez University, Elche, Spain
| | - Irene Carrillo
- Health Psychology Department, Miguel Hernandez University, Elche, Spain
| | - José Joaquín Mira
- Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, San Juan de Alicante, Spain
- Health Psychology Department, Miguel Hernandez University, Elche, Spain
- Alicante-Sant Joan d'Alacant Health Department, San Juan de Alicante, Spain
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16
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Nguyen H, Nasir M. Management of Chronic Asthma in Adults. Prim Care 2023; 50:179-190. [PMID: 37105600 DOI: 10.1016/j.pop.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Asthma is characterized by chronic inflammation and respiratory symptoms such as wheezing and coughing. In the United States, it affects 25 million people annually. Chronic smokers, poor adherence to medications, incorrect use of inhalers, and overall poor asthma control are known risk factors that lead to poorly controlled chronic asthmatics. Although asthma is traditionally categorized by severity, treatment by primary care providers is guided by the Global Initiative for Asthma or the National Asthma Education and Prevention Program. As more research is available, shared decision-making between health care providers and patients will lead to improved outcomes in managing chronic asthma.
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Affiliation(s)
- Huong Nguyen
- Family and Community Medicine, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H154/C1613, Hershey, PA, USA.
| | - Munima Nasir
- Family and Community Medicine, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H154/C1613, Hershey, PA, USA
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17
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Antoñón M, Pernía-Sánchez JV, Cancho-Soto T, Segovia-Molina I, Díez-Monge N, Cano A. Asthma control in children, socioeconomic inequality and health care. An Pediatr (Barc) 2023; 98:353-361. [PMID: 37055301 DOI: 10.1016/j.anpede.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/29/2022] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION Socioeconomic inequality (SEI) can adversely affect asthma control. The aim of this study was to establish the association of SEI with asthma control in children and caregiver quality of life. METHODS We assessed socioeconomic status based on the area of residence, according to the at risk of poverty rate (ARPR). After stratifying the paediatric population of Castilla y León (Spain) in ARPR tertiles, we selected participants by stratified random sampling, and identified children with asthma aged 6-14 years from the health records of primary care centres. We collected data through questionnaires completed by parents. The primary outcomes were asthma control and caregiver quality of life. We assessed their association with SEI, health care quality measures and individual factors (such as parental educational attainment) by means of multivariate regression models. RESULT The ARPR tertile was not associated with asthma control, quality of life or health care quality. A medium or high maternal educational attainment was associated with a lower risk of making an unscheduled or urgent visit (OR = .50; 95% CI, .27-.95; P = .034) and paternal educational attainment was associated with a lower risk of uncontrolled asthma (OR = 0.51; 95% CI, .28-.94; P = .030). CONCLUSION In the sample under study, SEI assessed at the local level was not associated with asthma control in children. Other factors, such as parental educational attainment, may have a protective effect.
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Affiliation(s)
- Miguel Antoñón
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | - Teresa Cancho-Soto
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Inés Segovia-Molina
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Nuria Díez-Monge
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain; Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Alfredo Cano
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain; Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain.
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18
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Control del asma en niños, desigualdad socioeconómica y asistencia sanitaria. An Pediatr (Barc) 2023. [DOI: 10.1016/j.anpedi.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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19
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Adinkrah E, Najand B, Young-Brinn A. Parental Education and Adolescents' Asthma: The Role of Ethnicity. CHILDREN (BASEL, SWITZERLAND) 2023; 10:267. [PMID: 36832395 PMCID: PMC9955909 DOI: 10.3390/children10020267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
While high parental education is associated with better health, this association may be weaker for ethnic minority than for ethnic majority families. It is unknown whether the association between parental education and adolescents' asthma also varies by ethnicity. AIM To study the association between parental education and adolescents' asthma overall and by ethnicity. METHODS The current study used data from the Population Assessment of Tobacco and Health (PATH)-Adolescents study. All participants were 12 to 17-year-old non-smokers (n = 8652). The outcome of interest was adolescents' asthma. The predictor of interest was baseline parental education, the covariates were age, sex, and number of parents present at baseline, and the moderator was ethnicity. RESULTS According to logistic regression analyses, higher parental education was predictive of adolescents' asthma; however, this association was weaker for Latino than non-Latino adolescents (OR 1.771; CI 1.282-2.446). We did not find a significant difference in the effect of parental education on asthma of White and African American adolescents. Our stratified models also showed that higher parental education was associated with lower asthma for non-Latino but not for Latino adolescents. CONCLUSION The effect of high parental education on adolescents' asthma prevalence differs between Latino and non-Latino families, with Latino families showing weaker protective effects of parental education on adolescents' asthma. Future research should test the role of exposure to environmental pollutants, neighborhood quality, and prevalence of smoking in social network members as well as other contextual factors at home, in school, and in the neighborhood that may increase prevalence of asthma in Latino adolescents regardless of their parental education. Given that these potential causes are multi-level, potential causes of such disparities should be tested in future multi-level research.
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Affiliation(s)
- Edward Adinkrah
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Marginalization-Related Diminished Returns Center, Los Angeles, CA 90059, USA
| | - Babak Najand
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Angela Young-Brinn
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Marginalization-Related Diminished Returns Center, Los Angeles, CA 90059, USA
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20
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Effects of an Asthma Education Camp Program on Quality of Life and Asthma Control among Thai Children with Asthma: A Quasi-Experimental Study. Healthcare (Basel) 2022; 10:healthcare10081561. [PMID: 36011217 PMCID: PMC9407909 DOI: 10.3390/healthcare10081561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Caregiver knowledge and management ability can improve asthma control and quality of life (QoL) among children with asthma. A quasi-experimental study was proposed to assess the effect of a 1 day educational camp program on the QoL of children with asthma and on their caregivers’ asthma knowledge and management. Children with asthma and their caregivers were invited to attend a camp. The Pediatric Asthma Quality of Life Questionnaire (PAQLQ), Childhood Asthma Control Test score, and forced expiratory volume in 1 s were assessed in children at the first, 3 month, 6 month, and 1 year visits. The caregiver’s knowledge, attitudes, and practice (KAP) survey was assessed at each visit. A total of 212 patients were enrolled (mean age: 8.56 ± 1.63 years) but only 72 patients attended the camp. There was no significant difference in baseline characteristics, asthma severity, or asthma risk factors between camp attendees and non-attendees. The KAP of caregivers who attended the camp was significantly higher than non-attendees at the 3 month and 6 month visits (16.86 ± 2.3 vs. 15.95 ± 2.78 (p = 0.009); 17.25 ± 2.22 vs. 16.7 ± 2.68 (p = 0.04)). QoL did not significantly differ between patient attendees vs. non-attendees. PAQLQ mean score correlated with asthma control, indicating that patients with well-controlled asthma had better QoL than those with unstable asthma control (p < 0.001). An asthma education camp can help increase self-management knowledge, even though its effect may be short-term. Integrating asthma education into routine care could enhance asthma management in children.
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21
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Abbasalizad Farhangi M, Mohammadi Tofigh A, Jahangiri L, Nikniaz Z, Nikniaz L. Sugar-sweetened beverages intake and the risk of obesity in children: An updated systematic review and dose-response meta-analysis. Pediatr Obes 2022; 17:e12914. [PMID: 35466543 DOI: 10.1111/ijpo.12914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/29/2022] [Accepted: 02/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The prevalence of childhood obesity has increased worldwide and has reached alarming proportions. Contradictive results from studies and reviews have fuelled an endless debate on the role of SSBs in the development of childhood obesity. OBJECTIVE This study aimed to assess the impact of sugar-sweetened beverages (SSBs) intake on body mass index (BMI), body fat percentage (BFP), and waist circumference (WC) among children. METHODS Databases including PubMed/MEDLINE, Scopus, Cochrane Library, EMBASE, and Web of Science were searched up to August 2021. Observational studies reporting the relation between SSBs intake and BMI, BFP, and WC were included. STATA version 15 was used to analyse the data. RESULTS In this meta-analysis, 33 studies with 121 282 subjects were included. Excessive SSBs intake was associated with 0.75 kg/m2 increase in BMI in children and adolescents (WMD: 0.75; CI 0.35-1.15; p < 0.001). In addition, high SSBs intake was significantly associated with higher WC (WMD: 2.35 cm; 95% CI, 1.34, 3.37; p = 0.016) and BFP (WMD: 2.81; CI 2.21-3.41; p < 0.001). No departure from linearity was detected in dose-response meta-analysis between SSBs consumption and changes in BMI, WC, and BFP. CONCLUSION High SSBs consumption was associated with increased BMI, WC, and BFP among children and adolescents. Further large prospective long-term interventions are recommended to confirm the observed relationships.
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Affiliation(s)
- Mahdieh Abbasalizad Farhangi
- Department of Community Nutrition, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arash Mohammadi Tofigh
- Department of general surgery, school of medicine, Shahid Beheshti University of medical sciences, Tehran, Iran
| | - Leila Jahangiri
- Department of Health Promotion and Education, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Nikniaz
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Nikniaz
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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22
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Uchima O, Keaulana S, Okihiro M, Sentell T. A scoping review of school-based asthma education programs for reducing children’s need for acute care services. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2091568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Olivia Uchima
- Graduate of the PhD in Public Health, The University of Hawaii of Manoa, Honolulu, HI, USA
| | - Samantha Keaulana
- Doctoral Candidate of the Office of Public Health Studies, The University of Hawaii of Manoa, Honolulu, HI, USA
| | - May Okihiro
- Pediatrician in the Department of Pediatrics, The University of Hawaii at Manoa, Honolulu, HI, USA
| | - Tetine Sentell
- Director and Professor of the Office of Public Health Studies, the University of Hawaii at Manoa, Honolulu, HI, USA
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23
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Com G, Amin R, Gunnett M, Antonetti C. Patient Characteristics and Caregiver Asthma Knowledge of Children with Well-Controlled and Poorly Controlled Asthma. J Asthma Allergy 2022; 15:793-802. [PMID: 35721305 PMCID: PMC9199526 DOI: 10.2147/jaa.s361135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/05/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To describe the socio-demographics and clinical characteristics of children in a pulmonology clinic or admitted to a children’s hospital with well-controlled and poorly controlled asthma, and to assess caregiver knowledge of asthma pathogenesis, treatment, and self-management. Patients and Methods A cohort of 132 children aged 2–18 years and their caregivers seen in a pediatric pulmonology clinic with a diagnosis of asthma (n=112) or admitted to the hospital with a diagnosis of asthma exacerbation (n=20) were invited to participate in a cross-sectional study. Caregivers completed a survey, which healthcare providers then used to tailor asthma education to the patient and caregiver. Two-tail t-tests and Chi-square tests were used to compare demographics and clinical characteristics of children with well-controlled vs poorly controlled asthma. Results Of 132 children, 111 children in this cohort had poorly controlled asthma (84%). Medicaid insurance was associated with poorly controlled asthma versus well-controlled asthma (63% vs 35% p=0.01). Asthma action plans (AAP) had previously been given to 113 caregivers (86%), but caregivers of children with both well-controlled and poorly controlled asthma still reported misconceptions about asthma pathology and management, such as stopping daily medications when asthma is controlled. Conclusion This study contributes to the existing evidence that socio-demographics have a significant impact on asthma prevalence and proper management. Our study suggests that caregivers of children with asthma need comprehensive asthma education beyond the AAP focusing on asthma-related misconceptions.
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Affiliation(s)
- Gulnur Com
- Department of Pediatric Pulmonology, University of Florida, Ascension Sacred Heart, Pensacola, FL, USA
| | - Raid Amin
- Department of Mathematics & Statistics, University of West Florida, Pensacola, FL, USA
| | - Mohini Gunnett
- Department of Pediatric Pulmonology, University of Alabama, Birmingham, AL, USA
| | - Callah Antonetti
- Department of Pediatrics, University of Florida, Ascension Sacred Heart, Pensacola, FL, USA
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Nikniaz Z, Tabrizi JS, Abbasalizad Farhangi M, Hosseini M, Tahmasebi S, Nikniaz L. Community‐based interventions to reduce sugar intake in healthy populations: A systematic review. WORLD MEDICAL & HEALTH POLICY 2022. [DOI: 10.1002/wmh3.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Zeinab Nikniaz
- Liver and Gastrointestinal Diseases Research Center, Medicine Faculty Tabriz University of Medical Sciences Tabriz Iran
| | - Jafar S. Tabrizi
- Tabriz Health Services Management Research Center, Faculty of Management and Medical Informatics Tabriz University of Medical Sciences Tabriz Iran
| | | | | | - Sanaz Tahmasebi
- Student Research Committee Tabriz University of Medical Sciences Tabriz Iran
| | - Leila Nikniaz
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences Faculty of Management and Medical Informatics Tabriz Iran
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25
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Jain RP, Als D, Vaivada T, Bhutta ZA. Prevention and Management of High-Burden Noncommunicable Diseases in School-Age Children: A Systematic Review. Pediatrics 2022; 149:186938. [PMID: 35503327 DOI: 10.1542/peds.2021-053852f] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Noncommunicable diseases (NCDs) are chronic conditions requiring health care, education, social and community services, addressing prevention, treatment, and management. This review aimed to summarize and synthesize the available evidence on interventions from systematic reviews of high-burden NCDs and risk factors among school-aged children. METHODS The following databases were used for this research: Medline, Embase, The Cochrane Library, and the Campbell library. The search dates were from 2000 to 2021. We included systematic reviews that synthesized studies to evaluate intervention effectiveness in children aged 5 to 19 years globally. Two reviewers independently extracted data and assessed methodological quality of included reviews using the AMSTAR 2 tool. RESULTS Fifty studies were included. Asthma had the highest number of eligible reviews (n = 19). Of the reviews reporting the delivery platform, 27% (n = 16) reported outpatient settings, 13% (n = 8) home and community-based respectively, and 8% (n = 5) school-based platforms. Included reviews primarily (69%) reported high-income country data. This may limit the results' generalizability for school-aged children and adolescents in low- and middle- income countries. CONCLUSIONS School-aged children and adolescents affected by NCDs require access to quality care, treatment, and support to effectively manage their diseases into adulthood. Strengthening research and the capacity of countries, especially low- and middle- income countries, for early screening, risk education and management of disease are crucial for NCD prevention and control.
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Affiliation(s)
- Reena P Jain
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Daina Als
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Tyler Vaivada
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Canada.,Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
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26
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Ghozali MT, Satibi S, Ikawati Z, Lazuardi L. The efficient use of smartphone apps to improve the level of asthma knowledge. J Med Life 2022; 15:625-630. [PMID: 35815086 PMCID: PMC9262265 DOI: 10.25122/jml-2021-0367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/24/2022] [Indexed: 11/17/2022] Open
Abstract
Patient education is one of the important aspects of improving knowledge and quality of asthma control. In this digital era, it can be made with the support of an app - or known as mHealth. Unfortunately, implementing applications for patient education is relatively new among asthmatic patients in Indonesia. This study aimed to determine the efficacy of the educational content of the AsmaDroid® app on the levels of asthma knowledge among asthmatic patients. This study was a randomized controlled trial carried out from December 2019 to March 2020 in the Special Region of Yogyakarta, Indonesia. A quota sampling was employed, resulting in 140 study participants being categorized into control and treatment groups. Before and after the 4-week treatment period, all participants were asked to complete a pre-test and post-test of the Asthma General Knowledge Questionnaire for Adults (AGKQA) questionnaire. All the scores were then compared to determine the efficacy of educational content on the levels of asthma knowledge. The results of descriptive statistics reported that the pretest scores of AGKQA from the control group (minimum, maximum, and mean) were 9, 25, and 19.04±2.56, respectively, and post-test scores were 10, 27, and 18.79±3.59 (p=0.47). Meanwhile, in the treatment group, these were 13, 25, and 19.11±2.87, while post-test scores were 16, 31, 23.6±3.95 (p=0.01). Additionally, there was a difference between the post-test scores of the control and treatment groups, namely 4.81 (p=0.01). The educational content of the app significantly improved the levels of asthma knowledge.
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Affiliation(s)
| | - Satibi Satibi
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia,Corresponding Author: Satibi Satibi, Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia. E-mail:
| | - Zullies Ikawati
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Lutfan Lazuardi
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Martin J, Townshend J, Brodlie M. Diagnosis and management of asthma in children. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001277. [PMID: 35648804 PMCID: PMC9045042 DOI: 10.1136/bmjpo-2021-001277] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/13/2022] [Indexed: 12/13/2022] Open
Abstract
Asthma is the the most common chronic respiratory condition of childhood worldwide, with around 14% of children and young people affected. Despite the high prevalence, paediatric asthma outcomes are inadequate, and there are several avoidable deaths each year. Characteristic asthma features include wheeze, shortness of breath and cough, which are typically triggered by a number of possible stimuli. There are several diagnostic challenges, and as a result, both overdiagnosis and underdiagnosis of paediatric asthma remain problematic.Effective asthma management involves a holistic approach addressing both pharmacological and non-pharmacological management, as well as education and self-management aspects. Working in partnership with children and families is key in promoting good outcomes. Education on how to take treatment effectively, trigger avoidance, modifiable risk factors and actions to take during acute attacks via personalised asthma action plans is essential.This review aimed to provide an overview of good clinical practice in the diagnosis and management of paediatric asthma. We discuss the current diagnostic challenges and predictors of life-threatening attacks. Additionally, we outline the similarities and differences in global paediatric asthma guidelines and highlight potential future developments in care. It is hoped that this review will be useful for healthcare providers working in a range of child health settings.
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Affiliation(s)
- Joanne Martin
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Northern Foundation School, Health Education England North East, Newcastle upon Tyne, UK.,James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, UK
| | - Jennifer Townshend
- Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Malcolm Brodlie
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK .,Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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28
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Samady W, Rodriguez VA, Gupta R, Palac H, Pongracic JA, Press VG. Interactive Inpatient Asthma Education: A Randomized Controlled Trial. Hosp Pediatr 2022; 12:239-247. [PMID: 35190827 DOI: 10.1542/hpeds.2021-006259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Inpatient asthma education interventions provide benefit compared with usual care, but evaluation of the most effective educational model is needed. We compared the impact of interactive versus didactic inpatient pediatric asthma education on subsequent emergency department (ED) visits and hospitalizations. METHODS Children (aged 2‒16) with asthma admitted to a tertiary care children's hospital with an asthma exacerbation between October 2016 and June 2017 were randomly assigned to interactive or didactic (control) asthma education. The primary outcome was asthma ED visits at 6 and 12 months; secondary outcomes included hospitalizations (6 and 12 months), inhaler technique, asthma knowledge, symptoms, quality of life, and parental management skills at baseline, discharge, and/or 12 months. RESULTS One hundred forty participants (69 interactive, 71 control) completed the study. There were no differences in ED visits at 6 or 12 months. Compared to controls, the interactive group had fewer hospitalizations (10.1% vs 22.5%; P = .04) at 6 months. Inhaler technique in the interactive group improved at discharge (mean change 4.07 [95% confidence interval (CI): 3.21-4.94]) and remained increased at 12 months (P = .03). Patient-reported asthma symptoms and quality of life were similar in both groups at baseline (19.9 vs 20.62, best possible score 8) and significantly improved in the interactive group at 12 months (least square mean change, 3.52 vs -1.75; P < .01). CONCLUSIONS There were no differences in ED visits; however, the interactive education reduced asthma hospitalizations over a 6-month period. These findings demonstrate that educational delivery methods can play a role in improving clinical outcomes for asthma.
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Affiliation(s)
- Waheeda Samady
- Divisions of Hospital-Based Medicine
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Victoria A Rodriguez
- Divisions of Hospital-Based Medicine
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ruchi Gupta
- Academic General Pediatrics
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Jacqueline A Pongracic
- Allergy and Immunology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Davis SA, Beznos B, Carpenter DM, Tudor G, Garcia N, Sleath B. Trends in Adolescent Asthma Responsibility Over a 12-Month Study Period. J Adolesc Health 2022; 70:478-482. [PMID: 34823985 PMCID: PMC8889904 DOI: 10.1016/j.jadohealth.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study is to assess factors that influence adolescent asthma responsibility and how patient- and parent-reported asthma responsibility changes over a 12-month period. METHODS One hundred sixty-four adolescents and their parents completed questionnaires at baseline and 12 months, including the asthma responsibility questionnaire, in which higher scores indicate greater adolescent responsibility. Multiple linear regression was used to assess how baseline asthma responsibility, self-efficacy, outcome expectations, and demographic characteristics were associated with 12-month asthma responsibility. RESULTS Asthma responsibility as reported by both adolescents and parents shifted significantly toward the adolescent over the study period (p < .001). Most individual scale items (e.g., noticing signs and symptoms of asthma, starting treatment when symptoms occur) also showed significant shifts toward greater adolescent responsibility. In the regression models, higher baseline asthma responsibility and older age were significant predictors of both higher adolescent- and parent-reported 12-month asthma responsibility, while female gender and mild asthma severity also predicted higher parent-reported asthma responsibility. CONCLUSIONS Asthma responsibility shifted toward adolescents over a 12-month period. Regardless of age and gender, all types of adolescents were able to improve their responsibility level based on adolescent-reported results. Older females, according to parent-reported results, were more likely to improve their responsibility. Providers need to make sure adolescents are learning all the necessary skills to manage asthma independently before they reach adulthood.
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Affiliation(s)
- Scott A. Davis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Bethany Beznos
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Delesha M. Carpenter
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Gail Tudor
- Southern New Hampshire University, Manchester, NH, USA
| | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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30
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Rhee H, Love T, Wicks MN, Tumiel-Berhalter L, Sloand E, Harrington D, Walters L. Long-term Effectiveness of a Peer-Led Asthma Self-management Program on Asthma Outcomes in Adolescents Living in Urban Areas: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2137492. [PMID: 34874404 PMCID: PMC8652603 DOI: 10.1001/jamanetworkopen.2021.37492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/09/2021] [Indexed: 01/18/2023] Open
Abstract
Importance Long-term effectiveness of a peer-led asthma self-management program in improving asthma outcomes in adolescents living in urban areas has not been established. Objective To determine the long-term effects of a peer-led program on asthma control, quality of life, and asthma management among predominantly racial and ethnic minority adolescents living in urban areas. Design, Setting, and Participants A parallel-group, randomized clinical trial was conducted in 2015 to 2019 in 3 metropolitan cities in the US: Buffalo, New York; Baltimore, Maryland; and Memphis, Tennessee. Adolescents aged 12 to 17 years old with persistent asthma were recruited mainly through clinical practices and schools. Participants were followed-up for 15 months after the intervention. Double-blinding was achieved for baseline. Data analysis was performed from June 2019 to June 2020. Interventions The intervention group received a peer-led asthma self-management program; the control group received the identical program led by adult health care professionals. Peer leaders made follow-up contacts every other month for 12 months. Main Outcomes and Measures The primary outcome was quality of life measured by the Pediatric Asthma Quality of Life Questionnaire, which consists of 3 subscales that measure symptoms (10 items), activity limitations (5 items), and emotional functioning (8 items) in the past 2 weeks. Each item was measured on a 7-point scale, with higher mean scores indicating better quality of life. Secondary measures included the Asthma Control Questionnaire and an asthma self-management index capturing steps to prevent and manage symptoms, self-efficacy, and lung function. Results Of 395 eligible adolescents, 35 refused, 38 did not show or were lost to contact, and 2 withdrew before randomization; 320 adolescents participated (mean [SD] age, 14.3 [1.71] years), including 168 boys (52.5%), 251 Black or African American adolescents (78.4%), and 232 adolescents (72.5%) with public health insurance. Of 320 enrolled, 303 were included in the longitudinal analysis. Response rates were 80% or higher at all time points. The peer-led group had greater improvement in outcomes than the adult-led group, with adjusted mean differences (AMDs) between baseline and 15 months of 0.75 vs 0.37 for quality of life (between-group AMD, 0.38; 95% CI, 0.07 to 0.63) and -0.59 vs -0.31 for asthma control (between-group AMD, -0.28; 95% CI, -0.51 to -0.01). Outcomes were not affected by bimonthly contact doses. Conclusions and Relevance In this randomized clinical trial, a peer-led asthma self-management education was more effective than an adult-led program in improving asthma outcomes, with the improvements sustained for up to 15 months. These findings suggest that a peer-led asthma self-management program should be considered in addressing the disproportionate asthma burden in racial and ethnic minority adolescents living in urban communities. Trial Registration ClinicalTrials.gov Identifier: NCT02293499.
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Affiliation(s)
- Hyekyun Rhee
- School of Nursing, University of Rochester, Rochester, New York
- Now with School of Nursing, University of Texas at Austin, Austin
| | - Tanzy Love
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
| | - Mona N. Wicks
- College of Nursing, University of Tennessee Health Science Center, Memphis
| | - Laurene Tumiel-Berhalter
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo
| | - Elizabeth Sloand
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Donald Harrington
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
| | - Leanne Walters
- Department of Social Work, Roberts Wesleyan College, Rochester, New York
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Improved asthma outcomes among at-risk children in a pharmacist-led, interdisciplinary school-based health clinic: A pilot study of the CAReS program. J Am Pharm Assoc (2003) 2021; 62:519-525.e1. [PMID: 34863634 DOI: 10.1016/j.japh.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Disparities in access to care and outcomes have been identified among children with asthma living in underserved communities. The Caring for Asthma in our Region's Schoolchildren program was established to reduce disparities by providing school-based, comprehensive asthma care by a pharmacist-led, interdisciplinary team to high-risk pediatric populations in the Greater Pittsburgh area. OBJECTIVE To investigate program impact on follow-up appointment attendance, delivery of guideline-based care, asthma control, asthma morbidity (emergency department [ED] visits, oral corticosteroid [OCS] requirement), and asthma-related knowledge and quality of life. METHODS The study enrolled 50 children with asthma from 6 elementary schools (September 2014-December 2017). Children completed 5 visits over a 3-month period. McNemar's test assessed improvement in guideline-based controller therapy use and reduced morbidity (ED visits or OCS requirement). Generalized estimating equation analyses determined the significance of monthly improvements in asthma control, asthma knowledge, and quality of life. RESULTS A 100% show rate was achieved in nearly all participants (92.0%). Most of the patients were African-American (56%). In children with persistent disease, only 21.4% were prescribed controller therapy at baseline, which improved to 78.5% upon enrollment (P < 0.05). Asthma control statistically significantly improved (P < 0.05), and a reduction in percentage of patients who required an ED visit or an OCS burst pre-to postintervention was also statistically significant (31.3% vs. 14.6%, P < 0.05). The goal of 100% treatment plan knowledge was achieved in 67% of caregivers within 1 month and increased from 6% to 60% in children over 3 months (P < 0.05). Asthma-related quality of life also improved statistically significantly pre-to postintervention (P < 0.05). CONCLUSIONS Disparities in asthma outcomes owing to inadequate access to health care can be addressed. Improved asthma control, asthma medication knowledge, quality of life, and reduced morbidity in high-risk pediatric patients are achievable as demonstrated by our study. Our findings support the feasibility and value of a pharmacist-led, interdisciplinary school-based health care delivery model in providing comprehensive asthma care to at-risk pediatric populations.
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O’Connor A, Tai A, Carson-Chahhoud K. Isn't There an App for That? The Role of Smartphone and Tablet Applications for Asthma Education and Self-Management in Adolescents. CHILDREN (BASEL, SWITZERLAND) 2021; 8:786. [PMID: 34572218 PMCID: PMC8467082 DOI: 10.3390/children8090786] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 01/03/2023]
Abstract
Asthma is one of the most common chronic diseases worldwide, with a substantial proportion of the asthma population being children and adolescents. Self-management is recognized as a key component to asthma management, with multiple international guidelines emphasizing the need for adequate self-management skills for good asthma control. Unfortunately, the uptake amongst young people and adolescents is low, with often suboptimal engagement to self-management education and skills contributing to poor adherence to medication as well as poor perception of asthma symptoms. Innovative solutions to deliver education and self-management to adolescents are clearly needed. mHealth is the use of mobile devices such as smartphones and tablet devices to improve healthcare and has been used in multiple chronic diseases. This review articles explores the current use of mHealth in asthma, specifically smartphone and tablet applications as a generation-appropriate, accessible delivery modality for provision of asthma education and self-management interventions in adolescents. Current evidence gaps are also highlighted, which should be addressed in future research.
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Affiliation(s)
- Antonia O’Connor
- Respiratory and Sleep Department, Women’s and Children’s Hospital, 72 King Williams Road, North Adelaide, SA 5006, Australia;
| | - Andrew Tai
- Respiratory and Sleep Department, Women’s and Children’s Hospital, 72 King Williams Road, North Adelaide, SA 5006, Australia;
- Robinson Research Institute, University of Adelaide, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide, SA 5006, Australia
| | - Kristin Carson-Chahhoud
- Adelaide Medical School, University of Adelaide, Adelaide Health and Medical Sciences Building, Corner of North Terrace & George Street, Adelaide, SA 5000, Australia;
- Translational Medicine and Technology Group, Australian Centre for Precision Health, University of South Australia, Level 8 South SAHMRI Building, North Terrace, Adelaide, SA 5000, Australia
- Australian Centre for Precision Health, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia
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Simonsmeier BA, Flaig M, Simacek T, Schneider M. What sixty years of research says about the effectiveness of patient education on health: a second order meta-analysis. Health Psychol Rev 2021; 16:450-474. [PMID: 34384337 DOI: 10.1080/17437199.2021.1967184] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Although meta-analyses have examined the association between patient education and health, the validity and quality of this evidence have not been comprehensively assessed. This second order meta-analysis combined previous meta-analyses that examined the effectiveness of patient education on health outcomes as an overall weighted grand mean d¯¯. Further, measures of methodological quality, meaningful variability across first order meta-analyses, and evidence for publication bias were examined. Forty meta-analyses were identified, investigating 156 associations between patient education and health summarizing data from over 776 studies including more than 74.947 patients. Quantitative analyses showed that patient education positively affects health outcomes with d¯¯ = 0.316 (95% CI [0.304, 0.329]). Summarizing data exclusively from randomized controlled trials indicated a causal effect. Patient education was effective for patients with neoplasms, diabetes, mental and behavioral disorders, diseases of the circulatory system, the respiratory system, and the musculoskeletal system. Patient education was effective in the reduction of medication use, pain, and visits to medical facilities, and significantly improved physiological, physical, psychological outcomes, and patients' general function. Overall, the findings reveal firm evidence for the effectiveness of patient education on health outcomes. However, theory-based interventions are lacking and need to be implemented to enable a successful transfer from theory to practice.
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Affiliation(s)
| | - Maja Flaig
- University of Tübingen, Tübingen, Germany
| | - Thomas Simacek
- Department of Educational Psychology, University of Trier, Trier, Germany
| | - Michael Schneider
- Department of Educational Psychology, University of Trier, Trier, Germany
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Uchima O, Taira DA, Ahn HJ, Choi SY, Okihiro M, Sentell T. Disparities in Potentially Preventable Emergency Department Visits for Children with Asthma among Asian Americans, Pacific Islanders, and Whites in Hawai'i. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7096. [PMID: 34281033 PMCID: PMC8296946 DOI: 10.3390/ijerph18137096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 11/21/2022]
Abstract
The cost burdens of potentially preventable emergency department visits for pediatric asthma were estimated for Asian Americans, Pacific Islanders, and Whites using Hawai'i statewide 2015-2016 data. The cost burden of the 3234 preventable emergency department visits over the study period was over $1.9 million. Native Hawaiians had the largest proportion (36.5%) of all preventable emergency department visits and accounted for the highest costs for the two years at $709,698. After adjusting for other factors, costs for preventable pediatric-asthma-related emergency department visits differed significantly by age, insurance provider, and island of residency. Reducing potentially preventable emergency department visits would not only improve health disparities among Native Hawaiians compared to other racial or ethnic populations in Hawai'i, but could also generate cost savings for public and private insurance payers.
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Affiliation(s)
- Olivia Uchima
- Office of Public Health Studies, University of Hawai‘i at Manoa, 1960 East-West Road, Honolulu, HI 96822, USA;
| | - Deborah A. Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai‘i at Hilo, 677 Ala Moana Boulevard, Honolulu, HI 96813, USA;
| | - Hyeong Jun Ahn
- Department of Quantitative Health Sciences, University of Hawai‘i at Manoa, 651 Ilalo Street, Medical Education Building, Honolulu, HI 96813, USA; (H.J.A.); (S.Y.C.)
| | - So Yung Choi
- Department of Quantitative Health Sciences, University of Hawai‘i at Manoa, 651 Ilalo Street, Medical Education Building, Honolulu, HI 96813, USA; (H.J.A.); (S.Y.C.)
| | - May Okihiro
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI 96813, USA;
| | - Tetine Sentell
- Office of Public Health Studies, University of Hawai‘i at Manoa, 1960 East-West Road, Honolulu, HI 96822, USA;
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Zeinali F, Mohammad Karimi N, Jafari M, Akbarzadeh Moghadam E. Rapid and Deep versus Normal Breathing in Salbutamol Inhalation Effectiveness; a Letter to Editor. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2021; 9:e42. [PMID: 34223187 PMCID: PMC8221548 DOI: 10.22037/aaem.v9i1.1122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Faeze Zeinali
- Emergency Medicine Department, Shahid Sadoughi Hospital ,Shahid sadoughi University of Medical Sciences, Yazd, Iran
| | - Naser Mohammad Karimi
- Emergency Medicine Department, Shahid Sadoughi Hospital ,Shahid sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohamadali Jafari
- Emergency Medicine Department, Shahid Sadoughi Hospital ,Shahid sadoughi University of Medical Sciences, Yazd, Iran
| | - Ebrahim Akbarzadeh Moghadam
- Emergency Medicine Department, Shahid Sadoughi Hospital ,Shahid sadoughi University of Medical Sciences, Yazd, Iran
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Pité H, Carvalho S, Morais-Almeida M. The challenges and facilitators of self-management in pediatric asthma. Curr Opin Allergy Clin Immunol 2021; 21:135-143. [PMID: 33560741 DOI: 10.1097/aci.0000000000000731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Self-management education in asthma can dramatically reduce asthma morbidity, but specific pediatric challenges need to be addressed. The purpose of this review is to discuss the most recent and significant advances regarding self-management interventions in pediatric asthma. RECENT FINDINGS Recent evidence supports school-based programs including asthma self-management skills for children to significantly improve asthma control. A defined theoretical intervention framework, parent involvement, child satisfaction, and running the intervention outside the child's own free time are suggested drivers of successful implementation. Real-time telemedically delivered asthma education may also improve asthma-related outcomes in children. Moreover, mobile applications supporting self-management are generally welcomed by children and parents. Current evidence supports the use of models of health behaviors change in mobile application design and content development; self-monitoring alone is ineffective but useful when coupled with decision support for proactive care. SUMMARY School-based and e-health interventions are potential facilitators for the implementation of successful self-management asthma programs, providing access to large numbers of children with asthma. This supports the healthcare practitioners to work together with researchers to promote these interventions, while following current recommendations for the effective transition of children into competent and confident adults to continue to successfully self-manage their asthma.
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Affiliation(s)
- Helena Pité
- Allergy Center, CUF Descobertas Hospital and CUF Tejo Hospital, Lisbon, Portugal
- CEDOC, Chronic Diseases Research Center, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sara Carvalho
- Allergy Center, CUF Descobertas Hospital and CUF Tejo Hospital, Lisbon, Portugal
| | - Mário Morais-Almeida
- Allergy Center, CUF Descobertas Hospital and CUF Tejo Hospital, Lisbon, Portugal
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Overview of Self-Management Skills and Associated Assessment Tools for Children with Inflammatory Bowel Disease. GASTROINTESTINAL DISORDERS 2021. [DOI: 10.3390/gidisord3020007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Self-management is a multi-modal approach for managing chronic conditions that encompasses a number of different elements; knowledge, adherence, self-regulation, communication, and cognitive factors. Self-management has been shown to be beneficial for adults with inflammatory bowel disease (IBD), and for children with IBD it may help them learn to take control of their complex treatment regimens and lead to positive disease outcomes. The development of self-management skills for children with IBD is vital in order to maximize their potential for health autonomy, but it is still an emergent field in this population. This review provides an over-arching view of the self-management elements specific to children with IBD, and highlights outcome measures that may be used to assess skills within each field as well as the efficacy of targeted interventions.
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Macedo LA, de Oliveira Santos Silva R, Silvestre CC, Alcântara TDS, de Magalhães Simões S, Lyra DP. Effect of pharmacists' interventions on health outcomes of children with asthma: A systematic review. J Am Pharm Assoc (2003) 2021; 61:e28-e43. [PMID: 33608222 DOI: 10.1016/j.japh.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/10/2020] [Accepted: 01/03/2021] [Indexed: 12/12/2022]
Abstract
METHODS A literature search was performed in January 23, 2018 at the Embase, LILACS, OpenThesis, PubMed, Cochrane Library, and Web of Science databases through January 23, 2018, using keywords related to "asthma," "pharmacist," and "children." This systematic review followed the methodologic standards recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included intervention studies on the effect of pharmacists' interventions on pediatric patients with asthma, performed in hospital or ambulatory care settings, with presenting process and outcome indicators as a result of pharmacists' interventions. The methodologic quality of the included studies was assessed independently by 2 researchers. The Cohen kappa index was used to measure the degree of agreement between the 2 investigators. RESULTS The search yielded 3671 records, of which 5 were included in this review. Most of these studies were conducted in the United States (n = 2) and in outpatient clinics (n = 4). All studies described components of pharmacists' interventions. The most reported category concerning pharmacists' work process was the initial assessment of patients' conditions, with the assessment of outcomes (at baseline and follow-up) as the only category present in all studies. The most assessed outcomes at baseline were asthma control, emergency department visits, medication use and technique, and adherence to asthma therapy. At follow-up, emergency department visits were the most evaluated outcome (n = 2), and no study assessed economic outcomes. The average consultation time ranged from 20 to 45 minutes, and the number of encounters ranged from 2 to 3. CONCLUSION This study highlighted the limited number of studies, most with low quality, on the impact of the pharmacist on pediatric asthma. The most assessed outcome was the number of emergency department visits, with positive results after interventions. Heterogeneity regarding assessed outcomes and work processes was noted, which limited comparison of the results and interventions.
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Chan M, Gray M, Burns C, Owens L, Woolfenden S, Lingam R, Jaffe A, Homaira N. Community-based interventions for childhood asthma using comprehensive approaches: a systematic review and meta-analysis. Allergy Asthma Clin Immunol 2021; 17:19. [PMID: 33588934 PMCID: PMC7885565 DOI: 10.1186/s13223-021-00522-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/29/2021] [Indexed: 12/21/2022] Open
Abstract
Objective We conducted a systematic review and meta-analysis to determine the effectiveness of comprehensive community-based interventions with ≥ 2 components in improving asthma outcomes in children. Methods A systematic search of Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE), Cochrane Library and hand search of reference collections were conducted to identify any research articles published in English between 2000 and 2019. All studies reporting community-based asthma interventions with ≥ 2 components (e.g., asthma self-management education, home environmental assessment or care coordination etc.) for children aged ≤ 18 years were included. Meta-analyses were performed using random-effects model to estimate pooled odds ratio (OR) with 95% confidence intervals (CIs). Results Of the 2352 studies identified, 21 studies were included in the final analysis: 19 pre-post interventions, one randomised controlled trial (RCT) and one retrospective study. Comprehensive asthma programs with multicomponent interventions were associated with significant reduction in asthma-related Emergency Department (ED) visits (OR = 0.26; 95% CI 0.20–0.35), hospitalizations (OR = 0.24; 95% CI 0.15–0.38), number of days (mean difference = − 2.58; 95% CI − 3.00 to − 2.17) and nights with asthma symptoms (mean difference = − 2.14; 95% CI − 2.94 to − 1.34), use of short-acting asthma medications/bronchodilators (BD) (OR = 0.28; 95% CI 0.16–0.51), and increase use of asthma action plan (AAP) (OR = 8.87; 95% CI 3.85–20.45). Conclusion Community-based asthma care using more comprehensive approaches may improve childhood asthma management and reduce asthma related health care utilization.
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Affiliation(s)
- Mei Chan
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia
| | - Melinda Gray
- Respiratory Department, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Christine Burns
- Respiratory Department, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Louisa Owens
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Susan Woolfenden
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Raghu Lingam
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Adam Jaffe
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Nusrat Homaira
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2031, Australia. .,Respiratory Department, Sydney Children's Hospital, Randwick, NSW 2031, Australia.
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Rehabilitation and Prevention of Hand Eczema. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gurria JP, Simpson B, Tuncel-Kara S, Bates C, McKenna E, Rogers T, Kraemer A, Platt M, Mecoli M, Garcia VF, Brown RL. Standardization of clinical care pathway leads to sustained decreased length of stay following Nuss pectus repair: A multidisciplinary quality improvement initiative. J Pediatr Surg 2020; 55:2690-2698. [PMID: 32972738 DOI: 10.1016/j.jpedsurg.2020.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 07/17/2020] [Accepted: 08/01/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Postoperatively, standardized clinical care pathways (SCCPs) help patients reach necessary milestones for discharge. The objective of this study was to achieve 90% compliance with a pectus specific SCCP within 9 months of implementation. We hypothesized that adherence to a pectus SCCP following the Nuss procedure would decrease postsurgical length of stay (LOS). METHODS A multidisciplinary team implemented the pectus SCCP, including goals for mobility, lung recruitment, pain control, intake, and output. The full protocol included 42 components, tracked using chart reviews and a patient-directed checklist. The primary process measure was compliance with the pectus SCCP. The primary outcome measure was LOS; secondary outcomes were patient charges, patient satisfaction, and hospital readmission. RESULTS Total study patients were n = 509: 159 patients pre-intervention, 350 patients post-intervention (80 implementation group; 270 sustain group). SCCP compliance data were collected on 164 patients post-intervention - 80 implementation, 84 sustain. LOS, ED visits, and hospital readmissions were recorded for all 509 patients. Mean LOS decreased from 4.5 days to 3.4 days, with >90% adherence to the pectus SCCP postintervention. There were no readmissions owing to pain despite earlier termination of epidural analgesia. Total patient charges decreased by 30% and patient satisfaction was high. CONCLUSION Using quality improvement methodology with strict adherence to a pectus SCCP, we had significant reduction in LOS and patient charge without compromising effective postoperative pain management or patient satisfaction. TYPE OF STUDY Clinical research; quality improvement. LEVEL OF EVIDENCE V.
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Affiliation(s)
| | - Blair Simpson
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Christina Bates
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Emily McKenna
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Tracy Rogers
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Aimee Kraemer
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Michael Platt
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Marc Mecoli
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Victor F Garcia
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Hall T, Rooks R, Kaufman C. Intersections of Adverse Childhood Experiences, Race and Ethnicity and Asthma Outcomes: Findings from the Behavioral Risk Factor Surveillance System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218236. [PMID: 33171864 PMCID: PMC7664623 DOI: 10.3390/ijerph17218236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 02/07/2023]
Abstract
Racial and ethnic minority subpopulations experience a disproportionate burden of asthma and adverse childhood experiences (ACEs). These disparities result from systematic differences in risk exposure, opportunity access, and return on resources, but we know little about how accumulated differentials in ACEs may be associated with adult asthma by racial/ethnic groups. We used Behavioral Risk Factor Surveillance System data (N = 114,015) from 2009 through 2012 and logistic regression to examine the relationship between ACEs and adult asthma using an intersectional lens, investigating potential differences for women and men aged 18 and older across seven racial/ethnic groups. ACEs were significantly related to asthma, adjusting for race/ethnicity and other covariates. Compared to the reference group (Asians), asthma risk was significantly greater for Black/African American, American Indian and Alaska Native (AIAN), White, and multiracial respondents. In sex-stratified interactional models, ACEs were significantly related to asthma among women. The relationship between ACEs and asthma was significantly weaker for Black/African American and AIAN women compared to the reference group (Asian women). The findings merit attention for the prevention and early detection of ACEs to mitigate long-term health disparities, supporting standardized screening and referrals in clinical settings, evidence-based prevention in communities, and the exploration of strategies to buffer the influence of adversities in health.
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Affiliation(s)
- Tristen Hall
- Department of Family Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Health and Behavioral Sciences, College of Liberal Arts and Sciences, University of Colorado Denver, Denver, CO 80204, USA;
- Correspondence: ; Tel.: +1-303-724-8009
| | - Ronica Rooks
- Department of Health and Behavioral Sciences, College of Liberal Arts and Sciences, University of Colorado Denver, Denver, CO 80204, USA;
| | - Carol Kaufman
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
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Duenas-Meza E, Giraldo-Cadavid LF, Karpf E, Afanador F, Angarita OL, Barón O, Medina MS, Pachón A, Gonzalez A, Jurado J, Torres-Duque CA. Cost-utility analysis of an integrated care program for children with asthma in a medium-income country. Pediatr Pulmonol 2020; 55:3110-3118. [PMID: 33460317 DOI: 10.1002/ppul.24996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the cost-utility of an integrated care program (ASMAIRE Infantil Program [PAI]) for children with asthma compared with standard of care. METHODS A decision-analytic model was used to compare an integrated care program compared to the standard of care in children with asthma in Bogota, Colombia. Baseline characteristics of the patients were established according to the distribution of patients in the PAI database. Other inputs were obtained from published meta-analysis, local registries, medical bills, general mortality data, and expert opinion. Costs were presented in 2017 Colombian pesos. Outcomes included quality-adjusted life-years (QALYs). Costs and outcomes were discounted by 5% per year. Incremental cost-utility ratios were presented for PAI compared with standard of care. Univariate and multivariate probabilistic sensitivity analyses were conducted to assess model robustness to parameter uncertainty. RESULTS The model predicted that patients that are part of the PAI would accrue more QALYs than patients on standard of care. The incremental results suggest that the PAI is a cost-effective treatment (incremental cost-utility ratio of Colombian pesos $33 753 817/QALY) compared with standard of care. Sensitivity analyses suggest that results are most sensitive to cost of care (with and without PAI) and costs of severe exacerbation. However, the PAI is cost-effective irrespective of variation in any of the input parameters. CONCLUSION Our model predicted that an integrated intervention for the management of asthma in pediatric patients improves QALYs, reduces number of disease related exacerbations compared to standard therapy and is cost-effective for the long-term control of the disease in Colombia.
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Affiliation(s)
- Elida Duenas-Meza
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Pediatric Department, School of Medicine, University of La Sabana, Bogotá, Colombia.,Department of Pediatric, Fundación Cardioinfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Luis F Giraldo-Cadavid
- Department of Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Department of Epidemiology and Biostatistics, School of Medicine, University of La Sabana, Bogotá, Colombia
| | | | | | | | - Oscar Barón
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Department of Pediatric, Fundación Cardioinfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Maria S Medina
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Department of Pediatric, Fundación Cardioinfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Angelica Pachón
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia
| | - Angelica Gonzalez
- Department of Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia
| | - Jenny Jurado
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Pediatric Department, School of Medicine, University of La Sabana, Bogotá, Colombia.,Department of Pediatric, Fundación Cardioinfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Carlos A Torres-Duque
- Department of Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,School of Medicine, University of La Sabana, Bogotá, Colombia
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Crosby LE, Hood A, Kidwell K, Nwankwo C, Strong H, Quinn C, Britto MT. Improving self-management in adolescents with sickle cell disease. Pediatr Blood Cancer 2020; 67:e28492. [PMID: 32697889 PMCID: PMC7722105 DOI: 10.1002/pbc.28492] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/29/2020] [Accepted: 05/24/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is associated with significant medical challenges that often worsen in adolescence when caregivers are beginning to transfer responsibility for disease management. Behavioral activation (BA) is an important precedent to improvements in self-management and ultimately health outcomes; however, few interventions targeting BA have been developed for the SCD population. The goal of the present study was to evaluate a technology-enhanced self-management intervention for adolescents and young adults (AYA) with SCD targeting BA domains (ie, disease knowledge, self-efficacy, motivation, and self-management skills). DESIGN/METHODS Participants were randomized to one of two study arms. SCThrive participants (N = 26) completed six weekly group sessions, an in-person booster session, and used a companion app (iManage) to record symptoms, progress on goals, and connect with other group members. Each SCHealthEd participant (N = 27) received six weekly phone calls on SCD-related and general health education topics. All AYA completed questionnaires assessing BA at baseline and posttreatment. RESULTS Separate mixed ANOVA analyses to assess for the effects of group (SCThrive/SCHealthEd), time (baseline/posttreatment), and group × time interaction indicated that there was a clinically meaningful improvement (8-point change) in self-efficacy, with a medium effect size, P = .09, η2 = .06, and there was statistically significant improvement in one self-management skill (tracking health), P = .001, d = .71, among SCThrive participants. CONCLUSIONS The results support the potential for a self-management intervention to improve self-efficacy in AYA with SCD. Health care providers are encouraged to target BA skills to support self-management of AYA with SCD.
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Affiliation(s)
- Lori E. Crosby
- Division of Behavioral Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Anna Hood
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Katherine Kidwell
- Division of Behavioral Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Cara Nwankwo
- Division of Behavioral Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Oklahoma State University, Department of Psychology, Stillwater, OK
| | - Heather Strong
- Division of Behavioral Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Charles Quinn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Maria T. Britto
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Adolescent and Transition Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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Hartmann-Boyce J, Gunnell J, Drake J, Otunla A, Suklan J, Schofield E, Kinton J, Inada-Kim M, Hobbs FDR, Dennison P. Asthma and COVID-19: review of evidence on risks and management considerations. BMJ Evid Based Med 2020; 26:bmjebm-2020-111506. [PMID: 32883705 DOI: 10.1136/bmjebm-2020-111506] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Respiratory illnesses typically present increased risks to people with asthma (PWA). However, data on the risks of COVID-19 to PWA have presented contradictory findings, with implications for asthma management. OBJECTIVE To assess the risks and management considerations of COVID-19 in people with asthma (PWA). METHOD We conducted a rapid literature review. We searched PubMed, medRxiv, LitCovid, TRIP, Google and Google Scholar for terms relating to asthma and COVID-19, and for systematic reviews related to specific management questions within our review, in April 2020. References were screened and data were extracted by one reviewer. RESULTS We extracted data from 139 references. The evidence available is limited, with some sources suggesting an under-representation of PWA in hospitalised cases and others showing an increased risk of worse outcomes in PWA, which may be associated with disease severity. Consensus broadly holds that asthma medications should be continued as usual. Almost all aspects of asthma care will be disrupted during the pandemic due not only to limits in face-to-face care but also to the fact that many of the diagnostic tools used in asthma are considered aerosol-generating procedures. Self-management and remote interventions may be of benefit for asthma care during this time but have not been tested in this context. CONCLUSIONS Evidence on COVID-19 and asthma is limited and continuing to emerge. More research is needed on the possible associations between asthma and COVID-19 infection and severity, as well as on interventions to support asthma care in light of constraints and disruptions to healthcare systems. We found no evidence regarding health inequalities, and this urgently needs to be addressed in the literature as the burdens of asthma and of COVID-19 are not equally distributed across the population.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - James Gunnell
- Medical Sciences Division, University of Oxford, Oxford, Oxfordshire, UK
| | - Jonny Drake
- Medical Sciences Division, University of Oxford, Oxford, Oxfordshire, UK
| | - Afolarin Otunla
- Medical Sciences Division, University of Oxford, Oxford, Oxfordshire, UK
| | - Jana Suklan
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Ella Schofield
- Medical Sciences Division, University of Oxford, Oxford, Oxfordshire, UK
| | - Jade Kinton
- Medical Sciences Division, University of Oxford, Oxford, Oxfordshire, UK
| | - Matt Inada-Kim
- Royal Hampshire County Hospital, Winchester, Hampshire, UK
| | - F D Richard Hobbs
- Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Paddy Dennison
- University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK
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Mosler G, Harris K, Grigg J, Steed L. Developing a theory-based multimedia intervention for schools to improve young people's asthma: my asthma in school (MAIS). Pilot Feasibility Stud 2020; 6:122. [PMID: 32884832 PMCID: PMC7465390 DOI: 10.1186/s40814-020-00670-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 08/19/2020] [Indexed: 01/30/2023] Open
Abstract
Background Asthma control in adolescents is low with half of the young people in a London study identified as having suboptimal control when measured using the Asthma Control Test. Control of asthma symptoms can be improved by addressing barriers to good self-management, such as poor understanding of asthma and adherence to medication. The aim of this study was therefore to develop the My Asthma in School (MAIS) intervention for the improvement of asthma control and self-management in adolescents and to test its initial feasibility. The intervention intended to combine a strong focus on theory with a design specifically aimed to engage adolescents. Methods The intervention development was based on previous qualitative and quantitative findings, and on guidelines from the Medical Research Council for the development of complex interventions. The COM-B (Capability, Opportunity, Motivation-Behaviour) model was applied to inform the design of intervention elements. Behavioural targets were identified from existing barriers to good asthma self-management and were then used to guide the development of engaging intervention elements, which were described using the Behavioural Change Technique (BCT) Taxonomy version 1. Adolescents were involved throughout this process. The MAIS intervention was tested in a feasibility phase in London secondary schools with adolescents aged between 11 and 13. Results The complex school-based MAIS intervention comprised a first school visit from a theatre group, who conducted a workshop with all year 7-8 students and addressed peer understanding and attitudes to asthma. The second visit included four self-management workshops for adolescents with asthma, including games, short-films and role play activities. Forty different types of techniques to change behaviour were applied, totalling 163 instances of BCT use across intervention elements, addressing all areas of capability, opportunity and motivation. In this initial feasibility study, 1814 adolescents with and without asthma from nine schools received the theatre intervention visit; 23 adolescents with asthma from one of the schools attended the workshop visit. The intervention was found acceptable and engaging, and 91.4% of participants agreed that the workshops changed how they think or feel about asthma. Conclusion This study demonstrates development and initial feasibility of a complex theory-based intervention, and how it can combine engaging media and interactive elements, to achieve a multi-directional approach to behavioural change. However more work is needed to assess the feasibility of trial processes, including recruitment and delivery format of the workshops.
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Affiliation(s)
- Gioia Mosler
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, London, E1 2AT UK
| | - Katherine Harris
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, London, E1 2AT UK
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, London, E1 2AT UK
| | - Liz Steed
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, 58 Turner St, London, E1 2AB UK
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Rhee H, Love T, Harrington D, Walters L. Comparing Three Measures of Self-Efficacy of Asthma Self-Management in Adolescents. Acad Pediatr 2020; 20:983-990. [PMID: 32194214 PMCID: PMC7483287 DOI: 10.1016/j.acap.2020.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 03/06/2020] [Accepted: 03/08/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This study examines the relationships between 3 measures of asthma-related self-efficacy and compares them by their relationships to quality of life, medication adherence, asthma control, asthma knowledge, and attitudes in adolescents. METHODS Participants included 371 urban adolescents (age 12-20 years) with asthma. Three self-efficacy measures included the Asthma Outcome Expectation-self-efficacy subscale (AOE-SE), Asthma Management Index-self-efficacy subscale (AMI-SE), and the Asthma Self-Efficacy scale (ASE). RESULTS The sample included 50% male, predominantly African American (78.4%) participants. All 3 measures of self-efficacy were positively correlated with each other (r = 0.46-0.54, P < .001). After controlling for gender, age, race, and health insurance type, all 3 self-efficacy measures predicted the symptom domain of quality of life, adherence, asthma control, and knowledge. Activity limitation was predicted by AMI-SE (B = 0.19, P = .008) and ASE (B = 0.38, P < .001) but not by AOE-SE, while emotional function associated only with ASE (B = 0.37, P < 0.001). Attitudes were positively associated with AOE-SE and ASE (B = 1.83 and 2.87, respectively, P < 0.001 for both), but not with AMI-SE. CONCLUSIONS Medication adherence and symptom control in adolescents were predicted by self-efficacy measured by the 3 measures, while these measures differed in their performance in predicting psychosocial outcomes. ASE appears the measure of choice in measuring adolescents' self-efficacy given its association with all outcome measures of the study. Further research is needed to investigate the generalized use of the self-efficacy measures in populations with varying demographic or asthma characteristics.
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Affiliation(s)
- Hyekyun Rhee
- University of Rochester School of Nursing (H Rhee and L Walters), Rochester, NY.
| | - Tanzy Love
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center (T Love and D Harrington), Rochester, NY
| | - Donald Harrington
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center (T Love and D Harrington), Rochester, NY
| | - Leanne Walters
- University of Rochester School of Nursing (H Rhee and L Walters), Rochester, NY
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Community-based interventions to increase dairy intake in healthy populations: a systematic review. Public Health Rev 2020; 41:18. [PMID: 32774990 PMCID: PMC7401205 DOI: 10.1186/s40985-020-00135-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/18/2020] [Indexed: 12/03/2022] Open
Abstract
Background Considering the low frequency of dairy intake in the population, interventions aiming to increase its consumption can be a priority for any health system. Objective This study aims to summarize community-based interventions for improving dairy consumption and their effectiveness to help policy-makers in designing coherent public health strategies. Methods This study was conducted in 2019, using PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, Web of Science, ProQuest, and Google Scholar. Two independent reviewers selected the eligible studies, and the outcomes of interest were extracted. The quality of eligible studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for randomized controlled trials and quasi-experimental studies. Results Out of 521 initially identified articles, 25 studies were included. Interventions reported in 19 studies were effective in increasing dairy consumption. Interventions in high-income countries were more effective than those in middle- and low-income countries. Interventions in health centers and supermarkets were more effective than the community and school-level interventions. Interventions in supermarkets and adolescents as target groups were more effective than children, middle-aged people, and the elderly. Also, educational interventions and changing buying/selling pattern were more effective than multiple interventions. Interventions longer than 24 and 48 weeks were more effective than shorter interventions. Conclusion Three policy options including educational interventions, multiple interventions, and changing the purchase pattern are suggested. It seems that applying all of the interventions together can be more effective. Also, long-term and well-designed future studies in different settings are recommended to confirm these results.
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Arakawa H, Adachi Y, Ebisawa M, Fujisawa T, Arakawa H, Adachi Y, Ebisaw M, Fujisawa T, Akasawa A, Inoue T, Ohya Y, Kameda M, Kurihara K, Shimojo N, Suehiro Y, Mochizuki H, Yoshihara S, Iwanaga T, Kuroki H, Takase M, Masuko I, Hirai K, Yoshida K, Inoue Y, Nagao M, Miyaji Y, Iio M, Ito Y, Takizawa T, Futamura M, Tezuka J, Fukuda H, Yoshida Y, Nishimoto H, Fukuie T, Sato S, Yamada Y, Okafuji I, Yamamoto-Hanada K, Sasaki M, Tanaka Y, Nakajima Y, Isozaki A, Inage E, Yagi H, Shimizu M, Akashi K, Kawamoto N, Manabe T, Murai H, Takaoka Y, Miura T, Hiraguchi Y, Sugiyama T, Sugimoto M, Suzuki S, Natsume O, Kitazawa H, Yamaide A, Wada T, Nishima S. Japanese guidelines for childhood asthma 2020. Allergol Int 2020; 69:314-330. [PMID: 33213779 DOI: 10.1016/j.alit.2020.02.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 02/18/2020] [Indexed: 10/24/2022] Open
Abstract
The Japanese Guideline for Childhood Asthma (JGCA) 2020 is a translation of the Japanese Pediatric Guideline for the Treatment and Management of Asthma (JPGL) 2017 into English, which was published by the Japanese Society of Pediatric Allergy and Clinical Immunology. It makes recommendations for best practices in the management of childhood asthma, including management of acute exacerbations and non-pharmacological and pharmacological management. These guidelines will be of interest to non-specialist physicians involved in the care of children with asthma. In JPGL, JPGL2017 is the first evidence-based guidelines updated according to the GRADE system and Minds approach, and it addresses eight clinical questions about the treatment of childhood asthma. In children aged ≤5 years, infant and preschool asthma is diagnosed according to the response to short acting beta2 agonists or the effect of a therapeutic trial during 1 month with controller treatment and worsening after treatment cessation. Long-term management both promotes pharmacological therapy and measures against risk factors that induce exacerbation, better patient education and a partnership with trinity. In addition, long-term management should not be carried out without review but rather be based on a cycle of evaluation, adjustment and treatment. In JPGL2017, the transdermal patch and oral beta2 agonists are positioned as drugs within the concept of "short-term additional treatment" to be used until the symptoms are stabilized when the control state transiently deteriorates.
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Lo Cao E, Amir N, McKay A, Durkan AM. Parental understanding of relapsing idiopathic nephrotic syndrome-Where are the knowledge gaps? Acta Paediatr 2020; 109:1465-1472. [PMID: 31773812 DOI: 10.1111/apa.15111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 11/28/2022]
Abstract
AIM To assess parental understanding of idiopathic nephrotic syndrome (INS) and its management, to enable targeted education in areas of deficit. METHODS Families of children with at least one relapse of INS were interviewed, following a template covering key domains of (a) disease understanding, (b) management of INS and (c) access to information. Common trends and responses were identified and notable observations recorded. RESULTS Twenty-one parents were interviewed. The mean duration of INS was 4.4 years (range 0.5-14.5 years), with a mean of two steroid-sparing agents used. Although 90% parents self-reported that they understood INS, only 29% could appropriately define relapse and 24% name potential complications. The management of INS was generally good, with most parents appropriately testing urine (81%) and managing relapses (90%). Unnecessary dietary restrictions were imposed on 57% during remission. The Internet was searched by 90% of parents for disease and drug information. Further information was desired in paper form (71%), hospital website (81%) and face-to-face workshop (90%), plus educational materials for schools. CONCLUSION Parents overestimated their understanding of INS; however, their management was generally well done. Parents desired more information and support in various forms.
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Affiliation(s)
- Edward Lo Cao
- The Children's Hospital at Westmead Westmead NSW Australia
- The University of Sydney Sydney NSW Australia
| | - Noa Amir
- The Children's Hospital at Westmead Westmead NSW Australia
| | - Ashlene McKay
- The Children's Hospital at Westmead Westmead NSW Australia
| | - Anne M. Durkan
- The Children's Hospital at Westmead Westmead NSW Australia
- The University of Sydney Sydney NSW Australia
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