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Swetschinski L, Fong KC, Morello-Frosch R, Marshall JD, Bell ML. Exposures to ambient particulate matter are associated with reduced adult earnings potential. ENVIRONMENTAL RESEARCH 2023:116391. [PMID: 37308068 DOI: 10.1016/j.envres.2023.116391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/27/2023] [Accepted: 06/09/2023] [Indexed: 06/14/2023]
Abstract
The societal costs of air pollution have historically been measured in terms of premature deaths (including the corresponding values of statistical lives lost), disability-adjusted life years, and medical costs. Emerging research, however, demonstrated potential impacts of air pollution on human capital formation. Extended contact with pollutants such as airborne particulate matter among young persons whose biological systems are still developing can result in pulmonary, neurobehavioral, and birth complications, hindering academic performance as well as skills and knowledge acquisition. Using a dataset that tracks 2014-2015 incomes for 96.2% of Americans born between 1979 and 1983, we assessed the association between childhood exposure to fine particulate matter (PM2.5) and adult earnings outcomes across U.S. Census tracts. After accounting for pertinent economic covariates and regional random effects, our regression models indicate that early-life exposure to PM2.5 is associated with lower predicted income percentiles by mid-adulthood; all else equal, children raised in high pollution tracts (at the 75th percentile of PM2.5) are estimated to have approximately a 0.51 decrease in income percentile relative to children raised in low pollution tracts (at the 25th percentile of PM2.5). For a person earning the median income, this difference corresponds to a $436 lower annual income (in 2015 USD). We estimate that 2014-2015 earnings for the 1978-1983 birth cohort would have been ∼$7.18 billion higher had their childhood exposure met U.S. air quality standards for PM2.5. Stratified models show that the relationship between PM2.5 and diminished earnings is more pronounced for low-income children and for children living in rural environments. These findings raise concerns about long-term environmental and economic justice for children living in areas with poor air quality where air pollution could act as a barrier to intergenerational class equity.
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Affiliation(s)
- Lucien Swetschinski
- Yale School of the Environment, Yale University, 195 Prospect Street, New Haven, CT, 06511, USA.
| | - Kelvin C Fong
- Department of Earth and Environmental Sciences, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Rachel Morello-Frosch
- Department of Environmental Science, Policy, and Management, University of California-Berkeley, Berkeley, CA, USA; School of Public Health, University of California-Berkeley, Berkeley, CA, USA.
| | - Julian D Marshall
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA, USA.
| | - Michelle L Bell
- Yale School of the Environment, Yale University, 195 Prospect Street, New Haven, CT, 06511, USA.
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2
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Jay MA, Sanders-Ellis D, Blackburn R, Deighton J, Gilbert R. Umbrella systematic review finds limited evidence that school absence explains the association between chronic health conditions and lower academic attainment. Front Public Health 2023; 11:1122769. [PMID: 37361156 PMCID: PMC10288991 DOI: 10.3389/fpubh.2023.1122769] [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: 12/13/2022] [Accepted: 05/12/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Absence from school is more frequent for children with chronic health conditions (CHCs) than their peers and may be one reason why average academic attainment scores are lower among children with CHCs. Methods We determined whether school absence explains the association between CHCs and academic attainment through a systematic review of systematic reviews of comparative studies involving children with or without CHCs and academic attainment. We extracted results from any studies that tested whether school absence mediated the association between CHCs and academic attainment. Results We identified 27 systematic reviews which included 441 unique studies of 7, 549, 267 children from 47 jurisdictions. Reviews either covered CHCs generally or were condition-specific (e.g., chronic pain, depression, or asthma). Whereas reviews found an association between a range of CHCs (CHCs generally, cystic fibrosis, hemophilia A, end-stage renal disease (pre-transplant), end-stage kidney disease (pre-transplant), spina bifida, congenital heart disease, orofacial clefts, mental disorders, depression, and chronic pain) and academic attainment, and though it was widely hypothesized that absence was a mediator in these associations, only 7 of 441 studies tested this, and all findings show no evidence of absence mediation. Conclusion CHCs are associated with lower academic attainment, but we found limited evidence of whether school absence mediates this association. Policies that focus solely on reducing school absence, without adequate additional support, are unlikely to benefit children with CHCs. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=285031, identifier: CRD42021285031.
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Affiliation(s)
- Matthew A. Jay
- UCL GOS Institute of Child Health, Population, Policy and Practice Research and Teaching Department, University College London, London, United Kingdom
| | - David Sanders-Ellis
- UCL Institute of Education, Social Research Institute, University College London, London, United Kingdom
| | - Ruth Blackburn
- UCL Institute of Health Informatics, University College London, London, United Kingdom
| | - Jessica Deighton
- The Evidence Based Practice Unit, University College London and Anna Freud Centre for Children and Families, London, United Kingdom
| | - Ruth Gilbert
- UCL GOS Institute of Child Health, Population, Policy and Practice Research and Teaching Department, University College London, London, United Kingdom
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3
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Peng L, Wen WP. Socioeconomic status and asthma: A bidirectional Mendelian randomization study. World Allergy Organ J 2023; 16:100790. [PMID: 37484875 PMCID: PMC10362521 DOI: 10.1016/j.waojou.2023.100790] [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: 08/25/2022] [Revised: 04/23/2023] [Accepted: 05/23/2023] [Indexed: 07/25/2023] Open
Abstract
Background Asthma is closely associated with lower socioeconomic status (SES), while the causal relationship between asthma and SES is undetermined. We aim to examine bidirectional relationships between asthma and SES using two-sample bidirectional Mendelian randomization (MR) for assessing potential causal inference. Methods Education attainment (years of schooling), household income, and Townsend deprivation index (TDI) were 3 indicators of SES considered in our study. The genetic summary data for SES and asthma were retrieved from publicly available genome-wide association studies (GWASs) conducted in participants of European ancestry. The MR estimates from each genetic instrument were combined using random effects inverse variance weighted (IVW) meta-analysis, with alternate methods (eg, MR-Egger, weighted median). Horizontal pleiotropy was assessed by sensitivity analyses. Analyses were performed using the package TwoSampleMR in R. Results The genetically instrumented years of schooling, household income, and TDI were not associated with the risk of asthma. However, according to the IVW method, 1.72 times increase in the odds ratio (OR) for asthma will lead to 0.024 standard deviation (SD) decrease in the years of schooling, 0.026 SD decrease in the household income, and 0.016 SD increase in the TDI. Although the substantial heterogeneity may undermine the reliability of results to some extent, sensitivity analyses further supported the causation of low household income by asthma. Conclusion Our study indicated that genetically predicted asthma may play a causal role in lowering the household income. However, the causal role of lower SES in asthma development was not supported by our MR analyses. Considering the heterogeneity in the current study, additional MR studies are needed to validate the results in the future.
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Affiliation(s)
- Liang Peng
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Institute of Otorhinolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wei-Ping Wen
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Institute of Otorhinolaryngology Head and Neck Surgery, Sun Yat-sen University, Guangzhou, Guangdong, China
- Department of Otorhinolaryngology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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Kim S, Stanton K, Park Y, Thomas S. A Mobile App for Children With Asthma to Monitor Indoor Air Quality (AirBuddy): Development and Usability Study. JMIR Form Res 2022; 6:e37118. [PMID: 35604753 PMCID: PMC9171598 DOI: 10.2196/37118] [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: 02/07/2022] [Revised: 03/21/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
Background Indoor air quality is an important environmental factor that triggers and exacerbates asthma, the most common chronic disease in children. A mobile app to monitor indoor air quality could help occupants keep their indoor air quality clean. However, no app is available that allows children to monitor and improve their indoor air quality. Objective Previously, we conducted a series of user-centered design studies to identify user needs and design requirements toward creating a mobile app that helps children with asthma to engage in monitoring and improving indoor air quality as part of their asthma management. Based on the findings from these studies, we created AirBuddy, a child-friendly app that visualizes air quality indoors and outdoors. Methods This paper reports on the findings from a field deployment with 7 pediatric asthma patients, where we evaluated AirBuddy’s usability and usefulness in real-world settings by conducting weekly semistructured interviews for 8 weeks. Results All participants positively responded to the usefulness and usability of AirBuddy, which we believe is thanks to the iterative, user-centered design approach that allowed us to identify and address potential usability issues early on and throughout the design process. Conclusions This project contributes to the field of mHealth app design for children by demonstrating how a user-centered design process can lead to the development of digital devices that are more acceptable and relevant to target users’ needs.
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Affiliation(s)
- Sunyoung Kim
- Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Kaitlyn Stanton
- Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Yunoh Park
- Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Stephen Thomas
- Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
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Schyllert C, Andersson M, Backman H, Lindberg A, Rönmark E, Hedman L. Childhood onset asthma is associated with lower educational level in young adults - A prospective cohort study. Respir Med 2021; 186:106514. [PMID: 34198167 DOI: 10.1016/j.rmed.2021.106514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/19/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Asthma is associated with low socioeconomic status among both children and adults, and adolescents with asthma report more school absenteeism than those without. However, it is unclear whether asthma in childhood and adolescence affects socioeconomic status in adulthood. METHODS Within the Obstructive Lung disease In Northern Sweden Studies, all children in grade 1 and 2 in three municipalities were invited to a questionnaire survey, 97% participated (n = 3430). They were followed annually until age 19, and thereafter at age 28 years. In this study, participants at ages 8 y, 12 y, 19 y and 28 y (n = 2017) were included. Asthma was categorized into childhood onset (up to age 12 y) and adolescent onset (from 12 to 19 y). Data for assessment of socioeconomic status was collected at 28 y and included educational level, occupation, and occupational exposure to gas, dust and/or fumes (GDF). RESULTS Childhood onset asthma was associated with having compulsory school as the highest educational level at age 28 y, also after adjustment for sex, smoking and BMI at age 19 y and socioeconomic factors in childhood (OR 4.84 95%CI 2.01-11.65), and the pattern was the same among men and women. However, we found no significant associations between asthma in childhood or adolescence and socioeconomic groups, occupational groups or occupational exposure to GDF at age 28 y. CONCLUSIONS Even though asthma in high-income countries, such as Sweden, is well recognised and treated, this study highlight that childhood onset asthma may have a negative long-term effect with regard to educational level in young adulthood.
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Affiliation(s)
- Christian Schyllert
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
| | - Martin Andersson
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden; Department of Health Sciences, Division of Nursing, Luleå University of Technology, 971 87, Luleå, Sweden.
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden.
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, 901 87, Umeå, Sweden; Department of Health Sciences, Division of Nursing, Luleå University of Technology, 971 87, Luleå, Sweden.
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6
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Gidaris D, Stabouli S, Eleftheriou K, Cassimos D, Urquhart D, Kotsis V, Zafeiriou D. Subjective sleep-related breathing disorders and executive function in children with intermittent or mild persistent asthma. CLINICAL RESPIRATORY JOURNAL 2021; 15:794-799. [PMID: 33752268 DOI: 10.1111/crj.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/14/2021] [Accepted: 03/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The impact on executive function performance of sleep-related disorders in asthmatic children has been scarcely studied in community settings. The aims of the present study were to assess the prevalence of sleep-related breathing disorders (SRBD) in children with intermittent or mild persistent asthma in primary care settings, and to examine the possible correlations with measures of executive function. METHODS We performed a case-control study including 76 children with asthma (intermittent or mild persistent) and 85 healthy controls. The parents of both patients and controls completed the Paediatric Seep Questionnaire (PSQ) and the Behaviour Rating Inventory of Executive Function (BRIEF) questionnaire. RESULTS We did not find any statistically significant differences regarding the scales of PSQ. Additionally, there were no statistical differences between asthmatic children and controls regarding the scales of the BRIEF questionnaire. In both asthmatic children and controls the score of the scale of obstructive sleep-related breathing disorder was significantly correlated with the T scores of the two composite scales (BRI and MI) and the Global Executive Composite. CONCLUSION In children with intermittent or mild persistent asthma under the care of private general paediatricians there were no statistically significant differences regarding subjective SBD compared to the healthy controls. Also there were no statistical differences between asthmatic children and controls regarding behavioural correlates of executive function during everyday life.
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Affiliation(s)
- Dimos Gidaris
- 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.,University of Nicosia Medical School, Nicosia, Cyprus
| | - Stella Stabouli
- 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Dimitrios Cassimos
- Department of Paediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Don Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK
| | - Vasilios Kotsis
- 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Greece
| | - Dimitrios Zafeiriou
- 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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7
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Pulmonary Health Effects of Indoor Volatile Organic Compounds-A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041578. [PMID: 33562372 PMCID: PMC7914726 DOI: 10.3390/ijerph18041578] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/26/2022]
Abstract
Volatile organic compounds (VOCs) are commonly found in consumer products, including furniture, sealants and paints. Thus, indoor VOCs have become a public health concern, especially in high-income countries (HICs), where people spend most of their time indoors, and indoor and outdoor air exchange is minimal due to a lack of ventilation. VOCs produce high levels of reaction with the airway epithelium and mucosa membrane and is linked with pulmonary diseases. This paper takes a stock of the literature to assess the strength of association (measured by effect size) between VOCs and pulmonary diseases with the focus on asthma and its related symptoms by conducting a meta-analysis. The literature was searched using the PubMed database. A total of 49 studies that measured VOCs or VOC types and pulmonary health outcomes were included in the analysis. The results of these studies were tabulated, and standard effect size of each study was computed. Most studies were conducted in high-income countries, including France (n = 7), Japan (n = 7) and the United States (n = 6). Our analysis suggests that VOCs have a medium-sized effect on pulmonary diseases, including the onset of asthma (effect size (or Cohen's d) ~0.37; 95% confidence interval (CI) = 0.25-0.49; n = 23) and wheezing (effective size ~0.26; 95% CI = 0.10-0.42; n = 10). The effect size also varied by country, age and disease type. Multiple stakeholders must be engaged in strategies to mitigate and manage VOC exposure and its associated pulmonary disease burden.
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Cividini S, Sinha I, Donegan S, Maden M, Culeddu G, Rose K, Fulton O, Hughes DA, Turner S, Tudur Smith C. EstablishINg the best STEp-up treatments for children with uncontrolled asthma despite INhaled corticosteroids (EINSTEIN): protocol for a systematic review, network meta-analysis and cost-effectiveness analysis using individual participant data (IPD). BMJ Open 2021; 11:e040528. [PMID: 33550231 PMCID: PMC7925932 DOI: 10.1136/bmjopen-2020-040528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Asthma affects millions of children worldwide-1.1 million children in the UK. Asthma symptoms cannot be cured but can be controlled with low-dose inhaled corticosteroids (ICSs) in the majority of individuals. Treatment with a low-dose ICS, however, fails to control asthma symptoms in around 10%-15% of children and this places the individual at increased risk for an asthma attack. At present, there is no clear preferred treatment option for a child whose asthma is not controlled by low-dose ICS and international guidelines currently recommend at least three treatment options. Herein, we propose a systematic review and individual participant data network meta-analysis (IPD-NMA) aiming to synthesise all available published and unpublished evidence from randomised controlled trials (RCTs) to establish the clinical effectiveness of pharmacological treatments in children and adolescents with uncontrolled asthma on ICS and help to make evidence-informed treatment choices. This will be used to parameterise a Markov-based economic model to assess the cost-effectiveness of alternative treatment options in order to inform decisions in the context of drug formularies and clinical guidelines. METHODS AND ANALYSIS We will search in MEDLINE, the Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, NICE Technology Appraisals and the National Institute for Health Research (NIHR) Health Technology Assessment series for RCTs of interventions in patients with uncontrolled asthma on ICS. All studies where children and adolescents were eligible for inclusion will be considered, and authors or sponsors will be contacted to request IPD on patients aged <18. The reference lists of existing clinical guidelines, along with included studies and relevant reviews, will be checked to identify further relevant studies. Unpublished studies will be located by searching across a range of clinical trial registries, including internal trial registers for pharmaceutical companies. All studies will be appraised for inclusion against predefined inclusion and exclusion criteria by two independent reviewers with disagreements resolved through discussion with a third reviewer. We will perform an IPD-NMA-eventually supplemented with aggregate data for the RCTs without IPD-to establish both the probability that a treatment is best and the probability that a particular treatment is most likely to be effective for a specific profile of the patient. The IPD-NMA will be performed for each outcome variable within a Bayesian framework, using the WinBUGS software. Also, potential patient-level characteristics that may modify treatment effects will be explored, which represents one of the strengths of this study. ETHICS AND DISSEMINATION The Committee on Research Ethics, University of Liverpool, has confirmed that ethics review is not required. The dissemination plan consists of publishing the results in an open-access medical journal, a plain-language summary available for parents and children, dissemination via local, national and international meetings and conferences and the press offices of our Higher Education Institutions (HEIs). A synopsis of results will be disseminated to NICE and British Thoracic Society/Scottish Intercollegiate Guidelines Network (SIGN) as highly relevant to future clinical guideline updates. PROSPERO REGISTRATION NUMBER CRD42019127599.
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Affiliation(s)
- Sofia Cividini
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Ian Sinha
- Alder Hey Children's Foundation NHS Trust, Liverpool, UK
| | - Sarah Donegan
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group (LRIG), University of Liverpool, Liverpool, UK
| | - Giovanna Culeddu
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Katie Rose
- Alder Hey Children's Foundation NHS Trust, Liverpool, UK
| | | | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Stephen Turner
- Department of Child Health, University Court of the University of Aberdeen, Aberdeen, UK
| | - Catrin Tudur Smith
- Department of Health Data Science, University of Liverpool, Liverpool, UK
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9
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Hughes A, Wade KH, Dickson M, Rice F, Davies A, Davies NM, Howe LD. Common health conditions in childhood and adolescence, school absence, and educational attainment: Mendelian randomization study. NPJ SCIENCE OF LEARNING 2021; 6:1. [PMID: 33398003 PMCID: PMC7782810 DOI: 10.1038/s41539-020-00080-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/19/2020] [Indexed: 05/30/2023]
Abstract
Good health is positively related to children's educational outcomes, but relationships may not be causal. Demonstrating a causal influence would strongly support childhood and adolescent health as important for education policy. We applied genetic causal inference methods to assess the causal relationship of common health conditions at age 10 (primary/elementary school) and 13 (mid-secondary/mid-high school) with educational attainment at 16 and school absence at 14-16. Participants were 6113 children from the Avon Longitudinal Study of Parents and Children (ALSPAC). Exposures were symptoms of attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), depression, asthma, migraines and BMI. Genetic liability for these conditions and BMI was indexed by polygenic scores. In non-genetic, multivariate-adjusted models, all health conditions except asthma and migraines were associated with poorer attainment and greater school absence. School absence substantially mediated effects of BMI (39.9% for BMI at 13) and migraines (72.0% at 10), on attainment with more modest mediation for emotional and neurodevelopmental conditions. In genetic models, a unit increase in standardized BMI at 10 predicted a 0.19 S.D. decrease (95% CI: 0.11, 0.28) in attainment at 16, equivalent to around a 1/3 grade lower in all subjects, and 8.7% more school absence (95% CI:1.8%,16.1%). Associations were similar at 13. Genetic liability for ADHD predicted lower attainment but not more absence. Triangulation across multiple approaches supports a causal, negative influence on educational outcomes of BMI and ADHD, but not of ASD, depression, asthma or migraine. Higher BMI in childhood and adolescence may causally impair educational outcomes.
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Affiliation(s)
- Amanda Hughes
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK.
- Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK.
| | - Kaitlin H Wade
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Matt Dickson
- Institute for Policy Research, University of Bath, Bath, UK
| | | | | | - Neil M Davies
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Laura D Howe
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, UK
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10
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Seppä VP, Turkalj M, Hult A, Maloča Vuljanko I, Plavec D, Erceg D, Petković G. Expiratory variability index (EVI) is associated with the severity of acute bronchial obstruction in small children: A proof-of-concept study. Pediatr Allergy Immunol 2020; 31:636-642. [PMID: 32307738 PMCID: PMC7496816 DOI: 10.1111/pai.13257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Lung function testing in small children is cumbersome. However, reduced variability of tidal breathing recorded using impedance pneumography (IP) during sleep was recently found to be a potential objective marker of wheeze in children aged 1-5 years. We aimed to investigate how an acute bronchial obstruction (BO) and its severity, and recovery thereof reflect in expiratory variability index (EVI). METHODS EVI was measured using a wearable IP system (Ventica®) during sleep in 40 healthy controls (aged 1.5-5.9 years) and 30 patients hospitalized due to acute BO (aged 1.3-5.3 years). In healthy controls, EVI was measured for 1-3 nights at their homes. Patients were measured for several nights during hospitalization, as practically feasible, and at home 2 and 4 weeks post-discharge. RESULTS We received 79 EVI results from 39 controls and 139 from 30 patients. 90% had previous BO episodes, 30% used asthma controller medication before and 100% after hospitalization. Compared to controls, EVI was significantly lower during hospitalization (P < .0001) having significant correlation with number of days to discharge (r = -.38, P = .004). At 2 or 4 weeks post-discharge, EVI was not significantly different from the controls (P = .14, P = .49, respectively). EVI was significantly associated with chest auscultation findings (P = .0001) being 17.5 (4.9) (median, IQR) with normal auscultation, 15.6 (7.4) in those with prolonged expiration and 11.4 (6.8) in those with wheeze and/or rales and crackles. CONCLUSIONS EVI was found to be a sensitive, objective marker of acute BO, showing strong association with changes in clinical status in wheezy children aged 1-5 years.
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Affiliation(s)
| | - Mirjana Turkalj
- Department of Pulmonology and Allergology for Preschool and Schoolchildren, Srebrnjak Children's Hospital, Zagreb, Croatia.,Catholic University of Croatia, Zagreb, Croatia.,Medical Faculty Osijek, JJ Strossmayer University, Osijek, Croatia
| | | | - Ivana Maloča Vuljanko
- Department of Pulmonology and Allergology for Infants and Young Children, Srebrnjak Children's Hospital, Zagreb, Croatia
| | - Davor Plavec
- Medical Faculty Osijek, JJ Strossmayer University, Osijek, Croatia.,Research Department, Srebrnjak Children's Hospital, Zagreb, Croatia
| | | | - Damir Erceg
- Department of Pulmonology and Allergology for Preschool and Schoolchildren, Srebrnjak Children's Hospital, Zagreb, Croatia.,Catholic University of Croatia, Zagreb, Croatia.,Medical Faculty Osijek, JJ Strossmayer University, Osijek, Croatia
| | - Giorgie Petković
- Department of Pulmonology and Allergology for Infants and Young Children, Srebrnjak Children's Hospital, Zagreb, Croatia
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11
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Seppä VP, Paassilta M, Kivistö J, Hult A, Viik J, Gracia-Tabuenca J, Karjalainen J. Reduced expiratory variability index (EVI) is associated with controller medication withdrawal and symptoms in wheezy children aged 1-5 years. Pediatr Allergy Immunol 2020; 31:489-495. [PMID: 32068911 PMCID: PMC7497189 DOI: 10.1111/pai.13234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lung function testing is an essential part of diagnostic workup and monitoring of asthma, but young children are lacking easy, routine testing methods. However, recent discoveries show reduced tidal breathing variability measured using impedance pneumography (IP) at home during sleep as a sign of airway obstruction. In this study, we assessed (a) the discriminative capacity of expiratory variability index (EVI) between healthy controls and young children with recurrent wheeze on-and-off controller medication, (b) association between EVI and parentally perceived obstructive symptoms (need for bronchodilator) and (c) measurement success rate. METHODS We included 68 patients (aged 1.0-5.6) and 40 healthy controls (aged 1.0-5.9 years). The patients were prescribed a three-month inhaled corticosteroid (ICS) treatment due to recurrent obstructive bronchitis. We measured EVI using IP at home at the end of the treatment (0W) and 2 (2W) and 4 (4W) weeks after ICS withdrawal. RESULTS EVI was higher in controls than in patients, and significant within-patient reduction occurred at 4W as compared to 2W or 0W. Area under curve of the ROC curve (controls vs all patients) at 4W was 0.78 (95% CI 0.70-0.85). Children who were administered bronchodilator by parental decision had lower EVI than those without bronchodilator need at 4W, but not at 0W or 2W. Patients with parent-reported airway infection, but no bronchodilator need, had normal EVI. Measurement success rate was 94%. CONCLUSION EVI was lower in patients than in controls and it reduced further after controller medication withdrawal, especially in the presence of parentally perceived wheeze symptoms. This technique shows a significant potential for routine lung function testing of wheezy young children.
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Affiliation(s)
| | - Marita Paassilta
- Allergy Centre, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juho Kivistö
- Allergy Centre, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Jari Viik
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Jussi Karjalainen
- Allergy Centre, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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12
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Lundholm C, Brew BK, D'Onofrio BM, Osvald EC, Larsson H, Almqvist C. Asthma and subsequent school performance at age 15-16 years: A Swedish population-based sibling control study. Sci Rep 2020; 10:7661. [PMID: 32377014 PMCID: PMC7203156 DOI: 10.1038/s41598-020-64633-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/16/2020] [Indexed: 12/27/2022] Open
Abstract
Asthma may negatively affect children’s school performance, such as grades and exam results. Results from previous studies have shown varying results and may have suffered from confounding and other biases. We used a Swedish population-based cohort of 570,595 children with data on asthma (including severity and control) in Grades 7–8 and 9, school performance from Grade 9 (grade point sum, non-eligibility for upper secondary school and national test results) and measured confounders from national registers. We used sibling comparisons to account for unmeasured familial factors. Children with asthma and severe asthma performed slightly better in school than children without asthma when adjusting for measured confounders, but the associations were attenuated in sibling comparisons. In contrast, children with uncontrolled asthma performed slightly worse (e.g. Grade 9: βadj = −9.9; 95% CI −12.8 to −7.0; Cohen’s d = 0.16). This association remained for uncontrolled asthma in Grade 9 in sibling comparisons (Grade 9: β = −7.7 points; 95% CI −12.6 to −2.6; Cohen’s d = 0.12), but not for Grades 7–8. The attenuation of estimates when controlling for familial factors using sibling comparisons suggests that the differences were due to familial factors, rather than being causal. The remaining associations in sibling comparisons between uncontrolled asthma in Grade 9 and school performance are consistent with a causal association.
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Affiliation(s)
- Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Bronwyn K Brew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,National Perinatal Epidemiology and Biostatistics Unit, Centre for Big Data Research in Health and School of Women and Children's Health, University of New South Wales, Sydney, Australia
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Emma Caffrey Osvald
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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13
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Health-resource use and quality of life in children with bronchiectasis: a multi-center pilot cohort study. BMC Health Serv Res 2019; 19:561. [PMID: 31409413 PMCID: PMC6693266 DOI: 10.1186/s12913-019-4414-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/09/2019] [Indexed: 01/27/2023] Open
Abstract
Background Bronchiectasis in children is an important, but under-researched, chronic pulmonary disorder that has negative impacts on health-related quality of life. Despite this, it does not receive the same attention as other chronic pulmonary conditions in children such as cystic fibrosis. We measured health resource use and health-related quality of life over a 12-month period in children with bronchiectasis. Methods We undertook a prospective cohort study of 85 children aged < 18-years with high-resolution chest computed-tomography confirmed bronchiectasis undergoing management in three pediatric respiratory medical clinics in Darwin and Brisbane, Australia and Auckland, New Zealand. Children with cystic fibrosis or receiving cancer treatment were excluded. Data collected included the frequency of healthcare attendances (general practice, specialists, hospital and/or emergency departments, and other), medication use, work and school/childcare absences for parents/carers and children respectively, and both parent/carer and child reported quality of life and cough severity. Results Overall, 951 child-months of observation were completed for 85 children (median age 8.7-years, interquartile range 5.4–11.3). The mean (standard deviation) number of exacerbations was 3.3 (2.2) per child-year. Thirty of 264 (11.4%) exacerbation episodes required hospitalization. Healthcare attendance and antibiotic use rates were high (30 and 50 per 100 child-months of observation respectively). A carer took leave from work for 53/236 (22.5%) routine clinic visits. Absences from school/childcare due to bronchiectasis were 24.9 children per 100 child-months. Quality of life scores for both the parent/carer and child were highly-correlated with one another, remained stable over time and were negatively associated with cough severity. Conclusions Health resource use in this cohort of children is high, reflecting their severe disease burden. Studies are now needed to quantify the direct and societal costs of disease and to evaluate interventions that may reduce disease burden, particularly hospitalizations. Electronic supplementary material The online version of this article (10.1186/s12913-019-4414-5) contains supplementary material, which is available to authorized users.
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14
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Harris K, Kneale D, Lasserson TJ, McDonald VM, Grigg J, Thomas J. School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review. Cochrane Database Syst Rev 2019; 1:CD011651. [PMID: 30687940 PMCID: PMC6353176 DOI: 10.1002/14651858.cd011651.pub2] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Asthma is a common respiratory condition in children that is characterised by symptoms including wheeze, shortness of breath, chest tightness, and cough. Children with asthma may be able to manage their condition more effectively by improving inhaler technique, and by recognising and responding to symptoms. Schools offer a potentially supportive environment for delivering interventions aimed at improving self-management skills among children. The educational ethos aligns with skill and knowledge acquisition and makes it easier to reach children with asthma who do not regularly engage with primary care. Given the multi-faceted nature of self-management interventions, there is a need to understand the combination of intervention features that are associated with successful delivery of asthma self-management programmes. OBJECTIVES This review has two primary objectives.• To identify the intervention features that are aligned with successful intervention implementation.• To assess effectiveness of school-based interventions provided to improve asthma self-management among children.We addressed the first objective by performing qualitative comparative analysis (QCA), a synthesis method described in depth later, of process evaluation studies to identify the combination of intervention components and processes that are aligned with successful intervention implementation.We pursued the second objective by undertaking meta-analyses of outcomes reported by outcome evaluation studies. We explored the link between how well an intervention is implemented and its effectiveness by using separate models, as well as by undertaking additional subgroup analyses. SEARCH METHODS We searched the Cochrane Airways Trials Register for randomised studies. To identify eligible process evaluation studies, we searched MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the Cochrane Database of Systematic Reviews (CDSR), Web of Knowledge, the Database of Promoting Health Effectiveness Reviews (DoPHER), the Database of Abstracts of Reviews of Effects (DARE), the International Biography of Social Science (IBSS), Bibliomap, Health Technology Assessment (HTA), Applied Social Sciences Index and Abstracts (ASSIA), and Sociological Abstracts (SocAbs). We conducted the latest search on 28 August 2017. SELECTION CRITERIA Participants were school-aged children with asthma who received the intervention in school. Interventions were eligible if their purpose was to help children improve management of their asthma by increasing knowledge, enhancing skills, or changing behaviour. Studies relevant to our first objective could be based on an experimental or quasi-experimental design and could use qualitative or quantitative methods of data collection. For the second objective we included randomised controlled trials (RCTs) where children were allocated individually or in clusters (e.g. classrooms or schools) to self-management interventions or no intervention control. DATA COLLECTION AND ANALYSIS We used qualitative comparative analysis (QCA) to identify intervention features that lead to successful implementation of asthma self-management interventions. We measured implementation success by reviewing reports of attrition, intervention dosage, and treatment adherence, irrespective of effects of the interventions.To measure the effects of interventions, we combined data from eligible studies for our primary outcomes: admission to hospital, emergency department (ED) visits, absence from school, and days of restricted activity due to asthma symptoms. Secondary outcomes included unplanned visits to healthcare providers, daytime and night-time symptoms, use of reliever therapies, and health-related quality of life as measured by the Asthma Quality of Life Questionnaire (AQLQ). MAIN RESULTS We included 55 studies in the review. Thirty-three studies in 14,174 children provided information for the QCA, and 33 RCTs in 12,623 children measured the effects of interventions. Eleven studies contributed to both the QCA and the analysis of effectiveness. Most studies were conducted in North America in socially disadvantaged populations. High school students were better represented among studies contributing to the QCA than in studies contributing to effectiveness evaluations, which more commonly included younger elementary and junior high school students. The interventions all attempted to improve knowledge of asthma, its triggers, and stressed the importance of regular practitioner review, although there was variation in how they were delivered.QCA results highlighted the importance of an intervention being theory driven, along with the importance of factors such as parent involvement, child satisfaction, and running the intervention outside the child's own time as drivers of successful implementation.Compared with no intervention, school-based self-management interventions probably reduce mean hospitalisations by an average of about 0.16 admissions per child over 12 months (SMD -0.19, 95% CI -0.35 to -0.04; 1873 participants; 6 studies, moderate certainty evidence). They may reduce the number of children who visit EDs from 7.5% to 5.4% over 12 months (OR 0.70, 95% CI 0.53 to 0.92; 3883 participants; 13 studies, low certainty evidence), and probably reduce unplanned visits to hospitals or primary care from 26% to 21% at 6 to 9 months (OR 0.74, 95% CI 0.60 to 0.90; 3490 participants; 5 studies, moderate certainty evidence). Self-management interventions probably reduce the number of days of restricted activity by just under half a day over a two-week period (MD 0.38 days 95% CI -0.41 to -0.18; 1852 participants; 3 studies, moderate certainty evidence). Effects of interventions on school absence are uncertain due to the variation between the results of the studies (MD 0.4 fewer school days missed per year with self-management (-1.25 to 0.45; 4609 participants; 10 studies, low certainty evidence). Evidence is insufficient to show whether the requirement for reliever medications is affected by these interventions (OR 0.52, 95% CI 0.15 to 1.81; 437 participants; 2 studies; very low-certainty evidence). Self-management interventions probably improve children's asthma-related quality of life by a small amount (MD 0.36 units higher on the Paediatric AQLQ(95% CI 0.06 to 0.64; 2587 participants; 7 studies, moderate certainty evidence). AUTHORS' CONCLUSIONS School-based asthma self-management interventions probably reduce hospital admission and may slightly reduce ED attendance, although their impact on school attendance could not be measured reliably. They may also reduce the number of days where children experience asthma symptoms, and probably lead to small improvements in asthma-related quality of life. Many of the studies tested the intervention in younger children from socially disadvantaged populations. Interventions that had a theoretical framework, engaged parents and were run outside of children's free time were associated with successful implementation.
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Affiliation(s)
- Katherine Harris
- Queen Mary University of LondonCentre for Child Health, Blizard InstituteLondonUKE1 2AT
| | - Dylan Kneale
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education20 Bedford WayLondonUKWC1H 0AL
| | - Toby J Lasserson
- Cochrane Central ExecutiveEditorial & Methods DepartmentSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Vanessa M McDonald
- The University of NewcastleSchool of Nursing and Midwifery, Priority Reseach Centre for Asthma and Respiratory DiseaseLocked Bag 1000New LambtionNewcastleNSWAustralia2305
| | - Jonathan Grigg
- Queen Mary University of LondonCentre for Child Health, Blizard InstituteLondonUKE1 2AT
| | - James Thomas
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education20 Bedford WayLondonUKWC1H 0AL
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15
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Nilsson S, Ödling M, Andersson N, Bergström A, Kull I. Does asthma affect school performance in adolescents? Results from the Swedish population-based birth cohort BAMSE. Pediatr Allergy Immunol 2018; 29:174-179. [PMID: 29314343 DOI: 10.1111/pai.12855] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Asthma is common among schoolchildren and may influence quality of life and school attendance. However, it is unclear if asthma affects school performance. The aim of this study was to examine whether different phenotypes of asthma affect school performance during adolescence. METHODS The study population consisted of 1715 adolescents from a population-based birth cohort, followed up to age 16 with questionnaires and clinical examinations. Asthma was defined as at least 4 wheeze episodes or at least 1 wheeze episode in combination with inhaled steroids in the last 12 months. School grades were obtained from Statistics Sweden, and logistic regression analysis was performed to investigate the association between the final overall grade from secondary school and asthma phenotypes. RESULTS Among the adolescents, 20.8% have had ever asthma; 24.2% early transient, 47.2% school-age onset, and 24.2% persistent asthma. At 16 years, 7.8% had asthma; 71.7% multimorbidity and 73.9% allergic asthma. A statistically significant association for performing less well was seen for ever asthma (ORadj = 1.43, 95% CI = 1.09-1.88). In analyses of asthma onset, an association was seen for school-age onset (ORadj = 1.49, CI = 1.02-2.16) and a tendency for persistent asthma (ORadj = 1.61, CI = 0.98-2.66), although with overlapping confidence intervals. Further, adolescents with uncontrolled asthma tended to perform less well (ORadj = 2.60, CI = 0.87-7.80) compared to adolescents with partly controlled (ORadj = 1.12, CI = 0.68-1.83) and fully controlled (ORadj = 1.29, CI = 0.55-3.01) asthma. CONCLUSIONS Our results indicate that asthma impairs school performance in adolescence. Moreover, some evidence suggests the adolescents with asthma during school age and with poorer asthma control to be more likely to perform less well.
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Affiliation(s)
- Sara Nilsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre of Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Maria Ödling
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Andersson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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16
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Loerbroks A, Bosch JA, Sheikh A, Yamamoto S, Herr RM. Reports of wheezing and of diagnosed asthma are associated with impaired social functioning: Secondary analysis of the cross-sectional World Health Survey data. J Psychosom Res 2018; 105:52-57. [PMID: 29332634 DOI: 10.1016/j.jpsychores.2017.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We sought to investigate whether there are associations between asthma and social functioning in adults from Western and non-Western countries. METHODS We analyzed data on individuals (94% aged 20+, 52% female) from 50 countries participating in the cross-sectional World Health Survey. We used information on self-reports of wheezing and an asthma diagnosis. Social functioning was defined by reports of severe or extreme difficulties related to personal relationships or participation in the community. Logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Wheezing was associated with impaired social functioning both in the overall sample (OR=2.40, 95%CI=2.09-2.75) and in Africa, South America and Asia (ORs≥2.47), but not in Europe (aOR=1.26, 95%CI=0.90-1.77). Analyses with self-reports of diagnosed asthma yielded similar, albeit weaker, associations (e.g. OR for the overall sample=1.63, 95%CI=1.38-1.92). We also combined asthma and wheezing into a single variable (reference group: no asthma diagnosis/no wheezing). We observed that in particular reports of wheezing were associated with impaired social functioning regardless of whether a concomitant asthma diagnosis was reported (OR=2.19, 95%CI=1.81-2.64) or not (OR=2.50, 95%CI=2.09-2.99). CONCLUSION Self-reports of wheezing and of diagnosed asthma are associated with impaired social functioning among adults in Africa, South America and Asia, but less so in Europe. These relationships are mainly driven by the experience of respiratory symptoms (i.e. wheezing). Our findings may partly be explained by regional variations in asthma control. Further research should elucidate the determinants and mechanisms of asthma-related impaired social functioning.
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Affiliation(s)
- Adrian Loerbroks
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany.
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Edinburgh, UK
| | - Shelby Yamamoto
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Raphael M Herr
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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17
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Lewis KM, Pikhart H, Morrison J. Does adiposity mediate the relationship between socioeconomic position and non-allergic asthma in childhood? J Epidemiol Community Health 2018; 72:390-396. [PMID: 29367283 PMCID: PMC5909742 DOI: 10.1136/jech-2017-209722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 11/18/2022]
Abstract
Background Despite its high prevalence, early onset and chronic nature, the causes of asthma are not clearly established. The present study examined a plausible but untested relationship in the development of non-allergic asthma; an asthma phenotype closely linked to deprivation and other preventable risk factors. Our aim was to determine the mediating role of adiposity in the relationship between socioeconomic position in infancy and non-allergic asthma emergence in mid-childhood. Methods To estimate the causal indirect effect of adiposity we applied the parametric g-computational procedure to 6203 singleton children from the UK Millennium Cohort Study. Adiposity was measured at age 7 by body mass index, waist circumference and waist circumference-to-height ratio. Children who developed non-allergic asthma between the age of 7 and 14 were compared with children without allergies or allergic asthma at these ages. Results We found no evidence to suggest that adiposity is a mediator in the relationship between socioeconomic position and the development of non-allergic asthma in mid-childhood. After adjustment for risk factors, the direct effect of socioeconomic position remained; children in the lowest tertile of socioeconomic position had a 43% (OR 1.43, 95% CI 1.38 to 1.49) greater odds of developing non-allergic asthma compared with the highest tertile. Conclusions Adiposity at age 7 does not mediate the relationship between socioeconomic position and non-allergic asthma. The results suggest that improving socioeconomic conditions and promoting healthy weight are both important in reducing the development of non-allergic asthma in early to mid-childhood.
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Affiliation(s)
- Kate Marie Lewis
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Hynek Pikhart
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Joana Morrison
- Research Department of Epidemiology and Public Health, University College London, London, UK
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18
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von Kobyletzki LB, Beckman L, Smeeth L, McKee M, Quint JK, Abuabara K, Langan S. Association between childhood allergic diseases, educational attainment and occupational status in later life: systematic review protocol. BMJ Open 2017; 7:e017245. [PMID: 29025838 PMCID: PMC5652581 DOI: 10.1136/bmjopen-2017-017245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Childhood allergic diseases may prevent affected children from achieving their academic potential. Potential mechanisms include absence from school due to illness and medical appointments. Experience of symptoms in classes or leisure time, and stigma associated with visible signs and symptoms, including skin disease, requirements for medication during school time or the need for specific diets, may also contribute to reduced educational attainment. Studies have investigated the association between specific allergic diseases and educational attainment. The aim of this study is to systematically review the literature on allergic diseases, educational attainment and occupational status, and if possible, calculate meta-analytic summary estimates for the associations. METHODS Systematic electronic searches in Medline, EMBASE, Cochrane, Cumulative Index to Nursing & Allied Health Literature (CINAHL), PsycINFO and education Resources Information Center (ERIC); hand search in reference lists of included papers and conference reports; search for unpublished studies in clinical trial registers and the New York Academy of Medicine Grey Literature Report; data extraction; and study quality assessment (Newcastle-Ottawa Scale) will be performed. ANALYSIS Data will be summarised descriptively, and meta-analysis including meta-regression to explore sources of heterogeneities will be performed if possible. ETHICS AND DISSEMINATION Dissemination in a peer-reviewed, open-access, international scientific journal is planned. PROSPERO REGISTRATION NUMBER CRD42017058036.
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Affiliation(s)
- Laura Beate von Kobyletzki
- Department of Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Public Health Sciences, Karlstads Universitet, Karlstad, Sweden
| | - Linda Beckman
- Department of Public Health Sciences, Karlstads Universitet, Karlstad, Sweden
| | - Liam Smeeth
- London School of Hygiene & Tropical Medicine, London, UK
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer K Quint
- Respiratory Epidemiology, Occupational Medicine and Public Health, Imperial College London, London, UK
| | - Katrina Abuabara
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, California, USA
| | - Sinead Langan
- London School of Hygiene & Tropical Medicine, London, UK
- Department of Dermatology, St John's Institute of Dermatology, London, UK
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19
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Lum A, Wakefield CE, Donnan B, Burns MA, Fardell JE, Marshall GM. Understanding the school experiences of children and adolescents with serious chronic illness: a systematic meta-review. Child Care Health Dev 2017; 43:645-662. [PMID: 28543609 DOI: 10.1111/cch.12475] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 03/17/2017] [Accepted: 04/15/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Serious chronic illness can have a detrimental effect on school attendance, participation and engagement, leaving affected students at risk of failing to meet their developmental potential. An improved understanding of factors that help to explain or mitigate this risk can help educators and health professionals deliver the most effective support. This meta-review critiqued the available evidence examining the link between six chronic illnesses (asthma, cancer, chronic kidney diseases, heart diseases, cystic fibrosis and gastrointestinal diseases) and children's and adolescents' school experiences and outcomes, as well as investigating the medical, school, psychosocial and sociodemographic factors that are linked to poorer or better school outcomes. METHODS We searched CINAHL, Cochrane Database, EMBASE, ERIC, MEDLINE, ProQuest Theses and Dissertations, and PsycINFO (2000-2015). Systematic and narrative reviews, and meta-analyses, of original studies examining students' subjective school experiences and objective school outcomes were eligible. We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria to critically appraise all systematic reviews. The Grading of Recommendations Assessment, Development, and Evaluation system guided our recommendations for practice and research. RESULTS Eighteen reviews of 172 studies including more than 40 000 students were eligible. Therefore, we chose to conduct a meta-review to provide an overview of the literature on the relationship between chronic illness and school experiences and outcomes. We also explored the associated medical, school, psychosocial and sociodemographic factors affecting the relationship between illness and school experiences and outcomes. CONCLUSION Students with chronic illness demonstrate mixed school experiences and outcomes that are often worse than students without chronic illness. Modifiable factors, such as students' engagement with school, may be novel yet appropriate targets of educational support to ensure that these students reach their full schooling potential.
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Affiliation(s)
- A Lum
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - C E Wakefield
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - B Donnan
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia.,Ronald McDonald House Charities, Sydney, NSW, Australia
| | - M A Burns
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - J E Fardell
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - G M Marshall
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.,Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
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20
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Irani F, Barbone JM, Beausoleil J, Gerald L. Is asthma associated with cognitive impairments? A meta-analytic review. J Clin Exp Neuropsychol 2017; 39:965-978. [PMID: 28325118 DOI: 10.1080/13803395.2017.1288802] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Asthma is a chronic disease with significant health burden and socioeconomic and racial/ethnic disparities related to diagnosis and treatment. Asthma primarily affects the lungs, but can impact brain function through direct and indirect mechanisms. Some studies have suggested that asthma negatively impacts cognition, while others have failed to identify asthma-related cognitive compromise. We aimed to conduct a meta-analysis of cognition in individuals with asthma compared to that in healthy controls. We also examined the impact of some key potential moderators. METHOD Data on cognitive outcome measures and sociodemographic, illness-related, and study-related variables were extracted from studies reporting cognitive test performance in individuals with asthma compared to that in controls. RESULTS There was no evidence of publication bias. A random-effects model examining differences in task performance between 2017 individuals with asthma and 2131 healthy controls showed significant effects in the small to medium range. Cognitive deficits associated with asthma were global, with strongest effects on broader measures involving academic achievement and executive functioning, but with additional impact on processing speed, global intellect, attention, visuospatial functioning, language, learning, and memory. Severity of asthma was a key moderator, with greatest cognitive deficits associated with severe asthma. Cognitive burden was also greatest in asthma patients who were younger, males, from low socioeconomic backgrounds, and from racial/ethnic minorities. Effects were independent of type of population (child versus adult), type of study (norm-referenced versus control-referenced), or reported use of oral or inhaled corticosteroid medications. CONCLUSIONS There is cognitive burden associated with asthma, particularly among vulnerable groups with severe asthma. This could be due to increased risk of intermittent cerebral hypoxia in severe asthma. The clinical need to assess cognition in individuals with asthma is underscored.
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Affiliation(s)
- Farzin Irani
- a Department of Psychology , West Chester University of Pennsylvania , West Chester , PA , USA
| | - Jordan Mark Barbone
- a Department of Psychology , West Chester University of Pennsylvania , West Chester , PA , USA
| | - Janet Beausoleil
- b Division of Allergy and Immunology , The Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - Lynn Gerald
- c Mel and Enid Zuckerman College of Public Health , University of Arizona , Tucson , AZ , USA.,d Asthma and Airways Disease Research Center , University of Arizona , Tucson , AZ , USA
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Monaghan LF, Gabe J. Embodying health identities: A study of young people with asthma. Soc Sci Med 2016; 160:1-8. [PMID: 27192143 DOI: 10.1016/j.socscimed.2016.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 11/26/2022]
Abstract
The embodiment of health identities is a growing area of interest. Questions posed in this literature include: how important is the body in our understandings/experiences of health, how are everyday definitions of health and self embodied despite chronic illness, and how do social relations influence these interpretations? Mindful of such questions, this paper draws on a qualitative study of mild to moderate asthma among young people in Ireland. In-depth interviews were undertaken with 31 respondents aged between 5 and 17, including boys (n = 15) and girls (n = 16) from different class and ethnic backgrounds. Core themes included: the importance of play, physical activity and sport; diet/nutrition; and physical appearance. Asthma sometimes presented challenges in relation to specific domains, notably strenuous physical activity, though in many other respects its potential impact was discursively minimised. Attentive to various modalities of the lived body, we illustrate how health identities are negotiated among young people diagnosed with a chronic illness. Connections are also made with the sociology of childhood and (ill) health, which views young people as active agents.
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Affiliation(s)
| | - Jonathan Gabe
- Royal Holloway, University of London, United Kingdom
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Loerbroks A, Leucht V, Keuneke S, Apfelbacher CJ, Sheikh A, Angerer P. Patients' needs in asthma treatment: development and initial validation of the NEAT questionnaire. J Asthma 2016; 53:427-37. [PMID: 26786054 DOI: 10.3109/02770903.2015.1099664] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE We aimed to develop and tentatively validate an instrument assessing patients' needs related to asthma treatment. METHODS Patients were recruited through various approaches (e.g. physicians, pharmacies and patient organizations). Utilizing a mixed methods design, we first conducted five focus groups to explore needs among patients. Next, we devised an item pool which was revised, reduced and evaluated by patients. Finally, data from a survey (n = 362) were used to further reduce the item pool and to examine the questionnaire's psychometric properties and validity. RESULTS Four broad needs categories emerged from the focus groups: (1) information needs; (2) consideration of patient views in diagnosis; (3) consideration of patient views in treatment planning; and (4) addressing patients' fears. We devised 45 items, which were reduced to 22 items based on patient feedback. The survey data suggested a 13-item scale with four subscales ("patient expertise", "drug effects", "handling drugs" and "exacerbations"). Cronbach's alpha was acceptable for those subscales (>0.7) and for the total score (0.9). Increasing scores on subscales and the total score (implying more unmet needs) showed close and consistent associations with poor asthma control, reduced quality of life and low treatment satisfaction. CONCLUSIONS The development process of the Needs in Asthma Treatment (NEAT) questionnaire ensured that needs of asthma patient are captured with high validity. The NEAT questionnaire has been shown to be valid, thereby representing a promising tool for research and delivery of patient-centered care.
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Affiliation(s)
- Adrian Loerbroks
- a Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf , Düsseldorf , Germany .,b Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University , Mannheim , Germany
| | - Verena Leucht
- a Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf , Düsseldorf , Germany
| | - Susanne Keuneke
- c Faculty of Philosophy, Social Sciences Institute, University of Düsseldorf , Düsseldorf , Germany
| | - Christian J Apfelbacher
- d Division of Medical Sociology, Department of Epidemiology and Preventive Medicine , University of Regensburg , Regensburg , Germany .,e Division of Public Health and Primary Care , Brighton and Sussex Medical School, University of Brighton , Falmer , UK
| | - Aziz Sheikh
- f Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Centre of Medical Informatics, The University of Edinburgh, Medical School , Edinburgh , UK .,g Division of General Internal Medicine and Primary Care , Brigham and Women's Hospital , Boston , MA , USA , and.,h Department of Medicine , Harvard Medical School , Boston , MA , USA
| | - Peter Angerer
- a Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf , Düsseldorf , Germany
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Monaghan LF, Gabe J. Chronic illness as biographical contingency? Young people's experiences of asthma. SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:1236-1253. [PMID: 26140434 DOI: 10.1111/1467-9566.12301] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Much research on chronic illness, which views the experience as disruptive, is adult-focused though there is an emerging literature on children's and young people's experiences. Drawing on 31 interviews conducted with young people diagnosed with asthma in south-west Ireland, this article contributes to this literature. The sample includes boys (n = 15) and girls (n = 16) aged between 5 and 17 from the Irish Traveller community and the larger settled community. The study also explores the potential value of what might be called biographical contingency. This concept refers to the way in which a chronic illness may be an 'only sometimes' problem and takes account of the 'now you see it, now you don't' nature of a condition that varies in terms of its symptoms, meanings and consequences. In concluding, we consider the uses and limitations of this concept and the interpretivist paradigm that typically informs qualitative research on the illness experience.
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Affiliation(s)
- Lee F Monaghan
- Department of Sociology, University of Limerick, Ireland
| | - Jonathan Gabe
- Centre for Criminology and Sociology, Royal Holloway, London, UK
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School Performance: A Matter of Health or Socio-Economic Background? Findings from the PIAMA Birth Cohort Study. PLoS One 2015; 10:e0134780. [PMID: 26247468 PMCID: PMC4527686 DOI: 10.1371/journal.pone.0134780] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 07/14/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Performance in primary school is a determinant of children's educational attainment and their socio-economic position and health inequalities in adulthood. We examined the relationship between five common childhood health conditions (asthma symptoms, eczema, general health, frequent respiratory infections, and overweight), health related school absence and family socio-economic status on children's school performance. METHODS We used data from 1,865 children in the Dutch PIAMA birth cohort study. School performance was measured as the teacher's assessment of a suitable secondary school level for the child, and the child's score on a standardized achievement test (Cito Test). Both school performance indicators were standardised using Z-scores. Childhood health was indicated by eczema, asthma symptoms, general health, frequent respiratory infections, overweight, and health related school absence. Children's health conditions were reported repeatedly between the age of one to eleven. School absenteeism was reported at age eleven. Highest attained educational level of the mother and father indicated family socio-economic status. We used linear regression models with heteroskedasticity-robust standard errors for our analyses with adjustment for sex of the child. RESULTS The health indicators used in our study were not associated with children's school performance, independently from parental educational level, with the exception of asthma symptoms (-0.03 z-score / -0.04 z-score with Cito Test score after adjusting for respectively maternal and paternal education) and missing more than 5 schooldays due to illness (-0.18 z-score with Cito Test score and -0.17 z-score with school level assessment after adjustment for paternal education). The effect estimates for these health indicators were much smaller though than the effect estimates for parental education, which was strongly associated with children's school performance. CONCLUSION Children's school performance was affected only slightly by a number of common childhood health problems, but was strongly associated with parental education.
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Gullach AJ, Risgaard B, Lynge TH, Jabbari R, Glinge C, Haunsø S, Backer V, Winkel BG, Tfelt-Hansen J. Sudden death in young persons with uncontrolled asthma--a nationwide cohort study in Denmark. BMC Pulm Med 2015; 15:35. [PMID: 25887740 PMCID: PMC4404085 DOI: 10.1186/s12890-015-0033-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 04/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asthma is a common chronic disease among young adults, and several studies have reported increased mortality rates in patients with asthma. However, no study has described sudden unexpected death in a nationwide setting in patients with uncontrolled asthma. We defined uncontrolled asthma as a previous hospital admittance because of asthma (of any severity) or when asthma was considered to have influenced the death according to the death certificate. The purpose of this study is to increase the medical focus on young persons with uncontrolled asthma and thereby hopefully aid in preventing sudden unexpected deaths. We therefore aimed to describe clinical characteristics, symptoms, causes of death, and contact with the healthcare system prior to sudden unexpected death in young persons with uncontrolled asthma. METHODS Through the review of death certificates, we found 625 sudden unexpected death cases in individuals aged 1-35 years in Denmark from 2000 to 2006. Of those, 49 persons with uncontrolled asthma were identified. Previous contacts with the healthcare system were identified, and available records from general practitioners were retrieved. RESULTS We identified 49 individuals who suffered from uncontrolled asthma. This corresponds to an incidence rate of 0.32 per 100,000 person-years. The cause of death in 31 cases (63%) was sudden cardiac death, and in 13 cases (27%), it was a fatal asthma attack. Symptoms (chest pain, dyspnea, seizures, general malaise, syncope, and palpitations) prior to death were reported in 41 (84%) of the cases. In 34 (69%) of the cases, antecedent symptoms (symptoms >24 hours before death) were present, and 28 (57%) patients had prodromal symptoms (symptoms <24 hours before death). The most common antecedent symptoms were dyspnea and chest pain, whereas the most common prodromal symptoms were dyspnea, general malaise, and/or fatigue. Twenty-eight patients (57%) sought medical advice from a general practitioner and/or emergency department due to these symptoms. CONCLUSION The cause of death was predominantly sudden cardiac death followed by fatal asthma attack. We found that 41 (84%) of patients suffered from symptoms prior to death and that 28 (57%) sought medical advice from the emergency department and/or general practitioners.
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Affiliation(s)
- Anders Juul Gullach
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. .,Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark.
| | - Bjarke Risgaard
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. .,Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark.
| | - Thomas Hadberg Lynge
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. .,Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark.
| | - Reza Jabbari
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. .,Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark.
| | - Charlotte Glinge
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. .,Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark.
| | - Stig Haunsø
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. .,Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark. .,Department of Medicine and Surgery, University of Copenhagen, Copenhagen, Denmark.
| | - Vibeke Backer
- Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
| | - Bo Gregers Winkel
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Copenhagen, Denmark. .,Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark.
| | - Jacob Tfelt-Hansen
- Laboratory of Molecular Cardiology, Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, 9312, Juliane Maries Vej 20, Copenhagen, 2100, Denmark. .,Department of Medicine and Surgery, University of Copenhagen, Copenhagen, Denmark.
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Harris KM, Kneale D, Lasserson TJ, McDonald VM, Grigg J, Thomas J. School-based self management interventions for asthma in children and adolescents: a mixed methods systematic review. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011651] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Katherine M Harris
- Queen Mary University of London; Centre for Paediatrics, Blizard Institute; Barts and the London School of Medicine and Dentistry London UK E1 2AT
| | - Dylan Kneale
- University College London; EPPI-Centre, Social Science Research Unit, UCL Institute of Education; 20 Bedford Way London UK WC1H 0AL
| | - Toby J Lasserson
- Cochrane Central Executive; Cochrane Editorial Unit; St Albans House 57-59 Haymarket London UK SW1Y 4QX
| | - Vanessa M McDonald
- The University of Newcastle; School of Nursing and Midwifery, Priority Reseach Centre for Asthma and Respiratory Disease; Locked Bag 1000 New Lambtion Newcastle NSW Australia 2305
| | - Jonathan Grigg
- Queen Mary University of London; Institute of Cell and Molecular Science, Blizzard Institute; London UK E1 2AT
| | - James Thomas
- University College London; EPPI-Centre, Social Science Research Unit, UCL Institute of Education; 20 Bedford Way London UK WC1H 0AL
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Al Aloola NA, Naik-Panvelkar P, Nissen L, Saini B. Asthma interventions in primary schools--a review. J Asthma 2014; 51:779-98. [PMID: 24730772 DOI: 10.3109/02770903.2014.914534] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To explore, in depth, the literature for evidence supporting asthma interventions delivered within primary schools and to identify any "gaps" in this research area. METHODS A literature search using electronic search engines (i.e. Medline, PubMed, Education Resources Information Center (ERIC), International Pharmaceutical Abstracts (IPA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and Informit) and the search terms "asthma", "asthma intervention" and "school-based asthma education program" (and derivatives of these keywords) was conducted. RESULTS Twenty-three articles met the inclusion criteria; of these eight were Randomised Controlled Trials. There was much variety in the type, content, delivery and outcome measures in these 23 studies. The most common intervention type was asthma education delivery. Most studies demonstrated improvement in clinical and humanistic markers, for example, asthma symptoms medication use (decrease in reliever medication use or decrease in the need for rescue oral steroid), inhaler use technique and spacer use competency, lung function and quality of life. Relatively few studies explored the effect of the intervention on academic outcomes. Most studies did not report on the sustainability or cost effectiveness of the intervention tested. Another drawback in the literature was the lack of details about the intervention and inconsistency in instruments selected for measuring outcomes. CONCLUSION School-based asthma interventions regardless of their heterogeneity have positive clinical, humanistic, health economical and academic outcomes.
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Affiliation(s)
- Noha A Al Aloola
- Department of Clinical Pharmacy , Faculty of Pharmacy, King Saud University, Riyadh , Saudi Arabia
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Cutuli JJ, Herbers JE, Lafavor TL, Ahumada SM, Masten AS, Oberg CN. Asthma and adaptive functioning among homeless kindergarten-aged children in emergency housing. J Health Care Poor Underserved 2014; 25:717-30. [PMID: 24858881 PMCID: PMC4498570 DOI: 10.1353/hpu.2014.0099] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Children who experience homelessness have elevated rates of asthma, a risk factor for other problems. Purpose. Examine rates of asthma and its relation to health care use and adaptive functioning among young children staying in family emergency shelters. METHODS Children and caregivers (N = 138) completed assessments in shelters, including measurement of child cognitive functioning, parent report of child health care service utilization and asthma diagnosis, and teacher report of child school functioning. RESULTS Asthma diagnosis was reported for 21% of 4-to-6-year-old children, about twice the national and state prevalences. Children with asthma used more health care services and had worse peer relationships. Asthma did not relate to cognitive test performance or subsequent academic performance, or to other behavior problems in school. CONCLUSIONS High rates of asthma remain an important issue for children in emergency family housing, a context with high levels of child risk for toxic stress exposure and developmental problems.
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Kawafha MM, Tawalbeh LI. The effect of asthma education program on knowledge of school teachers: a randomized controlled trial. West J Nurs Res 2014; 37:425-40. [PMID: 24682383 DOI: 10.1177/0193945914528070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to examine the effect of an asthma education program on schoolteachers' knowledge. Pre-test-post-test experimental randomized controlled design was used. A multistage-cluster sampling technique was used to randomly select governorate, primary schools, and schoolteachers. Schoolteachers were randomly assigned either to the experimental group (n = 36) and attended three educational sessions or to the control group (n = 38) who did not receive any intervention. Knowledge about asthma was measured using the Asthma General Knowledge Questionnaire for Adults (AGKQA). The results indicated that teachers in the experimental group showed significantly (p < .001) higher knowledge of asthma in the first post-test and the second post-test compared with those in the control group. Implementing asthma education enhanced schoolteachers' knowledge of asthma. The asthma education program should target schoolteachers to improve knowledge about asthma.
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Cho YM, Ryu SH, Choi MS, Tinyami ET, Seo S, Choung JT, Choi JW. Asthma and allergic diseases in preschool children in Korea: findings from the pilot study of the Korean Surveillance System for Childhood Asthma. J Asthma 2014; 51:373-9. [PMID: 24393081 DOI: 10.3109/02770903.2013.876648] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This article was intended to introduce the Korean Surveillance System for Childhood Asthma (KSSCA) and also to determine the factors that increase the risk for the development of asthma and allergic diseases in preschool children in Korea based on the study results. METHODS The KSSCA pilot study was a web-based, cross-sectional survey that sampled 1002 parents with a biological child aged 2-6 years that visited the website and participated in the survey. This website consisted of a questionnaire designed to measure the history and prevalence of asthma and allergic diseases, the characteristics of dwelling, lifestyle, and the socioeconomic status of the subjects. Using logistic regression analysis, odds ratios (ORs) and 95% confidence intervals (CIs) between each risk factor and disease development were calculated. RESULTS The rate of a family where a child had asthma was 7.4%, while 34.7% and 35.9% for allergic rhinitis and atopic dermatitis, respectively. The OR (95% CI) that a child whose parents had an allergic disease and was also diagnosed with an allergic disease was 2.86 (2.20-3.72). Children who lived in the first floor or basement of apartments had a higher risk of atopic dermatitis, as well as children from socioeconomically vulnerable families. Upon analysis of allergic reaction tests and disease development, it was found that asthma was associated with the positive reaction of cockroaches and food, allergic rhinitis with mites, and atopic dermatitis with mold and food. CONCLUSION The study indicated that genetic and some environmental or socioeconomic factors might be important in the development of asthma and allergic diseases among preschool children in Korea through the web-survey.
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Affiliation(s)
- Yong Min Cho
- Institute for Occupational & Environmental Health, Korea University , Seoul , Republic of Korea
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Cohen AK, Schuchter JW. Revitalizing communities together: the shared values, goals, and work of education, urban planning, and public health. J Urban Health 2013; 90:187-96. [PMID: 22711169 PMCID: PMC3675725 DOI: 10.1007/s11524-012-9733-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Inequities in education, the urban environment, and health co-exist and mutually reinforce each other. Educators, planners, and public health practitioners share commitments to place-based, participatory, youth-focused, and equitable work. They also have shared goals of building community resilience, social capital, and civic engagement. Interdisciplinary programs that embody these shared values and work towards these shared goals are emerging, including school-based health centers, full-service community schools, community health centers, Promise Neighborhoods, and Choice Neighborhoods. The intersection of these three fields represents an opportunity to intervene on social determinants of health. More collaborative research and practice across public health, education, and planning should build from the shared values identified to continue to address these common goals.
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Impact of asthma on educational attainment in a socioeconomically deprived population: a study linking health, education and social care datasets. PLoS One 2012; 7:e43977. [PMID: 23155367 PMCID: PMC3498297 DOI: 10.1371/journal.pone.0043977] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 07/27/2012] [Indexed: 11/19/2022] Open
Abstract
Background Asthma has the potential to adversely affect children's school examination performance, and hence longer term life chances. Asthma morbidity is especially high amongst UK ethnic minority children and those experiencing social adversity, populations which also have poor educational outcomes. We tested the hypothesis that asthma adversely affects performance in national school examinations in a large cohort from an area of ethnic diversity and social deprivation. Methods and Findings With a novel method (using patient and address-matching algorithms) we linked administrative and clinical data for 2002–2005 for children in east London aged 5–14 years to contemporaneous education and social care datasets. We modelled children's performance in school examinations in relation to socio-demographic and clinical variables. The dataset captured examination performance for 12,136 children who sat at least one national examination at Key Stages 1–3. For illustration, estimates are presented as percentage changes in Key Stage 2 results. Having asthma was associated with a 1.1% increase in examination scores (95%CI 0.4 to 1.7)%,p = 0.02. Worse scores were associated with Bangladeshi ethnicity −1.3%(−2.5 to −0.1)%,p = 0.03; special educational need −14.6%(−15.7 to −13.5)%,p = 0.02; mental health problems −2.5%(−4.1 to −0.9)%,p = 0.003, and social adversity: living in a smoking household −1.2(−1.7 to −0.6)%,p<0.001; living in social housing −0.8%(−1.3 to −0.2)% p = 0.01, and entitlement to free school meals −0.8%(−1.5 to −0.1)%,p<0.001. Conclusions Social adversity and ethnicity, but not asthma, are associated with poorer performance in national school examinations. Policies to improve educational attainment in socially deprived areas should focus on these factors.
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[Impact of an asthma educational intervention programme on teachers]. An Pediatr (Barc) 2012; 77:236-46. [PMID: 22498020 DOI: 10.1016/j.anpedi.2012.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 02/18/2012] [Accepted: 02/20/2012] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Our objective was to measure the impact of an educational intervention program on teacher's knowledge about asthma and its management. MATERIAL AND METHOD Before and after quasi-experimental study, with control group, of an educational intervention, which had as its aim to improve the teacher's knowledge of asthma and its management, was conducted in some schools of San Sebastian (Gipuzkoa), Spain. The Newcastle Asthma knowledge Questionnaire (NAKQ) was used as a measuring tool, and an adaptation of the asthma, sport and health program was used as an educational intervention. The Wilcoxon signed rank test was used to compare the total score of the questionnaire before and after the intervention, and the McNemar test was performed to compare the percentages of correct answers to each item. The Mann-Whitney U test was also performed to compare the baseline score and the score at three months between the intervention group and control group. The size of the effect and the standardised mean response were studied. RESULTS A total of 138 teachers from 6 schools, which were chosen at random (study group), and 43 teachers in the control group participated in the study. In the study group, the mean score of the NAKQ before the educational intervention was 16.1±3.4 points, with a median of 16 (range 7 to 23). After the intervention the mean score increased to 22.3±4.1, with a median of 23 (range, 6 to 29). The mean difference in the overall score of the NAKQ was 7.0±4.2 points, with a median of 8 (range, -2 to17). Furthermore, the size of the effect was 2.0 (> 0.8) and the standardised mean response was 1.7. After 3 months of the intervention the mean score of the NAKQ was 21.4±3.0 points, with a median of 22 (range, 12 to 29) which was significantly higher than the score obtained before the intervention (P<.001) and slightly lower than the score obtained immediately after the intervention, assuming a size of the effect of 1.6 and a standardised mean response of 1.2. In the control group, the level of knowledge did not change modified and was lower than the level of the intervention group (P<.001). CONCLUSIONS An educational intervention program conducted among teachers significantly increases their knowledge of asthma. Moreover, the increase reduces slightly but maintains its higher level for at least 3 months. In spite of the fact that some aspects of knowledge improved with the educational intervention, they were not optimal.
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Mazurek JM, Schleiff PL, Henneberger PK. Is childhood asthma associated with educational level and longest-held occupation? Am J Epidemiol 2012; 175:279-88. [PMID: 22223711 DOI: 10.1093/aje/kwr300] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Children with asthma can experience chronic morbidity that may interfere with education and career progression. The authors investigated retrospectively whether a history of childhood asthma is associated with educational level and longest-held occupation, by gender. Cross-sectional analysis included a nationally representative sample of 10,452 adults aged ≥20 years who participated in the US National Health and Nutrition Examination Survey (2001-2004). Logistic regression was used to assess associations between a childhood-asthma history and educational level, employment, and longest-held occupation. An estimated 6.9% of men and 5.8% of women had a childhood-asthma history. Persons with a childhood-asthma history tended to have a higher educational level than those with no asthma history. Among those who ever worked, and after adjustment for age and race/ethnicity, men with a childhood-asthma history were more likely to work in health-diagnosing occupations, other professional occupations, and as cooks; women with a childhood-asthma history were more likely to work in management-related, entertainment-related, and health service occupations. Compared with those with no asthma history, persons with a childhood-asthma history tended to achieve a higher educational level and, if they worked, were more likely to work in particular occupations.
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Affiliation(s)
- Jacek M Mazurek
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia 26505, USA.
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Nriagu J, Martin J, Smith P, Socier D. Residential hazards, high asthma prevalence and multimorbidity among children in Saginaw, Michigan. THE SCIENCE OF THE TOTAL ENVIRONMENT 2012; 416:53-61. [PMID: 22226391 DOI: 10.1016/j.scitotenv.2011.10.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Accepted: 10/20/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Comorbidities complicate our understanding of childhood asthma and its risk factors. This study examined the relationships between asthma, self-reported burden of disease symptoms and residential hazards in a representative sample of households in Saginaw, Michigan. STUDY DESIGN A population-based cross-sectional survey. METHOD The study involved 643 households randomly selected from the City of Saginaw (Michigan) with children 12 years of age or younger or pregnant woman. The survey was completed using random digit dialing, Computer-Assisted Telephone Interviewing (CATI) method. The audit instrument for residential hazards developed for the study was used to gather information on 71 household hazards organized in eight scales (dimensions): structural scale, moisture/mold scale, electrical scale, ventilation and combustion appliances scale, pest scale, pets scale, fire scale, and lifestyle-associated factors scale. The data were used to calculate an aggregate score of the household hazard index (HHI) for each housing unit. We also collected information on 43 symptoms of diseases likely to be associated with exposure to residential hazards as well as the demographic characteristics for each household. RESULTS Asthma prevalence rate among the 1206 children was 18.9% with 27.7% of households reporting at least one asthmatic child. The prevalence of health hazards in households of Saginaw was pervasively high with the rate for each of 29 hazards being over 30%. The HHI was found to be a good predictor of health outcomes in homes; the following linear regression equation describes the relationship between childhood asthma and the scores for individual scales of HHI: Number of Asthmatic Children=0.009(Structural)+0.004(Mold) +0 .019(Pests)-0.023(Pets)-0.029(Fire); (r(2)=0.054; p-value<0.001). Children who were living in housing units classified as high risk (top 25% of the HHI score) were found to be disproportionately afflicted with asthma, allergic reaction and burden of symptoms compared to children who lived in low-risk homes. Average number of symptoms in the households was 14±10 and the top 25% of the households had over 26 symptoms. Asthma was associated (comorbid) with each of the 40 symptoms (out of the 43) in the inventory scale, and the HHI was found to be a good predictor of the symptom burden (total count of symptoms) in participating households. CONCLUSIONS Recognition of the large extent of comorbidity in asthmatic children has implications for the way in which this disease should be treated or managed. In addition, the study of comorbidity between asthma and related risk factors may be important in understanding complex exposure-disease relationships which could lead to more effective interventions.
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Affiliation(s)
- Jerome Nriagu
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
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Trzcieniecka-Green A, Bargiel-Matusiewicz K, Wilczynska-Kwiatek A. Quality of life and activity of children suffering from bronchial asthma. Eur J Med Res 2010; 14 Suppl 4:147-50. [PMID: 20156746 PMCID: PMC3521355 DOI: 10.1186/2047-783x-14-s4-147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective The aim of this article was to analyze the quality of life of children suffering from bronchial asthma and to analyze their everyday activity. Methods The research was conducted in 137 children. The following questionnaires were used in the study: Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and a questionnaire designed by the authors specifically for the purpose of the study. Results The findings of the study show that illness duration (r = -0.2; P = 0.22) and gender (P = 0.37) do not influence the quality of life. It appears that among children ill with asthma a higher level of quality of life is typical for the children who live in the country side in comparison with those from cities (P < 0.05). The comparison was also made in terms of everyday activity of children ill with asthma and non-asthmatic children. The children ill with asthma displayed less social contacts with peers/friends (P < 0.05) and they performed less physical activities (P < 0.05). Conclusions The study points to the possible beneficial effects of activating children's social interactions, creating conditions for appropriate development of their social competences, and of stress reduction connected with social interactions. Asthmatic children should also be encouraged to intensify appropriate physical activity.
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Simons E, Hwang SA, Fitzgerald EF, Kielb C, Lin S. The impact of school building conditions on student absenteeism in Upstate New York. Am J Public Health 2010; 100:1679-86. [PMID: 20634471 DOI: 10.2105/ajph.2009.165324] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated Upstate New York school building conditions and examined the associations between school absenteeism and building condition problems. METHODS We merged data from the 2005 Building Condition Survey of Upstate New York schools with 2005 New York State Education Department student absenteeism data at the individual school level and evaluated associations between building conditions and absenteeism at or above the 90th percentile. RESULTS After adjustment for confounders, student absenteeism was associated with visible mold (odds ratio [OR]=2.22; 95% confidence interval [CI]=1.34, 3.68), humidity (OR=3.07; 95% CI=1.37, 6.89), poor ventilation (OR=3.10; 95% CI=1.79, 5.37), vermin (OR=2.23; 95% CI=1.32, 3.76), 6 or more individual building condition problems (OR=2.97; 95% CI=1.84, 4.79), and building system or structural problems related to these conditions. Schools in lower socioeconomic districts and schools attended by younger students showed the strongest associations between poor building conditions and absenteeism. CONCLUSIONS We found associations between student absenteeism and adverse school building conditions. Future studies should confirm these findings and prioritize strategies for school condition improvements.
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Affiliation(s)
- Elinor Simons
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Troy, NY, USA.
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Liberty KA, Pattemore P, Reid J, Tarren-Sweeney M. Beginning school with asthma independently predicts low achievement in a prospective cohort of children. Chest 2010; 138:1349-55. [PMID: 20558555 DOI: 10.1378/chest.10-0543] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Concerns about the achievement of children with asthma and respiratory conditions are especially important in New Zealand, which has one of the world's highest rates of childhood asthma. The present study evaluated whether entering school with asthma was associated with low achievement after the first year. METHODS A child cohort was recruited to a prospective study at time of first enrollment into randomly selected schools in Christchurch. Parent interviews covered demographics and respiratory status. Physician reports were sought for children with asthma, and all respiratory information was clinically reviewed. The children's achievement in reading and math was individually assessed at school entry and reassessed after 12 months. Schools reported absences. Intelligence subtests were administered. RESULTS Two hundred ninety-eight children were recruited, including 55 (18.5%) with current asthma. At 1-year follow-up, retention was 93.7%. Children who entered school with asthma were more likely to be ≥ 6 months behind other participants in reading words (P = .023) and books (P = .026), but not in math (P = .167) at the end of the first year of school. Achievement was not related to asthma severity. Entering school with asthma reliably predicted low reading achievement independent of other known covariates of low achievement (high absenteeism, minority status, male gender, single-parent family, poor academic skills at school entry, and low socioeconomic status). CONCLUSIONS Entering school with asthma was a significant predictor of low achievement in reading at 12-month follow-up, independent of asthma severity, high absenteeism, or other covariates of low achievement.
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Affiliation(s)
- Kathleen A Liberty
- Health Sciences Centre, University of Canterbury, Christchurch, New Zealand.
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Bruzzese JM, Unikel LH, Evans D, Bornstein L, Surrence K, Mellins RB. Asthma knowledge and asthma management behavior in urban elementary school teachers. J Asthma 2010; 47:185-91. [PMID: 20170327 PMCID: PMC4533894 DOI: 10.3109/02770900903519908] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although schools are an important setting for asthma care in youth, teachers' asthma knowledge and symptom management is poor. This study investigated the knowledge, prevention and management behaviors, and communication regarding asthma of teachers of low-income, ethnic minority students. It was hypothesized that relative to colleagues whose students did not have active asthma (i.e., did not have symptoms during the day), teachers of students with active asthma would have better asthma knowledge and that more would take asthma prevention steps and communicate with parents and school nurses. METHODS Drawing from 25 elementary schools in New York City, 320 pre-Kindergarten through 5th grade classroom teachers with at least one student with asthma completed measures assessing their asthma knowledge, steps taken to manage asthma, communication with the school nurse or parents, information they received about asthma, and whether or not they had at least one student in their class experience asthma symptoms. t test and chi-square were used to test hypotheses. RESULTS Asthma knowledge varied among teachers. Most could identify potential triggers, yet few knew that medication taken prior to exercise could prevent symptoms and that students with asthma need not avoid exercise. Communication between teachers and school nurses and between teachers and parents was lacking. Relative to colleagues whose students did not have active asthma, teachers whose students had active asthma had better asthma knowledge, more took steps to prevent students from having asthma symptoms, communicated with parents, and more initiated communication with the nurse. CONCLUSIONS Teachers' knowledge about asthma and asthma management is limited, especially among those whose students did not have active asthma. Teachers respond reactively to students who have symptoms in class by increasing prevention steps and communications with parents and the school nurse. A more proactive approach to managing asthma in schools is warranted.
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Affiliation(s)
- Jean-Marie Bruzzese
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, New York 10016, USA.
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Development and validation of the Asthma Life Impact Scale (ALIS). Respir Med 2010; 104:633-43. [PMID: 20053543 DOI: 10.1016/j.rmed.2009.11.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 11/17/2009] [Accepted: 11/29/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Current asthma patient-reported outcome (PRO) measures focus on symptoms and functioning and may not capture the holistic impact of asthma on the quality of life of the patient. OBJECTIVE To develop a PRO measure capturing the overall impact of asthma on patient's quality of life. METHODS Items for the Asthma Life Impact Scale (ALIS) were generated from patients with asthma during interviews in the UK and focus groups in the US. The ALIS was tested with UK and US asthma patients during cognitive debriefing interviews and included in large, two-administration, validation studies in the UK and US. RESULTS Issues raised by asthma patients during interviews (n = 39 patients) and focus groups (n = 16 patients) were included in the draft ALIS. Cognitive debriefing interviews with 29 UK and US asthma patients showed that the scale was relevant and comprehensive. 140 UK and 185 US asthma patients participated in the validation study. The analysis showed that the ALIS measures a single construct, namely the overall impact of asthma on patients' quality of life. Internal consistency (Cronbach's Alpha) was high (UK = 0.94; US = 0.92) as was test-retest reliability (UK = 0.93; US = 0.83). Patients reporting worse general health or more severe asthma had significantly higher ALIS scores (p < 0.001) (indicating greater negative impact of asthma). Correlations with the Asthma Quality of Life Questionnaire were moderate to high. CONCLUSIONS The final 22-item ALIS is unidimensional, reliable and valid, and a valuable tool for comprehensively assessing the holistic impact of asthma from the patient's perspective.
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Cutuli JJ, Herbers JE, Rinaldi M, Masten AS, Oberg CN. Asthma and behavior in homeless 4- to 7-year-olds. Pediatrics 2010; 125:145-51. [PMID: 19969617 DOI: 10.1542/peds.2009-0103] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Low-income, urban, ethnic minority children have higher rates of asthma, more severe symptoms, and more management issues, as well as high risk for academic and behavior problems. This study focused on asthma reported in young children who resided in a family emergency homeless shelter. Asthma rates were considered along with their relation to hospitalization and emergency department use and behavior that is important for school success, including cognitive function, conduct, and academic functioning. METHODS A total of 104 children (age 4.0-7.5 years) and parents were recruited while residing in an urban emergency homeless shelter for families. Children had no previously identified developmental delays and spoke English proficiently. Parents reported whether the child experienced asthma, as well as emergency department use and hospitalization. Parents and teachers completed measures of child inattention/hyperactivity and behavior problems. Cognitive function of children was directly assessed. RESULTS Asthma was reported for 27.9% of children, approximately 3 times the national average. Children with asthma had been hospitalized more often, showed higher levels of inattention/hyperactivity and behavior problems, and evidenced lower academic functioning. CONCLUSIONS Young children in homeless family emergency shelters have high rates of asthma and related problems that could lead to higher hospitalization rates, more behavioral problems, and lower academic functioning at school. Screening and treatment of children who stay in emergency family shelters may be particularly important for reducing risks associated with asthma in highly mobile, low-income families.
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Affiliation(s)
- J J Cutuli
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Basu K, Palmer CN, Tavendale R, Lipworth BJ, Mukhopadhyay S. Adrenergic β2-receptor genotype predisposes to exacerbations in steroid-treated asthmatic patients taking frequent albuterol or salmeterol. J Allergy Clin Immunol 2009; 124:1188-94.e3. [DOI: 10.1016/j.jaci.2009.07.043] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Revised: 06/30/2009] [Accepted: 07/24/2009] [Indexed: 11/30/2022]
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Atherly A, Nurmagambetov T, Williams S, Griffith M. An economic evaluation of the school-based "power breathing" asthma program. J Asthma 2009; 46:596-9. [PMID: 19657901 DOI: 10.1080/02770900903006257] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study evaluated the cost effectiveness of the "Power Breathing" program for asthma among middle and high school students. Few systematic evaluations of school based interventions--let alone cost-effectiveness programs--have been identified in the literature. Power Breathing was developed by the Asthma and Allergy Foundation of America and is currently available for implementation by school districts. For the overall evaluation, 8 junior high schools and 2 high schools were selected and matched based on grade range, enrollment, income and race/ethnicity. Schools were randomly assigned to the intervention or control group. Surveys were administered at baseline, immediately post-intervention and 3 months' post-intervention. Children in the intervention arm had a significant decrease in the number of days they experienced an asthma attack or had trouble breathing during a 2-week period of 0.18 days per 2 weeks. In contrast, subjects in the control group had an increase in the in the number of days experiencing an asthma attack or having trouble breathing during a 2-week period of 0.102, from 0.696 to 0.793. The program cost approximately $3.9 per asthma attack-free day gained, on par with pharmaceutical interventions, suggesting that Power Breathing may be a cost effective asthma intervention. The results of this study suggest that school-based interventions aimed at asthma, properly implemented and administrated, are an appropriate use of societal resources.
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Affiliation(s)
- Adam Atherly
- Health Policy and Management, Emory University, Atlanta, GA 30322, USA.
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Coffman JM, Cabana MD, Yelin EH. Do school-based asthma education programs improve self-management and health outcomes? Pediatrics 2009; 124:729-42. [PMID: 19651589 PMCID: PMC2875148 DOI: 10.1542/peds.2008-2085] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Asthma self-management education is critical for high-quality asthma care for children. A number of studies have assessed the effectiveness of providing asthma education in schools to augment education provided by primary care providers. OBJECTIVE To conduct a systematic review of the literature on school-based asthma education programs. METHODS As our data sources, we used 3 databases that index peer-reviewed literature: MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature. Inclusion criteria included publication in English and enrollment of children aged 4 to 17 years with a clinical diagnosis of asthma or symptoms consistent with asthma. RESULTS Twenty-five articles met the inclusion criteria. Synthesizing findings across studies was difficult because the characteristics of interventions and target populations varied widely, as did the outcomes assessed. In addition, some studies had major methodologic weaknesses. Most studies that compared asthma education to usual care found that school-based asthma education improved knowledge of asthma (7 of 10 studies), self-efficacy (6 of 8 studies), and self-management behaviors (7 of 8 studies). Fewer studies reported favorable effects on quality of life (4 of 8 studies), days of symptoms (5 of 11 studies), nights with symptoms (2 of 4 studies), and school absences (5 of 17 studies). CONCLUSIONS Although findings regarding effects of school-based asthma education programs on quality of life, school absences, and days and nights with symptoms were not consistent, our analyses suggest that school-based asthma education improves knowledge of asthma, self-efficacy, and self-management behaviors.
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Affiliation(s)
- Janet M. Coffman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, Department of Family and Community Medicine, University of California, San Francisco, California
| | - Michael D. Cabana
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, Department of Pediatrics, University of California, San Francisco, California
| | - Edward H. Yelin
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, Department of Medicine, University of California, San Francisco, California
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Chen E, Yeung WJJ. Measuring respiratory health in longitudinal social science surveys. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2009; 55:206-218. [PMID: 20183905 DOI: 10.1080/19485560903382411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Objectively assessing respiratory health in longitudinal social science surveys would involve collecting pulmonary function measures on research participants, either in clinic settings or at home. These measures include indicators of volume (e.g., maximal amount of air blown in the first second of a forced exhalation) and airflow (maximal speed air is exhaled during a forced exhalation). Equipment options include office spirometry, portable spirometry, or home peak flow monitoring. Each option has different equipment and personnel costs. The types of research questions that could be answered using pulmonary function measures in longitudinal household surveys are quite broad, ranging from effects of socioeconomic status and race/ethnicity on respiratory health to social/environmental factors that contribute to respiratory health to the long-term social and economic consequences of respiratory health problems. Currently, such data are lacking. Given the potential payoffs in scientific knowledge, adding these measures to population-based surveys merits serious consideration.
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Affiliation(s)
- Edith Chen
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.
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Basu K, Palmer CNA, Lipworth BJ, McLean WHI, Terron-Kwiatkowski A, Zhao Y, Liao H, Smith FJD, Mitra A, Mukhopadhyay S. Filaggrin null mutations are associated with increased asthma exacerbations in children and young adults. Allergy 2008; 63:1211-7. [PMID: 18307574 DOI: 10.1111/j.1398-9995.2008.01660.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Filaggrin (FLG) null mutations are important genetic predisposing factors for atopic asthma and have recently been shown to influence controller and reliever medication needs in asthmatic children. Our objective was to study the role of FLG null alleles in asthma exacerbations. METHODS FLG mutations R501X and 2282del4 were assayed in 1135 individuals ranging from 3 to 22 years old with asthma from Tayside and Dumfries, Scotland. Asthma exacerbations over the previous 6 months were also studied. RESULTS The FLG mutations were significantly associated with greater risk of exacerbations in children with asthma. Exacerbations were significant for the R501X but not the 2282del4 mutation and the combined genotype compared to the wild-type with odds ratios of 1.97 (95% CI, 1.19-3.22; P = 0.009) and 1.61 (95% CI, 1.08-2.40; P = 0.021), respectively. Individuals with FLG null alleles were more likely to require oral steroids (31.4%vs 19.5%; OR = 1.89; P = 0.021) for their exacerbations. There was also a 1.71-fold increased risk (42.6%vs 30%; P = 0.041) of school absence owing to asthma exacerbations in asthmatic individuals with FLG null mutation. On sub-group analysis, the effect of FLG mutations on asthma exacerbations is significant (P = 0.045) only for participants with relatively mild asthma controlled on inhaled steroids, with inhaled albuterol according to need. CONCLUSION In addition to their effect on asthma medication requirements reported previously, there is an association between the presence of FLG null mutations and the risk of asthma exacerbations in asthmatic children and young adults.
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Affiliation(s)
- K Basu
- Maternal and Child Health Sciences, Ninewells Hospital and Medical School, Dundee, UK
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Thaon I, Wild P, Mouchot L, Monfort C, Touranchet A, Kreutz G, Derriennic F, Paris C. Long-term occupational consequences of asthma in a large French cohort of male workers followed up for 5 years. Am J Ind Med 2008; 51:317-23. [PMID: 18286576 DOI: 10.1002/ajim.20570] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The aim of this study was to describe the long-term occupational consequences of asthma in males of the ESTEV study, a French longitudinal cohort of working subjects aged 37-52 at inclusion. METHODS Medical data, self-perceived health status, sick leave, occupational social class and employment characteristics were recorded twice by occupational physicians in 1990 (12,233 subjects) and 1995 (10,608 subjects). Asthma was characterized as to its onset (childhood, i.e., before age 20 vs. adult) and to its past versus current status by the physician. RESULTS Of the 398 asthmatics, the onset was before age 20 for 226 and the asthma status was classified as current for 159 subjects. Unemployment was not higher before baseline or during follow-up, in asthmatics as compared to non-asthmatics, despite a significantly higher prevalence of sick leave in the previous year among current asthmatics (38.4% vs. 27.0%, P = 0.005). Being a blue collar worker in 1990 is negatively related to childhood asthma but not to the current asthma status. In 1995, current adult-onset asthmatics had stopped working due to disability more frequently than never-asthmatics. CONCLUSION Our findings suggest that the major consequence of asthma on employment status is a selective exclusion, observed in childhood asthmatics at the beginning of their working life and in current adult-onset asthmatics at the end of their working life. Past unemployment was shown not to be higher in working asthmatics.
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Affiliation(s)
- Isabelle Thaon
- Department of Occupational Health, University Hospital, University of Franche-Comte, Besancon, France
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Reichman NE, Nepomnyaschy L. Maternal pre-pregnancy obesity and diagnosis of asthma in offspring at age 3 years. Matern Child Health J 2007; 12:725-33. [PMID: 17987372 DOI: 10.1007/s10995-007-0292-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Accepted: 10/04/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to examine the relationship between maternal pre-pregnancy obesity and a diagnosis of asthma in offspring at age 3 years. METHODS A population-based sample of children born in large U.S. cities in 1998-2000 was followed since birth (N=1971). The main outcome measure was whether the mother reported at 3 years that the child had ever been diagnosed with asthma. Multilevel logistic regression models were used to estimate the association between maternal pre-pregnancy obesity and child asthma diagnosis, as well as the extent to which the association can be explained by sociodemographic, medical, obstetric, and behavioral factors associated with both conditions. RESULTS Children with obese mothers had 52% higher odds of having an asthma diagnosis by age 3 (OR=1.52; 95% CI: 1.18-1.93). Sociodemographic, medical, obstetric, and behavioral factors explained some, but not all, of the association. CONCLUSIONS Maternal pre-pregnancy obesity is associated with diagnosis of asthma in offspring at age 3 years. The results from this study are preliminary and need to be replicated and further explored, but are suggestive of a complex intergenerational linkage between obesity and asthma.
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Affiliation(s)
- Nancy E Reichman
- Department of Pediatrics, Robert Wood Johnson Medical School, 97 Paterson St., Room 435, New Brunswick, NJ 08903, USA.
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Fleming LE, Kirkpatrick B, Backer LC, Bean JA, Wanner A, Reich A, Zaias J, Cheng YS, Pierce R, Naar J, Abraham WM, Baden DG. Aerosolized red-tide toxins (brevetoxins) and asthma. Chest 2007; 131:187-94. [PMID: 17218574 PMCID: PMC2683400 DOI: 10.1378/chest.06-1830] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND With the increasing incidence of asthma, there is increasing concern over environmental exposures that may trigger asthma exacerbations. Blooms of the marine microalgae, Karenia brevis, cause red tides (or harmful algal blooms) annually throughout the Gulf of Mexico. K brevis produces highly potent natural polyether toxins, called brevetoxins, which are sodium channel blockers, and possibly histamine activators. In experimental animals, brevetoxins cause significant bronchoconstriction. In humans, a significant increase in self-reported respiratory symptoms has been described after recreational and occupational exposures to Florida red-tide aerosols, particularly among individuals with asthma. METHODS Before and after 1 h spent on beaches with and without an active K brevis red-tide exposure, 97 persons >or= 12 years of age with physician-diagnosed asthma were evaluated by questionnaire and spirometry. Concomitant environmental monitoring, water and air sampling, and personal monitoring for brevetoxins were performed. RESULTS Participants were significantly more likely to report respiratory symptoms after K brevis red-tide aerosol exposure than before exposure. Participants demonstrated small, but statistically significant, decreases in FEV(1), midexpiratory phase of forced expiratory flow, and peak expiratory flow after exposure, particularly among those participants regularly using asthma medications. No significant differences were detected when there was no Florida red tide (ie, during nonexposure periods). CONCLUSIONS This study demonstrated objectively measurable adverse changes in lung function from exposure to aerosolized Florida red-tide toxins in asthmatic subjects, particularly among those requiring regular therapy with asthma medications. Future studies will assess these susceptible subpopulations in more depth, as well as the possible long-term effects of these toxins.
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Affiliation(s)
- Lora E Fleming
- National Institute of Environmental Health Sciences Marine and Freshwater Biomedical Sciences Center, Rosenstiel School of Marine and Atmospheric Sciences, University of Miami, Miami, FL, USA.
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Hyman JE, Jewetz ST, Matsumoto H, Choe JC, Vitale MG. Risk factors for school absence after acute orthopaedic injury in new york city. J Pediatr Orthop 2007; 27:415-20. [PMID: 17513963 DOI: 10.1097/01.bpb.0000271329.87104.06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of our study is to identify specific factors that affect a child's ability to attend school after an acute orthopaedic injury. One hundred and sixty-four school-aged patients receiving treatment for an acute orthopaedic injury at the Division of Pediatric Orthopaedics were interviewed along with their parents. Most participants were Hispanic, which reflects the population of the Washington Heights section of Manhattan served by our hospital. Follow-up telephone interviews were conducted with those parents whose children were unable to return to school. The parents were asked of both the total number of school absences and whether the child received home instruction. A survey regarding official school attendance policy was mailed to the principals of all the schools attended by the children in our study. Forty-seven percent of the children were unable to return to school immediately after their injuries. Nearly 70% (n = 51) of the children who did not immediately return to school attributed their nonattendance to their school's attendance policy. Only half of the absentees received home instruction. A multivariate analysis showed that both the type of school (public vs private) and the use of crutches were statistically significant risk factors for school absence. The median household income also trended toward significance in predicting school attendance. The responses to our survey regarding official school attendance policy demonstrated considerable variability among the schools. This study indicates that pediatric orthopaedic injuries and their treatment impact the ability of school-aged patients to attend school. Our study shows that children's socioeconomic background influences their ability to attend school while injured.
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Affiliation(s)
- Joshua E Hyman
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
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