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Chiel LE, Stevens EL, Bishay LC, Collins MS, Rama JA, Edgar L, McLean S, Haynes I, Muzumdar H, Weiss P, Boyer D, Giles BL. Pediatric Pulmonary Milestones 2.0: Development, Lessons Learned, and Future Directions. ATS Sch 2024; 5:19-31. [PMID: 38628297 PMCID: PMC11019770 DOI: 10.34197/ats-scholar.2023-0075ps] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/05/2023] [Indexed: 04/19/2024] Open
Abstract
Pediatric pulmonology fellowship training programs are required by the Accreditation Council for Graduate Medical Education to report Pediatric Subspecialty Milestones biannually to track fellow progress. However, several issues, such as lack of subspecialty-specific context and ambiguous language, have raised concerns about their validity and applicability to use for fellow assessment and curriculum development. In this Perspective, we briefly share the process of the Pediatric Pulmonology Milestones 2.0 Work Group in creating new specialty-specific Milestones and tailoring information on the Harmonized Milestones to pediatric pulmonologists, with the goal of improving the Milestones' utility for stakeholders, including pulmonology fellows, faculty, program directors, and accrediting bodies. In addition, we created a supplemental guide to better link the Milestones to pulmonary-specific scenarios to create a shared mental model between stakeholders and remove a potential detriment to validity. Through the process, a number of guiding principles were clarified, including: 1) every Milestone should be able to be assessed independently, without overlap with other Milestones; 2) there should be clear developmental progression from one Milestone to the next; 3) Milestones should be based on the unique skills expected of pediatric pulmonologists; and 4) health equity should be a core component to highlight as a top priority to all stakeholders. In this Perspective, we describe these principles that guided formulation of the Pediatric Pulmonary Milestones to help familiarize the pediatric pulmonary community with the new Milestones. In addition, we share lessons learned and challenges in our process to inform other specialties that may soon participate in this process.
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Affiliation(s)
- Laura E. Chiel
- Division of Pulmonary Medicine, Department
of Pediatrics, Boston Children’s Hospital, Harvard Medical School,
Boston, Massachusetts
| | - Erica L. Stevens
- Division of Pulmonology, Allergy, and
Immunology, Department of Pediatrics, Norton Children’s Hospital,
University of Louisville School of Medicine, Louisville, Kentucky
| | - Lara C. Bishay
- Division of Pulmonology and Sleep
Medicine, Department of Pediatrics, Children’s Hospital Los Angeles, Keck
School of Medicine of University of Southern California, Los Angeles,
California
| | - Melanie S. Collins
- Division of Pediatric Pulmonary Medicine,
Department of Pediatrics, Connecticut Children’s Hospital, University of
Connecticut School of Medicine, Harford, Connecticut
| | - Jennifer A. Rama
- Division of Pediatric Pulmonology,
Department of Pediatrics, Texas Children’s Hospital, Baylor College of
Medicine, Houston, Texas
| | - Laura Edgar
- Department of Research, Milestones
Development, and Evaluation, Accreditation Council for Graduate Medical
Education, Chicago, Illinois
| | - Sydney McLean
- Department of Research, Milestones
Development, and Evaluation, Accreditation Council for Graduate Medical
Education, Chicago, Illinois
| | - Ida Haynes
- Department of Research, Milestones
Development, and Evaluation, Accreditation Council for Graduate Medical
Education, Chicago, Illinois
| | - Hiren Muzumdar
- Division of Pulmonology, Department of
Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of
Pittsburgh, Pittsburgh, Pennsylvania
| | - Pnina Weiss
- Division of Pulmonary, Allergy,
Immunology, and Sleep Medicine, Department of Pediatrics, Yale Medicine, New
Haven, Connecticut
| | - Debra Boyer
- Division of Pulmonary and Sleep Medicine,
Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State
University College of Medicine, Columbus, Ohio; and
| | - B. Louise Giles
- Division of Pediatric Pulmonology,
Department of Pediatrics, Comer Children’s Hospital, University of
Chicago School of Medicine, Chicago, Illinois
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Shin YH, Hwang J, Kwon R, Lee SW, Kim MS, Shin JI, Yon DK. Global, regional, and national burden of allergic disorders and their risk factors in 204 countries and territories, from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019. Allergy 2023; 78:2232-2254. [PMID: 37431853 PMCID: PMC10529296 DOI: 10.1111/all.15807] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/13/2023] [Accepted: 05/23/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Asthma and atopic dermatitis (AD) are chronic allergic conditions, along with allergic rhinitis and food allergy and cause high morbidity and mortality both in children and adults. This study aims to evaluate the global, regional, national, and temporal trends of the burden of asthma and AD from 1990 to 2019 and analyze their associations with geographic, demographic, social, and clinical factors. METHODS Using data from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2019, we assessed the age-standardized prevalence, incidence, mortality, and disability-adjusted life years (DALYs) of both asthma and AD from 1990 to 2019, stratified by geographic region, age, sex, and socio-demographic index (SDI). DALYs were calculated as the sum of years lived with disability and years of life lost to premature mortality. Additionally, the disease burden of asthma attributable to high body mass index, occupational asthmagens, and smoking was described. RESULTS In 2019, there were a total of 262 million [95% uncertainty interval (UI): 224-309 million] cases of asthma and 171 million [95% UI: 165-178 million] total cases of AD globally; age-standardized prevalence rates were 3416 [95% UI: 2899-4066] and 2277 [95% UI: 2192-2369] per 100,000 population for asthma and AD, respectively, a 24.1% [95% UI: -27.2 to -20.8] decrease for asthma and a 4.3% [95% UI: 3.8-4.8] decrease for AD compared to baseline in 1990. Both asthma and AD had similar trends according to age, with age-specific prevalence rates peaking at age 5-9 years and rising again in adulthood. The prevalence and incidence of asthma and AD were both higher for individuals with higher SDI; however, mortality and DALYs rates of individuals with asthma had a reverse trend, with higher mortality and DALYs rates in those in the lower SDI quintiles. Of the three risk factors, high body mass index contributed to the highest DALYs and deaths due to asthma, accounting for a total of 3.65 million [95% UI: 2.14-5.60 million] asthma DALYs and 75,377 [95% UI: 40,615-122,841] asthma deaths. CONCLUSIONS Asthma and AD continue to cause significant morbidity worldwide, having increased in total prevalence and incidence cases worldwide, but having decreased in age-standardized prevalence rates from 1990 to 2019. Although both are more frequent at younger ages and more prevalent in high-SDI countries, each condition has distinct temporal and regional characteristics. Understanding the temporospatial trends in the disease burden of asthma and AD could guide future policies and interventions to better manage these diseases worldwide and achieve equity in prevention, diagnosis, and treatment.
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Affiliation(s)
| | - Jimin Hwang
- Department of Pediatrics, CHA University, Seoul, South Korea
- Department of Pediatrics, CHA Gangnam Medical Center, Seoul, South Korea
| | - Rosie Kwon
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
- Department of Pediatrics, Yonsei University, Seoul, South Korea
| | - Seung Won Lee
- Center for Digital Health, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Min Seo Kim
- Department of Precision Medicine, Sungkyunkwan University, Suwon, South Korea
| | - GBD 2019 Allergic Disorders Collaborators
- Department of Genomics and Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Seoul, South Korea
- Public Health Center, Ministry of Health and Welfare, Wando, South Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Keon Yon
- Center for Digital Health, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, South Korea
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Thomson D, Chen Y, Gennetian LA, Basurto LE. Earned Income Tax Credit Receipt By Hispanic Families With Children: State Outreach And Demographic Factors. Health Aff (Millwood) 2022; 41:1725-1734. [PMID: 36469820 DOI: 10.1377/hlthaff.2022.00725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The Earned Income Tax Credit (EITC), the largest refundable tax credit for low-to-middle-income US families with children, has been shown to improve maternal and child health and reduce public spending on health. However, many eligible families do not receive it. This study used 2014 Survey of Income and Program Participation data to explore predictors of EITC receipt among Hispanic families, an understudied segment of the eligible population. We found lower likelihoods of receipt among Hispanic income-eligible families, even those who were eligible US citizens by naturalization, compared with their peers. Parent self-employment and lower English language proficiency were also associated with lower EITC receipt. With new data collected on state policies, we found that states' granting of drivers' licenses to undocumented people, availability of government information in Spanish, and employer mandates to inform employees were associated with greater EITC receipt among all income-eligible families, including Hispanic families. These findings showcase ways in which information and outreach at the state level can support the equitable receipt of tax refunds and similar types of benefits distributed through the tax system.
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Society to cell: How child poverty gets “Under the Skin” to influence child development and lifelong health. DEVELOPMENTAL REVIEW 2021. [DOI: 10.1016/j.dr.2021.100983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Agrawal S, Iqbal S, Patel SJ, Freishtat R, Kochhar-Bryant C. Quality of life in at-risk school-aged children with asthma. J Asthma 2020; 58:1680-1688. [PMID: 32942908 DOI: 10.1080/02770903.2020.1825732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Asthma is the most common chronic condition of childhood. Urban, minority children from families of lower socioeconomic status have disproportionately higher rates of asthma and worse outcomes. We investigated the association between the presence of asthma and asthma severity among American, urban, minority children and reported quality of life (QOL) of children and their families. METHODS We performed a prospective, cross-sectional study comparing QOL of urban, minority elementary school-age children with and without asthma. A convenience sample of children was enrolled from the pediatric emergency department (ED) and a specialized asthma clinic, at a large urban children's hospital. We measured child and parent QOL using the Pediatric Quality of Life Inventory Version 4 (PEDSQL4), and evaluated associations with asthma, parental educational attainment, and frequency of ED visits. RESULTS We enrolled 66 children, 76% were African American, and 61% were female. Overall child QOL was higher for those without asthma (p = 0.017, d = 0.59). Children with asthma also visited the ED almost twice as frequently (t [64] = -3.505, p < 0.001, d = 0.8), and parents of children with asthma reported a lower overall QOL (p = 0.04, d = 0.53) than those without asthma. Among children with asthma, a higher overall child QOL was associated with decreased asthma severity, more ED visits, and higher parental educational attainment. CONCLUSIONS Urban, minority elementary school-age children with asthma report a lower QOL than those children without asthma, and decreased asthma severity was associated with higher QOL.
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Affiliation(s)
- Seema Agrawal
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sabah Iqbal
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
| | - Shilpa J Patel
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
| | - Robert Freishtat
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
| | - Carol Kochhar-Bryant
- Special Education and Disability Studies, The George Washington University, Washington, DC, USA
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Xie L, Gelfand A, Delclos GL, Atem FD, Kohl HW, Messiah SE. Estimated Prevalence of Asthma in US Children With Developmental Disabilities. JAMA Netw Open 2020; 3:e207728. [PMID: 32543699 PMCID: PMC7298611 DOI: 10.1001/jamanetworkopen.2020.7728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE The prevalence of asthma in US children with various developmental disabilities and delays is unclear, including how estimates vary by ethnic group. OBJECTIVE To report asthma prevalence estimates by various disability categories and developmental delays in a diverse sample of the US pediatric population. DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study encompassed a total of 71 811 families with children or adolescents aged 0 to 17 years (hereinafter referred to as children) who participated in the 2016 and 2017 National Survey of Children's Health. Data were collected from June 10, 2016, to February 10, 2017, for the 2016 survey and from August 10, 2017, to February 10, 2018, for the 2017 survey. Data were analyzed from September 20, 2019, to April 5, 2020. EXPOSURES Developmental disability, including attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, seizure, intellectual and/or learning disability, and vision, hearing, and/or speech delay. Delay was defined as not meeting growth milestones with unknown cause. MAIN OUTCOMES AND MEASURES Weighted asthma prevalence estimates and 95% CIs were generated for children with and without disabilities. RESULTS A total of 71 811 participants (mean [SE] age, 8.6 [0.1] years; 36 800 boys [51.1%; 95% CI, 50.2%-52.0%]; 50 219 non-Hispanic white [51.4%; 95% CI, 50.6%-52.3%]) were included in our final analytical sample, of whom 5687 (7.9%; 95% CI, 7.5%-8.4%) had asthma and 11 426 (15.3%; 95% CI, 14.7%-16.0%) had at least 1 disability. Overall asthma prevalence estimates were 10 percentage points higher in children with a disability (16.1%; 95% CI, 14.3%-17.8%) vs children without a disability (6.5%; 95% CI, 6.0%-6.9%). The odds of asthma were significantly higher in children with a disability (odds ratio [OR], 2.77; 95% CI, 2.39-3.21) or delay (OR, 2.22; 95% CI, 1.78-2.77) vs typically growing children. Adjusted models remained significant for all disability categories (overall adjusted OR, 2.21; 95% CI, 1.87-2.62). Subgroup analyses showed ethnic minorities had a higher prevalence of concurrent asthma and developmental disabilities vs non-Hispanic whites (19.8% [95% CI, 16.6%-23.0%] vs 12.6% [95% CI, 11.1%-14.0%]; P < .001). CONCLUSIONS AND RELEVANCE These results suggest that US children with various developmental disabilities or delay may have higher odds for developing asthma vs their typically developing peers. These findings support asthma screening in pediatric health care settings among patients with developmental disabilities and delays, particularly among those from ethnic minority backgrounds. In addition, very young children with asthma should be screened for disabilities and delays, because temporality cannot be determined by the current data source and analytical approach.
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Affiliation(s)
- Luyu Xie
- School of Public Health, University of Texas Health Science Center at Houston, Dallas Campus, Dallas
- Center for Pediatric Population Health, Children’s Health System of Texas, Dallas
| | - Andrew Gelfand
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - George L. Delclos
- School of Public Health, University of Texas Health Science Center at Houston, Houston campus, Houston
| | - Folefac D. Atem
- School of Public Health, University of Texas Health Science Center at Houston, Dallas Campus, Dallas
- Center for Pediatric Population Health, Children’s Health System of Texas, Dallas
| | - Harold W. Kohl
- School of Public Health, University of Texas Health Science Center at Houston, Austin campus, Austin
| | - Sarah E. Messiah
- School of Public Health, University of Texas Health Science Center at Houston, Dallas Campus, Dallas
- Center for Pediatric Population Health, Children’s Health System of Texas, Dallas
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Assari S, Chalian H, Bazargan M. High Education Level Protects European Americans but Not African Americans Against Chronic Obstructive Pulmonary Disease: National Health Interview Survey. INTERNATIONAL JOURNAL OF BIOMEDICAL ENGINEERING AND CLINICAL SCIENCE 2019; 5:16-23. [PMID: 31633081 PMCID: PMC6800655 DOI: 10.11648/j.ijbecs.20190502.12] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Education level reduces the risk of chronic diseases (CDs), including Chronic Obstructive Pulmonary Disease (COPD). Minorities' Diminished Returns, however, refer to smaller health benefits of socioeconomic position (SEP) improvement for racial and ethnic minorities compared to majority groups. It is not known if MDRs exist for the effects of education level on COPD for African Americans (AAs), relative to European Americans (EAs). AIMS Using a nationally representative sample, the current study explored racial and ethnic variation in the association between education level and COPD among American adults. METHODS Data came from the National Health Interview Survey (NHIS 2015), a national survey. A total of 25,488 adults (18+ years old) were included in the study. From this number, 4,533 (17.8%) were AAs and 20,955 (82.2%) were EAs. Education level was the independent variable. Outcome was COPD. Age, gender, and income were the covariates. Race/ethnicity was the moderator. RESULTS Overall, education level was inversely associated with the odds of COPD. A statistically significant interaction was found between race/ethnicity and education level on odds of COPD, indicating smaller effect of education for AAs compared to EAs. CONCLUSIONS In line with the Minorities' Diminished Returns (MDRs), highly educated AAs remained at high risk for COPD, a pattern which is not observed for EAs. Policies that exclusively address racial/ethnic inequalities in SEP may not be enough for eliminating racial/ethnic inequalities in COPD in the US. Public policies must go beyond equalizing SEP and address structural and environmental barriers that disproportionately increase risk of COPD in AAs across SEP levels. Future research should test if residential segregation and exposure to air pollutants contributes to high prevalence of COPD in highly educated AAs. Research is needed on multi-level interventions that may minimize MDR-related health disparities.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA
| | - Hamid Chalian
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA
- Department of Family Medicine, UCLA, Los Angeles, CA
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Assari S, Moghani Lankarani M. Poverty Status and Childhood Asthma in White and Black Families: National Survey of Children's Health. Healthcare (Basel) 2018; 6:E62. [PMID: 29895767 PMCID: PMC6023379 DOI: 10.3390/healthcare6020062] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/10/2018] [Accepted: 06/11/2018] [Indexed: 11/17/2022] Open
Abstract
Background: Living above the poverty line reduces the risk of physical illnesses, including childhood asthma (CA). Minorities’ Diminished Return theory, however, suggests that the protective effects of socioeconomic status (SES) on health are weaker for racial minorities than White families. It is unknown whether the association between SES and CA differs for White and Black families. Aims: Using a national sample, the current study compared Black and White families for the association between living above the poverty line and CA. Methods: Data came from the National Survey of Children’s Health (NSCH), 2003⁻2004, a national telephone survey. A total of 86,537 Black or White families with children (17 years old or younger) were included in the study. This sample was composed of 76,403 White (88.29%) and 10,134 Black (11.71%) families. Family SES (living above the poverty line) was the independent variable. The outcome was CA, reported by the parent. Age, gender, and childhood obesity were the covariates. Race was conceptualized as the moderator. A number of multivariable logistic regressions were used in the pooled sample and specific to each race for data analysis. Results: In the pooled sample, living above the poverty line was associated with lower odds of CA. An interaction was found between race and living above the poverty line on odds of CA, indicating a smaller association for Black compared to White families. Although race-stratified logistic regressions showed negative associations between living above the poverty line and CA in both White and Black families, the magnitude of this negative association was larger for White than Black families. Conclusions: The health gain from living above the poverty line may be smaller for Black than White families. Due to the existing Minorities’ Diminished Return, policies that merely reduce the racial gap in SES may not be sufficient in eliminating racial health disparities in the United States. Public policies must go beyond reducing poverty to address structural and environmental risk factors that disproportionately impact Blacks’ health. Policies should help Black families gain health as they gain upward social mobility. As they are more likely to face societal and structural barriers, multi-level interventions are needed for the health promotion of Blacks.
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Affiliation(s)
- Shervin Assari
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48104, USA.
- Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI 90095, USA.
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Joshi PK, Geronimo K, Romano B, Earle A, Rosenfeld L, Hardy EF, Acevedo-Garcia D. Integrating racial/ethnic equity into policy assessments to improve child health. Health Aff (Millwood) 2016; 33:2222-9. [PMID: 25489042 DOI: 10.1377/hlthaff.2014.1169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The US child population is rapidly becoming more racially and ethnically diverse, yet there are persistent racial/ethnic gaps in child health. Improving and expanding policies to reduce these gaps is increasingly a mandate of government agencies. Identifying effective policies requires a rigorous approach, yet there is a lack of information about which policies improve equity. This article introduces the Policy Equity Assessment, a framework that combines policy assessment and rigorous equity methods to both synthesize existing research and identify and conduct new analyses of policies' ability to reduce racial/ethnic inequities. We applied the Policy Equity Assessment to three policies: Head Start, the Family and Medical Leave Act, and a federal housing assistance program known as Section 8. Our results show racial/ethnic inequities in access to benefits and substantial data and evidence gaps regarding the impact of policies in improving racial/ethnic equity. These results should motivate policy makers to strengthen equity analysis.
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Affiliation(s)
- Pamela K Joshi
- Pamela K. Joshi is a senior research scientist at the Heller School for Social Policy and Management, Brandeis University, in Waltham, Massachusetts
| | - Kimberly Geronimo
- Kimberly Geronimo is a research associate at the Heller School for Social Policy and Management
| | - Bethany Romano
- Bethany Romano is a senior department coordinator at the Heller School for Social Policy and Management
| | - Alison Earle
- Alison Earle is a senior research scientist at the Heller School for Social Policy and Management
| | - Lindsay Rosenfeld
- Lindsay Rosenfeld is a research scientist at the Heller School for Social Policy and Management
| | - Erin F Hardy
- Erin F. Hardy is a fellow at the Heller School for Social Policy and Management
| | - Dolores Acevedo-Garcia
- Dolores Acevedo-Garcia is the Samuel F. and Rose B. Gingold Professor of Human Development and Social Policy and director of the Institute for Child, Youth, and Family Policy at the Heller School for Social Policy and Management
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Robinson K. Helicobacter pylori-Mediated Protection against Extra-Gastric Immune and Inflammatory Disorders: The Evidence and Controversies. Diseases 2015; 3:34-55. [PMID: 28943607 PMCID: PMC5548235 DOI: 10.3390/diseases3020034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/03/2015] [Accepted: 03/05/2015] [Indexed: 12/11/2022] Open
Abstract
A large number of studies link H. pylori infection with a reduced risk of developing extra-gastric conditions such as allergy, asthma, inflammatory bowel disease, coeliac disease and multiple sclerosis. The strength of the evidence for these protective associations is quite variable, and published studies often do not agree. This review article discusses some of the reasons for these discrepancies, and the difficulties faced when designing studies. Examples of some protective disease associations are described in detail, where the evidence is most abundant and thought to be more reliable. The most convincing of these are supported by published mechanistic data, for example with animal models, or incidence of disease exacerbation in humans following H. pylori eradication. Although controversial, this field is very important as the prevalence of H. pylori is decreasing throughout the world whilst many chronic diseases are becoming more common. These trends are likely to continue in the future, therefore it is important that we fully understand if and how H. pylori confers protection.
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Affiliation(s)
- Karen Robinson
- Nottingham Digestive Diseases Biomedical Research Unit, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK.
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Jobe AH, Tibboel D. Update in pediatric lung disease 2013. Am J Respir Crit Care Med 2014; 189:1031-6. [PMID: 24787065 DOI: 10.1164/rccm.201402-0230up] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Alan H Jobe
- 1 Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio; and
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