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Bender BG, Crooks J, Gerald JK, Hudson B, King DK, Kobernick A, Liu AH, Lowe AA, Morgan W, Nez P, Phan H, Wightman P, Gerald LB. Childhood asthma exacerbations on the Navajo Nation. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00429-X. [PMID: 38697473 DOI: 10.1016/j.jaip.2024.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
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Krings JG, Gerald JK, Blake KV, Krishnan JA, Reddel HK, Bacharier LB, Dixon AE, Sumino K, Gerald LB, Brownson RC, Persell SD, Clemens CJ, Hiller KM, Castro M, Martinez FD. A Call for the United States to Accelerate the Implementation of Reliever Combination Inhaled Corticosteroid-Formoterol Inhalers in Asthma. Am J Respir Crit Care Med 2023; 207:390-405. [PMID: 36538711 PMCID: PMC9940146 DOI: 10.1164/rccm.202209-1729pp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- James G. Krings
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Joe K. Gerald
- Department of Community Environment and Policy, Mel and Enid Zuckerman College of Public Health
- Asthma & Airway Disease Research Center, University of Arizona, Tucson, Arizona
| | - Kathryn V. Blake
- Center for Pharmacogenomics and Translational Research, Nemours Children’s Health, Jacksonville, Florida
| | | | - Helen K. Reddel
- The Woolcock Institute of Medical Research and The University of Sydney, Sydney, Australia
| | - Leonard B. Bacharier
- Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anne E. Dixon
- Division of Pulmonary Critical Care, Department of Medicine, University of Vermont, Burlington, Vermont
| | - Kaharu Sumino
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Lynn B. Gerald
- Population Health Sciences Program, University of Illinois Chicago, Chicago, Illinois
| | - Ross C. Brownson
- Department of Surgery, School of Medicine, and
- Prevention Research Center, Brown School, Washington University in Saint Louis, St. Louis, Missouri
| | - Stephen D. Persell
- Division of General Internal Medicine, Department of Medicine, and
- Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Katherine M. Hiller
- Department of Emergency Medicine, School of Medicine, Indiana University, Bloomington, Indiana; and
| | - Mario Castro
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of Kansas, Kansas City, Kansas
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Lowe AA, Gerald JK, Clemens C, Gerald LB. Compliance to a Standardized Protocol for Stock Albuterol Medication among School Staff. J Sch Nurs 2022:10598405221128053. [PMID: 36215303 DOI: 10.1177/10598405221128053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A stock inhaler program provided access to rescue medication (albuterol sulfate) for school children. School staff were provided with a standardized protocol for medication administration. We hypothesized licensed nurses were more likely to report compliant events compared to unlicensed school staff. Stock inhaler events were defined as either compliant or non-compliant. A school protocol compliance score was calculated using the total number of compliant events divided by the total number of all events. The protocol for administration indicated 4 puffs for mild respiratory distress and 8 puffs for severe respiratory distress; therefore, events were defined as compliant if the dose of medication was divisible by 4. A Cragg Poisson hurdle regression was used to examine the association between compliance score and school staff experience. One-hundred fifty-two schools reported 999 stock inhaler events. Of these events, 28% were compliant and 72% of events were non-compliant. After controlling for school organizational type, grades served, and school size, school staff experience was not predictive of protocol compliance. Future efforts should focus on improving protocol compliance among licensed nurses and unlicensed school staff.
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Affiliation(s)
- Ashley A Lowe
- Asthma & Airway Disease Research Center, 8041University of Arizona Health Sciences, Tucson, AZ, USA
| | - Joe K Gerald
- Mel and Enid Zuckerman College of Public Health, Department of Community, Environment & Policy, 8041University of Arizona, Tucson, AZ, USA
| | - Conrad Clemens
- College of Medicine - Tucson Campus, Department of Pediatrics, 8041University of Arizona, Tucson, AZ, USA
| | - Lynn B Gerald
- Asthma & Airway Disease Research Center, 8041University of Arizona Health Sciences, Tucson, AZ, USA
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Burns J, Rivers P, LeClair LB, Jovel KS, Rai RP, Lowe AA, Edwards LJ, Khan SM, Mathenge C, Ferraris M, Kuntz JL, Lamberte JM, Hegmann KT, Odean MJ, McLeland-Wieser H, Beitel S, Odame-Bamfo L, Schaefer Solle N, Mak J, Phillips AL, Sokol BE, Hollister J, Ochoa JS, Grant L, Thiese MS, Jacoby KB, Lutrick K, Pubillones FA, Yoo YM, Rentz Hunt D, Ellingson K, Berry MC, Gerald JK, Lopez J, Gerald LB, Wesley MG, Krupp K, Herring MK, Madhivanan P, Caban-Martinez AJ, Tyner HL, Meece JK, Yoon SK, Fowlkes AL, Naleway AL, Gwynn L, Burgess JL, Thompson MG, Olsho LE, Gaglani M. Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT): Protocol for a Multisite Longitudinal Cohort Study. JMIR Res Protoc 2022; 11:e37929. [PMID: 35635842 PMCID: PMC9377426 DOI: 10.2196/37929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Assessing the real-world effectiveness of COVID-19 vaccines and understanding the incidence and severity of SARS-CoV-2 illness in children are essential to inform policy and guide health care professionals in advising parents and caregivers of children who test positive for SARS-CoV-2. OBJECTIVE This report describes the objectives and methods for conducting the Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT) study. PROTECT is a longitudinal prospective pediatric cohort study designed to estimate SARS-CoV-2 incidence and COVID-19 vaccine effectiveness (VE) against infection among children aged 6 months to 17 years, as well as differences in SARS-CoV-2 infection and vaccine response between children and adolescents. METHODS The PROTECT multisite network was initiated in July 2021, which aims to enroll approximately 2305 children across four US locations and collect data over a 2-year surveillance period. The enrollment target was based on prospective power calculations and accounts for expected attrition and nonresponse. Study sites recruit parents and legal guardians of age-eligible children participating in the existing Arizona Healthcare, Emergency Response, and Other Essential Workers Surveillance (HEROES)-Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) network as well as from surrounding communities. Child demographics, medical history, COVID-19 exposure, vaccination history, and parents/legal guardians' knowledge and attitudes about COVID-19 are collected at baseline and throughout the study. Mid-turbinate nasal specimens are self-collected or collected by parents/legal guardians weekly, regardless of symptoms, for SARS-CoV-2 and influenza testing via reverse transcription-polymerase chain reaction (RT-PCR) assay, and the presence of COVID-like illness (CLI) is reported. Children who test positive for SARS-CoV-2 or influenza, or report CLI are monitored weekly by online surveys to report exposure and medical utilization until no longer ill. Children, with permission of their parents/legal guardians, may elect to contribute blood at enrollment, following SARS-CoV-2 infection, following COVID-19 vaccination, and at the end of the study period. PROTECT uses electronic medical record (EMR) linkages where available, and verifies COVID-19 and influenza vaccinations through EMR or state vaccine registries. RESULTS Data collection began in July 2021 and is expected to continue through the spring of 2023. As of April 13, 2022, 2371 children are enrolled in PROTECT. Enrollment is ongoing at all study sites. CONCLUSIONS As COVID-19 vaccine products are authorized for use in pediatric populations, PROTECT study data will provide real-world estimates of VE in preventing infection. In addition, this prospective cohort provides a unique opportunity to further understand SARS-CoV-2 incidence, clinical course, and key knowledge gaps that may inform public health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/37929.
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Affiliation(s)
- Joy Burns
- Abt Associates, Atlanta, GA, United States
| | - Patrick Rivers
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Krystal S Jovel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Ashley A Lowe
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Sana M Khan
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Clare Mathenge
- College of Medicine, Texas A&M University, Temple, TX, United States
| | - Maria Ferraris
- Leonard M Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Jennifer L Kuntz
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, United States
| | - Julie Mayo Lamberte
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Marilyn J Odean
- St. Luke's Regional Health Care System, Duluth, MN, United States
- Whiteside Institute for Clinical Research, St. Luke's, Duluth, MN, United States
| | | | - Shawn Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Leah Odame-Bamfo
- College of Medicine, Texas A&M University, Temple, TX, United States
| | | | - Josephine Mak
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Andrew L Phillips
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT, United States
| | | | - James Hollister
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Jezahel S Ochoa
- Leonard M Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Lauren Grant
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT, United States
| | | | - Karen Lutrick
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Felipe A Pubillones
- Leonard M Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Young M Yoo
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Katherine Ellingson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Joe K Gerald
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Lynn B Gerald
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Karl Krupp
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Purnima Madhivanan
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Harmony L Tyner
- St. Luke's Regional Health Care System, Duluth, MN, United States
| | - Jennifer K Meece
- Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Sarang K Yoon
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Ashley L Fowlkes
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Allison L Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, United States
| | - Lisa Gwynn
- Leonard M Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Mark G Thompson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Manjusha Gaglani
- College of Medicine, Texas A&M University, Temple, TX, United States
- Baylor Scott and White Health, Temple, TX, United States
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Naleway AL, Grant L, Caban‐Martinez AJ, Wesley MG, Burgess JL, Groover K, Gaglani M, Yoon SK, Tyner HL, Meece J, Kuntz JL, Yoo YM, Schaefer‐Solle N, Olsho LEW, Gerald JK, Rose S, Thiese MS, Lundgren J, Groom HC, Mak J, Louzado Feliciano P, Edwards LJ, Lutrick K, Dunnigan K, Phillips AL, Lamberte JM, Noriega R, Sokol BE, Odean M, Ellingson KD, Smith M, Hegmann KT, Respet K, Dickerson M, Cruz A, Fleary DE, Murthy K, Hunt A, Azziz‐Baumgartner E, Gallimore‐Wilson D, Harder JA, Odame‐Bamfo L, Viergutz J, Arvay M, Jones JM, Mistry P, Thompson MG, Fowlkes AL. Incidence of SARS-CoV-2 infection among COVID-19 vaccinated and unvaccinated healthcare personnel, first responders, and other essential and frontline workers: Eight US locations, January-September 2021. Influenza Other Respir Viruses 2022; 16:585-593. [PMID: 35023288 PMCID: PMC8983896 DOI: 10.1111/irv.12956] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND We sought to evaluate the impact of changes in estimates of COVID-19 vaccine effectiveness on the incidence of laboratory-confirmed infection among frontline workers at high risk for SARS-CoV-2. METHODS We analyzed data from a prospective frontline worker cohort to estimate the incidence of COVID-19 by month as well as the association of COVID-19 vaccination, occupation, demographics, physical distancing, and mask use with infection risk. Participants completed baseline and quarterly surveys, and each week self-collected mid-turbinate nasal swabs and reported symptoms. RESULTS Among 1018 unvaccinated and 3531 fully vaccinated workers, the monthly incidence of laboratory-confirmed SARS-CoV-2 infection in January 2021 was 13.9 (95% confidence interval [CI]: 10.4-17.4), declining to 0.5 (95% CI -0.4-1.4) per 1000 person-weeks in June. By September 2021, when the Delta variant predominated, incidence had once again risen to 13.6 (95% CI 7.8-19.4) per 1000 person-weeks. In contrast, there was no reportable incidence among fully vaccinated participants at the end of January 2021, and incidence remained low until September 2021 when it rose modestly to 4.1 (95% CI 1.9-3.8) per 1000. Below average facemask use was associated with a higher risk of infection for unvaccinated participants during exposure to persons who may have COVID-19 and vaccinated participants during hours in the community. CONCLUSIONS COVID-19 vaccination was significantly associated with a lower risk of SARS-CoV-2 infection despite Delta variant predominance. Our data demonstrate the added protective benefit of facemask use among both unvaccinated and vaccinated frontline workers.
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Affiliation(s)
| | - Lauren Grant
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | | | | | - Jefferey L. Burgess
- Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonArizonaUSA
| | | | - Manjusha Gaglani
- Baylor Scott and White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | - Sarang K. Yoon
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | | | - Jennifer Meece
- Marshfield Clinic Research InstituteMarshfieldWisconsinUSA
| | - Jennifer L. Kuntz
- Kaiser Permanente Northwest Center for Health ResearchPortlandOregonUSA
| | - Young M. Yoo
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | | | | | - Joe K. Gerald
- Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonArizonaUSA
| | - Spencer Rose
- Baylor Scott and White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | - Matthew S. Thiese
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | | | - Holly C. Groom
- Kaiser Permanente Northwest Center for Health ResearchPortlandOregonUSA
| | - Josephine Mak
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | | | | | - Karen Lutrick
- Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonArizonaUSA
| | - Kayan Dunnigan
- Baylor Scott and White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | - Andrew L. Phillips
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Julie Mayo Lamberte
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - Roger Noriega
- Leonard M. Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | - Marilyn Odean
- Whiteside Institute for Clinical Research, St. Luke'sDuluthMinnesotaUSA
| | | | | | - Kurt T. Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Karley Respet
- St. Luke's Regional Health Care SystemDuluthMinnesotaUSA
| | - Monica Dickerson
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - Alexandra Cruz
- Leonard M. Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | | | - Angela Hunt
- St. Luke's Regional Health Care SystemDuluthMinnesotaUSA
| | | | | | | | | | | | - Melissa Arvay
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - John M. Jones
- Leonard M. Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | - Mark G. Thompson
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - Ashley L. Fowlkes
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
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Lowe AA, Gerald JK, Clemens C, Gerald LB. School-based Stock Inhaler Programs and Neighborhood Disadvantage. J Health Care Poor Underserved 2022; 33:1083-1093. [DOI: 10.1353/hpu.2022.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Fowlkes AL, Yoon SK, Lutrick K, Gwynn L, Burns J, Grant L, Phillips AL, Ellingson K, Ferraris MV, LeClair LB, Mathenge C, Yoo YM, Thiese MS, Gerald LB, Solle NS, Jeddy Z, Odame-Bamfo L, Mak J, Hegmann KT, Gerald JK, Ochoa JS, Berry M, Rose S, Lamberte JM, Madhivanan P, Pubillones FA, Rai RP, Dunnigan K, Jones JT, Krupp K, Edwards LJ, Bedrick EJ, Sokol BE, Lowe A, McLeland-Wieser H, Jovel KS, Fleary DE, Khan SM, Poe B, Hollister J, Lopez J, Rivers P, Beitel S, Tyner HL, Naleway AL, Olsho LE, Caban-Martinez AJ, Burgess JL, Thompson MG, Gaglani M. Effectiveness of 2-Dose BNT162b2 (Pfizer BioNTech) mRNA Vaccine in Preventing SARS-CoV-2 Infection Among Children Aged 5-11 Years and Adolescents Aged 12-15 Years - PROTECT Cohort, July 2021-February 2022. MMWR Morb Mortal Wkly Rep 2022; 71:422-428. [PMID: 35298453 PMCID: PMC8942308 DOI: 10.15585/mmwr.mm7111e1] [Citation(s) in RCA: 99] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lutrick K, Rivers P, Yoo YM, Grant L, Hollister J, Jovel K, Khan S, Lowe A, Baccam Z, Hanson H, Olsho LE, Fowlkes A, Caban-Martinez AJ, Porter C, Yoon S, Meece J, Gaglani M, Burns J, Mayo Lamberte J, Nakayima Miiro F, Bissonnette A, LeClair L, Kutty PK, Romine JK, Stefanski E, Edwards LJ, Ellingson K, Gerald JK, Bedrick EJ, Madhivanan P, Krupp K, Gerald LB, Thompson M, Burgess JL. Interim Estimate of Vaccine Effectiveness of BNT162b2 (Pfizer-BioNTech) Vaccine in Preventing SARS-CoV-2 Infection Among Adolescents Aged 12-17 Years - Arizona, July-December 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1761-1765. [PMID: 34968373 PMCID: PMC8736269 DOI: 10.15585/mmwr.mm705152a2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ellingson KD, Gerald JK, Sun X, Hollister J, Lutrick K, Parker J, Rivers P, Beitel SC, Baccam Z, Lamberte JM, Grant L, Kim E, Bhattarai R, Komatsu K, Meece J, Kutty PK, Thompson MG, Burgess JL. Incidence of SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential Workers During a Prevaccination COVID-19 Surge in Arizona. JAMA Health Forum 2021; 2:e213318. [PMID: 35977166 PMCID: PMC8727035 DOI: 10.1001/jamahealthforum.2021.3318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/28/2021] [Indexed: 11/25/2022] Open
Abstract
Question Before COVID-19 vaccine availability, how comparable were rates of SARS-CoV-2 infection among health care personnel, first responders, and other essential workers? Findings This prospective cohort study of 1766 unvaccinated seronegative Arizona workers using self-administered reverse-transcription polymerase chain reaction testing found that first responders had a significantly higher incidence of SARS-CoV-2 infection than health care personnel, even after controlling for sociodemographic characteristics and underlying health and exposure indicators. Meaning The findings of this cohort study indicate that first responders warrant greater public health attention in context of the COVID-19 pandemic given their higher rates of SARS-CoV-2 infection. Importance Understanding the relative risk of SARS-CoV-2 infection across occupations can inform guidance to protect workers and communities. Less is known about infection risk for first responders and other essential workers than for health care personnel. Objective To compare the prevaccination incidence of SARS-CoV-2 infection among first responders and other essential workers with incidence among health care personnel. Design, Setting, and Participants This was a prospective cohort study of health care personnel, first responders, and other essential workers in Arizona from July 20, 2020, to March 14, 2021. Participants were seronegative at enrollment, had frequent direct contact with others at work, worked at least 20 hours per week, and submitted weekly nasal swab specimens for real-time reverse transcriptase polymerase chain reaction analysis. Data analyses were performed from April 19, 2021, to June 4, 2021. Exposures Occupation was the primary exposure of interest. Confounders assessed were sociodemographic characteristics, health status, community exposure, and work exposure. Main Outcomes and Measures Crude incidence of SARS-CoV-2 infection was defined as the sum of first positive SARS-CoV-2 infections in participants divided by person-weeks at risk. Negative binomial regression was used to model SARS-CoV-2 infection by occupation to estimate unadjusted and adjusted incidence rate ratios (IRRs). The least absolute shrinkage and selection operator (LASSO) method was used to generate a parsimonious multivariable model. Results The study cohort comprised 1766 Arizona workers (mean age [SD], 43.8 [11.1] years; 1093 [61.9%] female; 401 [22.7%] were Hispanic and 1530 [86.6%] were White individuals) of whom 44.2% were health care personnel, 22.4% first responders, and 33.4% other essential workers. The cohort was followed up for 23 393 person-weeks. Crude incidence of SARS-CoV-2 infection was 6.7, 13.2, and 7.4 per 1000 person-weeks at risk for health care personnel, first responders, and other essential workers, respectively. In unadjusted models, first responders had twice the incidence of infection as health care personnel (IRRs, 2.01; 95% CI, 1.44-2.79). While attenuated, this risk remained elevated in adjusted LASSO-optimized models (IRR, 1.60; 95% CI, 1.07-2.38). Risk of infection among other essential workers was no different than for health care personnel in unadjusted or adjusted models. Conclusions and Relevance This prospective cohort study found that first responders had a higher incidence of SARS-CoV-2 infection than health care personnel, even after adjusting for potential confounding factors. Given their frequent contact with each other and with the public and their high rates of SARS-CoV-2 infection, the safety challenges for first responders warrant greater public health attention and research.
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Affiliation(s)
- Katherine D. Ellingson
- Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson
| | - Joe K. Gerald
- Department of Community, Environment and Policy, University of Arizona, Tucson
| | - Xiaoxiao Sun
- Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson
| | - James Hollister
- Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson
| | - Karen Lutrick
- Department of Family and Community Medicine, University of Arizona, Tucson
| | - Joel Parker
- Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson
| | - Patrick Rivers
- Department of Health Promotion Sciences, University of Arizona, Tucson
| | - Shawn C. Beitel
- Department of Community, Environment and Policy, University of Arizona, Tucson
| | - Zoe Baccam
- Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson
| | | | - Lauren Grant
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Preeta K. Kutty
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jefferey L. Burgess
- Department of Community, Environment and Policy, University of Arizona, Tucson
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Gerald LB, Gerald JK, VanBuren JM, Lowe A, Guthrie CC, Klein EJ, Morrison A, Startup E, Denninghoff K. Randomized trial of the feasibility of ED-initiated school-based asthma medication supervision (ED-SAMS). Pilot Feasibility Stud 2021; 7:179. [PMID: 34579785 PMCID: PMC8474899 DOI: 10.1186/s40814-021-00913-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While using an inhaled corticosteroid (ICS) in the weeks after an ED visit reduces repeat visits, few children receive a needed prescription. Because a prescription may not be filled or used, dispensing ICS at discharge and supervising its use at school could overcome both barriers until follow-up care is established. To assess the feasibility of such an intervention, we conducted a pilot study among elementary-age school children with persistent asthma who were discharged from the ED following an asthma exacerbation. METHODS Eligible children were randomly assigned to ED-dispensing of ICS with home supervision or ED-dispensing of ICS with home and school supervision. The primary outcomes were ability to recruit and retain participants, ability to initiate school-supervised medication administration within 5 days of discharge, and participant satisfaction. RESULTS Despite identifying 437 potentially eligible children, only 13 (3%) were enrolled with 6 being randomized to the intervention group and 7 to the control group. Eleven (85%) randomized participants completed the 90-day interview (primary outcome) and 8 (62%) completed the 120-day interview (safety endpoint). Four (67%) intervention participants started their school regimen within 5 business days and 2 started within 6 business days. CONCLUSION While our pilot study did not meet its recruitment goal, it did achieve its primary purpose of assessing feasibility before undertaking a larger, more intensive study. Several major recruitment barriers need to be mitigated before EDs can successfully partner with schools to establish supervised ICS treatment. TRIAL REGISTRATION ClinicalTrials.gov , NCT03952286 . Registered 16 May 2019.
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Affiliation(s)
- Lynn B Gerald
- University of Arizona, Tucson, AZ, USA. .,Asthma and Airway Disease Research Center, 1501 N Campbell Avenue, Tucson, AZ, 85724, USA.
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11
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Volerman A, Lowe AA, Pappalardo AA, Anderson CMC, Blake KV, Bryant-Stephens T, Carr T, Carter H, Cicutto L, Gerald JK, Miller T, Moore NS, Phan H, Sadreameli SC, Tanner A, Winders TA, Gerald LB. Ensuring Access to Albuterol in Schools: From Policy to Implementation. An Official ATS/AANMA/ALA/NASN Policy Statement. Am J Respir Crit Care Med 2021; 204:508-522. [PMID: 34499024 PMCID: PMC8491259 DOI: 10.1164/rccm.202106-1550st] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Rationale: For children with asthma, access to quick-relief medications is critical to minimizing morbidity and mortality. An innovative and practical approach to ensure access at school is to maintain a supply of stock albuterol that can be used by any student who experiences respiratory distress. To make this possible, state laws allowing for stock albuterol are needed to improve medication access. Objectives: To provide policy recommendations and outline steps for passing and implementing stock albuterol laws. Methods: We assembled a diverse stakeholder group and reviewed guidelines, literature, statutes, regulations, and implementation documents related to school-based medication access. Stakeholders were divided into two groups—legislation and implementation—on the basis of expertise. Each group met virtually to review documents and draft recommendations. Recommendations were compiled and revised in iterative remote meetings with all stakeholders. Main Results: We offer several recommendations for crafting state legislation and facilitating program implementation. 1) Create a coalition of stakeholders to champion legislation and implement stock albuterol programs. The coalition should include school administrators, school nurses and health personnel, parents, or caregivers of children with asthma, pediatric primary care and subspecialty providers (e.g., pulmonologists/allergists), pharmacists, health department staff, and local/regional/national advocacy organizations. 2) Legislative components critical for effective implementation of stock albuterol programs include specifying that medication can be administered in good faith to any child in respiratory distress, establishing training requirements for school staff, providing immunity from civil liability for staff and prescribers, ensuring pharmacy laws allow prescriptions to be dispensed to schools, and suggesting inhalers with valved holding chambers/spacers for administration. 3) Select an experienced and committed legislator to sponsor legislation and guide revisions as needed during passage and implementation. This person should be from the majority party and serve on the legislature’s health or education committee. 4) Develop plans to disseminate legislation and regulations/policies to affected groups, including school administrators, school nurses, pharmacists, emergency responders, and primary/subspecialty clinicians. Periodically evaluate implementation effectiveness and need for adjustments. Conclusions: Stock albuterol in schools is a safe, practical, and potentially life-saving option for children with asthma, whether asthma is diagnosed or undiagnosed, who lack access to their personal quick-relief medication. Legislation is imperative for aiding in the adoption and implementation of school stock albuterol policies, and key policy inclusions can lay the groundwork for success. Future work should focus on passing legislation in all states, implementing policy in schools, and evaluating the impact of such programs on academic and health outcomes.
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Lowe AA, Gerald JK, Clemens C, Gaither C, Gerald LB. Medication Administration Practices in United States' Schools: A Systematic Review and Meta-synthesis. J Sch Nurs 2021; 38:21-34. [PMID: 34223784 DOI: 10.1177/10598405211026300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Schools often provide medication management to children at school, yet, most U.S. schools lack a full-time, licensed nurse. Schools rely heavily on unlicensed assistive personnel (UAP) to perform such tasks. This systematic review examined medication management among K-12 school nurses. Keyword searches in three databases were performed. We included studies that examined: (a) K-12 charter, private/parochial, or public schools, (b) UAPs and licensed nurses, (c) policies and practices for medication management, or (d) nurse delegation laws. Three concepts were synthesized: (a) level of training, (b) nurse delegation, and (c) emergency medications. One-hundred twelve articles were screened. Of these, 37.5% (42/112) were comprehensively reviewed. Eighty-one percent discussed level of training, 69% nurse delegation, and 57% emergency medications. Succinct and consistent policies within and across the United States aimed at increasing access to emergency medications in schools remain necessary.
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Affiliation(s)
- Ashley A Lowe
- Asthma & Airway Disease Research Center, 22165University of Arizona, Tucson, AZ, USA
| | - Joe K Gerald
- Department of Community Environment and Policy, Mel and Enid Zuckerman College of Public Health, Asthma & Airway Disease Research Center, 8041University of Arizona, Tucson, AZ, USA
| | - Conrad Clemens
- Department of Pediatrics, College of Medicine, 20878University of Arizona, Tucson, AZ, USA
| | | | - Lynn B Gerald
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, Asthma & Airway Disease Research Center, 8041University of Arizona, Tucson, AZ, USA
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Lutrick K, Ellingson KD, Baccam Z, Rivers P, Beitel S, Parker J, Hollister J, Sun X, Gerald JK, Komatsu K, Kim E, LaFleur B, Grant L, Yoo YM, Kumar A, Mayo Lamberte J, Cowling BJ, Cobey S, Thornburg NJ, Meece JK, Kutty P, Nikolich-Zugich J, Thompson MG, Burgess JL. COVID-19 Infection, Reinfection, and Vaccine Effectiveness in a Prospective Cohort of Arizona Frontline/Essential Workers: The AZ HEROES Research Protocol. JMIR Res Protoc 2021; 10:e28925. [PMID: 34057904 PMCID: PMC8386365 DOI: 10.2196/28925] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/09/2021] [Accepted: 05/26/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The Arizona Healthcare, Emergency Response, and Other Essential workers Study (AZ HEROES) aims to examine the epidemiology of SARS-CoV-2 infection and COVID-19 illness among adults with high occupational exposure risk. OBJECTIVE Study objectives include estimating incidence of SARS-CoV-2 infection in essential workers by symptom presentation and demographic factors, determining independent effects of occupational and community exposures on incidence of SARS-CoV-2 infection, establishing molecular and immunologic characteristics of SARS-CoV-2 infection in essential workers, describing the duration and patterns of rRT-PCR-positivity, and examining post-vaccine immunologic response. METHODS Eligible participants include Arizona residents aged 18-85 years who work at least 20 hours per week in an occupation involving regular direct contact (within three feet) with others. Recruitment goals are stratified by demographic characteristics (50% aged 40 or older, 50% women, and 50% Hispanic or American Indian), by occupation (40% healthcare personnel, 30% first responders, and 30% other essential workers), and by prior SARS-CoV-2 infection (with up to 50% seropositive at baseline). Information on sociodemographics, health and medical history, vaccination status, exposures to individuals with suspected or confirmed SARS-CoV-2 infection, use of personal protective equipment, and perceived risks are collected at enrollment and updated through quarterly surveys. Every week, participants complete active surveillance for COVID-19-like illness (CLI) and self-collect nasal swabs. Additional self-collected nasal swab and saliva specimens are collected in the event of CLI onset. Respiratory specimens are sent to Marshfield Laboratories and tested for SARS-CoV-2 by real-time reverse transcription polymerase chain reaction (rRT-PCR) assay. CLI symptoms and impact on work and productivity are followed through illness resolution. Serum specimens are collected every 3 months and additional sera are collected following incident rRT-PCR positivity and after each COVID-19 vaccine dose. Incidence of SARS-CoV-2 infections will be calculated by person-weeks at risk and compared by occupation and demographic characteristics and by seropositivity status and infection and vaccination history. RESULTS The AZ HEROES study was funded by the Centers for Disease Control and Prevention. Enrollment began July 27, 2020 and as of May 1, 2021 a total of 3,165 participants have been enrolled in the study. CONCLUSIONS AZ HEROES is unique in aiming to recruit a diverse sample of essential workers and prospectively following strata of SARS-CoV-2 seronegative and seropositive adults. Survey results combined with active surveillance data on exposure, CLI, weekly molecular diagnostic testing, and periodic serology will be used to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infection, assess the intensity and durability of immune responses to natural infection and COVID-19 vaccination, and contribute to the evaluation of COVID-19 vaccine effectiveness. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT DERR1-10.2196/28925.
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Affiliation(s)
- Karen Lutrick
- University of Arizona, College of Medicine - Tucson, 655 N Alvernon WaySuite 228, Tucson, US
| | | | - Zoe Baccam
- University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, US
| | - Patrick Rivers
- University of Arizona, College of Medicine - Tucson, 655 N Alvernon WaySuite 228, Tucson, US
| | - Shawn Beitel
- University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, US
| | - Joel Parker
- University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, US
| | - James Hollister
- University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, US
| | - Xiaoxiao Sun
- University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, US
| | - Joe K Gerald
- University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, US
| | | | | | | | - Lauren Grant
- Centers for Disease Control and Prevention, Atlanta, US
| | - Young M Yoo
- Centers for Disease Control and Prevention, Atlanta, US
| | - Archana Kumar
- Centers for Disease Control and Prevention, Atlanta, US
| | | | | | - Sarah Cobey
- University of Chicago, Ecology and Evolution, Chicago, US
| | | | | | - Preeta Kutty
- Centers for Disease Control and Prevention, Atlanta, US
| | - Janko Nikolich-Zugich
- University of Arizona, College of Medicine - Tucson, 655 N Alvernon WaySuite 228, Tucson, US
| | | | - Jefferey L Burgess
- University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson, US
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Lowe AA, Gerald JK, Clemens CJ, Stern DA, Gerald LB. Managing respiratory emergencies at school: A county-wide stock inhaler program. J Allergy Clin Immunol 2021; 148:420-427.e5. [PMID: 33581200 DOI: 10.1016/j.jaci.2021.01.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND A total of 15 states allow schools to manage respiratory emergencies among multiple students by using a single albuterol inhaler (stock inhaler) paired with a disposable holding chamber. OBJECTIVE Our aim was to evaluate implementation barriers and facilitators, as well as satisfaction with a stock inhaler program across K through12 schools in Pima County, Arizona. METHODS All public, charter, private, and parochial schools were offered supplies, web-based training, and technical assistance at no cost. The RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework was used to evaluate program implementation. School documentation logs were reviewed, school health personnel were surveyed, and a convenience sample of health personnel were interviewed. Chi-square tests evaluated categoric outcomes and Poisson hurdle regression examined stock inhaler use by school organization type, grade levels served, and type of school health personnel employed. RESULTS In all, 229 schools (68%) participated, reaching 82% of students in the county. A total of 152 schools (66%) used a stock inhaler, accounting for 1038 events. The mean number of puffs administered was 2.7 (SD = 1.2) per event, and most events (79%) involved students with asthma. Although most events (83.9%) resulted in the student returning to class, 15.6% resulted in students being sent home. Only 6 events resulted in 911 calls, and 5 of these led to an ambulance transport. School health personnel reported high levels of satisfaction, and all schools renewed participation for a second year. Program costs were $156 per school. CONCLUSION With technical assistance, stock inhaler programs can be feasibly implemented by schools in a wide range of settings, thereby increasing their capacity to safely manage respiratory emergencies.
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Affiliation(s)
- Ashley A Lowe
- Department of Health Promotion Sciences, the Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Ariz; Asthma & Airway Disease Research Center, The University of Arizona, Tucson, Ariz.
| | - Joe K Gerald
- Asthma & Airway Disease Research Center, The University of Arizona, Tucson, Ariz; Department of Community Environment and Policy, the Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Ariz
| | - Conrad J Clemens
- Department of Health Promotion Sciences, the Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Ariz; Department of Pediatrics, The University of Arizona College of Medicine, The University of Arizona, Tucson, Ariz
| | - Debra A Stern
- Asthma & Airway Disease Research Center, The University of Arizona, Tucson, Ariz
| | - Lynn B Gerald
- Department of Health Promotion Sciences, the Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Ariz; Asthma & Airway Disease Research Center, The University of Arizona, Tucson, Ariz
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Papp EM, Gerald JK, Sadreameli SC, Gerald LB. Why Every School Should Have a Stock Inhaler: One Nurse's Experience. Am J Public Health 2020; 109:1528-1529. [PMID: 31577486 DOI: 10.2105/ajph.2019.305314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Elaine M Papp
- Elaine M. Papp is with Health and Safety Works, LLC, Baltimore, MD. Joe K. Gerald is with the Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, and the Asthma and Airway Disease Research Center, University of Arizona, Tucson. S. Christy Sadreameli is with the Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University, Baltimore, MD. Lynn B. Gerald is with the Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, and the Asthma and Airway Disease Research Center, University of Arizona, Tucson
| | - Joe K Gerald
- Elaine M. Papp is with Health and Safety Works, LLC, Baltimore, MD. Joe K. Gerald is with the Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, and the Asthma and Airway Disease Research Center, University of Arizona, Tucson. S. Christy Sadreameli is with the Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University, Baltimore, MD. Lynn B. Gerald is with the Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, and the Asthma and Airway Disease Research Center, University of Arizona, Tucson
| | - S Christy Sadreameli
- Elaine M. Papp is with Health and Safety Works, LLC, Baltimore, MD. Joe K. Gerald is with the Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, and the Asthma and Airway Disease Research Center, University of Arizona, Tucson. S. Christy Sadreameli is with the Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University, Baltimore, MD. Lynn B. Gerald is with the Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, and the Asthma and Airway Disease Research Center, University of Arizona, Tucson
| | - Lynn B Gerald
- Elaine M. Papp is with Health and Safety Works, LLC, Baltimore, MD. Joe K. Gerald is with the Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, and the Asthma and Airway Disease Research Center, University of Arizona, Tucson. S. Christy Sadreameli is with the Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University, Baltimore, MD. Lynn B. Gerald is with the Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, and the Asthma and Airway Disease Research Center, University of Arizona, Tucson
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Patel MR, Press VG, Gerald LB, Barnes T, Blake K, Brown LK, Costello RW, Crim C, Forshag M, Gershon AS, Goss CH, Han MK, Lee TA, Sweet S, Gerald JK. Improving the Affordability of Prescription Medications for People with Chronic Respiratory Disease. An Official American Thoracic Society Policy Statement. Am J Respir Crit Care Med 2019; 198:1367-1374. [PMID: 30601674 DOI: 10.1164/rccm.201810-1865st] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Mounting evidence indicates that out-of-pocket costs for prescription medications, particularly among low- and middle-income patients with chronic diseases, are imposing financial burden, reducing medication adherence, and worsening health outcomes. This problem is exacerbated by a paucity of generic alternatives for prevalent lung diseases, such as asthma and chronic obstructive pulmonary disease, as well as high-cost medicines for rare diseases, such as cystic fibrosis. Affordability and access challenges are especially salient in the United States, as citizens of many other countries pay lower prices for and have greater access to prescription medications. METHODS The American Thoracic Society convened a multidisciplinary committee comprising experts in health policy pharmacoeconomics, behavioral sciences, and clinical care, along with individuals providing industry and patient perspectives. The report and its recommendation were iteratively developed over a year of in-person, telephonic, and electronic deliberation. RESULTS The committee unanimously recommended the establishment of a publicly funded, politically independent, impartial entity to systematically draft evidence-based pharmaceutical policy recommendations. The goal of this entity would be to generate evidence and action steps to ensure people have equitable and affordable access to prescription medications, to maximize the value of public and private pharmaceutical expenditures on health, to support novel drug development within a market-based economy, and to preserve clinician and patient choice regarding personalized treatment. An immediate priority is to examine the evidence and make recommendations regarding the need to have essential medicines with established clinical benefit from each drug class in all Tier 1 formularies and propose recommendations to reduce barriers to timely generic drug availability. CONCLUSIONS By making explicit, evidence-based recommendations, the entity can support the establishment of coherent national policies that expand access to affordable medications, improve the health of patients with chronic disease, and optimize the use of public and private resources.
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17
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Gerald JK. Benefits of Stock Epinephrine Likely Misestimated. JAMA Pediatr 2019; 173:798-799. [PMID: 31180468 DOI: 10.1001/jamapediatrics.2019.1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Brady BR, Nair US, Gerald JK, Yuan NP, Krupski LA, Thomson CA. Higher quality quit-date goal setting enhances quit attempts among quitline callers. Tob Prev Cessat 2019; 5:20. [PMID: 32411883 PMCID: PMC7205044 DOI: 10.18332/tpc/109537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 03/10/2019] [Accepted: 03/21/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION At tobacco quitlines, coaching and cessation medications are commonly structured around setting a date for making a quit attempt. However, limited literature evaluating this practice suggests that callers do not routinely set quit-date goals. High quality goal setting may increase the frequency of caller quit attempts. In this study, we examine the quality of quit-date goal setting and its association with in-program quit attempts and the timing of callers’ first quit attempt. METHODS Using call recordings, we scored the quality of quit-date goal setting among 90 callers enrolled at Arizona Smokers’ Helpline between August and December 2017. The primary exposure was quality of quit-date goal setting assessed using the Lorencatto et al. rating scale. Coding reliability was assessed using Cohen’s kappa. Multivariable logistic regression was used to examine the association between quality of goal setting and in-program quit attempts (>24 h tobacco free). RESULTS The mean quality goal setting score was 3.1 (range: -3 to 7). Sixty-nine callers (77%) set a quit date and 39 (43%) made a quit attempt. Compared to callers who experienced low-quality goal setting, the adjusted odds of in-program quitting for high quality goal setting was AOR=3.98 (95% CI: 1.55–10.20) and for making a quit attempt within two weeks OR=6.23 (95% CI: 1.52–25.49). CONCLUSIONS Quit-date goal setting is an important element of quitline services and callers benefit from high quality quit-date goal setting. Quitlines should establish quality improvement measures to ensure that coaches are trained to provide high quality quit-date goal setting opportunities to all callers.
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Affiliation(s)
| | - Uma S Nair
- University of Arizona, Tucson, United States
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Verhougstraete MP, Gerald JK, Gerba CP, Reynolds KA. Cost-benefit of point-of-use devices for lead reduction. Environ Res 2019; 171:260-265. [PMID: 30690272 DOI: 10.1016/j.envres.2019.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/04/2019] [Accepted: 01/08/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Lead exposure represents a significant human health concern that often occurs with little warning to the consumer. Water lead levels can be mitigated by point-of-use (POU) devices such as reverse osmosis, distillation, or activated carbon with lead reduction media. OBJECTIVES This study assessed a partial cost-benefit of residential installation of POU devices to reduce lead concentrations in drinking water and examined the economic impact at the community level based on exposures reported in Flint, Michigan. METHODS We calculated the individual consumer breakeven point for each lead abatement option by subtracting the lifetime cost of device installation and maintenance from the lifetime cost of lead exposure through its impact on intelligence (IQ) and lifetime earnings. This approach was then extrapolated to the community level based on reported lead exposures in Flint, Michigan. RESULTS Based on operating POU device costs, lead absorption from water, and economic losses associated with reduced IQ, initial water lead levels associated with consumer breakeven points for reverse osmosis (7.31 µg/L), activated carbon (3.73 µg/L), and distillation (12.0 µg/L) were calculated. For example, an individual consuming water with 25 µg/L of lead, similar to the 90th percentile of concentrations measured in Flint, Michigan, would have an expected blood lead level of 1.25 µg/dL, a corresponding loss of 0.641 IQ points, and a lifetime economic earnings loss of $14,284. Over 70 years of continued use, activated carbon with lead reduction media is the least expensive device to maintain and operate as compared to reverse osmosis and distillation. CONCLUSIONS Infrastructure failures related to drinking water are unpredictable and exposure to contaminates can have significant economic ramifications. POU devices represent a cost-effective option to reduce the impact of lead exposure, particularly when water lead concentrations exceed regulated levels.
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Affiliation(s)
- Marc P Verhougstraete
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N. Martin Ave., PO Box 245210, Tucson, AZ 85724, USA.
| | - Joe K Gerald
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Charles P Gerba
- Soil, Water, and Environmental Sciences, University of Arizona, Tucson, AZ, USA
| | - Kelly A Reynolds
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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Gerald JK, Hallmark B, Billheimer D, Martinez FD, Gerald LB. Are Latino children of Mexican origin with asthma less responsive to inhaled corticosteroids than white children? J Allergy Clin Immunol Pract 2019; 7:2419-2421. [PMID: 30857938 DOI: 10.1016/j.jaip.2019.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Joe K Gerald
- Department of Community Environment and Policy, The Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Ariz; The Asthma and Airways Disease Research Center, The University of Arizona, Tucson, Ariz.
| | - Brian Hallmark
- The Asthma and Airways Disease Research Center, The University of Arizona, Tucson, Ariz; The BIO5 Institute, The University of Arizona, Tucson, Ariz
| | - Dean Billheimer
- The Asthma and Airways Disease Research Center, The University of Arizona, Tucson, Ariz; The BIO5 Institute, The University of Arizona, Tucson, Ariz; Department of Epidemiology and Biostatistics, The Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Ariz
| | - Fernando D Martinez
- The Asthma and Airways Disease Research Center, The University of Arizona, Tucson, Ariz; The BIO5 Institute, The University of Arizona, Tucson, Ariz; Department of Pediatrics, The University of Arizona College of Medicine, The University of Arizona, Tucson, Ariz
| | - Lynn B Gerald
- The Asthma and Airways Disease Research Center, The University of Arizona, Tucson, Ariz; Department of Health Promotion Sciences, The Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Ariz
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Gerald JK, Fisher JM, Brown MA, Clemens CJ, Moore MA, Carvajal SC, Bryson D, Stefan N, Billheimer D, Gerald LB. School-supervised use of a once-daily inhaled corticosteroid regimen: A cluster randomized trial. J Allergy Clin Immunol 2018; 143:755-764. [PMID: 30118728 DOI: 10.1016/j.jaci.2018.06.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 06/22/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND School-supervised use of a once-daily inhaled corticosteroid regimen (supervised therapy) can improve medication adherence and asthma control. OBJECTIVE We sought to evaluate the effectiveness of supervised therapy in a unique setting and population. METHODS We conducted a cluster randomized trial of supervised therapy in 20 elementary schools with a disproportionate enrollment of low-income Latino students. Schools were purposively selected, matched, and randomized to receive 9 months of supervised therapy with mometasone furoate or usual care. All English- or Spanish-speaking students with self-reported asthma were eligible. The Asthma Control Questionnaire (ACQ) was interviewer administered quarterly at school. Students in supervised therapy schools were hypothesized to have lower ACQ scores than students in usual-care schools. RESULTS Of 393 enrolled students, 189 students receiving immediate intervention and 143 students receiving delayed intervention provided 1 or more ACQ data points, were between 6 and 10 years of age, and were included in the primary analysis. At baseline, 39% of students reported taking a controller medication, and 24% had well-controlled asthma. Eighty percent of students receiving immediate intervention were prescribed mometasone. Schools administered 98% of prescribed doses when students attended school. Absences, weekends, and holidays reduced calendar adherence to 53%. During the first year, the mean ACQ score for students receiving immediate and delayed intervention was 1.55 (95% CI, 1.41-1.70) and 1.64 (95% CI, 1.47-1.80), respectively. The estimated treatment effect was -0.08 (95% CI, -0.31 to 0.14). DISCUSSION Compared with usual care, supervised therapy did not improve asthma control among this population of Latino students. Additional research is warranted to confirm these results.
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Affiliation(s)
- Joe K Gerald
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Ariz; Asthma and Airways Disease Research Center, University of Arizona, Tucson, Ariz.
| | | | - Mark A Brown
- Department of Pediatrics, University of Colorado, Denver, Colo; The Breathing Institute, Children's Hospital Colorado, Denver, Colo
| | - Conrad J Clemens
- Department of Pediatrics, University of Arizona College of Medicine, University of Arizona, Tucson, Ariz
| | - Melissa A Moore
- Department of Pediatrics, University of Arizona College of Medicine, University of Arizona, Tucson, Ariz
| | - Scott C Carvajal
- Department of Health Promotion Sciences, the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Ariz
| | - Donna Bryson
- American Lung Association of Southern Arizona, Tucson, Ariz
| | - Nikki Stefan
- Department of Health Services, Tucson Unified School District, Tucson, Ariz
| | - Dean Billheimer
- BIO5 Institute, University of Arizona, Tucson, Ariz; Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Ariz
| | - Lynn B Gerald
- Asthma and Airways Disease Research Center, University of Arizona, Tucson, Ariz; Department of Health Promotion Sciences, the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Ariz
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Goodwin JL, Gerald LB, Johnson JLH, Gerald JK. Use of a disposable valved-holding chamber (spacer) in a school-based asthma trial. J Allergy Clin Immunol Pract 2017; 6:307-309. [PMID: 28970085 DOI: 10.1016/j.jaip.2017.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 11/29/2022]
Affiliation(s)
- James L Goodwin
- Asthma and Airways Disease Research Center, University of Arizona, Tucson, Ariz.
| | - Lynn B Gerald
- Asthma and Airways Disease Research Center, University of Arizona, Tucson, Ariz; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Ariz
| | | | - Joe K Gerald
- Asthma and Airways Disease Research Center, University of Arizona, Tucson, Ariz; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Ariz
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Gerald JK. The Benefit of Early Preventive Dental Care for Children. JAMA Pediatr 2017; 171:916. [PMID: 28759668 DOI: 10.1001/jamapediatrics.2017.2054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Joe K Gerald
- Public Health Policy and Management, The Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson
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Weiss CH, Krishnan JA, Au DH, Bender BG, Carson SS, Cattamanchi A, Cloutier MM, Cooke CR, Erickson K, George M, Gerald JK, Gerald LB, Goss CH, Gould MK, Hyzy R, Kahn JM, Mittman BS, Mosesón EM, Mularski RA, Parthasarathy S, Patel SR, Rand CS, Redeker NS, Reiss TF, Riekert KA, Rubenfeld GD, Tate JA, Wilson KC, Thomson CC. An Official American Thoracic Society Research Statement: Implementation Science in Pulmonary, Critical Care, and Sleep Medicine. Am J Respir Crit Care Med 2017; 194:1015-1025. [PMID: 27739895 PMCID: PMC5441016 DOI: 10.1164/rccm.201608-1690st] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many advances in health care fail to reach patients. Implementation science is the study of novel approaches to mitigate this evidence-to-practice gap. METHODS The American Thoracic Society (ATS) created a multidisciplinary ad hoc committee to develop a research statement on implementation science in pulmonary, critical care, and sleep medicine. The committee used an iterative consensus process to define implementation science and review the use of conceptual frameworks to guide implementation science for the pulmonary, critical care, and sleep community and to explore how professional medical societies such as the ATS can promote implementation science. RESULTS The committee defined implementation science as the study of the mechanisms by which effective health care interventions are either adopted or not adopted in clinical and community settings. The committee also distinguished implementation science from the act of implementation. Ideally, implementation science should include early and continuous stakeholder involvement and the use of conceptual frameworks (i.e., models to systematize the conduct of studies and standardize the communication of findings). Multiple conceptual frameworks are available, and we suggest the selection of one or more frameworks on the basis of the specific research question and setting. Professional medical societies such as the ATS can have an important role in promoting implementation science. Recommendations for professional societies to consider include: unifying implementation science activities through a single organizational structure, linking front-line clinicians with implementation scientists, seeking collaborations to prioritize and conduct implementation science studies, supporting implementation science projects through funding opportunities, working with research funding bodies to set the research agenda in the field, collaborating with external bodies responsible for health care delivery, disseminating results of implementation science through scientific journals and conferences, and teaching the next generation about implementation science through courses and other media. CONCLUSIONS Implementation science plays an increasingly important role in health care. Through support of implementation science, the ATS and other professional medical societies can work with other stakeholders to lead this effort.
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Bime C, Gerald JK, Wei CY, Holbrook JT, Teague WG, Wise RA, Gerald LB. Measurement characteristics of the childhood Asthma-Control Test and a shortened, child-only version. NPJ Prim Care Respir Med 2016; 26:16075. [PMID: 27763622 PMCID: PMC5072391 DOI: 10.1038/npjpcrm.2016.75] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 06/16/2016] [Accepted: 08/21/2016] [Indexed: 01/13/2023] Open
Abstract
The childhood Asthma-Control Test (C-ACT) is validated for assessing asthma control in paediatric asthma. Among children aged 4–11 years, the C-ACT requires the simultaneous presence of both parent and child. There is an unmet need for a tool that can be used to assess asthma control in children when parents or caregivers are not present such as in the school setting. We assessed the psychometric properties and estimated the minimally important difference (MID) of the C-ACT and a modified version, comprising only the child responses (C-ACTc). Asthma patients aged 6–11 years (n=161) from a previously completed multicenter randomised trial were included. Demographic information, spirometry and questionnaire scores were obtained at baseline and during follow-up. Participants or their guardians kept a daily asthma diary. Internal consistency reliabilities of the C-ACT and C-ACTc were 0.76 and 0.67 (Cronbach’s α), respectively. Test–retest reliabilities of the C-ACT and C-ACTc were 0.72 and 0.66 (intra-class correlation), respectively. Significant correlations were noted between C-ACT scores and ACQ scores (Spearman’s correlation r=−0.56, 95% CI (−0.66, −0.44), P<0.001). The strength of the correlation between C-ACTc scores and ACQ scores was weaker (Spearman’s correlation r=−0.46, 95% CI (−0.58, −0.33), P<0.001). We estimated the MID for the C-ACT and C-ACTc to be 2 points and 1 point, respectively. Among asthma patients aged 6–11 years, the C-ACT had good psychometric properties. The psychometric properties of a shortened child-only version (C-ACTc), although acceptable, are not as strong.
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Affiliation(s)
- Christian Bime
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of Arizona School of Medicine, Arizona Respiratory Center, Tucson, AZ, USA
| | - Joe K Gerald
- Mel and Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Arizona Respiratory Center, Tucson, AZ, USA
| | - Christine Y Wei
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janet T Holbrook
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - William G Teague
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Robert A Wise
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lynn B Gerald
- Mel and Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Arizona Respiratory Center, Tucson, AZ, USA
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Gerald JK, Moreno FA. Asthma and Depression: It's Complicated. J Allergy Clin Immunol Pract 2016; 4:74-5. [PMID: 26772927 DOI: 10.1016/j.jaip.2015.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Joe K Gerald
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Ariz.
| | - Francisco A Moreno
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, Ariz
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Chongpison Y, Hornbrook MC, Harris RB, Herrinton LJ, Gerald JK, Grant M, Bulkley JE, Wendel CS, Krouse RS. Self-reported depression and perceived financial burden among long-term rectal cancer survivors. Psychooncology 2015; 25:1350-1356. [PMID: 26365584 DOI: 10.1002/pon.3957] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 08/05/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Types of surgery for rectal cancer (RC), including permanent ostomy (PO) or temporary ostomy followed by anastomosis (TO) or initial anastomosis (AN), can affect psychological and financial well-being during active treatment. However, these relationships have not been well studied among long-term survivors (≥5 years post-diagnosis). METHODS A mailed survey with 576 long-term RC survivors who were members of Kaiser Permanente was conducted in 2010-2011. Prevalence of current depression was ascertained using a score of ≤45.6 on the Short Form-12 version 2 mental component summary. Perceived financial burden was assessed using a Likert scale ranging from 0 (none) to 10 (severe). Regression analyses were used to measure associations after adjustment for covariates. RESULTS The overall prevalence of depression was 24% among RC survivors with the highest prevalence among those with a history of PO (31%). The adjusted odds of depression among TO and AN survivors were lower than that among PO survivors, 0.42 (CI95% 0.20-0.89) and 0.59 (CI95% 0.37-0.93), respectively. Twenty-two percent perceived moderate-to-high current financial burden (≥4 points). PO survivors also reported higher mean financial burden than AN survivors (2.6 vs. 1.6, respectively; p = 0.002), but perceived burden comparably to TO survivors (2.3). Self-reported depression was associated with higher perceived financial burden (p < 0.001); surgical procedure history did not modify this relationship. CONCLUSIONS Depression was reported frequently among these long-term RC survivors, particularly among PO survivors. Depression was associated with greater perception of financial burden. Screening for depression and assessing financial well-being might improve care among long-term RC survivors.Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yuda Chongpison
- The University of Arizona College of Public Health, 1295 N. Martin Ave., Tucson, AZ, 85724, USA.
| | - Mark C Hornbrook
- Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Robin B Harris
- The University of Arizona College of Public Health, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - Lisa J Herrinton
- Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Joe K Gerald
- The University of Arizona College of Public Health, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - Marcia Grant
- City of Hope Medical Center/Beckman Research Institute, 1500 East Duarte Road Duarte, CA, 91010, USA
| | - Joanna E Bulkley
- Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Christopher S Wendel
- Southern Arizona Veterans Affairs Health Care System, 3601 S. 6th Ave., Tucson, AZ, 85723, USA.,The University of Arizona College of Medicine, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA
| | - Robert S Krouse
- Southern Arizona Veterans Affairs Health Care System, 3601 S. 6th Ave., Tucson, AZ, 85723, USA.,The University of Arizona College of Medicine, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA
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Gerald JK, Carr TF, Wei CY, Holbrook JT, Gerald LB. Albuterol Overuse: A Marker of Psychological Distress? J Allergy Clin Immunol Pract 2015; 3:957-62. [PMID: 26341049 DOI: 10.1016/j.jaip.2015.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/16/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Albuterol overuse, 3 or more canisters per year, is associated with poor asthma control and frequent exacerbations. OBJECTIVE To describe albuterol use on symptom and symptom-free days and identify predictors of albuterol overuse and controller medication underuse. METHODS Secondary analyses of data from adults with mild asthma from the Trial of Asthma Patient Education were carried out. Based on albuterol use of 80% or more on symptom days and less than 20% on symptom-free days, participants were characterized as expected users, overusers, or underusers of albuterol. Good controller medication adherence was defined as 80% or more of prescribed doses. Data included demographic characteristics, diary data, spirometry, and scores from standardized questionnaires. Bivariate associations were examined between categorization of medication use and measured characteristics. RESULTS Of the 416 participants, 212 (51%) were expected users, 114 (27%) were overusers, and 90 (22%) were underusers of albuterol. No differences were observed among the user groups by demographic characteristics or lung function. Expected users demonstrated the highest asthma-related knowledge, attitudes, and efficacy. Overusers reported the greatest symptom burden, worst asthma control, and highest frequency of symptom days. Overusers also had the highest burden of depression symptoms. More frequent symptom days accounted for 15% of overuse, greater use on symptom days accounted for 31%, and greater use on symptom free days accounted for 54% of overuse. Mean controller adherence was high across all groups, and there were no differences between the groups. CONCLUSIONS Although overusers experienced more frequent symptom days and used more albuterol on those days, most overuse was attributable to unexpected use on symptom-free days. High levels of comorbid depression were observed, particularly among overusers and among those nonadherent to controller medication.
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Affiliation(s)
- Joe K Gerald
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Ariz; Arizona Respiratory Center, The University of Arizona, Tucson, Ariz.
| | - Tara F Carr
- Arizona Respiratory Center, The University of Arizona, Tucson, Ariz
| | - Christine Y Wei
- Johns Hopkins University Bloomberg School of Public Health for the American Lung Association-Asthma Clinical Research Centers, Baltimore, Md
| | - Janet T Holbrook
- Johns Hopkins University Bloomberg School of Public Health for the American Lung Association-Asthma Clinical Research Centers, Baltimore, Md
| | - Lynn B Gerald
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Ariz; Arizona Respiratory Center, The University of Arizona, Tucson, Ariz
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Carson SS, Goss CH, Patel SR, Anzueto A, Au DH, Elborn S, Gerald JK, Gerald LB, Kahn JM, Malhotra A, Mularski RA, Riekert KA, Rubenfeld GD, Weaver TE, Krishnan JA. An official American Thoracic Society research statement: comparative effectiveness research in pulmonary, critical care, and sleep medicine. Am J Respir Crit Care Med 2014; 188:1253-61. [PMID: 24160906 DOI: 10.1164/rccm.201310-1790st] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Comparative effectiveness research (CER) is intended to inform decision making in clinical practice, and is central to patient-centered outcomes research (PCOR). PURPOSE To summarize key aspects of CER definitions and provide examples highlighting the complementary nature of efficacy and CER studies in pulmonary, critical care, and sleep medicine. METHODS An ad hoc working group of the American Thoracic Society with experience in clinical trials, health services research, quality improvement, and behavioral sciences in pulmonary, critical care, and sleep medicine was convened. The group used an iterative consensus process, including a review by American Thoracic Society committees and assemblies. RESULTS The traditional efficacy paradigm relies on clinical trials with high internal validity to evaluate interventions in narrowly defined populations and in research settings. Efficacy studies address the question, "Can it work in optimal conditions?" The CER paradigm employs a wide range of study designs to understand the effects of interventions in clinical settings. CER studies address the question, "Does it work in practice?" The results of efficacy and CER studies may or may not agree. CER incorporates many attributes of outcomes research and health services research, while placing greater emphasis on meeting the expressed needs of nonresearcher stakeholders (e.g., patients, clinicians, and others). CONCLUSIONS CER complements traditional efficacy research by placing greater emphasis on the effects of interventions in practice, and developing evidence to address the needs of the many stakeholders involved in health care decisions. Stakeholder engagement is an important component of CER.
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Gerald LB, Gerald JK, Zhang B, McClure LA, Bailey WC, Harrington KF. Can a school-based hand hygiene program reduce asthma exacerbations among elementary school children? J Allergy Clin Immunol 2012; 130:1317-24. [PMID: 23069487 PMCID: PMC3511646 DOI: 10.1016/j.jaci.2012.08.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 08/16/2012] [Accepted: 08/17/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Viral upper respiratory tract infections have been implicated as a major cause of asthma exacerbations among school-aged children. Regular hand washing is the most effective method to prevent the spread of viral respiratory tract infections, but effective hand-washing practices are difficult to establish in schools. OBJECTIVES This randomized controlled trial evaluated whether a standardized regimen of hand washing plus alcohol-based hand sanitizer could reduce asthma exacerbations more than schools' usual hand hygiene practices. METHODS This was a 2-year, community-based, randomized controlled crossover trial. Schools were randomized to usual care and then intervention (sequence 1) or intervention and then usual care (sequence 2). Intervention schools were provided with alcohol-based hand sanitizer, hand soap, and hand hygiene education. The primary outcome was the proportion of students experiencing an asthma exacerbation each month. Generalized estimating equations were used to model the difference in the marginal rate of exacerbations between sequences while controlling for individual demographic factors and the correlation within each student and between students within each school. RESULTS Five hundred twenty-seven students with asthma were enrolled among 31 schools. The hand hygiene intervention did not reduce the number of asthma exacerbations compared with the schools' usual hand hygiene practices (P = .132). There was a strong temporal trend because both sequences experienced fewer exacerbations during year 2 compared with year 1 (P < .001). CONCLUSIONS Although the intervention was not found to be effective, the results were confounded by the H1N1 influenza pandemic that resulted in substantially increased hand hygiene behaviors and resources in usual-care schools. Therefore these results should be viewed cautiously.
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Affiliation(s)
- Lynn B. Gerald
- Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, Arizona Respiratory Center, University of Arizona, 1295 N Martin Avenue, PO Box 245163, Tucson, AZ 85724-5163, (520)626-3243, (520)626-6093 FAX
| | - Joe K. Gerald
- Division of Community, Environment, and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Bin Zhang
- Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center
| | | | - William C. Bailey
- Lung Health Center School Of Medicine, University of Alabama at Birmingham
| | - Kathy F. Harrington
- Lung Health Center, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham
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Nuño T, Gerald JK, Harris R, Martinez ME, Estrada A, García F. Comparison of breast and cervical cancer screening utilization among rural and urban Hispanic and American Indian women in the Southwestern United States. Cancer Causes Control 2012; 23:1333-41. [DOI: 10.1007/s10552-012-0012-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 06/05/2012] [Indexed: 10/28/2022]
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Gerald JK, Stroupe N, McClure LA, Wheeler L, Gerald LB. Availability of Asthma Quick Relief Medication in Five Alabama School Systems. Pediatr Allergy Immunol Pulmonol 2012; 25:11-16. [PMID: 22454787 PMCID: PMC3306583 DOI: 10.1089/ped.2011.0118] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 11/28/2011] [Indexed: 11/12/2022]
Abstract
OBJECTIVES: This paper documents individual asthma action plan presence and quick relief medication (albuterol) availability for elementary students enrolled in five Alabama school systems. PATIENTS AND METHODS: Data were obtained during baseline data collection (fall 2005) of a school-based supervised asthma medication trial. All students attended 1 of 36 participating elementary schools across five school systems in Jefferson County, Alabama. In addition, they had to have physician-diagnosed asthma requiring daily controller medication. Each school system had its own superintendent and elected school board. Asthma action plan presence and albuterol availability was confirmed by study personnel. Asthma action plans had to contain daily and acute asthma management instructions. Predictors of asthma action plan presence and albuterol availability were also investigated. Associations between albuterol availability and self-reported characteristics including health care utilization prior to study enrollment and outcomes during the study baseline period were also investigated. RESULTS: Enrolled students had a mean (SD) age of 11.0 (2.1) years, 91% were African American, and 79% had moderate persistent asthma. No student had a complete asthma action plan on file and only 14% had albuterol physically available at school. Albuterol availability was not predicted by gender, race, insurance status, second-hand smoke exposure, need for pre-exercise albuterol, asthma severity, or self-reported health care utilization prior to study enrollment. Albuterol availability did not predict school absences, red/yellow peak flow recordings, or medication adherence during the study's baseline period. CONCLUSION: Despite policies permitting students to possess albuterol, few elementary students across five independent school systems in Alabama actually had it readily available at school.
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Affiliation(s)
- Joe K. Gerald
- Division of Community, Environment and Policy, University of Arizona, Tucson, Arizona
| | - Nancy Stroupe
- Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Leslie A. McClure
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lani Wheeler
- Division of Community, Environment and Policy, University of Arizona, Tucson, Arizona
- Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
- Arizona Respiratory Center, University of Arizona, Tucson, Arizona
| | - Lynn B. Gerald
- Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
- Arizona Respiratory Center, University of Arizona, Tucson, Arizona
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Gerald JK, McClure LA, Harrington KF, Moore T, Hernández-Martínez AC, Gerald LB. Measurement characteristics of the pediatric asthma health outcome measure. J Asthma 2012; 49:260-6. [PMID: 22335297 DOI: 10.3109/02770903.2012.656863] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The Pediatric Asthma Health Outcome Measure (PAHOM) was designed to measure quality-adjusted life years (QALYs) in children with asthma. Our objective was to compare parent- and child-reported PAHOM scores to each other, to parent-reported scores on the Juniper Asthma Control Questionnaire (ACQ), and to physician-rated asthma control. METHODS A convenience sample of primarily African-American parent-child dyads (N = 261) was recruited from asthma clinics between May 2008 and May 2010. Correlations and differences in scores between the instruments and respondents were compared across variables of interest. The sensitivity and specificity of each, relative to physician-rated asthma control, were estimated. RESULTS Mean (SD) parent- and child-reported PAHOM scores were significantly different, 0.91 (0.13) and 0.95 (0.08), respectively, (p < .01) and were weakly correlated (0.24). Parent-reported PAHOM and parent-reported ACQ, 5-item version (ACQ5) scores were moderately correlated (-0.69). Both the parent- and child-reported PAHOM scores distinguished between physician-rated well-controlled and not well-controlled asthma (p < .01 and p < .01, respectively). When compared with physician-rated asthma control, the areas under the receiver operating characteristic (ROC) curves for the parent-reported PAHOM and the ACQ5 were similar (p = .11), but both performed better than the child-reported PAHOM (both p < .01). Discussion. The validity of the PAHOM is supported by its moderate correlation with the ACQ and its association with physician-rated asthma control. Although intended to be administered to children, parent-reported scores were better predictors of physician-rated asthma control. CONCLUSIONS A validation study in a more economically and ethnically diverse population is needed. Until then, we recommend the PAHOM to be administered to both parents and children.
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Affiliation(s)
- Joe K Gerald
- Division of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA.
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Levine DA, Funkhouser EM, Houston TK, Gerald JK, Johnson-Roe N, Allison JJ, Richman J, Kiefe CI. Improving care after myocardial infarction using a 2-year internet-delivered intervention: the Department of Veterans Affairs myocardial infarction-plus cluster-randomized trial. ACTA ACUST UNITED AC 2012; 171:1910-7. [PMID: 22123798 DOI: 10.1001/archinternmed.2011.498] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Cardiovascular risk reduction in ambulatory patients who survive myocardial infarction (MI) is effective but underused. We sought to evaluate a provider-directed, Internet-delivered intervention to improve cardiovascular management for post-MI outpatients. METHODS The Department of Veterans Affairs (VA) MI-Plus study was a cluster-randomized trial involving 168 community-based primary care clinics and 847 providers in 26 states, the Virgin Islands, and Puerto Rico, from January 1, 2002, through December 31, 2008, with the clinic as the randomization unit. We collected administrative data for 15,847 post-MI patients and medical record data for 10,452 of these. A multicomponent, Internet-delivered intervention included quarterly educational modules, practice guidelines, monthly literature summaries, and automated e-mail reminders delivered to providers for 27 months. Main outcome measures included percentage of patients who achieved each of 7 clinical indicators, a composite score of the 7 clinical indicators, and mean low-density lipoprotein cholesterol and hemoglobin A(1c) levels. RESULTS Clinics had a median of 3 providers (interquartile range, 2-6), with a median of 50.0% of providers (33.3%-66.7%) participating in the study. Patients in intervention clinics had greater improvements (from 70.0% to 85.5%) in the percentages prescribed β-blockers than patients in control clinics (71.9% to 84.0%; adjusted improvement gain for intervention vs control, 2.6%; 95% CI, 0.1%-4.1%). We found nonsignificant differences in improvements favoring patients in intervention clinics for 5 of 6 remaining clinical indicators and levels of low-density lipoprotein cholesterol and hemoglobin A(1c). CONCLUSION A longitudinal, Internet-delivered intervention improved only 1 of 7 clinical indicators of cardiovascular management in ambulatory post-MI patients.
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Affiliation(s)
- Deborah A Levine
- Department of Medicine, University of Michigan, Ann Arbor, 48109, USA.
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Gerald LB, Gerald JK, McClure LA, Harrington K, Erwin S, Bailey WC. Redesigning a large school-based clinical trial in response to changes in community practice. Clin Trials 2011; 8:311-9. [PMID: 21730079 PMCID: PMC3145214 DOI: 10.1177/1740774511403513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Asthma exacerbations are seasonal with the greatest risk in elementary-age
students occurring shortly after returning to school following summer break. Recent
research suggests that this seasonality in children is primarily related to viral
respiratory tract infections. Regular hand washing is the most effective method to
prevent the spread of viral respiratory infections; unfortunately, achieving hand
washing recommendations in schools is difficult. Therefore, we designed a study to
evaluate the effect of hand sanitizer use in elementary schools on exacerbations
among children with asthma. Purpose To describe the process of redesigning the trial in response to changes in
the safety profile of the hand sanitizer as well as changes in hand hygiene practice
in the schools. Methods The original trial was a randomized, longitudinal, subject-blinded,
placebo-controlled, community-based crossover trial. The primary aim was to evaluate
the incremental effectiveness of hand sanitizer use in addition to usual hand hygiene
practices to decrease asthma exacerbations in elementary-age children. Three events
occurred that required major modifications to the original study protocol: (1) safety
concerns arose regarding the hand sanitizer’s active ingredient; (2) no substitute
placebo hand sanitizer was available; and (3) community preferences changed regarding
hand hygiene practices in the schools. Results The revised protocol is a randomized, longitudinal, community-based crossover
trial. The primary aim is to evaluate the incremental effectiveness of a two-step
hand hygiene process (hand hygiene education plus institutionally provided
alcohol-based hand sanitizer) versus usual care to decrease asthma exacerbations.
Enrollment was completed in May 2009 with 527 students from 30 schools. The
intervention began in August 2009 and will continue through May 2011. Study results
should be available at the end of 2011. Limitations The changed design does not allow us to directly measure the effectiveness of
hand sanitizer use as a supplement to traditional hand washing practices. Conclusions The need to balance a rigorous study design with one that is acceptable to
the community requires investigators to be actively involved with community
collaborators and able to adapt study protocols to fit changing community
practices.
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Affiliation(s)
- Lynn B Gerald
- Mel and Enid Zuckerman College of Public Health, and the Arizona Respiratory Center, University of Arizona, Tucson, USA.
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Funkhouser E, Levine DA, Gerald JK, Houston TK, Johnson NK, Allison JJ, Kiefe CI. Recruitment activities for a nationwide, population-based, group-randomized trial: the VA MI-Plus study. Implement Sci 2011; 6:105. [PMID: 21906278 PMCID: PMC3184080 DOI: 10.1186/1748-5908-6-105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 09/09/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Veterans Health Administration (VHA) oversees the largest integrated healthcare system in the United States. The feasibility of a large-scale, nationwide, group-randomized implementation trial of VHA outpatient practices has not been reported. We describe the recruitment and enrollment of such a trial testing a clinician-directed, Internet-delivered intervention for improving the care of postmyocardial infarction patients with multiple comorbidities. METHODS With a recruitment goal of 200 eligible community-based outpatient clinics, parent VHA facilities (medical centers) were recruited because they oversee their affiliated clinics and the research conducted there. Eligible facilities had at least four VHA-owned and -operated primary care clinics, an affiliated Institutional Review Board (IRB), and no ongoing, potentially overlapping, quality-improvement study. Between December 2003 and December 2005, in two consecutive phases, we used initial and then intensified recruitment strategies. RESULTS Overall, 48 of 66 (73%) eligible facilities were recruited. Of the 219 clinics and 957 clinicians associated with the 48 facilities, 168 (78%) clinics and 401 (42%) clinicians participated. The median time from initial facility contact to clinic enrollment was 222 days, which decreased by over one-third from the first to the second recruitment phase (medians: 323 and 195 days, respectively; p < .001), when more structured recruitment with physician recruiters was implemented and a dedicated IRB manager was added to the coordinating center staff. CONCLUSIONS Large group-randomized trials benefit from having dedicated physician investigators and IRB personnel involved in recruitment. A large-scale, nationally representative, group-randomized trial of community-based clinics is feasible within the VHA or a similar national healthcare system.
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Affiliation(s)
- Ellen Funkhouser
- VA Research Enhancement Award Program (REAP), Birmingham VA Medical Center, Birmingham, AL, USA.
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Gerald JK, Grad R, Bailey WC, Gerald LB. Cost-effectiveness of school-based asthma screening in an urban setting. J Allergy Clin Immunol 2010; 125:643-50, 650.e1-650.e12. [PMID: 20226298 DOI: 10.1016/j.jaci.2009.12.984] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 12/11/2009] [Accepted: 12/15/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND Much has been done to promote population-based childhood asthma screening; however, concerns remain regarding its cost-effectiveness. OBJECTIVES To conduct a cost-effectiveness analysis of school-based asthma screening strategies. METHODS A 5 health state Markov approach (symptom-free, symptom, exacerbation recovery, emergency department, and hospitalization day) was used to evaluate school-based screening in a simulated population of urban elementary-age school children. Two questionnaire and 2 multistage strategies incorporating spirometry or spirometry with exercise testing were evaluated from the societal perspective by using 365 daily cycles. The outcome was 2006 dollars per quality-adjusted life year (QALY). RESULTS The most efficient strategy identified children with previously diagnosed but poorly controlled asthma at a cost of $150,000 per QALY (95% CI, $65,800-$318,000). Uncertainty surrounding the cost-effectiveness estimate was primarily a result of the symptom day preference weight estimate (44%), the probability of confirmation after screening (17%), the adequacy of asthma control in the population (9%), and the estimated treatment effect on symptoms (6%). Screening generated an additional 21 symptom-free day equivalents per child identified with previously diagnosed but not well controlled asthma and led to $85.55, $12.36, and $2.58 in additional screening, daily treatment, and indirect costs and $5.01 less in emergency department and hospitalization costs. CONCLUSION Population-based asthma screening is not cost-effective at $50,000 per QALY and has only a 20% chance of being cost-effective at $100,000 per QALY. The most efficient approach is to screen for previously diagnosed but poorly controlled asthma. Linking screening with better treatment, and long-term adherence strategies might yield future cost-effective approaches.
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Affiliation(s)
- Joe K Gerald
- Division of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Ariz 85724, USA.
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Abstract
OBJECTIVE Population-based asthma detection is a potential strategy to reduce asthma morbidity in children; however, the burden of respiratory symptoms and health care use among children identified by case detection is not well known. METHODS Data come from a school-based asthma case detection validation study of 3539 children. Respiratory symptoms, emergency department (ED) visits, and hospitalizations were assessed by questionnaire for children whose case detection result and physician study diagnosis agreed. RESULTS Physician evaluation of 530 case detection results yielded 420 cases of agreement (168 children with previously diagnosed asthma, 39 with undiagnosed asthma, and 213 without asthma). Children with previously diagnosed asthma were more likely to be male (P < .0001). No differences in severity were observed in children with previously and undiagnosed asthma (P = .31). Children with undiagnosed asthma reported less frequent daytime and nighttime symptoms than children with previously diagnosed asthma but more than those without asthma (P < .0001). The proportion of children with at least 1 respiratory-related ED visit in the past year was 32%, 3%, and 3% for those with previously diagnosed, undiagnosed, and no asthma, respectively (P < .0001). The proportion with at least 1 respiratory-related hospitalization was 8%, 0%, and 0%, respectively (P < .0001). There were no differences in nonrespiratory ED visits (P = .93). CONCLUSIONS Despite similar physician-rated severity, children with undiagnosed asthma reported significantly less frequent respiratory symptoms and health care use than children with previously diagnosed asthma. These findings suggest that the potential health gains from case detection may be smaller than expected.
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Affiliation(s)
- Joe K. Gerald
- Division of Public Health Policy and Management, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Yanhui Sun
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Roni Grad
- Arizona Respiratory Center, University of Arizona, Tucson, Arizona
| | - Lynn B. Gerald
- Arizona Respiratory Center, University of Arizona, Tucson, Arizona,Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
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Gerald LB, Gerald JK, Gibson L, Patel K, Zhang S, McClure LA. Changes in environmental tobacco smoke exposure and asthma morbidity among urban school children. Chest 2008; 135:911-916. [PMID: 19017893 DOI: 10.1378/chest.08-1869] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Environmental tobacco smoke (ETS) exposure is associated with poor asthma outcomes in children. However, little is known about natural changes in ETS exposure over time in children with asthma and how these changes may affect health-care utilization. This article documents the relationship between changes in ETS exposure and childhood asthma morbidity among children enrolled in a clinical trial of supervised asthma therapy. METHODS Data for this analysis come from a large randomized clinical trial of supervised asthma therapy in which 290 children with persistent asthma were randomized to receive either usual care or supervised asthma therapy. No smoking cessation counseling or ETS exposure education was provided to caregivers; however, children were given 20 min of asthma education, which incorporated discussion of the avoidance of asthma triggers, including ETS. Asthma morbidity and ETS exposure data were collected from caregivers via telephone interviews at baseline and at the 1-year follow-up. RESULTS At baseline, 28% of caregivers reported ETS exposure in the home and 19% reported exposure outside of the primary household only. Among children whose ETS exposure decreased from baseline, fewer hospitalizations (p = 0.034) and emergency department (ED) visits (p < or = 0.001) were reported in the 12 months prior to the second interview compared to the 12 months prior to the first interview. Additionally, these children were 48% less likely (p = 0.042) to experience an episode of poor asthma control (EPAC). CONCLUSIONS This is the first study to demonstrate an association between ETS exposure reduction and fewer EPACs, respiratory-related ED visits, and hospitalizations. These findings emphasize the importance of ETS exposure reduction as a mechanism to improve asthma control and morbidity. Potential policy implications include supporting ETS reductions and smoking cessation interventions for parents and caregivers of children with asthma. Research to identify the most cost-effective strategy is warranted.
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Affiliation(s)
- Lynn B Gerald
- Health System Information Services, School of Public Health, University of Alabama at Birmingham, Birmingham, AL; Critical Care Medicine, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
| | - Joe K Gerald
- Lung Health Center, School of Medicine, Department of Medicine, Division of Pulmonary, Allergy
| | - Linda Gibson
- Lung Health Center, School of Medicine, Department of Medicine, Division of Pulmonary, Allergy; Critical Care Medicine, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Karna Patel
- Lung Health Center, School of Medicine, Department of Medicine, Division of Pulmonary, Allergy
| | - Sijian Zhang
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Leslie A McClure
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
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