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Schwartz A, Beemer LR, Ajibewa TA, Scott-Andrews KQ, Lewis TC, Robinson LE, Hasson RE. An exploratory analysis examining differences in physical activity and motor competence in children with and without asthma: brief report. J Asthma 2023; 60:2153-2159. [PMID: 37339004 DOI: 10.1080/02770903.2023.2225606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/12/2023] [Accepted: 06/11/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE The purpose of this pilot study was to examine potential differences in motor competence (MC) and physical activity (PA) between children with and without asthma. METHODS Thirty-seven children and adolescents completed the Exercises for a Healthy Asthma Lifestyle and Enjoyment study (46% with asthma, 51% female, 11.1 ± 0.4 years, and 46% White). Motor competence was assessed using the Movement Assessment Battery for Children 2nd edition (MABC-2). PA was assessed using accelerometry. RESULTS Children with asthma had significantly lower MC in the domain of aiming and catching (with asthma: 8.2 ± 0.4 vs. without asthma: 9.9 ± 0.5; p = 0.03) and fewer daily minutes spent in moderate-to-vigorous PA (MVPA) (with asthma: 18.0 ± 2.3 min vs. without asthma: 27.2 ± 3.6 min; p = 0.047). There were no significant group differences in manual dexterity, balance, total MABC-2 score, or total daily PA (all ps > 0.05). CONCLUSIONS This study provides confirmatory evidence that children with asthma display lower MC and spend less time in MVPA compared to children without asthma. Because MC is a prerequisite for engaging in PA, future research should seek to determine if the differences observed in MC contribute to disparities in MVPA observed in this clinical population.
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Affiliation(s)
- Anna Schwartz
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - Lexie R Beemer
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Toby C Lewis
- School of Medicine, University of Michigan, Ann Arbor, MI, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Leah E Robinson
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca E Hasson
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
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2
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Beemer LR, Lewis TC, Ajibewa TA, Dopp R, B Eisman A, Hasson RE. Classroom-Based Strategies to Reduce Disparities in Physical Activity Among Children with Asthma. Prev Sci 2022; 23:587-597. [PMID: 35080712 DOI: 10.1007/s11121-022-01347-7] [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] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Abstract
Children with asthma often experience physical activity (PA) induced symptoms 5-15 min following the start of exercise. Classroom PA breaks provide short intermittent bouts of PA and may represent a novel strategy to safely promote PA participation in this clinical population. The purpose of this study was to determine the feasibility of a classroom-based PA intervention, Interrupting Prolonged Sitting with Activity (InPACT), where teachers implement 5 × 4-min moderate-to-vigorous physical activity (MVPA) breaks throughout the school day. Nine classrooms at one elementary-middle school in Detroit, MI (student demographics: 79% Hispanic; 80% on free/reduced lunch; 31% prevalence of asthma and asthma-like symptoms) participated in this 20-week intervention. Asthma status was self-reported via the International Study of Asthma and Allergies in Childhood (ISAAC) Video Questionnaire in conjunction with nurse documentation. PA participation, exercise intensity, and asthmatic symptom occurrence were assessed via direct observation. Students accumulated approximately 17 min of activity per day during PA breaks. Compared to students without asthma, a higher percentage of students with asthma participated in MVPA (asthma: 52.9% ± 1.2%; non-asthma: 46.2% ± 0.8%; p = 0.01), a lower percentage participated in light PA (asthma: 25.9% ± 1.0%; non-asthma: 30.1% ± 0.7%; p = 0.01), and sedentary time during activity breaks (asthma: 21.2% ± 0.9%; non-asthma: 23.8% ± 0.7%; p = 0.02). Out of 294 observations, six instances of asthmatic symptoms (coughing) were observed in students with asthma 5-15 min following the PA break. Symptoms self-resolved within 15-min of the PA break and did not result in sustained exercise-induced bronchoconstriction. Classroom-based interventions that incorporate short intermittent bouts of PA represent safe exercises for children with asthma and may help to reduce PA disparities in this clinical population.
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Affiliation(s)
- Lexie R Beemer
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.,Childhood Disparities Research Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Toby C Lewis
- School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Tiwaloluwa A Ajibewa
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.,Childhood Disparities Research Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Richard Dopp
- Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Andria B Eisman
- College of Education, Wayne State University, Detroit, MI, USA
| | - Rebecca E Hasson
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA. .,Childhood Disparities Research Laboratory, University of Michigan, Ann Arbor, MI, USA. .,School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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3
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Dabaja E, Dabaja K, Ismail M, Haidous M, Hamka A, Alexander Blackwood R, Lewis TC. Pediatric Muslim Fasting Practices in Southeast Michigan: A Community Survey. J Community Health 2021; 45:732-738. [PMID: 31902047 DOI: 10.1007/s10900-020-00788-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
During the holy month of Ramadan, Muslims fast from all water, food, and medications from dawn till dusk. To date, the existing medical literature focuses on adult fasting with little attention paid to pediatric fasting practices. An anonymous, digital, bilingual survey was conducted using Qualtrics software. Participants were recruited in-person at various community clinics, businesses, and mosques as well as online via social media. To be eligible for the study, participants must identify as Muslim and be parents or guardians of child/ren between the age/s of 7 and 18. Between July 2017 and May 2018, 918 people took part in the initial survey, with 70% (524/751) of participants living in Wayne County, MI. Approximately 80% (624/779) identified as Arab American and 57% (437/773) as immigrants to the US. Over 63% (522/827) of participants reported that their child's health care provider was unaware that their child/ren fasted during Ramadan. In addition, 75% (613/820) of participants indicated that their child's health care provider did not offer them any medical advice regarding fasting. However, 69% (554/805) of participants reported being comfortable discussing fasting practices with their child's doctor. Furthermore, 80% (569/714), of participants reported that their child/ren's doctor had a good or an advanced understanding of fasting. Our study is an important first step in helping elucidate beliefs and practices about Muslim pediatric fasting in Michigan. In addition, it highlights a stark contrast between the perceptions of parents and the current clinical practice of their physicians.
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Affiliation(s)
- Emman Dabaja
- Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien Street, Detroit, MI, 48201, USA.
| | - Khalil Dabaja
- College of Arts, Sciences, and Letters, University of Michigan - Dearborn, Dearborn, MI, 48127, USA
| | - Malak Ismail
- College of Literature, Sciences, and Arts, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Muhammad Haidous
- College of Arts, Sciences, and Letters, University of Michigan - Dearborn, Dearborn, MI, 48127, USA
| | - Adnan Hamka
- College of Arts, Sciences, and Letters, University of Michigan - Dearborn, Dearborn, MI, 48127, USA
| | | | - Toby C Lewis
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, 48109, USA
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4
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Jazaeri S, Goldsmith AM, Jarman CR, Lee J, Hershenson MB, Lewis TC. Nasal interferon responses to community rhinovirus infections are similar in controls and children with asthma. Ann Allergy Asthma Immunol 2021; 126:690-695.e1. [PMID: 33515711 DOI: 10.1016/j.anai.2021.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/12/2020] [Accepted: 01/19/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Rhinovirus (RV) is the main cause of asthma exacerbations in children. Some studies reported that persons with asthma have attenuated interferon (IFN) responses to experimental RV infection compared with healthy individuals. However, responses to community-acquired RV infections in controls and children with asthma have not been compared. OBJECTIVE To evaluate nasal cytokine responses after natural RV infections in people with asthma and healthy children. METHODS We compared nasal cytokine expression among controls and children with asthma during healthy, virus-negative surveillance weeks and self-reported RV-positive sick weeks. A total of 14 controls and 21 patients with asthma were studied. Asthma disease severity was based on symptoms and medication use. Viral genome was detected by multiplex polymerase chain reaction. Nasal cytokine protein levels were determined by multiplex assays. RESULTS Two out of 47 surveillance weeks tested positive for RV, illustrating an asymptomatic infection rate of 5%. A total of 38 of 47 sick weeks (81%) tested positive for the respiratory virus. Of these, 33 (87%) were positive for RV. During well weeks, nasal interleukin 8 (IL-8), IL-12, and IL-1β levels were higher in children with asthma than controls. Compared with healthy virus-negative surveillance weeks, IL-8, IL-13, and interferon beta increased during colds only in patients with asthma. In both controls and children with asthma, the nasal levels of interferon gamma, interferon lambda-1, IL-1β, IL-8, and IL-10 increased during RV-positive sick weeks. During RV infection, IL-8, IL-1β, and tumor necrosis factor-α levels were strongly correlated. CONCLUSION In both controls and patients with asthma, natural RV infection results in robust type II and III IFN responses.
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Affiliation(s)
| | - Adam M Goldsmith
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Caitlin R Jarman
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Julie Lee
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Marc B Hershenson
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Toby C Lewis
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan.
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5
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Sur I, Scott-Andrews KQ, Beemer LR, Ajibewa TA, Robinson LE, Lewis TC, Hasson RE. Perceived And Actual Motor Competence And Physical Activity In Children With And Without Asthma. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000671280.40829.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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6
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Ajibewa TA, Beemer LR, Scott-Andrews KQ, Sur I, Robinson LE, Lewis TC, Hasson RE. Acute Effects Of Intermittent Physical Activity On Psychological Stress And Insecurity In Children And Adolescents With And Without Asthma. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000671300.10328.c8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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7
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Moore PE, Boyer D, Perkins R, Katz ES, Castro-Codesal ML, MacLean JE, Akil N, Esther CR, Kaslow J, Lewis TC, Krone KA, Quizon A, Simpson R, Benscoter D, Spielberg DR, Melicoff E, Kuklinski CA, Blatter JA, Dy J, Rettig JS, Horani A, Gross J. American Thoracic Society 2019 Pediatric Core Curriculum. Pediatr Pulmonol 2019; 54:1880-1894. [PMID: 31456278 DOI: 10.1002/ppul.24482] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/04/2019] [Indexed: 11/07/2022]
Abstract
The American Thoracic Society Pediatric Core Curriculum updates clinicians annually in pediatric pulmonary disease in a 3 to 4 year recurring cycle of topics. The 2019 course was presented in May during the Annual International Conference. An American Board of Pediatrics Maintenance of Certification module and a continuing medical education exercise covering the contents of the Core Curriculum can be accessed online at www.thoracic.org.
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Affiliation(s)
- Paul E Moore
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Debra Boyer
- Division of Respiratory Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ryan Perkins
- Division of Respiratory Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eliot S Katz
- Division of Respiratory Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maria L Castro-Codesal
- Division of Pediatric Respirology, Pulmonary, and Asthma, Department of Pediatrics, University of Alberta, Alberta, Canada
| | - Joanna E MacLean
- Division of Pediatric Respirology, Pulmonary, and Asthma, Department of Pediatrics, University of Alberta, Alberta, Canada
| | - Nour Akil
- Division of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Charles R Esther
- Division of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jacob Kaslow
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Toby C Lewis
- Department of Pediatrics, University of Michigan Medical School, Ann Harbor, Michigan
| | - Katie A Krone
- Division of Respiratory Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Annabelle Quizon
- Division of Pediatric Pulmonology, Rady Children's Hospital, University of California San Diego, San Diego, California
| | - Ryne Simpson
- Division of Pulmonary Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Dan Benscoter
- Division of Pulmonary Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David R Spielberg
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Ernestina Melicoff
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Cadence A Kuklinski
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Joshua A Blatter
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jamie Dy
- Department of Pediatrics, UCSF, San Francisco, California
| | - Jordan S Rettig
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amjad Horani
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Jane Gross
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, National Jewish Hospital, Denver, Colorado
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8
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Han M, Bentley JK, Rajput C, Lei J, Ishikawa T, Jarman CR, Lee J, Goldsmith AM, Jackson WT, Hoenerhoff MJ, Lewis TC, Hershenson MB. Inflammasome activation is required for human rhinovirus-induced airway inflammation in naive and allergen-sensitized mice. Mucosal Immunol 2019; 12:958-968. [PMID: 31089187 PMCID: PMC6668626 DOI: 10.1038/s41385-019-0172-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/09/2019] [Accepted: 04/29/2019] [Indexed: 02/04/2023]
Abstract
Activation of the inflammasome is a key function of the innate immune response that regulates inflammation in response to microbial substances. Inflammasome activation by human rhinovirus (RV), a major cause of asthma exacerbations, has not been well studied. We examined whether RV induces inflammasome activation in vivo, molecular mechanisms underlying RV-stimulated inflammasome priming and activation, and the contribution of inflammasome activation to RV-induced airway inflammation and exacerbation. RV infection triggered lung mRNA and protein expression of pro-IL-1β and NLRP3, indicative of inflammasome priming, as well as cleavage of caspase-1 and pro-IL-1β, completing inflammasome activation. Immunofluorescence staining showed IL-1β in lung macrophages. Depletion with clodronate liposomes and adoptive transfer experiments showed macrophages to be required and sufficient for RV-induced inflammasome activation. TLR2 was required for RV-induced inflammasome priming in vivo. UV irradiation blocked inflammasome activation and RV genome was sufficient for inflammasome activation in primed cells. Naive and house dust mite-treated NLRP3-/- and IL-1β-/- mice, as well as IL-1 receptor antagonist-treated mice, showed attenuated airway inflammation and responsiveness following RV infection. We conclude that RV-induced inflammasome activation is required for maximal airway inflammation and hyperresponsiveness in naive and allergic mice. The inflammasome represents a molecular target for RV-induced asthma exacerbations.
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Affiliation(s)
- Mingyuan Han
- Department of Pediatrics,University of Michigan Medical School, Ann Arbor, MI 48109
| | - J. Kelley Bentley
- Department of Pediatrics,University of Michigan Medical School, Ann Arbor, MI 48109
| | - Charu Rajput
- Department of Pediatrics,University of Michigan Medical School, Ann Arbor, MI 48109
| | - Jing Lei
- Department of Pediatrics,University of Michigan Medical School, Ann Arbor, MI 48109
| | - Tomoko Ishikawa
- Department of Pediatrics,University of Michigan Medical School, Ann Arbor, MI 48109
| | - Caitlin R. Jarman
- Department of Pediatrics,University of Michigan Medical School, Ann Arbor, MI 48109
| | - Julie Lee
- Department of Pediatrics,University of Michigan Medical School, Ann Arbor, MI 48109
| | - Adam M. Goldsmith
- Department of Pediatrics,University of Michigan Medical School, Ann Arbor, MI 48109
| | - William T. Jackson
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD 21201
| | - Mark J. Hoenerhoff
- Department of Unit for Laboratory Animal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109
| | - Toby C. Lewis
- Department of Pediatrics,University of Michigan Medical School, Ann Arbor, MI 48109
| | - Marc B. Hershenson
- Department of Pediatrics,University of Michigan Medical School, Ann Arbor, MI 48109;,Department of Molecular and Integrative Physiology,University of Michigan Medical School, Ann Arbor, MI 48109
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9
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Abstract
Background: There is a clear relationship between obesity and asthma, with obesity recognized as a risk factor for asthma. There is mounting evidence, however, that asthma may predict obesity risk via behavioral pathways. Objectives: The purpose of this study was to assess the cross-sectional relationships between asthma, body mass index (BMI) percentile, and behavioral factors including caloric intake, dietary inflammatory index, moderate-vigorous physical activity (MVPA), and sedentary time (SED) among African American adolescents. Methods: A community-based sample of 195 African American youth (ages 11-18 years) were included in this analysis. Asthma status was based on self-report using the International Study of Asthma and Allergies in Children's Phase Three questionnaire. MVPA and SED were measured via accelerometry, and caloric intake and dietary inflammatory index were evaluated with the Food Frequency Questionnaire. Weight status was assessed via BMI percentile using measured weight, height, and CDC growth charts. Results: Adolescents with a history of asthma were significantly more overweight (62% vs. 43%, p = 0.04) and consumed a higher inflammatory diet (1.6 ± 0.3 vs. 1.0 ± 0.2, p = 0.02) than their peers who never had asthma. After adjusting for all covariates, activity and dietary variables, odds ratio analysis revealed adolescents who reported ever having asthma were 3.1 ± 1.5 times as likely to be overweight or obese than adolescents with no asthma history (p = 0.02). Conclusions: Presence of asthma history was associated with increased obesity risk in African American adolescents, independent of behavioral factors. Longitudinal studies are needed to better understand the relationship between asthma and obesity in African American adolescents.
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Affiliation(s)
- Matthew R Nagy
- Childhood Disparities Research Laboratory, University of Michigan, Ann Arbor, Michigan, USA.,School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Kellye C McGlumphy
- Childhood Disparities Research Laboratory, University of Michigan, Ann Arbor, Michigan, USA.,School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard Dopp
- School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Toby C Lewis
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Rebecca E Hasson
- Childhood Disparities Research Laboratory, University of Michigan, Ann Arbor, Michigan, USA.,School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
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10
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Coombe CM, Schulz AJ, Guluma L, Allen AJ, Gray C, Brakefield-Caldwell W, Guzman JR, Lewis TC, Reyes AG, Rowe Z, Pappas LA, Israel BA. Enhancing Capacity of Community-Academic Partnerships to Achieve Health Equity: Results From the CBPR Partnership Academy. Health Promot Pract 2018; 21:552-563. [PMID: 30596283 DOI: 10.1177/1524839918818830] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Community-based participatory research (CBPR) is an equitable partnership approach that links academic researchers, community organizations, and public health practitioners to work together to understand and address health inequities. Although numerous educational materials on CBPR exist, few training programs develop the skills and knowledge needed to establish effective, equitable partnerships. Furthermore, there are few professional development opportunities for academic researchers, practitioners, and community members to obtain these competencies in an experiential co-learning process. In response, the Detroit Community-Academic Urban Research Center developed the CBPR Partnership Academy, an innovative, yearlong capacity-building program facilitated by experienced community and academic partners, involving an intensive short course, partnership development, grant proposal preparation and funding, mentoring, online learning forums, and networking. Three diverse cohorts (36 teams) from 18 states and 2 tribal nations have participated. We describe the rationale and components of the training program and present results from the first two cohorts. Evaluation results suggest enhanced competence and efficacy in conducting CBPR. Outcomes include partnerships established, grant proposals submitted and funded, workshops and research conducted, and findings disseminated. A community-academic partner-based, integrated, applied program can be effective for professional development and establishing innovative linkages between academics and practitioners aimed at achieving health equity.
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Affiliation(s)
| | | | | | | | - Carol Gray
- University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Angela G Reyes
- Detroit Hispanic Development Corporation, Detroit, MI, USA
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11
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Lewis TC, Metitiri EE, Mentz GB, Ren X, Carpenter AR, Goldsmith AM, Wicklund KE, Eder BN, Comstock AT, Ricci JM, Brennan SR, Washington GL, Owens KB, Mukherjee B, Robins TG, Batterman SA, Hershenson MB. Influence of viral infection on the relationships between airway cytokines and lung function in asthmatic children. Respir Res 2018; 19:228. [PMID: 30463560 PMCID: PMC6249926 DOI: 10.1186/s12931-018-0922-9] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/24/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Few longitudinal studies examine inflammation and lung function in asthma. We sought to determine the cytokines that reduce airflow, and the influence of respiratory viral infections on these relationships. METHODS Children underwent home collections of nasal lavage during scheduled surveillance periods and self-reported respiratory illnesses. We studied 53 children for one year, analyzing 392 surveillance samples and 203 samples from 85 respiratory illnesses. Generalized estimated equations were used to evaluate associations between nasal lavage biomarkers (7 mRNAs, 10 proteins), lung function and viral infection. RESULTS As anticipated, viral infection was associated with increased cytokines and reduced FVC and FEV1. However, we found frequent and strong interactions between biomarkers and virus on lung function. For example, in the absence of viral infection, CXCL10 mRNA, MDA5 mRNA, CXCL10, IL-4, IL-13, CCL4, CCL5, CCL20 and CCL24 were negatively associated with FVC. In contrast, during infection, the opposite relationship was frequently found, with IL-4, IL-13, CCL5, CCL20 and CCL24 levels associated with less severe reductions in both FVC and FEV1. CONCLUSIONS In asthmatic children, airflow obstruction is driven by specific pro-inflammatory cytokines. In the absence of viral infection, higher cytokine levels are associated with decreasing lung function. However, with infection, there is a reversal in this relationship, with cytokine abundance associated with reduced lung function decline. While nasal samples may not reflect lower airway responses, these data suggest that some aspects of the inflammatory response may be protective against viral infection. This study may have ramifications for the treatment of viral-induced asthma exacerbations.
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Affiliation(s)
- Toby C. Lewis
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, 1150 W. Medical Center Dr., Building MSRB2, Room 3570B, Ann Arbor, MI 48109-5688 USA
- Environmental Health Sciences, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
- Health Behavior/Health Education, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
| | - Ediri E. Metitiri
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, 1150 W. Medical Center Dr., Building MSRB2, Room 3570B, Ann Arbor, MI 48109-5688 USA
| | - Graciela B. Mentz
- Health Behavior/Health Education, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
| | - Xiaodan Ren
- Environmental Health Sciences, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
| | - Ashley R. Carpenter
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, 1150 W. Medical Center Dr., Building MSRB2, Room 3570B, Ann Arbor, MI 48109-5688 USA
| | - Adam M. Goldsmith
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, 1150 W. Medical Center Dr., Building MSRB2, Room 3570B, Ann Arbor, MI 48109-5688 USA
| | - Kyra E. Wicklund
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, 1150 W. Medical Center Dr., Building MSRB2, Room 3570B, Ann Arbor, MI 48109-5688 USA
- Epidemiology, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
| | - Breanna N. Eder
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, 1150 W. Medical Center Dr., Building MSRB2, Room 3570B, Ann Arbor, MI 48109-5688 USA
| | - Adam T. Comstock
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, 1150 W. Medical Center Dr., Building MSRB2, Room 3570B, Ann Arbor, MI 48109-5688 USA
| | - Jeannette M. Ricci
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, 1150 W. Medical Center Dr., Building MSRB2, Room 3570B, Ann Arbor, MI 48109-5688 USA
| | - Sean R. Brennan
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, 1150 W. Medical Center Dr., Building MSRB2, Room 3570B, Ann Arbor, MI 48109-5688 USA
| | - Ginger L. Washington
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, 1150 W. Medical Center Dr., Building MSRB2, Room 3570B, Ann Arbor, MI 48109-5688 USA
| | - Kendall B. Owens
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, 1150 W. Medical Center Dr., Building MSRB2, Room 3570B, Ann Arbor, MI 48109-5688 USA
| | - Bhramar Mukherjee
- Departments of Biostatistics, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
| | - Thomas G. Robins
- Environmental Health Sciences, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
| | - Stuart A. Batterman
- Environmental Health Sciences, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
| | - Marc B. Hershenson
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, 1150 W. Medical Center Dr., Building MSRB2, Room 3570B, Ann Arbor, MI 48109-5688 USA
- Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, USA
| | - the Community Action Against Asthma Steering Committee
- Departments of Pediatrics and Communicable Diseases, University of Michigan Medical School, 1150 W. Medical Center Dr., Building MSRB2, Room 3570B, Ann Arbor, MI 48109-5688 USA
- Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, USA
- Departments of Biostatistics, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
- Environmental Health Sciences, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
- Epidemiology, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
- Health Behavior/Health Education, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI 48109 USA
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12
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Lewis TC, Metitiri EE, Mentz GB, Ren X, Goldsmith AM, Eder BN, Wicklund KE, Walsh MP, Comstock AT, Ricci JM, Brennan SR, Washington GL, Owens KB, Mukherjee B, Robins TG, Batterman SA, Hershenson MB. Impact of community respiratory viral infections in urban children with asthma. Ann Allergy Asthma Immunol 2018; 122:175-183.e2. [PMID: 30385348 PMCID: PMC6360098 DOI: 10.1016/j.anai.2018.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/13/2018] [Accepted: 10/21/2018] [Indexed: 12/13/2022]
Abstract
Background Upper respiratory tract viral infections cause asthma exacerbations in children. However, the impact of natural colds on children with asthma in the community, particularly in the high-risk urban environment, is less well defined. Objective We hypothesized that children with high-symptom upper respiratory viral infections have reduced airway function and greater respiratory tract inflammation than children with virus-positive low-symptom illnesses or virus-negative upper respiratory tract symptoms. Methods We studied 53 children with asthma from Detroit, Michigan, during scheduled surveillance periods and self-reported respiratory illnesses for 1 year. Symptom score, spirometry, fraction of exhaled nitric oxide (FeNO), and nasal aspirate biomarkers, and viral nucleic acid and rhinovirus (RV) copy number were assessed. Results Of 658 aspirates collected, 22.9% of surveillance samples and 33.7% of respiratory illnesses were virus-positive. Compared with the virus-negative asymptomatic condition, children with severe colds (symptom score ≥5) showed reduced forced expiratory flow at 25% to 75% of the pulmonary volume (FEF25%-75%), higher nasal messenger RNA expression of C-X-C motif chemokine ligand (CXCL)-10 and melanoma differentiation-associated protein 5, and higher protein abundance of CXCL8, CXCL10 and C-C motif chemokine ligands (CCL)-2, CCL4, CCL20, and CCL24. Children with mild (symptom score, 1-4) and asymptomatic infections showed normal airway function and fewer biomarker elevations. Virus-negative cold-like illnesses demonstrated increased FeNO, minimal biomarker elevation, and normal airflow. The RV copy number was associated with nasal chemokine levels but not symptom score. Conclusion Urban children with asthma with high-symptom respiratory viral infections have reduced FEF25%-75% and more elevations of nasal biomarkers than children with mild or symptomatic infections, or virus-negative illnesses.
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Affiliation(s)
- Toby C Lewis
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan; Department of Environmental Health Sciences, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan; Department of Health Behavior/Health Education, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Ediri E Metitiri
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Graciela B Mentz
- Department of Health Behavior/Health Education, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Xiaodan Ren
- Department of Environmental Health Sciences, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Adam M Goldsmith
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Breanna N Eder
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kyra E Wicklund
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Megan P Walsh
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Adam T Comstock
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jeannette M Ricci
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Sean R Brennan
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ginger L Washington
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kendall B Owens
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Thomas G Robins
- Department of Environmental Health Sciences, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Stuart A Batterman
- Department of Environmental Health Sciences, University of Michigan School of Public Health; University of Michigan, Ann Arbor, Michigan
| | - Marc B Hershenson
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan; Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, Michigan.
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Simon CT, Lewis TC, Neemuchwala F, Arteta M, Rabah R. Pulmonary alveolar microlithiasis: A case report with a novel mutation in the SLC34A2 gene and review of the literature. Human Pathology: Case Reports 2018. [DOI: 10.1016/j.ehpc.2018.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Schulz AJ, Mentz GB, Sampson N, Ward M, Anderson R, de Majo R, Israel BA, Lewis TC, Wilkins D. RACE AND THE DISTRIBUTION OF SOCIAL AND PHYSICAL ENVIRONMENTAL RISK: A Case Example from the Detroit Metropolitan Area. Du Bois Rev 2016; 13:285-304. [PMID: 28951763 PMCID: PMC5610908 DOI: 10.1017/s1742058x16000163] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Since W. E. B. Du Bois documented the physical and social environments of Philadelphia's predominantly African American Seventh Ward over a century ago, there has been continued interest in understanding the distribution of social and physical environments by racial make-up of communities. Characterization of these environments allows for documentation of inequities, identifies communities which encounter heightened risk, and can inform action to promote health equity. In this paper, we apply and extend Du Bois's approach to examine the contemporary distribution of physical environmental exposures, health risks, and social vulnerabilities in the Detroit metropolitan area, one of the most racially-segregated areas in the United States. We begin by mapping the proximity of sensitive populations to hazardous land uses, their exposure to air pollutants and associated health risks, and social vulnerabilities, as well as cumulative risk (combined proximity, exposure, and vulnerability), across Census tracts. Next, we assess, quantitatively, the extent to which communities of color experience excess burdens of environmental exposures and associated health risks, economic and age-related vulnerabilities, and cumulative risk. The results, depicted in maps presented in the paper, suggest that Census tracts with greater proportions of people of color disproportionately encounter physical environmental exposures, socioeconomic vulnerabilities, and combined risk. Quantitative tests of inequality confirm these distributions, with statistically greater exposures, vulnerabilities, and cumulative risk in Census tracts with larger proportions of people of color. Together, these findings identify communities that experience disproportionate cumulative risk in the Detroit metropolitan area and quantify the inequitable distribution of risk by Census tract relative to the proportion of people of color. They identify clear opportunities for prioritizing communities for legislative, regulatory, policy, and local actions to promote environmental justice and health equity.
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Affiliation(s)
- Amy J Schulz
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
| | - Graciela B Mentz
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
| | - Natalie Sampson
- Department of Health and Human Services, University of Michigan-Dearborn
| | - Melanie Ward
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
| | | | - Ricardo de Majo
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
| | - Barbara A Israel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
| | - Toby C Lewis
- Department of Pediatrics and Communicable Diseases and Environmental Health Sciences, University of Michigan, Ann Arbor
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Ramirez IA, Caverly LL, Kalikin LM, Goldsmith AM, Lewis TC, Burke DT, LiPuma JJ, Sajjan US, Hershenson MB. Differential responses to rhinovirus- and influenza-associated pulmonary exacerbations in patients with cystic fibrosis. Ann Am Thorac Soc 2014; 11:554-61. [PMID: 24641803 PMCID: PMC4225796 DOI: 10.1513/annalsats.201310-346oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 10/07/2013] [Accepted: 01/26/2014] [Indexed: 12/25/2022] Open
Abstract
RATIONALE The mechanism by which viruses cause exacerbations of chronic airway disease and the capacity of patients with cystic fibrosis (CF) to respond to viral infection are not precisely known. OBJECTIVES To determine the antiviral response to infection in patients with CF. METHODS Sputum was collected from patients with CF with respiratory exacerbation. Viruses were detected in multiplex polymerase chain reaction (PCR)-based assays. Gene expression of 84 antiviral response genes was measured, using a focused quantitative PCR gene array. MEASUREMENTS AND MAIN RESULTS We examined 36 samples from 23 patients with respiratory exacerbation. Fourteen samples tested virus-positive and 22 virus-negative. When we compared exacerbations associated with rhinovirus (RV, n = 9) and influenza (n = 5) with virus-negative specimens, we found distinct patterns of antiviral gene expression. RV was associated with greater than twofold induction of five genes, including those encoding the monocyte-attracting chemokines CXCL10, CXCL11, and CXCL9. Influenza was associated with overexpression of 20 genes, including those encoding the cytokines tumor necrosis factor and IL-12; the kinases MEK, TBK-1, and STAT-1; the apoptosis proteins caspase-8 and caspase-10; the influenza double-stranded RNA receptor RIG-I and its downstream effector MAVS; and pyrin, an IFN-stimulated protein involved in influenza resistance. CONCLUSIONS We conclude that virus-induced exacerbations of CF are associated with immune responses tailored to specific infections. Influenza induced a more potent response consisting of inflammation, whereas RV infection had a pronounced effect on chemokine expression. As far as we are aware, this study is the first to compare specific responses to different viruses in live patients with chronic airway disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Marc B. Hershenson
- Department of Pediatrics and Communicable Diseases
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, Michigan
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Sampson NR, Parker EA, Cheezum RR, Lewis TC, O'Toole A, Zuniga A, Patton J, Robbins TG, Keirns CC. "I wouldn't look at it as stress": conceptualizations of caregiver stress among low-income families of children with asthma. J Health Care Poor Underserved 2013; 24:275-88. [PMID: 23377734 DOI: 10.1353/hpu.2013.0021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Low-income caregivers of children with asthma experience multiple stressors, likely worsening family health. As part of Community Action Against Asthma's community-based participatory research partnership, researchers conducted 40 qualitative semi-structured interviews and quantitative surveys with low-income caregivers of children with asthma in Detroit, Michigan. Participants described daily childhood asthma experiences and completed scales including the Peds Quality of Life Family Impact Module and Zarit Burden Caregiver Scale. Quantitative scale findings suggested participants are moderately stressed or affected by their child's illness. While there was some accordance between qualitative and quantitative findings, qualitative findings additionally captured many relevant life stressors, seemingly overlooked or conflated in scale responses. Many participants described asthma as part of childrearing, rather than as a stressor or burden. Findings encourage improvement of clinical, psychometric assessments used to measure and address stressors that shape health for many families with children with asthma.
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Affiliation(s)
- Natalie R Sampson
- Department of Health Behavior Health Education at the University of Michigan School of Public Health (UM-SPH), Ann Arbor, MI 48109, USA
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Lewis TC, Henderson TA, Carpenter AR, Ramirez IA, McHenry CL, Goldsmith AM, Ren X, Mentz GB, Mukherjee B, Robins TG, Joiner TA, Mohammad LS, Nguyen ER, Burns MA, Burke DT, Hershenson MB. Nasal cytokine responses to natural colds in asthmatic children. Clin Exp Allergy 2013. [PMID: 23181789 PMCID: PMC4219353 DOI: 10.1111/cea.12005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background The mechanisms by which viruses induce asthma exacerbations are not well understood. Objective We characterized fluctuations in nasal aspirate cytokines during naturally occurring respiratory viral infections in children with asthma. Methods Sixteen children underwent home collections of nasal aspirates when they were without cold symptoms and again during self‐reported respiratory illnesses. The presence of viral infection was ascertained by multiplex PCR. Cytokines were measured using multiplex immune assay. mRNA expression for selected markers of viral infection was measured using RT‐PCR. A cumulative respiratory symptom score was calculated for each day of measurement. Generalized estimated equations were used to evaluate associations between viral infection and marker elevation, and between marker elevation and symptom score. Results The 16 patients completed a total of 37 weeks of assessment (15 ‘well’ weeks; 22 self‐assessed ‘sick’ weeks). Viral infections were detected in 3 of the ‘well’ weeks and 17 of the ‘sick’ weeks (10 rhinovirus, three coronavirus, two influenza A, two influenza B, two respiratory syncytial virus, one parainfluenza). Compared to virus‐negative well weeks, nasal aspirate IFN‐γ, CXCL8/IL‐8, CXCL10/IP‐10, CCL5/RANTES, CCL11/eotaxin‐1, CCL2/MCP‐1, CCL4/MIP‐1β, CCL7/MCP‐3, and CCL20/MIP3α protein levels increased during virus‐positive sick weeks. Only a subset of cytokines (IFN‐γ, CXCL8, CCL2, CCL4, CCL5, and CCL20) correlated with self‐reported respiratory tract symptoms. While many aspirates were dilute and showed no mRNA signal, viral infection significantly increased the number of samples that were positive for IFN‐λ1, IFN‐λ2/3, TLR3, RIG‐I, and IRF7 mRNA. Conclusions and clinical relevance We conclude that in children with asthma, naturally occurring viral infections apparently induce a robust innate immune response including expression of specific chemokines, IFNs, and IFN‐responsive genes.
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Affiliation(s)
- T C Lewis
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA
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18
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Lewis TC, Robins TG, Mentz GB, Zhang X, Mukherjee B, Lin X, Keeler GJ, Dvonch JT, Yip FY, O'Neill MS, Parker EA, Israel BA, Max PT, Reyes A. Air pollution and respiratory symptoms among children with asthma: vulnerability by corticosteroid use and residence area. Sci Total Environ 2013; 448:48-55. [PMID: 23273373 PMCID: PMC4327853 DOI: 10.1016/j.scitotenv.2012.11.070] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 10/31/2012] [Accepted: 11/19/2012] [Indexed: 05/10/2023]
Abstract
RATIONALE Information on how ambient air pollution affects susceptible populations is needed to ensure protective air quality standards. OBJECTIVES To estimate the effect of community-level ambient particulate matter (PM) and ozone (O) on respiratory symptoms among primarily African-American and Latino, lower-income asthmatic children living in Detroit, Michigan and to evaluate factors associated with heterogeneity in observed health effects. METHODS A cohort of 298 children with asthma was studied prospectively from 1999 to 2002. For 14days each season over 11 seasons, children completed a respiratory symptom diary. Simultaneously, ambient pollutant concentrations were measured at two community-level monitoring sites. Logistic regression models using generalized estimating equations were fit for each respiratory symptom in single pollutant models, looking for interactions by area or by corticosteroid use, a marker of more severe asthma. Exposures of interest were: daily concentrations of PM<10μm, <2.5μm, and between 10 and 2.5μm in aerodynamic diameter (PM, PM, and PM respectively), the daily 8-hour maximum concentration of O (8HrPeak), and the daily 1-hour maximum concentration of O (1HrPeak). RESULTS Outdoor PM, PM, 8HrPeak, and 1HrPeak O concentrations were associated with increased odds of respiratory symptoms, particularly among children using corticosteroid medication and among children living in the southwest community of Detroit. Similar patterns of associations were not seen with PM. CONCLUSIONS PM and O at levels near or below annual standard levels are associated with negative health impact in this population of asthmatic children. Variation in effects within the city of Detroit and among the subgroup using steroids emphasizes the importance of spatially refined exposure assessment and the need for further studies to elucidate mechanisms and effective risk reduction interventions.
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Affiliation(s)
- Toby C Lewis
- Department of Pediatrics, Division of Pulmonology, University of Michigan Medical School, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-5212, United States.
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Cheezum RR, Parker EA, Sampson NR, Lewis TC, O'Toole A, Patton J, Robins TG, Keirns CC. Nightwatch: Sleep Disruption of Caregivers of Children With Asthma in Detroit. ACTA ACUST UNITED AC 2013; 4:217-225. [PMID: 25419470 DOI: 10.1177/2150129713478635] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Caregiving for ill loved ones can affect sleep quality and quantity. Insufficient sleep has been associated with worse physical and mental health outcomes, and it is known to affect work performance and ability to accomplish necessary tasks. While some research has looked at the sleep of caregivers of loved ones with chronic illness and found that they experience poorer sleep, little is known about the impact of caring for a child with asthma on the caregiver's sleep and the ways in which their sleep may be affected. Community Action Against Asthma, a community-based participatory research partnership, conducted interviews with semistructured and open-ended questions with 40 caregivers of children with asthma who live in Detroit. Findings showed that caregivers regularly experience poor quality sleep because of sleeping lightly in order to listen for the child's symptoms, wake multiple times to check on the child because of worry, and provide care for child when he or she experiences symptoms in the middle of the night. Results of the Epworth Sleepiness Scale indicate that 12.5% of caregivers received a score of 16 or more, the score on the scale used to indicate likely presence of a sleep disorder, and 42.5% had a score of 10 or more, indicating excessive sleepiness. Sleep disturbance in caregivers is an underrecognized consequence of childhood asthma, with implications for providers caring for children with asthma.
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Affiliation(s)
- Rebecca R Cheezum
- School of Health Sciences, Oakland University, Rochester, Michigan (RRC); the College of Public Health, the University of Iowa, Iowa City, Iowa (EAP); Health Behavior and Health Education Department (NRS, AO, JP) and Department of Environmental Health Sciences (TCL, TGR), University of Michigan, Ann Arbor, Michigan; and the Department of Preventive Medicine, Stony Brook University, Stony Brook, New York (CCK)
| | - Edith A Parker
- School of Health Sciences, Oakland University, Rochester, Michigan (RRC); the College of Public Health, the University of Iowa, Iowa City, Iowa (EAP); Health Behavior and Health Education Department (NRS, AO, JP) and Department of Environmental Health Sciences (TCL, TGR), University of Michigan, Ann Arbor, Michigan; and the Department of Preventive Medicine, Stony Brook University, Stony Brook, New York (CCK)
| | - Natalie R Sampson
- School of Health Sciences, Oakland University, Rochester, Michigan (RRC); the College of Public Health, the University of Iowa, Iowa City, Iowa (EAP); Health Behavior and Health Education Department (NRS, AO, JP) and Department of Environmental Health Sciences (TCL, TGR), University of Michigan, Ann Arbor, Michigan; and the Department of Preventive Medicine, Stony Brook University, Stony Brook, New York (CCK)
| | - Toby C Lewis
- School of Health Sciences, Oakland University, Rochester, Michigan (RRC); the College of Public Health, the University of Iowa, Iowa City, Iowa (EAP); Health Behavior and Health Education Department (NRS, AO, JP) and Department of Environmental Health Sciences (TCL, TGR), University of Michigan, Ann Arbor, Michigan; and the Department of Preventive Medicine, Stony Brook University, Stony Brook, New York (CCK)
| | - Ashley O'Toole
- School of Health Sciences, Oakland University, Rochester, Michigan (RRC); the College of Public Health, the University of Iowa, Iowa City, Iowa (EAP); Health Behavior and Health Education Department (NRS, AO, JP) and Department of Environmental Health Sciences (TCL, TGR), University of Michigan, Ann Arbor, Michigan; and the Department of Preventive Medicine, Stony Brook University, Stony Brook, New York (CCK)
| | - Jean Patton
- School of Health Sciences, Oakland University, Rochester, Michigan (RRC); the College of Public Health, the University of Iowa, Iowa City, Iowa (EAP); Health Behavior and Health Education Department (NRS, AO, JP) and Department of Environmental Health Sciences (TCL, TGR), University of Michigan, Ann Arbor, Michigan; and the Department of Preventive Medicine, Stony Brook University, Stony Brook, New York (CCK)
| | - Thomas G Robins
- School of Health Sciences, Oakland University, Rochester, Michigan (RRC); the College of Public Health, the University of Iowa, Iowa City, Iowa (EAP); Health Behavior and Health Education Department (NRS, AO, JP) and Department of Environmental Health Sciences (TCL, TGR), University of Michigan, Ann Arbor, Michigan; and the Department of Preventive Medicine, Stony Brook University, Stony Brook, New York (CCK)
| | - Carla C Keirns
- School of Health Sciences, Oakland University, Rochester, Michigan (RRC); the College of Public Health, the University of Iowa, Iowa City, Iowa (EAP); Health Behavior and Health Education Department (NRS, AO, JP) and Department of Environmental Health Sciences (TCL, TGR), University of Michigan, Ann Arbor, Michigan; and the Department of Preventive Medicine, Stony Brook University, Stony Brook, New York (CCK)
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Sampson NR, Parker EA, Cheezum RR, Lewis TC, O'Toole A, Patton J, Zuniga A, Robins TG, Keirns CC. A life course perspective on stress and health among caregivers of children with asthma in Detroit. Fam Community Health 2013; 36:51-62. [PMID: 23168346 PMCID: PMC3984896 DOI: 10.1097/fch.0b013e31826d7620] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Low-income caregivers raising children with asthma experience many obstacles to their own health, including stress. To understand and describe their daily experiences, researchers conducted 40 qualitative interviews supplemented with descriptive quantitative surveys in Detroit, Michigan, as part of a community-based participatory research partnership of Community Action Against Asthma. Prevalence of chronic illness is noticeably higher among participants than the general US population. Caregivers identified stress processes that may influence disproportionate health outcomes and risk-related behaviors over their lifetime. Applying a life course perspective, findings suggest that public health interventions should address family-level comorbidities, increase instrumental social support, and acknowledge practical coping mechanisms.
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Affiliation(s)
- Natalie R Sampson
- Department of Health Behavior Health Education, University of Michigan, Ann Arbor, MI, USA.
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Schneider D, Hong JY, Bowman ER, Chung Y, Nagarkar DR, McHenry CL, Goldsmith AM, Bentley JK, Lewis TC, Hershenson MB. Macrophage/epithelial cell CCL2 contributes to rhinovirus-induced hyperresponsiveness and inflammation in a mouse model of allergic airways disease. Am J Physiol Lung Cell Mol Physiol 2012. [PMID: 23204071 DOI: 10.1152/ajplung.00182.2012] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Human rhinovirus (HRV) infections lead to exacerbations of lower airways disease in asthmatic patients but not in healthy individuals. However, underlying mechanisms remain to be completely elucidated. We hypothesized that the Th2-driven allergic environment enhances HRV-induced CC chemokine production, leading to asthma exacerbations. Ovalbumin (OVA)-sensitized and -challenged mice inoculated with HRV showed significant increases in the expression of lung CC chemokine ligand (CCL)-2/monocyte chemotactic protein (MCP)-1, CCL4/macrophage inflammatory protein (MIP)-1β, CCL7/MCP-3, CCL19/MIP-3β, and CCL20/MIP3α compared with mice treated with OVA alone. Inhibition of CCL2 with neutralizing antibody significantly attenuated HRV-induced airways inflammation and hyperresponsiveness in OVA-treated mice. Immunohistochemical stains showed colocalization of CCL2 with HRV in epithelial cells and CD68-positive macrophages, and flow cytometry showed increased CCL2(+), CD11b(+) cells in the lungs of OVA-treated, HRV-infected mice. Compared with lung macrophages from naïve mice, macrophages from OVA-exposed mice expressed significantly more CCL2 in response to HRV infection ex vivo. Pretreatment of mouse lung macrophages and BEAS-2B human bronchial epithelial cells with interleukin (IL)-4 and IL-13 increased HRV-induced CCL2 expression, and mouse lung macrophages from IL-4 receptor knockout mice showed reduced CCL2 expression in response to HRV, suggesting that exposure to these Th2 cytokines plays a role in the altered HRV response. Finally, bronchoalveolar macrophages from children with asthma elaborated more CCL2 upon ex vivo exposure to HRV than cells from nonasthmatic patients. We conclude that CCL2 production by epithelial cells and macrophages contributes to HRV-induced airway hyperresponsiveness and inflammation in a mouse model of allergic airways disease and may play a role in HRV-induced asthma exacerbations.
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Affiliation(s)
- Dina Schneider
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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Dombkowski KJ, Harrison SR, Cohn LM, Lewis TC, Clark SJ. Continuity of prescribers of short-acting beta agonists among children with asthma. J Pediatr 2009; 155:788-94. [PMID: 19683253 DOI: 10.1016/j.jpeds.2009.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 05/14/2009] [Accepted: 06/15/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether short-acting beta-agonist (SABA) prescriber continuity was associated with emergency department visits among children with asthma. STUDY DESIGN An analysis of Michigan Medicaid administrative claims (2004-2005) for children ages 5 to 18 with asthma. Logistic regression models assessed the effect of SABA prescriber continuity (the number and site of prescribers) on emergency department visits, controlling for demographics, historical (2004) asthma use and SABA prescription frequency (2-5 low; > or = 6 high). RESULTS Most children had one SABA prescriber (62%); 13% had multiple prescribers in the same practice as the primary care provider and 25% had multiple prescribers in different practices. Children with multiple prescribers in different practices had increased odds of an emergency department visit compared with those with 1 prescriber, among those with high SABA prescription frequency (AOR: 2.7, 95% CI: 1.9, 3.9), as well as those with low prescription frequency (AOR: 1.7, 95% CI: 1.3, 2.2). CONCLUSIONS Children with discontinuity of SABA prescribers have an increased risk of asthma emergency department visits, irrespective of their SABA prescription frequency. Primary care providers may have difficulty identifying patients at high risk with asthma solely on the basis of SABAs prescribed within their own practices.
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Affiliation(s)
- Kevin J Dombkowski
- Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI 48109-0456, USA.
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Hassan F, Lewis TC, Davis MM, Gebremariam A, Dombkowski K. Hospital utilization and costs among children with influenza, 2003. Am J Prev Med 2009; 36:292-6. [PMID: 19201147 DOI: 10.1016/j.amepre.2008.11.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 09/30/2008] [Accepted: 11/20/2008] [Indexed: 12/17/2022]
Abstract
BACKGROUND Longstanding recommendations for influenza vaccines among children were augmented by the Advisory Committee on Immunization Practices (ACIP) in 2002 and again in 2008 to encourage vaccination among healthy children aged 6 months-18 years. Little is known about the hospital costs and length of stay among high-risk and otherwise healthy children for the groups affected by the 2002 and 2008 recommendations of the ACIP. The burden of influenza may vary between children with high-risk medical conditions and those who are otherwise healthy. The objective of the current study was to characterize the national burden of influenza hospitalizations and to evaluate how hospital costs and length of stay varied among children diagnosed with influenza. METHODS A retrospective analysis of influenza hospitalizations was performed in 2006 using the Healthcare Cost and Utilization Project Kids' Inpatient Database, a nationally representative database of hospital discharge records for children from January to December 2003. Children aged <or=18 years with the primary or secondary diagnosis of influenza were classified into three groups based on ACIP recommendations (0-5 months, 6-23 months, 24 months-18 years) and further subdivided by diagnostic codes (asthma, other chronic diseases, without chronic conditions). The outcome measures were aggregate national and mean hospital costs and mean length of stay. RESULTS In 2003, aggregate national costs for children with a diagnosis of influenza were $76.5 million, 55% of which was among the group for whom an influenza vaccine was recommended or encouraged in 2003. These costs corresponded to 77,264 inpatient days for 27,363 influenza hospitalizations (2.8 days average length of stay). Mean costs were higher for children with influenza and chronic diseases ($7774) compared to those for children with asthma ($3469) and children without chronic conditions ($2785). Sub-analyses regarding recently expanded national recommendations revealed that 41% of all hospitalizations with a diagnosis of influenza were among otherwise healthy children aged 24 months-18 years. CONCLUSIONS In 2003, over half of the influenza hospitalizations and costs associated with influenza occurred among children for whom an influenza vaccination was recommended. The frequency of influenza hospitalizations among children aged 24 months-18 years supports recent expansion of the ACIP influenza vaccination recommendations.
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Affiliation(s)
- Fauziya Hassan
- Division of Sleep Medicine, Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, Michigan 48109-5456, USA.
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Parker EA, Israel BA, Robins TG, Mentz G, Brakefield-Caldwell W, Ramirez E, Edgren KK, Salinas M, Lewis TC. Evaluation of Community Action Against Asthma: a community health worker intervention to improve children's asthma-related health by reducing household environmental triggers for asthma. Health Educ Behav 2007; 35:376-95. [PMID: 17761540 PMCID: PMC4676080 DOI: 10.1177/1090198106290622] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article describes the evaluation of a community-based participatory research (CBPR) community health worker (CHW) intervention to improve children's asthma-related health by reducing household environmental triggers for asthma. After randomization to an intervention or control group, 298 households in Detroit, Michigan, with a child, aged 7 to 11, with persistent asthma symptoms participated. The intervention was effective in increasing some of the measures of lung function (daily nadir Forced Expiratory Volume at one second [p = .03] and daily nadir Peak Flow [p = .02]), reducing the frequency of two symptoms ("cough that won't go away," "coughing with exercise"), reducing the proportion of children requiring unscheduled medical visits and reporting inadequate use of asthma controller medication, reducing caregiver report of depressive symptoms, reducing concentrations of dog allergen in the dust, and increasing some behaviors related to reducing indoor environmental triggers. The results suggest a CHW environmental intervention can improve children's asthma-related health, although the pathway for improvement is complex.
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Affiliation(s)
- Edith A Parker
- School of Public Health, Ann Arbor, Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
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Redding GJ, Singleton RJ, DeMain J, Bulkow LR, Martinez P, Lewis TC, Zanis C, Butler JC. Relationship between IgE and specific aeroallergen sensitivity in Alaskan native children. Ann Allergy Asthma Immunol 2006; 97:209-15. [PMID: 16937753 DOI: 10.1016/s1081-1206(10)60015-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The relationship between atopic disease and serum IgE levels varies among populations and geographic regions. The close association of atopy with IgE may not occur in subarctic populations as it does in developed countries in temperate climates. OBJECTIVE To evaluate the relationship between total and specific IgE concentrations and clinical atopy in 5- to 8-year-old Alaskan native children. METHODS Medical record reviews, interviews, physical examinations, serum IgE measurements, and radioallergosorbent testing (RAST) were performed. RESULTS The IgE geometric mean was 122.1 IU/mL. Fifty-eight percent of patients had IgE levels greater than 70 IU/mL, and 17% had levels greater than 1,000 IU/mL; 14% had RAST values greater than 0.35 kU/L. Both IgE levels greater than 70 IU/mL and greater than 1,000 IU/mL were associated with RAST values greater than 0.35 IU/L (P = .004) and early wheezing (P = .005) but not with current wheezing, asthma, eczema, or a history of allergies. A RAST value greater than 3.51 kU/L was associated with eczema (P = .04) but not with allergies or wheezing. Children with current wheezing were more likely to have allergies (P = .03) but not eczema, an IgE level greater than 70 IU/mL, or a positive RAST value. Children hospitalized with respiratory syncytial virus (RSV) were not more likely than controls to have current wheezing. CONCLUSIONS Elevated serum IgE concentrations, including levels greater than 1,000 IU/mL, are common among Alaskan native children; positive RAST reactions to aeroallergens are not. The IgE levels do not relate to wheezing, eczema, a history of allergies, or past hospitalization for RSV infection but likely reflect infections other than RSV and environmental factors in subarctic indigenous populations.
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Affiliation(s)
- Gregory J Redding
- Department of Pediatrics, University of Washington School of Medicine, Seattle, USA.
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Edgren KK, Parker EA, Israel BA, Lewis TC, Salinas MA, Robins TG, Hill YR. Community involvement in the conduct of a health education intervention and research project: Community Action Against Asthma. Health Promot Pract 2005; 6:263-9. [PMID: 16020621 DOI: 10.1177/1524839903260696] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is a need for more guidance on how to implement community-based participatory research, particularly on the roles of community members, throughout the process. This article focuses on how a Steering Committee, composed of representatives from community-based organizations, a local health department, an integrated health care system, and academia from the University of Michigan, participated in the design and implementation of a children's asthma study in Detroit, Michigan: Community Action Against Asthma. In addition, this article focuses on the role of community members as data collectors, examining a variety of sophisticated data collection roles. A description and analysis of how community members shaped and participated in the project, the lessons learned, and recommendations for practitioners are also presented.
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Day GM, Motherwell WDS, Ammon HL, Boerrigter SXM, Della Valle RG, Venuti E, Dzyabchenko A, Dunitz JD, Schweizer B, van Eijck BP, Erk P, Facelli JC, Bazterra VE, Ferraro MB, Hofmann DWM, Leusen FJJ, Liang C, Pantelides CC, Karamertzanis PG, Price SL, Lewis TC, Nowell H, Torrisi A, Scheraga HA, Arnautova YA, Schmidt MU, Verwer P. A third blind test of crystal structure prediction. Acta Crystallogr B Struct Sci 2005; 61:511-27. [PMID: 16186652 DOI: 10.1107/s0108768105016563] [Citation(s) in RCA: 241] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2004] [Accepted: 05/24/2005] [Indexed: 11/10/2022]
Abstract
Following the interest generated by two previous blind tests of crystal structure prediction (CSP1999 and CSP2001), a third such collaborative project (CSP2004) was hosted by the Cambridge Crystallographic Data Centre. A range of methodologies used in searching for and ranking the likelihood of predicted crystal structures is represented amongst the 18 participating research groups, although most are based on the global minimization of the lattice energy. Initially the participants were given molecular diagrams of three molecules and asked to submit three predictions for the most likely crystal structure of each. Unlike earlier blind tests, no restriction was placed on the possible space group of the target crystal structures. Furthermore, Z′ = 2 structures were allowed. Part-way through the test, a partial structure report was discovered for one of the molecules, which could no longer be considered a blind test. Hence, a second molecule from the same category (small, rigid with common atom types) was offered to the participants as a replacement. Success rates within the three submitted predictions were lower than in the previous tests – there was only one successful prediction for any of the three `blind' molecules. For the `simplest' rigid molecule, this lack of success is partly due to the observed structure crystallizing with two molecules in the asymmetric unit. As in the 2001 blind test, there was no success in predicting the structure of the flexible molecule. The results highlight the necessity for better energy models, capable of simultaneously describing conformational and packing energies with high accuracy. There is also a need for improvements in search procedures for crystals with more than one independent molecule, as well as for molecules with conformational flexibility. These are necessary requirements for the prediction of possible thermodynamically favoured polymorphs. Which of these are actually realised is also influenced by as yet insufficiently understood processes of nucleation and crystal growth.
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Affiliation(s)
- G M Day
- The Pfizer Institute for Pharmaceutical Materials Science, University Chemical Laboratory, University of Cambridge, Lensfield Road, Cambridge CB2 1EW, England.
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Lewis TC, Robins TG, Dvonch JT, Keeler GJ, Yip FY, Mentz GB, Lin X, Parker EA, Israel BA, Gonzalez L, Hill Y. Air pollution-associated changes in lung function among asthmatic children in Detroit. Environ Health Perspect 2005; 113:1068-75. [PMID: 16079081 PMCID: PMC1280351 DOI: 10.1289/ehp.7533] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2004] [Accepted: 05/05/2005] [Indexed: 05/03/2023]
Abstract
In a longitudinal cohort study of primary-school-age children with asthma in Detroit, Michigan, we examined relationships between lung function and ambient levels of particulate matter < or = 10 microm and < or = 2.5 microm in diameter (PM10 and PM2.5) and ozone at varying lag intervals using generalized estimating equations. Models considered effect modification by maintenance corticosteroid (CS) use and by the presence of an upper respiratory infection (URI) as recorded in a daily diary among 86 children who participated in six 2-week seasonal assessments from winter 2001 through spring 2002. Participants were predominantly African American from families with low income, and > 75% were categorized as having persistent asthma. In both single-pollutant and two-pollutant models, many regressions demonstrated associations between higher exposure to ambient pollutants and poorer lung function (increased diurnal variability and decreased lowest daily values for forced expiratory volume in 1 sec) among children using CSs but not among those not using CSs, and among children reporting URI symptoms but not among those who did not report URIs. Our findings suggest that levels of air pollutants in Detroit, which are above the current National Ambient Air Quality Standards, adversely affect lung function of susceptible asthmatic children.
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Affiliation(s)
- Toby C Lewis
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA.
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O’Neill MS, Lewis TC, Robins TG, Dvonch JT, Keeler GJ, Mentz GB, Lin X, Parker E, Israel BA, Gonzalez L, Hill Y, Max P. 130: Asthma Symptoms and Airborne Particle Exposure Among Children with Asthma in Detroit. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s33a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M S O’Neill
- University of Michigan, Detroit Hispanic Development Coalition, Department of Health and Wellness Promotion, City of Detroit
| | - T C Lewis
- University of Michigan, Detroit Hispanic Development Coalition, Department of Health and Wellness Promotion, City of Detroit
| | - T G Robins
- University of Michigan, Detroit Hispanic Development Coalition, Department of Health and Wellness Promotion, City of Detroit
| | - J T Dvonch
- University of Michigan, Detroit Hispanic Development Coalition, Department of Health and Wellness Promotion, City of Detroit
| | - G J Keeler
- University of Michigan, Detroit Hispanic Development Coalition, Department of Health and Wellness Promotion, City of Detroit
| | - G B Mentz
- University of Michigan, Detroit Hispanic Development Coalition, Department of Health and Wellness Promotion, City of Detroit
| | - X Lin
- University of Michigan, Detroit Hispanic Development Coalition, Department of Health and Wellness Promotion, City of Detroit
| | - E Parker
- University of Michigan, Detroit Hispanic Development Coalition, Department of Health and Wellness Promotion, City of Detroit
| | - B A Israel
- University of Michigan, Detroit Hispanic Development Coalition, Department of Health and Wellness Promotion, City of Detroit
| | - L Gonzalez
- University of Michigan, Detroit Hispanic Development Coalition, Department of Health and Wellness Promotion, City of Detroit
| | - Y Hill
- University of Michigan, Detroit Hispanic Development Coalition, Department of Health and Wellness Promotion, City of Detroit
| | - P Max
- University of Michigan, Detroit Hispanic Development Coalition, Department of Health and Wellness Promotion, City of Detroit
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Cabana MD, Slish KK, Lewis TC, Brown RW, Nan B, Lin X, Clark NM. Parental management of asthma triggers within a child's environment. J Allergy Clin Immunol 2004; 114:352-7. [PMID: 15316515 DOI: 10.1016/j.jaci.2004.04.047] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Control of environmental precipitants of asthma is an important component of self-management. OBJECTIVE To assess the type and frequency of attempts by families to control environmental precipitants of symptoms and their degree of consistency with current guidelines. METHODS We analyzed data from a nationwide sample of 896 children (2-12 years) with asthma. We collected data on insurance, race, sex, income, asthma education exposure, and severity. Parents were asked open-ended questions about their child's asthma triggers and what, if any, actions they took to control these triggers. RESULTS We completed interviews with the parents of 896 of 1077 (83%) eligible patients. Patients had a mean age of 7.2 years, 65% were boys, 13% had Medicaid insurance, 12% were African American, and 31% had persistent asthma. Eighty percent (717/896) of parents could identify at least 1 asthma trigger (mean, 2.2; range, 0-9). Eighty-two percent (582/717) of these parents had attempted an environmental control measure. Of 1788 actions initiated, 916 (51%) were unlikely to be beneficial on the basis of current guidelines. No specific demographic characteristic predicted which parents were more or less likely to institute environmental controls. CONCLUSION In our sample, more than half (51%) of the environmental actions initiated were not specifically endorsed by current guidelines. Improving awareness about recognized methods to address triggers may help families use more effective measures. Clinicians should not assume that they can predict which families will be more or less likely to attempt environmental control, but should provide education regarding effective environmental measures for all families with potentially modifiable asthma triggers
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Affiliation(s)
- Michael D Cabana
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI 48109-0456, USA.
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Lewis TC, Robins TG, Joseph CLM, Parker EA, Israel BA, Rowe Z, Edgren KK, Salinas MA, Martinez ME, Brown RW. Identification of gaps in the diagnosis and treatment of childhood asthma using a community-based participatory research approach. J Urban Health 2004; 81:472-88. [PMID: 15273269 PMCID: PMC3455945 DOI: 10.1093/jurban/jth131] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The goal of this investigation was to use a community-based participatory research approach to develop, pilot test, and administer an asthma screening questionnaire to identify children with asthma and asthma symptoms in a community setting. This study was conducted as the recruitment effort for Community Action Against Asthma, a randomized trial of a household intervention to reduce exposure to environmental triggers of asthma and was not designed as a classic prevalence study. An asthma screening questionnaire was mailed and/or hand delivered to parents of 9,627 children, aged 5 to 11 years, in two geographic areas of Detroit, Michigan, with predominantly African American and Hispanic populations. Additional questionnaires were distributed via community networking. Measurements included parent report of their child's frequency of respiratory symptoms, presence of physician diagnosis of asthma, and frequency of doctor-prescribed asthma medication usage. Among the 3,067 completed questionnaires, 1,570 (51.2% of returned surveys, 16.3% of eligible population) were consistent with asthma of any severity and 398 (12.9% of returned surveys, 4.1% of eligible population) met criteria for moderate-to-severe asthma. Among those meeting criteria for moderate-to-severe asthma, over 30% had not been diagnosed by a physician, over one half were not taking daily asthma medication, and one quarter had not taken any physician-prescribed asthma medication in the past year. Screening surveys conducted within the context of a community-based participatory research partnership can identify large numbers of children with undiagnosed and/or undertreated moderate-to-severe asthma. These children are likely to benefit from interventions to reduce morbidity and improve quality of life.
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Affiliation(s)
- Toby C Lewis
- Department of Pediatrics and Communicable Diseases, University of Michigan School of Medicine, Ann Arbor, MI, USA.
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Lewis TC, Stout JW, Martinez P, Morray B, White LC, Heckbert SR, Redding GJ. Prevalence of asthma and chronic respiratory symptoms among Alaska Native children. Chest 2004; 125:1665-73. [PMID: 15136374 DOI: 10.1378/chest.125.5.1665] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To quantify the prevalence and impact of chronic respiratory symptoms among predominantly Alaska Native (AN)/American Indian (AI) middle school students. DESIGN School-based prevalence assessment using the International Study of Asthma and Allergy in Children survey, with supplemental video material and added questions about productive cough, exposure to tobacco smoke, and the functional impact of symptoms. SETTING The Yukon-Kuskokwim delta region of western Alaska. PARTICIPANTS A total of 466 children in the sixth to ninth grades, 81% of whom are AN/AI (377 children). INTERVENTIONS No study intervention. RESULTS Among the 377 AN/AI children, 40% reported one of the following three categories of chronic respiratory disease: physician-diagnosed asthma, 7.4%; asthma-like symptoms (ALS) without an asthma diagnosis, 11.4%; and chronic productive cough (CPC) without asthma diagnosis or symptoms, 21.5%. Symptom prevalence differed substantially between the largest town in the region and rural villages. After an adjustment for demographic factors, exposure to environmental tobacco smoke, active tobacco smoking, and self-report of atopy, village residents were 63% less likely to have ALS (p = 0.009), and had a twofold greater risk of CPC (p < 0.001) compared to children living in the town. Children with respiratory symptoms experienced sleep disturbances and accessed clinic visits for respiratory problems more often than did asymptomatic children. CONCLUSIONS Chronic respiratory symptoms are very common among AN children. CPC is an important nonasthmatic respiratory condition in this population. The differing patterns of respiratory illness within this region may help to elucidate the specific risk factors for asthma and chronic bronchitis in children.
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Affiliation(s)
- Toby C Lewis
- Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor, MI, USA.
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Abstract
Respiratory assessment of children with asthma or bronchiolitis is problematic because both the components of the assessment and their relative importance vary among care providers. Use of a systematic standard assessment process and clinical score may reduce interobserver variation. Our objective was to determine observer agreement among physicians (MD), nurses (RN), and respiratory therapists (RT), using a standard respiratory clinical score. A clinical score was developed incorporating four physiologic parameters: respiratory rate, retractions, dyspnea, and auscultation. One hundred and sixty-five provider pairs (e.g., MD-MD, RN-RT) independently assessed a total of 55 patients admitted for asthma, bronchiolitis, or wheezing at an urban tertiary-care hospital. A weighted kappa statistic measured agreement beyond chance. Rater pairs had high observed agreement on total score of 82-88% and weighted kappas ranging from 0.52 (MD-RN; 95% CI, 0.19, 0.79) to 0.65 (RN-RN; 95% CI, 0.46, 0.87). Observed agreement on individual components of the score ranged from 58% (auscultation) to 74% (dyspnea), with unweighted kappas of 0.36 (respiratory rate; 95% CI, 0.26, 0.46) to 0.53 (dyspnea; 95% CI, 0.41, 0.65). In conclusion, this respiratory clinical score demonstrates good interobserver agreement between MDs, RNs, and RTs. Future research is needed to examine validity and responsiveness in clinical settings. By standardizing respiratory assessments, use of a clinical score may facilitate care coordination by physicians, nurses, and respiratory therapists and thereby improve care of children hospitalized with asthma and bronchiolitis.
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Affiliation(s)
- Lenna L Liu
- Child Health Institute, University of Washington, Seattle, Washington 98115-8160, USA.
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Singleton RJ, Redding GJ, Lewis TC, Martinez P, Bulkow L, Morray B, Peters H, Gove J, Jones C, Stamey D, Talkington DF, DeMain J, Bernert JT, Butler JC. Sequelae of severe respiratory syncytial virus infection in infancy and early childhood among Alaska Native children. Pediatrics 2003; 112:285-90. [PMID: 12897275 DOI: 10.1542/peds.112.2.285] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE In 1993-1996, we conducted a nested case-control study to determine risk factors for hospitalization with respiratory syncytial virus (RSV) infection among Alaska Native infants and young children. In the current study, we returned to former RSV case-patients and their control subjects during 1999-2001 to determine whether children who are hospitalized with RSV at <2 years of age are more likely to develop chronic respiratory conditions. METHODS For each former RSV case-patient and control subject from remote villages in southwest Alaska, we reviewed medical records, interviewed parents, performed physical examinations and spirometry, collected sera, and analyzed chest radiographs. Case-patients were identified through surveillance for RSV hospitalization, and matched control subjects without lower respiratory infection (LRI)-related hospitalization were identified. RESULTS Hospitalization for RSV infection was associated with a significant increase in wheezing, LRIs, and asthma diagnosis during the first 4 years of life. The association decreased with age and was no longer significant by 5 years of age. However, hospitalization for RSV infection was associated with increased respiratory symptoms and increased chronic productive cough at 5 to 8 years of age. Children who were hospitalized with RSV were not more likely at follow-up to have allergies, eczema, or a positive family history of asthma. CONCLUSIONS Severe RSV infection in infancy may produce airway injury, which is manifested in chronic productive cough with or without wheezing and recurrent LRIs. Although the association of RSV infection with wheezing seems to be transient, children remain at higher risk for chronic productive cough at 5 to 8 years of age. RSV prevention modalities may prevent sequelae that occur early and later in childhood.
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Affiliation(s)
- Rosalyn J Singleton
- Centers for Disease Control and Prevention, National Center for Infectious Diseases, Arctic Investigations Program Anchorage, Anchorage, Alaska 99508, USA.
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Parker EA, Israel BA, Williams M, Brakefield-Caldwell W, Lewis TC, Robins T, Ramirez E, Rowe Z, Keeler G. Community action against asthma: examining the partnership process of a community-based participatory research project. J Gen Intern Med 2003; 18:558-67. [PMID: 12848839 PMCID: PMC1494884 DOI: 10.1046/j.1525-1497.2003.20322.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Community Action Against Asthma (CAAA) is a community-based participatory research (CBPR) project that assesses the effects of outdoor and indoor air quality on exacerbation of asthma in children, and tests household- and neighborhood-level interventions to reduce exposure to environmental asthma triggers. Representatives of community-based organizations, academia, an integrated health system, and the local health department work in partnership on CAAA's Steering Committee (SC) to design and implement the project. OBJECTIVE To conduct a process evaluation of the CAAA community-academic partnership. DESIGN In-depth interviews containing open-ended questions were conducted with SC members. Analysis included established methods for qualitative data, including focused coding and constant comparison methods. SETTING Community setting in Detroit, Michigan. PARTICIPANTS Twenty-three members of the CAAA SC. MEASUREMENTS Common themes identified by SC members relating to the partnership's ability to achieve project goals and the successes and challenges facing the partnership itself. MAIN RESULTS Identified partnership accomplishments included: successful implementation of a complex project, identification of children with previously undiagnosed asthma, and diverse participation and community influence in SC decisions. Challenges included ensuring all partners' influence in decision-making, the need to adjust to "a different way of doing things" in CBPR, constraints and costs of doing CBPR felt by all partners, ongoing need for communication and maintaining trust, and balancing the needs of science and the community through intervention. CONCLUSIONS CBPR can enhance and facilitate basic research, but care must be given to trust issues, governance issues, organizational culture, and costs of participation for all organizations involved.
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Affiliation(s)
- Edith A Parker
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1420 Washington Heights, Ann Arbor, MI 48109-2029, USA.
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Affiliation(s)
- T C Lewis
- Department of Pediatrics, Division of Pulmonary Medicine, University of Washington School of Medicine, Seattle, USA
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Brin EN, Lewis TC, Brin JA. A simple method for reducing backup of blood into intravenous lines caused by inflation of a blood pressure cuff. Anesth Analg 1990; 71:569. [PMID: 2221425 DOI: 10.1213/00000539-199011000-00031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
Ineffective erythropoiesis is an early feature of the myelodysplastic syndromes (MDS), usually accompanying an hypercellular marrow. In a previous study, concentrations of serum erythropoietin (EPO) in MDS have been shown to correlate inversely both with haemoglobin concentration and with % bone marrow erythroblasts. We have measured erythroid production using a radioisotopic technique in 20 patients with MDS. Although haemoglobin concentration shows a weak inverse relationship with serum EPO concentration there is considerable variation in EPO concentration at a given haemoglobin level. There is no correlation between serum EPO and total erythroid production, though there is a weak correlation with effective erythropoiesis. The data suggests that control mechanisms of erythropoiesis in patients with MDS are complex.
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Affiliation(s)
- D T Bowen
- Department of Haematology, University of Wales College of Medicine, Cardiff, U.K
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Bullington J, Mouton Perry SM, Rigby J, Pinkerton M, Rogers D, Lewis TC, Preganz P, Wood AJ, Wood M. The effect of advancing age on the sympathetic response to laryngoscopy and tracheal intubation. Anesth Analg 1989; 68:603-8. [PMID: 2541638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The effect of aging on the hemodynamic and sympathetic response to tracheal intubation was evaluated in 27 patients aged 18 to 80 years, ASA Class I and II, given atropine 0.4 mg and diazepam 10 mg as premedication and thiopental, 4.0 mg/kg, and succinylcholine 100 mg for anesthesia induction. Laryngoscopy and tracheal intubation was performed 60 seconds after induction. The elderly had significantly less chronotropic response to intubation 2, 3, 4, and 5 minutes after induction so that the maximum increase in heart rate above awake values was negatively correlated with age (R = -0.66, P less than 0.001). Baseline systolic blood pressure (SBP) and mean BP increased significantly with age (R = 0.81, P less than 0.001 and R = 0.76, P less than 0.001, respectively) but age was not significantly related to increases in SBP and mean BP following intubation. Baseline plasma norepinephrine (NE) levels increased with age ( R = 0.51, P less than 0.01). Following intubation, mean plasma NE concentrations were significantly higher in elderly patients than young patients, despite the diminished heart rate response. Heart rate (HR) per pg/ml of NE, a measure of cardiac sensitivity to beta stimulation, was therefore significantly less 2, 3, and 4 mins after induction in elderly patients than in younger patients. To determine if this alteration in cardiac sensitivity to endogenous catecholamines was reflected by changes in beta receptor function on lymphocytes, beta receptor density and the proportion of receptor binding agonist with high affinity (%RH) were measured. No significant correlation between beta-receptor affinity for agonist, %RH, or receptor density was found with age, HR, or HR per pg/ml NE.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J Bullington
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232
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Abstract
Fifteen temporomandibular joints (TMJs) in unfixed cadavers were examined clinically and then arthrograms were made. Eleven of the TMJ disks were mechanically displaced anteriorly before the arthrograms were made. The joints were removed, fixed, frozen, and sectioned perpendicular to the long axis of the condyle in 2 mm slices. The arthrograms of the joint were compared with arthrograms of each individual section and the original tissue slices to determine whether there was a definite correlation with true anatomic relationships. Because of the complexity of the internal morphology of the hard and soft tissues in the TMJ, no accurate or consistent conclusions about the actual physical relationships could be made by means of arthrogram.
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Affiliation(s)
- T C Lewis
- University of Louisville School of Dentistry, Ky
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Bear SE, Mercuri LG, Link K, Lewis TC. The performance of patient histories and physical evaluations by oral and maxillofacial surgeons. J Am Dent Assoc 1982; 105:243-4. [PMID: 6956622 DOI: 10.14219/jada.archive.1982.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Jarrard LE, Lewis TC. Effects of hippocampal ablation and intertrial interval on acquisition and extinction in a complex maze. Am J Psychol 1967; 80:66-72. [PMID: 6036360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Lewis TC. Spermatorrhœa. West J Med Surg 1844; 2:70-75. [PMID: 38208435 PMCID: PMC10379550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
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