Anna Volerman

Primary Care of the Childhood Cancer Survivor

Today more than 80% of children diagnosed with cancer are alive 5 years after diagnosis. Childhood cancer survivors encounter high rates of morbidity and mortality from late effects and, as a result, require long-term follow-up care. Care must be individualized based on the cancer type and therapies, which are detailed in a treatment summary. Primary care providers are instrumental to providing long-term care, which includes monitoring for recurrence and secondary malignancies, evaluating for and treating late effects, and providing preventive care and counseling. With appropriate surveillance, childhood cancer survivors can live physically and emotionally healthy lives.

Cervical Cancer Screening

of the Clinical Problem Approximately 12 000 new cases of cervical cancer are expected to occur in the United States in 2014, with 4000 deaths from the disease.1 Women younger than 50 years have the highest incidenceofcervicalcancer,andthedisease ismoreprevalent inHispanic andblackwomen. Fifty percent of women diagnosed with cervical cancer were never screened,andanadditional 10% werenot screened in the5-yearperiodbefore thediagnosis.1 Fordecades, screening has been performed via cytological examination of cells fromthecervical transformationzone (Papanicolaousmear). More recently, testing forHPV, the causative agent inmost cases of cervical cancer, has been added as a screeningmodality.

National Analysis of State Health Policies on Students' Right to Self-Carry and Self-Administer Asthma Inhalers at School

BACKGROUND Asthma has no known cure, and though manageable, it disrupts the everyday lives of over 6 million US children. Because children spend more than half of their waking hours in school, students must be able to carry and administer their inhaler at school to manage their asthma. METHODS This policy paper is a comprehensive review of all 50 states and the District of Columbias laws and policies for the self-carry and administration of quick-relief asthma inhalers among children in prekindergarten through 12th grade. RESULTS All states permit students to carry and administer their inhalers at school, although each state differs in their development and implementation of policies for asthma self-management at school. This review examines how states regulate self-carry policies by looking at policy development, regulated school systems, relevant stakeholders, required medical records, and school liability. CONCLUSIONS Each states laws have nuances that create gray areas, increasing the potential of misinterpreted or incorrectly implemented policies for asthma self-management at school. As a result, children may not have immediate access to their inhaler for symptom management or in an emergency. State policymakers should reform current laws to remove barriers for students to carry and use inhalers at school.

A qualitative study of parent perspectives on barriers, facilitators and expectations for school asthma care among urban, African-American children

Abstract Objectives: Minority children experience the disproportionate burden of asthma and its consequences. Studies suggest ethnic groups may experience asthma differently with varied perceptions and expectations among parents of African-American and Latino children. Because parents coordinate asthma care with the school, where children spend a significant amount of their day, this study’s goal was to determine parents’ perspectives on school asthma management. Methods: Focus groups were conducted with parents of children with asthma at four urban schools whose student population is predominantly African-American. A semi-structured guide was utilized focusing on barriers, facilitators and expectations for asthma care at school. Grounded theory principles were applied in this study. Results: Twenty-two parents (91% females) representing 13 elementary and 10 middle school children with asthma (61% boys) participated in four focus groups. Most children (87%) had persistent asthma. The identified barriers to effective school-based asthma care included limited awareness of children with asthma by teachers/staff, communication issues (e.g. school/parent, within school), inadequate education and lack of management plans or systems in place. In contrast, the identified facilitators included steps that fostered education, communication and awareness, as supported by management plans and parent initiative. Parents described their expectations for increased communication and education about asthma, better systems for identifying children with asthma, and a trained asthma point person for school-based asthma care. Conclusions: Parents of children with asthma identified important barriers, facilitators and expectations that must be considered to advance school asthma management. Improved school-based asthma care could lead to better health and academic outcomes.

Peanut Allergy Prevention

of the Clinical Problem Peanut allergy is the leading cause of death due to food-related anaphylaxis in the United States. Although the overall mortality rate is very low, the medical and psychosocial burden is substantial for the 2% of children and 1% of adults with peanut allergy.1 For some individuals, peanut allergy is identified early in life and persists through adulthood. Clinical practice guidelines have advised to exclude foods containing peanuts from the diets of infants and children until as late as 3 years of age despite limited evidence associating delayed introduction with allergy prevention.2 More recent evidence has questioned the benefit of delayed solid food introduction on atopic diseases, including asthma, eczema, and allergies.3

Solutions for Asthma Disparities

Childhood asthma prevalence has plateaued and may have declined for the first time since 1980.1 Although this news is promising, it is important not to lose sight of the significant disparities in asthma outcomes that remain by race, ethnicity, and socioeconomic status. We must reduce these disparities, and health care organizations’ increasing focus on population health presents a prime opportunity to do so. Now is a critical time to invest in research and quality improvement initiatives that directly target the persistent disparities in childhood asthma outcomes. Disparities in asthma outcomes have been documented since the 1980s. Children of racial or ethnic minorities face higher morbidity and mortality due to asthma when compared with white children. Non-Hispanic African American children have 2 to 3 times higher rates of hospitalization and emergency department visits compared with non-Hispanic white children. African American children face a 4.9-fold higher asthma mortality rate. In addition, Hispanic children are 2 times more likely to visit an emergency department and 1.5 times more likely to die due to asthma when compared with non-Hispanic children.2 Numerous individual- and system-level factors contribute to asthma disparities, including health care policies, health systems operations, and clinician, patient, family, and environmental factors. For example, minority children are less likely to be prescribed a controller medication when indicated and are less likely to adhere to therapy that is prescribed. Additional factors driving disparities include clinic-centric care, indoor allergen exposure, limited primary … Address correspondence to Anna Volerman, MD, Departments of Medicine and Pediatrics, University of Chicago, 5841 S Maryland Ave, MC 2007, Chicago, IL, 60637. E-mail: avolerman{at}uchicago.edu