Beverley J. Sheares

Effects of a school-based intervention for urban adolescents with asthma. A controlled trial.

RATIONALE Asthma prevalence and morbidity are especially elevated in adolescents, yet few interventions target this population. OBJECTIVES To test the efficacy of Asthma Self-Management for Adolescents (ASMA), a school-based intervention for adolescents and medical providers. METHODS Three hundred forty-five primarily Latino/a (46%) and African American (31%) high school students (mean age = 15.1 yr; 70% female) reporting an asthma diagnosis, symptoms of moderate to severe persistent asthma, and asthma medication use in the last 12 months were randomized to ASMA, an 8-week school-based intervention, or a wait-list control group. They were followed for 12 months. MEASUREMENTS AND MAIN RESULTS Students completed bimonthly assessments. Baseline, 6-month, and 12-month assessments were comprehensive; the others assessed interim health outcomes and urgent health care use. Primary outcomes were asthma self-management, symptom frequency, and quality of life (QOL); secondary outcomes were asthma medical management, school absences, days with activity limitations, and urgent health care use. Relative to control subjects, ASMA students reported significantly: more confidence to manage their asthma; taking more steps to prevent symptoms; greater use of controller medication and written treatment plans; fewer night awakenings, days with activity limitation, and school absences due to asthma; improved QOL; and fewer acute care visits, emergency department visits, and hospitalizations. In contrast, steps to manage asthma episodes, daytime symptom frequency, and school-reported absences did not differentiate the two groups. Most results were sustained over the 12 months. CONCLUSIONS ASMA is efficacious in improving asthma self-management and reducing asthma morbidity and urgent health care use in low-income urban minority adolescents.

Do Patients of Subspecialist Physicians Benefit from Written Asthma Action Plans

RATIONALE Asthma clinical guidelines suggest written asthma action plans are essential for improving self-management and outcomes. OBJECTIVES To assess the efficacy of written instructions in the form of a written asthma action plan provided by subspecialist physicians as part of usual asthma care during office visits. METHODS A total of 407 children and adults with persistent asthma receiving first-time care in pulmonary and allergy practices at 4 urban medical centers were randomized to receive either written instructions (n = 204) or no written instructions other than prescriptions (n = 203) from physicians. MEASUREMENTS AND MAIN RESULTS Using written asthma action plan forms as a vehicle for providing self-management instructions did not have a significant effect on any of the primary outcomes: (1) asthma symptom frequency, (2) emergency visits, or (3) asthma quality of life from baseline to 12-month follow-up. Both groups showed similar and significant reductions in asthma symptom frequency (daytime symptoms [P < 0.0001], nocturnal symptoms [P < 0.0001], β-agonist use [P < 0.0001]). There was also a significant reduction in emergency visits for the intervention (P < 0.0001) and control (P < 0.0006) groups. There was significant improvement in asthma quality-of-life scores for adults (P < 0.0001) and pediatric caregivers (P < 0.0001). CONCLUSIONS Our results suggest that using a written asthma action plan form as a vehicle for providing asthma management instructions to patients with persistent asthma who are receiving subspecialty care for the first time confers no added benefit beyond subspecialty-based medical care and education for asthma. Clinical trial registered with www.clinicaltrials.gov (NCT 00149461).

Sleep Problems in Urban, Minority, Early-School-Aged Children More Prevalent Than Previously Recognized

Objectives. To use the Children’s Sleep Habits Questionnaire (CSHQ) to characterize sleep problems in a group of 5- to 6-year-old minority children living in urban communities and to compare our findings with data from 5- to 6-year-old children in the original CSHQ validation study. Methods. A cross-sectional study design was used to collect sleep data from parents using the CSHQ. Results. The CSHQ was completed by 160 parents; 150 (94%) scored ≥41, indicating a sleep problem. The prevalence of having sleep problems for our minority community sample was significantly higher than the original community sample (94% vs 23%, P < .001). The minority sample also had significantly higher mean total CSHQ scores (51.5 vs 37.9, P < .001) and higher scores across all 8 subscales of the CSHQ (P < .001 for all comparisons). Conclusions. The results suggest that sleep problems may be more prevalent in urban, early-school-aged minority children than previously reported.

Fractional exhaled nitric oxide exchange parameters among 9-year-old inner-city children.

To determine the feasibility of using a multiple flow offline fractional exhaled nitric oxide (FeNO) collection method in an inner‐city cohort and determine this populations alveolar and conducting airway contributions of NO. We hypothesized that the flow independent NO parameters would be associated differentially with wheeze and seroatopy.

Unintentional child poisoning risk: A review of causal factors and prevention studies

ABSTRACT Unintentional child poisoning represents a significant public health priority in the United States and globally. This article was written to accomplish three goals: (a) outline and discuss a conceptual model of factors that lead to unintentional poisoning incidents among children under 5 years of age, including the roles of individual people, the environment, packaging and labeling of toxic products, and community and society; (b) review published literature concerning interventions designed specifically to reduce unintentional child poisoning; and (c) draw conclusions about what is known and what gaps exist in the current literature on unintentional child poisoning prevention to inform development, evaluation, and implementation of empirically supported, theoretically based prevention programs. The need for multi-faceted, multi-disciplinary, team-based approaches to prevention is emphasized.

Gender Differences in Pediatric Pulmonary Disease

Publisher Summary There is increasing medical interest in differences between females and males in both normal lung development, as well as in the incidence and expression of many pediatric lung disorders. This chapter aims to highlight the influence of gender on the development, diagnosis, management, and outcomes of pulmonary diseases. While it is likely that biological, environmental, behavioral, and socio-cultural factors underlie the gender differences in respiratory disease, many of the pathophysiologic mechanisms are not well delineated. The chapter reviews the anatomical, functional, and hormonal differences between the respiratory systems of females and males and delineates how changes occur from prenatal development through the adolescent years. Some common respiratory diseases with gender-specific differences are also reviewed.