Mary Ann Lewis

The potential impact of sexual equality on health.

There are major differences between the sexes in morbidity and mortality rates. At all ages males have higher death rates and are more frequently afflicted with the chronic diseases associated with considerable reductions in longevity. Trend data indicate that males have become relatively more disadvantaged during a period characterized by major advances in medicine and increased access to care. In contrast, rates of disability and use of services are higher among females. There is some evidence that these differences are associated more with behavioral than with biologic factors. Certain shifts in age-specific mortality rates reflect sex-role-related changes in behavior--e.g., increased consumption of tobacco by women and a reversal in sex mortality ratio for cancer of the lung. Changes in sex roles may affect directly, or indirectly through family dynamics, the health status of both sexes.

Randomized Trial of a Program to Enhance the Compéténcies of Children with Epilepsy

Summary: A randomized, controlled trial was conducted in Santiago, Chile to test the impact of a child‐centered, family‐focused educational program for children aged 7–14 years with epilepsy and for their parents. The objectives of the program developed and pilot‐tested in Los Angeles, California were to increase the childrens knowledge, perceptions of competency, and skills related to dealing with seizures. Children in the experimental group (n = 123) and their parents separately attended four 1 1/2‐h sessions and then met together at the end of each session to share learning experiences. Control children (n = 113) and their parents attended three 2‐h sessions with a traditional lecture followed by question‐and‐answer format. All participants were pretested and then retested 5 months after completion of the educational intervention. Although there was some knowledge increase among children in the control group, the knowledge of children in the experimental group was significantly enhanced in a variety of areas related to management of their seizures and unnecessary restriction of their social and play activities. There was a significant increase in the self‐perceptions of social compéténcy of children in the experimental group. Children in the experimental group without serious behavioral problems also reported significantly better behavior after the intervention than did control children. There was no impact on childrens disclosure of their diagnosis to friends and others.

Usability Testing of a Smartphone for Accessing a Web-Based e-Diary for Self-Monitoring of Pain and Symptoms in Sickle Cell Disease

We examined the usability of smartphones for accessing a web-based e-Diary for self-monitoring symptoms in children and adolescents with sickle cell disease (SCD). One group of participants (n=10; mean age, 13.1±2.4 y; 5 M; 5 F) responded to questions using precompleted paper-based measures. A second group (n=21; mean age, 13.4±2.4 y; 10 M; 11 F) responded based on pain and symptoms they experienced over the previous 12 hours. The e-Diary was completed with at least 80% accuracy when compared to paper-based measures. Symptoms experienced over the previous 12 hours included feeling tired (33.3%), headache (28.6%), coughing (23.8%), lack of energy/fatigue (19.0%), yellowing of the eyes (19.0%), pallor (19.0%), irritability (19.0%), stiffness in joints (19.0%), general weakness (14.3%), and pain (14.3%), rating on average as 2.0±1.7 (on 0 to 10 scale). Overall, sleep was good (8.1±1.4 on the 0 to 10 scale). In conclusion, children with SCD were able to use smartphones to access a web-based e-Diary for reporting pain and symptoms. Smartphones may improve self-reporting of symptoms and communication between patients and their health care providers, who may consequently be able to improve pain and symptom management in children and adolescents with SCD in a timely manner.

Remote monitoring of pain and symptoms using wireless technology in children and adolescents with sickle cell disease

Purpose: The purpose of this study was to examine (a) symptoms, (b) pain characteristics (intensity, location, quality), (c) pain medications and nonpharmacological strategies used for pain, (d) thoughts and feelings, and (e) healthcare visits. We also examined the relationship between pain and sleep. Data sources: Pain and symptoms were entered on an electronic e‐Diary using a smartphone and were remotely monitored by an advanced practice registered nurse (APRN). Sixty‐seven children and adolescents (10–17 years) reported mild to severe pain at home that did not require healthcare visits. Symptoms reported were (a) general symptoms such as tiredness/fatigue (34.7%), headache (20.8%), yellowing of the eyes (28.4%); (b) respiratory symptoms such as sniffling (32.9%), coughing (19.1%), changes in breathing (10.0%); and (c) musculoskeletal symptoms such as stiffness in joints (15.8%). A significant negative correlation was found between pain and sleep (r = −.387, p = .024). Factors that predict pain included previous history of sickle cell disease (SCD) related events, symptoms, and negative thoughts. Conclusion: Pain and multiple symptoms entered on a web‐based e‐Diary were remotely monitored by an APRN and prompted communications, further evaluation, and recommendations. Implications for practice: Remote monitoring using wireless technology may facilitate timely management of pain and symptoms and minimize negative consequences in SCD.

Rodent allergen in Los Angeles inner city homes of children with asthma

Recent studies have examined the presence of mouse allergen in inner city children with asthma. Researchers have found high levels of rodent allergen in homes sampled in the northeast and midwest United States, but there has been considerable variation between cities, and there have been few studies conducted in western states. We evaluated the frequency of rodent sightings and detectable mouse allergen and the housing conditions associated with these outcomes in inner city homes in Los Angeles. Two hundred and two families of school children, ages 6–16 living in inner city neighborhoods, participated in the study. Families were predominantly Latino (94%), and Spanish speaking (92%). At study entry, parents completed a home assessment questionnaire, and staff conducted a home evaluation and collected kitchen dust, which was analyzed for the presence of mouse allergen. Fifty-one percent of homes had detectable allergen in kitchen dust. All 33 families who reported the presence of rodents had detectable allergen in the home and were also more likely to have increased levels of allergen compared to those who did not report rodents. Unwashed dishes or food crumbs, lack of a working vacuum, and a caretaker report of a smoker in the home were all significantly associated with a greater risk of rodent sightings or detectable allergen (P < 0.05). Detached homes were significantly more likely to have detectable allergen. The prevalence of allergen is common enough that it may have public health implications for asthmatic children, and detectable allergen was not routinely identified based on rodent sightings. Many of the predictors of rodent allergen are amenable to low-cost interventions that can be integrated with other measures to reduce exposure to indoor allergens.

Children's Health-Related Decision Making

Requests for reprints may be addressed to Dr. Charles E. Lewis, Department of Medicine, UCLA School of Medicine, Los Angeles, CA 90024. During the twentieth century, a host of scientists from several disciplines have studied children. Investigators from the biological sciences have studied growth and development, immunological responses, and reactions to therapeutic treatments. I n contrast, behavioral or social scientists have focused on cognitive, personality, and psychosocial development. Despite this wide range of inquiries, no one has studied children as decision makers. In particular, no researchers have examined children’s decision making related to their own health. Only a few studies present data on health beliefs derived from healthy children, ages 5-12. Most are descriptive studies reporting data collected from children on one occasion. Four of these present data collected from children and their parents. 14 Three investigators followed a cohort of children

Facilitating Pediatric Patient-Provider Communications Using Wireless Technology in Children and Adolescents With Sickle Cell Disease

INTRODUCTION Use of wireless devices has the potential to transform delivery of primary care services for persons with sickle cell disease (SCD). The study examined text message communications between patients and an advanced practice registered nurse (APRN) and the different primary care activities that emerged with use of wireless technology. METHODS Patients (N = 37; mean age 13.9 ± 1.8 years; 45.9% male and 54.1% female) engaged in intermittent text conversations with the APRN as part of the Wireless Pain Intervention Program. Content analyses were used to analyze the content of text message exchanges between patients and the APRN. RESULTS The primary care needs that emerged were related to pain and symptom management and sickle cell crisis prevention. Two primary care categories (collaborating and coaching), four primary care subcategories (screening, referring, informing, and supporting), and 16 primary care activities were evident in text conversations. DISCUSSION The use of wireless technology may facilitate screening, prompt management of pain and symptoms, prevention or reduction of SCD-related complications, more efficient referral for treatments, timely patient education, and psychosocial support in children and adolescents with SCD.

Cost-effectiveness analysis of behavioral interventions to improve vaccination compliance in homeless adults

AIMS To estimate the cost-effectiveness of three behavioral interventions provided to enhance hepatitis A virus (HAV) and hepatitis B virus (HBV) joint vaccination (HAV/HBV) compliance among homeless persons living in Los Angeles County. SCOPE A cost-effectiveness analysis (CEA) based on data from a randomized trial where the costs and compliance data from the trial are incorporated into two Markov models, simulating the natural history of acute and chronic hepatitis infection, following HAV/HBV vaccination. CONCLUSIONS Reductions in HBV-related disease is cost-effective to society and is associated with substantial improvements in quality of life.

Evaluation and implementation of self-management programs for children with asthma

We have reviewed the needs and problems associated with the evaluation and implementation of programs designed to assist children with asthma and their parents to manage the illness. To date, there are several programs that have been evaluated and found to be effective in terms of the objectives and dimensions described. Implementation has presented a larger problem because there are few implementors and because of the major barriers to be overcome by those who would make these programs available to the significant numbers of children and families who would benefit. Unless ways can be found to overcome the medical and reimbursement barriers, asthma self-management programs will not thrive. The growing number of individuals enrolled in some form of health maintenance organization, however, suggests a greater market for asthma self-management programs, under circumstances in which the costs of emergency room use and hospital services must be borne by physicians and hospitals, rather than by their patients.

The Meaning of Survivorship as Defined by African American Breast Cancer Survivors.

Background: While there is an abundance of cancer survivorship research among various racial/ethnic groups, there is a paucity of research on survivors of African descent. To date, the meaning of survivorship has not been reported exclusively among African American breast cancer survivors (AABCS). Purpose: The purpose was to describe and understand the meaning of survivorship among community-dwelling AABCS, mostly recruited from breast cancer support groups. Method: Using a qualitative descriptive approach, an open-ended questionnaire explored the meaning of survivorship among 155 AABCS. An analysis of the content was performed. Results: Among AABCS, survivorship meant having a strong spiritual base, thriving, being resilient, and being altruistic. The survivors self-identified with and embraced the term survivor. Conclusions: These results provide an important understanding of the perspectives and meaning of survivorship among AABCS and may assist in developing cancer survivorship care plans that are relevant, responsive, patient centered, and culturally appropriate.