Phuong Vo

Promoting early detection of breast cancer among Vietnamese-American women

Although breast cancer is the second most common cancer among Vietnamese‐American women, previous research has shown that they are less likely to have ever had, and to be more often overdue for, clinical breast examinations (CBE) and mammograms than women in the general population.

The Association of Overweight and Obesity with Spirometric Values in Minority Children Referred for Asthma Evaluation

Background. Overweight, obesity, and asthma are more prevalent in minority children; yet, the association of overweight and obesity with spirometric values in asthmatic minorities is not well characterized. Objective. To study the relationship between weight, ethnicity, and spirometric values in children referred for asthma evaluation to a large inner-city hospital in Bronx, NY. Methods. Retrospective review of spirometry done at the first pulmonary clinic visit of 980 asthmatic children, aged 7–20 years, was conducted. Linear regression analysis was performed to elucidate the association of overweight and obesity with pulmonary function among Whites, African Americans, and Hispanics compared with their normal weight counterparts. Results. More African Americans (58%) and Hispanics (65.4%) were overweight and obese than Whites (51.2%) (p < .05). Compared with their normal weight counterparts, percent forced expiratory volume in the 1st second (FEV1)/forced vital capacity (FVC) ratio was lower in both overweight and obese African Americans (2.99%, p < .05 and 3.56%, p < .01, respectively) and Hispanics (2.64%, p < .05 and 2.36%, p < .05, respectively); these differences were found in obese (3.73%, p < .05) but not in overweight (0.68%, p = .7) Whites. Conclusions. FEV1/FVC ratio was lower in both overweight and obese African American and Hispanic children, while this association was present only among obese Whites compared with their normal weight counterparts. These results suggest that spirometric measures of lower airway obstruction decrease with smaller weight increments in minority children when compared with White children. In the context of the higher prevalence of overweight and obesity among African Americans and Hispanics, our findings offer one potential explanation for increased asthma among minority children.

WORKING TO EXIT POVERTY WHILE CARING FOR CHILDREN'S HEALTH AND DEVELOPMENT IN VIETNAM

Since the implementation of economic reforms in 1986, levels of urbanization, industrialization, and womens labour force participation have increased in Vietnam. This article focuses on the experiences of parents in Vietnam and how labour and social conditions affect their ability to work and exit poverty while caring for their childrens health and development. We interviewed a sample of 147 parents in Ho Chi Minh City using in-depth, semi-structured questionnaires. Sixty-three percent of parents had faced loss of income or promotions or had difficulty retaining jobs because they had to care for children. Fifty-eight percent of parents lost income while caring for their sick children because they had to take unpaid leave from work to care for their children or because they had to decrease productivity if they were able to continue working. Fifty percent of parents with school-age children experienced barriers to helping with homework, to attending meetings, or to participating in other aspects of their childrens education. The aftermath of the Vietnamese – American War affected parents through loss of extended family members, limiting access to a major traditional source of support. The war had affected other parents by preventing them from completing their education, which left them with job choices that offer little or no work benefits. Although Vietnam has made significant progress in providing early childhood care and education and legislating labour laws, working families’ experiences demonstrate the need to ensure that paid leave and work flexibility policies are available and implemented in all work sectors and to expand affordable, quality child care in order to help low-income working parents in Vietnam meet work demands and exit poverty while meeting their childrens needs.

The potential role of vitamin D in the link between obesity and asthma severity/control in children

Childhood obesity and asthma are major public health problems. Obesity is not only associated with increased risk of incident asthma, but it may worsen asthma severity/control. Although the mechanisms linking obesity with asthma expression have not been completely elucidated, evidence suggests that increased frequency of acute respiratory infection (ARI) and decreased corticosteroid responsiveness may help to explain how obesity worsens asthma expression. In addition, obese individuals have low vitamin D status, and emerging evidence suggests vitamin D affects risk of ARI and corticosteroid responsiveness in individuals with asthma. In this review, we summarize the association between obesity and asthma severity/control in children and discuss ARI and corticosteroid responsiveness as potential mediators in the obesity–asthma pathway. We also discuss the potential role of vitamin D, including a brief summary of recent randomized controlled trials of vitamin D supplementation.

Child Care Providers' Experiences Caring For Sick Children: Implications For Public Policy

This study examines the experiences of preschool and school-age child care providers regarding sick child care. In-depth, semi-structured interviews were conducted of child care providers at every city-sponsored preschool and afterschool program in an urban area in the United States. In addition, random sampling was used to identify home-based child care providers from a list obtained through a child care resources center. In spite of rules requiring that sick children be kept home, child care providers repeatedly described sick children whose health problems made it impossible to provide adequate care for the sick child at the same time as caring for the well children in their care. Problems arose for a range of reasons, including inability to provide sufficient attention to the sick child-s needs, inability to keep a sick child clean and well hydrated in the case of vomiting and diarrhea, spread of infectious diseases, and inability to care for healthy children adequately when meeting the needs of sick children. International public health policy implications for child care and paid family leave are discussed.

Impact of Cilia Ultrastructural Examination on the Diagnosis of Primary Ciliary Dyskinesia

Ultrastructural examination of cilia is the “gold standard” for diagnosing primary ciliary dyskinesia. There is little evidence suggesting the most effective method of procuring a ciliary biopsy and scant benchmark data on rates of conclusive biopsies or on the diagnostic impact of such biopsies. To critically assess rates of inconclusive, positive, and negative ciliary biopsies and to identify clinical factors associated with conclusive results, we reviewed ciliary biopsies submitted for electron microscopy from 2006 to 2011, noting whether specimens were adequate for analysis and whether the ciliary structure was normal. The biopsy site, method used, procedurists specialty, and clinical diagnoses were determined. Biopsy findings were categorized by diagnostic impact. Over 5 years, 187 patients had 211 biopsies. Conclusive results were obtained on 133/211 biopsies (63%); the remainder were insufficient. The rate of inconclusive biopsies did not vary significantly (P > 0.05; Fishers exact) among sampling methods. Abnormal results were identified in 8/133 (6.0%) of the adequate specimens. Forceps compared to brush biopsies (abnormal in 4/12 versus 4/121 of the adequate specimens, P = 0.002), along with multiple biopsy samples (taken on same or different days) compared with a single biopsy sample (abnormal in 3/12 versus 1/110 of the adequate specimens, P = 0.01), were more likely to yield an abnormal result. Only 63% of pediatric ciliary biopsies provide adequate morphology for analysis, the large majority of these samples showing normal ciliary anatomy. The method of obtaining biopsies did not significantly affect result conclusiveness. Understanding the diagnostic impact of ultrastructural analysis is important as new diagnostic algorithms are developed for primary ciliary dyskinesia.

Changes in emergency department concordance with guidelines for the management of stinging insect-induced anaphylaxis: 1999–2001 vs 2013–2015

BACKGROUND Changes in emergency department (ED) concordance with guidelines for the management of stinging insect-induced anaphylaxis (SIIA) are not known. OBJECTIVE To describe temporal changes in ED concordance with guidelines for the management of SIIAs. METHODS We analyzed data from 2 multicenter retrospective studies of patients with stinging insect-related acute allergic reactions seen in 1 of 14 North American EDs during 2 periods: 1999 through 2001 and 2013 through 2015. Visits were identified similarly across studies (eg, using International Classification of Diseases, Ninth Revision, Clinical Modification codes 989.5, 995.0, and 995.3). Anaphylaxis was defined as an acute allergic reaction with involvement of at least 2 organ systems or hypotension. We compared concordance between periods with 4 guideline recommendations: (1) treatment with epinephrine, (2) discharge prescription for epinephrine auto-injector, (3) referral to an allergist/immunologist, and (4) instructions to avoid the offending allergen. RESULTS We compared 182 patients with SIIA during 1999 to 2001 with 204 during 2013 to 2015. Any treatment with epinephrine (before arrival to the ED or in the ED) increased over time (30% vs 49%; P < .001). Prescriptions for epinephrine auto-injector at discharge increased significantly (34% vs 57%; P < .001), whereas documentation of referral to an allergist/immunologist decreased (28% vs 12%; P = .002), and instructions to avoid the offending allergen did not change (23% vs 24%; P = .94). Receipt of at least 3 guideline recommendations increased over time; however, the comparison was not statistically significant (10% vs 16%; P = .15). CONCLUSION During the nearly 15-year study interval, we observed increased ED concordance with epinephrine-related guideline recommendations for the management of SIIA. Reasons for the decrease in allergy/immunology referrals merit further study.

Allograft-Transmitted Histoplasma capsulatum Infection in a Solid Organ Transplant Recipient

Histoplasma capsulatum is a dimorphic fungus known to be endemic to the Mississippi and Ohio River valleys of North America. Infection is the result of exposure to the microconidia of the mold phase of the organism, and the degree of exposure and immunocompetency of the host are thought to be important determinants in the severity of consequent illness [1]. In most patients, histoplasmosis manifests as a self-limited respiratory illness with protean complaints that include fever, dry cough, and fatigue. The more severe form of the disease, progressive disseminated histoplasmosis, is far less common and is usually seen in very young, elderly, and immunosuppressed patients. Unfortunately, the diagnosis requires a high level of suspicion and is often delayed. We describe a case of progressive disseminated histoplasmosis in a pediatric orthotopic heart transplant recipient from a nonendemic area whose disease was acquired from the donor allograft and whose diagnosis was delayed because of an incomplete donor history.

Vitamin D Status at the Time of Hospitalization for Bronchiolitis and Its Association with Disease Severity

Objective To investigate the association between circulating 25‐hydroxyvitamin D [25(OH)D] status at admission and disease severity among infants hospitalized for bronchiolitis and to determine whether the association differs by the form of 25(OH)D—total, bioavailable or free 25(OH)D. Study design We conducted a 17‐center prospective cohort study of 1016 US infants <12 months old hospitalized with bronchiolitis. Vitamin D status was defined by total 25(OH)D levels, and by calculated levels of bioavailable and free 25(OH)D. Bronchiolitis severity was defined by requirement for intensive care and hospital length‐of‐stay (LOS). Logistic and Poisson regression were used for unadjusted and multivariable analyses. Results The median age of hospitalized infants was 3.2 months (IQR 1.6‐6.0). The median total 25(OH)D was 26.5 ng/mL (IQR 18.0‐33.1); 298 (29%) infants had total 25(OH)D <20 ng/mL. In multivariable models, infants with total 25(OH)D <20 ng/mL had higher risk of requiring intensive care (aOR 1.72, 95% CI 1.12‐2.64) and longer LOS (adjusted rate ratio 1.39, 95% CI 1.17‐1.65) compared with infants with total 25(OH)D ≥30 ng/mL. Infants with the lowest tertile of bioavailable 25(OH)D, compared with those with the highest tertile, had longer LOS (adjusted rate ratio 1.32, 95% CI 1.07‐1.62); admission to the intensive care unit was not statistically significant in the adjusted model (aOR 1.39, 95% CI 0.96‐2.64). Free 25(OH)D level was not associated with severity of bronchiolitis in either unadjusted or adjusted models. Conclusion In a large, multicenter cohort of US infants hospitalized for bronchiolitis, infants with total 25(OH)D <20 ng/mL had increased risk of intensive care and longer hospital LOS.