Roni Grad
University of Arizona
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Featured researches published by Roni Grad.
Pediatrics | 2009
Lynn B. Gerald; Leslie A. McClure; Joan M. Mangan; Kathy Harrington; Linda Gibson; Sue Erwin; Jody Atchison; Roni Grad
OBJECTIVE. We aimed to determine the effectiveness of school-based supervised asthma therapy in improving asthma control. The primary hypothesis was that the supervised-therapy group would have a smaller proportion of children experiencing an episode of poor asthma control each month, compared with those in the usual-care group. METHODS. Children were eligible if they had physician-diagnosed persistent asthma, the need for daily controller medication, and the ability to use a dry-powder inhaler and a peak flowmeter. The trial used a 2-group, randomized, longitudinal design with a 15-month follow-up period. A total of 290 children from 36 schools were assigned randomly to either school-based, supervised therapy or usual care. Ninety-one percent of the children were black, and 57% were male. The mean age was 11 years (SD: 2.1 years). An episode of poor asthma control was defined as ≥1 of the following each month: (1) an absence from school attributable to respiratory illness/asthma; (2) average use of rescue medication >2 times per week (not including preexercise treatment); or (3) ≥1 red or yellow peak flowmeter reading. RESULTS. Two hundred forty children completed the study. There were no differences in the likelihood of an episode of poor asthma control between the baseline period and the follow-up period for the usual-care group. For the supervised-therapy group, however, the odds of experiencing an episode of poor asthma control during the baseline period were 1.57 times the odds of experiencing an episode of poor asthma control during the follow-up period. Generalized estimating equation modeling revealed a marginally significant intervention–time period interaction, indicating that children in the supervised-therapy group showed greater improvement in asthma control. CONCLUSIONS. Supervised asthma therapy improves asthma control. Clinicians who have pediatric patients with asthma with poor outcomes that may be attributable to nonadherence should consider supervised therapy.
The Journal of Allergy and Clinical Immunology | 2012
Roni Grad; Wayne J. Morgan
Evidence from longitudinal cohort studies demonstrates that wheezing that begins in early life and continues into the school years generally persists into adulthood. This persistent wheezing is associated with lung function deficits and airways hyperresponsiveness that appear to be established in the first few years of life. Allergic sensitization early in life, early-life infection with rhinovirus, or colonization with any of a number of bacteria have been associated with increased risk of persistent wheeze. Early life, whether in utero or in the first few years of life, presents a window of vulnerability during which airway injury results in persistent airways dysfunction. Available data further suggest that a second such window of vulnerability might be present in the preadolescent and adolescent years. Lung function growth patterns established by age 6 years generally continue into early adulthood to middle adulthood, typically leaving groups of subjects with wheezing that persists into or relapses during adulthood with a mean FEV(1) of about 10% of predicted value less than their peers who do not wheeze. Subgroups of patients with persistent asthma, however, can have progressive decreases in lung function and enter adulthood with even lower lung function. The concern exists that these deficits in lung function apparent in early adulthood might put subjects at risk for the later development of chronic obstructive pulmonary disease.
Pediatrics | 2004
Lynn B. Gerald; Roni Grad; Anne Turner-Henson; Coralie Hains; Shenghui Tang; Ronald Feinstein; Keith M. Wille; Sue Erwin; William C. Bailey
Objective. The purpose of this study was to validate a 3-stage asthma case-detection procedure for elementary school-aged children. Methods. The study was performed in 10 elementary schools in 4 inner-city school systems, with a total enrollment of 3539 children. Results of the case-detection procedure were compared with the diagnosis of an asthma specialist study physician, to determine the sensitivity and specificity of the case-detection procedure. Results. Ninety-eight percent of children returned the asthma symptoms questionnaires, and 79% of those children consented to additional testing. Results indicated that the 3-stage procedure had good validity, with sensitivity, specificity, and predictive value of 82%, 93%, and 93%, respectively. A 2-stage procedure using questionnaires and spirometry had similar validity, with sensitivity, specificity, and predictive value of 78%, 93%, and 93%, respectively. However, given the time and expense associated with the 2- or 3-stage procedure and the difficulty of obtaining physician follow-up evaluation of the case-detection diagnosis, schools may prefer to use a 2-item questionnaire that has a lower sensitivity (66%) but higher specificity (96%) and predictive value (95%). Conclusions. Case-detection programs are generally well received by school personnel and can identify children with unrecognized or undiagnosed disease, as well as those with a current diagnosis but poorly controlled disease. This study yields substantial information regarding the validity, yield, and specific types of children who might be identified with the use of such procedures. For the choice of the method of case detection used in a school, the strengths and weaknesses of each procedure, as well as the resources available for case detection, physician referral, and follow-up procedures, must be considered.
The Journal of Allergy and Clinical Immunology | 2010
Joe K. Gerald; Roni Grad; William C. Bailey; Lynn B. Gerald
BACKGROUND Much has been done to promote population-based childhood asthma screening; however, concerns remain regarding its cost-effectiveness. OBJECTIVES To conduct a cost-effectiveness analysis of school-based asthma screening strategies. METHODS A 5 health state Markov approach (symptom-free, symptom, exacerbation recovery, emergency department, and hospitalization day) was used to evaluate school-based screening in a simulated population of urban elementary-age school children. Two questionnaire and 2 multistage strategies incorporating spirometry or spirometry with exercise testing were evaluated from the societal perspective by using 365 daily cycles. The outcome was 2006 dollars per quality-adjusted life year (QALY). RESULTS The most efficient strategy identified children with previously diagnosed but poorly controlled asthma at a cost of
Pediatrics | 2009
Joe K. Gerald; Yanhui Sun; Roni Grad; Lynn B. Gerald
150,000 per QALY (95% CI,
Journal of Asthma | 2009
Roni Grad; Leslie A. McClure; Sijon Zhang; Joan M. Mangan; Linda Gibson; Lynn B. Gerald
65,800-
Experimental Lung Research | 1990
Mark L. Witten; Roni Grad; Stuart F. Quan; Richard E. Sobonya; Andrea K. Hubbard; Lantz Rc; L. Amanda Lentz; Devine L; Richard J. Lemen
318,000). Uncertainty surrounding the cost-effectiveness estimate was primarily a result of the symptom day preference weight estimate (44%), the probability of confirmation after screening (17%), the adequacy of asthma control in the population (9%), and the estimated treatment effect on symptoms (6%). Screening generated an additional 21 symptom-free day equivalents per child identified with previously diagnosed but not well controlled asthma and led to
American Journal of Respiratory and Critical Care Medicine | 1994
David B. Coultas; Henry Gong; Roni Grad; Aaron Handler; Stephen A. McCurdy; Richard Player; Everett R. Rhoades; Jonathan M. Samet; Alvin Thomas; Michael Westley
85.55,
Pediatrics | 1993
Robert Katz; Kelly Hw; M. R. Crowley; Roni Grad; Bennie McWilliams; S. J. Murphy
12.36, and
Proceedings of the American Thoracic Society | 2007
Lynn B. Gerald; Marianna M. Sockrider; Roni Grad; Bruce G. Bender; Leslie P. Boss; Stanley P. Galant; Jorrit Gerritsen; Christine L. M. Joseph; Robert M. Kaplan; Julie A. Madden; Joan M. Mangan; Greg J. Redding; Diana K. Schmidt; Christina D. Schwindt; Virginia S. Taggart; Lani Wheeler; Kristin N. Van Hook; Paul V. Williams; Barbara P. Yawn; Bulend Yuksel
2.58 in additional screening, daily treatment, and indirect costs and