Seymour G. Williams

Asthma and Influenza Vaccination: Findings From the 1999–2001 National Health Interview Surveys

STUDY OBJECTIVES People with asthma are at high risk for complications from influenza; therefore, the Centers for Disease Control and Prevention recommends an annual influenza vaccination for people with asthma. Because little is known about such vaccination rates among adults, especially those aged 18 to 49 years and 50 to 64 years, we sought to estimate influenza vaccination rates among US adults. DESIGN Cross-sectional analyses of the 1999 to 2001 National Health Interview Surveys. SETTING US population. PARTICIPANTS Representative samples of US adults aged > or =18 years. MEASUREMENTS AND RESULTS Asthma status and receipt of influenza vaccination during the past 12 months were self-reported. We found that 35.1% (95% confidence interval [CI], 33.0 to 37.0%), 36.7% (95% CI, 34.7 to 38.6%), and 33.3% (95% CI, 31.6 to 35.0%) of participants with asthma reported having had an influenza vaccination in 1999 (n = 2,620), 2000 (n = 3,007), and 2001 (n = 3,582), respectively. Among participants aged 18 to 49 years, the vaccination rates were 20.9% (SE 1.2%), 22.7% (SE 1.2%), and 21.1% (SE 1.0%), respectively. Among participants aged 50 to 64 years, the vaccination rates were 46.2% (SE 2.6%), 47.8% (SE 2.3%), and 42.3% (SE 2.1%), respectively. Vaccination rates increased strongly with age and with education in each year. Associations with sex or with race or ethnicity were inconsistent during the 3 years. CONCLUSIONS The suboptimal vaccination rates among people with asthma aged 18 to 64 years suggest the need to increase influenza vaccination rates in this age group.

The Inner-City Asthma Intervention: description of a community-based implementation of an evidence-based approach to asthma management

BACKGROUND In 2000, the Centers for Disease Control and Prevention funded a 4-year project to implement the Inner-City Asthma Intervention (ICAI)-an asthma treatment and management project based on the protocol developed for the National Cooperative Inner-City Asthma Study (NCICAS) funded by the National Institutes of Health, National Institute of Allergy and Infectious Disease. OBJECTIVE To describe the ICAIs major components and implementation issues. METHODS Information contained in this article is based on project activity and management reports, site client tracking and data collection reports, site visit and other program oversight activity, and general subject matter knowledge. The site client tracking data collection process varied among sites during the intervention. Common definitions and processes were developed and implemented as needed. RESULTS Three of the 24 original sites discontinued participation. The remaining sites enrolled 4,174 children into the intervention. Although the project ended earlier than originally scheduled, 1,035 children completed the entire intervention. Of the 3,139 children who did not complete the entire protocol, 1,355 children and their families completed the core activities or the core activities plus one or more follow-up activities. CONCLUSION The ICAI project demonstrated that although there were a number of implementation issues to overcome, it is possible to implement effectively a proven National Institutes of Health protocol in the community setting.

Lower levels of antiretroviral therapy enrollment among men with HIV compared with women - 12 countries, 2002-2013

Equitable access to antiretroviral therapy (ART) for men and women with human immunodeficiency virus (HIV) infection is a principle endorsed by most countries and funding bodies, including the U.S. Presidents Emergency Plan for AIDS (acquired immunodeficiency syndrome) Relief (PEPFAR) (1). To evaluate gender equity in ART access among adults (defined for this report as persons aged ≥15 years), 765,087 adult ART patient medical records from 12 countries in five geographic regions* were analyzed to estimate the ratio of women to men among new ART enrollees for each calendar year during 2002-2013. This annual ratio was compared with estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS)(†) of the ratio of HIV-infected adult women to men in the general population. In all 10 African countries and Haiti, the most recent estimates of the ratio of adult women to men among new ART enrollees significantly exceeded the UNAIDS estimates for the female-to-male ratio among HIV-infected adults by 23%-83%. In six African countries and Haiti, the ratio of women to men among new adult ART enrollees increased more sharply over time than the estimated UNAIDS female-to-male ratio among adults with HIV in the general population. Increased ART coverage among men is needed to decrease their morbidity and mortality and to reduce HIV incidence among their sexual partners. Reaching more men with HIV testing and linkage-to-care services and adoption of test-and-treat ART eligibility guidelines (i.e., regular testing of adults, and offering treatment to all infected persons with ART, regardless of CD4 cell test results) could reduce gender inequity in ART coverage.

Improving pediatric asthma care through surveillance : The illinois emergency department asthma collaborative

OBJECTIVES. To better understand and improve the care of asthma patients who require emergency department (ED) care, the Illinois Emergency Department Asthma Collaborative (IEDAC) was created to develop, test, and disseminate an ED-based surveillance system. This report describes the development and testing of the pediatric IEDAC surveillance instruments and demonstrates how these instruments can be used to describe the health status, healthcare delivery, and outcome of children using ED services. METHODS. A convenience sample of 128 children presenting to 5 EDs in Illinois for asthma care was the study base. Data were collected on monthly samples of children aged 2 through 17 years who presented to these EDs from May to November 2003. Three instruments were used to collect data regarding the children’s pre-ED, ED, and post-ED experience. RESULTS. At the ED visit, 73.4% of children met national guideline criteria for persistent-level asthma symptoms. Among this group, 53.2% were using inhaled corticosteroid (ICS) medications. At 1 month follow-up, 66.6% of the children met the criteria for persistent-level asthma symptoms, which was statistically unchanged from the ED visit. Among the latter group, 64.2% were using ICS medications, again statistically unchanged compared with the ED visit. At follow-up, 24.5% of children were reported to have returned to an ED or were subsequently hospitalized. The majority of children were noted at follow-up to have limitation of at least some activity. CONCLUSIONS. Children who presented to IEDAC EDs were found to have a high level of asthma burden that continued at follow-up despite treatment. Moreover, a substantial proportion of children had returned to an ED or were subsequently hospitalized. Encouraging trends in medication use were observed, although suboptimal medication use was also observed.

Using Billing Data to Describe Patterns in Asthma-Related Emergency Department Visits in Children

OBJECTIVES. To describe the development and evaluation of a pilot emergency department (ED)-based asthma surveillance system for childhood asthma visits based on billing data and to illustrate how the data can be used to document trends and patterns in ED visits for asthma in children. METHODS. During 2001 and 2002, aggregate reports based on ED billing data from 3 hospitals in western Michigan were obtained from a single physician billing company. Data were tabulated and graphed to show trends in the monthly number of ED visits for asthma in children. Comparisons were made by age, gender, and site. We evaluated the system by using established guidelines. RESULTS. The data illustrated strong seasonal trends, as well as marked differences in ED use according to age and gender. The total numbers of asthma ED visits were remarkably similar between the 2 years evaluated; however, the timing and duration of the seasonal peaks differed. Our evaluation of the system found that it met many of the characteristics that define successful surveillance systems, including simplicity, flexibility, acceptability, sensitivity and positive predictive value, timeliness, and stability. However, the surveillance systems representativeness was limited by the inability to calculate valid population-based ED-visit rates. Despite this limitation, the data provided useful information by documenting the burden and demographic profile of children who use the ED for asthma care and in identifying seasonal and time-related trends. CONCLUSIONS. We were able to successfully implement a pilot ED-based surveillance system for childhood asthma visits by using billing data. This system promotes the understanding of the burden of asthma among children visiting the ED. The development of an ED-based surveillance system for childhood asthma visits using billing data is recommended, particularly when there is a desire to understand the characteristics of children with asthma who use the ED and/or a need to understand the impact of local asthma quality-improvement programs.

Clinical InvestigationsASTHMAAsthma and Influenza Vaccination: Findings From the 1999–2001 National Health Interview Surveys

STUDY OBJECTIVES People with asthma are at high risk for complications from influenza; therefore, the Centers for Disease Control and Prevention recommends an annual influenza vaccination for people with asthma. Because little is known about such vaccination rates among adults, especially those aged 18 to 49 years and 50 to 64 years, we sought to estimate influenza vaccination rates among US adults. DESIGN Cross-sectional analyses of the 1999 to 2001 National Health Interview Surveys. SETTING US population. PARTICIPANTS Representative samples of US adults aged > or =18 years. MEASUREMENTS AND RESULTS Asthma status and receipt of influenza vaccination during the past 12 months were self-reported. We found that 35.1% (95% confidence interval [CI], 33.0 to 37.0%), 36.7% (95% CI, 34.7 to 38.6%), and 33.3% (95% CI, 31.6 to 35.0%) of participants with asthma reported having had an influenza vaccination in 1999 (n = 2,620), 2000 (n = 3,007), and 2001 (n = 3,582), respectively. Among participants aged 18 to 49 years, the vaccination rates were 20.9% (SE 1.2%), 22.7% (SE 1.2%), and 21.1% (SE 1.0%), respectively. Among participants aged 50 to 64 years, the vaccination rates were 46.2% (SE 2.6%), 47.8% (SE 2.3%), and 42.3% (SE 2.1%), respectively. Vaccination rates increased strongly with age and with education in each year. Associations with sex or with race or ethnicity were inconsistent during the 3 years. CONCLUSIONS The suboptimal vaccination rates among people with asthma aged 18 to 64 years suggest the need to increase influenza vaccination rates in this age group.

From research to reality: from the National Cooperative Inner-City Asthma Study to the Inner-City Asthma Implementation

Several themes emerged from the information provided in this supplement. 1. Implementation of the protocol was feasible, although retention of participants was challenging and customization at each site was essential. 2. Masters degree level social workers were well suited to partnering with health care professionals to address the many issues involved in caring for children with asthma and their families. 3. Collaboration between team members and community partners was critical to successful implementation. 4. Sustainability beyond external funding is attainable if local funding is sought and outcome measures that are considered important to the community are measured and reported.