Shalini G. Forbis

Children and Firearms in the Home: A Southwestern Ohio Ambulatory Research Network (SOAR-Net) Study

Background: To ascertain the prevalence of gun ownership, gun safety education, and parental attitudes on gun counseling in a Midwestern sample. Methods: Parents seeking care at participating practices in the Southwestern Ohio Ambulatory Research Network were recruited to complete a survey about gun ownership, gun safety education, and gun counseling attitudes. Attitudes and beliefs were compared between gun owners and non-gun owners. Results: Twenty-four percent of respondents had at least 1 gun in the home. Military families were more likely to own a gun than civilian families (28% vs 18%, P = .001). Fifty-two percent of sample children have received gun safety education. Eight percent indicated that a physician had asked about guns or discussed gun safety issues during an office visit. A majority of parents indicated that physicians should ask about guns in the home (69%) and advise parents on safe storage (75%), but they should not advise parents to remove guns from the home (12% of gun owners, 42% of non-gun owners). Conclusions: Despite the morbidity and mortality associated with guns, physicians in this study do not seem to be addressing this risk with families. A majority of gun owners do not agree that physicians should counsel the removal of guns from the home but agree that they should discuss safe gun storage information.

Associations Between Parental Health Literacy, Use of Asthma Management Plans, and Child’s Asthma Control

Background. There are some studies demonstrating the effectiveness of the provision of written asthma action plans in improving asthma outcomes. There exist little data on the ability of parents to use these plans to make asthma care decisions. Objective. To assess the associations between parental health literacy (HL), parental ability to use a written asthma management plan (WAMP), and child’s asthma control. Methods. Parents completed a survey with questions related to WAMPs and child’s asthma, a HL screening tool, and 5 asthma vignettes. For vignettes, parents identified asthma control zone and then made decisions about asthma management. WAMP scores were totaled (0-32) and converted to a percent correct score. Associations between parental HL, WAMP scores, child’s asthma control, and demographics were determined with independent t tests or 1-way analysis of variance, and chi-square tests. Variables significantly associated with WAMP scores or asthma control were included in multiple logistic regression or multiple linear regression analyses. Results. A total of 176 surveys were included; the mean ± SD WAMP score was 58.9% ± 22.2%, and 25% of respondents had limited HL. Of respondents’ children, 38% had not well/poorly controlled asthma. In multiple regression analysis controlling for education level, limited HL was significantly associated with WAMP score (b = 11.3, standard error 3.8, P = .004). WAMP score was not associated with asthma control. Limited HL was associated with poor asthma control in univariate analysis, but not in a logistic regression model controlling for other significant variables. Only unmarried marital status (adjusted odds ratio 4.4, 95% CI 1.8-10.8, P = .001) was associated with asthma control. Conclusion. HL is associated with parental ability to use WAMPs to respond to asthma scenarios. Parental HL may play a role in parents’ ability to appropriately use WAMPs.

Knowledge-Driven Personalized Contextual mHealth Service for Asthma Management in Children

Wide adoption of smartphones and availability of low-cost sensors has resulted in seamless and continuous monitoring of physiology, environment, and public health notifications. However, personalized digital health and patient empowerment can become a reality only if the complex multisensory and multimodal data is processed within the patient context. Contextual processing of patient data along with personalized medical knowledge can lead to actionable information for better and timely decisions. We present a system called kHealth capable of aggregating multisensory and multimodal data from sensors (passive sensing) and answers to questionnaire (active sensing) from patients with asthma. We present our preliminary data analysis comprising data collected from real patients highlighting the challenges in deploying such an application. The results show strong promise to derive actionable information using a combination of physiological indicators from active and passive sensors that can help doctors determine more precisely the cause, severity, and control level of asthma. Information synthesized from kHealth can be used to alert patients and caregivers for seeking timely clinical assistance to better manage asthma and improve their quality of life.

Influences and Barriers on Physical Activity in Pediatric Oncology Patients

Objectives To determine the influence of family, peers, school, and physicians on exercise in pediatric oncology patients and evaluate the barriers to physical activity (PA) levels in this population. Methods A search of PubMed and Google Scholar resulted in 12 related articles. The articles were assessed for the influence of school systems, family, peers, self-efficacy, and physicians on exercise. Additionally, barriers and interventions to PA were also assessed. Limitations and research methodologies of each article were also evaluated. Results Many school systems were unsure of expectations in regards to PA for their returning students with cancer. Most schools acknowledged willingness to increase exercise for these students; however, there is a communication gap between the medical field and the school system on what expectations should be. Family is associated with increased PA levels and healthier diets in this population with children preferring mothers as exercise partners more than fathers. While physician interventions have been shown to positively impact PA, it has been reported that physicians are not engaging in exercise counseling with their patients. Conclusion Several issues and barriers related to PA in pediatric oncology population were identified. Studies have demonstrated that it is feasible to increase PA and self-efficacy in this population. Further research is needed to better understand and quantify these issues as well as further test the interventions that have been suggested in this review and have been successful in other pediatric populations.

Patient visits to a midwestern primary care practice-based research network: a comparison to two national primary care data sets.

Background: Regional primary care practice-based research networks (PBRNs) have made important contributions to the primary care literature, but have not been well-described. This study compares pediatric patient characteristics within a new regional PBRN to pediatric patient characteristics from two previously published national data sets. Methods: Descriptive patient data were collected by 25 Southwestern Ohio Ambulatory Research Network (SOAR-Net) clinicians between July 2003 and June 2004. These data were compared to pediatric patient characteristics from 57 Pediatric Research in Office Setting clinicians and 33 primary care pediatric clinicians who participated in the National Ambulatory Medical Care Survery. Results: SOAR-Net patients were almost twice as likely to use Medicaid (41.9% vs 22.0%/22.4%, p = 0.0001). SOAR-Net patients also were more likely to be African-American (23.7% vs 7.5%/17.6%, p = 0.002). About one third of patients in each sample were seen for a well visit. Conclusion: Regional networks with unique characteristics, such as a large number of Medicaid patients and/or many underserved minority patients have the potential to make significant contributions to primary care research by focusing on problems experienced within those segments of a population (e.g., indigent children and their families).

Contemporary Topics in Pediatric Pulmonology for the Primary Care Clinician

Disorders of the respiratory system are commonly encountered in the primary care setting. The presentations are myriad and this review will discuss some of the more intriguing or vexing disorders that the clinician must evaluate and treat. Among these are dyspnea, chronic cough, chest pain, wheezing, and asthma. Dyspnea and chest pain have a spectrum ranging from benign to serious, and the ability to effectively form a differential diagnosis is critical for reassurance and treatment, along with decisions on when to refer for specialist evaluation. Chronic cough is one of the more common reasons for primary care office visits, and once again, a proper differential diagnosis is necessary to assist the clinician in formulating an appropriate treatment plan. Infant wheezing creates much anxiety for parents and accounts for a large number of office visits and hospital admissions. Common diagnoses and evaluation strategies of early childhood wheezing are reviewed. Asthma is one of the most common chronic diseases of children and adults. The epidemiology, diagnosis, evaluation, treatment, and the patient/parent education process will be reviewed. A relatively new topic for primary care clinicians is cystic fibrosis newborn screening. The rationale, methods, outcomes, and implications will be reviewed. This screening program may present some challenges for clinicians caring for newborns, and an understanding of the screening process will help the clinician communicate effectively with parents of the patient.