Asthma-related health services and asthma control among women in Puerto Rico

Objectives: This study evaluates social, behavioral, and environmental determinants to differentiate between active and inactive asthma and how predisposing, enabling, and need factors elucidate asthma-related health services and asthma control among women in Puerto Rico. Methods: This study analyzed secondary cross-sectional data from a subsample of 625 adult females who participated in the Asthma Call Back Survey in Puerto Rico. Logistic and multinomial regression analyses were conducted to examine associations between explanatory variables and asthma outcomes. Results: In total, 63% of women reported active asthma, from which 37.9% have not well controlled or very poorly controlled asthma. Women with active asthma were significantly more likely to be out of work, have middle income (US$25,000–<US$35,000), and be obese (≥30 kg/m2). Perceived need of health status is a good predictor to know the odds ratio of women to use emergency room. Women with poorly controlled asthma were significantly associated with increased units of physician urgent visits and emergency room visits. Conclusion: The findings confirmed significant determinants for active asthma and adds information on odds ratio for sensitive subgroups that utilize asthma-related health services in higher proportion than their counterparts. These associations suggest a development of asthma management plan targeting women to control the condition and reduce health-care utilization.

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Higher Omega-3 Index Is Associated with Better Asthma Control and Lower Medication Dose: A Cross-Sectional Study

Nutrients ◽

10.3390/nu12010074 ◽

2019 ◽

Vol 12 (1) ◽

pp. 74 ◽

Cited By ~ 2

Author(s):

Isobel Stoodley ◽

Manohar Garg ◽

Hayley Scott ◽

Lesley Macdonald-Wicks ◽

Bronwyn Berthon ◽

...

Keyword(s):

Fatty Acids ◽

Asthma Control ◽

Inhaled Corticosteroids ◽

Asthma Management ◽

Airway Disease ◽

Cross Sectional Study ◽

Erythrocyte Membranes ◽

Omega 3 ◽

Asthma Control Questionnaire ◽

Cross Sectional

Asthma is a chronic inflammatory airway disease, associated with systemic inflammation. Omega-3 polyunsaturated fatty acids (n-3 PUFA) have established anti-inflammatory effects, thus having potential as an adjunct therapy in asthma. This study aimed to compare erythrocyte n-3 PUFA in adults with (n = 255) and without (n = 137) asthma and determine the relationship between erythrocyte n-3 PUFA and clinical asthma outcomes. Subjects had blood collected, lung function measured and Juniper Asthma Control Questionnaire (ACQ) score calculated. Fatty acids were measured in erythrocyte membranes by gas chromatography, and the omega-3 index (O3I) was calculated (% eicosapentaenoic acid + % docosahexaenoic acid). O3I was similar in subjects with and without asthma (p = 0.089). A higher O3I was observed in subjects with controlled or partially controlled asthma (ACQ < 1.5) compared to subjects with uncontrolled asthma (ACQ ≥ 1.5) (6.0% (5.4–7.2) versus 5.6% (4.6–6.4) p = 0.033). Subjects with a high O3I (≥8%) had a lower maintenance dose of inhaled corticosteroids (ICS) compared to those with a low O3I (<8%) (1000 μg (400–1000) versus 1000 μg (500–2000) p = 0.019). This study demonstrates that a higher O3I is associated with better asthma control and with lower ICS dose, suggesting that a higher erythrocyte n-3 PUFA level may have a role in asthma management.

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Asthma control and management among schoolchildren in urban Uganda: results from a cross-sectional study

Wellcome Open Research ◽

10.12688/wellcomeopenres.15460.1 ◽

2019 ◽

Vol 4 ◽

pp. 168 ◽

Cited By ~ 5

Author(s):

Harriet Mpairwe ◽

Pius Tumwesige ◽

Milly Namutebi ◽

Marble Nnaluwooza ◽

Tonny Katongole ◽

...

Keyword(s):

Asthma Control ◽

Asthma Management ◽

Cross Sectional Study ◽

P Value ◽

Asthma Diagnosis ◽

Sectional Study ◽

Asthma Control Test ◽

Cross Sectional ◽

Children With Asthma ◽

Control And Management

Background: Children from low- and middle-income countries have poor asthma control, mainly because of poor management. The extent of this problem in Uganda is not well known, but such information would be useful to guide policy and practice. We therefore conducted a cross-sectional study among schoolchildren with asthma in urban Uganda, to assess the level of asthma control and management. Methods: Schoolchildren aged 5-17 years were enrolled, asthma was diagnosed by the study medical team. Asthma control was assessed using the Asthma Control Test and the childhood Asthma Control Test. Data on previous asthma management was obtained using interviewer-led questionnaires. Data were analysed using multiple linear and multiple logistic regression. Results: We enrolled 561 children with asthma, of whom only 56% had ever had an asthma diagnosis. We categorised asthma as well-controlled (55.5%), partly-controlled (29.5%) and poorly-controlled (15.0%). Poor asthma control was associated with increasing age (adjusted regression coefficient [95% confidence interval], p-value: -1.07 [-1.20, -0.94], p<0.0001), concurrent allergic rhinitis (-1.33 [-2.28, -0.38], p=0.006), and city residence in early life (-1.99 [-3.69, -0.29], p=0.06). Regular use of inhaled asthma medication in the last 12 months was very low; 18.1% for salbutamol and 6.7% for inhaled corticosteroids. The main barriers to inhaled asthma medication use were lack of prescription (47.6%) and inaccurate diagnosis (38.8%). Increased inhaler use was associated with tertiary education of the fathers (adjusted odds ratio [95% confidence interval], p-value: 5.19 [2.39-11.28], p<0.0001), city residence in early life (4.66 [1.79-12.43], 0.002) and an asthma diagnosis prior to enrolment (11.39 [6.35-20.43], p<0.0001). Conclusions: This study confirms that children with asthma in Uganda generally have inadequate asthma control, which is attributable to poor asthma management. This could be improved through re-training of medical workers and patient education, and by increasing availability and affordability of essential asthma medications.

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Healthcare utilization among migrants to the UK: cross-sectional analysis of two national surveys

Journal of Health Services Research & Policy ◽

10.1177/1355819620911392 ◽

2020 ◽

Vol 26 (1) ◽

pp. 54-61 ◽

Cited By ~ 1

Author(s):

Catherine L Saunders ◽

Adam Steventon ◽

Barbara Janta ◽

Mai Stafford ◽

Carol Sinnott ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Health Care Utilization ◽

Dental Care ◽

Odds Ratio ◽

Service Planning ◽

Care Utilization ◽

Cross Sectional ◽

Objective Evidence ◽

The Uk

Objective To contribute objective evidence on health care utilization among migrants to the UK to inform policy and service planning. Methods We analysed data from Understanding Society, a household survey with fieldwork from 2015 to 2017, and the European Health Interview Survey with data collected between 2013 and 2014. We explored health service utilization among migrants to the UK across primary care, inpatient admissions and maternity care, outpatient care, mental health, dental care and physiotherapy. We adjusted for age, sex, long-term health conditions and time since moving to the UK. Results Health care utilization among migrants to the UK was lower than utilization among the UK-born population for all health care dimensions except inpatient admissions for childbirth; odds ratio (95%CI) range 0.58 (0.50–0.68) for dental care to 0.88 (0.78–0.98) for primary care). After adjusting for differences in age and self-reported health, these differences were no longer observed, except for dental care (odds ratio 0.57, 95%CI 0.49–0.66, P < 0.001). Across primary care, outpatient and inpatient care, utilization was lower among those who had recently migrated, increasing to the levels of the nonmigrant population after 10 years or more since migrating to the UK. Conclusions This study finds that newly arrived migrants tend to utilize less health care than the UK population and that this pattern was at least partly explained by better health, and younger age. Our findings contribute nationally representative evidence to inform public debate and decision-making on migration and health.

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Determinants of newborn care utilization in Pakistan: Findings from the Demographic and Health Surveys

F1000Research ◽

10.12688/f1000research.25700.2 ◽

2020 ◽

Vol 9 ◽

pp. 1061

Author(s):

Sathirakorn Pongpanich ◽

Abdul Ghaffar ◽

Najma Ghaffar ◽

Hafiz Abdul Majid

Keyword(s):

Maternal Health ◽

Health Services ◽

Postnatal Care ◽

Health Surveys ◽

Newborn Care ◽

Wealth Index ◽

Maternal Health Services ◽

Care Utilization ◽

Demographic And Health Surveys ◽

Cross Sectional

Background: Information on determinants of postnatal care is essential for maternal health services, and this information is scarce in Pakistan. This study aimed to determine the factors of newborn postnatal care utilization from the Pakistan Demographic and Health Surveys (PDHS) conducted from 2006–2018. Methods: We analyzed data from three rounds of cross-sectional, nationally representative PDHS 2006–07, 2012–13, and 2017–18. Multivariable logistic regression models were applied to explore factors associated with utilization of newborn postnatal care within two months. Results: This study included 5724 women from the 2006–07 PDHS, 7461 from the 2012–13 survey, and 8287 from the 2017–18 survey. The proportion of women receiving newborn postnatal care within the first two months of delivery increased from 13% in 2006–07 to 43% in 2012–13 but dropped to 27% in 2017–18. Respondent’s occupation and prenatal care utilization of maternal health services were common factors that significantly influenced newborn postnatal care utilization within two months. The utilization of postnatal care was greater among women having educated husbands and where the first child was a male in PDHS 2007 round. Higher wealth index and educated respondent had higher postnatal care utilization odds in DHS 2012 and DHS 2018. However, the odds of using postnatal care decreased with the number of household members and total number of children ever born in DHS 2012 and 2018 rounds. Conclusions: There was a general increase in the proportion of women who utilized postnatal care for their newborns during 2006–2013 but a decrease in 2018. The decreased utilization in 2018 warrants further investigation. Improving women’s economic status, education, employment, and antenatal care attendance and reducing parity may increase newborn postnatal care utilization.

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Patient and Physician Perspectives on Asthma and Its Therapy in Romania: Results of a Multicenter Survey

Medicina ◽

10.3390/medicina57101089 ◽

2021 ◽

Vol 57 (10) ◽

pp. 1089

Author(s):

Dragos Bumbacea ◽

Carmen Panaitescu ◽

Roxana Silvia Bumbacea

Keyword(s):

Maintenance Therapy ◽

Asthma Control ◽

Severe Asthma ◽

Asthma Management ◽

Asthma Severity ◽

Treatment Goals ◽

Cross Sectional ◽

Multicenter Survey ◽

Patient Reported ◽

Asthma Patients

Background and Objectives: Patient’s behaviours, attitudes and beliefs related to asthma and its treatment were shown to influence the adherence to therapy and the level of asthma control. This survey aimed to assess the level of asthma control and patient-reported behaviours, attitudes and expectations related to their disease in Romanian patients. Materials and Methods: This cross-sectional quantitative survey was performed in February-March 2019 and enrolled 70 specialist physicians experienced in asthma management and 433 asthma patients under their care. Results: Of the 433 patients enrolled, 19.4% had mild asthma, 60.5% moderate asthma and 20.1% severe asthma. For the previous 12 months, asthma symptoms, exacerbations and emergency room visits were common in the sample analysed, with significantly higher figures in severe asthma patients (p < 0.001). The most important treatment goal for asthma patients was participation in all activities of daily living, while for physicians this was preventing asthma exacerbations. The valuation of the treatment goals was different between patients with severe asthma and those with mild and moderate forms. Based on the patients’ responses, 3 attitude clusters were identified: empowered savvy (36.5% of the patients), pessimistic non-compliers (43.2%), and anxious strugglers (20.3%). “Empowered savvy” had the lowest frequency of severe asthma, the highest adherence to maintenance therapy and the highest level of confidence in the effectiveness of asthma medication. The opposite of this attitude cluster is the “anxious strugglers”, containing more patients with severe asthma, a higher score for worries about asthma therapy and better self-reported knowledge of their treatment, contrasting with a proportion of 25% taking maintenance therapy only when having breathing difficulties. Conclusion: Asthma control in Romania remains poor, with frequent exacerbations and hospitalizations. The differences in treatment goals found between patients and physicians and between different asthma severity groups suggest the need for more patient-centred approaches.

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Assessment of Asthma Control and Severity among Children According to Global Initiative for Asthma Guidelines in Sulaimani City-Iraq

European Scientific Journal ESJ ◽

10.19044/esj.2016.v12n3p160 ◽

2016 ◽

Vol 12 (3) ◽

pp. 160

Author(s):

Adnan M. H. Hamawandi ◽

Kosar M Ali ◽

Ali Z. Naji

Keyword(s):

Asthma Control ◽

Objective Assessment ◽

Asthma Management ◽

Persistent Asthma ◽

Cross Sectional ◽

Asthmatic Children ◽

Global Initiative For Asthma ◽

Severe Persistent Asthma ◽

Global Initiative ◽

Gina Guidelines

Background: Asthma is a common and potentially serious chronic disease that imposes a substantial burden on patients, their families and the community. Objective: Assessment of the level of asthma control and severity in asthmatic children in Sulaimani city according to the global initiative for asthma (GINA) guidelines. Methods: A cross-sectional study of 82 patients who are known cases of asthma, aged 5 – 15 years , from 1st of March 2014 to 1st of August 2014. Results: Out of 82 patients in our study, 20.8%were classified as having intermittent asthma all of them have well controlled asthma, 42.7% of those classified as having mild persistent asthma 65.7% of them have well controlled asthma, 26.8% of those classified as having moderate persistent asthma 54.5% of them have partly controlled asthma, and 9.8%of those classified as having severe persistent asthma the majority of them 87.5% have uncontrolled asthma and none of them reached to the controlled asthma level according to GINA guidelines. Regarding the peak expiratory flow (PFT) we notice that 58.8% of asthmatic children who were classified as having intermittent severity, their PEF measurements ranged between 160- 250 l/min while those with severe persistent asthma 75% of them have readings between 50-150 l/min. Conclusion: Current levels of asthma control in the Sulaimani city fall far short of the goals specified in the GINA guidelines for asthma management. Also there is a strong correlation between PEF measurements and the level of asthma severity,

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Management of Acute Asthma in Southeast Asian Tertiary Care.

10.21203/rs.3.rs-34318/v1 ◽

2020 ◽

Author(s):

MAU-ERN POH ◽

SUNDARI AMPIKAIPAKAN ◽

CHONG-KIN LIAM ◽

CHEE-SHEE CHAI ◽

DEVENTHARI RAMANAIDOO ◽

...

Keyword(s):

Southeast Asia ◽

Asthma Control ◽

Acute Asthma ◽

Tertiary Care ◽

Asthma Management ◽

Uncontrolled Asthma ◽

Cross Sectional ◽

Flow Measurements ◽

Tertiary Hospitals ◽

Controller Medications

Abstract Background: There have been limited reports looking into acute asthma care for patients admitted to tertiary hospitals in Southeast Asia. This study aims to determine the extent in which the 2019 Global Initiative for Asthma (GINA) guidelines were being met. It highlights aspects of excellent clinical management and areas requiring improvement. Methods: A cross-sectional prospective study of patients with acute asthma exacerbations admitted to the University of Malaya Medical Centre (UMMC) and Pantai Hospital Kuala Lumpur (PHKL), Malaysia from 1st July 2019 to 31st December 2019. Results: Of 172 patients admitted, 67.4% were females. There was proper documentation of asthma control assessment (100%), baseline controller and reliever medications (100%), peak expiratory flow measurements (78%), and inhaler technique review (69.8%). However, there was poor documentation of written asthma action plans (25%). 51.2% had not been admitted in the previous year. At baseline, 90% of patients had been prescribed inhaled corticosteroid (ICS). However, 40.5% of patients were not compliant with controller medications. Based on the GINA assessment for asthma control, 68% had uncontrolled asthma. While 91.9% of patients had a previous diagnosis of asthma, only 48.8% of patients had objective testing to support the diagnosis. All patients with newly-diagnosed asthma (8.1%) were commenced on a corticosteroid-containing-inhaler. Conclusion: Although acute asthma management in tertiary hospitals in Southeast Asia is relatively congruous with international guidelines, there is room for improvement. As the majority of patients found to have uncontrolled asthma were non-compliant with their controller medications, efforts to increase awareness on the perils of uncontrolled asthma is warranted.

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Dental Care Utilization among Veterans by Smoking Status

International Journal of Dentistry ◽

10.1155/2019/3419805 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

R. Constance Wiener ◽

Ruchi Bhandari ◽

Alcinda K. Trickett Shockey ◽

Christopher Waters

Keyword(s):

Logistic Regression ◽

Dental Care ◽

Odds Ratio ◽

Smoking Status ◽

Statistical Tests ◽

Secondary Data ◽

Care Utilization ◽

Cross Sectional ◽

Dental Care Utilization ◽

Never Smokers

Background. Given the critical importance of dental care utilization among veterans and the overall health consequences of tobacco use in all populations, the purpose of this research is to examine smoking as a risk factor for poor dental care utilization among United States Veterans.Methods. A secondary data analysis of cross-sectional data from the National Survey of Veterans was conducted. The primary outcome was dental care utilization (Yes, No). Frequency, chi-square analyses, and multivariate logistic regression statistical tests were performed while adjusting for confounding factors.Results. There were 6,308 veterans in the study. Veterans who were current smokers were less likely to have dental care utilization within the previous six months than former smokers or never smokers. In unadjusted logistic regression analysis, current smokers had an odds ratio of 2.83 [95% CI: 2.36, 3.40] as compared with never smokers. The adjusted odds ratio for current smoking on dental care utilization was 1.71 [95% CI: 1.40, 2.09] as compared with never smoking.Conclusions. Since veterans who smoked are less likely to have dental care utilization within the previous six months, they are at higher risk for later diagnosis of dental problems. Veterans who smoke should be specifically targeted with interventions to ensure frequent dental visits, so future problems may be averted or managed early in their development.

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The Impact of Asthma Management Guideline Dissemination on the Control of Asthma in the Community

Canadian Respiratory Journal ◽

10.1155/2001/213953 ◽

2001 ◽

Vol 8 (suppl a) ◽

pp. 41A-45A ◽

Cited By ~ 5

Author(s):

Robert L Cowie ◽

Margot F Underwood ◽

Sally Mack

Keyword(s):

Rural Communities ◽

Asthma Control ◽

Education Program ◽

Management Education ◽

Population Sample ◽

Asthma Management ◽

Cross Sectional Study ◽

Cross Sectional ◽

Significant Difference ◽

The Impact

OBJECTIVE: To measure the impact of asthma management education on the control of asthma in the community.DESIGN: A cross-sectional study comparing three communities.SETTING: Three rural communities in southern Alberta.PATIENTS AND METHODS: A population sample of patients with asthma attending a pharmacy to fill a prescription for asthma medication were selected from three communities. Patients were asked to complete a questionnaire relating to their asthma management and control.INTERVENTION: Three levels of asthma management education were provided in the three communities with populations of 6000 to 10,000. The levels of education ranged from standard continuing medical education programs relating to the national asthma guidelines and a visiting asthma nurse educator to the establishment of an asthma clinic and a multiple-target, intensive education program for health professionals, town leaders, local media, schools and the public. The survey of the population with asthma was conducted approximately one year after the education program had been completed.RESULTS: A total of 327 completed questionnaires were submitted. Analysis showed that there was no significant difference that could be attributed to the intervention in the management of asthma or in the level of asthma control among the patients from the three communities.RESULTS: A total of 327 completed questionnaires were submitted. Analysis showed that there was no significant difference that could be attributed to the intervention in the management of asthma or in the level of asthma control among the patients from the three communities.

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Influence of Gender Determinants on Informal Care and Health Service Utilization in Spain: Ten Years after the Approval of the Equality Law

Administrative Sciences ◽

10.3390/admsci11020042 ◽

2021 ◽

Vol 11 (2) ◽

pp. 42

Author(s):

Raquel Sánchez-Recio ◽

Cristina García-Ael ◽

Gabriela Topa

Keyword(s):

Health Services ◽

Informal Care ◽

Emergency Care ◽

Management Strategies ◽

Care Utilization ◽

Gender Inequalities ◽

Demand Model ◽

Cross Sectional ◽

Men And Women ◽

Use Of Health Services

The existence of gender inequalities in health, in the use of health services, and in the development of informal care has been demonstrated throughout scientific literature. In Spain, a law was passed in 2007 to promote effective equality between men and women. Despite this, different studies have shown that the previous gender inequalities are still present in Spanish society. For all these reasons, the objective of this paper is to study the differences by sex in informal care and in the use of emergency care, and to identify the existence of gender inequalities in Spain 10 years after the adoption of the aforementioned equality law. In this case, we development a cross-sectional study based on the 2017 Spanish National Health Survey of the Spanish population aged 16 and over. To analyze the influence of gender determinants on informal care and emergency care utilization, logistic regressions were performed, model 1 was adjusted for age, and model 2 was further adjusted too by the variables of the Andersen care demand model. The results showed that informal care and the use of the emergency care continues to be higher in women than in men. Informal care in women was related to a higher level of education. In emergency care, the older the age, the lower the probability of utilization, and living in a rural municipality was related to a higher probability of utilization for both sexes. Finally, we concluded that there is still a need for studies that analyze gender inequalities in different contexts, such as the informal care and the use of health services. This is especially relevant in Spain, where economic changes have led to a change in roles, mainly for women, and new management strategies are needed to achieve equity in care and effective equality between men and women.

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