Inadequate Therapy for Asthma Among Children in the United States

PEDIATRICS ◽  
2000 ◽  
Vol 105 (Supplement_2) ◽  
pp. 272-276
Author(s):  
Jill S. Halterman ◽  
C. Andrew Aligne ◽  
Peggy Auinger ◽  
John T. McBride ◽  
Peter G. Szilagyi
Keyword(s):  
Severe Asthma ◽  
Asthma Management ◽  
The United States ◽  
Asthma Therapy ◽  
National Guidelines ◽  
Cross Sectional ◽  
Asthma Morbidity ◽  
The Past ◽  
Maintenance Medication ◽  
Inadequate Therapy

Objective. Childhood asthma morbidity and mortality are increasing despite improvements in asthma therapy. We hypothesized that a substantial number of children with moderate to severe asthma are not taking the maintenance medications recommended by national guidelines. The objective of this study was to describe medication use among US children with asthma and determine risk factors for inadequate therapy. Methods. The National Health and Nutrition Examination Survey (NHANES) III 1988–1994 provided cross-sectional, parent-reported data for children 2 months to 16 years of age. Analysis focused on children with moderate to severe asthma (defined as having any hospitalization for wheezing, ≥2 acute visits for wheezing, or ≥3 episodes of wheezing over the past year). We defined these children as adequately treated if they had taken a maintenance medication (inhaled corticosteroid, cromolyn, or theophylline) during the past month. Demographic variables were analyzed for independent associations with inadequacy of therapy. The statistical analysis used SUDAAN software to account for the complex sampling design. Results. A total of 1025 children (9.4%) had physician-diagnosed asthma. Of those with moderate to severe asthma (n = 524), only 26% had taken a maintenance medication during the past month. Even among children with 2 or more hospitalizations over the previous year, only 32% had taken maintenance medications. In a logistic regression analysis, factors significantly associated with inadequate therapy included: age ≤5 years, Medicaid insurance, and Spanish language. Children surveyed after 1991, when national guidelines for asthma management became available, were no more likely to have taken maintenance medications than children surveyed before 1991. Conclusion. Most children with moderate to severe asthma in this nationally representative sample, including those with multiple hospitalizations, did not receive adequate asthma therapy. These children may incur avoidable morbidity. Young children, poor children, and children from Spanish-speaking families appear to be at particularly high risk for inadequate therapy.

scholarly journals Association between food insecurity and access to a mental health professional: cross-sectional analysis of NHANES 2007–2014

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nina Camille Burruss ◽  
Marina Girgis ◽  
Karen Elizabeth Green ◽  
Lingyi Lu ◽  
Deepak Palakshappa
Keyword(s):  
Mental Health ◽  
Health Professional ◽  
Food Insecurity ◽  
Mental Health Professional ◽  
The United States ◽  
Bivariate Analysis ◽  
Cross Sectional ◽  
The Past ◽  
Cross Sectional Analysis ◽  
Sectional Analysis

Abstract Background To determine if individuals with food insecurity (FI) were less likely to have seen a mental health professional (MHP) within the past year than individuals without FI. Methods This is a cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES) conducted in the United States between 2007 and 2014. All participants 20 years of age or older were eligible for this study. We excluded participants who were pregnant, missing FI data, or missing data from the Patient Health Questionnaire (PHQ-9). The primary outcome was self-reported contact with a MHP in the past 12 months. We used multivariable logistic regression models to test the association between FI and contact with a MHP, controlling for all demographic and clinical covariates. Results Of the 19,789 participants, 13.9% were food insecure and 8.1% had major depressive disorder (MDD). In bivariate analysis, participants with FI were significantly more likely to have MDD (5.3% vs 2.8%, p < 0.0001) and to have been seen by a MHP in the preceding 12 months (14.0% vs 6.9%, p < 0.0001). In multivariable models, adults with FI had higher odds of having seen a MHP (OR = 1.32, CI: 1.07, 1.64). Conclusions This study demonstrates that individuals with FI were significantly more likely to have seen a MHP in the preceding 12 months compared to individuals without FI. Given the growing interest in addressing unmet social needs in healthcare settings, this data suggests that visits with MHPs may be a valuable opportunity to screen for and intervene on FI.

Variability in Pediatric Brain Death Determination Protocols in the United States

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012225
Author(s):  
Conall Francoeur ◽  
Matthew J Weiss ◽  
Jennifer M Macdonald ◽  
Craig Press ◽  
David Matthew Greer ◽  
...  
Keyword(s):  
United States ◽  
Brain Injury ◽  
Organ Procurement ◽  
The United States ◽  
Cross Sectional Study ◽  
Neurologic Examination ◽  
National Guidelines ◽  
Cross Sectional ◽  
Organ Procurement Organizations ◽  
Death By Neurologic Criteria

Objective:To determine the variability in pediatric death by neurologic criteria (DNC) protocols between US pediatric institutions and compared to the 2011 DNC guidelines.Methods:Cross-sectional study of DNC protocols obtained from pediatric institutions in the United States (US) via regional organ procurement organizations. Protocols were evaluated across five domains: general DNC procedures, prerequisites, neurologic examination, apnea testing and ancillary testing. Descriptive statistics compared protocols to each other and the 2011 guidelines.Results:One hundred and thirty protocols were analyzed with 118 dated after publication of the 2011 guidelines. Of those 118 protocols, identification of a mechanism of irreversible brain injury was required in 97%, while 67% required an observation period after acute brain injury before DNC evaluation. Most protocols required guideline-based prerequisites such as exclusion of hypotension (94%), hypothermia (97%), and metabolic derangements (92%). On neurologic examination, 91% required a lack of responsiveness, 93% no response to noxious stimuli, and 99% loss of brainstem reflexes. 84% of protocols required the guideline-recommened two apnea tests. CO2 targets were consistent with guidelines in 64%. Contrary to guidelines, fifteen percent required ancillary testing for all patients and 15% permitted ancillary studies that are not validated in pediatrics.Conclusionsand Relevance: Variability exists between pediatric institutional DNC protocols in all domains of DNC determination, especially with respect to apnea and ancillary testing. Better alignment of DNC protocols with national guidelines may improve the consistency and accuracy of DNC determination.

E-Cigarette Advice to Patients From Physicians and Dentists in the United States

2017 ◽  
Vol 32 (5) ◽  
pp. 1228-1233 ◽  
Author(s):  
Olivier Drouin ◽  
Robert C. McMillen ◽  
Jonathan D. Klein ◽  
Jonathan P. Winickoff
Keyword(s):  
United States ◽  
The United States ◽  
Fisher Exact Test ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Exact Test ◽  
The Past ◽  
Random Digit Dialing ◽  
Potential Benefits ◽  
Nationally Representative

Purpose: To report on adults’ recall of discussion by physicians and dentists about e-cigarettes. Design: A nationally representative cross-sectional survey (Internet and random digit dialing) in the United States. Participants: Adults who ever used e-cigarettes. Measures: Participant-reported discussion about the potential benefits and harms of e-cigarettes with their doctor, dentist, or child’s doctor in the past 12 months. Analysis: Fisher exact test for the analysis between benefits and harms for each type of provider and for rates of advice between provider types. Results: Among the 3030 adults who completed the survey, 523 (17.2%) had ever used e-cigarettes. Of those who had seen their doctor, dentist, or child’s doctor in the last year, 7.3%, 1.7%, and 10.1%, respectively, reported discussing potential harms of e-cigarettes. Conversely, 5.8%, 1.7%, and 9.3% of patients who had seen their doctor, dentist, or child’s doctor in the last year reported that the clinician discussed the potential benefits of e-cigarettes. Each clinician type was as likely to discuss harms as benefits. Rates of advice were similar between doctors and child’s doctors but lower for dentists. Rates were comparable when the analysis was limited to current e-cigarette users, participants with children, or those who reported using both e-cigarettes and combusted tobacco. Conclusions: Few physicians and dentists discuss either the harms or benefits of e-cigarettes with their patients. These data suggest an opportunity to educate, train, and provide resources for physicians and dentists about e-cigarettes and their use.

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

Medicina ◽  
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.

Tracking Ignorance: Examining Changes in Immigrant Population Innumeracy in the United States from 2005 to 2013

2019 ◽  
Vol 16 (2) ◽  
pp. 329-339
Author(s):  
Daniel Herda
Keyword(s):  
Population Size ◽  
The United States ◽  
Immigrant Population ◽  
Foreign Born ◽  
Cross Sectional ◽  
The Past ◽  
Immigrant Populations ◽  
The Subject ◽  
The U.S ◽  
Over Time

Citizens’ tendency to overestimate the size of immigrant populations has been the subject of several studies over the past three decades. While we have learned a great deal about the extent, causes, and potential consequences of this population innumeracy, our understanding remains static. The current letter offers the first longitudinal consideration of immigrant population size misperceptions with an analysis across a nine-year span in the U.S. This study considers: 1) whether misperceptions have changed over time; 2) how these changes compare to the growth of the actual foreign-born population size; and 3) whether these changes are related to demographic and ideological factors. Results indicate that misperceptions have grown rapidly in the U.S, far outpacing the modest, actual increases across the period. Pooled cross-sectional analyses indicate that demographic factors do not explain the growth in misperceptions. However, the overestimates of politically conservative Americans have grown increasingly extreme over time.

Comparison of self-reported and test-identified chlamydial infections among young adults in the United States of America

Sexual Health ◽  
2006 ◽  
Vol 3 (4) ◽  
pp. 245 ◽  
Author(s):  
Bonita J. Iritani ◽  
Carol A. Ford ◽  
William C. Miller ◽  
Denise Dion Hallfors ◽  
Carolyn Tucker Halpern
Keyword(s):  
Chlamydial Infection ◽  
The United States ◽  
Nucleic Acid Amplification ◽  
Infection Prevalence ◽  
Cross Sectional ◽  
The Past ◽  
Sexually Transmissible Infections ◽  
Self Reports ◽  
Nationally Representative ◽  
Actual Prevalence

Background: Many studies rely on respondent reports of prior diagnosed sexually transmissible infections (STIs), but these self reports are likely to under-estimate infection prevalence. The extent of bias from using self-reported STI data, and whether bias varies by sex and race, is largely unknown. This gap is addressed using a large, nationally representative sample. Methods: Cross-sectional analyses of Wave III of the National Longitudinal Study of Adolescent Health. Participants were 18–26 years old (n = 12 359). Estimates of the prevalence of chlamydial infection based on self-reported diagnoses in the past year were compared with actual prevalence based on nucleic acid amplification testing (NAAT) at the time of data collection. Ratios of test-identified prevalence to self-reported diagnosis prevalence were calculated by sex and race/ethnicity groups. Larger ratios indicate greater extent of self reports under-estimating infection prevalence. Results: About 4.2% of the sample had a current NAAT-identified chlamydial infection, but only 3.0% reported having been diagnosed with chlamydia in the past year, yielding a ratio of 1.43. The ratio of test-identified infection prevalence to prevalence identified from self-reported diagnoses was larger among men than women (2.07 versus 1.14, P < 0.05). Among men, the ratio was larger among non-Hispanic blacks (2.40) compared with non-Hispanic whites (1.07, P < 0.05). Conclusions: Use of self-reported diagnoses under-estimates chlamydial infection prevalence, particularly among men, and among non-Hispanic black men. Reliance on self-reported STIs may consequently lead to biased conclusions, particularly for these groups. Use of biological testing for STIs in research studies is recommended.

Influenza Vaccination of Healthcare Workers in the United States, 1989-2002

2006 ◽  
Vol 27 (3) ◽  
pp. 257-265 ◽  
Author(s):  
Frances J. Walker ◽  
James A. Singleton ◽  
Pengjun Lu ◽  
Karen G. Wooten ◽  
Raymond A. Strikas
Keyword(s):  
United States ◽  
Influenza Vaccination ◽  
Healthcare Workers ◽  
Pneumococcal Vaccination ◽  
The United States ◽  
Hepatitis B Vaccination ◽  
Cross Sectional ◽  
Factors Associated ◽  
The Past ◽  
History Of

Objectives.We sought to estimate influenza vaccination coverage among healthcare workers (HCWs) in the United States during 1989-2002 and to identify factors associated with vaccination in this group. The Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for HCWs to reduce transmission of influenza to patients at high risk for serious complications of influenza.Design.Analysis of cross-sectional data from 1989-2002 surveys conducted by the National Health Interview Survey (NHIS). The outcome measure was self-reported influenza vaccination in the past 12 months. Bivariate and multivariate analysis of 2002 NHIS data.Setting.Household interviews conducted during 1989-2002, weighted to reflect the noninstitutionalized, civilian US population.Participants.Adults aged 18 years or older participated in the study. A total of 2,089 were employed in healthcare occupations or settings in 2002, and 17,160 were employed in nonhealthcare occupations or settings.Results.The influenza vaccination rate among US HCWs increased from 10.0% in 1989 to 38.4% in 2002, with no significant change since 1997. In a multivariate model that included data from the 2002 NHIS, factors associated with a higher rate of influenza vaccination among HCWs aged 18-64 years included age of 50 years or older (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.1), hospital employee status (OR, 1.5; 95% CI, 1.2-1.9), 1 or more visits to the office of a healthcare professional in the past 12 months (OR, 1.5; 95% CI, 1.1-2.2), receipt of employer-provided health insurance (OR, 1.5; 95% CI, 1.1-2.1), a history of pneumococcal vaccination (OR, 3.9; 95% CI, 2.5-6.1), and history of hepatitis B vaccination (OR, 1.9; 95% CI, 1.4-2.4). Non-Hispanic black persons were less likely to be vaccinated (OR, 0.6; 95% CI, 0.5-0.9) than non-Hispanic white persons. There were no significant differences in vaccination levels according to HCW occupation category.Conclusions.Influenza immunization among HCWs reached a plateau during 1997-2002. New strategies are needed to encourage US HCWs to receive influenza vaccination to prevent influenza illness in themselves and transmission of influenza to vulnerable patients.

scholarly journals Psychological Distress Among Smokers in the United States: 2008–2014

2017 ◽  
Vol 20 (6) ◽  
pp. 707-713 ◽  
Author(s):  
Michael J Zvolensky ◽  
Charles Jardin ◽  
Melanie M Wall ◽  
Misato Gbedemah ◽  
Deborah Hasin ◽  
...  
Keyword(s):  
Mental Health ◽  
United States ◽  
Psychological Distress ◽  
Family Income ◽  
Mental Health Problems ◽  
The United States ◽  
Cross Sectional ◽  
Annual Family Income ◽  
The Past ◽  
Never Smokers

Abstract Introduction Decline in smoking in the United States has slowed over the past 25 years. Mental health problems are common among smokers, and may be an impediment to quitting and remaining abstinent. The study investigated the relationship between serious (past-30-day) psychological distress (SPD) and smoking, estimated trends in the prevalence of SPD among current, former, and never smokers in the United States from 2008 to 2014, and investigated whether heterogeneity in these trends varied by sociodemographic characteristics. Methods Data were drawn from the National Household Survey on Drug Use (NSDUH), an annual cross-sectional study of persons ages 12 and over (N = 270 227). SPD and smoking in the past 30 days were examined using logistic regression models among adults 18 and older. The prevalence of SPD was examined annually among current, former, and never smokers from 2008 to 2014. Results SPD increased among smokers in the United States from 2008 to 2014. An increase in SPD was more rapid among non-daily smokers than daily smokers. The prevalence of SPD was higher among younger smokers, those with less formal education and lower annual family income and higher among current smokers than former and never smokers. The relationships between SPD and smoking were stronger among smokers with higher education levels and annual family income. Conclusions Our findings suggest an increase in SPD among smokers over time and that as smoking has declined, those with SPD are comprising a greater proportion of the remaining smokers. Results suggest that mental health must be integrated into mainstream tobacco control efforts. Implications The greater prevalence and increasing rate of Serious Psychological Distress among smokers, relative to former- and never-smokers, from 2008 to 2014 provides support that the greater mental health burden among smokers may be contributing to the slowed reduction in smoking prevalence in the United States. In addition, relationships between SPD and smoking were consistently stronger among smokers with higher levels of education and annual family income. Such results suggest the necessity of incorporating mental health treatments in tobacco use reduction efforts.

Thinking Outside the Inhaler: Potential Barriers to Controlled Asthma in Children

2004 ◽  
Vol 17 (3) ◽  
pp. 211-220
Author(s):  
Amy L. Potts ◽  
Carol B. Reagan
Keyword(s):  
Health Care Professionals ◽  
Asthma Management ◽  
The United States ◽  
Communication Education ◽  
National Guidelines ◽  
Parental Concerns ◽  
Childhood Morbidity ◽  
Children With Asthma ◽  
Psychosocial Influences ◽  
Asthma In Children

Asthma has reached epidemic proportions in the United States, increasing in prevalence especially among children. Despite the development of national goals and practice guidelines, childhood morbidity and mortality associated with asthma has continued to rise at astonishing rates. Effective management of asthma in children requires both improvements in following nationally recognized guidelines and addressing barriers associated with poor control. This article identifies barriers leading to uncontrolled asthma in children. Barriers in communication, education, resources, parental concerns, and psychosocial influences have resulted in nonadherence to national guidelines. Health care professionals have the opportunity to affect asthma management by addressing these barriers and improving the quality of care for children with asthma.

scholarly journals Barriers to HIV Testing and Opportunities for Expansion Using Home-Based HIV Self-Testing: Results of a National Study of Higher HIV Risk Young Men Who Have Sex With Men

SAGE Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 215824402110168
Author(s):  
Sarah J. Marks ◽  
Roland C. Merchant ◽  
Melissa A. Clark ◽  
Tao Liu ◽  
Joshua G. Rosenberger ◽  
...  
Keyword(s):  
Hiv Testing ◽  
The United States ◽  
National Study ◽  
National Guidelines ◽  
The Past ◽  
Home Based ◽  
Self Testing ◽  
Hiv Test ◽  
Condomless Anal Intercourse ◽  
Sex With Men

HIV incidence among young adult men-who-have-sex-with-men (YMSM) is among the highest in the United States (US), yet YMSM have lower rates of HIV testing than most other MSM. Among 1,835 U.S. Black, Hispanic, and White YMSM who reported condomless anal intercourse (CAI) in the prior year, 30% (95% confidence interval [CI]: [28%, 32%]) had not been tested for HIV in the past year as recommended by national guidelines, and 19% (95% CI: [17%, 21%]) had never been tested. Factors associated with not being tested in the past year included not having a primary care provider (PCP)) (odds ratio [OR]: 2.00, 95% CI: [1.53, 2.60]), discomfort with asking a PCP for an HIV test (OR: 2.66, 95% CI: [2.05, 3.44]), living in a smaller community (OR: 1.71, 95% CI: [1.35, 2.18]), younger age (OR: 2.00, 95% CI: [1.53, 2.60]), and greater self-perception of having an undiagnosed HIV infection (OR: 1.46, 95% CI: [1.07, 1.99]). YMSM who had not been tested in the prior year were less likely to know where to get tested, yet were interested in trying home-based HIV self-testing. This study shows that knowledge, clinician-relationship, geographic, and perceptional barriers must be overcome to improve HIV testing among YMSM. Home-based HIV self-testing may address some of these barriers, particularly for YMSM living in smaller communities.

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