Elementary School–Based Health Centers and Access to Preventive and Asthma-Related Care Among Publicly Insured Children With Asthma in Georgia

Objectives We assessed the effects of 3 new elementary school–based health centers (SBHCs) in disparate Georgia communities—predominantly non-Hispanic Black semi-urban, predominantly Hispanic urban, and predominantly non-Hispanic White rural—on asthma case management among children insured by Medicaid/Children’s Health Insurance Program (CHIP). Methods We used a quasi-experimental difference-in-differences analysis to measure changes in the treatment of children with asthma, Medicaid/CHIP, and access to an SBHC (treatment, n = 193) and children in the same county without such access (control, n = 163) in school years 2011-2013 and 2013-2018. Among children with access to an SBHC (n = 193), we tested for differences between users (34%) and nonusers of SBHCs. We used International Classification of Diseases diagnosis codes, Current Procedural Terminology codes, and National Drug Codes to measure well-child visits and influenza immunization; ≥3 asthma-related visits, asthma-relief medication, asthma-control medication, and ≥2 asthma-control medications; and emergency department visits during the child–school year. Results We found an increase of about 19 ( P = .01) to 33 ( P < .001) percentage points in the probability of having ≥3 asthma-related visits per child–school year and an increase of about 22 ( P = .003) to 24 ( P < .001) percentage points in the receipt of asthma-relief medication, among users of the predominantly non-Hispanic Black and Hispanic SBHCs. We found a 19 ( P = .01) to 29 ( P < .001) percentage-point increase in receipt of asthma-control medication and a 15 ( P = .03) to 30 ( P < .001) percentage-point increase in receipt of ≥2 asthma-control medications among users. Increases were largest in the predominantly non-Hispanic Black SBHC. Conclusion Implementation and use of elementary SBHCs can increase case management and recommended medications among racial/ethnic minority and publicly insured children with asthma.

Flea and tick treatment satisfaction, preference, and adherence of US cat owners prescribed topical fluralaner (Bravecto® Topical Solution for Cats)

Background: Fluralaner is a novel isoxazoline compound and the only systemically distributed ectoparasiticide approved in the United States for redosing at up to 12-week intervals for flea and tick control in cats. Other feline ectoparasiticides, including other systemic isoxazolines, are approved for redosing at monthly intervals. A survey developed in 2016 to assess the satisfaction, preference, and adherence of dog owners prescribed fluralaner as an ectoparasiticide with the treatment and veterinary flea and tick protection recommendations was adapted for completionby cat owners in the USA. Aim: The study objective was to use cat-owner survey data obtained at US veterinary practices to assess client satisfaction and utilization practices for fluralaner, and to evaluate owner adherence to current flea and tick control recommendations. Methods: US veterinary practices (n = 26) were asked to obtain completed surveys for up to 25 active clients who were currently treating their cats with a topical preparation of fluralaner for flea and tick control. Clients who had previously used flea and tick products for cats other than fluralaner were enrolled in the study. Participating cat owners completed an 11-question survey on their satisfaction with, preference for, and adherence to treatment recommendations for topically applied fluralaner as a feline flea and tick control medication. Results: The average cat in this study had a mean (± SD) body weight of 5.1 (± 0.9) kg and was 7.1 (±1.4) years old. Most cats lived in a home versus an apartment and more than half spent some time outside. Satisfaction was assessed with a 5-point Likert scale, with nearly all cat owners (97%) indicating that they were satisfied or very satisfied with fluralaner. Most of them (66%) had previously used other monthly flea and tick products for cats. Owners were not excluded if they had previously used a canine flea and tick product. The extended dosing interval up to 12 weeks was the most frequently selected benefit of fluralaner. Nearly 9 out of 10 respondents indicated they readministered fluralaner mostly on time or delayed by a few days, and most said they were more likely to give a repeat dose of fluralaner at the recommended redosing interval compared to monthly products. 87% of the responding cat owners preferred topical fluralaner over the monthly flea and tick products they had used. Conclusion: The extended dosing interval of up to 12 weeks was the leading preference factor and the key driver of user satisfaction with fluralaner leading to improved adherence to redosing recommendations. Cat owners said they were more likely to administer fluralaner at the recommended redosing interval compared to monthly products, indicating that less frequent redosing contributes to improved adherence.

Abstract P80: Control of Vascular Risk Factors and Response to Stroke Symptoms During the Most Restrictive Period of the Covid-19 Quarantine. A Survey of Population Behavior in Argentina

Background and objectives: In preparation for the influx of Covid-19 patients and as a contagion prevention strategy, healthcare systems reduced or discontinued provision of ‘‘non-urgent’’ care. This policy could potentially influence stroke prevention and management. We conducted a large population survey to assess the impact of mandatory social isolation on emergency consultations, routine health controls and the behavior of the population during the pandemic. Methods: We distributed multiple-choice anonymous questionnaires through the institutional email database and through the email database of clients of a beverage distribution company. Most respondents resided in the Metropolitan Area of Buenos Aires. This is the area where the infection rates were higher and restriction measures were stricter. The survey assessed demographic characteristics and actual and potential behaviors of people regarding medical checkups, risk factors control, medication provision and response to onset of symptoms consistent with stroke or TIA. Results: A total of 10,303 questionnaires were completed. Thirty-seven percent of the respondents were older than 60 years, 74% were women and 16% lived alone. One or more vascular risk factors were present in 39% of respondents. Seventy-six percent of participants did not continue to attend to their regular medical checkups during the mandatory social preventive isolation, 21% had difficulty obtaining medical prescriptions and only 38% considered hospitals were implementing appropriate measures to avoid Covid-19 infections. When asked about response in case of onset of stroke symptoms, 9% would not consult given the context of the pandemic. Six percent reported having had symptoms consistent with stroke or TIA and only 35% of those consulted in an Emergency Room. Most of the respondents (85%) reported they were waiting for the end of the quarantine to resume their usual medical care. Conclusions: The implementation of a strict quarantine may have some serious adverse effects on the proper prevention and treatment of stroke. Careful communication and better education strategies are needed to keep the population safe during the pandemic while avoiding increases in the risk of occurrence of other devastating diseases as stroke.

Modified dosage evaluation of continued release of DiDomenico sodium tablets by means of hydrophilic polymer blends

That term altered - discharge measurement manifestation is used to portray results that change the timing and rate for the arrival of the drug substance. A modified release measurement type will be characterized "as a particular case to which the pill arrival aspects for a period course or area need aid picked on finish restorative alternately comfort destinations not advertised by routine measurement structures, for example, solutions, ointments, alternately immediately dissolving dosages manifestations. xanthan gum, a polysaccharide, crude cashew gum, Diclofenac sodium powder, hydroxypropyl methylcellulose, microcrystalline cellulose, talc and magnesium stearate. Wet granulation, procedure of wet granulation in 6-Step. Every last one of batches of tablets passed that consistency and weight test and pill substance test the batches of tablets be that as clump 3 passed those pulverizing quality test every last one of batches and tablets yet batches 4 furthermore 10 passed the friability test. Tablets holding main xanthan gum similarly as arrival modifier attained the most astounding pulverizing quality friability proportion (CSFR) for the individuals clinched alongside clump 10 hosting those most reduced. Furthermore, the individuals for clump 3 required the most reduced swelling list. Those investigations need demonstrated that cashew furthermore xanthan gums utilized alone can't proficiently control medication regardless of discharge. Batches 7 and 8 holding xanthan gum also HPMC were capable on the result in supported medication regardless of discharge comparable to Voltaren retard.

Long-term effects of asthma medication on asthma symptoms: an application of the targeted maximum likelihood estimation

Background Long-term effectiveness of asthma control medication has been shown in clinical trials but results from observational studies with children and adolescents are lacking. Marginal structural models estimated using targeted maximum likelihood methods are a novel statistiscal approach for such studies as it allows to account for time-varying confounders and time-varying treatment. Therefore, we aimed to calculate the long-term risk of reporting asthma symptoms in relation to control medication use in a real-life setting from childhood to adulthood applying targeted maximum likelihood estimation. Methods In the prospective cohort study SOLAR (Study on Occupational Allergy Risks) we followed a German subsample of 121 asthmatic children (9–11 years old) of the ISAAC II cohort (International Study of Asthma and Allergies in Childhood) until the age of 19 to 24. We obtained self-reported questionnaire data on asthma control medication use at baseline (1995–1996) and first follow-up (2002–2003) as well as self-reported asthma symptoms at baseline, first and second follow-up (2007–2009). Three hypothetical treatment scenarios were defined: early sustained intervention, early unsustained intervention and no treatment at all. We performed longitudinal targeted maximum likelihood estimation combined with Super Learner algorithm to estimate the relative risk (RR) to report asthma symptoms at SOLAR I and SOLAR II in relation to the different hypothetical scenarios. Results A hypothetical intervention of early sustained treatment was associated with a statistically significant risk increment of asthma symptoms at second follow-up when compared to no treatment at all (RR: 1.51, 95% CI: 1.19–1.83) or early unsustained intervention (RR:1.38, 95% CI: 1.11–1.65). Conclusions While we could confirm the tagerted maximum likelihood estimation to be a usable and robust statistical tool, we did not observe a beneficial effect of asthma control medication on asthma symptoms. Because of potential due to the small sample size, lack of data on disease severity and reverse causation our results should, however, be interpreted with caution.

The Challenges of COVID-19 for People Living With Diabetes: Considerations for Digital Health

The coronavirus disease (COVID-19) is a global pandemic that significantly impacts people living with diabetes. Diabetes-related factors of glycemic control, medication pharmacodynamics, and insulin access can impact the severity of a COVID-19 infection. In this commentary, we explore how digital health can support the diabetes community through the pandemic. For those living with diabetes, digital health presents the opportunity to access care with greater convenience while not having to expose themselves to infection in an in-person clinic. Digital diabetes apps can increase agency in self-care and produce clinically significant improvement in glycemic control through facilitating the capture of diabetes device data. However, the ability to share these data back to the clinic to inform virtual care and enhance diabetes coaching and guidance remains a challenge. In the end, it requires an unnecessarily high level of technical sophistication on the clinic’s part and on those living with diabetes to routinely use their diabetes device data in clinic visits, virtual or otherwise. As the world comes together to fight the COVID-19 pandemic, close collaboration among the global diabetes community is critical to understand and manage the sustained impact of the pandemic on people living with diabetes.

The Challenges of COVID-19 for People Living With Diabetes: Considerations for Digital Health (Preprint)

UNSTRUCTURED The coronavirus disease (COVID-19) is a global pandemic that significantly impacts people living with diabetes. Diabetes-related factors of glycemic control, medication pharmacodynamics, and insulin access can impact the severity of a COVID-19 infection. In this commentary, we explore how digital health can support the diabetes community through the pandemic. For those living with diabetes, digital health presents the opportunity to access care with greater convenience while not having to expose themselves to infection in an in-person clinic. Digital diabetes apps can increase agency in self-care and produce clinically significant improvement in glycemic control through facilitating the capture of diabetes device data. However, the ability to share these data back to the clinic to inform virtual care and enhance diabetes coaching and guidance remains a challenge. In the end, it requires an unnecessarily high level of technical sophistication on the clinic’s part and on those living with diabetes to routinely use their diabetes device data in clinic visits, virtual or otherwise. As the world comes together to fight the COVID-19 pandemic, close collaboration among the global diabetes community is critical to understand and manage the sustained impact of the pandemic on people living with diabetes.