School-Based Telemedicine Interventions for Asthma: A Systematic Review.

BackgroundSchool health systems are increasingly investing in telemedicine platforms to address acute and chronic illnesses. Asthma, the most common chronic illness in childhood, is of particular interest given its high burden on school absenteeism.ObjectiveConduct a systematic review evaluating impact of school-based telemedicine programs on improving asthma-related outcomes.Data sourcesPubMed, Cochrane CENTRAL, CINAHL, ERIC, PsycINFO, Embase, and Google Scholar.Study eligibility criteriaOriginal research, including quasi-experimental studies, without restriction on the type of telemedicine.ParticipantsSchool-aged pediatric patients with asthma and their families.InterventionsSchool-based telemedicine.Study appraisal and synthesis methodsTwo authors independently screened each abstract, conducted full-text review, assessed study quality, and extracted information. A third author resolved disagreements.ResultsOf 371 articles identified, 7 were included for the review. Outcomes of interest were asthma symptom-free days, asthma symptom frequency, quality of life, health care utilization, school absences, and spirometry. Four of 7 studies reported significant increases in symptom-free days and/or decrease in symptom frequency. Five of 6 reported increases in at least one quality-of-life metric, 2 of 7 reported a decrease in at least 1 health care utilization metric, 1 of 3 showed reductions in school absences, and 1 of 2 reported improvements in spirometry measures.LimitationsVariability in intervention designs and outcome measures make comparisons and quantitative analyses across studies difficult. Only 2 of 7 studies were randomized controlled trials.Conclusions and implications of key findingsHigh-quality evidence supporting the use of school-based telemedicine programs to improve patient outcomes is limited. While available evidence suggests benefit, only 2 comparative trials were identified, and the contribution of telemedicine to these studies' results is unclear

Homelessness and Public Health in Los Angeles

Los Angeles faces a housing crisis of unprecedented scale. After years of underinvestment, in 2016/2017 LA County voters approved Measures H and HHH, which provided an infusion of resources for homeless services, permanent housing, and integrated outreach through the LA County Homeless Initiative (HI). An estimated 58,936 individuals in LA County remain homeless as of January 2019, 75% of them unsheltered and living on streets, in tents, or encampments. Our best estimates suggest that the homeless population has grown since 2017.HI takes a Housing First approach to homelessness, with the largest amount of total funds allocated to housing solutions. However, rehousing is often subject to delays in construction and case management. These delays, combined with persistent market forces driving new homelessness, have left the county well short of its targets. While no forecasts were issued, the initial gap analysis for HI had assumed a 34% reduction in the total homeless count from 2016 to 2019. The count has in fact increased by 26% over that period, meaning 28,000 more homeless clients than anticipated on any night. Whereas cities with comparable homeless crises such as New York have focused on increasing the availability of emergency shelters and safe havens in addition to permanent housing, LA County’s relatively low investment in transitional options has resulted in persistent levels of unsheltered homelessness.Research has shown that homelessness has severe health consequences. Homeless individuals have a high risk of mortality, with a recent LA County Medical Examiner report finding an average age of death of 48 for women and 51 for men. Homeless individuals have much higher risks of mental illness, substance abuse, infectious disease, chronic illness, violence, and reproductive health risks than the general population. Much less is known about the health burdens associated with being unsheltered, but most evidence points to substantially greater health risks given the more intense exposures to violence, weather, pollution, poor sanitation, and behavioral risk. Research is just beginning to quantify the burdens of living on the streets.Our analysis of the LA County homelessness response drew on expert interviews, data analysis, and document review. Beyond the growing numerical gap between HI’s targets and actual trends, we identified five critical service gaps that require immediate attention: Taking a person-centered approach that recognizes both the diversity of client needs and the limitations of existing resources, yet honors the principle that everyone deserves housing; Improving access to emergency shelters by reducing legal and political barriers to construction and adopting “low barrier shelters” that facilitate entry; Delivering comprehensive street medicine and other services to unsheltered homeless populations using evidence-based models that support the path to housing and recovery Adopting more extensive outreach models that engage citizens, empower homeless clients and leverage mobile technology so that case workers can focus on clients most in need; Strengthening data collection and research methods to understand the consequences of unsheltered homelessness, pilot new service models, and evaluate rehousing efforts

The Impact of Health Insurance Coverage on Short-Term and Long-Term Readmissions to the Emergency Department for Pediatric Patients with Asthma: A Retrospective Regression Analysis

Inadequate health insurance coverage may hinder the management of asthma in children in recurrent emergency department (ED) visits in comparison to children with health care insurance. Children with asthma who do not have health insurance are at risk of not having access to primary care physicians. They may live in poorer communities, where they are more likely to encounter higher concentrations of asthma-inducing agents or factors contributing to increased healthcare utilization, resulting in increased expenditures and reduced patient outcomes

POST COVID MANAGEMENT OF ASTHMA IN CHRONIC ASTHMA PATIENT

Asthma is defined as a chronic inflammatory disease of the airways. The chronic inflammation is associated with airway hyper responsiveness (an exaggerated airway narrowing response to triggers, such as allergens and exercise), that leads to recurrent symptoms such as wheezing, dyspnea (shortness of breath), chest tightness and coughing. Asthma is associated with T helper cell type-2 (Th2) immune responses, which are typical of other atopic conditions. Various allergic (e.g., dust mites, cockroach residue, furred animals, moulds, pollens) and non-allergic (e.g., infections, tobacco smoke, cold air, exercise) triggers produce a cascade of immune-mediated events leading to chronic airway inflammation. The Present Review Discuss and Focus about the various Risk factor associated with Covid 19 influenced Asthma Patient with their Possible Management

Clinical presentation and outcomes of COVID-19 compared with other respiratory virus infections and hospital populations

As of September 2022, more than 600 million cases of coronavirus disease 2019 (COVID-19) and 6.5 million deaths have been officially reported to the World Health Organization (WHO). The unfolding pandemic has exerted enormous strains on healthcare systems worldwide yet to be fully understood. The overarching aim of this thesis was to characterize clinical presentation and outcomes in adult patients hospitalized with COVID-19 and compare these with patients hospitalized with other respiratory virus infections as well as other hospital populations. Six retrospective cohort studies were conducted, all set in Stockholm Region in Sweden. In study I, baseline characteristics, clinical presentation, and outcomes in patients hospitalized with COVID-19 were compared with patients hospitalized with influenza, respiratory syncytial virus (RSV) infection, and other respiratory virus infections. Despite being younger and having an overall better health status, adult patients hospitalized with COVID-19 had an increased risk of severe outcomes, in particular mortality, compared with the other infections. These risks were greater among the elderly and during the first months of the pandemic. In study II, the prevalence of bacterial co-infections in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive community-acquired pneumonia (CAP) upon hospital admission was compared with patients hospitalized with influenza virus positive CAP and RSV positive CAP. The occurrence of detected bacterial co-infection upon hospital admission was substantially lower in the SARS-CoV-2 cohort compared with both the influenza and the RSV cohort. In study III, we compared the occurrence of ventilator-associated lower respiratory tract infection (VA-LRTI) in patients mechanically ventilated with versus without COVID-19. The incidence rate was increased in the COVID-19 cohort when compared with influenza and other infectious diseases but decreased when compared with most of the non-infectious diseases. Further, the incidence rate was in the COVID-19 cohort increased during the second wave when compared with the first wave of the pandemic. In study IV, the incidence rate and 30-day mortality rate of hospital-onset bacteraemia (HOB) were compared among patients hospitalized with COVID-19 and patients hospitalized without COVID-19 both before and during the pandemic. The incidence as well as mortality of HOB was increased for both COVID-19 and non-COVID-19 patients during the pandemic when compared with patients hospitalized before the pandemic. In study V, we investigated one-year mortality among patients admitted to the intensive care unit (ICU) with versus without COVID-19. Furthermore, we compared the number of days alive and free from hospitalization during one year in those patients who were discharged alive from the ICU-associated hospitalization. An increased risk of acute mortality was observed in patients treated in the ICU with versus without COVID-19, primarily among the elderly. On the contrary, survivors of COVID-19 critical illness had compared with other critical illness survivors more days alive and free from further hospitalizations during the next year. In study VI, we investigated the occurrence and characteristics of post COVID-19 condition (PCC) diagnosis across different severities of the acute COVID-19 episode. The occurrence of PCC diagnosis was substantially higher in individuals hospitalized versus not hospitalized during the acute COVID-19 episode. Associations between health status factors and PCC diagnosis differed by severity of the acute COVID-19 episode, with more and stronger associations among those not hospitalized during the acute infection. Increases in outpatient healthcare utilization up to one year after the acute infection indicated an incomplete recovery in individuals diagnosed with PCC. Taken together, these studies contribute to our understanding of the clinical epidemiology of COVID-19, highlighting severe acute clinical outcomes in hospitalized patients as well as a different occurrence and trajectory of PCC across different severities of the acute infection. Given the life-saving rollout of COVID-19 vaccines and the evolving nature of the virus, the generalizability of these findings over time needs to be carefully considered. Further investigations of the acute and in particular long-term effects of COVID-19 are warranted. An improved understanding of how the pandemic has caused disruptions and backlogs in healthcare delivery is also necessary

J Asthma

Objective:A better understanding of the impacts of the Coronavirus disease 2019 (COVID-19) pandemic on emergency department (ED) visits for asthma is needed to improve asthma control.Methods:Using data from the National Syndromic Surveillance Program (NSSP), we assessed changes in average weekly asthma ED visits in the United States in 3 surveillance periods: (1) March 15, 2020\u2013January 2, 2021; (2) January 3, 2021\u2013January 1, 2022; and (3) January 2\u2013March 5, 2022, relative to pre-pandemic comparison periods between December 30, 2018 and December 28, 2019. For each surveillance period, we assessed changes in asthma ED visits by age group and sex.Results:For the surveillance period beginning March 15, 2020, average weekly asthma ED visits declined 31% relative to what was observed during the comparison period \u2013 that is, from 45,276 visits/week in 2019 to 31,374 visits/week in 2020. Declines of over 19% and 26% were observed for 2021 and 2022, respectively, relative to the comparison periods. In all surveillance periods, the largest declines occurred among children, especially those ages 0\u20134 (74%) and 5\u201311 (66%) years.Conclusions:The COVID-19 pandemic impacted asthma ED visits in the United States. The impact was greater among children than adults, as ED visits among children were notably lower during all three pandemic surveillance periods than during the corresponding pre-pandemic periods. Additional information about the roles of behaviors of patients with asthma and changes in asthma care might improve our understanding of the reasons underlying these observed changes.CC999999/ImCDC/Intramural CDC HHSUnited States

Occupational Contributions to Respiratory Health Disparities.

Occupation is an important contributor to disparities in respiratory disease, affecting financial status, health-care access, and exposure to hazardous substances. Although occupation and associated exposures are included in the socioecological models, work exposures remain persistently absent from research on health inequities and their contribution to health. This article focuses on the occupational contribution to disparities in asthma, chronic obstructive pulmonary disease, silicosis, coronavirus disease 2019, and lung cancer. Because occupational exposures are largely preventable through proper workplace controls, the recognition of occupational causes of disease can provide an opportunity for interventions to bring about health equity

Examining the Home Interventionist Model of Care in Pediatric Asthma

Pediatric asthma disproportionately affects children living in urban areas and within families reporting an income below the poverty threshold. Home interventionist models of care, utilizing interventionists from the communities they serve, have been found to improve pediatric asthma symptoms and reduce Medicaid costs. Home interventionists, such as community health workers (CHWs) and Healthy Homes assessors (HHAs), focus on connecting care among schools, providers, and homes, and empowering families in accessing resources to overcome barriers to care. However, research is just beginning to understand how home interventionists create positive change among families within low-income, urban communities. This dissertation study used a qualitative data approach outlined in the author’s NHLBI-funded F31 training grant (PI: Dempster, F31HL158196) and secondary data analysis of an NHLBI-funded Asthma Empowerment grant that tested a randomized clinical trial of the community-based asthma program, RVA Breathes (PI: Everhart, U01HL138682). Participants in RVA Breathes identified predominantly African American or Black, resided in public housing, and reported an income below $25,000 a year in Richmond, VA. This mixed-methods dissertation examined the processes by which interventionists in RVA Breathes assisted families in managing their children’s asthma control over an 18-month period. Session notes and internal records from the RVA Breathes intervention were qualitatively analyzed in conjunction with caregiver and interventionist focus groups. Secondary data analyses used multilevel modeling to assess associations among caregiver stress, depressive symptoms, stressful life events, barriers to care, and asthma control over 18-months controlling for group assignment. Findings highlighted the positive impacts of RVA Breathes on families of children with asthma, even in the face of COVID-19. Caregivers and interventionists also provided recommendations for future intervention efforts. Quantitative analyses found improvements in caregiver stress, depressive symptoms, stressful life events, barriers to care, and asthma control over time. Using multilevel modelling, improvements in caregiver stress and stressful life events were associated with improvements in asthma control over time regardless of group assignment. Findings highlight the benefits of the RVA Breathes program for families of children with asthma and provide evidence for future models of care incorporating home interventionists

The Spill-Over Impact of the Novel Coronavirus-19 Pandemic on Medical Care and Disease Outcomes in Non-communicable Diseases: A Narrative Review

OBJECTIVES: The coronavirus-19 (COVID-19) pandemic has claimed more than 5 million lives worldwide by November 2021. Implementation of lockdown measures, reallocation of medical resources, compounded by the reluctance to seek help, makes it exceptionally challenging for people with non-communicable diseases (NCD) to manage their diseases. This review evaluates the spill-over impact of the COVID-19 pandemic on people with NCDs including cardiovascular diseases, cancer, diabetes mellitus, chronic respiratory disease, chronic kidney disease, dementia, mental health disorders, and musculoskeletal disorders. METHODS: Literature published in English was identified from PubMed and medRxiv from January 1, 2019 to November 30, 2020. A total of 119 articles were selected from 6,546 publications found. RESULTS: The reduction of in-person care, screening procedures, delays in diagnosis, treatment, and social distancing policies have unanimously led to undesirable impacts on both physical and psychological health of NCD patients. This is projected to contribute to more excess deaths in the future. CONCLUSION: The spill-over impact of COVID-19 on patients with NCD is just beginning to unravel, extra efforts must be taken for planning the resumption of NCD healthcare services post-pandemic