Pediatric Emergency Department Poster - 2019

Pediatric Emergency Department Poster - 2018https://scholarlycommons.libraryinfo.bhs.org/research_education/1011/thumbnail.jp

Content analysis of promotional material for asthma-related products and therapies on Instagram

BACKGROUND: Increasingly, social media is a source for information about health and disease self-management. We conducted a content analysis of promotional asthma-related posts on Instagram to understand whether promoted products and services are consistent with the recommendations found in the Global Initiative for Asthma (GINA) 2019 guidelines. METHODS: We collected every Instagram post incorporating a common, asthma-related hashtag between September 29, 2019 and October 5, 2019. Of these 2936 collected posts, we analyzed a random sample of 266, of which, 211 met our inclusion criteria. Using an inductive, qualitative approach, we categorized the promotional posts and compared each post\u27s content with the recommendations contained in the 2019 GINA guidelines. Posts were categorized as consistent with GINA if the content was supported by the GINA guidelines. Posts that promoted content that was not recommended by or was unrelated to the guidelines were categorized as not supported by GINA . RESULTS: Of 211 posts, 89 (42.2%) were promotional in nature. Of these, a total of 29 (32.6%) were categorized as being consistent with GINA guidelines. The majority of posts were not supported by the guidelines. Forty-one (46.1%) posts promoted content that was not recommended by the current guidelines. Nineteen (21.3%) posts promoted content that was unrelated to the guidelines. The majority of unsupported content promoted non-pharmacological therapies (n = 39, 65%) to manage asthma, such as black seed oil, salt-room therapy, or cupping. CONCLUSIONS: The majority of Instagram posts in our sample promoted products or services that were not supported by GINA guidelines. These findings suggest a need for providers to discuss online health information with patients and highlight an opportunity for providers and social media companies to promote evidence-based asthma treatments and self-management advice online

Detecting Associations between Early-Life DDT Exposures and Childhood Growth Patterns: A Novel Statistical Approach.

It has been hypothesized that environmental exposures at key development periods such as in utero play a role in childhood growth and obesity. To investigate whether in utero exposure to endocrine-disrupting chemicals, dichlorodiphenyltrichloroethane (DDT) and its metabolite, dichlorodiphenyldichloroethane (DDE), is associated with childhood physical growth, we took a novel statistical approach to analyze data from the CHAMACOS cohort study. To model heterogeneity in the growth patterns, we used a finite mixture model in combination with a data transformation to characterize body mass index (BMI) with four groups and estimated the association between exposure and group membership. In boys, higher maternal concentrations of DDT and DDE during pregnancy are associated with a BMI growth pattern that is stable until about age five followed by increased growth through age nine. In contrast, higher maternal DDT exposure during pregnancy is associated with a flat, relatively stable growth pattern in girls. This study suggests that in utero exposure to DDT and DDE may be associated with childhood BMI growth patterns, not just BMI level, and both the magnitude of exposure and sex may impact the relationship

Detecting Associations between Early-Life DDT Exposures and Childhood Growth Patterns: A Novel Statistical Approach.

It has been hypothesized that environmental exposures at key development periods such as in utero play a role in childhood growth and obesity. To investigate whether in utero exposure to endocrine-disrupting chemicals, dichlorodiphenyltrichloroethane (DDT) and its metabolite, dichlorodiphenyldichloroethane (DDE), is associated with childhood physical growth, we took a novel statistical approach to analyze data from the CHAMACOS cohort study. To model heterogeneity in the growth patterns, we used a finite mixture model in combination with a data transformation to characterize body mass index (BMI) with four groups and estimated the association between exposure and group membership. In boys, higher maternal concentrations of DDT and DDE during pregnancy are associated with a BMI growth pattern that is stable until about age five followed by increased growth through age nine. In contrast, higher maternal DDT exposure during pregnancy is associated with a flat, relatively stable growth pattern in girls. This study suggests that in utero exposure to DDT and DDE may be associated with childhood BMI growth patterns, not just BMI level, and both the magnitude of exposure and sex may impact the relationship

Evaluation of the Acceptability of a Proposed, Instagram-Based, Randomized Controlled Trial for People With Asthma: Survey Study

Background: Asthma is a chronic lung disease that affects nearly 25 million individuals in the United States. More research is needed into the potential for health care providers to leverage existing social media platforms to improve healthy behaviors and support individuals living with chronic health conditions. Objective: In this study, we assessed the willingness of Instagram users with poorly controlled asthma to participate in a pilot randomized controlled trial that will use Instagram as a means of providing social and informational support. In addition, we explored the potential for adapting the principles of photovoice and digital storytelling to Instagram. Methods: We conducted a survey study of Instagram users aged 18-40 years with poorly controlled asthma in the United States. Results: Over 3 weeks of recruitment, 457 individuals completed the presurvey screener; 347 (75.9%) were excluded and 110 (24.1%) were eligible and agreed to participate in the study. Of the 110 individuals, 82 (74.5%) completed the study survey. The mean age of the respondents was 21 (SD 5.3) years. Among respondents, 56% (46/82) were female, 65% (53/82) were non-Hispanic White, and 72% (59/82) had at least some college education. The majority of respondents (67/82, 82%) indicated that they would be willing to participate in the proposed study. Conclusions: Among young adult Instagram users with asthma, there is substantial interest in participating in a pilot randomized controlled trial that will use Instagram to connect participants with peers and a health coach to share information about self-management of asthma and build social connection. Keywords: Instagram; asthma; digital storytelling; social media; social support; young adult

Unnecessary Antibiotic Prescribing in Children Hospitalised for Asthma Exacerbation: A Retrospective National Cohort Study

Background: Antibiotic resistance represents a worldwide public health threat. Characterising prescribing patterns for conditions for which antibiotics have no role can inform antimicrobial stewardship efforts. Asthma is among the most common non-infectious diseases in children and results in 100 000 hospitalisations annually in the USA. We sought to identify the rate of antibiotic prescribing in children hospitalised for asthma exacerbations, and to characterise patient and hospital factors associated with receipt of antibiotics. Methods: Children and adolescents aged 2-17 years admitted to hospital between 1 October 2015 and 30 June 2018 with an asthma exacerbation were identified from the Premier Alliance Database. After excluding hospitalisations for which antibiotics appeared to have been justified, we assessed receipt and duration of antibiotic treatments during the hospital stay. We developed a hierarchical logistic regression model to identify patient and hospital factors associated with antibiotic treatment. For each hospital with at least 10 asthma cases we computed the percentage of cases receiving antibiotic treatment. Results: 23 129 hospital stays met inclusion criteria; in 3329 (14%) of these, antibiotics were prescribed without clear indication. Hospital prescribing rates varied widely (range 0%-95%), with 25% of hospitals prescribing antibiotics at a rate of 27.5% or more. Patient factors most strongly associated with receipt of antibiotics included the presence of a complex chronic condition (OR: 2.4, 95% CI 2.1 to 2.9; p\u3c0.0001) and admission to the intensive care unit compared with a general medical-surgical bed (OR: 1.6, 95% CI 1.5 to 1.9; p\u3c0.0001). Hospitalisation at general hospitals with minimum paediatric specialty support conferred a nearly threefold higher odds of antibiotic treatment (OR: 2.9, 95% CI 1.5 to 5.6; p\u3c0.0001). Conclusions: These findings illustrate an opportunity to reduce unnecessary exposure to antibiotics in children hospitalised with asthma, particularly in general hospitals where three-quarters of children in the USA receive their hospital-based care

Sex-specific distributions (boys, girls) of childhood BMI at 2, 3.5, 5, 7, and 9 years of age at follow-up for growth pattern groups detected by transformed mixture model, Center for the Health Assessment of Mothers and Children of Salina Study, 2000–2010.

<p>¹ Boys listed first</p><p>² Girls listed second</p><p>³ < 85th percentile</p><p>⁴ 85th–94.9th percentile</p><p>⁵ ≥ 95th percentile</p><p>BMI, body mass index; SD, standard deviation</p><p>Sex-specific distributions (boys, girls) of childhood BMI at 2, 3.5, 5, 7, and 9 years of age at follow-up for growth pattern groups detected by transformed mixture model, Center for the Health Assessment of Mothers and Children of Salina Study, 2000–2010.</p

Distribution of dhildhood BMI at 2, 3.5, 5, 7, and 9 years of age at follow-up, Center for the Health Assessment of Mothers and Children of Salina Study, 2000–2010.

<p>¹ < 85th percentile</p><p>² 85th–94.9th percentile</p><p>³ ≥ 95th percentile</p><p>BMI, body mass index; SD, standard deviation</p><p>Distribution of dhildhood BMI at 2, 3.5, 5, 7, and 9 years of age at follow-up, Center for the Health Assessment of Mothers and Children of Salina Study, 2000–2010.</p

Group BMI growth patterns.

<p>BMI longitudinal trajectories of children in study population, categorized by sex and data-driven groups based on posterior probabilities from an estimated finite mixture model without adjusting for baseline risk factors. Group mean BMI trajectories are overlaid for each sex-specific group.</p

Baseline Child and Maternal Characteristics of Study Population (n = 249), Center for the Health Assessment of Mothers and Children of Salina Study, 2000–2010.

<p>IQR, interquartile range</p><p>Baseline Child and Maternal Characteristics of Study Population (n = 249), Center for the Health Assessment of Mothers and Children of Salina Study, 2000–2010.</p