Partner randomized controlled trial: study protocol and coaching intervention

<p>Abstract</p> <p>Background</p> <p>Many children with asthma live with frequent symptoms and activity limitations, and visits for urgent care are common. Many pediatricians do not regularly meet with families to monitor asthma control, identify concerns or problems with management, or provide self-management education. Effective interventions to improve asthma care such as small group training and care redesign have been difficult to disseminate into office practice.</p> <p>Methods and design</p> <p>This paper describes the protocol for a randomized controlled trial (RCT) to evaluate a 12-month telephone-coaching program designed to support primary care management of children with persistent asthma and subsequently to improve asthma control and disease-related quality of life and reduce urgent care events for asthma care. Randomization occurred at the practice level with eligible families within a practice having access to the coaching program or to usual care. The coaching intervention was based on the transtheoretical model of behavior change. Targeted behaviors included 1) effective use of controller medications, 2) effective use of rescue medications and 3) monitoring to ensure optimal control. Trained lay coaches provided parents with education and support for asthma care, tailoring the information provided and frequency of contact to the parent's readiness to change their child's day-to-day asthma management. Coaching calls varied in frequency from weekly to monthly. For each participating family, follow-up measurements were obtained at 12- and 24-months after enrollment in the study during a telephone interview.</p> <p>The primary outcomes were the mean change in 1) the child's asthma control score, 2) the parent's quality of life score, and 3) the number of urgent care events assessed at 12 and 24 months. Secondary outcomes reflected adherence to guideline recommendations by the primary care pediatricians and included the proportion of children prescribed controller medications, having maintenance care visits at least twice a year, and an asthma action plan. Cost-effectiveness of the intervention was also measured.</p> <p>Discussion</p> <p>Twenty-two practices (66 physicians) were randomized (11 per treatment group), and 950 families with a child 3-12 years old with persistent asthma were enrolled. A description of the coaching intervention is presented.</p> <p>Trial registration</p> <p>ClinicalTrials.gov identifier <a href="http://www.clinicaltrials.gov/ct2/show/NCT00860834">NCT00860834</a>.</p

Grade retention risk among children with asthma and other chronic health conditions in a large urban school district.

Asthma accounts for 12.8 million missed school days for children nationwide. Whether this excess absenteeism contributes to poor outcomes such as grade retention is of interest. The Clark County School District in Las Vegas, NV has incorporated the Federal No Child Left Behind Act, which states that absences per individual in excess of 10 per school year are considered unapproved and may put a child at risk for repeating a grade. The purpose of this study was to determine if children with asthma are at increased risk for absenteeism associated with grade retention. Secondary data were obtained for students in attendance for the 2006-2007 school year. Days absent were weighted for enrollment time. Frequencies were obtained using descriptive statistics, and multivariate logistic regression was used to model the odds of absenteeism \u3e 10 days per year. Of 300 881 students, 27 299 (9.1%) reported having asthma, as determined by school health records. The population was 52% male, 37% white, and 39% Hispanic. Significant predictors of missing \u3e 10 days per school year included ethnicity, gender, grade, and health status (P \u3c 0.0001). Students with asthma (adjusted odds ratio [aOR], 1.5) or asthma plus another health condition (aOR, 1.6) were at significantly increased odds of missing \u3e 10 school days per year compared with healthy students or those with a medical condition other than asthma (P \u3c 0.0001). Lastly, some disparities were found in current grade point average by race, gender, and asthma status. Children with asthma have a greater risk of absenteeism associated with grade retention. Therefore, improved asthma management and tailored education is necessary to identify and eliminate asthma triggers in the home and school setting for school-aged children

Association Between Increased BMI and Severe School Absenteeism Among US Children and Adolescents: Findings from a National Survey, 2005–2008

Objective: School absenteeism may be an underlying cause of poor school performance among overweight and obese children. We examined the associations between school absenteeism and body mass index (BMI) in a nationally representative sample. Design and Subjects: We analyzed the data of 1387 children (6–11 years) and 2185 adolescents (12–18 years), who completed an interview and anthropometric measurement as a part of the National Health and Nutrition Examination Survey, 2005–2008. The CDC 2000 growth chart was used to categorize BMI status, and the number of school days missed during the past 12 months was assessed by asking the proxies or interviewees. Results:The prevalence of obesity and overweight were 18.96±1.44% (s.e.) and 16.41±0.78%, respectively, among study populations. The means of school days missed in the last 12 months were not statistically different between the normal-weight, overweight and obese groups, 3.79±0.56, 3.86±0.38 and 4.31±0.01 days, respectively. However, when \u3e2 days missed per school month was defined as severe absence, the prevalence of severe absence were 1.57%, 2.99% and 4.94% respectively, among 6–11-year-old children with normal, overweight and obese. The adjusted odds of severe school absence were 2.27 (95% confidence interval=0.64–8.03) and 3.93 (1.55–9.95), respectively, among overweight and obese children compared with normal-weight peers (P for trend test Conclusion: Increased body weight is independently associated with severe school absenteeism in children but not adolescents. Future research is needed to determine the nature, and academic and social significance of this association

Indoor air quality and health in schools

Objective: To determine whether indoor air quality in schools is associated with the prevalence of allergic and respiratory diseases in children. Methods: We evaluated 1,019 students at 51 elementary schools in the city of Coimbra, Portugal. We applied a questionnaire that included questions regarding the demographic, social, and behavioral characteristics of students, as well as the presence of smoking in the family. We also evaluated the indoor air quality in the schools. Results: In the indoor air of the schools evaluated, we identified mean concentrations of carbon dioxide (CO2) above the maximum reference value, especially during the fall and winter. The CO2 concentration was sometimes as high as 1,942 ppm, implying a considerable health risk for the children. The most prevalent symptoms and respiratory diseases identified in the children were sneezing, rales, wheezing, rhinitis, and asthma. Other signs and symptoms, such as poor concentration, cough, headache, and irritation of mucous membranes, were identified. Lack of concentration was associated with CO2 concentrations above the maximum recommended level in indoor air (p = 0.002). There were no other significant associations. Conclusions: Most of the schools evaluated presented with reasonable air quality and thermal comfort. However, the concentrations of various pollutants, especially CO2, suggest the need for corrective interventions, such as reducing air pollutant sources and improving ventilation. There was a statistically significant association between lack of concentration in the children and exposure to high levels of CO2. The overall low level of pollution in the city of Coimbra might explain the lack of other significant associations

The Relationship Between School Absence, Academic Performance, and Asthma Status

BACKGROUND: Children with asthma experience more absenteeism from school compared with their nonasthma peers. Excessive absenteeism is related to lower student grades, psychological, social, and educational adjustment. Less is known about the relationship between the presence of asthma and the academic achievement in school-aged children. Since students with asthma miss more days from school, this may negatively impact their academic achievement. The goal of this study was to investigate the relationships between absenteeism, presence of asthma, and asthma severity level with standardized test level performance in a predominantly African American urban school district. METHODS: A cross-sectional analysis was conducted of 3812 students (aged 8-17 years) who took the Missouri Assessment Program (MAP) standardized test during the 2002-2003 academic year. RESULTS: After adjustment for covariates, a significant inverse relationship was found between absenteeism and test level performance on the MAP standardized test in all children (F = 203.9, p \u3c .001). There was no overall difference in test level achievement between those with and without asthma (p = .12). Though not statistically different, those with persistent asthma showed a modestly increased likelihood of scoring below Nearing Proficient compared with those with mild intermittent asthma (adjusted odds ratio = 1.93, 95% confidence intervals = 0.93-4.01, p = .08). CONCLUSIONS: A negative impact of absenteeism on standardized test level achievement was demonstrated in children from an urban African American school district. Children with asthma perform the same academically as their nonasthma peers. However, those with persistent asthma show a trend of performing worse on MAP standardized test scores and have more absence days compared with other students. More research is warranted on the effects of persistent asthma on academic achievement

Association of Leisure-Time Physical Activity to Cardiovascular Disease Prevalence in Relation to Smoking among Adult Nevadans

It is well known that cigarette smoking and physical activity have significant impacts on cardiovascular disease (CVD) mortality and morbidity. Meanwhile, it is of interest to understand whether physical activity protects against CVD for smokers in a similar manner as it does for non-smokers. The present study examined how leisure-time physical activity (LTPA) is associated with the prevalence of CVD in relation to smoking status among adult Nevadans, using data from the 2010 Nevada Behavioral Risk Factor Surveillance System. Of the 3,913 survey respondents, 8.5% self-reported that they had ever been diagnosed with CVD. People with a history of CVD were significantly less likely to engage in LTPA than those with no history of CVD (p \u3c 0.05). After adjusting for common sociodemographic variables, it was revealed that people with CVD were twice more likely to not engage in LTPA than their counterparts independent of smoking status. Without taking LTPA into account, the odds of having CVD for current and former smokers was 1.87–2.25 times higher than the odds for non-smokers. Interestingly, however, if LTPA was accounted for, there was no significant difference in the odds of having CVD between current and non-smokers. These results indicate that LTPA is inversely associated with the prevalence of CVD independent of smoking status, and that regular physical activity may protect against CVD for smokers as well as for non-smokers. Physical activity, along with smoking cessation, should be promoted to better prevent and control CVD among smokers

Self-reported prevalence of childhood allergic diseases in three cities of China: a multicenter study

<p>Abstract</p> <p>Background</p> <p>Several studies conducted during the 1990s indicated that childhood allergic diseases were increasing worldwide, but more recent investigations in some Western countries have suggested that the trend is stabilizing or may even be reversing. However, few data are available on the current status of allergic disease prevalence in Chinese children. The aim of the present study was to investigate the prevalence rates of asthma, allergic rhinitis, and eczema in children of three major cities of China, to determine the status of allergic diseases among Chinese children generally, and to evaluate the prevalence of allergic diseases in children of different ages.</p> <p>Methods</p> <p>We conducted a cross-sectional survey between October 2008 and May 2009 in three major cities of China (Beijing, Chongqing, and Guangzhou) to evaluate the prevalence rates of childhood allergic diseases including asthma, allergic rhinitis, and eczema, using a questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC) group. A total of 24,290 children aged 0-14 years were interviewed, using a multi-stage sampling method. To acquire data on children aged 3-14 years, we visited schools and kindergartens. To access children too young to attend school or kindergarten, we extended our survey to community health service centers. Each questionnaire was completed by a parent or guardian of a child after an informed consent form was signed.</p> <p>Results</p> <p>Of the 24,290 children in our study, 12,908 (53.14%) were males and 11,382 (46.86%) females; 10,372 (42.70%) were from Beijing, 9,846 (40.53%) from Chongqing, and 4,072 (16.77%) from Guangzhou. Our survey indicated that in Beijing, Chongqing, and Guangzhou, the prevalence rates of asthma were 3.15%, 7.45%, and 2.09%, respectively; the rates of allergic rhinitis were 14.46%, 20.42%, and 7.83%; and the rates of eczema were 20.64%, 10.02%, and 7.22%. The prevalence of allergic diseases varied with age. Asthma was relatively less common both in children aged under 2 years, and in those aged 9 years or more, in each of the three cities. The prevalence of allergic rhinitis was also lower in children younger than 2 years. The prevalence of eczema fell with age.</p> <p>Conclusions</p> <p>A marked increase in the prevalence rates of allergic diseases in China (compared with earlier data) was evident. Further studies exploring the precise causes of this increase are warranted.</p