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OBJECTIVES:To systematically review the literature to characterize interventions with potential to improve outcomes for minority patients with asthma. DATA SOURCES: Medline, PsycINFO, CINAHL, Cochrane Trial Databases, expert review, reference review, meeting abstracts. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTEVENTIONS: Medical Subject Heading (MeSH) terms related to asthma were combined with terms to identify intervention studies focused on minority populations. Inclusion criteria: adult population; intervention studies with majority of non-White participants. STUDY APPRAISAL AND SYNTHESIS OF METHODS:Study quality was assessed using Downs and Black (DB) checklists. We examined heterogeneity of studies through comparing study population, study design, intervention characteristics, and outcomes. RESULTS: Twenty-four articles met inclusion criteria. Mean quality score was 21.0. Study populations targeted primarily African American (n=14), followed by Latino/a (n=4), Asian Americans (n=1), or a combination of the above (n=5). The most commonly reported post-intervention outcome was use of health care resources, followed by symptom control and self-management skills. The most common intervention-type studied was patient education. Although less-than half were culturally tailored, language-appropriate education appeared particularly successful. Several system-level interventions focused on specialty clinics with promising findings, although health disparities collaboratives did not have similarly promising results. LIMITATIONS: Publication bias may limit our findings; we were unable to perform a meta-analysis limiting the review's quantitative evaluation. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS:Overall, education delivered by health care professionals appeared effective in improving outcomes for minority patients with asthma. Few were culturally tailored and one included a comparison group, limiting the conclusions that can be drawn from cultural tailoring. Systemredesign showed great promise, particularly the use of team-based specialty clinics and long-term follow-up after acute care visits. Future research should evaluate the role of tailoring educational strategies, focus on patient-centered education, and incorporate outpatient follow-up and/or a team-based approach.

Background Factors at multiple ecological levels, including the child, family, home, medical care, and community, impact adolescent asthma outcomes. Objective This systematic review characterizes behavioral interventions at the child, family, home, medical system, and community level to improve asthma management among adolescents. Methods A systematic search of PubMed, SCOPUS, OVID, PsycINFO, CINAHL, and reference review databases was conducted from January 1, 2000 through August 10, 2014. Articles were included if the title or abstract included asthma AND intervention AND (Education OR self-management OR behavioral OR technology OR trigger reduction); and the mean/median age of participants was between eleven and sixteen years. We compared populations, intervention characteristics, study designs, outcomes, settings, and intervention levels across studies to evaluate behavioral interventions to improve asthma management for adolescents. Results Of 1230 articles identified and reviewed, 24 articles (21 unique studies) met inclusion criteria. Promising approaches to improving adherence to daily controller medications include: objective monitoring of inhaled corticosteroid adherence with allergist/immunologist feedback on medication taking behavior and school nurse directly observed therapy. Efficacy at increasing asthma self-management skills was demonstrated using group interactive learning in the school setting. This systematic review is not a meta-analysis, thus limiting its quantitative assessment of studies. Publication bias may also limit our findings. Conclusions Novel strategies to objectively increase controller medication adherence for adolescents include allergist/immunologist feedback and school nurse directly observed therapy. Schools, the most common setting across studies in this review, provide the opportunity for group interactive learning to improve asthma knowledge and self-management skills.

Introduction: Exposure to cadmium, cobalt, lead, and manganese has been associated with decreased pulmonary function in adults. Little is known about the magnitude of these associations among children in the United States. Objectives: We evaluated cross-sectional associations of blood and urinary concentrations of cadmium, cobalt, lead, and manganese with pulmonary function measures [forced expiratory volume in one second (FEV1; milliliters), forced vital capacity (FVC; milliliters), ratio of FEV1 to FVC (FEV1:FVC), and mid-exhalation forced expiratory flow rate (FEF 25–75%; milliliters/second)] in a sample of 1,234 6–17 year olds, who participated in the 2011–2012 survey cycle of the National Health and Nutrition Examination Survey (NHANES). Methods: Survey-weighted linear regression was used to estimate beta coefficients and 95% confidence intervals (CIs) for the associations between metal exposure tertiles or quartiles and pulmonary function test parameters, with adjustment for relevant covariates. Results: Blood manganese concentration was inversely associated with FVC (β for highest versus lowest quartile=−97.1, 95% CI=−230.6, 36.4; p for trend=0.03). Urinary manganese was inversely associated with FEV1:FVC and FEF 25–75% (p for trend=0.05 and 0.02, respectively). Urinary lead was inversely associated with FEF 25–75% (p for trend=0.01). The associations between blood manganese and both FEV1 and FVC differed by age (p for interaction=0.04 and 0.04, respectively), indicating an inverse trend that was strongest among older youth. Conclusions: Environmental exposure to manganese and lead may adversely impact the pulmonary function of young people in the United States. Our findings highlight a need to prioritize children’s environmental health and evaluate these associations prospectively.

The transcription factor Pax8 is involved in the morphogenesis of the thyroid gland and in the maintenance of the differentiated thyroid phenotype. Despite the critical role played by Pax8 during thyroid development and differentiation, very little is known of its post-translational modifications and how these modifications may regulate its activity. We focused our attention on the study of a specific post-translational modification, i.e., sumoylation. Sumoylation is a dynamic and reversible process regulating gene expression by altering transcription factor stability, protein-protein interaction and subcellular localization of target proteins. The analysis of Pax8 protein sequence revealed the presence of one sumoylation consensus motif (jKxE), strongly conserved among mammals, amphibians, and fish. We demonstrated that Pax8 is sumoylated by the addition of a single small ubiquitin-like modifier (SUMO) molecule on its lysine residue 309 and that Pax8 K309R , a substitution mutant in which the candidate lysine is replaced with an arginine, is no longer modified by SUMO. In addition, we analyzed whether protein inhibitor of activated signal transducers and activators of transcription (PIASy), a member of the PIAS STAT family of proteins, could function as a SUMO ligase and we demonstrated that indeed PIASy is able to increase the fraction of sumoylated Pax8. Interestingly, we show that Pax8 is targeted in the SUMO nuclear bodies, which are structures that regulate the nucleoplasmic concentration of transcription factors by SUMO trapping. Finally, we report here that the steady-state protein level of Pax8 is controlled by sumoylation.

AimsTo estimate if chronic anticoagulant (CAC) treatment is associated with morbidity and mortality outcomes of patients hospitalized for SARS-CoV-2 infection.MethodsIn this European multicentric cohort study, we included 1186 patients of whom 144 were on CAC (12.1%) with positive coronavirus disease 2019 testing between 1 February and 30 July 2020. The average treatment effect (ATE) analysis with a propensity score-matching (PSM) algorithm was used to estimate the impact of CAC on the primary outcomes defined as in-hospital death, major and minor bleeding events, cardiovascular complications (CCI), and acute kidney injury (AKI). We also investigated if different dosages of in-hospital heparin were associated with in-hospital survival.ResultsIn unadjusted populations, primary outcomes were significantly higher among CAC patients compared with non-CAC patients: all-cause death (35% vs. 18% P < 0.001), major and minor bleeding (14% vs. 8% P = 0.026; 25% vs. 17% P = 0.014), CCI (27% vs. 14% P < 0.001), and AKI (42% vs. 19% P < 0.001). In ATE analysis with PSM, there was no significant association between CAC and primary outcomes except for an increased incidence of AKI (ATE +10.2%, 95% confidence interval 0.3–20.1%, P = 0.044). Conversely, in-hospital heparin, regardless of dose, was associated with a significantly higher survival compared with no anticoagulation.ConclusionsThe use of CAC was not associated with the primary outcomes except for the increase in AKI. However, in the adjusted survival analysis, any dose of in-hospital anticoagulation was associated with significantly higher survival compared with no anticoagulation.

Objective Psychosocial factors play a role in child asthma morbidity and disparities, but their impact on asthma intervention effectiveness is less understood. This study examined how child, parent, and family psychosocial factors moderated asthma response to, and changed in response to, 2 community asthma interventions among urban minority youth. Methods Asthma Action at Erie was a randomized comparative effectiveness trial examining a community health worker (CHW) home intervention versus certified asthma educator (AE-C) services for children aged 5–16 with uncontrolled asthma (N = 223; mean age = 9.37, SD = 3.02; 85.2% Hispanic). Asthma control was assessed via the Asthma Control Test (ACT)/childhood ACT and activity limitation. Baseline child/parent depression and posttraumatic stress disorder (PTSD) symptoms, family chaos, and social support were examined as treatment moderators. We also tested intervention effects on psychosocial outcomes. Results For parents with higher baseline depression symptoms, youth in the CHW group had greater ACT improvement by 24 months (7.49 points) versus AE-C (4.76 points) and 51% reduction in days of limitation by 6 months versus AE-C (ß = −0.118; p = .0145). For higher parent PTSD symptoms, youth in CHW had 68% fewer days of limitation at 24 months versus AE-C (ß = −0.091; p = .0102). Psychosocial outcomes did not vary by group, but parent depression, parent and child PTSD symptoms, and social support improved for all. Conclusions CHW intervention was associated with improved asthma control among families with higher parent strain. Findings have implications for utilizing tailored CHW home interventions to optimize asthma outcomes in at-risk families.

Background Asthma disproportionately affects minority youth. Understanding the home medication environment and its relation to medication adherence can shape interventions to improve health outcomes. Objective To describe the asthma medication environment in the homes of urban minority youth and to determine predictors of medication use and technique in this population. Methods Baseline data from two cohorts of minority youth with asthma in Chicago were combined for cross-sectional analysis. Bilingual research assistants (RAs) collected data in the home. RAs asked caregivers and children to self-report medications using pictures and observed children’s asthma medications and inhaler technique. Results The sample contained 175 mainly Latino youth (85.6%) ranging from 5–18 years old. Most were on public insurance (80%) and had uncontrolled asthma by self-report (89.7%). Only 27.4% had a spacer, 74.9% had a quick relief medicine and 48.6% had any controller medicine. RA observations of controllers agreed with children (36%) and parental self-report (42.3%) but did not match the specific observed controllers. Children reported less parental help with medications (43%) than their parents (58.1%). One child was able to properly demonstrate 100% of the inhaler steps and 35.6% achieved >70% of inhaler steps. Better medication technique was associated with having a controller (b=12.2, SE=3.0, p <0.0001), quick reliever (b=8.05, SE=3.5, p=0.023) and a spacer (b=9.3, SE=3.54, p=0.009). Conclusions This rigorous evaluation of the home medication environment of high risk youth demonstrated that many families lack critical medications, devices, and technique for proper management of asthma.