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Background Severe asthma subjects have increased physiologically measured air trapping. However, a similar study using CT measures of air trapping has not been performed. This study was designed to address two hypotheses: 1) air trapping, measured by multi-detector CT quantitative methodology, would be a predictor of a more severe asthma phenotype; and 2) historical, clinical, allergic, or inflammatory risk factors could be identified via multivariate analysis. Methods Multi-detector CT scanning of a subset of the Severe Asthma Research Program subjects was performed at functional residual capacity. Air trapping was defined as 9.66% or more of the lung tissue less than −850 HU. Subjects who were defined as air trappers were then compared to non-trappers on clinical and demographic factors using both univariate and multivariate statistical analysis. Results Air trappers were significantly more likely to have a history of asthma-related hospitalizations, ICU visits and/or mechanical ventilation. Duration of asthma (OR 1.42, 95% CI 1.08–1.87), history of pneumonia (OR 8.55, 95% CI 2.07–35.26), high levels of airway neutrophils (OR 8.67, 95% CI 2.05–36.57), air flow obstruction (FEV1/FVC) (OR 1.61, 95% CI 1.21–2.14) and atopy (OR 11.54, 95% CI 1.97–67.70), were identified as independent risk factors associated with the air trapping phenotype. Conclusions Quantitative CT determined air trapping in asthmatic subjects identifies a group of individuals with a high risk of severe disease. Several independent risk factors for the presence of this phenotype were identified, perhaps most interestingly history of pneumonia, neutrophilic inflammation, and atopy.

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To describe the association of residential mobility with child health. We conducted descriptive, bivariate, and multivariable analyses of data from 63,131 children, 6-17 years, from the 2007 National Survey of Children's Health. Logistic regression was used to explore the association of residential mobility with child health and measures of well-being. Analyses were carried out using SAS-callable SUDAAN to appropriately weight estimates and adjust for the complex sampling design. After adjusting for age, race/ethnicity, presence of a special health care need, family structure, parental education, poverty level, and health insurance status, children who moved ≥ 3 times were more likely to have poorer reported overall physical (AOR 1.21 [95 %CI: 1.01-1.46]) and oral health status (AOR 1.31 [95 % CI: 1.15-1.49]), and ≥ 1 moderate/severe chronic conditions (AOR 1.40 [95 % CI: 1.19-1.65]) than children who had no lifetime moves. When compared to children who had never moved, children who moved ≥ 3 times were more likely to be uninsured/have periods of no coverage (AOR 1.35; 95 % CI: 0.98-1.87) and lack a medical home (AOR 1.16, 95 % CI: 1.04-1.31). None of the outcomes were statistically significant for children who moved fewer than 3 times. Clinicians need to be aware that children who move frequently may lack stable medical homes and consistent coverage increasing their risk of poor health outcomes and aggravation of mild or underlying chronic conditions. Public health systems could provide the necessary link between parents and clinicians to ensure that continuous, coordinated care is established for children who move frequently.

The results demonstrate an association of increasing ground-level ozone with an increase in clinic visits for adverse respiratory-related effects in the following day (lag day 1) in Sublette County; the magnitude was strongest during the winter months; this association during the winter months in a rural location warrants further investigation.

Perinatal regionalization, or risk-appropriate care, is an approach that classifies facilities based on capabilities to ensure women and infants receive care at a facility that aligns with their risk. The CDC designed the Levels of Care Assessment Tool (LOCATe) to assist jurisdictions working in risk-appropriate care in assessing a facility’s level of maternal and neonatal care aligned with the most current American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine (ACOG/SMFM) and American Academy of Pediatrics (AAP) guidelines. LOCATe produces standardized assessments for each hospital that participates and facilitates conversations among stakeholders in risk-appropriate care. This article describes how public health departments implement and use LOCATe in their jurisdictions.

The association among rural-urban communities, neighborhood characteristics, and youth physical activity is inconsistent in the literature. We used data from the 2007 National Survey of Children's Health, for youth aged 10-17 years (n = 45,392), to examine the association between physical activity and neighborhood characteristics, after adjusting for known confounders. We also examined the association between physical activity and neighborhood characteristics within seven levels of Rural-Urban Commuting Areas (RUCAs) that depict a continuum from isolated rural to dense urban communities. Attainment of a minimum physical activity level differed by RUCA (P = 0.0004). In adjusted, RUCA-specific models, the presence of parks was associated with attaining a minimum physical activity level in only one of the seven RUCAs (adjusted odds ratio: 3.49; 95 % confidence interval: 1.55, 7.84). This analysis identified no association between youths' minimum physical activity attainment and neighborhood characteristics in unstratified models; and, RUCA-specific models showed little heterogeneity by rural-urban community type. Although this analysis found little association between youth physical activity and neighborhood characteristics, the findings could reflect the crude categorization of the neighborhood amenities (sidewalks, parks, recreation centers) and detracting elements (litter, dilapidated housing, © Springer Science+Business Media New York (outside the USA) 2012 Correspondence to: Laurin Kasehagen, lkasehagen@cdc.gov. HHS Public Access Author manuscriptMatern Child Health J. Author manuscript; available in PMC 2015 January 21. Published in final edited form as:Matern Child Health J. 2012 December ; 16(0 2): 258-267. doi:10.1007/s10995-012-1188-3. Author ManuscriptAuthor Manuscript Author ManuscriptAuthor Manuscript vandalism) and suggests that simple measurement of the presence of an amenity or detracting element is insufficient for determining potential associations with reaching minimum levels of physical activity. By exploring neighborhood characteristics and features of neighborhood amenities within the context of well-defined community types, like RUCAs, we can better understand how and why these factors contribute to different levels of youth physical activity.

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