Asthma in Non–Inner City Head Start Children

McGill, Kelly A.; Sorkness, Christine A.; Ferguson-Page, Carole; Gern, James E.; Havighurst, Thomas C.; Knipfer, Barbara; Lemanske, Robert F.; Busse, William W.

doi:10.1542/peds.102.1.77

Cited by 34 publications

(28 citation statements)

References 33 publications

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“…3 Parents in these communities rely on Head Start and other subsidized preschool childcare programs, so it is not surprising that high asthma prevalence and associated morbidity have been reported in Head Start populations. [4][5][6] Several studies have documented the link between asthma and environmental factors such as a smoker living in the residence, pets, cockroaches, rats or mice, and mold. [7][8][9][10][11][12] Limited data suggest that homes of Head Start children hold environmental factors that may worsen asthma.…”

Section: Introductionmentioning

confidence: 99%

Self-Reported Moisture or Mildew in the Homes of Head Start Children with Asthma is Associated with Greater Asthma Morbidity

Bonner

Matte²,

Fagan³

et al. 2006

J Urban Health

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This study used results from a cross-sectional survey of parents of 3- to 5-year-old children with asthma to assess the frequency of self-reported home environmental conditions that could contribute to worsening asthma and examined the relationship between these factors and the child's asthma morbidity. Participants were 149 parents drawn from the two largest agencies that provide subsidized preschool childcare services in East and Central Harlem, inner-city communities with high prevalence of asthma. The sample represented 77% of eligibles determined by a validated case-identification instrument. Data were collected on demographics, symptoms, medication use, Emergency Department visits and hospitalization, and environmental conditions in the home. One or more of these home environmental conditions were reported by 92% of participants. Controlling for other environmental conditions and demographics, associations were found between self-reported presence of moisture or mildew on ceilings, walls, or windows and higher frequency of hospitalizations for breathing-related problems (OR = 3.31; 95% CI 1.62-6.75), frequent episodes of wheezing (OR = 3.25; 95% CI 1.8-6.0), and higher frequency of night symptoms due to asthma (OR = 2.19; 95% CI 1.4-3.41). Having a carpet or rug in the child's bedroom or the living room was also associated with hospitalizations (OR = 3.23; 95% CI 1.53-6.8), and male gender was marginally associated with the frequency of night symptoms (OR = 1.51; 95% CI .95-2.4). Asthma is prevalent in the Head Start population, and exposure to home environmental conditions that may worsen asthma is common in the socially disadvantaged populations served by Head Start programs.

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Section: Introductionmentioning

confidence: 99%

Self-Reported Moisture or Mildew in the Homes of Head Start Children with Asthma is Associated with Greater Asthma Morbidity

Bonner

Matte²,

Fagan³

et al. 2006

J Urban Health

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“…1 Approximately 9.2 million children Ͻ18 years of age have at some point in their lives been diagnosed as having asthma. 2 Studies suggest that asthma is both undertreated and underdiagnosed, [3][4][5][6][7] which leads to increased morbidity. Asthma-related morbidity is largely preventable with optimal diagnosis and treatment and improved patient education.…”

mentioning

confidence: 99%

Validation of a Multistage Asthma Case-Detection Procedure for Elementary School Children

Gerald

Grad²,

Turner-Henson³

et al. 2004

Pediatrics

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ABSTRACT. Objective. The purpose of this study was to validate a 3-stage asthma case-detection procedure for elementary school-aged children.Methods. The study was performed in 10 elementary schools in 4 inner-city school systems, with a total enrollment of 3539 children. Results of the case-detection procedure were compared with the diagnosis of an asthma specialist study physician, to determine the sensitivity and specificity of the case-detection procedure.Results. Ninety-eight percent of children returned the asthma symptoms questionnaires, and 79% of those children consented to additional testing. Results indicated that the 3-stage procedure had good validity, with sensitivity, specificity, and predictive value of 82%, 93%, and 93%, respectively. A 2-stage procedure using questionnaires and spirometry had similar validity, with sensitivity, specificity, and predictive value of 78%, 93%, and 93%, respectively. However, given the time and expense associated with the 2-or 3-stage procedure and the difficulty of obtaining physician follow-up evaluation of the case-detection diagnosis, schools may prefer to use a 2-item questionnaire that has a lower sensitivity (66%) but higher specificity (96%) and predictive value (95%).Conclusions. Case-detection programs are generally well received by school personnel and can identify children with unrecognized or undiagnosed disease, as well as those with a current diagnosis but poorly controlled disease. This study yields substantial information regarding the validity, yield, and specific types of children who might be identified with the use of such procedures. For the choice of the method of case detection used in a school, the strengths and weaknesses of each procedure, as well as the resources available for case detection, physician referral, and follow-up procedures, must be considered.

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“…The highest rates of prophylactic pharmacological treatment have been observed in Finland (80%), in the United Kingdom (52.5%), and in the United States (47.5%). (23)(24)(25) In 1988, one group of authors studied 266 children with asthma hospitalized in Australia and found a much higher percentage of individuals Therefore, we conclude that the rate at which such patients seek outpatient follow-up treatment for asthma is far from acceptable, which may be a reflection of the situation in which we find the Brazilian Unified Health Care System. The present study reveals that, among patients hospitalized for acute asthma, full access to treatment and to preventive medication is the exception.…”

Section: Discussionmentioning

confidence: 78%

A hospitalização por asma e a carência de acompanhamento ambulatorial

et al. 2007

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Objective: To determine whether the children and adolescents with acute asthma attacks admitted to two public hospitals in the city of Recife, Brazil underwent outpatient follow-up treatment for the prevention and control of asthma. Methods: A prospective case series study of hospitalized patients with asthma. The patients were asked to complete a questionnaire at admission in order to determine the frequency of prophylactic outpatient follow-up treatment. Patients presenting two or more attacks of asthma that were responsive to bronchodilators were classified as having asthma. Results: In the intervals between asthma attacks, 67% (112/167 -data regarding 2 patients were not available) of the patients had been treated only in the emergency room. Although 53.3% (89/167 -data regarding 2 patients were not provided) of the patients had been referred to outpatient treatment, only 16% (27/169) had visited an outpatient asthma clinic regularly for preventive treatment, and only 13% (22/169) had used prophylactic medication. Conclusion: Most of the children and adolescents hospitalized with asthma had not undergone preventive outpatient follow-up treatment. Various problems related to the health care system, such as non-referral for outpatient follow-up treatment at hospital discharge, limited access to outpatient clinics, and the cost of prophylactic medication, might have contributed to the low rate of outpatient follow-up treatment in the population studied. Public health care policies that allow asthma control programs to work effectively should be implemented.

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Asthma in Non–Inner City Head Start Children

Cited by 34 publications

References 33 publications

Self-Reported Moisture or Mildew in the Homes of Head Start Children with Asthma is Associated with Greater Asthma Morbidity

Self-Reported Moisture or Mildew in the Homes of Head Start Children with Asthma is Associated with Greater Asthma Morbidity

Validation of a Multistage Asthma Case-Detection Procedure for Elementary School Children

A hospitalização por asma e a carência de acompanhamento ambulatorial

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