Impact of COVID-19 on pediatric asthma-related healthcare utilization in New York City: a community-based study.

BACKGROUND: COVID-19 disproportionately affects families of low socioeconomic status and may worsen health disparities that existed prior to the pandemic. Asthma is a common chronic disease in children exacerbated by environmental exposures. METHODS: A cross-sectional survey was conducted to understand the impact of the initial stage of the pandemic on environmental and social conditions, along with access to care for children with asthma in New York City (NYC). Participants were recruited from a community-based organization in East Harlem and a nearby academic Pediatric Pulmonary clinic and categorized as having either public or private insurance (n = 51). RESULTS: Factors significantly associated with public compared to private insurance respectively were: increased reports of indoor asthma triggers (cockroach 76% vs 23%; mold 40% vs 12%), reduced income (72% vs 27%), and housing insecurity (32% vs 0%). Participants with public insurance were more likely to experience conditions less conducive to social distancing compared to respondents with private insurance, such as remaining in NYC (92% vs 38%) and using public transportation (44% vs 4%); families with private insurance also had greater access to remote work (81% vs 8%). Families with public insurance were significantly more likely to test positive for SARS-CoV-2 (48% vs 15%) but less likely to have gotten tested (76% vs 100%). Families with public insurance also reported greater challenges accessing office medical care and less access to telehealth, although not statistically significant (44% vs 19%; 68% vs 85%, respectively). CONCLUSIONS: Findings highlight disproportionate burdens of the pandemic, and how these disparities affect children with asthma in urban environments.

Effect of a Self-management Support Intervention on Asthma Outcomes in Older Adults: The SAMBA Study Randomized Clinical Trial.

IMPORTANCE: Older adults with asthma have worse control and outcomes than younger adults. Interventions to address suboptimal self-management among older adults with asthma are typically not tailored to the specific needs of the patient. OBJECTIVE: To test the effect of a comprehensive, patient-tailored asthma self-management support intervention for older adults on clinical and self-management outcomes. DESIGN, SETTING, AND PARTICIPANTS: Three-arm randomized clinical trial conducted between February 2014 and December 2017 at primary care practices and personal residences in New York City. Adults 60 years and older with persistent, uncontrolled asthma were identified from electronic medical records at an academic medical center and a federally qualified health center. Of 1349 patients assessed for eligibility, 406 met eligibility criteria, consented to participate, and were randomized to 1 of 3 groups: home-based intervention, clinic-based intervention, or control (usual care). A total of 391 patients received the allocated treatment. INTERVENTIONS: Screening for psychosocial, physical, cognitive, and environmental barriers to asthma control and self-management with actions to address identified barriers. The intervention was delivered in the home or primary care practices by asthma care coaches. MAIN OUTCOMES AND MEASURES: Primary outcomes were the Asthma Control Test, Mini Asthma Quality of Life Questionnaire, Medication Adherence Rating Scale, metered dose inhaler technique, and emergency department visits for asthma care. Primary analyses compared intervention (home or clinic based) with usual care. RESULTS: Of the 391 patients who received treatment, 58 (15.1%) were men, and the mean (SD) age was 67.8 (7.4) years. After accounting for baseline scores, scores on the asthma control test were better in the intervention groups vs the control group (difference-in-differences at 3 months, 1.2; 95% CI, 0.2-2.2; P = .02; 6 months, 1.0; 95% CI, 0.0-2.1; P = .049; 12 months, 0.6; 95% CI, -0.5 to 1.8; P = .28; and overall, χ2 = 13.4, with 4 degrees of freedom; P = .01). Emergency department visits were lower at 12 months for the intervention groups vs the control group (16 [6.2%] vs 17 [12.7%]; P = .03; adjusted odds ratio, 0.8; 95% CI, 0.6-0.99; P = .03). Statistically significant improvements were observed for the intervention vs control patients in quality of life (overall effect: χ2 = 10.5, with 4 degrees of freedom; P = .01), medication adherence (overall effect: χ2 = 9.5, with 4 degrees of freedom; P = .049), and inhaler technique (metered-dose inhaler technique, correctly completed steps at 12 months, median [range]: 75% [0%-100%] vs 58% [0%-100%]). No significant differences in outcomes were observed between patients receiving the intervention in home vs practice settings. CONCLUSIONS AND RELEVANCE: An intervention directed by patients' needs and barriers improved asthma outcomes and self-management behaviors among older adults. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02316223.

Rationale and design of a comparative effectiveness trial of home- and clinic-based self-management support coaching for older adults with asthma.

Older adults with asthma face numerous barriers to effective self-management and asthma control, and experience worse outcomes than younger asthmatics. Yet, there have been no controlled trials of interventions specifically designed to improve their care and outcomes. Through a multi-stakeholder collaboration (patients, academia, community-based organizations, a state department of health, and an advocacy organization) we developed a multi-component asthma self-management support intervention to address the myriad psychosocial, functional, health status, and cognitive barriers to effective asthma self-management in adults ages 60 and older. We are recruiting 425 New Yorkers in Manhattan and the Bronx for a pragmatic randomized controlled trial with 3 arms: the intervention delivered in primary care settings or in their home, or usual care. In the intervention, care coaches use a novel screening tool to identify the specific barriers to asthma control and self-management they experience. Once identified, the coach and patient choose from a menu of actions to address it. The intervention emphasizes efficiency, flexibility, shared decision making and goal setting, communication strategies appropriate for individuals with limited cognition and literacy skills, and ongoing reinforcement and support. Additionally, we introduced asthma-specific enhancements to the electronic health records of all participating clinical practices, including an asthma severity assessment, clinical decision support, and a patient-tailored asthma action plan. Patients will be followed for 12months and interviewed at baseline, 3, 6, and 12months and data on emergency department visits and hospitalizations will be obtained through the New York State Statewide Planning and Research Cooperative System.

Comportamiento de la velocidad de sedimentación globular en recién nacidos con posible sepsis / Behavior of the erythrocyte sedimentation rate in newborn infants with possible sepsis

Se determinó el comportamiento de la velocidad de sedimentación globular en recién nacidos catalogados como posiblemente sépticos (antecedentes, cuadro clínico, laboratorio), durante los tres primeros días de vida; para lo cual se comparó los valores de velocidad de sedimentación globular de recién nacidos normales obtenidos anteriormente (18), con los valores de recién nacidos con posible sepsis. Obteniéndose gráficas de velocidad de sedimentación globular para cada día, con su respectiva sensibilidad y especificidad. La prueba será considerada como confirmatoria de sepsis, cuando tenga un cuadro clínico sugestivo de sepsis, siendo los valores de velocidad de sedimentación globular de 3 mm/hr a las 24 horas, 9 mm/hr a las 48 horas y 10 mm/hr, a las 72 horas de vida respectivamente. Para utilizar la prueba como detección de sepsis en recién nacidos asintomáticos los valores de velocidad de sedimentación globular serán de 2 mm/hr a las 24 horas, 3 mm/hr a las 48 horas y de 4 mm/hr, a las 72 horas de haber nacido

Distribución de los valores de velocidad de sedimentación globular en recién nacidos normales y grado de correlación entre los valores de VSG-hematocrito / Distribution of the values of erythrocyte sedimentation rate in normal newborns and the degree of correlation of hematocrit-ESR

Utilizando el método de mini-velocidad de sedimentación globular, se determinó en forma prospectiva en 45 neonatos durante los tres primeros días de vida, los valores normales de velocidad de sedimentación globular en el 95 percentil: para que sirvan como patrón de comparación con otras entidades donde el valor se encuentre alterado; los valores encontrados son: 0-3mm/hora dentro de las primeras 24 horas, 0-8mm/hora a las 48 horas y 1-7mm/hora a las 72 horas. Además, se demostró que el hematocrito no influye en el valor de velocidad de sedimentación globular en los tres primeros días de vida, ya que en las primeras 48 horas no existe correlación adecuada, hematocrito - VSG a las 72 horas de vida el grado de error es alto a pesar de la buena correlación

Peso placentario y problemas perinatales / Placental weight and perinatal problems

La relación del tamaño placentario y problemas perinatales fue determinada en 110 recién nacidos de bajo riesgo. La incidencia de problemas perinatales: Apgar menor de 7, líquido amniótico meconial y distress fetal, fue mayor en aquellos recien nacidos con una relación peso recién nacido/peso placentario menor de 7 (p < 0.05). En base a estos datos, concluímos que recién nacidos de bajo riesgo unidos a placentas relativamente grandes están sujetos a un mayor riesgo de desarrollar problemas perinatales