Dorsoventrally asymmetric expression of miR319/TCP generates dorsal-specific venation patterning in petunia corolla tube.

Vein-associated pigmentation (Venation) is a type of floral coloration adopted by plants to attract pollinators. Several petunia (Petunia hybrida) lines generate dorsoventrally asymmetric venation patterning of the corolla tube, in which venation is only presents in the dorsal tube. The molecular mechanism underlying this trait is unknown. Here, we demonstrate that miR319 is preferentially expressed in the dorsal corolla tube, leading to dorsoventrally asymmetric expression of its target genes. Transgenic lines overexpressing phy-miR319a generated uniform venation patterning of the corolla tube. Knockout of TCP genes targeted by miR319 promoted venation patterning in the ventral and dorsal tube, while overexpression of the miR319 target gene, PhTCP6, wholly inhibited corolla tube venation patterning. In addition, miR319-targeted TCPs negatively regulated venation patterning, likely by repressing the regulator of venation patterning, AN4. Together, our data demonstrate that asymmetric expression of miR319 promotes venation patterning in the petunia dorsal tube alone by repressing the expression of its target TCP genes, which negatively regulate corolla tube venation patterning. These findings provide novel insight into how the dorsoventrally asymmetric distribution of venation patterning is established in zygomorphic flowers.

Medicaid Expansion and Health Care Use Among Adults With Asthma and Low Incomes: The Adult Asthma Call-Back Survey.

OBJECTIVES: Asthma disproportionately affects Black people and people with low incomes, but Medicaid expansion (hereinafter, expansion) data on these populations are limited. We investigated health care use among adults with asthma, before and after expansion, and examined whether asthma-related health care use after expansion varied by demographic characteristics. METHODS: We analyzed data from the 2011-2013 and 2015-2019 Behavioral Risk Factor Surveillance System Adult Asthma Call-Back Survey on participants aged 18-64 years with current asthma and low incomes in 23 US states. We assessed 5 asthma-related outcomes, including medical visits (routine and emergency) and medication use, for expansion and nonexpansion groups. We used t tests to compare weighted percentages and 95% CIs, then performed adjusted difference-in-differences analyses. Secondary analyses stratified data by race, ethnicity, and sex. RESULTS: Primary analyses (N = 10 796) found no significant associations between expansion and any outcome. Analyses stratified by race and ethnicity found no significant changes (eg, asthma controller medication use among non-Hispanic Black participants in the expansion group was 24.1% [95% CI, 14.4%-37.5%] in 2011-2013 and 35.5% [95% CI, 27.0%-45.1%] in 2015-2019; P = .13). Use of asthma controller medication increased significantly among non-Hispanic Other participants in the nonexpansion group (2011-2013: 16.0% [95% CI, 9.5%-25.5%]; 2015-2019: 40.2% [95% CI, 25.5%-56.8%]; P = .01). Asthma-related hospitalizations decreased significantly among women in the expansion group: 2011-2013 (7.8%; 95% CI, 5.3%-11.3%) and 2015-2019 (3.5%; 95% CI, 2.5%-4.9%) (P = .009). CONCLUSIONS: Investigating factors other than health insurance (eg, social determinants of health) that influence the use of asthma-related health care could advance knowledge of potential strategies to advance health equity for adults with asthma and lower incomes.

Factors associated with emergency department visits for asthma resulting in hospital admission-United States, 2020.

OBJECTIVE: To identify risk factors associated with hospital admission following an ED visit for asthma at the time of discharge among U.S. children and adults. METHODS: Asthma emergency department visits resulting in hospital admissions using discharge data among children (aged 0-17 years) and adults (aged 18 years or older) from the 2020 Nationwide Emergency Department Sample (NEDS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality were examined. Risk factors associated with hospital admission following ED visits were identified using univariable and multi-variable logistic regression models. RESULTS: Among children, hospital admission after asthma-related ED visits was higher for females, ages less than 12 years, and discharged in January-March or in October-December and lower for Black children, Hispanic children, Medicaid or Medicare beneficiaries, other/no charge/self-pay, and in metropolitan non-teaching or non-metropolitan hospitals. Among adults, asthma ED visits resulting in hospital admissions were higher for females, ages 35 years or older, discharged in January-March, and for Medicare beneficiaries and lower for Black adults, Hispanic adults, adults of other races, other/no charge/self-pay, in metropolitan non-teaching or non-metropolitan hospitals, and median household income quartiles for patient's ZIP Code of less than $59,000 were lower. CONCLUSIONS: Sociodemographic factors, healthcare use, and household income were significantly associated with hospital admissions at the time of discharge from the ED. Examining hospital admission after an ED visit for asthma is important in identifying these groups and better addressing their healthcare needs.

Adult asthma prevalence and trend analysis by urban-rural status across sociodemographic characteristics-United States, 2012-20.

Background: Asthma prevalence estimates among adults are limited for urban-rural classification across sociodemographic characteristics. Objectives: This study examined current asthma prevalence and annual trends by 6-level urban-rural categories across sociodemographic characteristics among US adults. Methods: Asthma prevalence for 2020 and annual trends for 2012-20 were estimated using Behavioral Risk Factor Surveillance System data. The 2013 National Center for Health Statistics urban and rural categories were used to define urban-rural status. Results: Current asthma prevalence was higher in medium (9.7%; prevalence ratio 1.103 [95% CI 1.037, 1.174]) and small (9.9%; 1.111 [1.031, 1.197]) metro than in large fringe metropolitan (8.6%), was higher in micropolitan (10.2%) than in both large fringe (8.6%; 1.115 [1.042, 1.194]) and large central metropolitan (8.8%; 1.080 [1.001, 1.066]) areas. Prevalence by sociodemographic characteristics varied between urban-rural scheme; the prevalence was significantly higher among adults aged 55-64 years in micropolitan (11.9%), women in small metro (12.8%), and other race non-Hispanic in noncore (most rural) (13.6%) areas, adults without a high school diploma in micropolitan areas (13.8%), household income <100% of federal poverty level in micropolitan areas (15.7%), and adults with insurance coverage in micropolitan areas (10.3%) compared to the corresponding populations in other urban-rural categories. During 2012-20, an increasing trend in prevalence was observed only in medium metro areas, with an annual percentage change of 0.81. Conclusions: Asthma prevalence differed by 6-level urban-rural categories. These findings might be helpful in establishing effective asthma control programs and targeting resource allocation at the local level.

Asthma disparities among U.S. children and adults.

OBJECTIVE: To assess factors that are associated with asthma prevalence and asthma attacks among children (0-17 years) and adults (18 years and over) in the United States of America. METHODS: The 2019-2021 National Health Interview Survey data were analyzed using multivariable logistic regression models to determine associations between health outcomes (i.e. current asthma and asthma attacks) and demographic and socioeconomic factors. Each health outcome was regressed over each characteristic variable, adjusting for age, sex, and race/ethnicity for adults and sex and race/ethnicity for children. RESULTS: Asthma was more common among children who were male, blacks, parental education less than bachelor's, or had public health insurance, and among adults who had less than a bachelor's degree, do not own a home, or not in the workforce. Persons in families facing difficulty paying medical bills were more likely to have current asthma (children: aPR = 1.62[1.40-1.88]; adults: aPR = 1.67[1.55-1.81]) and asthma attacks (children: aPR = 1.34[1.15-1.56]; adults: aPR = 1.31[1.20-1.43]). Persons with family income <100% federal poverty threshold (FPT) (children: aPR = 1.39[1.17-1.64]; adults: aPR = 1.64[1.50-1.80]) or adults 100-199% FPT (aPR = 1.28[1.19-1.39]) were more likely to have current asthma. Children and adults with family income <100% FPT and adults 100-199% FPT were also more likely to have asthma attacks. Having asthma attacks was common among adults not in the workforce as well (aPR = 1.17[1.07-1.27]). CONCLUSIONS: Asthma affects certain groups disproportionately. The findings of this paper suggesting asthma disparities continue to persist may increase public health programs awareness to better deliver effective and evidence-based interventions.

Assessing asthma self-management education among US children with current asthma, Asthma Call-back Survey (ACBS) 2015-2017.

OBJECTIVE: Asthma self-management education (AS-ME) is an effective strategy to help children with asthma achieve better asthma control and outcome. The objective of this study is to assess the association between the prevalence of receiving AS-ME curriculum components and sociodemographic characteristics among children with current asthma. METHODS: Behavioral Risk Factor Surveillance System, child Asthma Call-back Survey 2015-2017 aggregated data were used. Multivariable logistic regression models were used to assess associations of each AS-ME component question and sociodemographic characteristic, adjusting for sample weighting. RESULTS: Among 3,213 children with current asthma, 52% of children reported ever being given an asthma action plan by a doctor or other healthcare professional. After adjusting for other variables, boys and Non-Hispanic Black children were more likely to report being given an action plan (APR= 1.15[95% CI 1.00-1.32] and APR= 1.28[95% CI 1.07-1.54] respectively). Non-Hispanic Black (APR = 2.15 [95% CI 1.30-3.55]), non-Hispanic, other race (APR = 1.95 [95% CI1.04-3.66]), and Hispanic children (APR = 1.84 [95% CI 1.18-2.89]) were more likely to report taking a course to learn how to manage asthma than non-Hispanic White children. Hispanic children (40.8%) were more likely to report being advised to change home environment compared to non-Hispanic Whites (31.5%) (APR =1.28 [95% CI 1.01-1.63). CONCLUSION: The prevalence of some elements of asthma-self management education was relatively low and there were differences observed in the prevalence of receiving AS-ME by race/ethnicity, parental education, and income. Targeted implementation of asthma self-management components and interventions may improve asthma control and reduce asthma morbidity.

Screen of high efficiency cellulose degrading strains and effects on tea residues dietary fiber modification: Structural properties and adsorption capacities.

In our study, two high efficiency cellulose degrading strains were screened, isolated and identified as Cochliobolus kusanoi and Aspergillus puulaauensis by 18S rDNA gene sequencing. In addition, the composite microbial system was constructed to develop the synergistic effect among different strains. Under the optimum conditions, the yield of soluble dietary fiber from tea residues by mixed fermentation method (MF-SDF) dramatically increased compared to single strain fermentation. The structural analysis demonstrated that all samples possessed the representative infrared absorption peaks of polysaccharides, whereas MF-SDF revealed more loose structure, lower crystallinity and smaller molecular size. For the adsorption capacities indexes, MF-SDF also owned the highest adsorbing capacity for the water molecule, oil molecule, cholesterol molecule and nitrite ion. Overall, our data showed that mixed fermentation method could be better choices to improve the functional properties of dietary fiber, and screening of cellulose degrading strains could provide new thinkings for the study of dietary fiber modification and realize high-quality utilization of crop residues.

Study on multiplanar measurements of infant hips with three-dimensional ultrasonography.

PURPOSE: An automatic evaluation technology based on artificial intelligence and three-dimensional ultrasonography (3D US) is proposed for hip US inspection plane selection. This study aimed to evaluate the consistency of the α angle as measured using 3D US to select the section plane and two-dimensional ultrasonography (2D US) to manually select the Graf image, as well as to explore the feasibility of diagnosing developmental dysplasia of the hip (DDH) using 3D US and reconstruction technology. METHODS: A total of 216 infant hips were included and assessed by doctors using 3D US layer-by-layer. The researchers used a computer to identify the coronal images that met the Graf standard and then compared the αX values obtained with the αG values measured artificially by 2D US. RESULTS: Compared with 2D US, 3D US more clearly showed the relative positions of the ilium, ischia, and pubis. The measured α value of the optimal section obtained by 3D US showed good agreement with the measured α value of the standard Graf section. CONCLUSION: The artificial intelligence and 3D US-based automatic evaluation technology for section selection and inspection for DDH showed good agreement with the Graf method based on standard sections.

Asthma Among Adults and Children by Urban-Rural Classification Scheme, United States, 2016-2018.

OBJECTIVES: Although data on the prevalence of current asthma among adults and children are available at national, regional, and state levels, such data are limited at the substate level (eg, urban-rural classification and county). We examined the prevalence of current asthma in adults and children across 6 levels of urban-rural classification in each state. METHODS: We estimated current asthma prevalence among adults for urban-rural categories in the 50 states and the District of Columbia and among children for urban-rural categories in 27 states by analyzing 2016-2018 Behavioral Risk Factor Surveillance System survey data. We used the 2013 National Center for Health Statistics 6-level urban-rural classification scheme to define urban-rural status of counties. RESULTS: During 2016-2018, the current asthma prevalence among US adults in medium metropolitan (9.5%), small metropolitan (9.5%), micropolitan (10.0%), and noncore (9.6%) areas was higher than the asthma prevalence in large central metropolitan (8.6%) and large fringe metropolitan (8.7%) areas. Current asthma prevalence in adults differed significantly among the 6 levels of urban-rural categories in 19 states. In addition, the prevalence of current asthma in adults was significantly higher in the Northeast (9.9%) than in the South (8.7%) and the West (8.8%). The current asthma prevalence in children differed significantly by urban-rural categories in 7 of 27 states. For these 7 states, the prevalence of asthma in children was higher in large central metropolitan areas than in micropolitan or noncore areas, except for Oregon, in which the prevalence in the large central metropolitan area was the lowest. CONCLUSIONS: Knowledge about county-level current asthma prevalence in adults and children may aid state and local policy makers and public health officers in establishing effective asthma control programs and targeted resource allocation.

Uncontrolled asthma and household environmental exposures in Puerto Rico.

OBJECTIVE: To describe asthma control and household environmental exposures among adults and children with asthma in Puerto Rico. METHODS: A cross-sectional analysis was conducted using data from the 2014-2016 Behavioral Risk Factor Surveillance System Asthma Call-back Survey on 931 adults and 177 children with current asthma in Puerto Rico. These data were analyzed to assess the prevalence of uncontrolled asthma in Puerto Rico and potential associations with household environmental exposure to cockroaches, smoke, and mold. Asthma control was classified using daytime and nighttime symptoms, activity limitation, and short-acting beta agonist use. Prevalence and prevalence ratios were calculated, adjusting for sample weighting. RESULTS: An estimated 53% of adults with asthma and 29% of children with asthma in Puerto Rico have uncontrolled asthma. Among adults with asthma, in the past 30 days, 29% had seen or smelled mold and 50% had seen cockroaches; in the past week, 12% reported having someone smoke in their home. Adults with uncontrolled asthma were 1.4 times more likely to have observed mold in their homes than were those with controlled asthma when adjusting for age, sex, education, and income (prevalence ratio [95% confidence interval]: 1.4 [1.1, 1.8]). Children with uncontrolled asthma were also more likely to have mold observed in their home than were children with controlled asthma (adjusted PR [95% CI]: 3.0 [1.3, 7.1]). CONCLUSIONS: Uncontrolled asthma is common among adults and children with asthma in Puerto Rico. These results suggest potential differences in household mold exposure by asthma control status.

Trends in Asthma-Related School Health Policies and Practices in the US States.

BACKGROUND: Asthma is one of the leading causes of school absenteeism. Schools can play an important role in coordinating asthma care. The purpose of this study was to assess the implementation of asthma-related school health policies and practices across states and how they have changed over time. METHODS: Data were analyzed from 36 states that conducted School Health Profiles surveys during 2008 to 2018. Trends in 6 topics were analyzed by logistic regression and JointPoint trend test. RESULTS: Trends in efforts to identify and track students with asthma and improve students' and parents' knowledge about asthma were stable or increased. Interest among lead health education teachers in receiving professional development on asthma trended downward in 35 of 36 states. CONCLUSIONS: Stable to upward trends suggest that a majority of schools have maintained or improved their efforts to identify and track students with asthma and increase the knowledge of students and parents about asthma. However, further improvement is needed in referral of students with asthma to health care professionals and encouraging asthma-related professional development of lead health education teachers.

Asthma Surveillance - United States, 2006-2018.

PROBLEM: Asthma is a chronic disease of the airways that requires ongoing medical management. Socioeconomic and demographic factors as well as health care use might influence health patterns in urban and rural areas. Persons living in rural areas tend to have less access to health care and health resources and worse health outcomes. Characterizing asthma indicators (i.e., prevalence of current asthma, asthma attacks, emergency department and urgent care center [ED/UCC] visits, and asthma-associated deaths) and determining how asthma exacerbations and health care use vary across the United States by geographic area, including differences between urban and rural areas, and by sociodemographic factors can help identify subpopulations at risk for asthma-related complications. REPORTING PERIOD: 2006-2018. DESCRIPTION OF SYSTEM: The National Health Interview Survey (NHIS) is an annual cross-sectional household health survey among the civilian noninstitutionalized population in the United States. NHIS data were used to produce estimates for current asthma and among them, asthma attacks and ED/UCC visits. National Vital Statistics System (NVSS) data were used to estimate asthma deaths. Estimates of current asthma, asthma attacks, ED/UCC visits, and asthma mortality rates are described by demographic characteristics, poverty level (except for deaths), and geographic area for 2016-2018. Trends in asthma indicators by metropolitan statistical area (MSA) category for 2006-2018 were determined. Current asthma and asthma attack prevalence are provided by MSA category and state for 2016-2018. Detailed urban-rural classifications (six levels) were determined by merging 2013 National Center for Health Statistics (NCHS) urban-rural classification data with 2016-2018 NHIS data by county and state variables. All subregional estimates were accessed through the NCHS Research Data Center. RESULTS: Current asthma was higher among boys aged <18 years, women aged ≥18 years, non-Hispanic Black (Black) persons, non-Hispanic multiple-race (multiple-race) persons, and Puerto Rican persons. Asthma attacks were more prevalent among children, females, and multiple-race persons. ED/UCC visits were more prevalent among children, women aged ≥18 years, and all racial and ethnic groups (i.e., Black, non-Hispanic Asian, multiple race, and Hispanic, including Puerto Rican, Mexican, and other Hispanic) except American Indian and Alaska Native persons compared with non-Hispanic White (White) persons. Asthma deaths were higher among adults, females, and Black persons. All pertinent asthma outcomes were also more prevalent among persons with low family incomes. Current asthma prevalence was higher in the Northeast than in the South and the West, particularly in small MSA areas. The prevalence was also higher in small and medium metropolitan areas than in large central metropolitan areas. The prevalence of asthma attacks differed by MSA category in four states. The prevalence of ED/UCC visits was higher in the South than the Northeast and the Midwest and was also higher in large central metropolitan areas than in micropolitan and noncore areas. The asthma mortality rate was highest in non-MSAs, specifically noncore areas. The asthma mortality rate was also higher in the Northeast, Midwest, and West than in the South. Within large MSAs, asthma deaths were higher in the Northeast and Midwest than the South and West. INTERPRETATION: Despite some improvements in asthma outcomes over time, the findings from this report indicate that disparities in asthma indicators persist by demographic characteristics, poverty level, and geographic location. PUBLIC HEALTH ACTION: Disparities in asthma outcomes and health care use in rural and urban populations identified from NHIS and NVSS can aid public health programs in directing resources and interventions to improve asthma outcomes. These data also can be used to develop strategic goals and achieve CDC's Controlling Childhood Asthma and Reducing Emergencies (CCARE) initiative to reduce childhood asthma hospitalizations and ED visits and prevent 500,000 asthma-related hospitalizations and ED visits by 2024.

Asthma-related emergency department (ED) visits and post-ED visit hospital and critical care admissions, National Hospital Ambulatory Medical Care Survey, 2010-2015.

Background: Exacerbation of asthma symptoms increases the likelihood of emergency department (ED) visits and hospitalizations. Because the ED is an important healthcare resource for immediate asthma care with acute exacerbations, we identify those populations most likely to seek ED treatment for asthma and describe the asthma burden for post-ED visit hospitalizations and critical care units.Methods: We examined the characteristics of asthma-related ED visits and hospital admissions and assessed the association between them using multivariable logistic regression models by analyzing data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) during 2010-2015.Results: Of all ED visits, 1.32% were asthma-related; of all ED visits that resulted in hospitalization, 1.12% were asthma-related and, of all ED visits that resulted in admission to a critical care unit, 1.20% were asthma related. The percentages of asthma-related ED visits and post-ED hospitalizations (H) were greater among children (adjusted prevalence ratio: ED: 2.28 [1.96.29-2.65]; H: 8.75 [5.93-12.92]) than among adults and greater for blacks (ED: (2.26 [1.97-2.60]; H: 3.25 [2.07-5.12]) and Hispanics (ED: (1.74 [1.47-2.08]; H: 2.424 [1.46-4.00]) than for whites. The percentage of ED visits was also greater for those covered by Medicaid or the Children's Health Insurance Program (CHIP) than by private insurance.Conclusions: Both asthma-related ED visits and post-ED hospitalizations were greater for children, blacks, and Hispanics. ED visits were also greater for Medicaid/CHIP. These findings might help prompt future studies on identifying additional potential risk factors for frequent ED visits among disproportionally affected subpopulations.

Medicaid expansion, health insurance coverage, and cost barriers to care among low-income adults with asthma: the Adult Asthma Call-Back Survey.

OBJECTIVE: To examine Medicaid expansion (ME) effects on health insurance coverage (HIC) and cost barriers to medical care among people with asthma. METHOD: We analyzed 2012-2013 and 2015-2016 data from low-income adults with current asthma aged 18-64 years in the Behavioral Risk Factor Surveillance System Asthma Call-Back Survey (state-level telephone survey). We calculated weighted percentages and 95% confidence intervals from ME and non-ME jurisdictions (according to 2014 ME status). Outcomes were HIC and cost barriers to buying asthma medication (MED), seeing a health care provider for asthma (HCP), or any asthma care (AAC). Using SUDAAN, we performed survey-weighted difference-in-differences analyses, adjusting for demographics. Subgroup analyses were stratified by demographics. RESULTS: Our study population included 6445 participants from 25 states plus Puerto Rico. In 2015-2016 compared to 2012-2013, HIC was more common in ME jurisdictions (P < 0.001) but unchanged in non-ME jurisdictions. Adjusted difference-in-differences analyses showed ME was associated with a statistically significant 13.36 percentage-point increase in HIC (standard error = 0.053). Cost barriers to MED, HCP, and AAC did not change significantly for either group in descriptive and difference-in-differences analyses. In subgroup analyses, we noted variation in outcomes by demographics and 2014 ME status. CONCLUSIONS: We found ME significantly affected HIC among low-income adults with asthma, but not cost barriers to asthma-related health care. Strategies to reduce cost barriers to asthma care could further improve health care access among low-income adults with asthma in ME jurisdictions.

Consistency of Indices Obtained via Hip Medial Ultrasound and Magnetic Resonance Imaging in Reduction and Spica Cast Treatment for Developmental Dysplasia of the Hip.

Children younger than 18 mo with developmental dysplasia of the hip (DDH) were treated with reduction and spica cast. X-Ray, computed tomography or magnetic resonance imaging (MRI) was used to evaluate reduction effectiveness. This study explored the hip medial ultrasonography method and anatomic structure sonograms. Twenty-eight children with DDH were enrolled. A total of 51 hips (24 left hips /27 right hips) were measured, including 30 affected hips and 21 normal hips. Various indices, including femoral head diameter (DIA), triradiate cartilage-femoral distance (TFD), acetabular-femoral distance (AFD) and ilium-femoral distance (IFD), were measured in the acetabular median coronal plane of ultrasound and the median coronal plane of MRI. The intra-group correlation coefficients for DIA, TFD, AFD and IFD were 0.968 (95% confidence interval: 0.917-0.985), 0.959 (0.929-0 976), 0.923 (0.869-0.955) and 0.950 (0914-0.971), respectively. Hip medial ultrasound and MRI exhibited good consistency. It is feasible to use hip medial ultrasound to evaluate the reduction of DDH in infants and children after spica cast.

Update: Characteristics of Health Care Personnel with COVID-19 - United States, February 12-July 16, 2020.

As of September 21, 2020, the coronavirus disease 2019 (COVID-19) pandemic had resulted in 6,786,352 cases and 199,024 deaths in the United States.* Health care personnel (HCP) are essential workers at risk for exposure to patients or infectious materials (1). The impact of COVID-19 on U.S. HCP was first described using national case surveillance data in April 2020 (2). Since then, the number of reported HCP with COVID-19 has increased tenfold. This update describes demographic characteristics, underlying medical conditions, hospitalizations, and intensive care unit (ICU) admissions, stratified by vital status, among 100,570 HCP with COVID-19 reported to CDC during February 12-July 16, 2020. HCP occupation type and job setting are newly reported. HCP status was available for 571,708 (22%) of 2,633,585 cases reported to CDC. Most HCP with COVID-19 were female (79%), aged 16-44 years (57%), not hospitalized (92%), and lacked all 10 underlying medical conditions specified on the case report form† (56%). Of HCP with COVID-19, 641 died. Compared with nonfatal COVID-19 HCP cases, a higher percentage of fatal cases occurred in males (38% versus 22%), persons aged ≥65 years (44% versus 4%), non-Hispanic Asians (Asians) (20% versus 9%), non-Hispanic Blacks (Blacks) (32% versus 25%), and persons with any of the 10 underlying medical conditions specified on the case report form (92% versus 41%). From a subset of jurisdictions reporting occupation type or job setting for HCP with COVID-19, nurses were the most frequently identified single occupation type (30%), and nursing and residential care facilities were the most common job setting (67%). Ensuring access to personal protective equipment (PPE) and training, and practices such as universal use of face masks at work, wearing masks in the community, and observing social distancing remain critical strategies to protect HCP and those they serve.

Cost barriers to asthma care by health insurance type among children with asthma.

Objective: Children with asthma have ongoing health care needs and health insurance is a vital part of their health care access. Health care coverage may be associated with various cost barriers to asthma care. We examined cost barriers to receiving asthma care by health insurance type and coverage continuity among children with asthma using the 2012-2014 Child Asthma Call-back Survey (ACBS).Methods: The study sample included 3788 children under age 18 years with current asthma who had responses to the ACBS by adult proxy. Associations between cost barriers to asthma care and treatment were analyzed by demographic, health insurance coverage, and urban residence variables using multivariable logistic regression models.Results: Among insured children, more blacks reported a cost barrier to seeing a doctor (10.6% [5.9, 18.3]) compared with whites (2.9% [2.1, 4.0]) (p = 0.03). Adjusting for demographic factors (sex, age, and race), uninsured and having partial year coverage were associated with cost barrier to seeing a doctor (adjusted prevalence ratio aPR = 8.07 [4.78, 13.61] and aPR = 6.58 [3.78, 11.45], respectively) and affording medication (aPR = 8.35 [5.23, 13.34] and aPR = 4.93 [2.96, 8.19], respectively), compared with children who had full year coverage. Public insurance was associated with cost barrier to seeing a doctor (aPR = 4.43 [2.57, 7.62]), compared with private insurance.Conclusions: Having no health insurance, partial year coverage, and public insurance were associated with cost barriers to asthma care. Improving health insurance coverage may help strengthen access to and reduce cost barriers to asthma care.

Comparison response patterns on landline and cell phone in a call back survey: effects of demographic characteristics and lag days.

The Asthma Call-back Survey (ACBS) is conducted after the Behavioral Risk Factor Surveillance System (BRFSS) survey by calling BRFSS respondents who reported ever being diagnosed with asthma. To find response patterns and increase ACBS response rates, we first examined whether obtaining consents during the BRFSS survey could increase call back response rates by reducing the refusal and break-off. Then, we assessed how the lag days between BRFSS and ACBS interviews affected response rates. BRFSS cell phone respondents agreed more often to being called back than did landline respondents (75.5 vs. 70.9 percent). However, when respondents were contacted for ACBS, the cell phone response rate was lower than landline response rate (43.4 vs. 47.0 percent), except among males aged 25-34 years, for which the cell phone response rate was 2.1 percent higher than the landline response rate. ACBS response rate for landline and cell phone response were highest if the callback was within 2 days of BRFSS interviews (92.3 vs. 88.8 percent). As lag days increased, the response rate decreased. The cell phone response rate showed a sharper drop; after 2 weeks, the response rate gap between landline and cell phone samples reached 17.3 percent.

Long-term control medication use and asthma control status among children and adults with asthma.

BACKGROUND: Uncontrolled asthma decreases quality of life and increases health care use. Most people with asthma need daily use of long-term control (LTC) medications for asthma symptoms and to prevent asthma attacks. Ongoing assessment of a person's level of asthma control and medication use is important in determining the effectiveness of current treatment to decrease the frequency and intensity of symptoms and functional limitations. OBJECTIVE: To assess the use of LTC medication among children and adults with current asthma and identify contributing factors for LTC medication use. METHODS: We used the 2006-2010 Behavioral Risk Factor Surveillance System (BRFSS) child and adult Asthma Call-back Survey (ACBS) data to assess the level of asthma control and LTC medication use. Asthma control was classified as well controlled and uncontrolled using guideline-based measures. We used multivariable logistic regression models to identify contributing factors for LTC medication use and having uncontrolled asthma. RESULTS: Among persons with current asthma, 46.0% of children and 41.5% of adults were taking LTC medications and 38.4% of children and 50.0% of adults had uncontrolled asthma. Among children who had uncontrolled asthma (38.4%), 24.1% were taking LTC medications and 14.3% were not taking LTC medications. Among adults who had uncontrolled asthma (50.0%), 26.7% were taking LTC medications and 23.3% were not taking LTC medications. CONCLUSIONS: Using BRFSS ACBS data to assess the level of asthma control and LTC medication use can identify subpopulations of persons with asthma who receive suboptimal treatment, for which better asthma-related medical treatment and management are needed.