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1.
Environ Res ; 194: 110628, 2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33345894

RESUMO

BACKGROUND: Evidence on the relationship between exposure to greenness and adolescent mental health is limited. The purpose of this study was to examine the association between greenness throughout childhood and mental health at age 12 years. METHODS: We assessed greenness using the satellite-based measure of Normalized Difference Vegetation Index (NDVI) within 200m, 400m, and 800m of home address at birth, age 12 years, and across childhood (averaged for each year from birth to age 12) among the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS) cohort. Self-reported symptoms of anxiety and depression were assessed at age 12 years using the Spence Children's Anxiety Scale (SCAS) and Children's Depression Inventory 2 (CDI 2), respectively. Associations were estimated using linear regression, adjusting for covariates including traffic-related air pollution, neurological hazard exposure, blood lead level, household income, and community deprivation. RESULTS: In adjusted models, NDVI was largely not associated with self-reported anxiety and depression symptoms, except for the SCAS separation anxiety subscale at 400m and 800m (0.1 unit increase mean NDVI 400m: ß = -0.97, 95% CI: -1.86, -0.07; 800m: ß = -1.33, 95% CI: -2.32, -0.34). CONCLUSION: While we found no direct relationship between greenness and overall symptoms of anxiety and depression in adolescents upon adjustment for relevant covariates at the 200m distance, greenness may lesson symptoms of separation anxiety within 400m and 800m distance from the home address at age 12 years. Future research should examine mechanisms for these relationships at the community- and individual-level.

2.
JMIR Med Inform ; 8(12): e23530, 2020 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-33325834

RESUMO

BACKGROUND: Despite steady gains in life expectancy, individuals with cystic fibrosis (CF) lung disease still experience rapid pulmonary decline throughout their clinical course, which can ultimately end in respiratory failure. Point-of-care tools for accurate and timely information regarding the risk of rapid decline is essential for clinical decision support. OBJECTIVE: This study aims to translate a novel algorithm for earlier, more accurate prediction of rapid lung function decline in patients with CF into an interactive web-based application that can be integrated within electronic health record systems, via collaborative development with clinicians. METHODS: Longitudinal clinical history, lung function measurements, and time-invariant characteristics were obtained for 30,879 patients with CF who were followed in the US Cystic Fibrosis Foundation Patient Registry (2003-2015). We iteratively developed the application using the R Shiny framework and by conducting a qualitative study with care provider focus groups (N=17). RESULTS: A clinical conceptual model and 4 themes were identified through coded feedback from application users: (1) ambiguity in rapid decline, (2) clinical utility, (3) clinical significance, and (4) specific suggested revisions. These themes were used to revise our application to the currently released version, available online for exploration. This study has advanced the application's potential prognostic utility for monitoring individuals with CF lung disease. Further application development will incorporate additional clinical characteristics requested by the users and also a more modular layout that can be useful for care provider and family interactions. CONCLUSIONS: Our framework for creating an interactive and visual analytics platform enables generalized development of applications to synthesize, model, and translate electronic health data, thereby enhancing clinical decision support and improving care and health outcomes for chronic diseases and disorders. A prospective implementation study is necessary to evaluate this tool's effectiveness regarding increased communication, enhanced shared decision-making, and improved clinical outcomes for patients with CF.

3.
Clin Infect Dis ; 2020 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-32761072

RESUMO

BACKGROUND: Proadrenomedullin (proADM), a vasodilatory peptide with antimicrobial and anti-inflammatory properties, predicts severe outcomes in adults with community-acquired pneumonia (CAP) to a greater degree than C-reactive protein and procalcitonin. We evaluated the ability of proADM to predict disease severity across a range of clinical outcomes in children with suspected CAP. METHODS: We performed a prospective cohort study of children 3 months to 18 years with CAP in the emergency department (ED). Disease severity was defined as: mild (discharged home), mild-moderate (hospitalized but not moderate-severe or severe), moderate-severe (e.g., hospitalized with supplemental oxygen, broadening of antibiotics, complicated pneumonia), and severe (e.g., vasoactive infusions, chest drainage, severe sepsis). Outcomes were examined using proportional odds logistic regression within the cohort with suspected CAP and in a subset with radiographic CAP. RESULTS: Among 369 children, median proADM increased with disease severity [mild: median 0.53 nmol/L (IQR:0.43, 0.73), mild-moderate: 0.56 nmol/L (IQR:0.45, 0.71), moderate-severe: 0.61 nmol/L (IQR:0.47, 0.77), severe: 0.70 nmol/L (IQR:0.55, 1.04) (p=.002)]. ProADM was significantly associated with increased odds of developing severe outcomes (suspected CAP odds ratio (OR) 1.68 [95% CI, 1.2, 2.36], radiographic CAP OR 2.11 [95% CI, 1.36, 3.38]) adjusted for age, fever duration, antibiotic use, and pathogen. ProADM had an area under the ROC curve (AUC) of 0.64 (95%CI, 0.56,0.72) in those with suspected CAP and AUC 0.77 (95% CI, 0.68,0.87) in radiographic CAP. CONCLUSIONS: ProADM was associated with severe disease and discriminated moderately well children who developed severe disease from those who did not, particularly in radiographic CAP.

4.
Am J Transplant ; 2020 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-32654392

RESUMO

One in 10 people die awaiting transplantation from donor shortage. Only half of Americans register as organ donors. In this cross-sectional study, we evaluated population-level associations of neighborhood socioeconomic deprivation and racial segregation on organ donor registration rates. We analyzed state identification card demographic and organ donor registration data from 5 states to estimate the association between a neighborhood socioeconomic deprivation index (range [0, 1]; higher values indicate more deprivation) and a racial index of concentration at the extreme (ICE) (range [-1, 1]; lower values indicate predominantly black neighborhoods, higher values indicate predominantly white neighborhoods) on organ donor registration rates within a specified geography (census tract or ZIP code tabulation area [ZCTA]). Among 26 720 738 registrants, 32% of the sample were registered organ donors. At the census tract level, with each 0.1 decrease in the deprivation index, the organ donor registration rate increased by 6.8% (95% confidence interval [CI]: 6.6%, 7.0%). With each 0.1 increase in the racial ICE, the rate increased by 1.5% (95% CI: 1.5%, 1.6%). These associations held true at the ZCTA level. Areas with less socioeconomic deprivation and a higher concentration of white residents have higher organ donor registration rates. Public health initiatives should consider neighborhood context and novel data sources in designing optimal intervention strategies.

5.
J Pediatr ; 222: 52-58.e1, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32423682

RESUMO

OBJECTIVES: To categorize newborn infants in Hamilton County, Ohio by late pregnancy fetal opioid exposure status and to assess their first-year healthcare utilization. STUDY DESIGN: We used a population-based cohort of 41 136 live births from 2014-2017 and analyzed healthcare encounters in the first year of life from electronic health records. We prospectively assessed for the presence of opioids in maternal urine collected at delivery and for a diagnosis of newborn neonatal abstinence syndrome (NAS). At birth, infants were classified as unexposed to opioids, exposed to opioids and diagnosed with NAS, or subclinically exposed to opioids (exposure that did not result in NAS). RESULTS: The prevalence of newborn opioid exposure was 37 per 1000 births. The duration of the hospital birth encounter was significantly longer for infants with subclinical exposure compared with unexposed infants (10% increase; 95% CI, 7%-13%). However, duration for infants with subclinical exposure was shorter compared to those with NAS. Neither subclinical exposure nor NAS was associated with total emergency department visits. Subclinical exposure was associated with increased odds of having at least 1 hospitalization in the first year. However, the total length of stay for hospitalizations was 82% that of the unexposed group (95% CI, 75%-89%). Infants with NAS had a 213% longer total length of stay compared with the unexposed group (95% CI, 191%-237%). CONCLUSIONS: Subclinical and overt opioid exposure among newborn infants was associated with increased first-year healthcare utilization. From 2014 to 2017, this cost the Hamilton County healthcare system an estimated $1 109 452 for longer birth encounters alone.


Assuntos
Analgésicos Opioides/efeitos adversos , Síndrome de Abstinência Neonatal/diagnóstico , Síndrome de Abstinência Neonatal/epidemiologia , Transtornos Relacionados ao Uso de Opioides , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Complicações na Gravidez , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Prevalência
6.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32404432

RESUMO

BACKGROUND: Host biomarkers predict disease severity in adults with community-acquired pneumonia (CAP). We evaluated the association of the white blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP), and procalcitonin with the development of severe outcomes in children with CAP. METHODS: We performed a prospective cohort study of children 3 months to 18 years of age with CAP in the emergency department. The primary outcome was disease severity: mild (discharged from the hospital), mild-moderate (hospitalized but not moderate-severe or severe), moderate-severe (eg, hospitalized with receipt of intravenous fluids, supplemental oxygen, complicated pneumonia), and severe (eg, intensive care, vasoactive infusions, chest drainage, severe sepsis). Outcomes were examined within the cohort with suspected CAP and in a subset with radiographic CAP. RESULTS: Of 477 children, there were no statistical differences in the median WBC count, ANC, CRP, or procalcitonin across severity categories. No biomarker had adequate discriminatory ability between severe and nonsevere disease (area under the curve [AUC]: 0.53-0.6 for suspected CAP and 0.59-0.64 for radiographic CAP). In analyses adjusted for age, antibiotic use, fever duration, and viral pathogen detection, CRP was associated with moderate-severe disease (odds ratio 1.12; 95% confidence interval, 1.0-1.25). CRP and procalcitonin revealed good discrimination of children with empyema requiring chest drainage (AUC: 0.83) and sepsis with vasoactive infusions (CRP AUC: 0.74; procalcitonin AUC: 0.78), although prevalence of these outcomes was low. CONCLUSIONS: WBC count, ANC, CRP, and procalcitonin are generally not useful to discriminate nonsevere from severe disease in children with CAP, although CRP and procalcitonin may have some utility in predicting the most severe outcomes.


Assuntos
Pneumonia/sangue , Pneumonia/diagnóstico por imagem , Índice de Gravidade de Doença , Adolescente , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Calcitonina/sangue , Criança , Pré-Escolar , Estudos de Coortes , Infecções Comunitárias Adquiridas/sangue , Infecções Comunitárias Adquiridas/diagnóstico por imagem , Infecções Comunitárias Adquiridas/epidemiologia , Humanos , Lactente , Pneumonia/epidemiologia , Estudos Prospectivos
7.
Expert Rev Respir Med ; 14(7): 737-748, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32264725

RESUMO

INTRODUCTION: Natural, social, and constructed environments play a critical role in the development and exacerbation of respiratory diseases. However, less is known regarding the influence of these environmental/community risk factors on the health of individuals living with cystic fibrosis (CF), compared to other pulmonary disorders. AREAS COVERED: Here, we review current knowledge of environmental exposures related to CF, which suggests that environmental/community risk factors do interact with the respiratory tract to affect outcomes. Studies discussed in this review were identified in PubMed between March 2019 and March 2020. Although the limited data available do not suggest that avoiding potentially detrimental exposures other than secondhand smoke could improve outcomes, additional research incorporating novel markers of environmental exposures and community characteristics obtained at localized levels is needed. EXPERT OPINION: As we outline, some environmental exposures and community characteristics are modifiable; if not by the individual, then by policy. We recommend a variety of strategies to advance understanding of environmental influences on CF disease progression.

8.
Transplantation ; 104(11): 2346-2353, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32032293

RESUMO

BACKGROUND: Neighborhood socioeconomic deprivation is associated with adverse health outcomes. We sought to determine if neighborhood socioeconomic deprivation was associated with adherence to immunosuppressive medications after liver transplantation. METHODS: We conducted a secondary analysis of a multicenter, prospective cohort of children enrolled in the medication adherence in children who had a liver transplant study (enrollment 2010-2013). Participants (N = 271) received a liver transplant ≥1 year before enrollment and were subsequently treated with tacrolimus. The primary exposure, connected to geocoded participant home addresses, was a neighborhood socioeconomic deprivation index (range 0-1, higher indicates more deprivation). The primary outcome was the medication level variability index (MLVI), a surrogate measure of adherence to immunosuppression in pediatric liver transplant recipients. Higher MLVI indicates worse adherence behavior; values ≥2.5 are predictive of late allograft rejection. RESULTS: There was a 5% increase in MLVI for each 0.1 increase in deprivation index (95% confidence interval, -1% to 11%; P = 0.08). Roughly 24% of participants from the most deprived quartile had an MLVI ≥2.5 compared with 12% in the remaining 3 quartiles (P = 0.018). Black children were more likely to have high MLVI even after adjusting for deprivation (adjusted odds ratio 4.0 95% confidence interval, 1.7-10.6). CONCLUSIONS: This is the first study to evaluate associations between neighborhood socioeconomic deprivation and an objective surrogate measure of medication adherence in children posttransplant. These findings suggest that neighborhood context may be an important consideration when assessing adherence. Differential rates of medication adherence may partly explain links between neighborhood factors and adverse health outcomes following pediatric liver transplantation.

9.
Public Health Nurs ; 37(3): 453-460, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31899558

RESUMO

Greenness such as trees, plants, and shrubs may positively influence mental and physical health, but the relationship between greenness and asthma is poorly understood. Because asthma is the most prevalent child respiratory disease internationally, elucidating the role of greenness may substantially benefit public health. The purpose of this systematic review was to synthesize findings related to effects of greenness on asthma in children. Following PRISMA guidelines, six databases were searched for international publication of primary research results relevant to the relationship between greenness and child asthma. Of 82 initial results, seven articles remained after removal of duplicates and applying exclusion criteria. Six reported no direct association between greenness and child asthma, while one found increased greenness protective for asthma. None found a negative direct association between greenness and child asthma. Evidence supported benefits of greenness on child asthma through mediation of factors such as exposure to tobacco smoke, high traffic volume, and difficult family relationships. Even without a direct association, greenness can be considered a public health asset as it may mediate other factors contributing to asthma in children. Public health nurses can use these findings to educate clients and partners while advocating for policies to protect greenness.

10.
J Pediatr Gastroenterol Nutr ; 70(3): 364-370, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31651666

RESUMO

BACKGROUND AND OBJECTIVES: Nonalcoholic fatty liver disease (NAFLD) is linked to obesity. Obesity is associated with lower socioeconomic status (SES). An independent link between pediatric NAFLD and SES has not been elucidated. The objective of this study was to evaluate the distribution of socioeconomic deprivation, measured using an area-level proxy, in pediatric patients with known NAFLD and to determine whether deprivation is associated with liver disease severity. METHODS: Retrospective study of patients <21 years with NAFLD, followed from 2009 to 2018. The patients' addresses were mapped to census tracts, which were then linked to the community deprivation index (CDI; range 0--1, higher values indicating higher deprivation, calculated from six SES-related variables available publicly in US Census databases). RESULTS: Two cohorts were evaluated; 1 with MRI (magnetic resonance imaging) and/or MRE (magnetic resonance elastography) findings indicative of NAFLD (n = 334), and another with biopsy-confirmed NAFLD (n = 245). In the MRI and histology cohorts, the majority were boys (66%), non-Hispanic (77%-78%), severely obese (79%-80%), and publicly insured (55%-56%, respectively). The median CDI for both groups was 0.36 (range 0.15-0.85). In both cohorts, patients living above the median CDI were more likely to be younger at initial presentation, time of MRI, and time of liver biopsy. MRI-measured fat fraction and liver stiffness, as well as histologic characteristics were not different between the high- and low-deprivation groups. CONCLUSIONS: Children with NAFLD were found across the spectrum of deprivation. Although children from more deprived neighborhoods present at a younger age, they exhibit the same degree of NAFLD severity as their peers from less deprived areas.

11.
Stat Med ; 39(6): 740-756, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31816119

RESUMO

Cystic fibrosis (CF) is a progressive, genetic disease characterized by frequent, prolonged drops in lung function. Accurately predicting rapid underlying lung-function decline is essential for clinical decision support and timely intervention. Determining whether an individual is experiencing a period of rapid decline is complicated due to its heterogeneous timing and extent, and error component of the measured lung function. We construct individualized predictive probabilities for "nowcasting" rapid decline. We assume each patient's true longitudinal lung function, S(t), follows a nonlinear, nonstationary stochastic process, and accommodate between-patient heterogeneity through random effects. Corresponding lung-function decline at time t is defined as the rate of change, S'(t). We predict S'(t) conditional on observed covariate and measurement history by modeling a measured lung function as a noisy version of S(t). The method is applied to data on 30 879 US CF Registry patients. Results are contrasted with a currently employed decision rule using single-center data on 212 individuals. Rapid decline is identified earlier using predictive probabilities than the center's currently employed decision rule (mean difference: 0.65 years; 95% confidence interval (CI): 0.41, 0.89). We constructed a bootstrapping algorithm to obtain CIs for predictive probabilities. We illustrate real-time implementation with R Shiny. Predictive accuracy is investigated using empirical simulations, which suggest this approach more accurately detects peak decline, compared with a uniform threshold of rapid decline. Median area under the ROC curve estimates (Q1-Q3) were 0.817 (0.814-0.822) and 0.745 (0.741-0.747), respectively, implying reasonable accuracy for both. This article demonstrates how individualized rate of change estimates can be coupled with probabilistic predictive inference and implementation for a useful medical-monitoring approach.

12.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31676680

RESUMO

BACKGROUND: Disparities in health service use have been described across a range of sociodemographic factors. Patterns of PICU use have not been thoroughly assessed. METHODS: This was a population-level, retrospective analysis of admissions to the Cincinnati Children's Hospital Medical Center PICU between 2011 and 2016. Residential addresses of patients were geocoded and spatially joined to census tracts. Pediatric patients were eligible for inclusion if they resided within Hamilton County, Ohio. PICU admission and bed-day rates were calculated by using numerators of admissions and bed days, respectively, over a denominator of tract child population. Relationships between tract-level PICU use and child poverty were assessed by using Spearman's ρ and analysis of variance. Analyses were event based; children admitted multiple times were counted as discrete admissions. RESULTS: There were 4071 included admissions involving 3129 unique children contributing a total of 12 297 PICU bed days. Child poverty was positively associated with PICU admission rates (r = 0.59; P < .001) and bed-day rates (r = 0.47; P < .001). When tracts were grouped into quintiles based on child poverty rates, the PICU bed-day rate ranged from 23.4 days per 1000 children in the lowest poverty quintile to 81.9 days in the highest poverty quintile (P < .001). CONCLUSIONS: The association between poverty and poor health outcomes includes pediatric intensive care use. This association exists for children who grow up in poverty and around poverty. Future efforts should characterize the interplay between patient- and neighborhood-level risk factors and explore neighborhood-level interventions to improve child health.


Assuntos
Disparidades em Assistência à Saúde/economia , Unidades de Terapia Intensiva Pediátrica/economia , Admissão do Paciente/economia , Pobreza/economia , Características de Residência , Criança , Pré-Escolar , Feminino , Disparidades em Assistência à Saúde/tendências , Humanos , Unidades de Terapia Intensiva Pediátrica/tendências , Masculino , Ohio/epidemiologia , Admissão do Paciente/tendências , Pobreza/tendências , Estudos Retrospectivos
13.
Environ Health Perspect ; 127(9): 97006, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31553231

RESUMO

BACKGROUND: Acute exposure to ambient particulate matter <2.5µm in aerodynamic diameter (PM2.5) has been associated with adult psychiatric exacerbations but has not been studied in children. OBJECTIVES: Our objectives were to estimate the association between acute exposures to ambient PM2.5 and psychiatric emergency department (ED) utilization and to determine if it is modified by community deprivation. METHODS: We used a time-stratified case-crossover design to analyze all pediatric, psychiatric ED encounters at Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio, from 2011 to 2015 (n=13,176). Conditional logistic regression models adjusted for temperature, humidity, and holiday effects were used to estimate the odds ratio (OR) for a psychiatric ED visit 0-3 d after ambient PM2.5 exposures, estimated at residential addresses using a spatiotemporal model. RESULTS: A 10-µg/m3 increase in PM2.5 was associated with a significant increase in any psychiatric ED utilization 1 [OR=1.07 (95% CI: 1.02, 1.12)] and 2 [OR=1.05 (95% CI: 1.00, 1.10)] d later. When stratified by visit reason, associations were significant for ED visits related to adjustment disorder {e.g., 1-d lag [OR=1.24 (95% CI: 1.02, 1.52)] and suicidality 1-d lag [OR=1.44 (95% CI: 1.03, 2.02)]}. There were significant differences according to community deprivation, with some lags showing stronger associations among children in high versus low deprivation areas for ED visits for anxiety {1-d lag [OR=1.39 (95% CI: 0.96, 2.01) vs. 0.85 (95% CI: 0.62, 1.17)] and suicidality same day [OR=1.98 (95% CI: 1.22, 3.23) vs. 0.93 (95% CI: 0.60, 1.45)]}. In contrast, for some lags, associations with ED visits for adjustment disorder were weaker for children in high-deprivation areas {1-d lag [OR=1.00 (95% CI: 0.76, 1.33) vs. 1.50 (95% CI: 1.16, 1.93)]}. DISCUSSION: These findings warrant additional research to confirm the associations in other populations. https://doi.org/10.1289/EHP4815.


Assuntos
Poluição do Ar/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Poluentes Atmosféricos/análise , Asma , Criança , Feminino , Humanos , Masculino , Dióxido de Nitrogênio/análise , Material Particulado
14.
Pediatr Infect Dis J ; 38(9): 894-899, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31232897

RESUMO

BACKGROUND: The British Thoracic Society (BTS) guideline for pediatric community-acquired pneumonia (CAP) outlines severity criteria to guide clinical decision-making. Our objective was to examine the predictive performance of the criteria on the need for hospitalization (NFH) and disposition. METHODS: This was a retrospective cohort study of children 3 months-18 years of age diagnosed with CAP in an urban, pediatric emergency department (ED) in the United States from September 2014 to August 2015. Children with chronic medical conditions, recent ED visits, and ED transfers were excluded. The main outcomes were interventions or diagnoses that necessitate hospitalization (ie, NFH) and disposition (eg, admit vs. discharge). Test characteristics, stratified by age, were calculated for each outcome. RESULTS: Of 518 eligible children, 56.6% (n = 293) were discharged from the ED with 372 children meeting at least 1 BTS criterion. Overall BTS criteria were specific but not sensitive for NFH nor for disposition. For children <1 year of age sensitive criteria included not feeding and temperature for NFH and tachycardia, cyanosis and not feeding for disposition. For children ≥1 year of age, tachycardia had a sensitivity of >0.60 for both outcomes. The areas under the receiver operator characteristic curves for predicting any BTS criteria was 0.57 for NFH and 0.84 for disposition. CONCLUSIONS: The BTS CAP severity criteria had fair to excellent ability to predict NFH and disposition, respectively. Although specific, the low sensitivity and poor discriminatory ability for NFH of these criteria suggest a need for improved prognostic tools for children with CAP.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Hospitalização , Pneumonia/diagnóstico , Índice de Gravidade de Doença , Adolescente , Criança , Pré-Escolar , Tomada de Decisão Clínica , Infecções Comunitárias Adquiridas/complicações , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Masculino , Alta do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Prognóstico , Estudos Retrospectivos , Sociedades , Medicina Estatal , Estados Unidos
15.
J Allergy Clin Immunol ; 143(6): 2002-2006, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31063735

RESUMO

Epidemiologic studies have found air pollution to be causally linked to respiratory health including the exacerbation and development of childhood asthma. Accurately characterizing exposure is paramount in these studies to ensure valid estimates of health effects. Here, we provide a brief overview of the evolution of air pollution exposure assessment ranging from the use of ground-based, single-site air monitoring stations for population-level estimates to recent advances in spatiotemporal models, which use advanced machine learning algorithms and satellite-based data to accurately estimate individual-level daily exposures at high spatial resolutions. In addition, we review recent advances in sensor technology that enable the use of personal monitoring in epidemiologic studies, long-considered the "holy grail" of air pollution exposure assessment. Finally, we highlight key advantages and uses of each approach including the generalizability and public health relevance of air pollution models and the accuracy of personal monitors that are useful to guide personalized prevention strategies. Investigators and clinicians interested in the effects of air pollution on allergic disease and asthma should carefully consider the pros and cons of each approach to guide their application in research and practice.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/análise , Monitoramento Ambiental/métodos , Exposição por Inalação/análise , Estudos Epidemiológicos , Humanos , Hipersensibilidade/epidemiologia , Modelos Teóricos , Medição de Risco
16.
Sci Total Environ ; 668: 760-767, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-30865906

RESUMO

Despite reported health benefits of urban greenspace (gs), the epidemiological evidence is less clear for allergic disease. To address a limitation of previous research, we examined the associations of medium- and high-resolution residential gs measures and tree and/or grass canopies with allergic outcomes for children enrolled in the longitudinal cincinnati childhood allergy and air pollution study (ccaaps). We estimated residential gs based on 400 m radial buffers around participant addresses (n = 478) using the normalized differential vegetation index (ndvi) and land cover-derived urban greenspace (ugs) (tree and grass coverage, combined and separate) at 30 m and 1.5-2.5 m resolution, respectively. Associations between outdoor aeroallergen sensitization and allergic rhinitis at age 7 and residential gs measures at different exposure windows were examined using multivariable logistic regression models. A 10% increase in ugs-derived grass coverage was associated with an increased risk of sensitization to grass pollens (adjusted odds ratio [aor]: 1.27; 95% confidence interval = 1.02-1.58). For each 10% increase in ugs-derived tree canopy coverage, nonstatistically significant decreased odds were found for grass pollen sensitization, tree pollen sensitization, and sensitization to either (aor range = 0.87-0.94). Results similar in magnitude to ugs-tree canopy coverage were detected for ndvi and allergic sensitizations. High-resolution (down to 1.5 m) gs measures of grass- and tree-covered areas showed associations in opposite directions for different allergy outcomes. These data suggest that measures strongly correlated with tree canopy (e.g., ndvi) may be insufficient to detect health effects associated with proximity to different types of vegetation or help elucidate mechanisms related to specific gs exposure pathways.


Assuntos
Poluição do Ar/estatística & dados numéricos , Alérgenos/análise , Exposição Ambiental/estatística & dados numéricos , Rinite Alérgica/epidemiologia , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Razão de Chances , Pólen , Desenvolvimento Sustentável/tendências , Árvores
17.
IEEE J Transl Eng Health Med ; 7: 2800108, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30800534

RESUMO

The clinical course of cystic fibrosis (CF) lung disease is marked by acute drops of lung function, defined clinically as rapid decline. As such, lung function is monitored routinely through pulmonary function testing, producing hundreds of measurements over the lifespan of an individual patient. Point-of-care technologies aimed at improving detection of rapid decline have been limited. Our aim in this early translational study is to develop and translate a predictive algorithm into a prototype prognostic tool for improved detection of rapid decline. The predictive algorithm was developed, validated and checked for 6-month, 1-year, and 2-year forecast accuracies using data on demographic and clinical characteristics from 30 879 patients aged 6 years and older who were followed in the U.S. Cystic Fibrosis Foundation Patient Registry from 2003 to 2015. Predictions of rapid decline based on the algorithm were compared to a detection algorithm currently being used at a CF center with 212 patients who received care between 2012-2017. The algorithm was translated into a prototype web application using RShiny, which resulted from an iterative development and refinement based on clinician feedback. The study showed that the algorithm had excellent predictive accuracy and earlier detection of rapid decline, compared to the current approach, and yielded a prototype platform with the potential to serve as a viable point-of-care tool. Future work includes implementation of this clinical prototype, which will be evaluated prospectively under real-world settings, with the aim of improving the pre-visit planning process for CF point of care. Likely extensions to other point-of-care settings are discussed.

18.
J Pediatr ; 207: 233-240, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30545565

RESUMO

OBJECTIVE: To assess the relationship between greenspace exposure and childhood internalizing and externalizing behaviors. STUDY DESIGN: We analyzed data from the Cincinnati Childhood Allergy and Air Pollution Study, an ongoing prospective birth cohort. Greenspace exposure was estimated based on children's addresses using normalized difference vegetation index (NDVI) images. Neurobehavioral outcomes were assessed using the Behavioral Assessment System for Children, Second Edition. Regression models adjusted for neighborhood deprivation, maternal education, race, and sex assessed the risk for problematic internalizing and externalizing behaviors at residential greenspace buffers of 200, 400, and 800 m. RESULTS: There were 562 and 313 children in our age 7- and 12-year analyses, respectively. At age 7 years, a 0.1-unit increase in NDVI was associated with decreased conduct scores (ß = -1.10, 95% CI [-2.14, -0.06], 200 m). At age 12 years, a 0.1-unit increase in NDVI was associated with a decrease in anxiety scores (ß = -1.83, 95% CI [-3.44, -0.22], 800 m), decreased depression scores (ß = -1.36, 95% CI [-2.61, -0.12], 200 m), and decreased somatization scores (ß = -1.83, 95% CI [-3.22, -0.44], 200 m). CONCLUSIONS: This study provides evidence that increased exposure to residential greenspace is associated with reduced youth's problematic internal and external behaviors, measured by Behavioral Assessment System for Children, Second Edition, at ages 7 and 12 years. Improved understanding of this mechanism could allow for implementation of neighborhood-level approaches for reducing the risk for childhood behavioral problems.


Assuntos
Poluição do Ar/efeitos adversos , Transtornos do Comportamento Infantil/epidemiologia , Comportamento Infantil , Parques Recreativos/estatística & dados numéricos , População Urbana , Criança , Transtornos do Comportamento Infantil/psicologia , Pré-Escolar , Feminino , Seguimentos , Humanos , Incidência , Lactente , Masculino , Ohio/epidemiologia , Estudos Prospectivos
19.
Prehosp Emerg Care ; 23(2): 225-232, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30118621

RESUMO

BACKGROUND: Pediatric emergency medical services (EMS) utilization is costly and resource intensive; significant variation exists across large-scale geographies. Less is known about variation at smaller geographic levels where factors including lack of transportation, low health literacy, and decreased access to medical homes may be more relevant. Our objective was to determine whether pediatric EMS utilization varied across Hamilton County, Ohio, census tracts and whether such utilization was associated with socioeconomic deprivation. METHODS: This was a retrospective analysis of children living in Hamilton County, Ohio, transported by EMS to the Cincinnati Children's emergency department between July 1, 2014, and July 31, 2016. Participants' addresses were assigned to census tracts and an EMS utilization rate and deprivation index were calculated for each. Pearson's correlation coefficients evaluated relationships between tract-level EMS utilization and deprivation. Tract-level deprivation was used as a predictor in patient-level evaluations of acuity. RESULTS: During the study period, there were 4,877 pediatric EMS transports from 219 of the 222 county census tracts. The county EMS utilization rate during the study period was 2.4 transports per 100 children (range 0.2-11). EMS utilization rates were positively correlated with increasing deprivation (r = 0.72, 95% confidence interval [CI], 0.65-0.77). Deprivation was associated with lower illness severity at triage, fewer transports resulting in resuscitation suite use, and fewer transports resulting in hospitalizations (all p < 0.05). CONCLUSIONS: EMS utilization varied substantially across census tracts in Hamilton County, Ohio. A deeper understanding into why certain socioeconomically deprived areas contribute to disproportionately high rates of EMS utilization could support development of targeted interventions to improve use.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Criança , Pré-Escolar , Utilização de Instalações e Serviços , Feminino , Humanos , Masculino , Ohio , Estudos Retrospectivos , Fatores Socioeconômicos
20.
Ann Epidemiol ; 30: 37-43, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30563729

RESUMO

PURPOSE: The purpose of the study was to conduct an individual-level analysis of hospital utilization during the first year of life to test the hypothesis that community material deprivation increases health care utilization. METHODS: We used a population-based perinatal data repository based on linkage of electronic health records from regional delivery hospitals to subsequent hospital utilization at the region's only dedicated children's hospital. Zero-inflated Poisson and Cox proportional hazards regression models were used to quantify the causal role of a census tract-based deprivation index on the total number, length, and time until hospital utilization during the first year of life. RESULTS: After adjusting for any neonatal intensive care unit admission, chronic complex conditions, race and ethnicity, insurance status, birth season, and very low birth weight, we found that a 10% increase in the deprivation index caused a 1.032-fold increase (95% confidence interval (CI), [1.025-1.040]) in post initial hospitalization length of stay, a 1.011-fold increase (95% CI, [1.002-1.021]) in number of post initial hospital encounters, and 1.022-fold increase (95% CI, [1.009-1.035]) in hazard for hospitalization utilization during the first year of life. CONCLUSIONS: Interventions designed to reduce material deprivation and income inequalities could significantly reduce infant hospital utilization.


Assuntos
Hospitalização/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Pobreza , Características de Residência , Fatores Socioeconômicos , Assistência à Saúde , Registros Eletrônicos de Saúde , Feminino , Humanos , Lactente , Seguro Saúde , Masculino , Vigilância da População , Modelos de Riscos Proporcionais , Assistência Pública , Estudos Retrospectivos , Meio Social , População Urbana
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