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1.
Sleep Health ; 5(6): 532-538, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31708438

RESUMO

BACKGROUND: Suboptimal sleep has been documented in at-risk groups such as urban minority children, particularly those with asthma. It is therefore critical to examine differences in sleep outcomes across specific racial and ethnic groups and to identify factors that contribute to such variations in sleep outcomes to inform tailored interventions to improve sleep health. OBJECTIVES: The objectives were to examine racial/ethnic differences in sleep outcomes among urban children with and without asthma and to evaluate the extent to which asthma status and aspects of sleep hygiene and the sleep environment contribute to racial/ethnic differences in sleep outcomes in this sample. METHODS: Two hundred and sixteen African American, Latino, or non-Latino white (NLW) urban children, ages 7-9 years, with (n = 216) and without asthma (n = 130) and their primary caregivers were included. Objective sleep duration and efficiency were assessed via actigraphy. Asthma status was assessed by a study clinician. Caregiver-reported sleep hygiene and exposure to noise were assessed using a questionnaire. RESULTS: Minority children in the sample had, on average, shorter sleep duration compared to NLW children during the monitoring period (mean difference Latino vs NLW = -22.10, SE = 5.02; mean difference AA vs NLW = -18.69, SE = 5.28) Additionally, several racial/ethnic group differences in sleep outcomes emerged and were dependent on whether or not children had asthma. Specifically, Latinos had lower mean number of awakenings compared to NLWs but only among control participants with no asthma. Furthermore, specific aspects of sleep hygiene and exposure to nighttime noise in the home and neighborhood contributed to racial/ethnic differences in sleep outcomes. CONCLUSION: Considering urban stressors and asthma status when treating pediatric populations is important, as factors related to urban stress and asthma management may influence sleep hygiene practices and sleep outcomes.


Assuntos
Afro-Americanos/estatística & dados numéricos , Asma/etnologia , Disparidades nos Níveis de Saúde , Hispano-Americanos/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Sono , Saúde da População Urbana/etnologia , Cuidadores , Criança , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , New England , Higiene do Sono , Inquéritos e Questionários , Fatores de Tempo
2.
Medicine (Baltimore) ; 98(42): e17327, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626088

RESUMO

To explore the association of a disintegrin and metalloprotease 33 (ADAM33) polymorphisms with childhood asthma susceptibility, we conducted this case-control study.In this case-control study, we selected 96 asthma children and 86 healthy children to conduct the genotyping of ADAM33 polymorphisms through polymerase chain reaction-direct sequencing (PCR-DS). Hardy-Weinberg equilibrium (HWE) status in the control group was detected adopting chi-square test. Frequency differences of genotypes, alleles, and haplotypes were compared by chi-square test between the case and control groups. Linkage disequilibrium (LD) between polymorphisms was checked using Haploview software. Association intensity of the polymorphisms with the disease risk was assessed by odds ratio (OR) and 95% confidence interval (95%CI).The frequency of rs678881 GA genotype was obviously higher in cases than in controls (P = .03) and the carriage of this genotype conferred higher risk of asthma among children than GG genotype (OR = 2.03, 95%CI = 1.05-3.91). However, neither rs2280089 nor rs2853209 polymorphism was significantly associated with the risk of childhood asthma. Strong LD was found among rs678881, rs2280089 and rs2853209, and haplotype GGT was distinctly associated with the risk of asthma in children (OR = 0.28, 95%CI = 0.13-0.57).ADAM33 rs678881 polymorphism is significantly correlated with increased susceptibility to asthma in Chinese Han children. Besides, haplotype GGT among the 3 polymorphisms was obviously associated with decreased risk of childhood asthma.


Assuntos
Proteínas ADAM/genética , Asma/genética , Alelos , Asma/sangue , Asma/etnologia , Estudos de Casos e Controles , Criança , Pré-Escolar , China/epidemiologia , Feminino , Predisposição Genética para Doença/etnologia , Genótipo , Haplótipos , Humanos , Masculino , Reação em Cadeia da Polimerase , Polimorfismo de Nucleotídeo Único , Fatores de Risco
3.
BMC Public Health ; 19(1): 912, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288792

RESUMO

BACKGROUND: Childhood asthma is a significant health issue with 8.3% prevalence in the U.S. Its prevalence is particularly higher among low-income communities in the Texas-Mexico border region, as they often lack access to clinical care and health insurance. This study examines the impact of a home-based education led by Community Health Workers (CHWs) on health outcomes for asthmatic, predominantly Hispanic children in these communities. METHODS: The study was a quasi-experimental design to learn the effectiveness of the asthma home-based education by comparing changes of health outcomes between baseline and follow-up of intervention and control groups. This study enrolled 290 participants, consisting of 130 in the intervention group and 160 in the control group. The educational intervention led by the CHWs referenced the Asthma and Healthy Homes curriculum and contents of the Seven Principles of Healthy Homes. The multiple linear regression analysis was conducted to estimate the associations between the intervention and each health outcome. RESULTS: When comparing the intervention group with the control group, the intervention group showed a significantly greater decrease in asthma attacks than the control group (p = 0.049). Although all of the five Children's Health Survey for Asthma (CHSA) scores showed significant improvements between baseline and follow-up in both groups, we found that increases of CHSA scores in the intervention group were higher than the control group except for emotional health of children (EC) score. The multiple linear regression models demonstrated that the mean changes in asthma attacks (p = 0.036) and emotional health of families (EF) score (p = 0.038) were significantly better in the intervention group than the control group, adjusting for children's age of diagnosis, household income, use of steroids, family history of allergy, and type of insurance. CONCLUSIONS: This study concluded that the home-based education by CHWs effectively improve health outcomes among children in communities lacking access to medical resources. The findings suggest the importance of the home-based education program in promoting emotional and medical care for children and their families in low-income communities like those in the Texas-Mexico border region.


Assuntos
Asma/etnologia , Hispano-Americanos/educação , Serviços de Assistência Domiciliar/organização & administração , Educação de Pacientes como Assunto/métodos , Adolescente , Criança , Pré-Escolar , Agentes Comunitários de Saúde , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Masculino , México , Áreas de Pobreza , Avaliação de Programas e Projetos de Saúde , Texas
4.
Public Health Rep ; 134(4): 338-343, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31120804

RESUMO

Few studies have examined the asthma burden among small racial/ethnic minority groups such as Asian children. We examined asthma disparities among children aged 4-17 in 6 small non-Hispanic racial/ethnic minority groups (American Indian/Alaska Native [AI/AN], Asian Indian, Chinese, Filipino, other Asian, and multiple race) by using the 2006-2015 National Health Interview Survey. These small minority groups represented a weighted 6.1% of the study population (6770 of 88 049). The prevalence of current asthma ranged from 5.5% (95% confidence interval [CI], 3.5%-7.5%) among Chinese children to 13.8% (95% CI, 10.4%-17.2%) among multiple-race children and 14.6% (95% CI, 10.8%-18.4%) among AI/AN children. Compared with non-Hispanic white children, AI/AN (adjusted odds ratio [aOR] = 1.6; 95% CI, 1.2-2.2) and multiple-race (aOR = 1.4; 95% CI, 1.0-2.0) children had higher odds for current asthma. Several small racial/ethnic minority groups are at heightened risk of asthma-associated outcomes, highlighting the need for further research on these populations.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Asma/etnologia , Asma/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Razão de Chances , Vigilância da População , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia , Estados Unidos/etnologia
5.
BMC Health Serv Res ; 19(1): 322, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31117994

RESUMO

BACKGROUND: Regular asthma reviews are recommended by international guidelines to improve the quality of life of asthma patients. To facilitate these reviews in primary care practice, there is a need for structured asthma review tools. AIM: The aim of this study was to assess the metric properties of the Greek-translated version of the Active Life with Asthma (ALMA) review. METHODS: A convenience sample of 156 asthmatic patients from three public hospitals participated in this methodological study with a descriptive cross-sectional correlation design. Participants responded to the 19-item ALMA questionnaire and provided socio-demographic and clinical information. The construct validity of the tool was explored in exploratory factor analysis and the internal consistency of scale and sub-scales was estimated using Cronbach's α. Convergence validity was assessed using the Asthma Control Questionnaire (ACQ), a commonly used asthma control measure, and concurrent criterion validity was assessed using the MiniAQoL, an asthma-specific quality of life questionnaire. Known-group validity was assessed based on observed differences in terms of frequency of hospitalizations or emergency visits in the past year. RESULTS: Amongst 156 participants, 95 (60.9%) were women and the median age was 50-65 years old. Exploratory factor analysis (KMO = 0.83 and Bartlett test < 0.001) with principal component extraction and orthogonal rotation revealed a clear structure of three factors with little cross-loading: physical, environmental and mental domains, as in the original study. Cronbach's alpha coefficient for internal consistency for the whole scale was 0.85, while for the sub-scales, these were: environmental a = 0.69, mental a = 0.76 and physical a = 0.85. Test-retest reliability based on the correlation between scores of 20 participants responding twice two weeks apart was r = 0.92. There was stong correlation in the expected direction between ALMA and ACQ (r = - 0.70) as well as miniAQoL (r = 0.71). Finally, there were statistically significant higher ALMA scores in participants who reported emergency visits and hospital admissions in the past year. CONCLUSION: In general, the ALMA showed good metric properties. It appears to be a reliable and valid tool which can be used as a measure for asthma control and self-management in clinical practice as well as future descriptive or intervention research studies.


Assuntos
Asma/psicologia , Qualidade de Vida , Adolescente , Adulto , Idoso , Asma/etnologia , Asma/prevenção & controle , Estudos Transversais , Análise Fatorial , Feminino , Grécia/etnologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Gravidade do Paciente , Exame Físico/métodos , Atenção Primária à Saúde , Psicometria , Reprodutibilidade dos Testes , Autogestão/métodos , Inquéritos e Questionários , Tradução , Adulto Jovem
7.
Ann Allergy Asthma Immunol ; 122(5): 471-477, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30872028

RESUMO

BACKGROUND: Urban minority children experience high levels of asthma morbidity. Poor school performance can be an indicator that asthma is in poor control. Little attention has been paid to examining real-time links between asthma and academic performance, particularly in high-risk groups. OBJECTIVE: Examine 1) academic performance across a range of indicators in a group of urban children with asthma and urban children without chronic illness and ethnic differences in these associations, and 2) associations between asthma and academic performance in the group of urban children with asthma and ethnic differences in these associations. METHODS: Two hundred sixteen black/African American (33%), Latino (46%), and non-Latino white (21%) urban children, ages 7 to 9 years completed a clinic- and home-based protocol that assessed asthma and allergy status, objective measurements of lung function, and academic functioning. RESULTS: Analyses revealed that children with asthma experienced a higher number of school absences when compared with healthy controls. Greater disparities in academic outcomes emerged when examining ethnic differences within the groups of children with and without asthma. Poor academic outcomes were observed in Latino children with asthma. Furthermore, a strong correspondence of poor asthma outcomes and decrements in academic performance were seen in the full sample, and these associations emerged across ethnic groups. CONCLUSION: Asthma activity contributes to poorer academic outcomes across a range of indicators, and urban minority children with asthma, particularly Latino children, may be at heightened risk for poorer academic performance. School management guidelines for asthma need to be consistently implemented and tailored for school staff, caregivers, and students with asthma to address challenges of managing asthma within the urban school setting.


Assuntos
Desempenho Acadêmico/estatística & dados numéricos , Asma/etnologia , Asma/fisiopatologia , Absenteísmo , Desempenho Acadêmico/etnologia , Afro-Americanos , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Criança , Doença Crônica , Grupo com Ancestrais do Continente Europeu , Feminino , Hispano-Americanos , Humanos , Estudos Longitudinais , Masculino , Guias de Prática Clínica como Assunto , Rhode Island , Estudantes , População Urbana
9.
Ann Allergy Asthma Immunol ; 122(5): 456-462, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30772392

RESUMO

OBJECTIVE: Asthma and atopic dermatitis (AD) are complex diseases with striking disparities across racial and ethnic groups, which may be partly attributable to genetic factors. Here we summarize current knowledge from asthma and AD genome-wide association studies (GWAS) and pharmacogenetic studies in African ancestry populations. DATA SOURCES: GWAS catalog; PUBMed. STUDY SELECTIONS: GWAS catalog studies with trait annotations "asthma" and "atopic eczema" and African ancestry individuals in the discovery dataset; the recent CAAPA asthma GWAS; reports on pharmacogenetic studies in asthma and AD. RESULTS: Although GWASs have revolutionized gene discovery for multiple complex traits, African Americans continue to be severely underrepresented in sufficiently powered genetics studies. Indeed, of the 16 asthma and 21 AD loci that reached genomewide significance in Europeans, very few have replicated in African ancestry populations. Challenges in comparing results from European vs African ancestry cohorts include modest sample size, differences in risk allele frequency, effect size, correlation between genetic variants, and environmental exposure in evolutionary history. African Americans also constitute a small percentage of dermatological and respiratory-focused clinical trials. Pharmacogenetic studies have similarly been focused largely on non-Hispanic whites, despite compelling evidence that genetic variation from different ancestral backgrounds may alter therapeutic efficacy of asthma and AD drugs. CONCLUSION: Large-scale genetic studies of asthma and AD in African Americans are essential to reduce research and health disparities and empower scientific discoveries.


Assuntos
Asma/etnologia , Asma/genética , Dermatite Atópica/etnologia , Dermatite Atópica/genética , Predisposição Genética para Doença , Grupo com Ancestrais do Continente Africano , Alelos , Asma/epidemiologia , Asma/imunologia , Evolução Biológica , Dermatite Atópica/epidemiologia , Dermatite Atópica/imunologia , Grupo com Ancestrais do Continente Europeu , Frequência do Gene , Loci Gênicos , Genoma Humano , Estudo de Associação Genômica Ampla , Disparidades nos Níveis de Saúde , Hispano-Americanos , Humanos , Prevalência , Tamanho da Amostra
11.
J Immigr Minor Health ; 21(3): 659-663, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30073436

RESUMO

Obstructive pulmonary disease outcomes in the United States differ between Latinos and non-Hispanic whites. There is little objective data about diagnosis prevalence and primary care visit frequency in these disease processes. We used electronic health record data to perform a retrospective cohort analysis of 34,849 low-income patients seen at Oregon community health centers between 2009 and 2013 to assess joint racial/ethnic and insurance disparities in diagnosis and visit rates between Latino and non-Hispanic white patients. The overall study prevalence of obstructive lung disease was 18%. Latinos had lower odds of obstructive lung disease diagnosis (OR 0.37, 95% CI 0.30-0.44). Among those diagnosed prior to 2009, the uninsured (regardless of race/ethnicity) had lower visit rates during 2009-2013 than the insured. This study identified racial/ethnic disparities in the diagnosis of obstructive pulmonary disease between Latinos and non-Hispanic Whites, confirming trends observed in survey research but controlling for important confounders. Health insurance was associated with basic care utilization, suggesting that lack of health insurance could lessen the quality of care for obstructive pulmonary disease in Latino and non-Hispanic white patients.


Assuntos
Asma/etnologia , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/etnologia , Adulto , Idoso , Registros Eletrônicos de Saúde , Grupo com Ancestrais do Continente Europeu , Feminino , Acesso aos Serviços de Saúde , Disparidades nos Níveis de Saúde , Hispano-Americanos , Humanos , Masculino , Pessoa de Meia-Idade , Oregon/epidemiologia , Pobreza/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
12.
Pediatr Emerg Care ; 35(3): 209-215, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28926508

RESUMO

OBJECTIVE: To assess the variation between racial/ethnic groups in emergency department (ED) treatment of asthma for pediatric patients. METHODS: This study was a cross-sectional analysis of pediatric (2-18 years) asthma visits among 6 EDs in the Upper Midwest between June 2011 and May 2012. We used mixed-effects logistic regression to assess the odds of receiving steroids, radiology tests, and returning to the ED within 30 days. We conducted a subanalysis of asthma visits where patients received at least 1 albuterol treatment in the ED. RESULTS: The sample included 2909 asthma visits by 1755 patients who were discharged home from the ED. After adjusting for demographics, insurance type, and triage score, African American (adjusted odds ratio [aOR], 1.78; 95% confidence interval [CI], 1.40-2.26) and Hispanic (aOR, 1.64; 95% CI, 1.22-2.22) patients had higher odds of receiving steroids compared with whites. African Americans (aOR, 0.58; 95% CI, 0.46-0.74) also had lower odds of radiological testing compared with whites. Asians had the lowest odds of 30-day ED revisits (aOR, 0.26; 95% CI, 0.08-0.84), with no other significant differences detected between racial/ethnic groups. Subgroup analyses of asthma patients who received albuterol revealed similar results, with American Indians showing lower odds of radiological testing as well (aOR, 0.47; 95% CI, 0.22-1.01). CONCLUSIONS: In this study, children from racial/ethnic minority groups had higher odds of steroid administration and lower odds of radiological testing compared with white children. The underlying reasons for these differences are likely multifactorial, including varying levels of disease severity, health literacy, and access to care.


Assuntos
Asma/terapia , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Adolescente , Albuterol/administração & dosagem , Asma/etnologia , Broncodilatadores/administração & dosagem , Criança , Pré-Escolar , Estudos Transversais , Grupos Étnicos , Feminino , Glucocorticoides/administração & dosagem , Humanos , Masculino , Readmissão do Paciente , Estados Unidos
13.
Acta Ophthalmol ; 97(5): 497-504, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30426693

RESUMO

PURPOSE: To study sociodemographic factors, associated diseases and survival of Danish keratoconus patients. METHODS: All patients diagnosed with keratoconus 1977-2015 (n = 2679) were matched to 10 persons who had not been diagnosed with keratoconus (n = 26 790). Conditional logistic regression assessed whether sociodemographic factors and specific systemic diseases were associated with the odds of keratoconus. Mortality was assessed with time-to-event analysis. RESULTS: After adjustment, non-Europeans had more than threefold higher odds of keratoconus compared to Europeans (OR, 3.34; 96% CI 2.94-3.80). Single persons had 27% higher odds (OR, 1.27; 95% CI 1.13-1.43), and divorced persons had 18% lower odds (OR 0.82; 95% CI 0.68-0.97) of keratoconus compared with persons in a relationship. Persons living in cities with <500 and 500-4999 inhabitants had 40% (OR, 0.60; 95% CI 0.51-0.71) and 30% (OR, 0.70; 95% CI 0.61-0.81) lower odds of keratoconus, respectively, compared with those living in the capital (>1 000 000 inhabitants). Persons receiving government substitution had 68% higher odds of keratoconus (OR, 1.68; 95% CI 1.30-2.17) compared to self-employed. Keratoconus patients had more than twofold higher odds of asthma (OR, 2.21; 95% CI 1.91-2.55), more than threefold higher odds of allergic rhinitis (OR, 3.44; 95% CI 2.75-4.30), more than sevenfold higher odds of atopic dermatitis (OR, 7.97; 95% CI, 6.21-10.21) and 69% higher odds of depression (OR, 1.69; 95% CI 1.18-2.43). Mortality rates were similar among keratoconus patients and controls (HR, 1.02; 95% CI 0.90-1.16). CONCLUSION: Danish keratoconus patients differ from controls on several sociodemographic factors and have higher risk of allergic rhinitis, asthma, atopic dermatitis and depression. They do not have excess mortality compared to controls.


Assuntos
Asma/etnologia , Depressão/etnologia , Dermatite Atópica/etnologia , Grupos Étnicos , Ceratocone/etnologia , Vigilância da População , Rinite Alérgica/etnologia , Adulto , Comorbidade/tendências , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Ceratocone/complicações , Masculino , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências
15.
J Adv Nurs ; 75(4): 876-887, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30479020

RESUMO

AIM: To evaluate the preliminary effectiveness of the BRief Evaluation of Asthma THerapy intervention, a 7-min primary care provider-delivered shared decision-making protocol that uses motivational interviewing to address erroneous asthma disease and medication beliefs. DESIGN: A multi-centre masked two-arm group-randomized clinical trial. METHODS: This 2-year pilot study is funded (September 2016) by the National Institute of Nursing Research. Eight providers will be randomized to one of two arms: the active intervention (N = 4) or a dose-matched attention control (N = 4). Providers will deliver the intervention to which they were randomized to 10 Black adult patients with uncontrolled asthma (N = 80). Patients will be followed three months postintervention to test the preliminary intervention effects on asthma control (primary outcome) and on medication adherence, lung function, and asthma-related quality of life (secondary outcomes). DISCUSSION: This study will evaluate the preliminary impact of a novel shared decision-making intervention delivered in a real world setting to address erroneous disease and medication beliefs as a means of improving asthma control in Black adults. Results will inform a future, large-scale randomized trial with sufficient power to test the intervention's effectiveness. IMPACT: Shared decision-making is an evidence-based intervention with proven effectiveness when implemented in the context of labour- and time-intensive research protocols. Medication adherence is linked with the marked disparities evident in poor and minority adults with asthma. Addressing this requires a novel multifactorial approach as we have proposed. To ensure sustainability, shared decision-making interventions must be adapted to and integrated into real-world settings. TRIAL REGISTRATION: Registered at clincialtrials.gov as NCT03036267 and NCT03300752.


Assuntos
Asma/prevenção & controle , Entrevista Motivacional , Administração por Inalação , Adulto , Afro-Americanos/etnologia , Afro-Americanos/psicologia , Antiasmáticos/administração & dosagem , Asma/etnologia , Asma/psicologia , Atitude Frente a Saúde , Tomada de Decisões , Feminino , Volume Expiratório Forçado/fisiologia , Estilo de Vida Saudável , Humanos , Masculino , Adesão à Medicação/etnologia , Adesão à Medicação/psicologia , Estudos Multicêntricos como Assunto , Satisfação do Paciente , Philadelphia , Projetos Piloto , Ensaios Clínicos Controlados Aleatórios como Assunto , Inquéritos e Questionários
16.
Ethn Health ; 24(1): 1-23, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-28359207

RESUMO

OBJECTIVES: Despite high asthma prevalence, relatively little is known about the epidemiology of asthma in Hawaii or among Native Hawaiian/Other Pacific Islanders (NHOPI). We sought to better characterize racial/ethnic differences in asthma prevalence and in sociodemographic factors associated with asthma among Hawaii adults. DESIGN: We conducted multivariable logistic regression using 2001-2010 Behavioral Risk Factor Surveillance System data from Hawaii, and computed adjusted prevalence and ratios. RESULTS: Asthma prevalence markedly varied between self-identified census categories of race in Hawaii, with NHOPI having the highest estimates of both lifetime (20.9%, 95% confidence interval [CI]: 19.5%-22.4%) and current (12.2%, CI: 11.2%-13.3%) asthma. Highest asthma prevalence among NHOPI persisted after controlling for potential confounders and within most sociodemographic categories. Among females Asians reported the lowest asthma prevalence, whereas among males point estimates of asthma prevalence were often lowest for Whites. Females often had greater asthma prevalence than males of the same race, but the degree to which gender modified asthma prevalence differed by both race and sociodemographic strata. Gender disparities in asthma prevalence were greatest and most frequent among Whites, and for current asthma among all races. Sociodemographic factors potentially predictive of adult asthma prevalence in Hawaii varied by race and gender. CONCLUSION: Asthma disproportionately affects or is recognized more often among women and NHOPI adults in Hawaii, and occurs less or is under-reported among Asian women. The sociodemographic characteristics included in this study's model did not explain asthma disparities between races and/or gender. This investigation provides a baseline with which to plan additionally needed prevention programs, epidemiological investigations, and surveillance for asthma in Hawaii.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Asma/epidemiologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Adulto , Idoso , Asma/etnologia , Sistema de Vigilância de Fator de Risco Comportamental , Estudos Transversais , Feminino , Hawaii , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
17.
Sci Rep ; 8(1): 14475, 2018 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-30262839

RESUMO

The genetic architecture of asthma was relatively well explored. However, some work remains in the field to improve our understanding on asthma genetics, especially in non-Caucasian populations and with regards to commonly neglected genetic variants, such as Copy Number Variations (CNVs). In the present study, we investigated the contribution of CNVs on asthma risk among Latin Americans. CNVs were inferred from SNP genotyping data. Genome wide burden and association analyses were conducted to evaluate the impact of CNVs on asthma outcome. We found no significant difference in the numbers of CNVs between asthmatics and non-asthmatics. Nevertheless, we found that CNVs are larger in patients then in healthy controls and that CNVs from cases intersect significantly more genes and regulatory elements. We also found that a deletion at 6p22.1 is associated with asthma symptoms in children from Salvador (Brazil) and in young adults from Pelotas (Brazil). To support our results, we conducted an in silico functional analysis and found that this deletion spans several regulatory elements, including two promoter elements active in lung cells. In conclusion, we found robust evidence that CNVs could contribute for asthma susceptibility. These results uncover a new perspective on the influence of genetic factors modulating asthma risk.


Assuntos
Asma/genética , Deleção Cromossômica , Cromossomos Humanos Par 6/genética , Dosagem de Genes , Predisposição Genética para Doença , Polimorfismo de Nucleotídeo Único , Adulto , Asma/etnologia , Brasil/etnologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino
18.
Med Care ; 56(11): 919-926, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30216201

RESUMO

BACKGROUND: This paper provides statewide estimates on health care access and utilization patterns and physical and behavioral health by citizenship and documentation status among Latinos in California. METHODS: This study used data from the 2011-2015 California Health Interview Survey to examine health care access and utilization and physical and behavioral health among a representative sample of all nonelderly Latino and US-born non-Latino white adults (N=51,386). Multivariable regressions estimated the associations between the dependent measures and citizenship/documentation status among Latinos (US-born, naturalized citizen, green card holder, and undocumented). RESULTS: Adjusted results from multivariable analyses observed worse access and utilization patterns among immigrant Latinos compared with US-born Latinos, with undocumented immigrants using significantly less health care. Undocumented Latinos had lower odds of self-reporting excellent/very good health status compared with US-born Latinos, despite them having lower odds of having several physical and behavioral health outcomes (overweight/obesity, physician-diagnosed hypertension, asthma, self-reported psychological distress, and need for behavioral health services). Among those reporting a need for behavioral health services, access was also worse for undocumented Latinos when compared with US-born Latinos. CONCLUSIONS: Patterns of poor health care access and utilization and better physical and behavioral health are observed across the continuum of documentation status, with undocumented immigrants having the worst access and utilization patterns and less disease. Despite fewer reported diagnoses and better mental health, undocumented Latinos reported poorer health status than their US-born counterparts.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Hispano-Americanos/estatística & dados numéricos , Saúde Mental/etnologia , Imigrantes Indocumentados/estatística & dados numéricos , Adolescente , Adulto , Asma/etnologia , California , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Hipertensão/etnologia , Masculino , Pessoa de Meia-Idade , Sobrepeso/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Fatores Socioeconômicos , Estresse Psicológico/etnologia , Adulto Jovem
19.
Pediatrics ; 142(4)2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30185428

RESUMO

: media-1vid110.1542/5804911922001PEDS-VA_2017-3737Video Abstract BACKGROUND: African American adolescents appear to be the most at risk for asthma morbidity and mortality even compared with other minority groups, yet there are few successful interventions for this population that are used to target poorly controlled asthma. METHODS: African American adolescents (age 12-16 years) with moderate-to-severe persistent asthma and ≥1 inpatient hospitalization or ≥2 emergency department visits in 12 months were randomly assigned to Multisystemic Therapy-Health Care or an attention control group (N = 167). Multisystemic Therapy-Health Care is a 6-month home- and community-based treatment that has been shown to improve illness management and health outcomes in high-risk adolescents by addressing the unique barriers for each individual family with cognitive behavioral interventions. The attention control condition was weekly family supportive counseling, which was also provided for 6 months in the home. The primary outcome was lung function (forced expiratory volume in 1 second [FEV1]) measured over 12 months of follow-up. RESULTS: Linear mixed-effects models revealed that compared with adolescents in the comparison group, adolescents in the treatment group had significantly greater improvements in FEV1 secondary outcomes of adherence to controller medication, and the frequency of asthma symptoms. Adolescents in the treatment group had greater reductions in hospitalizations, but there were no differences in reductions in emergency department visits. CONCLUSIONS: A comprehensive family- and community-based treatment significantly improved FEV1, medication adherence, asthma symptom frequency, and inpatient hospitalizations in African American adolescents with poorly controlled asthma. Further evaluation in effectiveness and implementation trials is warranted.


Assuntos
Afro-Americanos/etnologia , Antiasmáticos/uso terapêutico , Asma/etnologia , Asma/terapia , Serviços de Saúde Comunitária/métodos , Adesão à Medicação/psicologia , Adolescente , Antiasmáticos/farmacologia , Asma/psicologia , Criança , Aconselhamento/métodos , Feminino , Seguimentos , Volume Expiratório Forçado/efeitos dos fármacos , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Resultado do Tratamento
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