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1.
MMWR Surveill Summ ; 70(5): 1-32, 2021 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-34529643

RESUMO

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.


Assuntos
Asma/epidemiologia , Disparidades nos Níveis de Saúde , Vigilância da População , Adolescente , Adulto , Distribuição por Idade , Idoso , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Asma/etnologia , Asma/terapia , Criança , Pré-Escolar , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , População Rural/estatística & dados numéricos , Distribuição por Sexo , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos , Adulto Jovem
3.
Andes Pediatr ; 92(2): 226-233, 2021 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-34106161

RESUMO

INTRODUCTION: The prevalence of asthma in Chile ranges from 10.2 to 14.9%. In previous studies, the Araucanía Region has not been included. OBJECTIVE: To determine the prevalence of asthma in the school po pulation of the Araucanía Region. SUBJECTS AND METHOD: The ISAAC questionnaires were used for asthma symptoms in addition to a questionnaire for recording sociodemographic data, belonging to the Mapuche ethnicity, type of heating, exposure to indoor air pollution, and family history. The Binomial Regression Model was used to evaluate the effect of each of the different variables of inter est, adjusting by age groups (6-7 and 13-14 years). The model also evaluated the additive interaction between these variables and age. RESULTS: 823 surveys were applied, where the prevalence of asthma was 14.2% and 23.2% in the 6-7 year old group and the 13-14 year old group, respectively. 43.7% de clare to be Mapuche, 32.9% live in rural areas, and 81.4% use firewood as a heating method. Through binomial regression model analysis, where for the study group, living in the coastal commune was significantly associated with a lower prevalence of asthma (-13.2% [CI: -17.7 to -8.6]. The history of an asthmatic mother was significantly associated with a higher prevalence of asthma (17.9% [CI: 2.7 to 33.1]. Living in a rural area, to be Mapuche or the type of heating used, showed differences statistically significant (p 0.18, p 0.609 and p 0.480, respectively) Conclusion: 13-14 year-olds school children in the Araucanía Region presented a higher prevalence of asthma. There was an association with asthma in the mother where this increase is not associated with living in a rural area, to be Ma puche or type of heating.


Assuntos
Asma/epidemiologia , Povos Indígenas/estatística & dados numéricos , Distribuição por Idade , Fatores Etários , Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Asma/etnologia , Criança , Chile/epidemiologia , Chile/etnologia , Estudos Transversais , Feminino , Calefação/métodos , Humanos , Mães , Prevalência , Fatores de Risco , População Rural
4.
N Z Med J ; 134(1533): 80-95, 2021 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-33927426

RESUMO

AIM: To document trends in number and cost of asthma hospital admissions and asthma prescriptions in children (0-14 years) from 2010-2019 in New Zealand. METHOD: A retrospective analysis of public hospital admission and pharmaceutical prescription data. RESULTS: The dataset included 39,731 hospitalisations with asthma as a discharge diagnosis and 5,512,856 prescriptions for asthma medication in children ≤14 years old. From 2010 to 2019, there was a 45% reduction in the number of asthma hospitalisations and an 18% reduction in prescriptions attributable to asthma. Declines were evident for both Maori and non-Maori children. However, Maori children were hospitalised with asthma at twice the rate of non-Maori children (7.2/1,000 versus 3.5/1,000, p<0.001), and a larger proportion of Maori children had an asthma readmission within 90 days of their first admission (18% versus 14%, p <0.001). Asthma admission rates for children from families living in the highest deprivation areas were, on average, 2.8 times higher than in the least deprived areas. We estimate that the combined cost of asthma hospitalisations and prescriptions was $165m. Of this, $103m was for hospital admissions and $62m was for prescriptions. CONCLUSIONS: Although hospitalisations and prescriptions attributable to asthma have declined, there are clear inequities in the health outcomes of New Zealand children with asthma. Our analysis indicates that many New Zealand children, particularly Maori children and those living in areas of high deprivation, are not receiving levels of primary care for asthma that are consistent with prevention.


Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Asma/economia , Hospitalização/economia , Pobreza/economia , Medicamentos sob Prescrição/economia , Adolescente , Antiasmáticos/economia , Asma/epidemiologia , Asma/etnologia , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Política de Saúde , Humanos , Incidência , Lactente , Tempo de Internação , Nova Zelândia/epidemiologia , Estudos Retrospectivos , Estações do Ano
5.
Thorax ; 76(6): 539-546, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33419952

RESUMO

BACKGROUND: Australia has one of the highest rates of asthma worldwide. Indigenous children have a particularly high burden of risk determinants for asthma, yet little is known about the asthma risk profile in this population. AIM: To identify and quantify potentially preventable risk factors for hospitalised asthma in Australian Aboriginal children (1-4 years of age). METHODS: Birth, hospital and emergency data for all Aboriginal children born 2003-2012 in Western Australia were linked (n=32 333). Asthma was identified from hospitalisation codes. ORs and population attributable fractions were calculated for maternal age at birth, remoteness, area-level disadvantage, prematurity, low birth weight, maternal smoking in pregnancy, mode of delivery, maternal trauma and hospitalisations for acute respiratory tract infection (ARTI) in the first year of life. RESULTS: There were 705 (2.7%) children hospitalised at least once for asthma. Risk factors associated with asthma included: being hospitalised for an ARTI (OR 4.06, 95% CI 3.44 to 4.78), area-level disadvantage (OR 1.58, 95% CI 1.28 to 1.94), being born at <33 weeks' gestation (OR 3.30, 95% CI 2.52 to 4.32) or birth weight <1500 g (OR 2.35, 95% CI 1.39 to 3.99). The proportion of asthma attributable to an ARTI was 31%, area-level disadvantage 18%, maternal smoking 5%, and low gestational age and birth weight were 3%-7%. We did not observe a higher risk of asthma in those children who were from remote areas. CONCLUSION: Improving care for pregnant Aboriginal women as well as for Aboriginal infants with ARTI may help reduce the burden of asthma in the Indigenous population.


Assuntos
Asma/prevenção & controle , Hospitalização/estatística & dados numéricos , Pacientes Internados , Vigilância da População/métodos , Medição de Risco/métodos , Asma/etnologia , Austrália/epidemiologia , Pré-Escolar , Feminino , Seguimentos , Humanos , Incidência , Lactente , Masculino , Estudos Retrospectivos , Fatores de Risco
6.
Prim Care ; 48(1): 67-81, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33516425

RESUMO

This article describes hematologic, nutritional, allergic/asthmatic conditions, lead screening, and management of these among immigrants and refugees. Some of these conditions present more frequently or differently in the newcomer population. Early identification and treatment are key to improving health outcomes. Screening and treatment suggested in this article are based on current guidelines and are intended for primary care providers who are caring for refugee and immigrant patients, especially within a medical home. Special considerations include level of education, instruction, demonstration, and cultural humility.


Assuntos
Emigrantes e Imigrantes , Programas de Rastreamento/organização & administração , Refugiados , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/etnologia , Asma/diagnóstico , Asma/etnologia , Doenças Transmissíveis/diagnóstico , Doenças Transmissíveis/etnologia , Características Culturais , Dieta/etnologia , Testes Hematológicos , Humanos , Hipersensibilidade/diagnóstico , Hipersensibilidade/etnologia , Testes de Função Renal , Chumbo/sangue , Testes de Função Hepática , Programas de Rastreamento/normas , Medição de Risco , Estados Unidos/epidemiologia
7.
J Asthma ; 58(6): 742-749, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-32072838

RESUMO

Objective: Self-efficacy is the personal belief that a behavior can produce a desired result; and in asthma, self-efficacy in asthma care has been related to improvements in asthma outcomes and children's quality of life. To appreciate the full burden of asthma on families, the relationship between parental self-efficacy and quality of life also needs further study. We aim to characterize this relationship.Methods: Secondary analysis of measurements of parents of children with persistent asthma (n = 252; ages 4-17 years) from a large urban area were identified from a randomized trial; the association between baseline assessments of parental quality of life, measured by the Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ), and parental self-efficacy, measured through the Parental Asthma Management Self-Efficacy Scale (PAMSES), were examined through multivariable linear regression.Results: Parental self-efficacy in asthma was positively associated with quality of life among parents of racially and ethnically diverse children (p = 0.01). Confidence in using medications correctly (p = 0.03), having inhalers during a child's serious breathing problem (p = 0.02), and knowing which medications to use during a child's serious breathing problem (p = 0.04) were associated with a clinically meaningful difference in parental quality of life. Other significant factors associated with parental quality of life included Hispanic/Latino ethnicity (p < 0.01) of the child and Asthma Control Test scores (p < 0.01).Conclusion: The findings suggest that improving parental confidence on when and how to use their child's asthma medications, particularly during an asthma attack, might be clinically meaningful in enhancing parent's quality of life.


Assuntos
Asma/tratamento farmacológico , Asma/epidemiologia , Broncodilatadores/uso terapêutico , Pais/psicologia , Autoeficácia , Adolescente , Corticosteroides/uso terapêutico , Asma/etnologia , Broncodilatadores/administração & dosagem , Criança , Pré-Escolar , Estudos Transversais , Quimioterapia Combinada , Feminino , Humanos , Masculino , Aplicativos Móveis , Nebulizadores e Vaporizadores , Qualidade de Vida , Testes de Função Respiratória , Fatores Socioeconômicos
8.
J Asthma ; 58(3): 405-412, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-31749394

RESUMO

OBJECTIVES: In New York City, asthma prevalence is greater in Hispanics than non-Hispanics for both children (10.9% vs. 7.4%) and adults (9.0% vs. 6.3%). Disparities in asthma management among Hispanics are found to arise, in part, from a limited education about asthma. Using elements of Community Based Participatory Research (CBPR), we worked with the community to identify asthma priorities and misconceptions among Hispanics and used that information to develop a tailored asthma educational tool-the Asthma Training Modules (ATMs). METHODS: Over the past 3 years (2016, 2017, and 2018), we conducted educational asthma workshops to collect and analyze information to develop the ATMs and a summary of the ATMs in an Asthma Educational Card (AEC). We trained 6 Asthma-Community-Leaders using the ATMs, who assembled community members for teaching sessions using the AEC. Participants completed a pre-and-post asthma knowledge questionnaire. RESULTS: We identified asthma priorities and misconceptions themed on: culturally relevant resources for Hispanics, symptom and trigger recognition, and treatments. A total of 104 participants attended the teaching sessions led by Asthma-Community-Leaders and participants' mean knowledge score increased from 64% pre-teaching to 85% post-teaching, (p < 0.01). CONCLUSION: Our community-led education, which included a tailored asthma educational tool and trained Asthma-Community-Leaders, successfully improved asthma knowledge among Hispanics. Further studies are warranted to determine whether these results are reproducible among a larger cohort and what the comparative effectiveness of our intervention as compared to other education-based interventions.


Assuntos
Asma/etnologia , Educação em Saúde/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , /educação , Participação da Comunidade , Pesquisa Participativa Baseada na Comunidade , Competência Cultural , Humanos , Cidade de Nova Iorque/epidemiologia , Fatores Socioeconômicos
9.
J Asthma ; 58(7): 939-945, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-32189532

RESUMO

OBJECTIVE: This study explored the associations of asthma and long-term asthma control medication with tooth wear among American adolescents and young adults. METHODS: Data from 2186 participants of the National Health and Nutrition Examination Survey (NHANES) were used. Asthma and prescribed long-term medication were collected through questionnaires. The number of surfaces with tooth wear was determined during clinical examinations. Associations were tested in Hurdle regression models adjusting for confounders. RESULTS: The prevalence of tooth wear was 58%, with an average of 6.1 (SD: 4.0) surfaces affected among those with the condition. The prevalence of asthma was 10.3%, with 2.9% of participants using long-term medication for asthma control. In the adjusted regression model, asthma was not associated with tooth wear. However, long-term control medication was associated with greater odds of having tooth wear (odds ratio: 3.33; 95%CI: 1.24-8.97), but it was not associated with the number of surfaces with tooth wear among those with the condition (rate ratio: 1.01; 95% CI: 0.58-1.75). CONCLUSION: This cross-sectional analysis of national data shows that taking long-term asthma medication was positively associated with having tooth wear.


Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Asma/epidemiologia , Desgaste dos Dentes/epidemiologia , Adolescente , Adulto , Antiasmáticos/administração & dosagem , Antiasmáticos/efeitos adversos , Asma/etnologia , Bebidas Gaseificadas/estatística & dados numéricos , Criança , Estudos Transversais , Feminino , Refluxo Gastroesofágico/epidemiologia , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Odontológico/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Fatores Socioeconômicos , Desgaste dos Dentes/etnologia , Estados Unidos , Adulto Jovem
10.
J Asthma ; 58(4): 430-437, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-31877060

RESUMO

OBJECTIVES: We sought to update the prevalence estimates of parent-reported asthma diagnosis by Environmental Tobacco Smoke (ETS) exposure in the United States (US) pediatric population. METHODS: This cross-sectional study included 71,811 families with children who participated in the 2016-2017 National Survey of Children's Health (NSCH). Weighted asthma prevalence estimates were calculated for ETS-exposed and non-exposed children. Chi-square analysis compared asthma prevalence between the two exposure groups and logistic regression analysis generated adjusted odds ratios (aORs) of asthma diagnosis by ETS exposure by sex, race/ethnicity, and household education and income level. RESULTS: Asthma prevalence estimates were significantly higher in ETS-exposed vs. non-exposed children (10.7% vs. 7.8%, p < 0.001). Children with a smoker in the house are 30% more likely to have an asthma diagnosis vs. children with no smokers in the house (aOR 1.29, 95% Confidence Interval [CI] 1.09-1.52). Significant predictors for ETS exposure included < high school education and lower family income. Conversely, non-Hispanic black and Hispanic children were less likely to have ETS exposure vs. non-Hispanic white children. CONCLUSIONS: ETS exposure is a significant risk factor for asthma in the US pediatric population. Smoking cessation initiatives targeting non-Hispanic white parents from lower socioeconomic may improve children's chronic pulmonary health risk.


Assuntos
Asma/epidemiologia , Poluição por Fumaça de Tabaco/estatística & dados numéricos , Adolescente , Fatores Etários , Asma/etnologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Prevalência , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos
11.
Fam Community Health ; 44(1): 32-42, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33055573

RESUMO

Black children are twice as likely as non-Hispanic white children to have asthma due to an interplay of socioeconomic, historical, and industrial factors. The underlying socio-economic and structural inequities result in poor adherence to recommended asthma management treatments. National guidelines suggest asthma action plans (AAPs) as a tool for patient self-management, yet they remain underutilized. Boot Camp Translation (BCT), rooted in community-based participatory research, provides a method for engaging communities to improve health literacy. This article describes the successful use of BCT to develop a culturally relevant AAP promotion campaign in West Louisville, a predominantly Black community that experiences social and health disparities.


Assuntos
Afro-Americanos/estatística & dados numéricos , Asma/etnologia , Assistência à Saúde Culturalmente Competente , Letramento em Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde/métodos , Asma/prevenção & controle , Criança , Pesquisa Participativa Baseada na Comunidade , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Humanos , Adesão à Medicação , Desenvolvimento de Programas , Indicadores de Qualidade em Assistência à Saúde , População Urbana
12.
J Asthma ; 58(9): 1261-1269, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-32493146

RESUMO

OBJECTIVE: Asthma, a major cause of disability and reduced quality of life, has a high global prevalence and burden of death. Despite the propitious guidelines, a substantial portion of asthmatics reportedly have poorly controlled disease. In the current study, we have examined risk factors for uncontrolled asthma in specialty clinics and its association with impaired quality of life. METHODS: A multicentre cross-sectional survey of asthma patients, 18 years and older, was conducted in Trinidad. Asthma Control Test (ACT) and the Juniper Mini Asthma Quality of Life Questionnaire (Mini AQLQ-J) were used to assess the disease control and quality of life, respectively. Data were analyzed using the Chi-square test and multivariable logistic regression controlling for gender. RESULTS: Of a total of 428 patients included, asthma was uncontrolled in 72.4% and asthma related quality of life was moderate to severely impaired in 86% of the studied population. In the multivariate regression models, poorly controlled asthma was associated with obesity (OR 2.25; 95% CI 1.30-3.39), late-onset asthma (OR 1.72; 95% CI 1.04-2.84), features of sleep apnea (OR 1.77; 95% CI 1.01-3.07) and depression (OR 2.01; 95% CI 1.04-3.86). Impaired quality of life was associated with Indo-Caribbean ethnicity (OR 3.19; 95% CI = 1.68-6.06). CONCLUSIONS: In this Caribbean population, uncontrolled asthma was independently associated with obesity, late-onset disease, and comorbidities of sleep apnea and depression. Poor asthma-related quality of life was independently associated with Indo-Caribbean ethnicity.


Assuntos
Asma/epidemiologia , Depressão/epidemiologia , Obesidade/epidemiologia , Síndromes da Apneia do Sono/epidemiologia , Adolescente , Adulto , Idade de Início , Idoso , Asma/etnologia , Comorbidade , Estudos Transversais , Depressão/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Qualidade de Vida , Fatores de Risco , Síndromes da Apneia do Sono/etnologia , Inquéritos e Questionários , Trinidad e Tobago/epidemiologia , Trinidad e Tobago/etnologia , Adulto Jovem
13.
J Ethnopharmacol ; 269: 113558, 2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33186702

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Asthma is a costly global health problem that negatively influences the quality of life of patients. The Chinese Materia Medica (CMM) contains remedies that have been used for the treatment of asthma for millennia. This article strives to systematically summarize the current research progress so that more comprehensive examinations of various databases related to CMM anti-asthma drugs, can be performed, so as to sequentially provide effective basic data for development and application of anti-asthma drugs based on the CMM. MATERIALS AND METHODS: The research data published over the past 20 years for asthma treatment based on traditional CMM remedies were retrieved and collected from libraries and online databases (PubMed, ScienceDirect, Elsevier, Spring Link, Web of Science, PubChem Compound, Wan Fang, CNKI, Baidu, and Google Scholar). Information was also added from classic CMM, literature, conference papers on classic herbal formulae, and dissertations (PhD or Masters) based on traditional Chinese medicine. RESULTS: This review systematically summarizes the experimental studies on the treatment of asthma with CMM, covering the effective chemical components, typical asthma models, important mechanisms and traditional anti-asthma CMM formulae. The therapy value of the CMM for anti-asthma is clarified, and the original data and theoretical research foundation are provided for the development of new anti-asthmatic data and research for the CMM. CONCLUSIONS: Substantial progress against asthma has been made through relevant experimental research based on the CMM. These advances improved the theoretical basis of anti-asthma drugs for CMM and provided a theoretical basis for the application of a asthma treatment that is unique. By compiling these data, it is expected that the CMM will now contain a clearer mechanism of action and a greater amount of practical data that can be used for future anti-asthma drug research.


Assuntos
Asma/tratamento farmacológico , Asma/etnologia , Medicamentos de Ervas Chinesas/uso terapêutico , Materia Medica/uso terapêutico , Medicina Tradicional Chinesa/métodos , Animais , China/etnologia , Humanos , Medicina Tradicional Chinesa/tendências
14.
J Asthma ; 58(10): 1395-1406, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-32546119

RESUMO

BACKGROUND: Asthma disproportionately impacts youth from marginalized minority backgrounds. Aspects of core asthma management (asthma management and medication beliefs) were examined among a cohort of diverse families. METHODS: Caregiver-youth dyads (N = 92; Mage= 13.8 years; non-Hispanic/Latinx White (NLW) = 40%; Black/African-American = 25%; Hispanic/Latinx= 35%) completed a medication beliefs questionnaire (Medication Necessity, Medication Concerns) and a semi-structured interview (Family Asthma Management System Scale (FAMSS)). FAMSS subscales (Asthma Knowledge, Symptom Assessment, Family Response to Symptoms, Child Response to Symptoms, Environmental Control, Medication Adherence, Family-Provider Collaboration, and Balanced Integration) were used for analyses. RESULTS: More Hispanic/Latinx families were at or below the poverty line (75%) relative to NLW (22%) and Black/African-American (39%) families (p < 0.001). Adherence (p < 0.01), Knowledge (p < 0.001), and Symptom Assessment (p < 0.01) were higher for NLW relative to Black/African-American families. Collaboration was higher among NLW (p = 0.01) and Hispanic/Latinx families (p = 0.05). Effect sizes were moderate (η2= 0.10-0.12). Parental race/ethnicity moderated the relationship between adherence and parental perceived medication concern and necessity for NLW and Hispanic/Latinx families. As medication concerns increased, medication adherence decreased, however, only for NLW and Hispanic/Latinx families. CONCLUSIONS: In this sample, racial/ethnic differences emerged for elements of asthma management. Interview-based ratings of asthma management among Black/African-American families depicted lower asthma knowledge, lower levels of family-provider collaboration, and lower medication adherence. The relationship between medication concerns and adherence appeared to differ by ethnic group. Future research is needed to elucidate cultural factors that influence family-provider relationships and health-related behaviors, like medication use/adherence.


Assuntos
Asma/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Relações Profissional-Família , /estatística & dados numéricos , Adolescente , Afro-Americanos , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Feminino , Humanos , Masculino , Adesão à Medicação , Pobreza , Estudos Prospectivos , Características de Residência , Fatores Socioeconômicos , Avaliação de Sintomas
15.
JAMA Netw Open ; 3(11): e2025134, 2020 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-33175177

RESUMO

Importance: Adults who belong to racial/ethnic minority groups are more likely than White adults to receive a diagnosis of chronic disease in the United States. Objective: To evaluate which health indicators have improved or become worse among Black and Hispanic middle-aged and older adults since the Minority Health and Health Disparities Research and Education Act of 2000. Design, Setting, and Participants: In this repeated cross-sectional study, a total of 4 856 326 records were extracted from the Behavioral Risk Factor Surveillance System from January 1999 through December 2018 of persons who self-identified as Black (non-Hispanic), Hispanic (non-White), or White and who were 45 years or older. Exposure: The 1999 legislation to reduce racial/ethnic health disparities. Main Outcomes and Measures: Poor health indicators and disparities including major chronic diseases, physical inactivity, uninsured status, and overall poor health. Results: Among the 4 856 326 participants (2 958 041 [60.9%] women; mean [SD] age, 60.4 [11.8] years), Black adults showed an overall decrease indicating improvement in uninsured status (ß = -0.40%; P < .001) and physical inactivity (ß = -0.29%; P < .001), while they showed an overall increase indicating deterioration in hypertension (ß = 0.88%; P < .001), diabetes (ß = 0.52%; P < .001), asthma (ß = 0.25%; P < .001), and stroke (ß = 0.15%; P < .001) during the last 20 years. The Black-White gap (ie, the change in ß between groups) showed improvement (2 trend lines converging) in uninsured status (-0.20%; P < .001) and physical inactivity (-0.29%; P < .001), while the Black-White gap worsened (2 trend lines diverging) in diabetes (0.14%; P < .001), hypertension (0.15%; P < .001), coronary heart disease (0.07%; P < .001), stroke (0.07%; P < .001), and asthma (0.11%; P < .001). Hispanic adults showed improvement in physical inactivity (ß = -0.28%; P = .02) and perceived poor health (ß = -0.22%; P = .001), while they showed overall deterioration in hypertension (ß = 0.79%; P < .001) and diabetes (ß = 0.50%; P < .001). The Hispanic-White gap showed improvement in coronary heart disease (-0.15%; P < .001), stroke (-0.04%; P < .001), kidney disease (-0.06%; P < .001), asthma (-0.06%; P = .02), arthritis (-0.26%; P < .001), depression (-0.23%; P < .001), and physical inactivity (-0.10%; P = .001), while the Hispanic-White gap worsened in diabetes (0.15%; P < .001), hypertension (0.05%; P = .03), and uninsured status (0.09%; P < .001). Conclusions and Relevance: This study suggests that Black-White disparities increased in diabetes, hypertension, and asthma, while Hispanic-White disparities remained in diabetes, hypertension, and uninsured status.


Assuntos
Asma/etnologia , Diabetes Mellitus/etnologia , Disparidades nos Níveis de Saúde , Hipertensão/etnologia , Pessoas sem Cobertura de Seguro de Saúde/etnologia , Saúde das Minorias/tendências , Comportamento Sedentário/etnologia , Afro-Americanos/estatística & dados numéricos , Idoso , Artrite/etnologia , Doença das Coronárias/etnologia , Estudos Transversais , Depressão/etnologia , Feminino , Indicadores Básicos de Saúde , Humanos , Seguro Saúde/tendências , Nefropatias/etnologia , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/etnologia , Estados Unidos/epidemiologia , /estatística & dados numéricos
16.
Artigo em Inglês | MEDLINE | ID: mdl-33171864

RESUMO

Racial and ethnic minority subpopulations experience a disproportionate burden of asthma and adverse childhood experiences (ACEs). These disparities result from systematic differences in risk exposure, opportunity access, and return on resources, but we know little about how accumulated differentials in ACEs may be associated with adult asthma by racial/ethnic groups. We used Behavioral Risk Factor Surveillance System data (N = 114,015) from 2009 through 2012 and logistic regression to examine the relationship between ACEs and adult asthma using an intersectional lens, investigating potential differences for women and men aged 18 and older across seven racial/ethnic groups. ACEs were significantly related to asthma, adjusting for race/ethnicity and other covariates. Compared to the reference group (Asians), asthma risk was significantly greater for Black/African American, American Indian and Alaska Native (AIAN), White, and multiracial respondents. In sex-stratified interactional models, ACEs were significantly related to asthma among women. The relationship between ACEs and asthma was significantly weaker for Black/African American and AIAN women compared to the reference group (Asian women). The findings merit attention for the prevention and early detection of ACEs to mitigate long-term health disparities, supporting standardized screening and referrals in clinical settings, evidence-based prevention in communities, and the exploration of strategies to buffer the influence of adversities in health.


Assuntos
Adultos Sobreviventes de Eventos Adversos na Infância/psicologia , Experiências Adversas da Infância/etnologia , Asma/epidemiologia , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Asma/etnologia , Sistema de Vigilância de Fator de Risco Comportamental , Criança , Feminino , Disparidades em Assistência à Saúde/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Índice de Gravidade de Doença , Distribuição por Sexo , Classe Social , Determinantes Sociais da Saúde , Adulto Jovem
17.
BMC Med Genet ; 21(1): 232, 2020 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-33228581

RESUMO

BACKGROUND: Previous studies evaluated the association of IL-4 C33T polymorphism and risk of bronchial asthma but failed to establish a consistent conclusive association. In the present meta-analysis, we intend to define a more reliable estimate of the association in the presence of filling published literature. METHODS: An exhaustive search in Web of Science, Scopus, and PubMed databases was performed to identify all relevant publications before September 2020, and 24 publications (28 studies) with 6587 cases and 8408 controls were included in final analysis. The association between polymorphism and risk of asthma were measured by Odd ratios (ORs) and 95% confidence intervals (CIs). Moreover, Cochran's Q and the I2 statistics were used to evaluate the degree of heterogeneity between studies. RESULTS: In the overall study populations, a significant positive association was detected under all genotype models and announced the IL-4 C33T polymorphism as a potential risk factor in the pathogenesis of asthma. In the subgroup analysis by age, a significant association between IL-4 C33T polymorphism and risk of asthma in different age groups was identified in allelic model, which highlighted the predisposing role of the T allele for the asthma risk in all three age groups. Furthermore, the results of subgroup analysis by continent were heterogenous. Accordingly, IL-4 C33T polymorphism was a risk factor in Europeans (all models except heterozygote comparison), Americans (all models except recessive and homozygote comparison) and Asians (just recessive and allelic model). Finally, the ethnicity-specific analysis disclosed a significant association between IL-4 C33T polymorphism and asthma risk in Caucasians (all genotype models except heterozygote comparison), while this association was not significant in African-Americans. CONCLUSIONS: This study suggests that IL-4 C33T polymorphism potentially acts as a risk factor for asthma in different ethnicities and age groups.


Assuntos
Asma/genética , Predisposição Genética para Doença , Interleucina-4/genética , Polimorfismo de Nucleotídeo Único , Fatores Etários , Alelos , Asma/diagnóstico , Asma/etnologia , Asma/imunologia , Estudos de Casos e Controles , Expressão Gênica , Frequência do Gene , Humanos , Interleucina-4/imunologia , Razão de Chances , Fatores de Risco
18.
BMC Pulm Med ; 20(1): 305, 2020 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-33213402

RESUMO

BACKGROUND: As a main line of defense of the respiratory tract, the airway epithelium plays an important role in the pathogenesis of asthma. CDHR3 and EMSY were reported to be expressed in the human airway epithelium. Although previous genome-wide association studies found that the two genes were associated with asthma susceptibility, similar observations have not been made in the Chinese Han population. METHODS: A total of 300 asthma patients and 418 healthy controls unrelated Chinese Han individuals were enrolled. Tag-single nucleotide polymorphisms (Tag-SNPs) were genotyped and the associations between SNPs and asthma risk were analyzed by binary logistic regression analysis. RESULTS: After adjusting for confounding factors, the A allele of rs3847076 in CDHR3 was associated with increased susceptibility to asthma (OR = 1.407, 95% CI: 1.030-1.923). For the EMSY gene, the T alleles of both rs2508746 and rs12278256 were related with decreased susceptibility to asthma (additive model: OR = 0.718, 95% CI: 0.536-0.961; OR = 0.558, 95% CI: 0.332-0.937, respectively). In addition, the GG genotype of rs1892953 showed an association with increased asthma risk under the recessive model (OR = 1.667, 95% CI: 1.104-2.518) and the GATCTGAGT haplotype in EMSY was associated with reduced asthma risk (P = 0.037). CONCLUSIONS: This study identified novel associations of rs3847076 in CDHR3, as well as rs1892953, rs2508746 and rs12278256 in EMSY with adult asthma susceptibility in the Chinese Han population. Our observations suggest that CDHR3 and EMSY may play important roles in the pathogenesis of asthma in Chinese individuals. Further study with larger sample size is needed.


Assuntos
Asma/genética , Caderinas/genética , Células Epiteliais/patologia , Proteínas de Membrana/genética , Proteínas de Neoplasias/genética , Proteínas Nucleares/genética , Proteínas Repressoras/genética , Mucosa Respiratória/patologia , Adulto , Alelos , Asma/etnologia , Proteínas Relacionadas a Caderinas , Caderinas/fisiologia , Estudos de Casos e Controles , Suscetibilidade a Doenças , Feminino , Genótipo , Humanos , Modelos Logísticos , Masculino , Proteínas de Membrana/fisiologia , Pessoa de Meia-Idade , Proteínas de Neoplasias/fisiologia , Proteínas Nucleares/fisiologia , Polimorfismo de Nucleotídeo Único , Proteínas Repressoras/fisiologia
19.
BMC Pulm Med ; 20(1): 303, 2020 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-33208131

RESUMO

BACKGROUND: Asthma is a common chronic lung disease in children. We aimed to determine the associations between stress-induced phosphoprotein 1 (STIP1) and glucocorticoid-induced transcript 1 (GLCCI1) polymorphisms and susceptibility of childhood asthma and inhaled corticosteroid (ICS) response in children. METHODS: A total of 263 Chinese Han asthmatic children were recruited from the Xiangya Hospital, Central South University. Pulmonary function tests were performed before the treatment and 3 months after the treatment. One hundred fifty non-asthmatic children were recruited. Each participant's DNA was extracted from the peripheral blood and Method of MassARRAY was used to genotype the single-nucleotide polymorphisms (SNPs). RESULTS: STIP1 rs2236647 wild-type homozygote (CC) was associated with increased asthma risk of children (OR = 1.858, 95% CI:1.205-2.864), but not associated with the ICS response. GLCCI1 rs37969, rs37972 and rs37973 polymorphisms were not associated with the risk of childhood asthma. However, rs37969 mutant genotypes (TT/GT) were significantly associated with less improvement in PD20 (p = 0.028). We also found significant associations between rs37969, rs37972 and rs37973 mutant genotypes and less improvement in maximal midexpiratory flow (MMEF) after ICS treatment for 3 months (p = 0.036, p = 0.010 and p = 0.003, respectively). CONCLUSIONS: STIP1 rs2236647 was associated with asthma risk of children and GLCCI1 rs37969 mutant genotypes were associated with less improvement in airway hyper-responsiveness. GLCCI1 rs37969, rs37972 and rs37973 polymorphisms might be associated with pulmonary function in childhood asthma patients after ICS treatment.


Assuntos
Corticosteroides/administração & dosagem , Asma/tratamento farmacológico , Asma/genética , Proteínas de Choque Térmico/genética , Receptores de Glucocorticoides/genética , Administração por Inalação , Asma/etnologia , Asma/fisiopatologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Suscetibilidade a Doenças , Feminino , Genótipo , Humanos , Masculino , Mutação , Polimorfismo de Nucleotídeo Único , Testes de Função Respiratória
20.
PLoS One ; 15(11): e0242364, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33237978

RESUMO

BACKGROUND: Mitochondria support critical cellular functions, such as energy production through oxidative phosphorylation, regulation of reactive oxygen species, apoptosis, and calcium homeostasis. OBJECTIVE: Given the heightened level of cellular activity in patients with asthma, we sought to determine whether mitochondrial DNA (mtDNA) copy number measured in peripheral blood differed between individuals with and without asthma. METHODS: Whole genome sequence data was generated as part of the Trans-Omics for Precision Medicine (TOPMed) Program on participants from the Study of Asthma Phenotypes and Pharmacogenomic Interactions by Race-ethnicity (SAPPHIRE) and the Study of African Americans, Asthma, Genes, & Environment II (SAGE II). We restricted our analysis to individuals who self-identified as African American (3,651 asthma cases and 1,344 controls). Mitochondrial copy number was estimated using the sequencing read depth ratio for the mitochondrial and nuclear genomes. Respiratory complex expression was assessed using RNA-sequencing. RESULTS: Average mitochondrial copy number was significantly higher among individuals with asthma when compared with controls (SAPPHIRE: 218.60 vs. 200.47, P<0.001; SAGE II: 235.99 vs. 223.07, P<0.001). Asthma status was significantly associated with mitochondrial copy number after accounting for potential explanatory variables, such as participant age, sex, leukocyte counts, and mitochondrial haplogroup. Despite the consistent relationship between asthma status and mitochondrial copy number, the latter was not associated with time-to-exacerbation or patient-reported asthma control. Mitochondrial respiratory complex gene expression was disproportionately lower in individuals with asthma when compared with individuals without asthma and other protein-encoding genes. CONCLUSIONS: We observed a robust association between asthma and higher mitochondrial copy number. Asthma having an effect on mitochondria function was also supported by lower respiratory complex gene expression in this group.


Assuntos
Afro-Americanos/genética , Asma/genética , Variações do Número de Cópias de DNA , DNA Mitocondrial/genética , Adulto , Asma/etnologia , Sequência de Bases , Estudos de Coortes , DNA Mitocondrial/sangue , Complexo de Proteínas da Cadeia de Transporte de Elétrons/genética , Feminino , Citometria de Fluxo , Humanos , Leucócitos/ultraestrutura , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , RNA/genética , Sensibilidade e Especificidade , Sequenciamento Completo do Genoma , Adulto Jovem
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