Educational program on self-management for asthmatic school children

This study was conducted to improve asthmatic school children's knowledge, belief and behavior related to asthma in order to improve their control of the disease. A total of 54 school children suffering from moderate or severe asthma who are attending the allergy center affiliated to school Students' Hospital of Alexandria were enrolled in the present study. An educational intervention was provided to these asthmatic children, each one was accompanied by one of his/her parents. It consisted of two components: classes conducted in group settings and individualized monthly visits. The intervention continued for a 6-month period. An interview questionnaire was used to assess both children's and parent's knowledge and beliefs related to asthma before and after the intervention. The children's inhaler use technique was also assessed twice by an observational check list. The study revealed significant improvement in both children's and parent's knowledge and beliefs concerning asthma inhaler use technique which significantly improved and positive behavioral changes were reported. The frequency of emergency room visits (ERV) due to asthma over a 6-month period after the initial assessment was substantially less than in the prior 6-month period (p<0.05). It could be concluded that patient education can significantly affect asthmatic's knowledge and behavior and consequently morbidity as revealed by reduction of frequency of ERV. It should be considered one of the major components of asthma care.     

支气管哮喘患儿实施一体化管理模式效果评价

目的探讨一体化管理模式对哮喘患儿的情绪障碍、自我意识及生活质量方面的改善效果,为临床治疗和管理儿童哮喘提供依据。方法选取40例哮喘患儿,实施一体化管理模式(医院-社区-家庭-学校),分别于干预前和干预后6个月对哮喘患儿进行情绪障碍、自我意识及生活质量方面的量表评价,比较哮喘患儿干预前后的效果。结果干预后的焦虑、抑郁、行为等情绪障碍评分均明显低于干预前(P0.05);干预后的行为、智力与学校情况、躯体外貌与属性、焦虑、合群、幸福与满足等评分均明显高于干预前(P0.05);干预后的躯体功能、情绪功能、角色功能、认知功能、社会功能等评分均明显高于干预前(P0.05)。结论实施一体化管理,可明显改善患儿的情绪障碍,提高自我意识和生活质量,能够达到哮喘患儿管理和控制的目的,值得推广。     

Cost-utility of a disease management program for patients with asthma

OBJECTIVES: The long-term cost-utility of a disease management program (DMP) for adults with asthma was assessed compared to usual care. METHODS: A DMP for patients with asthma has been developed and implemented in the region of Maastricht (The Netherlands). By integrating care, the program aims to continuously improve quality of care within existing budgets. A clinical trial was performed over a period of 15 months to collect data on costs and effects of the program and usual care. These data were used to inform a probabilistic decision-analytic model to estimate the 5-year impact of the program beyond follow-up. A societal perspective was adopted, with outcomes assessed in terms of costs per quality-adjusted life-year (QALY). RESULTS: The DMP is associated with a gain in QALYs compared to usual care (2.7+/-.2 versus 3.4+/-.8), at lower costs (3,302+/-314 euro versus 2,973+/-304 euro), thus leading to dominance. The probability that disease management is the more cost-effective strategy is 76 percent at a societal willingness to pay (WTP) for an additional QALY of 0 euro, reaching 95 percent probability at a WTP of 1,000 euro per additional QALY. CONCLUSIONS: Organizing health care according to the principles of disease management for adults with asthma has a high probability of being cost-effective and is associated with a gain in QALYs at lower costs.     

Outcomes for a comprehensive school-based asthma management program

This article describes the evaluation of a comprehensive school-based asthma management program in an inner-city, largely African-American school system. All 54 elementary schools (combined enrollment 13,247 students) from a single urban school system participated in this study. Schools were randomly divided between immediate and delayed intervention programs. The intervention consisted of 3 separate educational programs (for school faculty/staff, students with asthma, and peers without asthma) and medical management for the children with asthma (including an Individual Asthma Action Plan, medications, and peakflow meters). Children with asthma were identified using a case detection program and 736 were enrolled into the intervention study. No significant differences were observed in school absences, grade point average, emergency room visits, or hospitalizations between the immediate and delayed intervention groups. Significant increases in knowledge were observed in the immediate intervention group. This study of a school-based asthma management education and medical intervention program did not show any differences between the intervention and control groups on morbidity outcomes. Our experience leads us to believe that such measures are difficult to impact and are not always reliable. Future researchers should be aware of the problems associated with using such measures. In addition, connecting children with a regular source of health care in this population was difficult. More intensive methods of medical management, such as school-based health centers or supervised asthma therapy, might prove more effective in inner-city schools.     

Factors associated with asthma in school children

To investigate the factors associated with asthma in school children, a case-control study of 203 asthmatic and 203 non-asthmatic children (103 males and 100 females in each group) aged 6 to 18 years, was organized during the period September 1992 to May 1993 in Al Ain city, United Arab Emirates. Cases comprised known asthmatic children who were regularly receiving medication for asthma and were confirmed as asthmatics by a physician. Cases and controls were matched by age and sex. A questionnaire was used to obtain information about respiratory illnesses (pneumonia, bronchitis, bronchiolitis, sinusitis and croup); atopy (allergic rhinitis and atopic dermatitis) and familial allergic diseases (parental asthma and atopy). Information about socioeconomic status and limitations to children as a result of asthma were also obtained. Logistic regression analysis showed that bronchitis, atopy (allergic rhinitis and atopic dermatitis), croup, parental asthma and parental atopic dermatitis were significant risk factors for childhood asthma after adjusting for other confounding covariates. The model also showed that parental asthma (p < 0.0001) is much more influential than parental atopic dermatitis (p = 0.01) as a risk factor for asthma. Although pneumonia and sinusitis were significant risk factors when analyzed univariately, they were not significant after adjusting for other covariates. Bronchiolitis, smoking and socioeconomic status were beyond the reach of statistical significance as risk factors to asthma in our sample.     

Development of a health education program for parents of preschool children with asthma

This paper presents the development and pilot testing of a self-management education program for parents of preschool children (0-4 years) with asthma, involving general practitioners, asthma nurses, community nurses and doctors of child health centers. The program intends to integrate education in the medical care provided to the child (and the parent). The program contains four manuals, one for each group of health care providers, and a booklet for parents. The manuals identify the educational tasks per discipline and regulate referral from one discipline to another. The booklet provides written information for parents. In the development of the program, representative from both the target population and the providers of the education were involved in needs assessment surveys. Findings of these surveys were integrated into the design of the program. Then, a pilot study was conducted to test the efficacy of the program during group sessions. Findings indicate that the variables measured (knowledge, attitude, self-efficacy and self-management behaviors) improved significantly from pre- to post-test. Finally, the program was revised for the next phase in which the program will be evaluated in primary health care with a controlled trial.     

Personal endotoxin exposure in a panel study of school children with asthma

Background

Endotoxin exposure has been associated with asthma exacerbations and increased asthma prevalence. However, there is little data regarding personal exposure to endotoxin in children at risk, or the relation of personal endotoxin exposure to residential or ambient airborne endotoxin. The relation between personal endotoxin and personal air pollution exposures is also unknown.

Methods

We characterized personal endotoxin exposures in 45 school children with asthma ages 9-18 years using 376 repeated measurements from a PM_2.5 active personal exposure monitor. We also assayed endotoxin in PM_2.5 samples collected from ambient regional sites (N = 97 days) and from a subset of 12 indoor and outdoor subject home sites (N = 109 and 111 days, respectively) in Riverside and Whittier, California. Endotoxin was measured using the Limulus Amoebocyte Lysate kinetic chromogenic assay. At the same time, we measured personal, home and ambient exposure to PM_2.5 mass, elemental carbon (EC), and organic carbon (OC). To assess exposure relations we used both rank correlations and mixed linear regression models, adjusted for personal temperature and relative humidity.

Results

We found small positive correlations of personal endotoxin with personal PM_2.5 EC and OC, but not personal PM_2.5 mass or stationary site air pollutant measurements. Outdoor home, indoor home and ambient endotoxin were moderately to strongly correlated with each other. However, in mixed models, personal endotoxin was not associated with indoor home or outdoor home endotoxin, but was associated with ambient endotoxin. Dog and cat ownership were significantly associated with increased personal but not indoor endotoxin.

Conclusions

Daily fixed site measurements of endotoxin in the home environment may not predict daily personal exposure, although a larger sample size may be needed to assess this. This conclusion is relevant to short-term exposures involved in the acute exacerbation of asthma.     

Prevalence of exercise-induced asthma in school children

BACKGROUND: Although asthma is the most common pulmonary condition in pediatrics, the incidence of exercise-induced asthma (EIA) in school children is not well documented and few studies have been devoted to the condition. There are considerable variations in morbidity and mortality between countries. This study was designed to evaluate the prevalence of EIA in children in the 6th grade (11-14 year-olds) in one French department (Haute-Vienne) and to identify undiagnosed cases. METHODS: The representative sample was obtained over a period of 28 days (February 2(nd) to April 10(th) 1998) by cluster sampling method, stratified by size of the schools. The number of subjects planned was 891. The selected children filled in a questionnaire on their asthma history and were subjected to an outdoor exercise test (6 minute run). Respiratory function was measured with a peak flow-meter. RESULTS: Seven hundred and eighty two school children were included in this survey. Participation rate was 87.8%. The prevalence of asthma from the questionnaire was 10.7% (CI 95%: 8.7 - 12.8). After exercise, 68 school children presented exercise-induced bronchospasm: the prevalence of the EIA was 8.7% (CI 95%: 6.9 - 10.5). Among these 68 school children, 27 were known asthmatics and 41 were not. With the 10 treated asthmatics, the overall prevalence of EIA was therefore estimated at 9.9% (CI 95%: 8.2 - 11.7). CONCLUSION: The prevalence of asthma and EIA was close to that found in other studies using a similar methodology. EIA remains under-diagnosed since 41 undeclared asthmatic school children were identified in our population. Nurses'information is necessary to initiate the use of systematically testing respiratory function (with a peak flow meter) at least once a year. Efficient management of the asthmatic child requires cooperation between the various professionals dealing with school children.     

Information needs for OVC program management and evaluation: a framework

Programs serving orphans and vulnerable children (OVC) have become increasingly complex over the last decade, necessitating programs to collect more information to ensure adequate management. Programs are also facing greater pressure to demonstrate an interest in understanding impact and value for money, which is similarly leading to changes in the ways programs collect information and the types of information collected. In order to gather such information and contain costs, governments and programs are collecting increasing amounts of information at every interaction with program beneficiaries. This has led to a high burden on those providing, gathering, and inputting information and low data quality overall.

In this paper, we present a framework for categorizing different information needs for OVC program management and evaluation. The purpose of this framework is to support OVC program staff and donors to more clearly define information-collection strategies based on the information needed, why it is needed, and by whom it is needed. This will improve the efficiency of data-collection efforts, and improve the availability of the right (high-quality) data for various decision-making processes.     

Assessing the efficacy of a school-based asthma education program for children: a pilot study

BACKGROUND: Asthma diminishes the health-related quality of life for many school-aged children. This study sought to explore the effect of a School-Based Asthma Education Program (SBAEP) on quality of life. METHODS: Children with asthma who attended grades 1-5 at two selected schools were requested to participate in this pilot study. Participants at one school were provided with a SBAEP, those at another school (control group) were provided with written educational material about asthma. The children completed the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) before and one month after the educational interventions. RESULTS: There were clinically important improvements in the SBAEP group in quality of life, specifically in the symptom subdomain. CONCLUSIONS: The "Air Force" SBAEP appears to result in a favourable trend in quality of life for children. A larger scale trial is required following revisions to the program.     

Children with diabetes: perceptions of supports for self-management at school

Diabetes affects many children. Researchers know little about children's perceptions of what type of support they need at school, which was a focus of this study. Group interviews and surveys examined children's perceptions of support in caring for their diabetes (type I diabetes) from school nurses, teachers, and friends. Results indicated the children felt supported at school, but improved flexibility by teachers and nurses (e.g., let me keep my meter with me always) and individualized care plans may improve their ability to manage their diabetes at school. Participating in after-school activities may be difficult for middle school youth. Children reported they needed additional help and support to cope with hypoglycemic episodes.     

Summative evaluation of a pilot aquatic exercise program for children with disabilities

BackgroundChildren with disabilities have lower physical activity levels and participate less in community-based sport and exercise programs than do children without disabilities. This in part is due to environmental barriers and lack of appropriate resources in these programs. Adaptive programs encouraging increased physical activity for children with disabilities are needed, and as these programs are developed, they should be critically evaluated.PurposeThe purposes of this article are to describe a pilot aquatic exercise program for children with disabilities, to evaluate the program, and to determine areas of strength and areas needing modifications.MethodsA summative program evaluation design was used to assess this twice per week aquatic exercise program lasting 14 weeks. Sixteen children, ages 6-12 years, with developmental disabilities participated in the program. Children swam laps, participated in relay races and water basketball games, and performed arm and leg strengthening exercises using aquatic noodles, foam barbells, and water for resistance. Swimming skills, program evaluation questionnaires, physical activity questionnaires, and interviews of pool site directors were used to determine program outcomes.ResultsFindings suggest that children made improvements in their swimming skills, parents were satisfied with the program, and children increased their physical activity levels during the program and maintained the increased physical activity levels six months after the program ended. The program continued in some form after the 14-week intervention ended.ConclusionsThe program was successful in achieving its objectives and recommendations for application of this program are provided.     

Partners in action: a public health program for baccalaureate nursing students

Because of the current state of health systems changes and bioterrorist threats, the time is ripe for expanded community-based partnerships. The project described in this article, titled Partners in Action: University of Delaware and Delaware Division of Public Health, created a replicable academic-public health partnership. This new partnership developed undergraduate public health nursing clinical experiences and addressed the documented public health resource and service needs across the state of Delaware. Twenty-six students and 20 public health staff participated in the Partners in Action program over 2 semesters. Important public health services were delivered while students developed critical public health skills and received academic credit for their work. Public health preceptors, staff, nursing students, and faculty met on a regular basis for focus groups and public health in-services, using classroom, video, and Web-based formats. Partners in Action targeted medically underserved areas and offered health education and disease screenings. Community-based organizations and residents worked with students, faculty and public health staff to develop, implement, and evaluate this partnership. Partners in Action's evaluation included formative and summative measures. Partners in Action outcomes can serve as a blueprint for the replication of such programs at other schools of nursing.     

Building the case for asthma as a disease management program.

Asthma is a common disease that affects between 5.5% and 7.0% of the population. It is an example of a disease where good guidelines and an accepted model of treatment exist, but have not been fully implemented. In the latter part of 2000, Blue Cross Blue Shield of Minnesota (BCBSM) had existing and successful disease management (DM) programs for diabetes and heart disease and was looking to expand the concept to other diseases. Asthma was one of the conditions under consideration. This study, done in conjunction with PharMetrics, Inc. of Watertown, MA was done to establish the opportunity present to help Blue Cross members with the disease, and to help decide whether developing such a program made sense for the health plan. In addition, if the answer to the second question were yes, the study would lay the groundwork for that program. Using 2 years of BCBSM claims data, the study identified, stratified, and analyzed the cohort of BCBSM members with a diagnosis of asthma according to severity of illness, individual drug or drug combination treatment, emergency room usage, hospitalization, and total episode costs for asthma. Health plan results were bench-marked against the experience of others across the country represented in the (then) 20+ million managed care lives in PharMetrics' Integrated Outcomes Database. The results showed that in some of the recommended guidelines for asthma care BCBSM members led the nation in compliance, but that there was ample opportunity for improvement thus justifying moving forward in developing a disease management program. The results also seemed to validate many of the recommendations for asthma care expressed in the Expert Panel Report 2 on the diagnosis and treatment of asthma from the National Heart Lung and Blood Institute of the National Institutes of Health.