UI - 20582881 PMID- 11149990 DA - 20010122 DCOM- 20010208 IS - 0091-6749 VI - 107 IP - 1 DP - 2001 Jan TI - House dust mite and cockroach exposure are strong risk factors for positive allergy skin test responses in the Childhood Asthma Management Program. PG - 48-54 AB - BACKGROUND: Children with asthma have a high prevalence of environmental allergies, especially to indoor allergens. The relationships of exposure to indoor allergens (dust mites, cat, dog, cockroach, and molds) and other host factors to allergy sensitization have not been evaluated simultaneously in a large cohort. OBJECTIVES: We studied 1041 children aged 5 to 12 years with mild-to-moderate asthma to determine risk factors associated with having positive allergy skin test responses to indoor allergens. Also, we described, compared, and contrasted 6 allergens in the home environments of these children from 8 North American cities. METHODS: Data were used from baseline visits of the Childhood Asthma Management Program. Patients' sensitivities to house dust mites (Dermatophagoides farinae and Dermatophagoides pteronyssinus), cats, dogs, cockroaches, and molds were examined for relationships to demographic variables, home dust allergen exposures, number of other positive allergy skin test responses, total serum IgE levels, and smoking in the home. RESULTS: San Diego (78.5%) and Toronto (59.3%) had the topmost percentages of homes with moderate-to-high house dust mite levels. Boston (21.5%), St Louis (16.3%), and Baltimore (13.4%) had the highest percentages of homes with detectable levels of cockroach allergen. For house dust mites, the higher the level of allergen exposure, the more likely patients were to have positive allergy skin test responses, with relative odds of 9.0 (95% confidence interval, 5.4-15.1) for those exposed to high mite levels (>10.0 microg/g dust) relative to those unexposed. Even exposure to low levels of mite allergen (0.020-2.0 &mgr;g/g) was found to be a significant risk factor for sensitization. For cockroach allergen, those with detectable home exposure were more likely to have positive skin test responses (relative odds, 2.2; 95% confidence interval, 1.3-3.8) than those with undetectable exposure. In contrast, levels of exposure to cat, dog, and mold allergens were not related to sensitization rates. For cat allergen, this may reflect lower rates of cat ownership among highly sensitized subjects. Furthermore, the number of allergy skin test responses that were positive, excluding the test for the outcome of interest for each model, and total serum IgE levels were strong independent predictors of sensitization. CONCLUSIONS: Levels of exposure determined by house dust analysis are important determinants of sensitization for dust mite and cockroach allergen. This relationship was not demonstrable for cat, dog, or mold allergens, possibly because of confounding factors. For all allergens studied, the degree of atopy, determined by the total number of positive skin test responses or by total serum IgE levels, is an important contributing risk factor for sensitization. AD - Johns Hopkins Asthma and Allergy Center, Baltimore, MD, USA. AU - Huss K AU - Adkinson NF AU - Eggleston PA AU - Dawson C AU - Van Natta ML AU - Hamilton RG LA - eng PT - Journal Article CY - UNITED STATES TA - J Allergy Clin Immunol JC - H53 JID - 1275002 RN - 0 (Allergens) RN - 37341-29-0 (IgE) SB - AIM SB - IM MH - Air Pollution, Indoor/statistics & numerical data MH - Allergens/*analysis MH - Animal MH - Asthma/diagnosis/epidemiology/*immunology MH - Cats/immunology MH - Child MH - Child, Preschool MH - Cockroaches/*immunology MH - Cross-Sectional Studies MH - Dogs/immunology MH - Dose-Response Relationship, Immunologic MH - Dust/*analysis MH - Female MH - Human MH - Hypersensitivity, Immediate/immunology MH - IgE/blood MH - Male MH - Mites/*immunology MH - Risk Factors MH - Skin Tests EDAT- 2001/1/10 11 MHDA- 2001/3/3 10:1:00 AID - a111146 [pii] URL - http://www.mosby.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art& artType=abs&id=a111146&target= PST - ppublish SO - J Allergy Clin Immunol 2001 Jan;107(1):48-54. UI - 20575936 PMID- 11133405 DA - 20010129 DCOM- 20010208 IS - 0091-6765 VI - 108 IP - 12 DP - 2000 Dec TI - A 4-year-old girl with manifestations of multiple chemical sensitivities. PG - 1219-23 AB - Multiple chemical sensitivities (MCS) syndrome, also known as idiopathic environmental intolerance, is a controversial diagnosis that encompasses a wide range of waxing and waning, subjective symptoms referable to more than one body system and provoked by exposure to low levels of chemicals, foods, or other agents in the environment. Although MCS has been studied extensively, a unifying mechanism explaining the illness remains obscure, and clinicians are divided as to whether such a medical entity exists separately from psychosomatic syndromes. MCS is an adult diagnosis; there is little reference to pediatric cases in the scientific literature. In this case from the Pediatric Environmental Health Subspecialty Unit at Boston's Children's Hospital, I present the case of a preschool child who had suffered from milk allergy and poor weight gain as an infant, and then later developed asthma, allergic symptoms, sinusitis, headaches, fatigue, and rashes precipitated by an expanding variety of chemicals, foods, and allergens. I review definitions, mechanisms, diagnostic strategies, and management, and discuss some uniquely pediatric features of MCS as illustrated by this case. AD - Pediatric Environmental Health Subspecialty Unit and Clinical Toxicology Program, Children's Hospital Boston, MA 02115, USA. woolf@a1.tch.harvard.edu AU - Woolf A LA - eng PT - Clinical Conference PT - Journal Article CY - UNITED STATES TA - Environ Health Perspect JC - EI0 JID - 0330411 SB - IM MH - Adaptation, Psychological MH - Case Report MH - Child, Preschool MH - Diagnosis, Differential MH - Diet MH - *Environmental Exposure MH - Family Health MH - Female MH - Food Hypersensitivity MH - Human MH - Multiple Chemical Sensitivity/*diagnosis/physiopathology/therapy EDAT- 2001/1/3 11 MHDA- 2001/3/3 10:1:00 AID - sc271_5_1835 [pii] PST - ppublish SO - Environ Health Perspect 2000 Dec;108(12):1219-23. UI - 20416450 PMID- 10960213 DA - 20000913 DCOM- 20001030 IS - 1054-139X VI - 27 IP - 3 DP - 2000 Sep TI - Video intervention/prevention assessment: a patient-centered methodology for understanding the adolescent illness experience. PG - 155-65 AB - OBJECTIVE: To better understand the issues and needs of adolescents with chronic health conditions, the Video Intervention/Prevention Assessment (VIA) integrates video technology with qualitative research methods to obtain a patient-centered perspective on illness and health care. METHODS: Young people with chronic disease are interviewed for condition-specific verbal reports (CSVRs) of their medical and psychosocial histories. Standardized health-related quality of life (HRQL) instruments are administered. Trained to use video camcorders, participants record visual narratives of their illness experiences. They document their daily lives, interview families and friends, and record personal monologues regarding their observations, behaviors, understandings, and beliefs about their disease. On completion of the visual narratives, HRQL is again evaluated. Verbal, scaled, and visual data are analyzed from three perspectives: medical, psychosocial, and anthropological. Data from the CSVRs, HRQLs, and visual narratives are triangulated to validate and enrich findings. RESULTS: Investigating the illness experience from the adolescent patient's perspective, the VIA method was pilot-tested with children and adolescents with asthma. As a research tool, VIA found environmental risk factors, medication adherence problems, and outcome-affecting illness beliefs and psychological states that were not identified by standard clinical tools. As an intervention, VIA showed that it may be an effective tool for health-related environmental surveys. Participants' condition-specific quality of life showed measurable improvement after the self-examination process of VIA. As communication, VIA made apparently counterproductive patient behaviors understandable by showing them in context with the adolescent's experience of illness and health care. VIA can enhance medical history-taking and management strategies, improve adolescents' self-management skills, and educate clinicians, families, and students of the health care professions about the realities of the adolescent living with a chronic health condition. AD - Division of Adolescent/Young Adult Medicine, Children's Hospital, Boston, Massachusetts 02115, USA. AU - Rich M AU - Lamola S AU - Gordon J AU - Chalfen R LA - eng PT - Journal Article CY - UNITED STATES TA - J Adolesc Health JC - A0J JID - 9102136 SB - IM MH - Adolescence MH - Asthma/etiology/*psychology/rehabilitation MH - Boston MH - Child MH - Chronic Disease/psychology MH - Female MH - Hospitals, Pediatric MH - Hospitals, Urban MH - Human MH - Informed Consent MH - Interviews/*methods MH - Male MH - Medical History Taking/*methods MH - Patient-Centered Care/*methods MH - Physician-Patient Relations MH - Pilot Projects MH - *Quality of Life MH - *Sick Role MH - Support, Non-U.S. Gov't MH - *Video Recording/methods EDAT- 2000/8/26 11 MHDA- 2001/2/28 10:1:00 AID - S1054139X00001142 [pii] PST - ppublish SO - J Adolesc Health 2000 Sep;27(3):155-65. UI - 20358823 PMID- 10891023 DA - 20000801 DCOM- 20000801 LR - 20001218 IS - 1072-4710 VI - 154 IP - 7 DP - 2000 Jul TI - Relationship between disease and psychological adaptation in children in the Childhood Asthma Management Program and their families. CAMP Research Group. PG - 706-13 AB - OBJECTIVE: To test the hypotheses that the burden of childhood asthma compromises psychological adaptation and that the degree of compromise increases with disease severity. DESIGN: The Childhood Asthma Management Program (CAMP) is a multicenter randomized clinical trial initiated and funded by the National Heart, Lung, and Blood Institute. SETTING: Study sites were located in Albuquerque, NM, Baltimore, Md, Boston, Mass, Denver, Colo, St Louis, Mo, San Diego, Calif, Seattle, Wash, and Toronto, Ontario. PARTICIPANTS: A total of 1,041 children aged 5 to 12 years were randomized to the trial after confirming their mild to moderate asthma. MAIN OUTCOME MEASURES: Psychological questionnaires administered at baseline to parents and participants assessed anxiety, depression, behavioral competence, social support, and family functioning. RESULTS: Psychological difficulty was not increased in this group of asthmatic children and their families. Psychological adaptation in the children was associated with the psychological adaptation of the family but not with disease-related variables. Scores from the Impact on Family Scale, a measure of family quality of life related to the child's illness, were associated more strongly with the overall psychological characteristics of the family and child and very little with disease characteristics or severity. CONCLUSIONS: Mild to moderate asthma has imposed modest effects on the daily life but not the psychological health of this group of children. Variation in the psychological characteristics of these children was, as is the case for most children, traceable to the overall psychological adaptation of their families. AD - National Jewish Medical and Research Center, Denver, Colo 80206, USA. AU - Bender BG AU - Annett RD AU - Ikle D AU - DuHamel TR AU - Rand C AU - Strunk RC LA - eng ID - NO1-HR16044/HR/NHLBI ID - NO1-HR16045/HR/NHLBI ID - NO1-HR16046/HR/NHLBI ID - et al. PT - Journal Article CY - UNITED STATES TA - Arch Pediatr Adolesc Med JC - BWF JID - 9422751 SB - AIM SB - IM MH - *Adaptation, Psychological MH - Asthma/*psychology/rehabilitation MH - Child MH - Child, Preschool MH - Cost of Illness MH - Family/*psychology MH - Female MH - Human MH - Male MH - Parent-Child Relations MH - Personality Assessment MH - *Sick Role MH - Support, U.S. Gov't, P.H.S. EDAT- 2000/07/13 11 MHDA- 2000/08/06 11 AID - poa90439 [pii] PST - ppublish SO - Arch Pediatr Adolesc Med 2000 Jul;154(7):706-13. UI - 20306675 PMID- 10850502 DA - 20000621 DCOM- 20000621 LR - 20001218 IS - 1072-4710 VI - 154 IP - 6 DP - 2000 Jun TI - Comparing asthma care for Medicaid and non-Medicaid children in a health maintenance organization. PG - 563-8 AB - OBJECTIVE: To compare ambulatory visit patterns, rates of medication use, and emergency department and hospital utilization for children with asthma covered under Medicaid and commercial payers within the same health maintenance organization (HMO). DESIGN: Retrospective cohort study. SETTING: Eleven staff-model pediatric departments of an HMO. PATIENTS: A total of 1928 Medicaid and 11007 non-Medicaid children aged 2 to 18 years with at least 1 encounter with a diagnosis of asthma between October 1, 1991, and September 30, 1996. METHODS: We linked patient-level data from the HMO's automated medical record system for ambulatory encounters, a claims system for emergency department and hospital care, and an automated pharmacy dispensing database. Medicaid and non-Medicaid patients were compared for all encounter types and for prescribing and dispensing of beta-agonist and controller medications (inhaled corticosteroids and cromolyn sodium). Incidence rate ratios were calculated from Poisson regression models to control for age, sex, and, when appropriate, beta-agonist dispensing rate. The number of refills authorized on each prescription and the fraction of medications dispensed as refills compared with new prescriptions were compared for Medicaid and non-Medicaid patients. RESULTS: Medicaid-insured children in the HMO were 1.4 times (95% confidence interval, 1.2-1.5) more likely to receive care in emergency departments and 1.3 times (95% confidence interval, 1.1-1.5) more likely to be hospitalized for their asthma compared with non-Medicaid members. Medicaid and non-Medicaid enrollees had similar yearly rates of nonurgent (1.32 vs 1.17) and urgent (0.38 vs 0.31) ambulatory visits. Beta-agonists were dispensed roughly equally to Medicaid and non-Medicaid members. Although Medicaid patients were less likely to have controller medications dispensed (relative risk, 0.72; 95% confidence interval, 0.69-0.74), they were equally likely to have them prescribed. CONCLUSIONS: Differences in ambulatory contact for Medicaid members do not explain the higher rates of emergency department visits and hospitalization in this population. Reasons for lower rates of dispensing of controller medications should continue to be investigated as one cause of increased morbidity for low-income children with asthma. AD - Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass 02215, USA. AU - Finkelstein JA AU - Barton MB AU - Donahue JG AU - Algatt-Bergstrom P AU - Markson LE AU - Platt R LA - eng PT - Journal Article CY - UNITED STATES TA - Arch Pediatr Adolesc Med JC - BWF JID - 9422751 RN - 0 (Anti-Asthmatic Agents) SB - AIM SB - IM MH - Adolescence MH - Anti-Asthmatic Agents/therapeutic use MH - Asthma/*drug therapy MH - Boston MH - Child MH - Child, Preschool MH - Chronic Disease MH - Cohort Studies MH - Comparative Study MH - Emergencies MH - Female MH - Health Maintenance Organizations/statistics & numerical data/*utilization MH - Human MH - Male MH - Medicaid/statistics & numerical data/*utilization MH - Retrospective Studies MH - Support, Non-U.S. Gov't MH - United States EDAT- 2000/06/13 09 MHDA- 2000/06/24 11 PST - ppublish SO - Arch Pediatr Adolesc Med 2000 Jun;154(6):563-8.