Biomedical subjects

Daphne Koinis-Mitchell

Publications and source records attributed to Daphne Koinis-Mitchell.

5 recordsLinked to original sources

PubMed2026

Maternal adverse childhood experiences and prenatal stress: Intergenerational transmission and offspring mental health in the ECHO Cohort.

BACKGROUND: The rising global prevalence of pediatric mental health problems requires the identification of preventable factors underlying their development. This study assessed whether maternal adverse childhood experiences (ACEs) and pregnancy stress were intergenerationally associated with offspring mental health. METHODS: This study used data from 34 sites in the nationwide Environmental Influences on Child Health Outcomes Cohort. Eligible parent-child dyads (child age: 1.5-18 years) provided data on at least one measure of maternal stress and at least one measure of child mental health. Study aims were evaluated using regression analyses, including interaction tests to determine potential effect modifiers. RESULTS: Participants were organized into three subsamples with data on (1) maternal ACEs (N = 2,906), (2) perceived prenatal stress (N = 4,441), and (3) both stress exposures (N = 834). After adjusting for confounders, maternal ACEs and prenatal stress were significantly associated with child mental health problems (B = 2.53 [95% confidence interval [CI]: 2.09, 2.96], p < 0.0001 and B = 2.36 [95% CI: 2.03, 2.68], p < 0.0001, respectively). Among participants with data on both stress exposures, maternal ACEs (B = 1.72, 95% CI: [0.96, 2.48], p < 0.0001) and prenatal stress (B = 2.05, 95% CI: [1.29, 2.80], p < 0.0001) were independently associated with child mental health problems. Neither maternal ACEs nor child sex modified the association between prenatal stress and child mental health problems. CONCLUSIONS: Maternal exposure to ACEs and pregnancy stress were associated with the development of child mental health problems. These findings highlight the need for policies and interventions that mitigate exposure to adversity and protect pregnant individuals and their children from the intergenerational transmission of mental health problems.

Humans↗

PubMed2007

Multiple urban and asthma-related risks and their association with asthma morbidity in children.

OBJECTIVE: To determine whether a multi-dimensional cumulative risk index (CRI) is a stronger predictor of asthma morbidity in urban, school-aged children with asthma, than poverty or severity alone. METHODS: A total of 163 children with asthma, ages 7-15 years (42% female; 69% ethnic minority) and their primary caregivers completed interview-based questionnaires, focusing on potential cultural, contextual, and asthma-specific risks that can impact asthma morbidity. RESULTS: Higher levels of cumulative risks were associated with more asthma morbidity, after controlling for poverty level or asthma severity. Analyses by ethnic group and subgroup also supported the relationship between the CRI and specific indices of asthma morbidity. CONCLUSIONS: This study demonstrates the utility of multiple-dimensional risk models for predicting variations in asthma morbidity in urban children. Research efforts with urban families who have children with asthma need to consider the context of urban poverty as it relates to children's cultural backgrounds and specific asthma outcomes.

Adolescent↗

PubMed2006

Asthma disparities in the prevalence, morbidity, and treatment of Latino children.

The paper reviews the existing research related to asthma disparities and frames the results of this research within a conceptual model modified from the Institute of Medicine model in order to explain asthma health disparities in Latino children in the USA. The model of pediatric asthma disparity presented is based on the conceptualization of health disparities as the result of a complex interaction of factors related to four main domains: the individual and family, the environment or context in which the child lives, the health-care system, and provider characteristics. Asthma disparities are discussed as they are reflected in the process of care (access and quality of treatment) and outcome (prevalence, morbidity, severity) experienced by Latino children. The potential mechanisms that may account for the asthma disparities documented as reflected by the conceptual model proposed are discussed. Finally, several suggestions for future research examining determinants that account for asthma disparities are examined.

Asthma↗

PubMed2006

A culturally competent asthma management intervention: a randomized controlled pilot study.

BACKGROUND: Despite significant medical advances, many ethnic and racial minority children who live in inner cities continue to experience disproportionately high levels of asthma morbidity and mortality compared with white children. As a result, a growing number of psychosocial asthma management interventions are being developed to address their needs; however, only a few of these interventions have incorporated cultural variables into their treatments and have had their efficacy evaluated. OBJECTIVE: To examine the efficacy of the Multifamily Asthma Group Treatment (MFAGT), designed to enhance asthma management and reduce emergency department (ED) visits among African American and Hispanic families. METHODS: Twenty-four African American and Hispanic families who have children with asthma were randomly assigned to either the MFAGT or the Standard Psychoeducational Asthma Intervention. Differences in the number of ED visits and the level of asthma management in both groups were compared 1 year before and 1 year after the intervention. In addition, these groups were contrasted to a control group that did not receive any psychoeducational intervention. RESULTS: The MFAGT was significantly (P = .04) more effective than the Standard Psychoeducational Asthma Intervention and the control in decreasing ED visits and increasing parental asthma knowledge. CONCLUSIONS: These preliminary results suggest that the MFAGT is efficacious in enhancing asthma management and in reducing ED visits in inner-city African American and Hispanic children from a lower socioeconomic background.

Adolescent↗

PubMed2005

Patterns of quick-relief and long-term controller medication use in pediatric asthma.

OBJECTIVES: To simultaneously examine adherence to long-term controller and quick-relief medications and to contrast patterns of medication use in children with asthma. STUDY DESIGN: Cross-sectional, 1-month follow-up study conducted with 75 children ages 8 to 16 years diagnosed with persistent asthma and prescribed quick-relief and long-term controller medications by metered dose inhaler. Participants were a subsample of a larger adherence study. The primary outcome measure was adherence to both medications as measured by electronic monitoring devices. A classification framework for contrasting adherence patterns between medication classes was developed to identify cases for individual analysis. RESULTS: High levels of nonadherence to long-term controller medications (median = 46% of prescribed doses taken) and variable patterns of quick-relief medication use (range = 0 to 251 doses over the month) were documented, whereas consistent relationships between patterns of medication use across both classes were not found. Individual cases identified by the classification scheme illustrated the complexity and clinical utility of contrasting adherence patterns. CONCLUSIONS: Monitoring long-term controller medication adherence may be more predictive of morbidity than quick-relief medication use, except in outlier cases in which monitoring both medication types may be valuable for clinical and empirical purposes.

Administration, Inhalation↗