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Biomedical subjects

Noreen M Clark

Publications and source records attributed to Noreen M Clark.

At least 19 recordsLinked to original sources
PubMed2006

Allergens in school settings: results of environmental assessments in 3 city school systems.

Environmental allergens are major triggers for pediatric asthma. While children's greatest exposure to indoor allergens is in the home, other public places where children spend a large amount of time, such as school and day care centers, may also be sources of significant allergen encounters. The purpose of this article is to describe schoolroom allergen levels from 3 different geographic sites obtained from dust samples collected in the fall and in spring. Environmental dust samples were collected from elementary schools in Birmingham (AL), Detroit (MI), and Houston (TX), from 4 room locations, including the cafeteria, library, upper grades, and lower grades. Samples were assayed for dust mite (Dermatophagoides pteronyssinus and Dermatophagoides farinae), cat (Felis domesticus), and cockroach (Blatella germanica 2) allergen levels. Allergen levels varied by geographic location and type of schoolroom. Schoolroom settings differed by the type of flooring (hard and carpet), room characteristics and use (food service, library shelves with books, and general classroom with multiple types of materials [individual desks and different types of furniture]), and the average age of the schoolroom dwellers (younger vs. older children). Dust mite, cat, and cockroach allergens were present in all schoolrooms and all sites at varying levels by season and by type of room. Schools may be important sources of direct allergen exposure and reservoirs that could potentially contribute to allergic sensitization and disease exacerbation in children. Further studies are needed to carefully examine the environmental allergen load in schools and its effect on children.

Air Pollutants↗
PubMed2006

Working with a Head Start population with asthma: lessons learned.

The Early Childhood Asthma Project involved asthma case identification in 35 Head Start centers in Detroit, MI, and attempted implementation of an intervention designed to help families manage a child's asthma more effectively. Surveys were distributed to the parents of all Head Start children (3408), and 2198 complete surveys were returned. Case detection found probable asthma in 30% of the children whose parent returned a sufficiently complete survey. Implementation of the intervention was unsuccessful in this setting. Obstacles to effective implementation included the sample's low participation and high attrition, limited involvement of Head Start personnel, factors related to the program approach, and the target population's beliefs about asthma.

Asthma↗
PubMed2006

Community coalitions to control chronic disease: Allies against asthma as a model and case study.

There is a rich and extensive literature regarding coalitions as vehicles for amassing resources, influence, and energy in pursuit of a health goal. Despite insufficient empirical data regarding outcome, a number of observers have posited the aspects of coalition processes thought to lead to goal attainment. The supplement, which this article is part of, is devoted to an examination of how these elements fitted together (or did not) in the seven areas across the United States where Allies coalitions devoted themselves to achieving asthma control. The aim of this article is to present the theoretical bases for the work of the coalitions. It illustrates and emphasizes how the community context influenced coalition development, how membership was involved in and assessed coalition processes and structures, and the community-wide actions that were instituted and the capacities they were trying to strengthen.

Asthma↗
PubMed2006

Collaborative design and implementation of a multisite community coalition evaluation.

Evaluation designs assessing community coalitions must balance measures of how coalitions do their work and evidence that the coalitions are making a difference. The Allies cross-site evaluation attempts to determine the combined effects of the seven coalitions' work at the individual, organizational, and community levels. Principal components considered are (a) contextual factors of the coalition community, (b) coalition processes and structure, (c) planning and planning products, (d) implementation actions, (e) activities and collaborations, (f) anticipated intermediate outcomes, and (g) expected asthma related health outcomes. Measurements are quantitative and qualitative, and data generated by these methods are used as ends in themselves and as a way to confirm or inform other measures. Evaluation has been an integral part of the planning and implementation phases of the Allies coalition work, with a priority of involving all of the partners in conceiving of and deciding upon the elements of assessment.

Community Networks↗
PubMed2006

Impact of physician asthma care education on patient outcomes.

OBJECTIVE: We evaluated the effectiveness of a continuing medical education program, Physician Asthma Care Education, in improving pediatricians' asthma therapeutic and communication skills and patients' health care utilization for asthma. METHODS: We conducted a randomized trial in 10 regions in the United States. Primary care providers were recruited and randomly assigned by site to receive the program provided by local faculty. The program included 2 interactive seminar sessions (2.5 hours each) that reviewed national asthma guidelines, communication skills, and key educational messages. Format included short lectures, case discussions, and a video modeling communication techniques. We collected information on parent perceptions of physicians' communication, the child's asthma symptoms, and patients' asthma health care utilization. We used multivariate regression models to determine differences between control and intervention groups. RESULTS: A total of 101 primary care providers and a random sample of 870 of their asthma patients participated. After 1 year, we completed follow-up telephone interviews with the parents of 731 of the 870 patients. Compared to control subjects, parents reported that physicians in the intervention group were more likely to inquire about patients' concerns about asthma, encourage patients to be physically active, and set goals for successful treatment. Patients of physicians that attended the program had a greater decrease in days limited by asthma symptoms (8.5 vs 15.6 days), as well as decreased emergency department asthma visits (0.30 vs 0.55 visits per year). CONCLUSIONS: The Physician Asthma Care Education program was used in a range of locations and was effective in improving parent-reported provider communication skills, the number of days affected by asthma symptoms, and asthma health care use. Patients with more frequent asthma symptoms and higher health care utilization at baseline were more likely to benefit from their physician's participation in the program.

Asthma↗
PubMed2006

Asthma educational seminar targeting Medicaid providers.

BACKGROUND: Medicaid-insured children have high risk of asthma but are less likely to receive care in keeping with national guidelines. We targeted providers who care for a large proportion of Medicaid-insured children and presented a 2-session multimedia asthma-education seminar that emphasizes communication and teaching techniques, to enhance providers' asthma-care teaching skills. METHODS: Five Medicaid-approved health maintenance organizations recruited pediatric primary-care providers. Providers were surveyed at baseline, 6 months, and 12 months to determine if they reported changes in their use of certain asthma-care communication techniques. RESULTS: Fifty-three of 70 participating providers completed the program and initial survey. They reported that 50% (median) of their patients were insured by Medicaid. At baseline, providers reported they were very confident of their asthma knowledge; however, they were less confident in interactions with patients/families regarding asthma self-management skills. Providers reported use of written plans less than half of the time. The response rate was 60% at 6 months and 71% at 1 year. Twenty-eight providers completed all 3 surveys. They reported significantly more frequent use of communication and counseling techniques that involved patient/parent asthma education and self-management skills at the 6-month point, that were partly sustained at 1 year. Reported provision of written asthma plans to patients had increased significantly at 6 months, but that increase was not sustained at the 1-year point. CONCLUSIONS: The seminar significantly enhanced knowledge of specific communication techniques related to asthma-teaching goals and reported use of asthma action plans to enhance self-management skills; however, these practices appear to need frequent reinforcement.

Asthma↗
PubMed2005

Effect of asthma intervention on children with undiagnosed asthma.

OBJECTIVE: To measure the effect of an asthma intervention on the functional status and morbidity of children with undiagnosed asthma. STUDY DESIGN: Data from a randomized trial were used to compare outcomes at baseline and follow-up for children with undiagnosed and diagnosed asthma. We studied 510 symptomatic children with diagnosed asthma (diagnosed) and 299 children with symptoms but no diagnosis (undiagnosed). Baseline functioning and morbidity were similar for undiagnosed and diagnosed patients classified as moderate-severe. RESULTS: There were fewer undiagnosed reported allergies, seasonal symptoms, and other respiratory diagnoses (all P < 0.01). Among the moderate-severe, functional status, for example, symptom-days ( P = .02), symptom-nights ( P < .01), and days of restricted activity ( P < .01), was significantly reduced at follow-up for the undiagnosed in the intervention group but not for undiagnosed control subjects. Findings were similar for children with diagnosed asthma. CONCLUSIONS: Children with undiagnosed asthma were generally nonatopic, although some had symptoms at a level comparable to children with a diagnosis. The intervention successfully improved functional status for children with undiagnosed asthma as well as for children with diagnosed asthma. These results can be applied to ongoing discussions related to case detection.

Absenteeism↗
PubMed2005

Asking the correct questions to assess asthma symptoms.

A national survey of 896 parents of children with asthma was performed and responses to 2 types of inquiry were compared: global assessment versus specific assessment of symptoms. Almost all parents, 860 (96%), described their child's asthma as under "good control'' when asked a global assessment question. However, 306 (34%)-when asked specific questions-actually described poor asthma control with frequent symptoms. Medicaid insurance (OR: 1.59; 95% CI: 1.03, 2.44) and parental smoking (OR: 1.60; 95% CI: 1.06, 2.43) increased the likelihood that parents' responses would be at risk for misinterpretation. Increased education (OR 0.41: 95% CI: 0.18, 0.91) and English as the primary language (OR 0.39; 95% CI 0.16, 0.96) were associated with decreased likelihood of misinterpretation. Vague, global assessment questions lead to incomplete clinical information and places the patient at risk for inadequate asthma therapy. A better approach is to use specific questions to determine the frequency of daytime or nighttime symptoms.

Adult↗
PubMed2005

Schools' capacity to help low-income, minority children to manage asthma.

This article describes the challenges and strengths of asthma management in 14 low-income, predominantly African American urban elementary schools serving more than 5,000 students. Asthma prevalence was 24.5%. Teachers, school principals, parents, and children described how asthma was managed at school. Data from classmates of students with asthma showed that they had moderate to high levels of information about the disease. Data from teachers indicated the great need for practical instruction on how they might effectively support a child with asthma in the classroom and on the playground. Principals raised concerns about expectations for the functioning of school staff and implementation of school policies especially related to asthma emergencies. Parents reported a range of problems their children face at school. Data from children with asthma showed that 75% believed asthma affected their school work. Findings from this study should be useful to school personnel, health providers, and others who assist children and their families to manage asthma at school. Data suggest that making school nursing services available is warranted, given the impact of asthma on the school community.

Administrative Personnel↗
PubMed2005

A trial of asthma self-management in Beijing schools.

OBJECTIVES: This study examined the effectiveness in children in China of an asthma education programme adapted from a model developed in the USA. METHODS: Six hundred and thirty-nine children in 21 elementary schools in one agricultural and one industrial area participated in a randomized, controlled trial. Data were collected at baseline and 1 year subsequently. The self-regulation-based programme addressed topics including preventing and managing symptoms, using medicines, and identifying and controlling triggers. RESULTS: Positive effects on treatment children v. control children were noted in school performance (0.21 v. - 0.06, p=0.04), absences (-0.55 v. -0.32, p= 0.02), and home environment (1.78 v. 4.75, p= 0.009). Industrial-area children additionally benefited from fewer hospitalizations (odds ratio =1.96, p =0.05) and asthma-related concerns of parents (-0.63 v. -0.34, p = 0.001). Agricultural-area parents showed greater improvement in asthma management (0.93 v. 0.26, p= 0.0001), and expressed more negative feelings about asthma (-0.13 v. - 0.58, p= 0.04) and asthma concerns (-0.31 v. -0.63, p= 0.0001). DISCUSSION: The programme provided overall benefits related to school performance, absences, and home environment. In the agricultural area, where fewer resources were available, benefits were fewer and concerns greater. In the industrial area, where education and income were higher, additional benefits related to healthcare use and parents' quality of life were realized.

Asthma↗
PubMed2004

Parental management of asthma triggers within a child's environment.

BACKGROUND: Control of environmental precipitants of asthma is an important component of self-management. OBJECTIVE: To assess the type and frequency of attempts by families to control environmental precipitants of symptoms and their degree of consistency with current guidelines. METHODS: We analyzed data from a nationwide sample of 896 children (2-12 years) with asthma. We collected data on insurance, race, sex, income, asthma education exposure, and severity. Parents were asked open-ended questions about their child's asthma triggers and what, if any, actions they took to control these triggers. RESULTS: We completed interviews with the parents of 896 of 1077 (83%) eligible patients. Patients had a mean age of 7.2 years, 65% were boys, 13% had Medicaid insurance, 12% were African American, and 31% had persistent asthma. Eighty percent (717/896) of parents could identify at least 1 asthma trigger (mean, 2.2; range, 0-9). Eighty-two percent (582/717) of these parents had attempted an environmental control measure. Of 1788 actions initiated, 916 (51%) were unlikely to be beneficial on the basis of current guidelines. No specific demographic characteristic predicted which parents were more or less likely to institute environmental controls. CONCLUSION: In our sample, more than half (51%) of the environmental actions initiated were not specifically endorsed by current guidelines. Improving awareness about recognized methods to address triggers may help families use more effective measures. Clinicians should not assume that they can predict which families will be more or less likely to attempt environmental control, but should provide education regarding effective environmental measures for all families with potentially modifiable asthma triggers

Asthma↗
PubMed2004

Pediatrician attitudes and practices regarding collaborative asthma education.

Pediatric practices were surveyed in 10 regions of the country to determine physician attitudes and practices regarding approaches to asthma education. Many physician respondents thought that nurses were just as effective as physicians in providing asthma education. In almost all practices a physician was involved; in two thirds of practices, an allied health professional; and in almost half of practices (48%), a registered nurse was involved. The type of healthcare professional involved in education was not associated with percentage of patients with Medicaid insurance, practice ownership, or setting. Given the multidisciplinary approach to education in many pediatric practices, quality improvement efforts to enhance asthma education by pediatric practices could be further enhanced by directly involving allied health professionals who practice in primary care settings.

Asthma↗
PubMed2004

Understanding and reducing stress and psychological distress in older women with heart disease.

Stress and psychological distress were assessed in 457 older women who were subsequently randomized to a six-week heart disease management program ("Women take PRIDE") or to a "usual care" control group. Baseline distress was significantly associated with age, symptoms, physical functioning, social support, optimism, and self-esteem (p < .05). Only 20% of women reported their physician had recommended reducing stress. At four months follow-up, intervention women compared to controls were significantly more likely to report reductions in stress levels (p = 0.02) and also showed improvement in emotional behavior (p = 0.09).

Aged↗
PubMed2004

Effects of a comprehensive school-based asthma program on symptoms, parent management, grades, and absenteeism.

STUDY OBJECTIVE: This study assessed the impact of a comprehensive school-based asthma program on symptoms, grades, and school absences in children, and parents' asthma management practices. DESIGN: Randomized controlled trial. SETTING: Fourteen elementary schools in low-income neighborhoods in Detroit, MI. PARTICIPANTS: Eight hundred thirty-five children with asthma in grades 2 through 5 and their parents. INTERVENTION: The intervention entailed six components for children, their parents, classmates, and school personnel to encourage and enable disease management. MEASUREMENTS AND RESULTS: Parents completed telephone interviews and the schools provided data at baseline and 24 months after intervention. At follow-up, treatment children with persistent disease had significant declines in both daytime (14% fewer, p < 0.0001) and nighttime (14% fewer, p < 0.0001) symptoms. Among children with both mild intermittent and persistent disease, those in the treatment group had 17% fewer daytime symptoms (p < 0.0001) but 40% more nighttime symptoms. Treatment children had higher grades for science (p < 0.02) but not reading, mathematics, or physical education. No differences in school absences for all causes between groups were noted in school records. However, parents of treatment group children reported fewer absences attributable to asthma in the previous 3 months (34% fewer, p < 0.0001) and 12 months (8% fewer, p < 0.05). Parents of treatment children had higher scores (2.19 greater, p = 0.02) on an asthma management index. The program may have stimulated attention to symptoms at night by parents of children with mild intermittent disease. Overall, the intervention provided significant benefits, particularly for children with persistent asthma.

Absenteeism↗
PubMed2004

Physician asthma education program improves outcomes for children of low-income families.

STUDY OBJECTIVES: To determine whether an interactive physician seminar that has been shown to improve patient/parent satisfaction and to decrease emergency department visits for children with asthma was also effective for those children from low-income families. DESIGN: Seventy-four pediatricians and 637 of their patients were randomized to receive two asthma seminars or no educational programs and were observed for 2 years. SETTING: Physicians in the New York, NY, and Ann Arbor, MI, areas were enrolled, and, on average, 10 patients with asthma per provider were surveyed and observed for 2 years. PATIENTS OR PARTICIPANTS: A total of 637 subjects were enrolled, and 369 subjects remained in the study after 2 years. Of these, 279 had complete medical and survey information. INTERVENTIONS: Physicians were randomized, and then a random sample of their patients was enrolled and surveyed regarding the physician's communication style, the child's asthma symptoms, medical needs, and asthma care. Low income was defined as annual income of < 20,000 dollars. MEASUREMENTS AND RESULTS: The families of 36 children (13%) had an income of < 20,000 dollars, and they were treated by 23 physicians. Low-income children in the treatment group tended to have higher levels of use of controller medications, to receive a written asthma action plan, and to miss fewer days of school, although these differences were not statistically significant compared to low-income children in the control group. However, low-income treatment group children were significantly less likely to be admitted to an emergency department (annual rate, 0.208 vs 1.441, respectively) or to a hospital (annual rate, 0 vs 0.029, respectively) for asthma care compared to children in the control group. CONCLUSIONS: The educational program for physicians improved asthma outcomes for their low-income patients. Provider interventions targeted to these high-risk patients may diminish hospital and emergency department asthma care.

Asthma↗
PubMed2004

Limits of the HEDIS criteria in determining asthma severity for children.

OBJECTIVE: Although the Health Plan Employer Data Information Set (HEDIS) is a common method for evaluating the quality of asthma care, its accuracy in characterizing persistent asthma in children is unknown. The objective of this study was to compare the assessment of asthma severity (persistent vs nonpersistent asthma) using the HEDIS criteria versus clinical criteria using National Heart, Lung, and Blood Institute (NHLBI) guidelines. METHODS: In a cross-sectional study, we analyzed baseline data from interviews with the parents of 896 children who had asthma and participated in a randomized controlled trial. Patients had an active clinical diagnosis of asthma, were between 2 and 12 years of age, and had no other pulmonary diseases. Patients had persistent asthma by parent report according to the HEDIS criteria when, within the last year, they had 1 asthma inpatient admission or emergency department visit or 4 asthma medication dispensing events, or 4 outpatient asthma visits and at least 2 asthma medication dispensing events. Patients had persistent asthma by parent report according to the NHLBI criteria when, within the last 2 months, they had nighttime asthma symptoms >2 nights/mo or daytime asthma symptoms >2 days/wk. We calculated the sensitivity of each HEDIS criterion, separately and then combined, using the NHLBI criteria as a gold standard. RESULTS: On the basis of HEDIS criteria, 656 (73%) patients had persistent asthma, compared with 338 (38%) using NHLBI criteria. Although the HEDIS criteria for persistent asthma were fairly sensitive (0.89), they were not very specific (0.70). For children without daily controller medications (n = 346), the sensitivity was even lower (0.45), but the specificity was similar (0.68). We found that the test characteristics were fairly consistent across different age group strata (2-4, 5-9, and 10-12 years of age). CONCLUSIONS: HEDIS criteria used to determine the quality of asthma care should be interpreted with caution. Although the criteria for persistent disease-used to determine which children require daily controller medications-are fairly sensitive, they are not very specific and include children who may not require such medications.

Anti-Asthmatic Agents↗