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S Redd

Publications and source records attributed to S Redd.

8 recordsLinked to original sources
PubMed2000

Effect of asthma on the quality of life among children and their caregivers in the Atlanta Empowerment Zone.

BACKGROUND AND OBJECTIVE: Asthma is the most common chronic pediatric disease and exacts a toll on the health-related quality of life of affected children and their primary caregivers. This investigation describes the relationship between the clinical severity of asthma among inner-city children and their quality of life and that of their primary adult caregivers. METHODS: Telephone interview data were collected from individual adult caregivers of 5-12-year-old children with asthma. Questions addressed the history, diagnosis, and management of the child's asthma, the child's family and social background, the family's socioeconomic status, the caregiver's knowledge and attitude about asthma, and the health-related quality of life of both the child and the caregiver. An asthma severity score was calculated from the caregiver's responses to questions about their child's wheezing frequency, nocturnal and early morning symptoms, and speaking during an asthma attack, as well as the impact of the disease on their child's physical activity and breathing during the prior 4-month period. A clinical asthma triage score was determined from information collected at the emergency department about the child's oxygen saturation, alertness, use of accessory respiratory muscles, extent of breathlessness, and peak expiratory flow. Spearman correlation coefficients were used to identify association between quality of life and disease severity, caretaker's asthma knowledge, and functional impact of asthma symptoms. RESULTS: Data from 240 of 755 eligible children were analyzed. Most children were younger than 11 years, male, black, and non-Hispanic. The children's median duration of asthma diagnosis was 86% of their life (range less than 1 to 11.3 years, median 5.0 years). Of the primary caregivers, 69% had at least completed high school, and 90% reported a total monthly household income of $1,600 or less. The maximum possible quality-of-life score and the median for caregivers were 91 and 70, respectively; for children, the same scores were 69 and 58, respectively. In addition, there was significant negative correlation of the quality-of-life scores of both the caregivers and children with the number of schooldays the children missed (r = -0.24 and r = -0.26, respectively, P < .001 for both) and the caregivers' and children's asthma severity scores (r = -0.39 and r = -0.47, respectively, P < .001 for both). The quality-of-life scores of the children and caregivers did not correlate significantly with the asthma triage scores. CONCLUSIONS: The questionnaires captured baseline quality-of-life information about this urban population and will facilitate longitudinal monitoring. The fact that the quality-of-life scores of children with asthma correlated with those of their adult caregivers, but not with their clinical triage scores, highlights the impact of asthma on families and the importance of having a long-term comprehensive management plan that is not based on exacerbations, but that includes both the children and their primary caregivers.

Asthma↗
PubMed1999

Timing and effectiveness of requirements for a second dose of measles vaccine.

OBJECTIVE: Previous measles elimination goals have failed in the United States despite high coverage of schoolchildren with a single dose of measles vaccine. Since 1989 advisory groups have recommended that schoolchildren receive a second dose of measles vaccine as part of a revised strategy to eliminate measles from the US. States have responded by phasing in requirements for a second dose of measles vaccine at school entry for various age groups at primary school entrance, secondary school entrance or both. The purpose of this analysis was to evaluate the effectiveness of the requirements for a second dose of measles vaccine and to determine whether a primary or secondary school entrance requirement was more effective in lowering measles incidence. METHODS: Using national surveillance data we examined the influence of state requirements for the second dose of measles vaccine on measles incidence from 1993 through 1995. RESULTS: Overall measles incidence was lower in states that had a requirement for a second dose of measles vaccine at either primary school entrance [relative risk (RR) = 0.35; 95% confidence interval, 0.25 to 0.49] or secondary school entrance (RR = 0.38; 95% confidence interval 0.29 to 0.50), compared with states without a second dose requirement. Incidence was lowest in states that required a second dose of measles vaccine at both primary and secondary school entrance (RR = 0.22; 95% confidence interval, 0.13 to 0.37). CONCLUSIONS: Our findings demonstrate that a requirement for a second dose of measles vaccine at either primary or secondary school entrance is effective in lowering measles incidence, with a greater reduction occurring in states where the second dose is required for both age groups.

Adolescent↗
PubMed1998

A model to estimate the potential economic benefits of measles eradication for the United States.

Measles incidence is at a nadir in many parts of the world due to vaccination efforts. Although the technical feasibility of eradication has been acknowledged, financial and political commitment need to be concomitantly identified on the national and global level. We demonstrate the potential value of measles eradication by identifying the potential cost-savings to one country resulting from measles eradication. For the US, measles eradication would save $45 million annually. If achieved by the year 2010, the US would save $500 million to $4.1 billion depending on the year of elimination, post-eradication schedule and discount rate. Intensification of measles control efforts in the US beyond current levels would have minimal marginal benefits on disease burden reduction. Allocation of resources to achieve global measles eradication is the next level of efficiency which would provide substantial savings. Countries may adapt this model to estimate their savings for consideration of the required political and financial contribution towards a global measles eradication program.

Adolescent↗
PubMed1998

Evaluation of a pregnancy-testing protocol in adolescents undergoing surgery.

STUDY OBJECTIVE: The purpose of this study was to determine the rate of unknown and nondisclosed pregnancies identified from a preoperative protocol for pregnancy testing of adolescents. DESIGN: A protocol was developed for pregnancy testing of all 12-21-year-old females presenting to the day surgery unit (DSU) at a large children's hospital. The charts of all patients identified with a positive urine ICON II human chorionic gonadotropin (uhCG) assay result were reviewed for demographic data, presurgical and postsurgical diagnosis, and proposed and actual procedure performed. Adolescents were asked the date of their last menstrual period (LMP), whether they were sexually active (SA) (engaged in vaginal intercourse), and whether they might be pregnant, and a uhCG was performed. SETTING: DSU at a large children's hospital in Boston, Massachusetts. PARTICIPANTS: All 12-21-year-old females presenting to DSU. MAIN OUTCOME MEASURES: Disclosure of sexual activity, date of LMP, and any possibility of pregnancy. The initial decision (continuation, abortion, or undecided) at the time of identification of the positive uhCG, compliance with follow-up referral appointments, outcome of the pregnancy, and subsequent choice of contraception were also documented. RESULTS: A total of 801 adolescent girls presented to the DSU for a surgical procedure between October 1994 and July 1996 and had a uhCG. Six of the 801 girls had a positive uhCG; 4 of 801 (0.49%) were pregnant. The remaining two had false-positive uhCG tests associated with ovarian failure and elevated gonadotropins. An LMP was recorded for the four pregnant patients, but only two patients were able to identify an exact date. SA was admitted by two of four and denied by the other two. One of the two who disclosed SA admitted to the possibility of being pregnant in response to the question, the other denied the possibility of pregnancy. The two who denied SA also failed to disclose the possibility of pregnancy. After disclosure of a positive uhCG, the surgical procedure was postponed in all four individuals. CONCLUSIONS: A routine preoperative uhCG testing program identified 4 of 801 (0.49%) patients with previously undiagnosed pregnancy. The current protocol has contributed to enhanced care and identifies pregnant adolescents who need counseling before surgical procedures are performed.

Abortion, Induced↗
PubMedDate not supplied

Fas and Fas ligand immunolocalization in pancreatic islets of NOD mice during spontaneous and cyclophosphamide-accelerated diabetes.

During insulin-dependent diabetes mellitus, immune cells which infiltrate pancreatic islets mediate beta cell destruction over a prolonged asymptomatic prediabetic period. The molecular mechanisms of beta cell death in vivo remain unresolved. At least two major molecular processes of destruction have been proposed. One involves the Fas-FasL (Fas-Fas ligand) system and the other, the perforin pathway. Here, dual-label immunohistochemistry was employed to examine the intra-islet expression, distribution and cellular sources of Fas and FasL in the NOD mouse, during spontaneous diabetes (days 21, 40 and 90) and following acceleration of diabetes with cyclophosphamide (days 0, 4, 7, 11 and 14 after cyclophosphamide administration). The expression of the proteins was correlated with advancing disease. FasL was expressed constitutively in most beta cells but not in glucagon or somatostatin cells or islet inflammatory cells and paralleled the loss of insulin immunolabelling with advancing disease. It was also expressed in beta cells of non-diabetes prone CD-1 and C57BL/6 mice from a young age (day 21). Strong immunolabelling for Fas was first observed in extra-islet macrophages and those close to the islet in NOD and non-diabetes-prone mice. During spontaneous and cyclophosphamide diabetes, it was observed in a higher proportion of islet infiltrating macrophages than CD4 and CD8 T cells, concomitant with advancing insulitis. In cyclophosphamide-treated mice, the proportion of Fas-positive intra-islet CD4 and CD8 T cells at day 14 (with and without diabetes) was considerably higher than at days 0, 4, 7 and 11. At days 11 and 14, a proportion of Fas-positive intra-islet macrophages co-expressed interleukin-1beta and inducible nitric oxide synthase. Fas was not detectable in beta cells and other islet endocrine cells during spontaneous and cyclophosphamide induced diabetes. Our results show constitutive expression of FasL in beta cells in the NOD mouse and predominant expression of Fas in intra-islet macrophages and to a lesser extent in T cells prior to diabetes onset. Interleukin-1beta in intra-islet macrophages may induce Fas and inducible nitric oxide synthase expression in an autocrine and paracrine manner and mediate beta cell destruction or even death of some macrophages and T cells. However, other mechanisms of beta cell destruction during spontaneous and cyclophosphamide-accelerated diabetes and independent of Fas-FasL, require examination.

Animals↗