First Year Of Enrollment Research Articles

Hyponatremia: incidence, risk factors, and consequences in the elderly in a home-based primary care program.

Aims: To determine the incidence, risk factors, etiology, and associations of hyponatremia in community-dwelling elderly with geriatric morbidity and mortality. Materials: Elderly participants of a single center home-based primary care program were included. Method: Retrospective chart review was conducted on demographic and clinical variables, comorbid diseases, frailty by Fried criteria and biochemical tests over a 1-year period. Primary outcome measure was a composite of falls, fractures due to falls, and hospitalization witnessed within the first year of enrollment into the program. Secondary outcome was all-cause mortality. Results: The study population (n = 608) had a mean age of 84.3 ± 9.3 years and was largely female (77.1%) and African-American (89.5%). Mean follow-up was 41.5 months. Frailty was seen in 44.4%. Incidence of all-cause mortality was 26.9%. Initial hyponatremia occurred in 8.71% (n = 53), and persistent hyponatremia (> 6 months of low serum sodium) in 4.1% (n = 25) of the study population. The major causes of hyponatremia included multiple potential causes, idiopathic syndrome of inappropriate anti-diuretic hormone (SIADH) and medications (thiazides and selective serotonin reuptake inhibitor (SSRI)). Primary outcome was independently associated with frailty (Odds ratio (OR) of 2.33) and persistent but not initial hyponatremia (OR 3.52). Secondary outcome was independently associated with age > 75 years (OR 2.88) and Afro-American race (OR 2.09) only but not to frailty or hyponatremia. Conclusions: Hyponatremia is common in home-bound elderly patients and its persistence independently contributes to falls, fractures, and hospitalization but not mortality. Our study highlights a new association of hyponatremia with frailty and underscores the need to study time-dependent association of hyponatremia with epidemiological outcomes.

Medicaid Expansion and the Affordable Care Act: Data From the First Year of Enrollment at Kaiser Permanente Northern California

Medicaid Expansion and the Affordable Care Act: Data From the First Year of Enrollment at Kaiser Permanente Northern California

Incidence and risk factors for early wound complications after spinal arthrodesis in children: analysis of 30-day follow-up data from the ACS-NSQIP.

Retrospective review of prospectively collected data. To determine the incidence and risk factors for 30-day wound complication after spinal arthrodesis in pediatric patients. Although multiple prior studies have reported on wound complications in pediatric spine, the majority have been single-center retrospective series. The National Surgical Quality Improvement Program (NSQIP) employs on-site personnel to prospectively collect 30-day morbidity data from 50 pediatric centers. Year 2012 was the first year of enrollment, and 1915 cases with thoracic or lumbar spinal fusion were included. Patients were divided into cohorts of those with and without a wound complication, with univariate and multivariate analyses used to identify risk factors. A P value of less than 0.05 was considered significant. Wound complications occurred in 67 patients (3.5%). The incidence was significantly higher in patients with congenital (4.35%) or neuromuscular (4.67%) diagnoses, as opposed to idiopathic (2.7%) or infantile (1.61%). Procedures with fusions extending to the pelvis (9.91%) or an osteotomy (4.99%) were associated with higher risk. Longer hospital lengths of stay, increased operative time, increased patient body mass index, and patients with cardiac, gastrointestinal, neurological, or pulmonary comorbidities were also associated with a higher risk. In the multivariate analysis, a body mass index of more than 30 kg/m2, patients with cardiac risk factors, and fusions extending to the pelvis were independent risk factors. Data from this large prospective multicenter study confirm that the incidence of early wound complications in pediatric spine surgery is low. Patients with a fusion extending to the pelvis, obese patients, and patients with significant cardiac conditions were independently associated with higher risk for this complication. These data should be useful for patients' counseling and for preoperative risk stratification. Interventions for minimizing wound complication risk may be most applicable to the high-risk groups identified here. 2.

P-025 Corticosteroid Use in A Prospective, Community-Based Cohort of Newly Diagnosed Inflammatory Bowel Disease Patients

Previous population-based studies report corticosteroid (CS) exposure rates that range from 39% to 75% within the first year of diagnosis with surgical resection rates as high as 13%–18% in the same timeframe.1–2 These reports represent an older cohort of patients enrolled over prolonged periods of time and do not necessarily reflect current treatment approaches. In this study, we examine CS use during the first year of IBD diagnosis in a novel, inception cohort. Data were derived from the Ocean State Crohn’s and Colitis Area Registry (OSCCAR), a prospective inception cohort of IBD patients who are residents of Rhode Island. Participants are enrolled within 12 months of diagnosis and complete follow-up assessments quarterly over the course of the first year. Participants who had been enrolled within 3 months from the date of diagnosis and had a confirmed diagnosis based on the NIDDK IBD Genetics Consortium criteria were included in current analyses. Table 1 outlines baseline clinical characteristics of patients included in our analyses (N = 272). Overall, 60% of Crohn’s disease (CD) and 57% of ulcerative colitis (UC) patients were exposed to at least one course of systemic CS during year 1.83% of patients treated with CS received their first course within 3 months of enrollment. Twenty-seven percent were exposed to topical steroid preparation (budesonide or rectal steroids) in year 1. Of the 66 patients with CD and 45 with UC not exposed to CS, 18 (27%) and 8 (18%) were treated with a topical steroid, respectively. Table 2 summarizes clinical outcomes. Five patients (2%) required a surgical resection in year 1.17% of all patients were treated with a biologic in year 1.26% of CD and 17% of UC patients exposed to systemic CS during year 1 were ultimately treated with a biologic. However, 17% of CD patients not exposed to CS during year 1 were treated with a biologic. All UC patients treated with a biologic were exposed to CS at some point during year 1. As of April 2013, 84 of the 272 (31%) patients included in our analyses had been treated with a biologic and 15 (6%) ultimately required a surgical resection. In this community-based cohort, 59% were exposed to at least one course of CS during their first year of enrollment. In contrast to previous studies, OSCCAR represents a more modern cohort of patients. While steroid exposure rates were similar or slightly higher than in previous reports, we observed a low rate of surgical resection. Future analysis will focus on how the effects of more contemporary treatments may have played a role in the low rates of surgery we observe.

Comparing the Effectiveness of Telemedicine and Traditional Surveillance in Providing Diabetic Retinopathy Screening Examinations: A Randomized Controlled Trial

To determine the effectiveness of telemedicine for providing diabetic retinopathy screening examinations compared with the effectiveness of traditional surveillance in community health clinics with a high proportion of minorities, including American Indian/Alaska Natives. We conducted a multicenter, randomized controlled trial and assigned diabetic participants to one of two groups: (1) telemedicine with a nonmydriatic camera or (2) traditional surveillance with an eye care provider. For those receiving telemedicine, the criteria for requiring follow-up with an eye care provider were (1) moderate nonproliferative diabetic retinopathy or higher, (2) presence of clinically significant macular edema, or (3) "unable to grade" result for diabetic retinopathy or macular edema. The telemedicine group (n=296) was more likely to receive a diabetic retinopathy screening examination within the first year of enrollment compared with the traditional surveillance group (n=271) (94% versus 56%, p<0.001). The overall prevalence of diabetic retinopathy at baseline was 21.4%, and macular edema was present in 1.4% of participants. In the telemedicine group, 20.5% would require further evaluation with an eye care provider, and 86% of these referrals were because of poor-quality digital images. Telemedicine using nonmydriatic cameras increased the proportion of participants who obtained diabetic retinopathy screening examinations, and most did not require follow-up with an eye care provider. Telemedicine may be a more effective way to screen patients for diabetic retinopathy and to triage further evaluation with an eye care provider. Methods to decrease poor quality imaging would improve the effectiveness of telemedicine for diabetic retinopathy screening examinations.

P.4.7 The natural history of myotubular myopathy, summary of the first year of enrollment

Myotubular myopathy (MTM) is an X-linked disorder characterized by muscle weakness, hypotonia, external ophthalmoplegia, and respiratory failure. At this time, no treatments exist for MTM. To prepare for future therapy development, the natural history of a condition must be well established. This study sought to expand on the two previous natural history studies that were performed over one decade ago. A five year prospective natural history study was launched in 2011. Data was gathered through a patient-reported survey, physical examination, pulmonary function testing (PFT), repetitive stimulation testing, collection of medical records, and pedigree. In the first year, 37 MTM participants (20 living, 7 deceased) were enrolled ranging from 10 months to 41 years. The majority of participants were wheelchair (70%) and ventilator dependent (78%). Scoliosis was reported among 67% of participants, developing at an average age of 2.93 years. Similar to the study performed by Herman and colleagues (1999), additional medical problems were reported including cardiac (35%), liver (40%), kidney (20%), and clotting (25%). PFT’s (n = 4) and the Hammersmith Functional Motor Scale (n = 6) were performed on a subset of participants and were not found to be useful outcome measures. Additionally, repetitive stimulation was performed on a subset of participants (n = 8) and no evidence of neuromuscular junction abnormalities were detected. Our results are similar to the previous studies, showing increased survival of MTM patients and the identification of additional medical problems which may require screening. Preclinical data has shown abnormalities in the neuromuscular junction, however, this was not confirmed in our small cohort of participants. Lastly, the investigation of additional outcome measures will be needed in preparation for future clinical trials.

Incidence and predictors of tuberculosis among adult people living with human immunodeficiency virus at the University of Gondar Referral Hospital, Northwest Ethiopia

BackgroundTuberculosis (TB) is the leading killer of people living with HIV (PLHIV). Many of these deaths occur in developing countries. This study aimed at determining the incidence and predictors of tuberculosis among PLHIV.MethodsA five year retrospective follow up study was conducted among adult PLHIV. The Cox proportional hazards model was used to identify predictors.ResultsA total of 470 patients were followed and produced 1724.13 Person-Years (PY) of observation, and 136 new TB cases occurred during the follow up period. The overall incidence density of TB was 7.88 per 100 PY. It was high (95.9/100PY) in the first year of enrolment. The cumulative proportion of TB- free survivals was 79% and 67% at the end of the first and fifth years, respectively. Baseline WHO clinical stage III (AHR = 2.88, 95% CI = 1.53-5.43), WHO clinical stage IV (AHR = 3.82, 95% CI = 1.86-7.85), CD4 count <50 cell/ul (AHR = 2.13, 95% CI = 1.28-3.53) and ambulatory or bed ridden functional status (AHR = 1.64, 95%CI = 1.13-2.38) were predictors of time to TB occurrence.ConclusionsTB incidence rate among PLHIV, especially in the first year of enrollment was high. Advanced WHO clinical stage, limited functional status, and low CD4 count (<50 cell cell/ul) were found to be the independent predictors of TB occurrence. Early care seeking and initiation of HAART to improve the CD4 count and functional status are important to reduce the risk of TB infection.

What's in a relationship?

Purpose – Increasingly, higher education institutions are being held to account for the performance of their students internally in terms of academic performance and timely program completion, as well as externally through job placement. This challenge is compounded by a range of additional factors including fluctuating, international economic conditions, an increasingly globalised, competitive environment, widespread provision of online qualifications, and high student drop-out rates. There is a pressing need therefore to understand the factors which contribute to positive perceptions of institutional services and the way in which these drive student retention, especially within the first year experience. This research aims to explore the role of affective commitment in students' perceived satisfaction within the student-university relationship and the effect of this on retention in an Australian tertiary context. Design/methodology/approach – A qualitative approach was adopted using four focus groups and eight in-depth interviews with first year undergraduate students enrolled at a large metropolitan Australian university. In addition, an online expert forum was used to obtain qualitative verbatim from 22 internationally-based faculty educators. Findings – The results of this study suggest that the development of deeply entrenched emotional bonds with students is important in facilitating high levels of satisfaction during the first year experience. In addition, a sense of belonging was perceived by faculty as being the primary mechanism for ensuring the retention of students beyond the first year of enrolment. Practical implications – From a managerial perspective, uncovering the nature of student-institution relationships and the importance of affective forms of commitment will enable higher education institutions to develop more targeted relationship marketing programs to increase student retention. Originality/value – In a unique contribution, this research examines this issue from the perspective of first year students, as well as from an international faculty perspective, enabling a multi-dimensional comparison to be drawn between the perceptions of the student, and the service provider.

Do Ethnic Disparities Extend to Subspecialty Diabetes Care?

It is unclear if disparities described in diabetes primary care extend to subspecialty diabetes care. This retrospective observational study examined disparities in diabetes outcomes in a subspecialty practice by assessing glycemic improvement in type 2 diabetes patients during the first year of enrollment. Electronic data were gathered on 3,945 subjects. The outcome was the proportion of white and minority (Asian, black, and Hispanic) subjects achieving a hemoglobin A1C (A1C) level of ≤7% after the first year of care. Logistic regression was used to identify factors associated with odds of achieving A1C ≤7%. Minority patients had greater diabetes duration, more social disadvantages and missed appointments, and worse control at presentation than whites. The proportion of patients reaching target A1C rose from 37 to 52% among white patients and from 28 to 40% among minority patients. Significant differences between whites and minorities in the rates of patients reaching A1C ≤7% were found only among those with higher initial A1C (iA1C) levels (32% vs. 20.9%; P = .002 in third iA1C quartile, and 28.2% vs. 17.9%; P = .0003 in fourth iA1C quartile). The interaction between race/ethnicity and the top two iA1C quartiles remained significant in the fully adjusted model. Reaching an A1C level of ≤7% depends strongly upon the glycemic level at initial presentation to specialty care, not race. However, minority patients with the highest baseline A1C levels do not improve to the same degree as white patients, and therefore should be targeted for more intensive diabetes care management.

Comparison of Emotional Intelligence Scores among Engineering Students at Different Stages of an Academic Program

Intelligence quotient (IQ) has been widely used as a measure of an individual’s intellectual abilities. Emotional intelligence or emotional quotient (EQ) is equally important in defining excellent work performance. An increasing number of employers have started considering fresh graduates with high EQ because the job market is already full of academically competent candidates. With this motivation considered, this study aims to compare the EQ levels of four groups of undergraduate students in their first year of enrollment in their academic program and at the start of each succeeding academic year in the Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia (UKM). The EQ scores of these students were also monitored until their graduation. The EQ levels were determined using the Malaysian EQ Inventory (MEQI) test developed by UKM researchers. A comparative study of EQ levels among five batches of students was conducted, starting from their first enrollment in their respective programs. One batch of students has completed the study, and their MEQI results indicated a slight reduction in the total EQ scores. However, two domains recorded improvement: social skills and maturity. Thus, tertiary education is not expected to change student EQ levels, completely because EQ level comprises cognitive and emotional qualities developed during primary and secondary years of education. Innovative strategies on effective teaching and learning activities should be identified to determine their positive influence on the development of EQ domains.

Using latent growth curve modeling to examine changes in mental health outcomes for children enrolled in a system of care.

MeckCARES, a system of care (SOC) in Mecklenburg County, North Carolina, is designed to serve youth with severe emotional disturbances and their families. This study employed latent growth curve (LGC) modeling to examine (a) the degree to which youth improved on indicators of adjustment over the course of the first year of enrollment in MeckCARES, and (b) the services or demographic variables associated with individual differences in the rate of change over time. Participant caregivers (N = 121) reported on 3 major indicators of youth adjustment at baseline, 6-month follow-up, and 12-month follow-up. Primary analyses indicated that there was a modest yet significant improvement in all 3 outcome measures over the first year of enrollment in MeckCARES. Additional analyses revealed that caregiver reports of receiving case management at any point in the first year were associated with improvement in behavioral and emotional strengths as well as a reduction in psychological and behavioral symptoms. No significant differences in rate of change were observed based on caregiver-reported receipt of individual or family therapy nor any demographic variables. These findings suggest that MeckCARES may be particularly effective when youth are receiving case management services. Additional implications for practice are discussed.

Bildung einer Kontrollgruppe mithilfe von Matched-Pairs auf Basis von GKV-Routinedaten zur prospektiven Evaluation von Einschreibemodellen

Various study approaches can be considered for the investigation of the efficiency of enrollment models, like GP-centred health-care contract or disease management programmes. As an active and independent enrollment into care models is effected by the insured (self-selection), a randomisation cannot be applied. The matched pairs design - in which for every insured a control insured with comparable morbidity is selected - presents an alternative investigation method. A precondition is a model that describes appropriately the morbidity on the basis of available routine data. The aim of this study was to develop a procedure that selects comparable insured persons on the basis of routine data of the statutory health-care funds. Apart from age, gender, care status, insured status, days of disability, region, health insurance and belonging to an enrollment model, also ambulant as well as stationary performance data for the year 2005 following the PCG/DCG procedure for morbidity-oriented matching design developed by Lamers and Vliet (2003) were applied. Thereby the consumption of certain medications prescribed is determining for the allocation of patients to pharmaceutical cost groups (PCG). Additionally a classification into diagnosis cost groups (DCG) according to stationary diagnoses was conducted. Within the scope of the enrollment models the formation of matched pairs following the PCG/DCG procedure represents an appropriate study design for the creation of a control group. In the first year of enrollment the insured of the interventional and those of the control group show a comparable morbidity. When applying 9 matching criteria a control insured person can be found for 87% of the enrolled individuals. There are various and complex possibilities to define morbidity. Variable parameters within the presented matched pairs design are the number of used matching criteria as well as minimum drug consumption limit relevant for the classification in PCGs. Alternative models are possible for morbidity definition considering, apart from the stationary diagnosis, also the ambulant diagnosis. When taking into account a higher number of morbidity criteria, the matched pairs design is confronted with dimensionality issues. The propensity score matching is discussed as approach to solve this problem.

Changes in Body Mass Index Z Score Over the Course of the Academic Year Among Children Attending Head Start

We tested the hypothesis that among 3- to 5-year-old children attending Head Start, body mass index z score will decline during the academic year and increase during the summer. We used retrospective longitudinal growth data collected over 5 academic years from 1914 children (51% boys, 62% white) enrolled in a Michigan Head Start program. Changes in body mass index (BMI) z score, calculated as annual rate of change, during 2 academic years and the intervening summer were assessed by piecewise linear regression analysis. Potential covariates were gender, single-parent status, program year, race/ethnicity, age at initial enrollment, and family income (divided by household size). Mean BMI z score at the start of Head Start enrollment was 0.52 (95% confidence interval [95% CI] 0.39 to 0.65). Mean annual rates of BMI z score change were: -0.07 (95% CI -0.28 to 0.14) during the first year of enrollment, 0.62 (95% CI -0.0005 to 1.23) over the summer, and -0.82 (95% CI -1.50 to -0.13) during the second year of enrollment. The effect was most robust among girls of minority race/ethnicity. Head Start is associated with a shifting of BMI z scores toward the norm among low-income preschool-aged children, particularly among girls of minority race/ethnicity.

Tumor Volume of Growth Hormone-Secreting Pituitary Adenomas during Treatment with Pegvisomant: A Prospective Multicenter Study

Clinical and biochemical remission in acromegaly can frequently be achieved with the recombinant GH receptor antagonist pegvisomant, even when other treatments fail. However, increases in tumor volume have been reported. Because previous studies suffer from inhomogenous magnetic resonance imaging (MRI) protocols, this prospective study examined the long-term course of adenoma volume during pegvisomant therapy by standardized MRI. Five centers in Germany participated. High-resolution MRI was performed at baseline and 6, 12, and 24 months after enrollment. Patients were outpatients, and pegvisomant is third-line therapy in most of the cases. The primary end point was tumor volume at 24 month follow-up, measured by a single, double-blinded rater. Forty-five of 61 patients completed 24 months' follow-up (73.8%). Tumor volume increase greater than 25% during the study was observed in three of 61 patients (4.9%), all during the first year of enrollment. All three patients had had octreotide treatment before initiation of pegvisomant; none of them had had radiotherapy. All volumetric findings were comparable with clinical radiological interpretations. ANOVA revealed no significant change in tumor volume after 24 months (n = 45). This study shows that pegvisomant therapy infrequently coincides with tumor growth during long-term treatment of acromegaly. Because all significant tumor volume increases occurred during the first year, these changes might correlate to the change of medication and thus be the result of a rebound from somatostatin-induced shrinkage.

A telehealth nursing intervention reduces hospitalizations in children with complex health conditions

The U Special Kids Program (USK) at the University of Minnesota provides care coordination and case management services by telephone to children with special health-care needs. We measured the effect of the USK programme on hospital resource utilization using a retrospective record review. Information on hospitalizations was collected for children enrolled in the programme for at least two years and validated for accuracy against inpatient claims data. Hospitalizations were classified as planned, unplanned or due to lack of home care. A total of 43 children enrolled in the USK programme between July 1996 and December 2006 met the study criteria. The children had multiple, complex conditions. During the period of the study, there were 61 planned hospitalizations, 184 unplanned hospitalizations and 3 hospitalizations due to lack of home care. The number of unplanned hospitalizations decreased from 74 in the first year of enrolment to 35 in the second; this reduction was significant (P < 0.007). In the subsequent years, the rate of unplanned admissions stabilized. In contrast, the rate of planned hospitalizations was relatively constant over the five-year enrolment period. Telephone-based care coordination and case management is a promising approach for children with multiple, complex health conditions.

Factors associated with response to a follow-up postal questionnaire in a cohort of American Indians

Objective The aim of the study was to collect pilot data on response rates to a follow-up postal questionnaire in a cohort of American Indians living in the Southwestern United States. We tested the effect of questionnaire length on response. Methods Cohort members were American Indian adults aged 18 and over who completed the baseline study visit. Study participants ( N = 1587), cohort members who completed the baseline study visit during the first year of enrollment, were randomized into two groups to receive either an 18-page or 3-page follow-up postal questionnaire. Data were collected between October 2005 and March 2006. Results The response rates after two questionnaire mailings and a reminder postcard were significantly higher for the short versus the long (56.2%, 48.1% p = < 0.01) questionnaire. Being female and being aged 50 or older were associated with returning a completed questionnaire. A reminder postcard and second mailing improved response by 11.7% and 13.4% respectively. Conclusions These results show that a postal questionnaire can be used in a cohort of American Indians living in the Southwest, but suggest that questionnaires should be short and repeat mailings are needed.

Consistency of antidepressant and chronic nonpsychiatric medication use in a high-risk clinical population

Background Antidepressant nonadherence is a significant threat to clinical outcomes and can be divided into 2 primary domains, persistence and consistency. Although antidepressant persistence has been well described, little is known about consistency patterns. Objectives The primary objective of this study was to characterize consistency among persistent antidepressant users. Patients with depression may also exhibit poor adherence to medications for chronic comorbid conditions. Thus, a second objective was to compare their consistency with chronic, nonpsychiatric medications with that of nonantidepressant users. Methods Continuously eligible adult patients were selected from the Iowa Medicaid Pharmaceutical Case Management program based on receiving an antidepressant or a selected chronic nonpsychiatric medication for at least the first 4 months after program enrollment. Consistency over the first year of enrollment was determined from prescription refill patterns, using the MED-OUT index. Results The mean consistency rate was 86% among the 1122 persistent antidepressant users. Consistency was not significantly different among polyantidepressant users or across the antidepressant classes. Among antidepressant users, consistency with antidepressants was not significantly different from consistency with chronic nonpsychiatric medications. Antidepressant users were not significantly less consistent with chronic nonpsychiatric medications than nonantidepressant users, after controlling for the confounding factors of age, sex, and total number of medications. Conclusions Consistency with medications in this population of persistent antidepressant users with medical illnesses was fairly good, and comparable to that of nonantidepressant users. The unique population may have influenced consistency rates. Focusing on persistent antidepressant users may have limited the expected impact of depression on medication consistency.

Asthma control and future asthma-related morbidity in inner-city asthmatic children

Asthma guidelines recommend routine evaluation of asthma control, which includes measurements of impairment and risk. It is unclear whether rigorous asthma control changes risk of asthma morbidity. To examine whether the degree of asthma control in inner-city asthmatic children results in differential risk reduction of future asthma-related morbidity. This retrospective observational study examines 960 inner-city children with asthma who were highly engaged in an asthma-specific disease management program for a minimum of 2 years. Degree of asthma control was determined during the first year of enrollment and was categorized as well controlled (> or = 80% of visits in control), moderately controlled (50%-79% of visits in control), or difficult to control (< 50% of visits in control). Risk and probability of asthma-related morbidity at each visit were determined during the second year of enrollment and included self-reported asthma exacerbations requiring systemic corticosteroid rescue and emergency department visits or hospitalizations. Increasing the degree of asthma control measured during the first year of enrollment led to statistically significant incremental reductions in risk of acute asthma exacerbations and emergency department visits or hospitalizations during the second year of enrollment. Achieving and maintaining asthma control in inner-city children with asthma results in significant reductions in asthma-related morbidity. Systematic assessments of asthma control may be useful for predicting future risk in children with asthma.

Longitudinal Patterns of Predominant Asthma Disease Activity in Pediatric Patients Enrolled in an Asthma-Specific Disease Management Program

To determine if patterns of predominant asthma disease activity are more closely related than baseline asthma severity to measures of morbidity (acute asthma attack, emergency room visit/hospitalization, missed school days, and/or steroid burst). Retrospective analysis was performed for inner-city Los Angeles asthmatic children (3 to 18 years of age) during their first year of enrollment in an asthma-specific disease management program. All measures of morbidity were more closely related to patterns of predominant disease activity than baseline severity. We conclude that patterns of predominant disease activity are a more significant predictor of asthma morbidity than is baseline severity.

Infant Care Patterns at Epidemiologic Study of Cystic Fibrosis Sites That Achieve Superior Childhood Lung Function

Previous analyses of the Epidemiologic Study of Cystic Fibrosis database revealed that sites with the highest average patient lung function monitor patients and treat with antibiotics more aggressively than those where average lung function is lowest. The aim of this study was to assess whether patterns of care for infants at cystic fibrosis sites with superior average lung function in 6- to 12-year-old children showed any differences from those at the lowest outcome sites. We divided cystic fibrosis sites with > or = 20 patients who were 6 to 12 years of age into quartiles on the basis of median forced expiratory volume in 1 second of that age group in 2003 and compared demographic and clinical characteristics and treatment patterns during the first year of enrollment for patients who were aged 0 to 3 years at those sites in 1994 to 1999. The analysis included 755 infants from 12 upper quartile sites and 743 infants from 12 lower quartile sites. Upper quartile sites had more infants whose disease was diagnosed by family history or newborn screening, fewer infants with symptoms at diagnosis, higher weight for age at enrollment, more white patients, and more deltaF508 homozygotes. Medical conditions and respiratory tract microbiology differed between sites. Infants at upper quartile sites had more office and sick visits; more respiratory tract cultures; and more frequent use of intravenous antibiotics, oral corticosteroids, mast cell stabilizers, and mucolytics; but they received less chest physiotherapy, inhaled bronchodilators, oral nutritional supplements, and pancreatic enzymes. Both enrollment characteristics and infant care patterns are associated with lung function outcomes in later childhood. Our analysis suggests that pulmonary function of older children may be improved through specific interventions during the first 3 years of life.