Browsing by Subject "pediatric"
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Item Asthma Outcomes of Children in a Pediatric Asthma Program: A Comparison of Outcomes Among Publicly and Privately Insured Participants(2010-05-01) Crowther, Anne E.; Reyes-Ortiz, CarlosThis study was a secondary analysis of the Asthma Management Program at Children’s Medical Center. The evaluation of outcomes of the six month program includes participants enrolled between June 2001 and August 2009 (n= 472). The program consisted of biweekly telephonic education and two home visits. In the bivariate analyses, privately insured children had significant lower means for emergency room visits, unscheduled clinic visits, and missed school days compared to those with public insurance (all p [less than] .05). All four asthma control outcomes improved from baseline to the 6 month followup (all p [less than] .001). In the multivariate longitudinal analyses, private insurance predicted lower number of emergency room consultations (beta 0.022, p [less than] .001) during the program.Item Factors Influencing Parents' Decision to Use Complementary and Alternative (CAM) Therapies in Children with Chronic Conditions(2023-05) Munshi, Aliyah I.; Fulda, Kimberly; Franks, Susan; Schranz, DamonIntroduction/Background: Complementary and Alternative Medicine, or CAM, therapies are defined as treatments, or therapies, outside of conventional medical practices, some of which have a basis outside of traditional Western practices and are often used in children with chronic conditions. Studies have found that patients, or caregivers of patients, do not always inform their doctors when they are using a CAM therapy, with this disconnect sometimes leading to interference in their treatment plan and possibly becoming a complicating factor. Therefore, it is important to understand the factors that influence a caregiver to use CAM therapies in order to bridge the gap in knowledge linking various factors to CAM therapy usage. Methods: Participants were recruited from the UNTHSC Health Pavilion Pediatrics and Family Medicine Clinics, as well as from various social media platforms. Data was collected through a survey questionnaire that 50 total eligible participants filled out. Participants answered questions regarding their CAM therapy usage, or their willingness to. They additionally answered questions about sociodemographic factors, their child's condition, and possible physician discussion of CAM therapies. Data was analyzed using descriptive statistics comparing CAM therapy usage to the variables mentioned previously. Results: Type of chronic condition was not associated with an increase in CAM therapy usage. 83.3% of participants whose child's condition was more severe reported having used CAM therapies while 76.9% of participants whose child's condition was less severe reported having used CAM therapies. Sociodemographic factors such as child race/ethnicity (p= 0.412), caregiver race/ethnicity (p=0.236), caregiver education level (p=0.180), caregiver marital status (p= 1.000), caregiver employment status (p=0.575), and reliable form of transportation (unable to perform test) were not associated with CAM therapy usage. Physician discussion of the following CAM therapies were associated with an increased usage, or willingness to use those CAM therapies: Botanical drugs/natural product drugs (p=0.032), breathing and relaxation techniques (0.009), dietary supplements (0.002), and psychotherapy (0.040). Conclusion: There was a trend possibly associating CAM therapy usage and severity; however, statistical tests were unable to be performed and prevented statistically backed conclusions to be made. Physician discussion of certain CAM therapies is associated with an increase in participants using those CAM therapies, or being willing to use them. Further studies with larger sample sizes gathered from more diverse recruitment sites are needed to better explore these relationships and possible factors that may influence a caregiver to use CAM therapies for their child with a chronic condition(s).Item Role of Arousal Threshold in Sleep Health Disparities and Outcomes Among Pediatric Patients with Obstructive Sleep Apnea(2022-05) Gracia, Fernando I.; Rickards, Caroline A.; Jones, Harlan P.; Basha, Riyaz; Cunningham, J. ThomasBlack/African American (Black) children are at increased risk of experiencing continued obstructive sleep apnea (OSA) disease following adenotonsillectomy (A&T), which is the first-line treatment for OSA in children. The nadir epiglottic pressure preceding arousal, known as the arousal threshold (ArTH), and allostatic load (AL), a measure of the impact of environmental stress on the body, are both associated with the severity and incidence of the disease. However, the contribution of these factors to the sleep health disparities among Black pediatric patients is unknown. Therefore, our overall objective of this study was to determine the role of arousal threshold and allostatic load in sleep health disparities amongst treatment outcomes in pediatric patients with OSA. The current study leveraged archival data from the Childhood Adenotonsillectomy Trial (CHAT). 464 children aged 5 to 9 years with obstructive sleep apnea were randomized to receive either early adenotonsillectomy or watchful waiting. Polysomnographic, cognitive, behavioral, and health outcomes were examined at baseline and after seven months. Our sample included 183 participants who had the required allostatic load baseline data for the analysis and a sub-sample of 98 participants who underwent adenotonsillectomy surgery and had follow-up data. We examined AL index among Black and White children to identify differences and create a model that could explain the noted sleep disparities in response to adenotonsillectomy surgery. To achieve the overall objective and test the first hypothesis that Black children will have increased arousal threshold and allostatic load compared to their White counterparts, univariate ANCOVAs were conducted to determine potential differences between Black and White children for ArTH and AL adjusted for demographic and socioeconomic factors. To test the second hypothesis that increased arousal threshold and allostatic load will predict higher adenotonsillectomy failure rates. Quadratic discriminant function analysis was used to determine if ArTH and AL load predicts adenotonsillectomy failure. A&T failure is defined as a participant having an obstructive apnea index (OAI) ≥ 1 and an apnea-hypopnea index (AHI) ≥ 2 at follow-up 7 months after A&T. Key findings were an increased allostatic load in Black children (P=0.09) and an interaction effect between race and premature birth. Black Children born premature had a higher allostatic load than White children born premature (P=0.09). Additionally, among the subsample of participants who underwent adenotonsillectomy surgery, a difference between Black and White race was found for ArTH (p < 0.05). For predicting the success and failure of adenotonsillectomy surgery, the test model showed a 54.8% success rate in predicting group membership. The findings from our study can be used to guide the development and testing of future sleep health interventions and further elucidate the etiology of sleep health disparities