Browsing by Subject "CHILDREN"

Now showing 1 - 5 of 5
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    A host gene expression approach for identifying triggers of asthma exacerbations.
    (PloS one, 2019-01) Lydon, Emily C; Bullard, Charles; Aydin, Mert; Better, Olga M; Mazur, Anna; Nicholson, Bradly P; Ko, Emily R; McClain, Micah T; Ginsburg, Geoffrey S; Woods, Chris W; Burke, Thomas W; Henao, Ricardo; Tsalik, Ephraim L
    RATIONALE:Asthma exacerbations often occur due to infectious triggers, but determining whether infection is present and whether it is bacterial or viral remains clinically challenging. A diagnostic strategy that clarifies these uncertainties could enable personalized asthma treatment and mitigate antibiotic overuse. OBJECTIVES:To explore the performance of validated peripheral blood gene expression signatures in discriminating bacterial, viral, and noninfectious triggers in subjects with asthma exacerbations. METHODS:Subjects with suspected asthma exacerbations of various etiologies were retrospectively selected for peripheral blood gene expression analysis from a pool of subjects previously enrolled in emergency departments with acute respiratory illness. RT-PCR quantified 87 gene targets, selected from microarray-based studies, followed by logistic regression modeling to define bacterial, viral, or noninfectious class. The model-predicted class was compared to clinical adjudication and procalcitonin. RESULTS:Of 46 subjects enrolled, 7 were clinically adjudicated as bacterial, 18 as viral, and 21 as noninfectious. Model prediction was congruent with clinical adjudication in 15/18 viral and 13/21 noninfectious cases, but only 1/7 bacterial cases. None of the adjudicated bacterial cases had confirmatory microbiology; the precise etiology in this group was uncertain. Procalcitonin classified only one subject in the cohort as bacterial. 47.8% of subjects received antibiotics. CONCLUSIONS:Our model classified asthma exacerbations by the underlying bacterial, viral, and noninfectious host response. Compared to clinical adjudication, the majority of discordances occurred in the bacterial group, due to either imperfect adjudication or model misclassification. Bacterial infection was identified infrequently by all classification schemes, but nearly half of subjects were prescribed antibiotics. A gene expression-based approach may offer useful diagnostic information in this population and guide appropriate antibiotic use.
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    Comparison of US Federal and Foundation Funding of Research for Sickle Cell Disease and Cystic Fibrosis and Factors Associated With Research Productivity.
    (JAMA network open, 2020-03-02) Farooq, Faheem; Mogayzel, Peter J; Lanzkron, Sophie; Haywood, Carlton; Strouse, John J
    Importance:Sickle cell disease (SCD) and cystic fibrosis (CF) are severe autosomal recessive disorders associated with intermittent disease exacerbations that require hospitalizations, progressive chronic organ injury, and substantial premature mortality. Research funding is a limited resource and may contribute to health care disparities, especially for rare diseases that disproportionally affect economically disadvantaged groups. Objective:To compare disease-specific funding between SCD and CF and the association between funding and research productivity. Design, Setting, and Participants:This cross-sectional study examined federal and foundation funding, publications indexed in PubMed, clinical trials registered in ClinicalTrials.gov, and new drug approvals from January 1, 2008, to December 31, 2018, in an estimated US population of approximately 90 000 individuals with SCD and approximately 30 000 individuals with CF. Main Outcomes and Measures:Federal and foundation funding, publications indexed in PubMed, clinical trial registrations, and new drug approvals. Results:From 2008 through 2018, federal funding was greater per person with CF compared with SCD (mean [SD], $2807 [$175] vs $812 [$147]; P < .001). Foundation expenditures were greater for CF than for SCD (mean [SD], $7690 [$3974] vs $102 [$13.7]; P < .001). Significantly more research articles (mean [SD], 1594 [225] vs 926 [157]; P < .001) and US Food and Drug Administration drug approvals (4 vs 1) were found for CF compared with SCD, but the total number of clinical trials was similar (mean [SD], 27.3 [6.9] vs 23.8 [6.3]; P = .22). Conclusions and Relevance:The findings show that disparities in funding between SCD and CF may be associated with decreased research productivity and novel drug development for SCD. Increased federal and foundation funding is needed for SCD and other diseases that disproportionately affect economically disadvantaged groups to address health care disparities.
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    Depression, quality of life, and medical resource utilization in sickle cell disease.
    (Blood advances, 2017-10-12) Adam, Soheir S; Flahiff, Charlene M; Kamble, Shital; Telen, Marilyn J; Reed, Shelby D; De Castro, Laura M
    Sickle cell disease (SCD) is a chronic, debilitating disorder. Chronically ill patients are at risk for depression, which can affect health-related quality of life (HRQoL), health care utilization, and cost. We performed an analytic epidemiologic prospective study to determine the prevalence of depression in adult patients with SCD and its association with HRQoL and medical resource utilization. Depression was measured by the Beck Depression Inventory and clinical history in adult SCD outpatients at a comprehensive SCD center. HRQoL was assessed using the SF36 form, and data were collected on medical resource utilization and corresponding cost. Neurocognitive functions were assessed using the CNS Vital Signs tool. Pain diaries were used to record daily pain. Out of 142 enrolled patients, 42 (35.2%) had depression. Depression was associated with worse physical and mental HRQoL scores (P < .0001 and P < .0001, respectively). Mean total inpatient costs ($25 000 vs $7487, P = .02) and total health care costs ($30 665 vs $13 016, P = .01) were significantly higher in patients with depression during the 12 months preceding diagnosis. Similarly, during the 6 months following diagnosis, mean total health care costs were significantly higher in depressed patients than in nondepressed patients ($13 766 vs $8670, P = .04). Depression is prevalent in adult patients with SCD and is associated with worse HRQoL and higher total health care costs. Efforts should focus on prevention, early diagnosis, and therapy for depression in SCD.
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    Point, walk, talk: Links between three early milestones, from observation and parental report.
    (Developmental psychology, 2019-08) Moore, Charlotte; Dailey, Shannon; Garrison, Hallie; Amatuni, Andrei; Bergelson, Elika
    Around their first birthdays, infants begin to point, walk, and talk. These abilities are appreciable both by researchers with strictly standardized criteria and caregivers with more relaxed notions of what each of these skills entails. Here, we compare the onsets of these skills and links among them across two data collection methods: observation and parental report. We examine pointing, walking, and talking in a sample of 44 infants studied longitudinally from 6 to 18 months. In this sample, links between pointing and vocabulary were tighter than those between walking and vocabulary, supporting a unified sociocommunicative growth account. Indeed, across several cross-sectional and longitudinal analyses, pointers had larger vocabularies than their nonpointing peers. In contrast to previous work, this did not hold for walkers' versus crawlers' vocabularies in our sample. Comparing across data sources, we find that reported and observed estimates of the growing vocabulary and of age of walk onset were closely correlated, while agreement between parents and researchers on pointing onset and talking onset was weaker. Taken together, these results support a developmental account in which gesture and language are intertwined aspects of early communication and symbolic thinking, whereas the shift from crawling to walking appears indistinct from age in its relation with language. We conclude that pointing, walking, and talking are on similar timelines yet distinct from one another, and discuss methodological and theoretical implications in the context of early development. (PsycINFO Database Record (c) 2019 APA, all rights reserved).