RATIONALE: Asthma disproportionately affects children living in impoverished communities; however, morbidity among high risk children living in rural environments has not been well-described.METHODS: We performed a cross-sectional investigation of asthma severity among children enrolled in rural public schools in the Arkansas Delta region.RESULTS: Data were analyzed on 109 rural children. Median age was 9 years, 54% were male, 83% African-American and 66% from low-income families. In the past 4 weeks, > 50% reported daytime symptoms ≥ 2 days/week or nocturnal symptoms > 2 nights/month, and 63% reported using rescue medication ≥ 2 days/week. Predictors for rescue medication use included inhaled corticosteroid use [OR 3.06; 95% CI, 1.05-8.91], maternal education beyond high school [OR 0.57; 95% CI 0.35-0.92] and poverty [OR 2.32; 95% CI 1.02-5.28]. Twenty-eight percent reported being treated in the emergency department in the 6 months preceding study enrollment and 43% reported acute care visits for asthma in the preceding 3 months. Increased maternal education was a predictor for acute care visits [OR 0.63; 95% CI 0.40-0.99]. Ninety-nine percent of participants had health insurance and the majority fit guidelines-based criteria for persistent asthma care, yet only 23% were taking daily inhaled corticosteroid therapy.CONCLUSIONS: Asthma is poorly controlled among this predominately minority, low-income rural cohort living in the Delta region of Arkansas. Controller asthma medication use was inadequate despite the fact that there was significant evidence of high healthcare utilization rates, poorly controlled baseline asthma symptoms and the majority of participants had medical insurance. RATIONALE: Asthma disproportionately affects children living in impoverished communities; however, morbidity among high risk children living in rural environments has not been well-described. METHODS: We performed a cross-sectional investigation of asthma severity among children enrolled in rural public schools in the Arkansas Delta region. RESULTS: Data were analyzed on 109 rural children. Median age was 9 years, 54% were male, 83% African-American and 66% from low-income families. In the past 4 weeks, > 50% reported daytime symptoms ≥ 2 days/week or nocturnal symptoms > 2 nights/month, and 63% reported using rescue medication ≥ 2 days/week. Predictors for rescue medication use included inhaled corticosteroid use [OR 3.06; 95% CI, 1.05-8.91], maternal education beyond high school [OR 0.57; 95% CI 0.35-0.92] and poverty [OR 2.32; 95% CI 1.02-5.28]. Twenty-eight percent reported being treated in the emergency department in the 6 months preceding study enrollment and 43% reported acute care visits for asthma in the preceding 3 months. Increased maternal education was a predictor for acute care visits [OR 0.63; 95% CI 0.40-0.99]. Ninety-nine percent of participants had health insurance and the majority fit guidelines-based criteria for persistent asthma care, yet only 23% were taking daily inhaled corticosteroid therapy. CONCLUSIONS: Asthma is poorly controlled among this predominately minority, low-income rural cohort living in the Delta region of Arkansas. Controller asthma medication use was inadequate despite the fact that there was significant evidence of high healthcare utilization rates, poorly controlled baseline asthma symptoms and the majority of participants had medical insurance.

RATIONALE: To examine the relationship between caregiver characteristics and morbidity among rural children with asthma in the Mississippi Delta region of Arkansas. METHODS: Caregivers of 116 rural children with persistent asthma were screened for depressive symptoms, life stressors, and asthma self-efficacy. The relationship between caregiver characteristics and asthma morbidity was examined. RESULTS: Of the 116 children enrolled, all reside in an agricultural rural environment, 82% were African-American, 55% male, and 70% from households with annual income ≤$20,000. Caregivers reported depressive symptoms (36%), feelings of helplessness during their child's asthma attacks (72%), and interference with their job (43%). The majority of caregivers reported that their child had symptoms consistent with poorly controlled asthma including daytime symptoms ≥2 days per week (54%), nocturnal symptoms ≥2 nights per month (61%), and rescue medication use ≥2 times per week (73%). No significant difference was detected in asthma symptoms among children whose caregivers reported depressive symptoms compared to those without depressive symptoms. Children of caregivers who reported that their child's asthma interfered with their job were more likely to report daytime symptoms ≥2 days per week [OR 3.31 (95% CI 1.46-7.53)] and nocturnal symptoms ≥2 nights per month [OR 2.41 (95% CI 1.05-5.53)]. Caregiver feelings of helplessness was more common [OR 2.9 (95%CI 1.21-7.33)] among children with day symptoms ≥2 days per week. CONCLUSIONS: Asthma morbidity is high among predominately low-income, minority rural children living in the Arkansas Delta region and increased asthma symptoms were associated with increased caregiver report of job interference and feelings of helplessness.

Introduction: Pediatric patients often require metered-dose inhaler (MDI) with holding chamber (HC) to overcome lack of coordination when receiving inhaled therapy In infants and young children unable to use a mouthpiece, it is necessary to use a mask interface. We compared the effect of varying mask static dead volume (SDV), respiratory rate (RR), and tidal volume (VT) on albuterol captured at the mouth opening (ACMO) in an in vitro model. Methods: An Aerochamber Max(R) without and with three mask sizes (SDV of 10, 36, 85, and 200 ml, respectively) was connected in series to a filter holder and breathing simulator. ACMO was measured at VTs = 36, 72, 145, and 290 ml and RR of 12 and 24. Each experiment comprised 10 puffs run for six respiratory cycles each. Albuterol was quantified via spectrophotometry at 276 nm. A P-value of 0.05 was considered significant. Results: Increasing VT increased ACMO (all SDVs and RRs). Adding SDV decreased ACMO, except for the small mask at VTs = 145 and 290 ml at RR = 12. Increasing SDV decreased ACMO, except at VT 36 ml (all masks) and VT = 72 ml (small = medium) at RR = 12 and VT = 36 ml (small = other and medium > large) at RR 24. Increasing RR increased ACMO for all SDVs at VTs = 36 and 72 ml, but not for VTs = 145 and 290 ml, except for no and large mask at VT = 145 ml. Conclusion: In general, decreasing SDV, increasing VT and increasing RR increase ACMO. Early transition from face mask to mouthpiece should be considered in children receiving albuterol via MDI with HC. Pediatr Pulmonol. 2010;45:224-229. (C) 2010 wiley-Liss, Inc.

RATIONALE: To compare asthma prevalence and morbidity between urban and rural schoolchildren in Arkansas.METHODS: We analyzed completed asthma screener data between urban (Little Rock, n = 5,417) and rural (Marvell and Eudora, n = 964) schoolchildren to compare asthma prevalence in each region. Data were analyzed to compare symptoms severity, medication use, and healthcare utilization among at-risk children in each group.RESULTS: Both populations were predominately African American [91% rural vs. 69% urban, p = 0.001] with significantly more rural children having state-issued medical insurance [78% vs. 37%, p < 0.001]. Physician-diagnosed asthma was similar between rural (20%) and urban (21%) children. Among the at-risk population, rural children were more likely to fit symptoms criteria for moderate-to-severe asthma compared to urban children [46% vs. 36%, p < 0.001]. Rural children were also more likely to be diagnosed with bronchitis [OR 3.4; 95% CI 2.5-4.6], had more recurrent breathing problems [OR 1.8; 95% CI 1.5-2.2], recurrent cough [OR 2.2; 95% CI 1.9-2.6], repeated episodes of bronchitis [OR 2.2; 95% CI 1.7-2.8] and recurrent chest tightness [OR1.8; 95% CI 1.5-2.2] in the preceding 2 years. Rural children were more likely to miss school due to asthma [p = 0.001], have exercise-induced symptoms [p = 0.001], and use rescue medications [p = 0.001] in the preceding 4 weeks. There were no differences in emergency healthcare utilization between groups.CONCLUSIONS: Although asthma remains a significant public health concern for children living in all regions of Arkansas, these data suggest rural children in Arkansas have significantly more morbidity due to asthma. RATIONALE: To compare asthma prevalence and morbidity between urban and rural schoolchildren in Arkansas. METHODS: We analyzed completed asthma screener data between urban (Little Rock, n = 5,417) and rural (Marvell and Eudora, n = 964) schoolchildren to compare asthma prevalence in each region. Data were analyzed to compare symptoms severity, medication use, and healthcare utilization among at-risk children in each group. RESULTS: Both populations were predominately African American [91% rural vs. 69% urban, p = 0.001] with significantly more rural children having state-issued medical insurance [78% vs. 37%, p < 0.001]. Physician-diagnosed asthma was similar between rural (20%) and urban (21%) children. Among the at-risk population, rural children were more likely to fit symptoms criteria for moderate-to-severe asthma compared to urban children [46% vs. 36%, p < 0.001]. Rural children were also more likely to be diagnosed with bronchitis [OR 3.4; 95% CI 2.5-4.6], had more recurrent breathing problems [OR 1.8; 95% CI 1.5-2.2], recurrent cough [OR 2.2; 95% CI 1.9-2.6], repeated episodes of bronchitis [OR 2.2; 95% CI 1.7-2.8] and recurrent chest tightness [OR1.8; 95% CI 1.5-2.2] in the preceding 2 years. Rural children were more likely to miss school due to asthma [p = 0.001], have exercise-induced symptoms [p = 0.001], and use rescue medications [p = 0.001] in the preceding 4 weeks. There were no differences in emergency healthcare utilization between groups. CONCLUSIONS: Although asthma remains a significant public health concern for children living in all regions of Arkansas, these data suggest rural children in Arkansas have significantly more morbidity due to asthma.

RationaleHome environmental exposure risks among high-risk rural children with asthma are poorly understood.MethodsThe primary caregivers of predominately low-income, minority children with asthma living in the Delta region of Arkansas completed a home environment questionnaire (HEQ) followed by a detailed home inspection with analysis of bedroom dust for common aeroallergens.ResultsThirty participants completed HEQ and 27 completed home inspection. The median age of homes was 30 years with 70% being single-family detached homes. Pet ownership (43%), environmental tobacco smoke exposure [ETS] (43%), and reported insecticide use in the past year (73%) were common. On home inspection, none of the participants had dust mite impermeable mattress or pillow encasements, 52% lacked central air-conditioning, 57% had wall-to-wall bedroom carpet, and 33% had stuffed toys on the child's bed. Evidence of rodent (11%) or cockroach (7%) infestation was not common. Detectable bedroom concentrations for each allergen were: Musm1 92%, Derp1/Derf1 92%, Canf1 79%, Feld1 38%, Blag1 38% and Blag2 29%. Median (range) bedroom allergen concentrations were Musm1 0.27 (BD [below detection]-35.4) μg/g, Derp1/f1 0.46 (BD-36.5) μg/g, Canf1 0.08 (BD-7.8) μg/g, Feld1 BD (BD-281.0) μg/g, Blag1 BD (BD-3.0 U/g) and Blag2 BD (BD-31.2 U/g).ConclusionsIn this high risk rural population, ETS, mouse, dog and dust mite allergen exposure is widespread, and home characteristics previously associated with increased dust mite and pet allergen exposure are common. Further studies to examine allergen exposure and the relationship to sensitization and endotoxin exposure should be carried out in this high-risk rural population. RationaleHome environmental exposure risks among high-risk rural children with asthma are poorly understood. Home environmental exposure risks among high-risk rural children with asthma are poorly understood. MethodsThe primary caregivers of predominately low-income, minority children with asthma living in the Delta region of Arkansas completed a home environment questionnaire (HEQ) followed by a detailed home inspection with analysis of bedroom dust for common aeroallergens. The primary caregivers of predominately low-income, minority children with asthma living in the Delta region of Arkansas completed a home environment questionnaire (HEQ) followed by a detailed home inspection with analysis of bedroom dust for common aeroallergens. ResultsThirty participants completed HEQ and 27 completed home inspection. The median age of homes was 30 years with 70% being single-family detached homes. Pet ownership (43%), environmental tobacco smoke exposure [ETS] (43%), and reported insecticide use in the past year (73%) were common. On home inspection, none of the participants had dust mite impermeable mattress or pillow encasements, 52% lacked central air-conditioning, 57% had wall-to-wall bedroom carpet, and 33% had stuffed toys on the child's bed. Evidence of rodent (11%) or cockroach (7%) infestation was not common. Detectable bedroom concentrations for each allergen were: Musm1 92%, Derp1/Derf1 92%, Canf1 79%, Feld1 38%, Blag1 38% and Blag2 29%. Median (range) bedroom allergen concentrations were Musm1 0.27 (BD [below detection]-35.4) μg/g, Derp1/f1 0.46 (BD-36.5) μg/g, Canf1 0.08 (BD-7.8) μg/g, Feld1 BD (BD-281.0) μg/g, Blag1 BD (BD-3.0 U/g) and Blag2 BD (BD-31.2 U/g). Thirty participants completed HEQ and 27 completed home inspection. The median age of homes was 30 years with 70% being single-family detached homes. Pet ownership (43%), environmental tobacco smoke exposure [ETS] (43%), and reported insecticide use in the past year (73%) were common. On home inspection, none of the participants had dust mite impermeable mattress or pillow encasements, 52% lacked central air-conditioning, 57% had wall-to-wall bedroom carpet, and 33% had stuffed toys on the child's bed. Evidence of rodent (11%) or cockroach (7%) infestation was not common. Detectable bedroom concentrations for each allergen were: Musm1 92%, Derp1/Derf1 92%, Canf1 79%, Feld1 38%, Blag1 38% and Blag2 29%. Median (range) bedroom allergen concentrations were Musm1 0.27 (BD [below detection]-35.4) μg/g, Derp1/f1 0.46 (BD-36.5) μg/g, Canf1 0.08 (BD-7.8) μg/g, Feld1 BD (BD-281.0) μg/g, Blag1 BD (BD-3.0 U/g) and Blag2 BD (BD-31.2 U/g). ConclusionsIn this high risk rural population, ETS, mouse, dog and dust mite allergen exposure is widespread, and home characteristics previously associated with increased dust mite and pet allergen exposure are common. Further studies to examine allergen exposure and the relationship to sensitization and endotoxin exposure should be carried out in this high-risk rural population. In this high risk rural population, ETS, mouse, dog and dust mite allergen exposure is widespread, and home characteristics previously associated with increased dust mite and pet allergen exposure are common. Further studies to examine allergen exposure and the relationship to sensitization and endotoxin exposure should be carried out in this high-risk rural population.

The significance of asthma morbidity in minority, low-income pediatric populations in rural US has not been fully described. We performed a cross-sectional investigation of children with asthma enrolled in Phillips and Chicot counties public schools. Participants were enrolled if they had physician-diagnosed asthma and current symptoms. A questionnaire format was utilized to examine patient and caregiver characteristics. Thirty children were enrolled between September 2006 and August 2007. The median age was 10 years, 60% were male, 90% African-American and 66% from low-income families. Exercise limitations were reported by 23/30 (77%) with 50% stating that asthma limited their daily activities ≥ 2 days/week. In the past 4 weeks, 53% had daytime symptoms ≥ 2 days/week and 53% had nocturnal symptoms > 2 nights/month. Seventeen percent reported missing ≥ 5 days from school due to asthma in the previous school year. In the past 6 months, 17% were hospitalized, 23% treated in the ER, and 40% had unscheduled physician's visits for asthma. All participants had health insurance (93% state-issued) and identified a primary care provider for regular asthma care, yet 57% denied taking daily controller asthma medications (inhaled and/or oral) with 17% taking inhaled corticosteroids daily and 40% taking oral controller daily. Asthma morbidity among this minority, low-income rural cohort is exceedingly high. Controller medication use was inadequate even though all participants had medical insurance and a regular healthcare provider. Findings suggest that future asthma investigations should be carried out to address the specific needs of high risk rural children with asthma.

An inbred strain of mice have been shown to exhibit a detectable immunological response to their own red blood cells on injecting either Corynebacterium parvum or SF 16-a bacterium isolated from the synovial fluid of a patient with rheumatoid arthritis. These micro-organisms have a marked adjuvant effect on the immunological system. The anti-red cell response has been detected by the immuno-cytoadherance test and the Jerne plaque method and animals injected with either organism show a pronounced increase in anti-red blood cell activity compared with saline-injected controls. This phenomenon has been correlated with haematological findings to determine the extent of any anaemia induced. Doses of 0 1 to 8 mg. (dry weight) of heat-killed organisms were capable of producing the effect which was maintained for up to 3 weeks. It is proposed that the anti-red cell response may be due to stimulation of preexisting antibody-forming cells and the antibody may act directly on red cells or facilitate their uptake by macrophages. This phenomenon, if it occurs in patients, may help to explain the anaemia of rheumatoid arthritis.