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Rochester, NY, United States

Crean H.F.,University of Rochester | Johnson D.B.,Childrens Institute
American Journal of Community Psychology

This study reports on aggressive outcomes from a cluster randomized trial of the Promoting Alternative Thinking Strategies (PATHS) curriculum. Fourteen elementary schools were randomly assigned to intervention or control condition and third grade students were followed through the fifth grade. Teacher and self-reports of student aggression, conduct problems, delinquency, acting out problems, and social information processing (SIP) variables were collected. Linear change for each of the SIP variables was noted with control students demonstrating increased normative beliefs about aggression, increased aggressive social problem solving, increased hostile attribution bias, and increased aggressive interpersonal negotiation strategies over time while PATHS students remained relatively stable. Teachers reported significant curvilinear change in student aggression, conduct problems, and acting out behavior problems; all favoring PATHS students. © 2013 Society for Community Research and Action. Source

Koehler A.D.,University of Rochester | Fagnano M.,University of Rochester | Montes G.,Childrens Institute | Halterman J.S.,University of Rochester
Maternal and Child Health Journal

To evaluate how having a child with both persistent asthma and a developmental disability (DD) affects caregiver burden and quality of life (QOL). 3-10 year old children with persistent asthma in urban Rochester, NY. Cross-sectional baseline survey (2006-2009). Parent report of autism spectrum disorder or other behavioral disorder requiring medication. Caregiver burden and QOL as measured by scores on previously validated depression, parenting confidence, and asthma-related QOL scales as well as an assessment of competing demands on the caregiver. Bivariate and multivariate regression analyses controlling for caregiver age, education, marital status, race, ethnicity, and child asthma symptom severity. We enrolled 530 children as part of a larger study (response rate: 74; 63 % Black, 73 % Medicaid). Of this sample, 70 children (13 %) were defined as having a DD. There were no differences in asthma symptom severity between children with and without a DD diagnosis. However, even after adjusting for potential confounders, caregivers of children with a DD reported worse scores on the depression (p = .003), parenting confidence (p < .001), and competing demands (p = .013) scales and worse asthma-related QOL (p = .035) compared to caregivers of typically developing children with asthma. Despite having similar asthma symptom severity, caregivers of children with both persistent asthma and a DD diagnosis report more burden and lower QOL compared to that of caregivers of typically developing children and persistent asthma. Further attention to this subgroup is needed to promote optimal support for caregivers. © 2014 Springer Science+Business Media New York. Source

Halterman J.S.,University of Rochester | Sauer J.,University of Rochester | Fagnano M.,University of Rochester | Montes G.,Childrens Institute | And 4 more authors.
Journal of Asthma

Objective. We previously conducted the School-Based Asthma Therapy trial to improve adherence to national asthma guidelines for urban children through directly observed administration of preventive asthma medications in school. The trial successfully improved outcomes among these children; however, several factors limit its potential for dissemination. To enhance sustainability, we subsequently developed a new model of care using web-based guides for efficient communications and integration within school and community systems. This article describes the development of the School-Based Preventive Asthma Care Technology (SB-PACT) trial. Method. We developed the SB-PACT web-based system based on stakeholder feedback, and conducted a pilot randomized trial with 100 children to establish its feasibility in facilitating preventive asthma care for high-risk children. The SB-PACT system represents a new model of care using web-based guides for asthma symptom screening, follow-up control assessments, and electronic communications with providers. Result. We enrolled and successfully screened all children using the web-based system. Most providers used the electronic communication system without difficulty, and the majority of children in the intervention group received preventive medications through school as planned and dose adjustments as needed. Several challenges to implementation also were encountered. Conclusions. This program is designed to promote sustainability of school-based asthma care, reduce program costs, and ultimately succeed in a real-world setting. With further refinements, it has the potential to be implemented nationally in schools. © 2012 Informa Healthcare USA, Inc. Source

Guarnaccia S.,Centro Io e LAsma | Holliday C.N.,Windber Research Institute | D'Agata E.,Centro Io e LAsma | Pluda A.,Centro Io e LAsma | And 6 more authors.
Allergy and Asthma Proceedings

Background: Asthma is the leading chronic condition among children. Given this international burden, clinicians and public health professionals applied the Expanded Chronic Care Model to address health adversities of pediatric patients with asthma. Objective: This study examined the influence of a clinical health promotion initiative on asthma control and appropriate medication management among pediatric patients. Methods: Patients (n = 304) were recruited and screened for participation in this study. All the patients participated in a motivational interview, received clinical care, and were monitored longitudinally. Eligible patients (n = 53) were referred to one or more intervention pathways regarding physical activity, nutrition, smoking cessation, and psychosocial wellness. A comparison group (n = 90) was eligible for an intervention but chose not to participate. This analysis focused on patients who were identified as needing a health intervention beyond asthma clinical care. Results: Among patients who were invited to participate in the health promotion pathways, significant decreases in asthma exacerbation were achieved by the patients who participated in the intervention compared with those who did not participate (p < 0.018). Significant improvements in asthma exacerbation, activity limitations, and asthma control were attributed to the time in clinical care (p < 0.001). In this group, asthma control significantly improved with medication (p < 0.002), and age was associated with a significant decrease in asthma exacerbation (p < 0.011). Conclusions: This pilot study demonstrated preliminary benefits in a child asthma population. In addition, this experience addressed the chronicity of pediatric asthma through patient-centered care. Copyright © 2016, OceanSide Publications, Inc., U.S.A. Source

Halterman J.S.,University of Rochester | Fagnano M.,University of Rochester | Montes G.,Childrens Institute | Fisher S.,University of Rochester | And 4 more authors.
Journal of Pediatrics

Objective: To test the feasibility and preliminary effectiveness of the School-Based Preventive Asthma Care Technology (SB-PACT) program, which includes directly observed therapy of preventive asthma medications in school facilitated by Web-based technology for systematic symptom screening, electronic report generation, and medication authorization from providers. Study design: We conducted a pilot randomized trial of SB-PACT versus usual care with 100 children (aged 3-10 years) from 19 inner-city schools in Rochester, New York. Outcomes were assessed longitudinally by blinded interviewers. Analyses included bivariate statistics and linear regression models, adjusting for baseline symptoms. Results: There were data for 99 subjects for analysis. We screened all children using the Web-based system, and 44 of 49 treatment group children received directly observed therapy as authorized by their providers. Treatment group children received preventive medications 98% of the time they were in school. Over the school year, children in the treatment group experienced nearly 1 additional symptom-free day over 2 weeks versus the usual care group (11.33 vs 10.40, P =.13). Treatment children also experienced fewer nights with symptoms (1.68 vs 2.20, P =.02), days requiring rescue medications (1.66 vs 2.44, P =.01), and days absent from school due to asthma (0.37 vs 0.85, P =.03) compared with usual care. Further, treatment children had a greater decrease in exhaled nitric oxide (-9.62 vs -0.39, P =.03), suggesting reduction in airway inflammation. Conclusion: The SB-PACT intervention demonstrated feasibility and improved outcomes across multiple measures in this pilot study. Future work will focus on further integration of preventive care delivery across community and primary care systems. Copyright © 2012 Mosby Inc. All rights reserved. Source

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