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Chicago Ridge, IL, United States

Eimer M.J.,University of Chicago | Brickman W.J.,Childrens Memorial Hospital | Brickman W.J.,Northwestern University | Seshadri R.,Smith Child Health Research Program | And 6 more authors.
Journal of Pediatrics | Year: 2011

Objective: A pilot study of adults who had onset of juvenile dermatomyositis (JDM) in childhood, before current therapeutic approaches, to characterize JDM symptoms and subclinical cardiovascular disease. Study design: Eight adults who had JDM assessed for disease activity and 8 healthy adults (cardiovascular disease controls) were tested for carotid intima media thickness and brachial arterial reactivity. Adults who had JDM and 16 age-, sex-, and body mass index-matched healthy metabolic controls were evaluated for body composition, blood pressure, fasting glucose, lipids, insulin resistance, leptin, adiponectin, proinflammatory oxidized high-density lipoprotein (HDL), and nail-fold capillary end row loops. Results: Adults with a history of JDM, median age 38 years (24-44 years) enrolled a median 29 years (9-38 years) after disease onset, had elevated disease activity scores, skin (7/8), muscle (4/8), and creatine phosphokinase (2/8). Compared with cardiovascular disease controls, adults who had JDM were younger, had lower body mass index and HDL cholesterol (P =.002), and increased intima media thickness (P =.015) and their brachial arterial reactivity suggested impairment of endothelial cell function. Compared with metabolic controls, adults who had JDM had higher systolic and diastolic blood pressure, P =.048, P =.002, respectively; lower adiponectin (P =.03); less upper arm fat (P =.008); HDL associated with end row loops loss (r = -0.838, P =.009); and increased proinflammatory oxidized HDL (P =.0037). Conclusion: Adults who had JDM, 29 years after disease onset, had progressive disease and increased cardiovascular risk factors. Copyright © 2011 Mosby Inc. All rights reserved. Source

Gupta R.,Smith Child Health Research Program | Gupta R.,Northwestern University | Holdford D.,Virginia Commonwealth University | Bilaver L.,Northwestern University | And 4 more authors.
JAMA Pediatrics | Year: 2013

IMPORTANCE: Describing the economic impact of childhood food allergy in the United States is important to guide public health policies. OBJECTIVE: To determine the economic impact of childhood food allergy in the United States and caregivers' willingness to pay for food allergy treatment. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional surveywas conducted from November 28, 2011, through January 26, 2012. A representative sample of 1643 US caregivers of a child with a current food allergy were recruited for participation. MAIN OUTCOMES AND MEASURES: Caregivers of children with food allergies were asked to quantify the direct medical, out-of-pocket, lost labor productivity, and related opportunity costs. As an alternative valuation approach, caregivers were asked their willingness to pay for an effective food allergy treatment. RESULTS: The overall economic cost of food allergy was estimated at $24.8 (95% CI, $20.6-$29.4) billion annually ($4184 per year per child). Direct medical costs were $4.3 (95% CI, $2.8-$6.3) billion annually, including clinician visits, emergency department visits, and hospitalizations. Costs borne by the family totaled $20.5 billion annually, including lost labor productivity, out-of-pocket, and opportunity costs. Lost labor productivity costs totaled $0.77 (95% CI, $0.53-$1.0) billion annually, accounting for caregiver time off work for medical visits. Out-of-pocket costs were $5.5 (95% CI, $4.7-$6.4) billion annually, with 31% stemming from the cost of special foods. Opportunity costs totaled $14.2 (95% CI, $10.5-$18.4) billion annually, relating to a caregiver needing to leave or change jobs. Caregivers reported a willingness to pay of $20.8 billion annually ($3504 per year per child) for food allergy treatment. CONCLUSIONS AND RELEVANCE: Childhood food allergy results in significant direct medical costs for the US health care system and even larger costs for families with a food-allergic child. Source

Yin H.S.,New York University | Gupta R.S.,Northwestern University | Tomopoulos S.,New York University | Wolf M.S.,Northwestern University | And 5 more authors.
Pediatrics | Year: 2013

OBJECTIVE: Recognition of the complexity of asthma management has led to the development of asthma treatment guidelines that include the recommendation that all pediatric asthma patients receive a written asthma action plan. We assessed the readability, suitability, and characteristics of asthma action plans, elements that contribute to the effectiveness of action plan use, particularly for those with limited literacy. METHODS: This was a descriptive study of 30 asthma action plans (27 state Department of Health (DOH)-endorsed, 3 national action plans endorsed by 6 states). Outcome measures: (1) readability (as assessed by Flesch Reading Ease, Flesch-Kincaid, Gunning Fog, Simple Measure of Gobbledygook, Forcast), (2) suitability (Suitability Assessment of Materials [SAM], adequate: ≥0.4; unsuitable: <0.4), (3) action plan characteristics (peak flow vs symptom-based, symptoms, recommended actions). RESULTS: Mean (SD) overall readability grade level was 7.2 (1.1) (range = 5.7-9.8); 70.0% were above a sixth-grade level. Mean (SD) suitability score was 0.74 (0.14). Overall, all action plans were found to be adequate, although 40.0% had an unsuitable score in at least 1 factor. The highest percent of unsuitable scores were found in the categories of layout/ typography (30.0%), learning stimulation/motivation (26.7%), and graphics (13.3%). There were no statistically significant differences between the average grade level or SAM score of state DOH developed action plans and those from or adapted from national organizations. Plans varied with respect to terms used, symptoms included, and recommended actions. CONCLUSIONS: Specific improvements in asthma action plans could maximize patient and parent understanding of appropriate asthma management and could particularly benefit individuals with limited literacy skills. Pediatrics 2013;131:e116-e126. Copyright © 2013 by the American Academy of Pediatrics. Source

Gupta R.S.,Northwestern University | Gupta R.S.,Smith Child Health Research Program | Springston E.E.,Northwestern University | Smith B.,Program in Health Services Research | And 4 more authors.
Journal of Allergy and Clinical Immunology | Year: 2013

Background: Childhood food allergy is a serious health problem. However, little is known about the frequency and manner in which it is currently diagnosed. Objective: To describe parent report of physician practices in the diagnosis of pediatric food allergy. Methods: Data from children with food allergy were identified for analysis from a representative survey administered in US households with children from June 2009 to February 2010. Analyses were performed at the level of the allergy. Demographic characteristics, symptom prevalence, and diagnostic methods were calculated as weighted proportions. Adjusted models were estimated to examine the association of reaction history and allergenic food with odds of physician diagnosis and testing. Results: Food allergies (n = 3,218) to 9 common allergens were reported among 2,355 children in a sample of 38,480. We found that 70.4% of reported food allergy was diagnosed by a physician. Among physician-diagnosed food allergy, 32.6% was not evaluated with diagnostic testing, 47.3% was assessed with a skin prick test, 39.9% with a serum specific IgE test, and 20.2% with an oral food challenge. Odds of physician diagnosis and testing were significantly higher for severe versus mild/moderate food allergy. Urticaria and angioedema were not reported as symptoms in 40.7% and 34.6% of severe food allergies, respectively. Conclusion: Thirty percent of parent-reported food allergies in this study were not diagnosed by a physician. One in 5 physician-diagnosed allergies was evaluated with oral food challenge. Understanding parent report of practices in food allergy provides insight into ways in which to streamline the diagnosis and management of care. © 2012 American Academy of Allergy, Asthma & Immunology. Source

Springston E.E.,Northwestern University | Springston E.E.,Smith Child Health Research Program | Smith B.,Hines Veterans Administration Hospital | Smith B.,Loyola University Chicago | And 5 more authors.
Annals of Allergy, Asthma and Immunology | Year: 2010

Background Pediatric food allergy is a serious health problem in the United States. As the number of affected children increases, more caregivers are charged with the responsibility of managing their child's food allergy. Objective To better understand the impact of pediatric food allergy on caregiver quality of life. Methods As part of a larger project examining the knowledge, attitudes, and beliefs of caregivers with food allergic children, the Food Allergy Quality of LifeParental Burden questionnaire was administered to a large sample of caregivers across the United States from January 1, 2008, to January 31, 2009. Findings were analyzed to describe caregiver quality of life and to examine the impact of the manifestation of food allergy on participant response. Results Data were collected from 1,126 caregivers. The impact of food allergy on caregiver quality of life varied widely with 1 exception: caregivers consistently reported being troubled by social limitations resulting from their child's food allergy. Poor quality of life was significantly more likely on a number of survey items among caregivers more knowledgeable about food allergy and among caregivers whose children had been to the emergency department for food allergy in the past year, had multiple food allergies, or were allergic to specific foods. Conclusions Previous research has emphasized the negative impact of food allergy on caregiver quality of life. This study illustrates the diverse experience of caring for a child with food allergy and the importance of considering the manifestation of disease when evaluating parental burden. © 2010 American College of Allergy, Asthma & Immunology. Source

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