Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-5 (of 5 Records) |
Query Trace: Herman EJ[original query] |
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Public health interventions for asthma: an umbrella review, 1990-2010
Labre MP , Herman EJ , Dumitru GG , Valenzuela KA , Cechman CL . Am J Prev Med 2012 42 (4) 403-10 CONTEXT: Asthma is a chronic respiratory disease increasingly prevalent in the U.S., particularly among children and certain minority groups. This umbrella review sought to assess and summarize existing systematic reviews of asthma-related interventions that might be carried out or supported by state or community asthma control programs, and to identify gaps in knowledge. EVIDENCE ACQUISITION: Eleven databases were searched through September 2010, using terms related to four concepts: asthma, review, intervention, and NOT medication. Reviews of the effectiveness of medications, medical procedures, complementary and alternative medicine, psychological interventions, family therapy, and nutrients or nutritional supplements were excluded. Two coders screened each record and extracted data from the included reviews. EVIDENCE SYNTHESIS: Data analysis was conducted from May to December 2010. Of 42 included reviews, 19 assessed the effectiveness of education and/or self-management, nine the reduction of indoor triggers, nine interventions to improve the provision of health care, and five examined other interventions. Several reviews found consistent evidence of effectiveness for self-management education, and one review determined that comprehensive home-based interventions including the reduction of multiple indoor asthma triggers are effective for children. Other reviews found limited or insufficient evidence because of study limitations. CONCLUSIONS: State or community asthma control programs should prioritize (1) implementing interventions for which the present review found evidence of effectiveness and (2) evaluating promising interventions that have not yet been adequately assessed. |
Effectiveness of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity: a Community Guide systematic review
Crocker DD , Kinyota S , Dumitru GG , Ligon CB , Herman EJ , Ferdinands JM , Hopkins DP , Lawrence BM , Sipe TA . Am J Prev Med 2011 41 S5-S32 CONTEXT: Asthma exacerbations are commonly triggered by exposure to allergens and irritants within the home. The purpose of this review was to evaluate evidence that interventions that target reducing these triggers through home visits may be beneficial in improving asthma outcomes. The interventions involve home visits by trained personnel to conduct two or more components that address asthma triggers in the home. Intervention components focus on reducing exposures to a range of asthma triggers (allergens and irritants) through environmental assessment, education, and remediation. EVIDENCE ACQUISITION: Using methods previously developed for the Guide to Community Preventive Services, a systematic review was conducted to evaluate the evidence on effectiveness of home-based, multi-trigger, multicomponent interventions with an environmental focus to improve asthma-related morbidity outcomes. The literature search identified over 10,800 citations. Of these, 23 studies met intervention and quality criteria for inclusion in the final analysis. EVIDENCE SYNTHESIS: In the 20 studies targeting children and adolescents, the number of days with asthma symptoms (symptom-days) was reduced by 0.8 days per 2 weeks, which is equivalent to 21.0 symptom-days per year (range of values: reduction of 0.6 to 2.3 days per year); school days missed were reduced by 12.3 days per year (range of values: reduction of 3.4 to 31.2 days per year); and the number of asthma acute care visits were reduced by 0.57 visits per year (interquartile interval: reduction of 0.33 to 1.71 visits per year). Only three studies reported outcomes among adults with asthma, finding inconsistent results. CONCLUSIONS: Home-based, multi-trigger, multicomponent interventions with an environmental focus are effective in improving overall quality of life and productivity in children and adolescents with asthma. The effectiveness of these interventions in adults is inconclusive due to the small number of studies and inconsistent results. Additional studies are needed to (1) evaluate the effectiveness of these interventions in adults and (2) determine the individual contributions of the various intervention components. |
Assessing community-based approaches to asthma control: the Controlling Asthma in American Cities Project
Herman EJ , Garbe PL , McGeehin MA . J Urban Health 2011 88 Suppl 1 1-6 More than 30 million people in the USA have been diagnosed with asthma during their lifetime. Of the 20 million US residents who currently have asthma, 12 million have had an asthma episode or attack during the past year. Asthma affects people of all races, both sexes, and all ages, and in every region of the USA. However, asthma occurs more often among children, women and girls, African Americans, Puerto Ricans, people in the Northeast, those living below the federal poverty level, and those with particular work-related exposures. Asthma death rates rose between 1980 and 1996 among both sexes and most age and ethnic groups, but have declined since 2000. Women and girls account for nearly 64% of asthma deaths overall, although, among children, more boys than girls die each year. Many of the 4,000 asthma-related deaths that occur annually could be avoided with proper treatment and care.1 | The burden of asthma in the USA has increased greatly over the last 25 years and affects our nation and health system in more ways than limited and lost lives. Asthma leads to almost 13 million outpatient physician visits and two million emergency department visits each year. Asthma is a leading cause of school absenteeism with children missing almost 14 million school days per year due to asthma.2 Asthma is the fourth leading cause of work absenteeism and diminished work productivity among adults, resulting in nearly 12 million missed or less productive workdays each year.2 The estimated annual cost of asthma for 2006 was over $32 billion, including nearly $28 billion in direct health care costs and $4.5 billion for indirect costs such as lost earnings due to illness or death.3 |
Conceptual framework of the Controlling Asthma in American Cities Project
Herman EJ . J Urban Health 2011 88 Suppl 1 7-15 The Controlling Asthma in American Cities Project (CAACP) was designed to improve the control of asthma in inner-city populations of children with a disparate burden of symptoms and adverse outcomes. As with many chronic diseases, asthma is the manifestation of multiple biologic, environmental, and social determinants. In addition to appropriate medical management, individuals with asthma must have logistical, financial, and cultural access to environments that allow avoidance of asthma triggers and encourage good asthma management practices. In recognition of this complexity, the CAACP required the seven project sites to coordinate and synchronize multiple interventions (education, healthcare access, medical management, trigger reduction) at multiple levels (individual, home, school, community, and policy) through the collaboration of relevant groups, institutions, and individuals. This paper describes the "program theory" of the CAACP project-the assumptions about how the project worked, how the components were linked, and what outcomes were anticipated. It relates the subsequent papers in the supplement to the program theory and describes how the papers can inform and guide other community-based interventions, and advance the translation of scientific knowledge to effective interventions in communities of need. |
A model-driven approach to qualitatively assessing the added value of community coalitions
Herman EJ , Keller A , Davis A , Ehrensberger R , Telleen S , Kurz R , Nesvold JH , Findley S , Bryant-Stephens T , Benson M , Fierro L . J Urban Health 2011 88 Suppl 1 130-43 Community-based coalitions are commonly formed to plan and to carry out public health interventions. The literature includes evaluations of coalition structure, composition, and functioning; evaluations of community-level changes achieved through coalition activities; and the association between coalition characteristics and various indicators of success. Little information is available on the comparative advantage or "added value" of conducting public health interventions through coalitions as opposed to less structured collaborative mechanisms. This paper describes a qualitative, iterative process carried out with site representatives of the Controlling Asthma in American Cities Project (CAACP) to identify outcomes directly attributable to coalitions. The process yielded 2 complementary sets of results. The first were criteria that articulated and limited the concept of "added value of coalitions". The criteria included consensus definitions, an organizing figure, a logic model, and inclusion/exclusion criteria. The second set of results identified site-specific activities that met the definitional criteria and were, by agreement, examples of CAACP coalitions' added value. Beyond the specific findings relevant to the added value of coalitions in this project, the use of a social ecological model to identify the components of added value and the placement of those components within a logic model specific to coalitions should provide useful tools for those planning and assessing coalition-based projects. |
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