ABSTRACT
Importance: Structural racism has been implicated in the disproportionally high asthma morbidity experienced by children living in disadvantaged, urban neighborhoods. Current approaches designed to reduce asthma triggers have modest impact. Objective: To examine whether participation in a housing mobility program that provided housing vouchers and assistance moving to low-poverty neighborhoods was associated with reduced asthma morbidity among children and to explore potential mediating factors. Design, Setting, and Participants: Cohort study of 123 children aged 5 to 17 years with persistent asthma whose families participated in the Baltimore Regional Housing Partnership housing mobility program from 2016 to 2020. Children were matched to 115 children enrolled in the Urban Environment and Childhood Asthma (URECA) birth cohort using propensity scores. Exposure: Moving to a low-poverty neighborhood. Main Outcomes: Caregiver-reported asthma exacerbations and symptoms. Results: Among 123 children enrolled in the program, median age was 8.4 years, 58 (47.2%) were female, and 120 (97.6%) were Black. Prior to moving, 89 of 110 children (81%) lived in a high-poverty census tract (>20% of families below the poverty line); after moving, only 1 of 106 children with after-move data (0.9%) lived in a high-poverty tract. Among this cohort, 15.1% (SD, 35.8) had at least 1 exacerbation per 3-month period prior to moving vs 8.5% (SD, 28.0) after moving, an adjusted difference of -6.8 percentage points (95% CI, -11.9% to -1.7%; P = .009). Maximum symptom days in the past 2 weeks were 5.1 (SD, 5.0) before moving and 2.7 (SD, 3.8) after moving, an adjusted difference of -2.37 days (95% CI, -3.14 to -1.59; P < .001). Results remained significant in propensity score-matched analyses with URECA data. Measures of stress, including social cohesion, neighborhood safety, and urban stress, all improved with moving and were estimated to mediate between 29% and 35% of the association between moving and asthma exacerbations. Conclusions and Relevance: Children with asthma whose families participated in a program that helped them move into low-poverty neighborhoods experienced significant improvements in asthma symptom days and exacerbations. This study adds to the limited evidence suggesting that programs to counter housing discrimination can reduce childhood asthma morbidity.
Subject(s)
Asthma , Housing , Residence Characteristics , Social Determinants of Health , Symptom Flare Up , Systemic Racism , Child , Female , Humans , Male , Asthma/diagnosis , Asthma/economics , Asthma/epidemiology , Asthma/psychology , Cohort Studies , Housing/economics , Poverty/economics , Poverty/ethnology , Poverty/psychology , Child, Preschool , Adolescent , Vulnerable Populations/psychology , Urban Population , Systemic Racism/economics , Systemic Racism/ethnology , Systemic Racism/psychology , Social Determinants of Health/economics , Social Determinants of Health/ethnologyABSTRACT
We report the case of a patient with livedoid vasculopathy that had been undiagnosed and inadequately treated for more than 10 years. To improve disease recognition and management, we review the pathogenesis, typical clinical presentation, diagnostic workup, and treatment options for livedoid vasculopathy.
Subject(s)
Leg Ulcer/diagnosis , Leg Ulcer/therapy , Livedo Reticularis/diagnosis , Aged , Bandages , Humans , Leg Ulcer/complications , Livedo Reticularis/complications , Male , Stockings, CompressionABSTRACT
OBJECTIVE: The aim of the study was to evaluate a novel infrared imaging device coupled with an intelligent software interface that may provide a more objective means of identifying anatomical sites at risk for pressure ulcer (PrU) development as compared with the Braden Scale for Predicting Pressure Sore Risk. DESIGN: Repeated-measures design. SETTING: Duke University Medical Center. PARTICIPANTS: One hundred patients admitted to a medical unit at risk for PrUs. MAIN RESULTS: Only 5 participants developed early stage PrUs (Stages I and II). However, the infrared imaging device not only predicted all 5 participants to be at risk, but also predicted the anatomical location where the ulcer would develop. The Braden Scale correctly identified 3 of 5 participants who developed PrUs. It was also determined that a temperature variance of 1.5° C was able to accurately predict PrU development. CONCLUSION: Infrared imaging using intelligent software may become a promising, objective method for identifying incipient PrUs and provide clinicians with specific anatomical locations for increased preventive interventions.
