Showing posts with label home safety. Show all posts
Showing posts with label home safety. Show all posts

Wednesday, March 18, 2015

To Air Is Human: New Tools In At Home Asthma Treatment


By: Kathleen Walsh  MD, MS; Editorial Board Memeber
 
      When I ask my adolescent daughter about her asthma care goals, she replies “I don’t have any,” with a sarcastic tone and a charming, braces-filled grin.  However, I know her goals include placing well in cross country races, passing her taekwondo tests, and getting good grades in school.
       All of these require excellent control of her asthma.  When she was a baby, my goals for her asthma were to minimize exacerbation frequency and duration both for her happiness and so I could finish residency.  While achieving my goals for my daughter’s asthma care has always been my primary motivation for adhering to her treatment, only recently have our goals become a part of our discussions with her clinicians.
       In this week’s Pediatrics, the MyAsthma intervention described by Fiks et al. (doi: 10.1542/peds.2014-3167) takes an important early step toward parent and physician shared decision making regarding asthma treatment at home.  MyAsthma is a portal-based intervention, where parents enter information about their child’s asthma, including their goals and their child’s current symptoms, several times a month.  The portal uses evidence-based protocols to support decisions by the family and clinician about when they need to communicate further and when to change the home treatment plan.
      Although the study was relatively small, with twenty-six children in the treatment arm and a 57% participation rate, the authors found statistically significant improvements in some outcomes.  Specifically, children in the treatment group had significantly larger improvements in ACT scores over the study period compared to controls.  In addition, parents in the treatment group reported significantly less missed work than controls.  While other portal-based asthma interventions exist, this is the first to ask parents about their asthma management goals.
      The identification of family care goals is a key step in the parent and clinician co-management of chronic disease.  The portal-based intervention described by Fiks provides decision support for asthma management when and where the patient needs it- at the family’s convenience and at home.  It also enables a partnership between families and clinicians through goal setting, enhanced communication, and early identification and mitigation of changes in health status.  The spread of promising interventions such as this one will provide the necessary support so that families and clinicians can collaborate to improve chronic disease outcomes.  For pediatricians, this is the kind of collaborative care we would like to provide to all of our patients and their families.  

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Wednesday, February 25, 2015

Washing the Dishes: A New Way to Reduce the Risk of Allergy!

By: Lewis First, MD, MS; Editor-in-Chief  
 

          We hear more and more in the news about the role of the hygiene hypothesis resulting in less allergic symptoms.  As a refresher, this hypothesis suggests that early microbial exposure triggers early immune stimulation that results in immunologic tolerance compared to later exposures that result in allergy and infection from a more inflammatory versus tolerant immune response. 
With that in mind, Hesselmar at al. (doi:10.1542/peds.2014-2968) decided to study the common practice of washing dishes to see if the washing dishes by hand (and thus exposing oneself to many more microbes than letting a dishwasher do the washing) resulted in less risk of allergy in those children.  The investigators collected data on more than 1000 children age 7-8 years in Sweden and asked them whether their families washed dishes and whether they had signs and symptoms of asthma, eczema, or allergic rhinitis as compared to those families who used a dishwasher.
To our surprise (perhaps yours as well), the families who do hand dishwashing showed much less allergic disease in their children compared to those who used the dishwasher.  So—does hand dishwashing mean more microbes to generate immunotolerance at an early age of exposure or not?  Is there another explanation for what the authors of this study show nicely in this study? 
Drs. Laurence Cheng and Michael Cabana (doi:10.1542/peds.2014-3911) have added an accompanying commentary to this study to try to clean up your concerns about whether or not to buy in or wash away your belief in the hygiene hypothesis.  Both the study and commentary dish out some provocative information and opinion, and we welcome your input as well. Just respond directly to this blog, or send us an e-letter or simply comment on our Facebook or Twitter page.

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Monday, November 10, 2014

Introducing the Newest Culprit for Childhood Home Injury: The Laundry Detergent Pod

Laundry detergent pods.
Photo by the US Consumer Protection Agency via Flickr
By: Lewis First, MD, MS; Editor-in-Chief 

Just when you thought you had provided all the anticipatory guidance needed to insure that parents of your patients were experts at safety-proofing their homes, along comes a new development—laundry detergent pods—a home product that is catching families by surprise with an ever-increasing rate of poisoning via ingestion or ocular exposures.

If you need proof, read the study we are releasing this week by Valdez et al. (doi: 10.1542/peds. 2014-0057) who looked at laundry detergent pod ingestions during 2012 to2013 and found an increase in exposures as per data from the National Poison Data System especially in children younger than 3 years of age.

If you haven’t seen a laundry detergent pod, picture a colorful shiny object that resembles candy. You can see how children are attracted to the objects and want to put them in their mouths.

Do you ask about laundry detergent pods in your home safety discussions and whether they are locked away—not just sitting on a table or an open cabinet accessible to small children? Have any of your patients ingested one or tried to?

We’d love you to come clean and share your stories of potential toxicity as well as what you think needs to be done to prevent these injuries from occurring. As much as we try to safety-proof the home, there is even more that can be done by the companies that make these. Changing how they are packaged, labeled, and perhaps even formulated may help avoid the complications reported in this study of a high volume of injuries due to laundry detergent pods.

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