Publications by authors named "Carlos A Camargo"

1,011 Publications

  • Page 1 of 1

Pulmonary Rehabilitation and Readmission Rates for Medicare Beneficiaries with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Chronic Obstr Pulm Dis 2021 Jul 16. Epub 2021 Jul 16.

Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States.

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http://dx.doi.org/10.15326/jcopdf.2020.0193DOI Listing
July 2021

Associations between sleep, stress, and cardiovascular health in emergency medical services personnel.

J Am Coll Emerg Physicians Open 2021 Aug 21;2(4):e12516. Epub 2021 Jul 21.

National Registry of Emergency Medical Technicians Columbus Ohio USA.

Objective: Our objective was to quantify the associations between sleep duration and perceived and chronic stress with ideal cardiovascular health (CVH) among emergency medical services (EMS) personnel from county-based EMS agencies.

Methods: We conducted a cross-sectional survey of cardiovascular disease (CVD)-free EMS personnel from 4 US EMS agencies. The questionnaire consisted of the Pittsburgh Sleep Quality Index (PSQI), Perceived Stress Scale (PSS), Chronic Burden Scale, and the CVH components (smoking, body mass index, physical activity, diet, blood glucose, blood pressure, cholesterol, each scored 0-2 points). The components were summed and ideal CVH considered 11-14 points. Mixed effects logistic regression models with a random intercept for agency were used to estimate the odds of ideal CVH for good sleep quality (PSQI < 5 points), recommended sleep duration (7 to < 9h), low perceived stress (PSS < 26 points), and low chronic stress (0 recent stressful events).

Results: We received 379 responses (response rate = 32%). There was low prevalence of good sleep quality (23%) and recommended sleep duration (25%), but 95% reported low perceived stress, and 33% had low chronic stress. Ideal CVH was reported by 30%. No significant associations between ideal CVH and sleep quality, perceived stress, or chronic stress were found. There was a nearly 2-fold increase in the odds of ideal CVH with recommended sleep duration (odds ratio: 1.83, 95% confidence interval: 1.08-3.10).

Conclusion: In this sample of EMS personnel, only recommended sleep duration was associated with ideal CVH. Future longitudinal studies are needed to understand the relationship between sleep, stress, and CVD in this understudied occupational group.
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http://dx.doi.org/10.1002/emp2.12516DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8295241PMC
August 2021

Proteome signature difference between respiratory viruses is associated with severity of bronchiolitis.

Pediatr Allergy Immunol 2021 Jul 27. Epub 2021 Jul 27.

Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Bronchiolitis is the leading cause of hospitalization in American infants. Most cases of severe bronchiolitis (i.e., bronchiolitis requiring hospitalization) are caused by two distinct viruses: respiratory syncytial virus (RSV) and rhinovirus (RV). Although bronchiolitis has been traditionally considered a single disease entity and guideline-recommended management does not differ by virus, emerging evidence suggests between-virus heterogeneity in the pathobiology and clinical severity. Indeed, recent studies suggest that RSV and RV bronchiolitis have different upper-airway microbiome (e.g., Streptococcus dominance in RSV infection vs. Moraxella and Haemophilus dominance in RV infection) and transcriptome profiles.
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http://dx.doi.org/10.1111/pai.13606DOI Listing
July 2021

Big Data, Data Science, and Causal Inference: A Primer for Clinicians.

Front Med (Lausanne) 2021 6;8:678047. Epub 2021 Jul 6.

Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States.

Clinicians handle a growing amount of clinical, biometric, and biomarker data. In this "big data" era, there is an emerging faith that the answer to all clinical and scientific questions reside in "big data" and that data will transform medicine into precision medicine. However, data by themselves are useless. It is the algorithms encoding causal reasoning and domain (e.g., clinical and biological) knowledge that prove transformative. The recent introduction of (health) data science presents an opportunity to re-think this data-centric view. For example, while precision medicine seeks to provide the right prevention and treatment strategy to the right patients at the right time, its realization cannot be achieved by algorithms that operate exclusively in data-driven prediction modes, as do most machine learning algorithms. Better understanding of data science and its tasks is vital to interpret findings and translate new discoveries into clinical practice. In this review, we first discuss the principles and major tasks of data science by organizing it into three defining tasks: (1) association and prediction, (2) intervention, and (3) counterfactual causal inference. Second, we review commonly-used data science tools with examples in the medical literature. Lastly, we outline current challenges and future directions in the fields of medicine, elaborating on how data science can enhance clinical effectiveness and inform medical practice. As machine learning algorithms become ubiquitous tools to handle quantitatively "big data," their integration with causal reasoning and domain knowledge is instrumental to qualitatively transform medicine, which will, in turn, improve health outcomes of patients.
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http://dx.doi.org/10.3389/fmed.2021.678047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8290071PMC
July 2021

Applying crisis standards of care to critically ill patients during the COVID-19 pandemic: Does race/ethnicity affect triage scoring?

J Am Coll Emerg Physicians Open 2021 Aug 12;2(4):e12502. Epub 2021 Jul 12.

Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA.

Objective: Given the variability in crisis standards of care (CSC) guidelines during the COVID-19 pandemic, we investigated the racial and ethnic differences in prioritization between 3 different CSC triage policies (New York, Massachusetts, USA), as well as a first come, first served (FCFS) approach, using a single patient population.

Methods: We performed a retrospective cohort study of patients with intensive care unit (ICU) needs at a tertiary hospital on its peak COVID-19 ICU census day. We used medical record data to calculate a CSC score under 3 criteria: New York, Massachusetts with full comorbidity list (Massachusetts1), and MA with a modified comorbidity list (Massachusetts2). The CSC scores, as well as FCFS, determined which patients were eligible to receive critical care under 2 scarcity scenarios: 50 versus 100 ICU bed capacity. We assessed the association between race/ethnicity and eligibility for critical care with logistic regression.

Results: Of 211 patients, 139 (66%) were male, 95 (45%) were Hispanic, 23 (11%) were non-Hispanic Black, and 69 (33%) were non-Hispanic White. Hispanic patients had the fewest comorbidities. Assuming a 50 ICU bed capacity, Hispanic patients had significantly higher odds of receiving critical care services across all CSC guidelines, except FCFS. However, assuming a 100 ICU bed capacity, Hispanic patients had greater odds of receiving critical care services under only the Massachusetts2 guidelines (odds ratio, 2.05; 95% CI, 1.09 to 3.85).

Conclusion: Varying CSC guidelines differentially affect racial and ethnic minority groups with regard to risk stratification. The equity implications of CSC guidelines require thorough investigation before CSC guidelines are implemented.
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http://dx.doi.org/10.1002/emp2.12502DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8275820PMC
August 2021

A comparison of case definitions for infant atopic dermatitis in a multicenter prospective cohort study.

Health Sci Rep 2021 Sep 12;4(3):e324. Epub 2021 Jul 12.

Department of Emergency Medicine Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA.

This study identified two infant AD case definitions that were strongly associated with known AD risk factors. These case definitions can be used to study novel AD risk factors in large cohort studies, potentially providing new insights into the epidemiology of infant AD.
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http://dx.doi.org/10.1002/hsr2.324DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8273877PMC
September 2021

Hospital-Initiated Care Bundle, Posthospitalization Care, and Outcomes in Adults with Asthma Exacerbation.

J Allergy Clin Immunol Pract 2021 Jul 12. Epub 2021 Jul 12.

Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

Background: Hospitalization for asthma exacerbation is an opportune setting for initiating preventive efforts. However, hospital-initiated preventive asthma care remains underdeveloped and its effectiveness is uncertain.

Objective: To examine the effectiveness of a hospital-initiated asthma care bundle on posthospitalization asthma care and clinical outcomes.

Methods: Prospective multicenter study of adults (18-54 years) hospitalized for asthma exacerbation in 2017 to 2019. During the hospitalization, we implemented an asthma-care bundle (inpatient laboratory testing, asthma education, and discharge care), and prospectively measured chronic asthma care (eg, immunoglobulin E testing, specialist care) and asthma exacerbation (ie, systemic corticosteroid use, emergency department [ED] visit, hospitalizations) outcomes. By applying a self-controlled case series method, we examined within-person changes in these outcomes before (2-year period) and after (1-year period) the bundle implementation.

Results: Of 103 adults hospitalized for asthma exacerbation, the median age was 40 years and 72% were female. Compared with the preimplementation period, the postimplementation period had improved posthospitalized asthma care, including serum specific immunoglobulin E testing (rate ratio [RR] 2.18; 95% confidence interval [95% CI] 0.99-4.84; P = .051) and evaluation by asthma specialist (RR 2.66; 95% CI 1.77-4.04; P < .001). Likewise, after care bundle implementation, patients had significantly lower annual rates of systemic corticosteroid use (4.2 vs 2.9 per person-year; RR 0.70; 95% CI 0.61-0.80; P < .001), ED visits (3.2 vs 2.7 per person-year; RR 0.83; 95% CI 0.72-0.95; P = .008), and hospitalizations (2.1 vs 1.8 per person-year; RR 0.82; 95% CI 0.69-0.97; P = .02). Stratified analyses by sex, race/ethnicity, and health insurance yielded consistent results.

Conclusions: After hospital-initiated care bundle implementation, patients had improved posthospitalization care and reduced rates of asthma exacerbation.
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http://dx.doi.org/10.1016/j.jaip.2021.06.044DOI Listing
July 2021

Comparing definitions of a pediatric emergency department.

J Am Coll Emerg Physicians Open 2021 Jun 22;2(3):e12478. Epub 2021 Jun 22.

Department of Emergency Medicine Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA.

Objective: Health services research on the differences in care between pediatric and general emergency departments (EDs) is limited by ambiguity regarding the definition of a pediatric ED. Our goal was to determine the proportion of EDs captured by commonly used definitions of pediatric ED.

Methods: We linked data for 2016 from two databases from New York State - the State Emergency Department Database and State Inpatient Database (SEDD/SID) and the National Emergency Department Inventory-USA (NEDI-USA). We examined the following 4 common definitions of pediatric ED: (1) admission capability, (2) physically distinct pediatric area in the ED, (3) membership in the Children's Hospital Association, and (4) volume of pediatric ED visits (patients <18 years ). We calculated the proportion of EDs that would be defined as pediatric for each criterion. We also examined the differences in patient demographics among pediatric EDs based on each criterion.

Results: A total of 160 New York EDs were included in the linked databases. Across the 4 criteria, the proportion of EDs meeting the definition of ranged from 0% to 86%. Of the EDs, 86% had pediatric admission capability, 27%-38% had a physically distinct pediatric ED, and 8% were members of the Children's Hospital Association. No hospitals met the SEDD/SID criterion of ≥70% visits for patients <18 years.

Discussion: The number of EDs and characteristics of patients seen varied widely based on the criterion used to define pediatric ED. Database linkage may make it challenging to identify pediatric hospitals in administrative data sets. A valid, standard definition of pediatric ED is critically needed to advance health services research.
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http://dx.doi.org/10.1002/emp2.12478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8219282PMC
June 2021

Vitamin D Status and Clinical Outcomes in Acute Respiratory Distress Syndrome: A Secondary Analysis From the Assessment of Low Tidal Volume and Elevated End-Expiratory Volume to Obviate Lung Injury (ALVEOLI) Trial.

J Intensive Care Med 2021 Jun 24:8850666211028139. Epub 2021 Jun 24.

Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.

Background: Acute respiratory distress syndrome (ARDS) is a highly morbid condition that has limited therapeutic options. Optimal vitamin D status has been linked to immunological effects that may benefit critically ill patients. Therefore, we investigated whether admission 25-hydroxyvitamin D levels (25OHD) are associated with clinical outcomes in ARDS patients.

Methods: We performed a secondary analysis of data from a randomized, controlled trial comparing oxygenation strategies in 549 patients with ARDS (NCT00000579). Baseline 25OHD was measured in stored plasma samples. We investigated the relationship between vitamin D status and ventilator-free days (VFD) as well as 90-day survival, using linear regression and Cox proportional hazard models, respectively. Analyses were adjusted for age, race, and Acute Physiology and Chronic Health Evaluation III score.

Results: Baseline 25OHD was measured in 476 patients. 90% of these individuals had 25OHD <20 ng/ml and 40% had 25OHD <10 ng/ml. Patients with 25OHD <20 ng/ml were likely to be ventilated for 3 days longer than patients with levels ≥20 ng/ml (ß 3.41; 95%CI 0.42-6.39: = 0.02). Patients with 25OHD <10 ng/ml were likely to be ventilated for 9 days longer (ß 9.27; 95%CI 7.24-11.02: < 0.001) and to have a 34% higher risk of 90-day mortality (HR 1.34; 95% CI 1.06-1.71: = 0.02) compared to patients with levels 10 ng/ml.

Conclusions: In patients with ARDS, vitamin D status is associated with duration of mechanical ventilation and 90-day mortality. Randomized, controlled trials are warranted to determine whether vitamin D supplementation improves clinical outcomes in ARDS patients.
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http://dx.doi.org/10.1177/08850666211028139DOI Listing
June 2021

Blood eosinophils, specific immunoglobulin E, and bronchiolitis severity.

Pediatr Pulmonol 2021 Jun 22. Epub 2021 Jun 22.

Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.

Background: Bronchiolitis is the leading cause of hospitalization for United States infants. Blood eosinophil and serum specific IgE (sIgE) levels are separately linked to clinical severity but few studies have examined these biomarkers together.

Objective: Among infants hospitalized for bronchiolitis, we investigated the association between (1) blood eosinophilia and severity, (2) sIgE sensitization and severity, and (3) interaction between the two biomarkers on severity.

Methods: We enrolled 1016 infants hospitalized for bronchiolitis between 2011 and 2014 across 17 U.S. hospitals into a prospective cohort study. Of those, 873 (86%) had eosinophils measured and all had sIgE levels from blood collected at hospitalization. We investigated higher bronchiolitis severity using intensive care therapy as the outcome (i.e., intensive care unit admission, intubation, and/or receipt of continuous positive pressure ventilation).

Results: Among 873 infants in the analytic cohort, 18% had blood eosinophilia of ≥3%, and 20% were positive for sIgE. With regard to bronchiolitis severity, 15% received intensive care therapy. In unadjusted analyses, eosinophils ≥3% was not associated with intensive care therapy, while sIgE was associated with a significantly higher risk (odds ratio [OR]: 1.44, 95% confidence interval [CI]: 1.08-1.92; p = .01). In a multivariable model for intensive care therapy, eosinophilia remained unassociated with severity, and sIgE remained associated (OR: 1.60, 95% CI: 1.05-2.45; p = .03). Also, sIgE did not modify the association between eosinophil level and intensive care therapy (p  = .14).

Conclusion: Blood eosinophilia of ≥3% was not associated with bronchiolitis severity. By contrast, sIgE was independently associated with bronchiolitis severity and did not modify the association between eosinophil level and severity.
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http://dx.doi.org/10.1002/ppul.25543DOI Listing
June 2021

Agricultural workers in meatpacking plants presenting to an emergency department with suspected COVID-19 infection are disproportionately Black and Hispanic.

Acad Emerg Med 2021 Jun 16. Epub 2021 Jun 16.

Department of Emergency Medicine, University of Indiana School of Medicine, Indianapolis, Indiana, USA.

Objective: Facilities that process and package meat for consumer sale and consumption (meatpacking plants) were early sites of coronavirus disease 2019 (COVID-19) outbreaks. The aim of this study was to characterize the association between meatpacking plant exposure and clinical outcomes among emergency department (ED) patients with COVID-19 symptoms.

Methods: This was a retrospective cohort study of patients presenting to a single ED, from March 1 to May 31, 2020, who had: 1) symptoms consistent with COVID-19 and 2) a COVID-19 test performed. The primary outcome was COVID-19 positivity, and secondary outcomes included hospital admission from the ED, ventilator use, intensive care unit (ICU) admission, hospital length of stay (LOS; <48 or ≥48 h), and mortality.

Results: Patients from meatpacking plants were more likely to be Black or Hispanic than the ED patients without this occupational exposure. Patients with a meatpacking plant exposure were more likely to test positive for COVID-19 (adjusted relative risk [aRR] = 2.37, 95% confidence interval [CI] = 1.59 to 3.53) but had similar rates of hospital admission (aRR = 0.94, 95% CI = 0.82 to 1.07) and hospital LOS (aRR = 0.76, 95% CI = 0.45 to 1.23). There was no significant difference in ventilator use among patients with meatpacking and nonmeatpacking plant exposure (8.2% vs. 11.1%, p = 0.531), ICU admissions (4.1% vs. 12.0%, p = 0.094), and mortality (2.0% vs. 4.1%, p = 0.473).

Conclusions: Workers in meatpacking plants in Iowa had a higher rate of testing positive for COVID-19 but were not more likely to be hospitalized for their illness. These patients were disproportionately Black and Hispanic.
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http://dx.doi.org/10.1111/acem.14314DOI Listing
June 2021

Integrated omics endotyping of infants with respiratory syncytial virus bronchiolitis and risk of childhood asthma.

Nat Commun 2021 06 14;12(1):3601. Epub 2021 Jun 14.

Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Respiratory syncytial virus (RSV) bronchiolitis is not only the leading cause of hospitalization in U.S. infants, but also a major risk factor for asthma development. While emerging evidence suggests clinical heterogeneity within RSV bronchiolitis, little is known about its biologically-distinct endotypes. Here, we integrated clinical, virus, airway microbiome (species-level), transcriptome, and metabolome data of 221 infants hospitalized with RSV bronchiolitis in a multicentre prospective cohort study. We identified four biologically- and clinically-meaningful endotypes: A) clinicalmicrobiomeinflammation, B) clinicalmicrobiomeinflammation, C) clinicalmicrobiomeinflammation, and D) clinicalmicrobiomeinflammation. Particularly, compared with endotype A infants, endotype B infants-who are characterized by a high proportion of IgE sensitization and rhinovirus coinfection, S. pneumoniae/M. catarrhalis codominance, and high IFN-α and -γ response-had a significantly higher risk for developing asthma (9% vs. 38%; OR, 6.00: 95%CI, 2.08-21.9; P = 0.002). Our findings provide an evidence base for the early identification of high-risk children during a critical period of airway development.
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http://dx.doi.org/10.1038/s41467-021-23859-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8203688PMC
June 2021

Allergic symptoms after mRNA COVID-19vaccination and risk of incomplete vaccination.

J Allergy Clin Immunol Pract 2021 Jun 11. Epub 2021 Jun 11.

Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Clinical Epidemiology Program, The Mongan Institute, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.

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http://dx.doi.org/10.1016/j.jaip.2021.05.031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192889PMC
June 2021

Metabolome subtyping of severe bronchiolitis in infancy and risk of childhood asthma.

J Allergy Clin Immunol 2021 Jun 10. Epub 2021 Jun 10.

Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

Background: Infants with bronchiolitis are at increased risk for developing asthma. Growing evidence suggests bronchiolitis is a heterogeneous condition.

Objectives: We sought to identify biologically distinct subgroups based on the metabolome signatures (metabotypes) in infants with severe bronchiolitis and to examine the longitudinal relationships of metabotypes with asthma development.

Methods: In a multicenter prospective cohort study of infants (age, <12 months) hospitalized for bronchiolitis, the nasopharyngeal airway metabolome was profiled at hospitalization. Using a clustering approach, this study identified mutually exclusive metabotypes. This study also examined their longitudinal association with the risk of developing asthma by 5 years of age.

Results: Of 918 infants hospitalized for bronchiolitis (median age, 3 months), this study identified 5 distinct metabotypes-characterized by their nasopharyngeal metabolome profile: A, glycerophosphocholine-high; B, amino acid-high, polyunsaturated fatty acid-low; C, amino acid-high, glycerophospholipid-low; D, glycerophospholipid-high; and E, mixed. Compared with infants with metabotype A (who clinically resembled "classic" bronchiolitis), infants with metabotype B had a significantly higher risk for developing asthma (23% vs 41%; adjusted odds ratio, 2.22; 95% CI, 1.07-4.69). The pathway analysis showed that metabotype B had enriched amino acid (eg, methionine, histidine, glutathione) and α-linolenic/linoleic acid metabolism pathways (false discovery rate, <5 × 10 for all). Finally, the transcriptome analysis revealed that infants with metabotype B had upregulated IFN-α and IL-6/JAK/STAT3 pathways and downregulated fatty acid metabolism pathways (false discovery rate, <0.05 for both).

Conclusions: In this multicenter prospective cohort study of infants with severe bronchiolitis, the clustering analysis of metabolome data identified biologically distinct metabotypes, including a metabotype characterized by high inflammatory amino acids and low polyunsaturated fatty acids that is at significantly increased risk for developing asthma.
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http://dx.doi.org/10.1016/j.jaci.2021.05.036DOI Listing
June 2021

Efficacy of inhaled salbutamol with and without prednisolone for first acute rhinovirus-induced wheezing episode.

Clin Exp Allergy 2021 Jun 1. Epub 2021 Jun 1.

Department of Paediatrics and Adolescent Medicine, University of Turku, Turku, Finland.

Background: Acute rhinovirus-induced wheezing is common in young children and may respond to systemic corticosteroid. There are no trials on the efficacy of inhaled beta -agonist in this clinical scenario.

Objective: To study post hoc the short-term (up to 2 months) efficacy of inhaled beta -agonist with and without oral corticosteroid in the first acute rhinovirus-induced severe wheezing episode in young hospitalized children.

Methods: The study population came from two randomized controlled trials comparing oral prednisolone (2 mg/kg/d for 3 days) to placebo: Vinku (n = 35, NCT00494624) used high-dose regular nebulized salbutamol (0.15 mg/kg 2-4 h intervals) and Vinku2 (n = 60, NCT00731575, EudraCT 2006-007100-42) used inhaled salbutamol on-demand. Both studies used identical detailed follow-up assessments. The primary outcome of the former was the duration of hospitalization and of the latter the occurrence of and the time to a new physician-confirmed wheezing episode within 2 months after discharge. Treatment groups included salbutamol high-dose vs. salbutamol on-demand while adjusting for prednisolone status and acknowledging for interactions with exception of the duration of hospitalization in which prednisolone groups could not be fully used due to protocol differences.

Results: Median age of subjects was 13 months, 32% were sensitized and 22% had doctor-diagnosed eczema. In the duration of hospitalization, salbutamol high-dose/placebo versus salbutamol on-demand/placebo groups did not differ (p = .12). In the occurrence of and time to relapse within 2 months, a significant group × treatment interaction was observed (both p = .02), such that high-dose group had less and longer time to relapses than on-demand group in prednisolone arm (both p < .05), but no difference was detected in placebo arm (both p > .26).

Conclusions: In young, hospitalized children with first episode of rhinovirus-induced wheezing, high-dose inhaled salbutamol may interact with oral prednisolone. However, further trials are warranted.
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http://dx.doi.org/10.1111/cea.13960DOI Listing
June 2021

Evaluation of the 2020 Pediatric Emergency Physician Workforce in the US.

JAMA Netw Open 2021 May 3;4(5):e2110084. Epub 2021 May 3.

Emergency Medicine Network, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Importance: Given the mortality disparities among children and adolescents in rural vs urban areas, the unique health care needs of pediatric patients, and the annual emergency department volume for this patient population, understanding the availability of pediatric emergency physicians (EPs) is important. Information regarding the available pediatric EP workforce is limited, however.

Objective: To describe the demographic characteristics, training, board certification, and geographic distribution of the 2020 clinically active pediatric EP workforce in the US.

Design, Setting, And Participants: This national cross-sectional study of the 2020 pediatric EP workforce used the American Medical Association Physician Masterfile database, which was linked to American Board of Medical Specialties board certification information. Self-reported training data in the database were analyzed to identify clinically active physicians who self-reported pediatric emergency medicine (EM) as their primary or secondary specialty. The Physician Masterfile data were obtained on March 11, 2020.

Main Outcomes And Measures: The Physician Masterfile was used to identify all clinically active pediatric EPs in the US. The definition of EM training was completion of an EM program (inclusive of both an EM residency and/or a pediatric EM fellowship) or a combined EM program (internal medicine and EM, family medicine and EM, or pediatrics and EM). Physician location was linked and classified by county-level Urban Influence Codes. Pediatric EP density was calculated and mapped using US Census Bureau population estimates.

Results: A total of 2403 clinically active pediatric EPs were working in 2020 (5% of all clinically active emergency physicians), of whom 1357 were women (56%) and the median (interquartile range) age was 46 (40-55) years. The overall pediatric EP population included 1718 physicians (71%) with EM training and 641 (27%) with pediatric training. Overall, 1639 (68%) were board certified in pediatric EM, of whom 1219 (74%) reported EM training and 400 (24%) reported pediatrics training. Nearly all pediatric EPs worked in urban areas (2369 of 2402 [99%]), and pediatric EPs in urban compared with rural areas were younger (median [interquartile range] age, 46 [40-55] years vs 59 [48-65] years). Pediatric EPs who completed their training 20 years ago or more compared with those who completed training more recently were less likely to work in urban settings (633 [97%] vs 0-4 years: 440 [99%], 5-9 years: 547 [99%], or 10-19 years: 723 [99%]; P = .006). Three states had 0 pediatric EPs (Montana, South Dakota, and Wyoming), and 3 states had pediatric EPs in only 1 county (Alaska, New Mexico, and North Dakota). Less than 1% of counties had 4 or more pediatric EPs per 100 000 population.

Conclusions And Relevance: This study found that almost all pediatric EPs worked in urban areas, leaving rural areas of the US with limited availability of pediatric emergency care. This finding may have profound implications for children and adolescents needing emergency care.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.10084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132138PMC
May 2021

US Childhood Asthma Incidence Rate Patterns From the ECHO Consortium to Identify High-Risk Groups for Primary Prevention.

JAMA Pediatr 2021 May 17:e210667. Epub 2021 May 17.

National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.

Importance: Asthma is the leading chronic illness in US children, but most descriptive epidemiological data are focused on prevalence.

Objective: To evaluate childhood asthma incidence rates across the nation by core demographic strata and parental history of asthma.

Design, Setting, And Participants: For this cohort study, a distributed meta-analysis was conducted within the Environmental Influences on Child Health Outcomes (ECHO) consortium for data collected from May 1, 1980, through March 31, 2018. Birth cohort data of children from 34 gestational weeks of age or older to 18 years of age from 31 cohorts in the ECHO consortium were included. Data were analyzed from June 14, 2018, to February 18, 2020.

Exposures: Caregiver report of physician-diagnosed asthma with age of diagnosis.

Main Outcome And Measures: Asthma incidence survival tables generated by each cohort were combined for each year of age using the Kaplan-Meier method. Age-specific incidence rates for each stratum and asthma incidence rate ratios by parental family history (FH), sex, and race/ethnicity were calculated.

Results: Of the 11 404 children (mean [SD] age, 10.0 [0.7] years; 5836 boys [51%]; 5909 White children [53%]) included in the primary analysis, 7326 children (64%) had no FH of asthma, 4078 (36%) had an FH of asthma, and 2494 (23%) were non-Hispanic Black children. Children with an FH had a nearly 2-fold higher incidence rate through the fourth year of life (incidence rate ratio [IRR], 1.94; 95% CI, 1.76-2.16) after which the rates converged with the non-FH group. Regardless of FH, asthma incidence rates among non-Hispanic Black children were markedly higher than those of non-Hispanic White children during the preschool years (IRR, 1.58; 95% CI, 1.31-1.86) with no FH at age 4 years and became lower than that of White children after age 9 to 10 years (IRR, 0.67; 95% CI, 0.50-0.89) with no FH. The rates for boys declined with age, whereas rates among girls were relatively steady across all ages, particularly among those without an FH of asthma.

Conclusions And Relevance: Analysis of these diverse birth cohorts suggests that asthma FH, as well as race/ethnicity and sex, were all associated with childhood asthma incidence rates. Black children had much higher incidences rates but only during the preschool years, irrespective of FH. To prevent asthma among children with an FH of asthma or among Black infants, results suggest that interventions should be developed to target early life.
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http://dx.doi.org/10.1001/jamapediatrics.2021.0667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129904PMC
May 2021

Vitamin D status and supplementation in Antarctica: a systematic review and meta- analysis.

Int J Circumpolar Health 2021 Dec;80(1):1926133

Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica De Chile, Santiago, Chile.

Living at high latitudes is associated with vitamin D (VD) deficiency. An ideal setting to study this is the Antarctic continent, which has temporary inhabitants, but the magnitude of the effect of living in Antarctica and the effects of VD supplementation on this population remain unclear. We performed a systematic review and meta-analysis to assess the effect of temporary residence in Antarctica and impact of VD supplementation on VD status of this population. Random-effects meta-analyses were performed to assess serum 25-hydroxyvitamin D (25(OH)D) concentration changes after Antarctic residence (13 studies, 294 subjects) and after VD supplementation (5 studies, 213 subjects). Serum 25(OH)D mean difference after temporary residence in Antarctica was -15.0 nmol/L (95%CI: -25.9, -4.2; I²=92%). Subgroup meta-analyses of studies evaluating Antarctic summer and winter stays showed 25(OH)D only decreases when overwintering (winter 25(OH)D change -17.0 nmol/L [95%CI: -24.1, -9.8; I²=83%] vs. summer 25(OH)D change 1.3 nmol/L [95%CI: -14.6, 17.1; I²=86%]). The meta-analysis of VD supplementation studies in Antarctica showed a mean 25(OH)D increase after supplementation of 10.8 nmol/L (95%CI: 3.3, 18.3; I²=88%). In conclusion, VD status significantly worsens after inhabiting Antarctica, particularly when over-wintering. VD supplementation can prevent worsening of VD status and should be considered in this population.
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http://dx.doi.org/10.1080/22423982.2021.1926133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128169PMC
December 2021

Emergency department revisits and rehospitalizations among infants and toddlers for acute allergic reactions.

Allergy Asthma Proc 2021 05;42(3):247-256

From the Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Allergic reactions, including anaphylaxis, are rising among children. Little is known about health care utilization among infants and toddlers. Our objective was to characterize health care utilization and charges for acute allergic reactions (AAR). We conducted a retrospective cohort study of trends in emergency department (ED) visits and revisits, hospitalizations and rehospitalizations, and charges among infants and toddlers (ages < 3 years), with an index ED visit or hospitalization for AAR (including anaphylaxis). We used data from population-based multipayer data: State Emergency Department Databases and State Inpatient Databases from New York and Nebraska. Multivariable logistic regression was used to identify factors associated with ED revisits and rehospitalizations. Between 2006 and 2015, infant and toddler ED visits for AAR increased from 27.8 per 10,000 population to 35.2 (P < 0.001), whereas hospitalizations for AAR remained stable (P = 0.11). In the one year after an index AAR visit, 5.1% of these patients had at least one AAR ED revisit and 5.9% had at least one AAR rehospitalization. Factors most strongly associated with AAR ED revisits included an index visit hospitalization and receipt of epinephrine. Total charges for AAR ED visits (2009-2015) and hospitalizations (2011-2015) were more than $29 million and $11 million, respectively. Total charges increased more than fourfold for both AAR ED revisits for AAR rehospitalizations during the study period. Infants and toddlers who presented with an AAR were at risk for ED revisits and rehospitalizations for AAR within the following year. The charges associated with these revisits were substantial and seemed to be increasing.
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http://dx.doi.org/10.2500/aap.2021.42.210031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143921PMC
May 2021

Interdisciplinary Approaches to COVID-19.

Adv Exp Med Biol 2021 ;1318:923-936

Universal Scientific Education and Research Network (USERN), The World, Tehran, Iran.

The coronavirus disease 2019 (COVID-19) pandemic has been a significant concern worldwide. The pandemic has demonstrated that public health issues are not merely a health concern but also affect society as a whole. In this chapter, we address the importance of bringing together the world's scientists to find appropriate solutions for controlling and managing the COVID-19 pandemic. Interdisciplinary cooperation, through modern scientific methods, could help to handle the consequences of the pandemic and to avoid the recurrence of future pandemics.
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http://dx.doi.org/10.1007/978-3-030-63761-3_52DOI Listing
May 2021

Proximity to Major Roads and Risks of Childhood Recurrent Wheeze and Asthma in a Severe Bronchiolitis Cohort.

Int J Environ Res Public Health 2021 04 15;18(8). Epub 2021 Apr 15.

Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.

Air pollution exposures have been suggested as risk factors for childhood respiratory diseases. We investigated proximity to major roads, an indicator of air pollution exposure, and its associations with childhood recurrent wheeze and asthma. We used data from a multicenter prospective cohort study of 921 infants hospitalized for bronchiolitis and recruited from 14 U.S. states. Primary exposure was residential proximity to the nearest major road at birth through age 3 years. Residential distance from nearest major road was divided into four categories: <100, 100-200, 201-300, and >300 m. Outcomes were parent-reported recurrent wheeze by age 3 years and asthma by age 5 years. Associations between residential proximity to major roads and respiratory outcomes were investigated using multivariable Cox proportional hazards modeling and logistic regression, adjusted for confounders. Out of 920 participants with home address data, pooled estimates identified 241 (26%) participants resided within 300 m of a major road, 296 (32%) developed recurrent wheeze by age 3, and 235 out of 858 participants (27%) developed asthma by 5 years. Participants who resided close to a major road had the highest risk of recurrent wheeze (adjusted hazards ratio for <100 m, 1.59, 95%CI: 1.08-2.33) and asthma (adjusted odds ratio for 201-300 m, 1.62, 95%CI: 1.16-2.25), compared to those residing >300 m from a major road. Proximity to major roads is associated with increased risks of recurrent wheeze and asthma in young children.
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http://dx.doi.org/10.3390/ijerph18084197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071463PMC
April 2021

Relationship of Soluble Interleukin-6 Receptors With Asthma: A Mendelian Randomization Study.

Front Med (Lausanne) 2021 12;8:665057. Epub 2021 Apr 12.

Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.

Emerging evidence suggests a potential role of interleukin-6 pathways-trans-signaling with soluble interleukin-6 receptors-in the asthma pathobiology. Despite the evidence for their associations with asthma, the causal role of soluble interleukin-6 receptors remains uncertain. We investigated the relations of soluble interleukin-6 receptors with asthma and its major phenotypes. We conducted a two-sample Mendelian randomization study. As genetic instruments, we selected 33 independent -acting variants strongly associated with the level of plasma soluble interleukin-6 receptor in the INTERVAL study. To investigate the association of variants with asthma and its phenotypes, we used genome-wide association study data from the UK Biobank. We combined variant-specific causal estimates by the inverse-variance weighted method for each outcome. Genetically-instrumented soluble interleukin-6 receptor level was associated with a significantly higher risk of overall asthma (OR per one standard deviation increment in inverse-rank normalized soluble interleukin-6 receptor level, 1.02; 95%CI, 1.01-1.03; = 0.004). Sensitivity analyses demonstrated consistent results and indicated no directional pleiotropy-e.g., MR-Egger (OR, 1.03; 95%CI, 1.01-1.05; = 0.002; =0.37). In the stratified analysis, the significant association persisted across asthma phenotypes-e.g., childhood asthma (OR, 1.05; 95%CI, 1.02-1.08; < 0.001) and obese asthma (OR, 1.02; 95%CI 1.01-1.03; = 0.007). Sensitivity analysis using 16 variants selected with different thresholds also demonstrated significant associations with overall asthma and its phenotypes. Genetically-instrumented soluble interleukin-6 receptor level was causally associated with modestly but significantly higher risks of asthma and its phenotypes. Our observations support further investigations into identifying specific endotypes in which interleukin-6 pathways may play major roles.
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http://dx.doi.org/10.3389/fmed.2021.665057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071981PMC
April 2021

Contributions of asthma, rhinitis and IgE to exhaled nitric oxide in adolescents.

ERJ Open Res 2021 Apr 19;7(2). Epub 2021 Apr 19.

Division of Pulmonary, Critical Care and Sleep Medicine, Dept of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Exhaled nitric oxide fraction ( ) is an indicator of allergic airway inflammation. However, it is unknown how asthma, allergic rhinitis (AR) and allergic sensitisation relate to , particularly among adolescents and in overlapping conditions. We sought to determine the associations between asthma, AR, and aeroallergen immunoglobulin (Ig)E and in adolescents. We measured among 929 adolescents (aged 11-16 years) in Project Viva, an unselected prebirth cohort in Massachusetts, USA. We defined asthma as ever asthma physician diagnosis plus wheezing in the past year or taking asthma medications in the past month, AR as a physician diagnosis of hay fever or AR, and aeroallergen IgE as any IgE >0.35 IU·mL among 592 participants who provided blood samples. We examined associations of asthma, AR and IgE with percent difference in in linear regression models adjusted for sex, race/ethnicity, age and height, maternal education and smoking during pregnancy, and household/neighbourhood demographics. Asthma (14%) was associated with 97% higher (95% CI 70-128%), AR (21%) with 45% higher (95% CI 28-65%), and aeroallergen IgE (58%) with 102% higher (95% CI 80-126%) compared to those without each condition, respectively. In the absence of asthma or AR, aeroallergen IgE was associated with 75% higher (95% CI 52-101), while asthma and AR were not associated with in the absence of IgE. The link between asthma and AR with is limited to those with IgE-mediated phenotypes. may be elevated in those with allergic sensitisation alone, even in the absence of asthma or AR.
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http://dx.doi.org/10.1183/23120541.00945-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053905PMC
April 2021

Improved diet quality is associated with decreased concentrations of inflammatory markers in adults with uncontrolled asthma.

Am J Clin Nutr 2021 Apr 19. Epub 2021 Apr 19.

Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.

Background: Asthma has become one of the major public health challenges, and recent studies show promising clinical benefits of dietary interventions, such as the Dietary Approaches to Stop Hypertension (DASH) diet.

Objective: The objective of this study was to examine whether changes in diet quality are associated with changes in inflammatory markers important in asthma pathophysiology.

Methods: In this exploratory study in patients with poorly controlled asthma participating in a randomized controlled trial of a DASH intervention study, changes in concentrations of a broad panel of serum proteins (51-plex Luminex assay, Affymetrix) were determined, and their relation to diet quality (DASH score) assessed by combining data of both intervention and usual-care control groups. Second, the relation between the serum proteins, other biomarkers of inflammation and nutrition, and Asthma Control Questionnaire (ACQ) was assessed.

Results: During the first 3 mo, diet quality (DASH scores) were inversely associated (P < 0.05, false discovery rate P < 0.09) with serum concentrations of a large number serum proteins, reflecting not only general proinflammatory markers such as IL-1β, transforming growth factor α (TGF-α), and IL-6 (r = -0.31 to -0.39) but also a number of proteins associated with asthmatic conditions, specifically several T-helper (Th) 2 (Th2; r = -0.29 to -0.34) and Th17 (r = -0.4) associated cytokines and growth factors. Monokine induced by gamma/chemokine (C-X-C motif) ligand 9 (CXCL9) (MIG/CXCL9), a T-cell attractant induced by IFN-γ previously linked to asthma exacerbations, appeared to be the marker most consistently associated with DASH diet quality for the entire 6-mo study period (r = -0.40 and -0.30 for 0-3 and 3-6 mo, respectively, and standardized coefficient loadings -0.13 in the partial least squares analyses). Decreases in 19 serum protein concentrations were also correlated with improved asthma control during the 6-mo study period.

Conclusions: Our data in adult patients with poorly controlled asthma suggest that dietary changes, like the introduction of DASH, may have beneficial effects on reducing inflammatory status. This trial was registered at http://www.clinicaltrials.gov as NCT01725945.
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http://dx.doi.org/10.1093/ajcn/nqab063DOI Listing
April 2021

Emergency Department Characteristics and Capabilities in Quito, Ecuador.

Ann Glob Health 2021 04 7;87(1):37. Epub 2021 Apr 7.

Massachusetts General Hospital, Boston, MA, US.

Background: Emergency care is an essential part of a health system. Ecuador has recognized emergency medicine as a specialty and has two emergency medicine residency training programs. However, little has been published about emergency department characteristics and capabilities in Ecuador.

Objective: We described the characteristics and capabilities of emergency departments (EDs) in Quito, Ecuador, in 2017, using the National Emergency Department Inventory (NEDI) survey.

Methods: The 23-item survey included questions pertaining to ED characteristics, including: visit volume, physical and administrative structure, clinical capabilities, technological resources, and consult personnel availability. This study included all EDs in Quito operating 24 hours/day, 7 days/week, and serving all patients seeking care. One representative from each ED was asked to complete the survey based on calendar year 2017.

Findings: Thirty EDs met the inclusion criteria, and 26 completed the survey (87% response). The median number of ED beds was 17 (range 2-61). Median annual visit volume was 22,580 (range 1,680 to 129,676). All but two EDs provided care for both children and adults. Cardiac monitors were available in 88% of EDs, CT scanners in 68%, and rooms for respiratory isolation in 31%. Most EDs could manage patients with general medicine (92%), general surgery (92%), and gynecology (88%) emergencies 24/7. Fewer were able to provide hand surgery (45%) and dental (28%) care 24/7. Typical length of stay was 1-6 hours in 65% and >6 hours in 31% of EDs. Half of EDs reported operating at full capacity and 27% reported operating over their capacity. When compared to private EDs, government EDs (public and social security) had a higher mean number of visits per year (50,090 government vs. 13,968 private, p < 0.001), higher mean number of ED beds (36 government vs. 9 private, p = 0.002), and higher length of stay (58% of patient stays > 6 hours in government EDs vs. 86% of patient stays 1-6 hours in private EDs, p = 0.009).

Conclusions: EDs in Quito varied widely with respect to annual visit volume, ability to treat different pathologies 24/7, and resources. Most EDs are functioning at or over capacity, and a substantial number have long lengths of stay. Further research and investment in emergency care could help increase the capacity and efficiency of EDs in Ecuador.
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http://dx.doi.org/10.5334/aogh.3129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8034401PMC
April 2021

Female emergency physician workforce in the United States, 2020.

Am J Emerg Med 2021 Apr 9. Epub 2021 Apr 9.

Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States of America.

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http://dx.doi.org/10.1016/j.ajem.2021.04.003DOI Listing
April 2021

Rituximab-induced hypogammaglobulinemia and infection risk in pediatric patients.

J Allergy Clin Immunol 2021 Apr 20. Epub 2021 Apr 20.

Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Department of Microbiology, Infectiology and Immunology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada. Electronic address:

Background: Rituximab is a B-cell depleting agent used in B-cell malignancies and autoimmune diseases. A subset of adult patients may develop prolonged and symptomatic hypogammaglobulinemia following rituximab treatment. However, this phenomenon has not been well delineated in the pediatric population.

Objectives: This study sought to determine the prevalence, risk factors, and clinical significance of hypogammaglobulinemia following rituximab therapy in children.

Methods: This was a multicenter, retrospective cohort study that extracted clinical and immunological data from pediatric patients who received rituximab.

Results: The cohort comprised 207 patients (median age, 12.0 years). Compared to baseline values, there was a significant increase in hypogammaglobulinemia post-rituximab therapy, with an increase in prevalence of hypo-IgG (28.7%-42.6%; P = .009), hypo-IgA (11.1%-20.4%; P = .02), and hypo-IgM (20.0%-62.0%; P < .0001). Additionally, low IgG levels at any time post-rituximab therapy were associated with a higher risk of serious infections (34.4% vs 18.9%; odds ratio, 2.3; 95% CI, 1.1-4.8; P = .03). Persistent IgG hypogammaglobulinemia was observed in 27 of 101 evaluable patients (26.7%). Significant risk factors for persistent IgG hypogammaglobulinemia included low IgG and IgA levels pre-rituximab therapy. Nine patients (4.3%) within the study were subsequently diagnosed with a primary immunodeficiency, 7 of which received rituximab for autoimmune cytopenias.

Conclusions: Hypogammaglobulinemia post-rituximab treatment is frequently diagnosed within the pediatric population. Low IgG levels are associated with a significant increase in serious infections, and underlying primary immunodeficiencies are relatively common in children receiving rituximab, thus highlighting the importance of immunologic monitoring both before and after rituximab therapy.
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http://dx.doi.org/10.1016/j.jaci.2021.03.041DOI Listing
April 2021

Geographically Indexed Referral Databases to Address Social Needs in the Emergency Department.

West J Emerg Med 2021 Mar 4;22(2):218-224. Epub 2021 Mar 4.

Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.

Introduction: Unmet health-related social needs (HRSN) are among the drivers of disparities in morbidity and mortality during public health emergencies such as the novel coronavirus 2019 (Covid-19) pandemic. Although emergency departments (ED) see a high volume of patients with HRSN, ED providers have limited time to complete detailed assessments of patients' HRSN and are not always able to provide up-to-date and comprehensive information to patients on available community resources. Electronic, geographically indexed resource database systems have the potential to provide an efficient way for emergency physicians to rapidly identify community resources in settings where immediate social work consultation is not accessible.

Methods: We conducted a systematic review of papers examining the use of geographically indexed resource database systems in healthcare to better understand how these services can be used in emergency care. We then conducted simulated, standardized searches using two nationally available databases (211 and Aunt Bertha), applied to a single metropolitan area (Boston).

Results: Our systematic review found that most public health and screening interventions using nationally available databases have focused on chronic care needs. A small subset of publications demonstrated that these databases were mobilized during disasters to successfully aid vulnerable populations during Hurricanes Katrina and Rita. A total of 408 standardized searches were conducted to identify community resources related to four domains of social needs (food, transportation, housing, and utilities). Although 99% of the resources identified by both databases were relevant to the search domains queried, a significant proportion of the resources identified by each database were restricted to a specific demographic (eg, veterans).

Conclusion: Our findings demonstrate that geographically indexed referral databases may be an effective tool to help ED providers connect patients to nearby community resources during public health emergencies. We recommend that EDs select a referral database based on the greatest number of resources that are not demographically restricted.
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http://dx.doi.org/10.5811/westjem.2020.11.49250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7972357PMC
March 2021

Leveraging "big data" in respiratory medicine - data science, causal inference, and precision medicine.

Expert Rev Respir Med 2021 Jun 15;15(6):717-721. Epub 2021 Apr 15.

Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

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http://dx.doi.org/10.1080/17476348.2021.1913061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8238913PMC
June 2021

The Role of Nutritional Factors in Asthma: Challenges and Opportunities for Epidemiological Research.

Int J Environ Res Public Health 2021 03 15;18(6). Epub 2021 Mar 15.

Université Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France.

The prevalence of asthma has nearly doubled over the last decades. Twentieth century changes in environmental and lifestyle factors, including changes in dietary habits, physical activity and the obesity epidemic, have been suggested to play a role in the increase of asthma prevalence and uncontrolled asthma worldwide. A large body of evidence has suggested that obesity is a likely risk factor for asthma, but mechanisms are still unclear. Regarding diet and physical activity, the literature remains inconclusive. Although the investigation of nutritional factors as a whole (i.e., the "diet, physical activity and body composition" triad) is highly relevant in terms of understanding underlying mechanisms, as well as designing effective public health interventions, their combined effects across the life course has not received a lot of attention. In this review, we discuss the state of the art regarding the role of nutritional factors in asthma, for each window of exposure. We focus on the methodological and conceptual challenges encountered in the investigation of the complex time-dependent interrelations between nutritional factors and asthma and its control, and their interaction with other determinants of asthma. Lastly, we provide guidance on how to address these challenges, as well as suggestions for future research.
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http://dx.doi.org/10.3390/ijerph18063013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999662PMC
March 2021
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