National Center for Healthy Housing, Columbia, MD, USA.
Public Health Rep. 2011 May-Jun;126 Suppl 1(Suppl 1):89-99. doi: 10.1177/00333549111260S112.
We examined the impact of a combination of home environmental interventions and nurse case management services on total settled dust loadings and on allergen concentrations in the homes of asthmatic children. METHODS Using a randomized longitudinal controlled trial study design, we randomly assigned homes of asthmatic children in Milwaukee to either a control (n = 64) or an intervention (n = 57) group. Control group homes received a visual assessment, education, bed/pillow dust mite encasings, and treatment of lead-based paint hazards. The intervention group received these same services plus nurse case management that included tailored, individual asthma action plans, provision of minor home repairs, home cleaning using special vacuuming and wet washing, and integrated pest management. Dust vacuum samples were collected from measured surface areas of floors in the TV room, kitchen, and child's bedroom at baseline and at three-, six-, and 12-month follow-up visits. Dust loading (mass per surface area) is a means of measuring total dust and the total amount of allergen present.
For the intervention group, geometric mean dust loadings declined significantly from baseline (39 milligrams per square foot [mg/ft2]) to postintervention (11 mg/ft2) (p < 0.001). Baseline dust loading, treatment group, visit, and season were significant predictors of follow-up dust loadings. Mean post-intervention dust loadings were 72% higher in the control group. The total amount of allergen in settled house dust declined significantly following the intervention because total dust loading declined; the concentration of allergens in settled dust did not change significantly.
The combination of nurse case management and home environmental interventions promotes collaboration between health and housing professionals and is effective in reducing exposures to allergens in settled dust.
我们研究了家庭环境干预措施与护士个案管理服务相结合对哮喘儿童家庭的总积尘负荷和过敏原浓度的影响。
采用随机纵向对照试验设计，我们随机将密尔沃基市哮喘儿童的家庭分为对照组（n=64）和干预组（n=57）。对照组家庭接受了目视评估、教育、床/枕头尘螨包裹、以及处理含铅油漆危害。干预组家庭接受了上述相同的服务，外加护士个案管理，包括定制的、个体化的哮喘行动计划、提供小的家庭维修、使用特殊的吸尘和湿洗清洁房屋，以及综合虫害管理。在基线和 3、6 和 12 个月随访时，从电视室、厨房和儿童卧室的测量表面区域采集灰尘真空样本。灰尘负荷（单位面积质量）是测量总灰尘和总过敏原含量的一种手段。
对于干预组，从基线（39 毫克/平方英尺[mg/ft2]）到干预后（11 mg/ft2），几何平均灰尘负荷显著下降（p<0.001）。基线灰尘负荷、治疗组、访问和季节是随访灰尘负荷的显著预测因素。对照组的平均干预后灰尘负荷高 72%。在干预后，由于总灰尘负荷下降，定居灰尘中的总过敏原量显著下降；定居灰尘中过敏原的浓度没有显著变化。
护士个案管理与家庭环境干预相结合促进了卫生和住房专业人员之间的合作，有效减少了定居灰尘中过敏原的暴露。
