Martin Molly A, Rothschild Steven K, Lynch Elizabeth, Christoffel Katherine Kaufer, Pagán Militza M, Rodriguez Jose Luis, Barnes Anna, Karavolos Kelly, Diaz Antonieta, Hoffman Lucretia M, Plata Diana, Villalpando Sandra
University of Illinois at Chicago, 840 South Wood Street, M/C 856, Chicago, IL, 60612, USA.
Rush University Medical Center, 1700 W Van Buren, Suite 470, Chicago, IL, 60612, USA.
BMC Pediatr. 2016 Dec 1;16(1):198. doi: 10.1186/s12887-016-0745-0.
The objective of this study was to design and test the feasibility and impact of a community health worker (CHW) intervention for comorbid asthma and obesity.
Using a proof of concept study design, we collected pre/post outcomes from a single intervention cohort of urban low-income in a single community area. A community-based participatory research approach was employed. Forty-six children and their caregivers were recruited. Children were 5-12 years old with physician-diagnosed asthma and body mass index (BMI) > 85%. Families were offered 12 home visits from CHWs that integrated asthma and obesity core curriculums. The primary asthma outcome was asthma control, measured via the Childhood Asthma Control Test (cACT). The primary obesity outcome was child body mass index (BMI).
Families received a median of 10 out of the 12 home visits over 1 year. At 1 year, there was a significant improvement in the number of children with controlled asthma as measured via cACT (85.7% at 1 year compared to 61.9% at baseline, p = 0.01). Activity limitations and emergency utilization were reduced while inhaler technique improved (p < 0.01 for all). Child BMI z-score was reduced: mean = 1.97 (SD 0.79) at 1 year compared to mean = 2.13 (SD 0.40) at baseline, p < 0.01. No association was seen between change in child BMI and change in asthma control. Worse baseline child depression scores were associated with less improvement in asthma control (p = 0.003) and higher baseline caregiver post-traumatic stress disorder scores were associated with increased child BMI (p = 0.012).
The CHW intervention has promise for improving asthma and weight outcomes in high-risk children with comorbid asthma and obesity; this model warrants further development and investigation.
本研究的目的是设计并测试一项针对哮喘与肥胖合并症的社区卫生工作者（CHW）干预措施的可行性及影响。
采用概念验证研究设计，我们从一个社区区域的城市低收入单一干预队列中收集干预前后的结果。采用基于社区的参与性研究方法。招募了46名儿童及其照顾者。儿童年龄为5至12岁，经医生诊断患有哮喘且体重指数（BMI）>85%。为家庭提供了12次由社区卫生工作者进行的家访，家访内容整合了哮喘和肥胖核心课程。哮喘的主要结局是通过儿童哮喘控制测试（cACT）衡量的哮喘控制情况。肥胖的主要结局是儿童体重指数（BMI）。
在1年时间里，家庭平均接受了12次家访中的10次。1年后，通过cACT测量，哮喘得到控制的儿童数量有显著改善（1年时为85.7%，而基线时为61.9%，p = 0.01）。活动受限和急诊利用率降低，同时吸入器使用技术得到改善（所有p值均<0.01）。儿童BMI z评分降低：1年时平均为1.97（标准差0.79），而基线时平均为2.13（标准差0.40），p<0.01。未发现儿童BMI变化与哮喘控制变化之间存在关联。基线时儿童抑郁评分较高与哮喘控制改善较少相关（p = 0.003），而基线时照顾者创伤后应激障碍评分较高与儿童BMI升高相关（p = 0.012）。
社区卫生工作者干预措施有望改善患有哮喘与肥胖合并症的高危儿童的哮喘和体重结局；该模式值得进一步开发和研究。
