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Childhood Asthma Rates Level Off, But Racial Disparities Remain

There’s finally some good news about childhood asthma in the United States: After rising for decades, the number of children with the breathing disorder has finally stopped increasing and may have started falling, according to a government analysis.

“That was a big surprise,” says Lara Akinbami of the National Center for Health Statistics. “We were expecting the increase to kind of continue. But in fact we saw the opposite.”

The percentage of U.S. children with asthma doubled in the 1980s and 1990s and had been increasing steadily since then. The reason for the increase has remained mysterious, but there may be many possible factors, including exposure to secondhand smoke, obesity and children’s immune systems failing to develop properly.

Akinbami and her colleagues detected the first change in that trend when they analyzed data from the National Health Interview Survey between 2001 and 2013.

Among children ages 17 and younger, the prevalence of asthma peaked at 9.7 percent in 2011 and then plateaued until 2013, when it declined to 8.3 percent, the researchers report Monday in the journal Pediatrics.

But asthma prevalence continues to rise among children in the poorest families and remains far more common among African-American children than white children. More than 14 percent of black children have asthma, compared with about 8 percent of white children. Black children are also much more likely than white children to suffer severe complications.

And it’s not clear “whether 2013 represents just one of the fluctuations in that leveling or whether that’s going to show us the beginning of a decreasing trend,” Akinbami says.

The reason for the shift remains as mysterious as the rise. One possibility is that the proportion of children who are genetically susceptible to asthma may have peaked, Akinbami says.

Regardless of the cause, other experts are welcoming the trend.

“It is good news for kids,” says Stephen Teach, chairman of pediatrics at the Children’s National Health System in Washington, D.C. In addition to deaths and hospitalizations, asthma attacks cause children to miss school and their parents to miss work.

“It’s an economic and health care drag on our system and our potential for children to develop,” Teach says.

Teach and others say we still have a long way to go.

“Roughly 1 in 9 children have asthma. That’s a pretty profound burden of a health condition in a population that really should be very, very healthy overall,” says Elizabeth Matsui, a professor of pediatrics at the Johns Hopkins Children’s Center in Baltimore. “So there’s still a lot of work to be done.”

That includes addressing the persistent racial and economic inequities. “There are stark and dramatic disparities in the prevalence of the disease,” Teach says.

Source: NPR – Rob Stein

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Faces of Treatment

July 22, 2015

A photo essay by Sarah Weiser detailing the difficult path to recovery faced by pregnant addicts at New York City’s Non-profit Center for Comprehensive Health Practice, one of the oldest centers in New York City to offer such treatment.

Angela Holmes, 37, with her fifth child, Jaheem Davis, 17 months old. Holmes first came to the Center for Comprehensive Health Practice (CCHP) in East Harlem in 2003, eight months pregnant and in desperate need of treatment for her heroin addiction. “I knew time was running out,” Holmes said. “Honestly this was the only program in New York that would take me pregnant.” Pregnant women addicted to opioids – whether illicit drugs like heroin or prescribed painkillers like OxyContin – face a dearth of treatment options, say doctors and patients alike.

 

Robin Beard, right, a Senior Counselor at CCHP, helps lead the Young Mothers group, which provides educational and other support for mothers and pregnant women on methadone. “When you have an addiction, so many things come into play,” says CCHP’s Medical Director Mariely Fernandez. “So many social factors, so many economic factors… you just can’t treat it in a singular, silo kind of approach.”

 

Nicole Watson, 22, and four months pregnant, adds water to her dose of methadone at CCHP. Methadone maintenance treatment is the widely recommended approach for pregnant women with opioid addiction and is safer for a fetus than an abstinence-only approach, experts say. CCHP’s Pregnant Addicts and Addicted Mothers (PAAM) program, which began in 1975, combines methadone treatment with access to counselors, therapists, and primary-care doctors.

 

Zasha Lugo, 25, listens during the Young Mothers group. Babies born to mothers on methadone can show symptoms of drug withdrawal, as was the case with Lugo’s two-month-old daughter, Ovenia. Such babies are routinely treated in the hospital. “I think the scary thing for the moms,” says Medical Director Fernandez, is that often “they really don’t know what to expect” when their babies are born. Ovenia is getting better now, says Lugo: “She’s beautiful. She has all her fingers and her toes. Her nose is where it’s supposed to be.”

 

Angela Holmes, 37, center, a recovering heroin addict who has been clean since 2007, with her daughter, Armani Davis, 6, left, and son Jermaine Davis, 12, at the Early Childhood Development Center at CCHP. Both children were born when Holmes was in methadone treatment. “I’m really trying to fix my life,” says Holmes, who adds that her drug use started at age 14 when she was given PCP by her stepfather. Holmes, who plans on returning to school, says she wants to lead her children by example. “My life story – which is negative to them – I don’t want to keep using that. I want to show them more than I can tell them.”

 

Nicole Watson, 22, part of CCHP’s Pregnant Addicts and Addicted Mothers program, talks with her counselor, Joanne Hernandez. Watson, who first started abusing prescription painkillers like Roxicodone and Percocet at age 14, began shooting heroin at 15. A deep downward spiral ended in a miscarriage, says Watson, after which she began methadone treatment. “Methadone is the only thing that’s been able to keep me clean and stable,” says Watson, now four months pregnant.

 

Nicole Watson drinks her methadone dose at CCHP. “I have guilt that people don’t really know about. They can’t look into my brain and know the guilt that I face for being on methadone.” But, Watson says, “I wish the world wasn’t so judgmental…I see babies who are born on methadone who’ve been very sick at birth, and you would never know they were on methadone. Because they’re so healthy, they’re such healthy babies now.”

 

The Young Mothers group for pregnant women and mothers on methadone meets at CCHP, as the daughter of one mother plays on the floor. Born with withdrawal symptoms, the infant was treated at the hospital and is now healthy. “Stigmas still exist” for pregnant women on methadone, says Liliana Villar-Durrani, Director of PAAM. And because of that, she says, women may be afraid to seek treatment or become anxious leading up to the birth of their child.

 

“Being around the mothers helps me,” says Nicole Watson, right, with Zasha Lugo, 25, center. “Without that, I don’t know if I’d be mentally prepared.” Watson says she feels the stigma surrounding addicted mothers. “That’s what society has done to us, it has labeled us, and it’s a shame.” But “I can’t stop what I’ve already done. All I can do is fix it, to the best of my ability.” And “if you strip me of my addiction, I’m still a woman. I’m still a young mother. I still love my child.”

 

Nicole Watson, right, jokes with her friend Nelson Colon, a fellow patient, outside CCHP. “What’s important to me is that I stabilize my life, I have a life for my baby,” says Watson. “She may not have everything that she wants, but she’ll damn well have everything that she needs.”

 

“I have a lot to look forward to, but I also have a lot of – how you say – trials and tribulations in my way,” says Nicole Watson, with the daughter of a fellow patient and close friend. “As soon as I got pregnant I saw a black hole. I didn’t see a future for myself. Now I see a beautiful future…I see myself growing a lot, and I see myself moving forward from this hole and this rut that I’ve been stuck in.”

Source: Retro Report – ​​Photographs by Sarah Weiser​​​

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Thank You CCHP Nurses

This week is Nurse Appreciation Week, a nationally recognized week where we stop and thank our amazing nurses and medical assistants for their hard work and dedication.

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