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Objective: The aim of this study was to describe nocturnal asthma symptoms among urban children with asthma and assess the burden of sleep difficulties between children with varying levels of nocturnal symptoms., Methods: We analyzed baseline data from 287 urban children with persistent asthma (aged 4-10 years) enrolled in the School-Based Asthma Therapy trial; Rochester, New York. Caregivers reported on nocturnal asthma symptoms (number of nights/2 weeks with wheezing or coughing), parent quality of life (Juniper's Pediatric Asthma Caregivers Quality of Life Questionnaire), and sleep quality by using the validated Children's Sleep Habits Questionnaire. We used bivariate and multivariate statistics to compare nocturnal asthma symptoms with sleep quality/quantity and quality of life., Results: Most children (mean age, 7.5 years) were black (62%); 74% had Medicaid. Forty-one percent of children had intermittent nocturnal asthma symptoms, 23% mild persistent, and 36% moderate to severe. Children's average total sleep quality score was 51 (range, 33-99) which is above the clinically significant cutoff of 41, indicating pervasive sleep disturbances among this population. Sleep scores were worse for children with more nocturnal asthma symptoms compared with those with milder symptoms on total score, as well as several subscales, including night wakings, parasomnias, and sleep disordered breathing (all P < .03). Parents of children with more nocturnal asthma symptoms reported their child having fewer nights with enough sleep in the past week (P = .018) and worse parent quality of life (P < .001)., Conclusions: Nocturnal asthma symptoms are prevalent in this population and are associated with poor sleep quality and worse parent quality of life. These findings have potential implications for understanding the disease burden of pediatric asthma., (Copyright © 2011 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Background: Low-income, minority teens have disproportionately high rates of asthma morbidity and are at high risk for nonadherence to preventive medications., Objective: To assess the feasibility and preliminary effectiveness of an innovative school-based asthma program to enhance the delivery of preventive care for 12-15 year olds with persistent asthma. We hypothesized that this intervention would (1) be feasible and acceptable among this population and (2) yield reduced asthma morbidity., Subjects/setting: Teens with persistent asthma and a current preventive medication prescription in Rochester, NY., Design: Single group pre-post pilot study during the 2009-2010 school year., Intervention: Teens visited the school nurse daily for 6-8 weeks at the start of the school year to receive directly observed therapy (DOT) of preventive asthma medications; 2-4 weeks following DOT initiation, they received three counseling sessions (one in-home and two via telephone) using motivational interviewing (MI) to explore attitudes about asthma management, build motivation for medication adherence, and support transition to independent preventive medication use., Primary Outcome: Number of symptom-free days (SFDs)/2 weeks; outcome data were collected 2 months after baseline and at the end of school year., Results: We enrolled 30 teens; 28 participated in the intervention. All teens initiated a trial of school-based DOT. All in-home MI visits were completed successfully, and 89% completed both follow-up sessions. Teens experienced an overall reduction of symptoms with more SFDs/2 weeks from baseline to 2-month and final (end of school year) assessments (8.71 vs. 10.79 vs. 12.89, respectively, p = .046 and p = .004). Teens also reported fewer days with symptoms, less activity limitation, and less rescue medication use (all p < .05). Exhaled nitric oxide levels decreased (p = .012), suggesting less airway inflammation. At the final assessment, teens reported significantly higher motivation to take their preventive medication every day (p = .043). At the end of the study, 79% of teens stated that they were better at managing asthma on their own, and 93% said they would participate in a similar program again., Conclusions: This pilot study provides preliminary evidence of the feasibility and effectiveness of a novel school-based intervention to promote independence in asthma management and improve asthma outcomes in urban teens.

We determined the effects of tropospheric ozone on the chemical composition of Quercus ilex L. leaves and their decomposition, with a view to assessing the influence of ozone on nutrient cycling and the sustainability of Mediterranean holm oak forests. Forming one of the most widespread thermophilous vegetation communities in the area, Q. ilex is a dominant and widespread evergreen oak in the Mediterranean, where concentrations of tropospheric ozone are particularly high. The dynamics of carbon, nitrogen, lignin and cellulose concentrations were monitored for six months during the decomposition of leaves from plants subjected to controlled ozone exposure in open-top chambers. Ozone-exposed leaves, compared to unexposed leaves, showed no significant differences in C, N, lignin and cellulose concentrations prior to the incubation in mesocosms. However, during decomposition, leaves from plants exposed to ozone lost C significantly more slowly and showed a higher C/N ratio than unexposed leaves. Ozone exposure significantly slowed down the decomposition rate, indicating a negative effect of tropospheric ozone on nutrient cycling, which may reduce long-term sustainability of the holm oak forest., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Objective: To explore the relationship between sleep-disordered breathing (SDB) and behavioral problems among inner-city children with asthma., Methods: We examined data for 194 children (aged 4-10 years) who were enrolled in a school-based asthma intervention program (response rate: 72%). SDB was assessed by using the Sleep-Related Breathing Disorder Questionnaire that contains 3 subscales: snoring, sleepiness, and attention/hyperactivity. For the current study, we modified the Sleep-Related Breathing Disorder Questionnaire by removing the 6 attention/hyperactivity items. A sleep score of >0.33 was considered indicative of SDB. To assess behavior, caregivers completed the Behavior Problem Index (BPI), which includes 8 behavioral subdomains. We conducted bivariate analyses and multiple linear regression to determine the association of SDB with BPI scores., Results: The majority of children (mean age: 8.2 years) were male (56%), black (66%), and insured by Medicaid (73%). Overall, 33% of the children experienced SDB. In bivariate analyses, children with SDB had significantly higher (worse) behavior scores compared with children without SDB on total BPI (13.7 vs 8.8) and the subdomains externalizing (9.4 vs 6.3), internalizing (4.4 vs 2.5), anxious/depressed (2.4 vs 1.3), headstrong (3.2 vs 2.1), antisocial (2.3 vs 1.7), hyperactive (3.0 vs 1.8), peer conflict (0.74 vs 0.43), and immature (2.0 vs 1.5). In multiple regression models adjusting for several important covariates, SDB remained significantly associated with total BPI scores and externalizing, internalizing, anxious/depressed, headstrong, and hyperactive behaviors. Results were consistent across SDB subscales (snoring, sleepiness)., Conclusions: We found that poor sleep was independently associated with behavior problems in a large proportion of urban children with asthma. Systematic screening for SDB in this high-risk population might help to identify children who would benefit from additional intervention.

Individuals with Parkinson's disease (PD) often require nursing home care, where access to neurologists is limited. Telemedicine uses information and communication technologies to provide health care to individuals who are geographically separate from providers. We present a video report of a nursing home resident with PD who received telemedicine visits over 8 months from a movement disorders specialist. The visits resulted in improvements in motor and cognitive symptoms and suggest that telemedicine may be useful for delivering care to this population., ((c) 2009 Movement Disorder Society.)

Stomatal closure and biosynthesis of antioxidant molecules are two fundamental components of the physiological machinery that lead to stress adaptation during plant's exposure to salinity. Since high stomatal resistance may also contribute in counteracting O(3) damages, we hypothesized that soil salinization may increase O(3) tolerance of crops. An experiment was performed with alfalfa grown in filtered (AOT40=0 in both years) and non-filtered (AOT40=9.7 in 2005 and 6.9 ppm h in 2006) open-top chambers. Alfalfa yield was reduced by O(3) (-33%) only in plants irrigated with salt-free water, while the increasing levels of soil salinity until 1.06 dS m(-1) reduced both stomatal conductance and plant O(3) uptake, thus linearly reducing O(3) effects on yield. Therefore a reliable flux-based model for assessing the effects of O(3) on crop yield should take into account soil salinity.

The Mediterranean environment, and most of the Italian peninsula, presents some peculiarities in terms of crop response to O(3) since most physiological mechanisms activated upon O(3) exposure, such as stomatal closure, often overlap and interact with those that underlie plant adaptation to drought and hyperosmotic stress, which are typical of these environments. OTC and EDU experiments have demonstrated that O(3) causes strong yield losses when crops are grown without water limitations. However, exposure to water or saline stress significantly reduced O(3) effects on crop yield. In this review, we present the methodological approaches that have been used to study plant-ozone interactions in Italy as well as biochemical, physiological and agronomic responses for representative cropping systems of the Mediterranean climate.

Objective: To describe screen time use and factors related to screen time among urban children with persistent asthma., Methods: We analyzed data for 224 children (aged 3 to 10 years) with persistent asthma. Parents reported on children's asthma severity, screen time use, and family practices regarding screen time. We asked parents: "On weekdays [and weekends] on average, over a 24-hour period, how many hours of screen time does your child have?" Parents also reported activity limitation due to asthma, and activities their child engaged in during times of activity limitation., Results: Most children were male (58%), black (65%), and had Medicaid (74%); average screen time was 3.4 hours per day. Most parents (74%) reported that their child had >2 hours of screen time per day, and one-third were concerned that their child had too much screen time. Many children (63%) engaged in screen time activities during activity limitation due to asthma. Children who needed to slow down or stop normal activity due to asthma had more screen time compared with children who didn't need to slow down (3.51 hours vs 2.44 hours, P = .02). Additionally, children who engaged in screen time activities during times of physical limitation had more screen time compared with children who engaged in other activities (3.67 hours vs 2.99 hours, P = .01)., Conclusions: We found that urban children with asthma, particularly those with activity limitation, have excessive use of screen time. Strategies are needed to avoid activity limitation by improving asthma care and to empower families with alternative strategies to avoid excess screen time.

Objective: To explore the relationship between environmental tobacco smoke (ETS) exposure and behavior among inner-city children with significant asthma., Methods: We analyzed baseline data for 200 children 4 to 10 years old who were enrolled in an asthma program. Environmental tobacco smoke exposure was measured by the child's salivary cotinine level. Caregivers completed the 28-item Behavior Problem Index (BPI). Positive responses were summed for a total BPI score, and children with scores >14 were considered to have significant behavior problems. We conducted Student t tests and multivariate regression analyses to determine the association of children's cotinine levels with BPI scores., Results: Overall, 56% of children were male, 65% were black, and 72% had Medicaid. Mean cotinine level was 1.47 ng/mL. Overall, 30% of children had total BPI scores >14. Children with cotinine values >1.47 ng/mL had significantly higher scores compared with children with lower cotinine values on total BPI (12.5 vs 10.2), as well as externalizing (9.0 vs 7.2), antisocial (2.3 vs 1.7), and immature (2.1 vs 1.6) subscales. In a multivariate model, log cotinine remained independently associated with externalizing (P = .04), headstrong (P = .04), and antisocial behavior (P = .04)., Conclusions: Cotinine levels are independently associated with problem behaviors among this sample of urban children with asthma.

The use of the Internet for health information is growing, but there is little control over the timeliness of updates or the accuracy of the information. Recent changes in recommendations for the treatment of acute otitis media were made in an effort to decrease the unnecessary use of antibiotics. We conducted a systematic review of Web sites to determine if consumers are likely to find appropriate information. Only 31% of relevant Web sites found explain the new "watch and wait" recommendation, and 41% include a recommendation to finish the full course of prescribed antibiotics. Web sites that include an update date, are reviewed by a physician, provide references, and have a nonprofit-type domain are more likely to contain updated information. Physicians should be aware that their patients might visit the office with expectations based on outdated information found on the Web. Organizations making recommendations should consider how to disseminate new information through the Web.

This study assessed knowledge regarding the harm of environmental tobacco smoke (ETS) exposure and barriers to reducing ETS from the point-of-view of urban parents of asthmatic children. We conducted in-depth interviews with 15 mothers of children with asthma. All parents had good knowledge regarding the harmful effects of ETS. While all children of smoking parents were exposed to ETS, parents described using various strategies to keep ETS away from children. Many parents experienced significant stress in their lives and used smoking to relieve their stress. Barriers to a smoke-free home included stress, addiction, and the use of ineffective strategies to reduce ETS exposure.

Our objective was to develop a composite index to measure and quantify preventive asthma care delivered in the primary care office. We documented preventive actions used for children with asthma at the time of an office visit and weighted actions based on their intensity to create a composite index. The usefulness of the index was supported by significant correlations with several measures of symptom severity. The composite index also varied by visit type, with the highest scores noted for asthma-related visits, compared to well-child and other illness visits. This composite index has potential use for research and quality improvement efforts.

Objective: Environmental tobacco smoke (ETS) increases morbidity for children with asthma. One method to reduce children's ETS exposure is to completely ban smoking in the home and car. We sought to evaluate the degree to which urban children with persistent asthma are protected by household and car smoking bans, and to determine whether health care professionals are counseling parents to implement smoking bans., Methods: We asked parents of children with asthma to complete an in-person interview including questions about asthma symptoms, smokers in the home, smoking bans (home and car), and the receipt of ETS counseling by health care professionals., Results: We included 231 children with persistent asthma symptoms (response rate 94%). Nearly half of the children lived with a smoker. Overall, only 64% of households had complete restrictions on smoking in the home and car. Even among the children with severe persistent symptoms, less than two-thirds were protected by a complete smoking ban. Among households with smokers, only 51% had a ban on smoking in the home and 49% in the car. The majority of caregivers had been questioned by health care professionals about home smoke exposure; less were asked about exposure in the car (40%) or given suggestions to decrease the child's exposure (58%)., Conclusions: To our knowledge this is the first study to establish the prevalence of smoking bans among children with persistent asthma. Many children with asthma, even those with the most severe symptoms, remain exposed to ETS in the home and in cars. Identifying and reducing smoke exposure among these children should be a health care priority.

Most research on the rapid mental processes of on-line language processing has been limited to the study of idealized, fluent utterances. Yet speakers are often disfluent, for example, saying "thee, uh, candle" instead of "the candle." By monitoring listeners' eye movements to objects in a display, we demonstrated that the fluency of an article ("thee uh" vs. "the") affects how listeners interpret the following noun. With a fluent article, listeners were biased toward an object that had been mentioned previously, but with a disfluent article, they were biased toward an object that had not been mentioned. These biases were apparent as early as lexical information became available, showing that disfluency affects the basic processes of decoding linguistic input.

Speakers are often disfluent, for example, saying "theee uh candle" instead of "the candle." Production data show that disfluencies occur more often during references to things that are discourse-new, rather than given. An eyetracking experiment shows that this correlation between disfluency and discourse status affects speech comprehensions. Subjects viewed scenes containing four objects, including two cohort competitors (e.g., camel, candle), and followed spoken instructions to move the objects. The first instruction established one cohort as discourse-given; the other was discourse-new. The second instruction was either fluent or disfluent, and referred to either the given or new cohort. Fluent instructions led to more initial fixations on the given cohort object (replicating Dahan et al., 2002). By contrast, disfluent instructions resulted in more fixations on the new cohort. This shows that discourse-new information can be accessible under some circumstances. More generally, it suggests that disfluency affects core language comprehension processes.