The medical quality becomes a very important issue of a scholar and the public opinion. The high quality medical service of patients center and customer direction already has been necessarily prepare conditions to get the best competition advantage of all levels hospital in Taiwan, now.¡CTherefore, all hospital manager believe that promote medical quality is the very important issue¡CThe medical service quality of Emergency Department plays the very important role in the whole hospital. The medical service quality indicator is acknowledged well trusty medical quality measurement tool. Donabedian point out that medical quality measurement is compose of structure¡Bprocess and outcome, and that the outcome quality indicator measurement is the trend¡CAsthma is one of the most common diseases among children. Because of rising morbidity, mortality and medical costs all over the world, asthma becomes a very important issue. So, The purpose of this study is to identify the key factors associated with the of outcomes quality. The example of Pediatric Asthma in a Teaching Hospital. Data take from the Teaching Hospital¡¦s TQIP database through 2003. There are 534 Pediatric asthma patients who are research samples and care take by 25 physicians. The research analyze patient¡¦s and physician¡¦s characteristic to described data, Correlation and Regression with SPSS software. Look for the characteristic what influence the outcome quality of Emergency Department. The outcome quality include that patient¡¦s state after the treatment, patient¡¦s stay time and unscheduled revisit to Emergency Department.¡CRegression analysis showed that. 1.patient¡¦s state after the treatment trend to be inpatient who care by experienced physician, younger, illness serious and reach on day shift. 2.patient¡¦s stay time longer who care by experienced physician, so that the consultations effectiveness should promote to reduce .patient¡¦s stay time¡C3.patient¡¦s stay time longer who younger, so that the staff take care more careful and pay attention to patient¡¦s condition change frequently¡Ato reduce uneasy of long-term stay in Emergency Department. 4.unscheduled revisit ratio in the study is 4.7%¡Abut not discover the correlation factor¡C Integrate above-mentioned¡Athe study find that ¡Aphysician¡¦s and patient¡¦s characteristic will influence medical outcome quality. The project hospital should with different influence factor to draw quality manage policy and stratagem, and improve Emergency Department quality will raise the satisfied degree.

Background: Previous research suggests that children living on farms have a lower prevalence of asthma compared to their more urban counterparts. Four potential explanations may underlie this association: personal factors, health care access, health risk behaviours, and the environmental explanation. Objectives: The objective of this thesis was to first compare the prevalence of asthma between children living on farms and those living in small towns. The second objective was to identify and compare potential risk and protective factors for childhood asthma in rural and farm environments. Finally, we interpreted the findings in light of the above explanations in terms of which is most likely to explain previously observed differences in pediatric asthma prevalence. Methods: We used cross-sectional data (n=834) from a 2003 study conducted in Estevan, Saskatchewan as well as cross-sectional data (n=2,259) collected as part of the Saskatchewan Rural Health Study in 2011. We determined differences in asthma prevalence and examined the distribution of potential risk and protective factors between farm and small town children. Using multiple logistic regression, we identified a number of potential risk and protective factors for both pediatric asthma and wheeze among these populations. Results: No differences in prevalence of asthma or wheeze were identified by farm and small town status in both analyses. Risk factors that were identified included: male sex, parental history of asthma, personal history of allergy, home dampness, being overweight or obese, premature birth, living in a single parent home, difficulty accessing routine healthcare, previous daycare attendance, having a mother that previously smoked, having mice in the home, having an air filter in the home and feeding livestock. Protective factors included: previous daycare attendance, having pets in the home and having a dehumidifier present in the home. Farm-specific protective factors included: filling or emptying grain bins, cleaning or playing in pens, and living on a grain farm. Conclusions: No differences in asthma or wheeze prevalence were identified between small town and farm children in these study populations. Findings primarily supported the environmental explanation for geographic differences in asthma prevalence identified historically, with modest support for the health care access explanation. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-09-20 16:44:44.525

The purpose of the present study was to examine how low-income, racial and ethnic minority, urban families experience and manage their child’s asthma. The rationale for this study stems from existing literature on asthma disparities and documented predictors of increased asthma morbidity and mortality. In particular, this study considered how specific types of stress may disproportionately impact low-income, racial and ethnic minority, urban families that have a child with asthma. This study aimed to determine associations between urban stressors (stressful life events, perceived discrimination, subjective socioeconomic status) and child asthma outcomes (emergency department visits, school days missed, asthma control), and considered depressive symptoms and asthma self-efficacy as mediators in these associations. Analyses were conducted in a sample of 97 urban caregivers and their children in Richmond, Virginia. Findings revealed that neighborhood stress was significantly associated with asthma control. Stressful life events were significantly associated with school days missed. Perceived discrimination and subjective SES were not significantly related to any child asthma outcomes. Bootstrapping procedures demonstrated that child depressive symptoms mediated the relation between neighborhood stress and asthma control. Child asthma self-efficacy did not significantly mediate associations between neighborhood stress and any child outcomes. Caregiver depressive symptoms and caregiver asthma self-efficacy did not significantly mediate any associations between caregiver-reported urban stressors and child asthma outcomes. Results from the present study suggest that urban stressors, especially neighborhood stress and stressful life events, are important to consider in the context of child asthma management and subsequent health outcomes. Exposure to urban stressors may further contribute to pediatric asthma disparities because they are disproportionately experienced by low-income, racial and ethnic minority, urban families. Each urban stressor that was related to a child outcome was associated with a particular asthma outcome. Specifically, child-reported neighborhood stress was related to asthma control. Caregiver-reported stressful life events were associated with school days missed. These findings suggest that exposure to specific types of stress may impact asthma management differently. Future research should, therefore, explore the impact and contribution of specific stressors in greater depth. Further, child depressive symptoms significantly mediated the relation between neighborhood stress and asthma control, although caregiver depressive symptoms did not significantly mediate any associations between urban stressors and child asthma outcomes. Additionally, both child and caregiver depressive symptoms were significantly associated with multiple urban stressors and child asthma outcomes. Depressive symptoms may, therefore, be important to target in future research as possible explanatory variables or variables that contribute to stress appraisals and child asthma outcomes.

Family factors have long been associated with the psychosocial adjustment of children with chronic illnesses, such as asthma (Minuchin, 1975; Rapee, 1997). Research indicates that negative family factors may also contribute to child disease severity, via bio-behavioral mechanisms of effect (Wood et al., 2006); however, these pathways have yet to be examined with a comprehensive focus on more positive family factors. This study sought to examine whether factors such as family cohesion, problem solving abilities, and communication influence asthma symptom severity in children via their effects on child depression and anxiety symptoms. Using structural equation modeling, we identified significant indirect associations between family factors and child asthma severity via child depressive symptoms; however, these associations were not present in models mediated by child anxiety symptoms. Results highlight the importance of families in pediatric asthma settings. Findings suggest differential roles for anxiety and depression in their associations with child asthma severity.

In spite of the National Asthma Education and Prevention Program guidelines outlining how to diagnose, treat, and educate asthmatics, asthma morbidity and mortality rates are still mounting. Furthermore, the minority population has disproportionately higher rates of unfavorable outcomes from asthma, thereby diminishing their quality of life. The study's theoretical framework was based on the health belief model and explored associations of asthma control with self-efficacy and asthma education. Few studies focus on asthma inequity. The purpose of this quantitative study was to assess relationships between asthma control, race, asthma education, and healthcare utilization amongst asthmatic children residing in the Midwest. Secondary data from the Centers for Disease Control's Behavioral Risk Factor Surveillance System's Asthma Call-back Survey were used (n=477,221). Participant characteristics were examined using descriptive statistics. A sequence of bivariate and logistic regression analysis was used to test each hypothesis. The findings revealed significant associations amongst asthma control, race, asthma education, and healthcare utilization. In addition, children with uncontrolled asthma have greater visits to the emergency department and to their pediatrician's office due to their asthma symptoms. Moreover, the study results indicated that African American children experienced uncontrolled asthma at a higher rate when compared to other children, consequently decreasing their quality of life. The study showed the need for policy change to expand funding and programs aimed at decreasing uncontrolled asthma by improving asthma education, especially in African American communities, in hope of empowering asthmatics to play a vital role in their health and increasing their quality of life.

The Brofenbrenner(1979) ecological theory was applied to examine the relationship between parent and child depressive mood and the moderation of relational quality at two levels; 1) parent-child (within family) and 2) family-social support (outside family) levels. It was hypothesized that both levels would buffer the predictive association of parent to child depressive mood. At the first level, the parent-child depressive mood association was qualified by an interaction with relatedness (categorized as inadequate and adequate) that approached a conventional level of significance, R2 = .023, F(1,101) = 2.77, p = .099. At the second level, the addition of social support as a moderator yielded a R2 =.028, F(1,101) = 3.11, p = .081. Exploratory analyses were performed to clarify each moderation. The findings suggest that relational quality within and outside the family have the potential to serve as protective factors in regards to depressive symptoms for children with asthma.

The Brofenbrenner(1979) ecological theory was applied to examine the relationship between parent and child depressive mood and the moderation of relational quality at two levels; 1) parent-child (within family) and 2) family-social support (outside family) levels. It was hypothesized that both levels would buffer the predictive association of parent to child depressive mood. At the first level, the parent-child depressive mood association was qualified by an interaction with relatedness (categorized as inadequate and adequate) that approached a conventional level of significance, R2 = .023, F(1,101) = 2.77, p = .099. At the second level, the addition of social support as a moderator yielded a R2 =.028, F(1,101) = 3.11, p = .081. Exploratory analyses were performed to clarify each moderation. The findings suggest that relational quality within and outside the family have the potential to serve as protective factors in regards to depressive symptoms for children with asthma.

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BACKGROUND: Asthma is a chronic inflammatory disease of the airways that disproportionately affects low-income and minority children in the United States. Some studies have found a clear link between poor housing quality and exposure to allergen triggers associated with increased risk of asthma. Other studies have evaluated the relationship between stressful circumstances due to chronic illness, premature birth or violence on asthma outcomes. Psychological stress is thought to weaken the immune and neuroendocrine response making the body more vulnerable to environmental allergens. Studies have been done to assess the impact of psychological stress due to violence or the care of long term-critically ill children on increased asthma morbidity. However, asthma morbidity is not equal in all low-income and minority communities. It is possible that a form of stress - housing stress - which results from living in substandard housing conditions, may in fact provide more insight into the pathways linking indoor home exposures and stress in a way that leads to greater asthma susceptibility. Few studies have been done to assess the impact of stress due to substandard housing conditions. OBJECTIVE: To determine the impact of severe housing stress due to dilapidation, mold and a lack of housing control on child asthma control and on caregiver asthma-related quality of life. METHODS: A total of 143 children with asthma living in Boston, Massachusetts and between the ages of 4 and 18 were enrolled in the Boston Allergen Sampling Study between 2008 and 2011. Home visits were conducted to measure the levels of common allergens in the home and assess child asthma control, housing stress, perceived stress, and caregiver asthma-related quality of life. Housing stress was assessed based on resident perceptions of dilapidation, mold, and a lack of housing control; perceived stress for the caregiver was assessed using the Perceived-Stress Scale (PSS); child asthma control was assessed using Asthma Control Test (ACT) scores; and caregiver asthma-related quality of life was assessed using the Pediatric Asthma Caregiver Quality of Life (PACQOL) questionnaires. RESULTS: In a multivariate logistic regression severe housing stress was associated with 7.5 times increased odds of poor asthma control (OR = 7.51, 95%CI 2.7 to 20.79, p<0.0001) for the child and 3.0 times increased odds of poor caregiver asthma-related quality of life (OR = 3.02, 95%CI 1.37 to 6.63, p<0.006). This association was significant after adjusting for potential confounders. CONCLUSIONS: Independent of allergen exposure, the association between severe housing stress and asthma health outcomes for both the child and caregiver indicate that there is an emotional stress-based pathway directly tied to poor housing quality that poses increased risk for worse asthma health outcomes.