Browsing by Author "Allsopp, Leslie C."
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Item Application of Geographic Information Systems to support Collaboration in Rural Osteopathic Medical Education and Community Health Initiatives(2022) Tadesse, Meron; Allsopp, Leslie C.; Smith, Annette; Bratton, Bobbie; Wagner, TeresaPurpose: Geographic Information Systems (GIS) support collaboration in public health program planning, implementation, and evaluation, but there is an absence of models for the application of GIS to enhance collaboration between rural health and medical education initiatives. Rural communities experience entrenched health disparities as a result of poor access to healthcare and other barriers inherent to remote circumstances. Although varying across rural populations, urgent issues include shortages and poor retention in the primary care workforce; lack of resources for population-specific needs; and threats to financial sustainability for rural practices. Challenges are posed by the need to span diverse geographic regions, administrative systems, and professional backgrounds. Collaboration between medical education and community health initiatives offers an opportunity to maximize the impacts of scarce rural health resources. The Texas College of Osteopathic Medicine, (TCOM) Department of Family Medicine began implementing an articulated Rural Family Medicine Track program in 1996. This community-based curriculum prepares students for life and practice in rural and underserved communities; it includes real-world experience of living and working in rural Texas with faculty from all specialties, and providing free, mobile clinic services. SaferCare Texas is a department at the University of North Texas Health Science Center whose mission is to eliminate preventable harm through innovation. SaferCare Texas' community health initiatives including health literacy programs and community health worker (CHW) training to expand the rural workforce, improve access to preventative care services, engage citizens in care decisions, and promote healthy living; these, in turn, may lead to the reduction of chronic illnesses, improved management and control of chronic conditions, and the early detection of treatable diseases. The purpose of this study is to explore the potential of Geographic Information Systems to enhance collaboration between existing Rural Family Medicine initiatives and the development and implementation of programs to increase CHW capacity in the Big Bend region of Texas, with a long-term goal of innovation and research to address rural health disparities. Methods: An interdisciplinary team has identified public datasets to advance collaboration. ESRI ArcGIS software is used as a mapping platform. Initial datasets include 1) Texas county boundaries obtained from Texas Department of Transportation (TxDOT) with the designation of hospital districts; 2) Texas census tract Social Vulnerability Index (SVI) which is comprised of 15 Social Determinants of Health and is developed by the Centers for Disease Control 3) location of Critical Access Hospitals and other clinical services, 4) Rural Family Practice preceptor and mobile, free clinic sites. Results: A preliminary map has been developed for use by project team members. Potential CHW sites and synergies to address unmet community health needs are being investigated. Identification of additional spatial data to support service coordination and collaboration is ongoing. Conclusions: Preliminary results indicate that data integration and visualization through GIS, may allow Rural Scholars and SaferCare Texas to more effectively engage rural health partners, develop a shared understanding of rural health issues, identify synergies to maximize the benefit of available resources, and provide a foundation for evaluation and research.Item Assessing the acceptability and perceived effectiveness of disposable holding chambers among school health staff responding to students in respiratory distress(2022) Winn, Andi; Fulda, Kimberly; Chamblee, Tracy; Allsopp, Leslie C.Purpose: Quick-relief medication (albuterol) for respiratory distress is a critical component of asthma care. For two decades, standing delegation orders (SDOs) for unassigned-albuterol at school have been recommended to ensure students have access to this potentially life-saving medication, but widespread implementation has been limited. Asthma 411 is an evidence-based model for school-based asthma programs that includes unassigned-albuterol within a framework of education and community resources. The Asthma 411 in Consortium in Tarrant County currently supports the implementation of this model with 11 partner school districts. Between 2002-2020, Asthma 411 used nebulizers as the delivery mechanism for albuterol. Due to concern about COVID-19 spread, an alternative delivery system was required beginning in 2020. The efficacy of Metered Dose Inhalers (MDIs) in combination with conventional holding chambers (spacers) is well-supported in the literature, but they are prohibitively expensive for this application. MDIs in combination with disposable spacers were identified as an affordable alternative. Disposable spacers are approved for use in schools based on effective medication delivery under laboratory conditions. No evidence is available about user experience when used for respiratory emergencies at school. Importantly, disposable spacers vary substantively from conventional spacers in design and materials. This study provides preliminary evidence of user experience with disposable spacers and their effectiveness in school-health settings. Methods: Semi-structured questions addressing user experience were embedded within a larger, annual survey regarding satisfaction with Asthma 411; specifically ease of use for school health staff, ease of use for students, and perceived effectiveness. A four-point Likert scale was employed to avoid neutral responses. Where health staff indicated somewhat or very negative experiences, an open-ended prompt requested additional information. Survey questions were reviewed by an interprofessional team with expertise in survey and evaluation research, Quality-Improvement, and the Asthma 411 program. Anonymous surveys were distributed to seven school districts (an estimated 176 school health staff) that had implemented disposable spacers for at least four months. This survey was conducted under North Texas Regional IRB protocol #2017-056. Results: Complete responses regarding MDI/spacer use were received from 146 staff (82.9%). Among these, 62.3% reported use of the disposable spacer for at least one instance of respiratory distress. Among users, 98% reported the MDI/disposable spacer was easy or somewhat easy for them to administer, 94% reported it was easy or somewhat easy for students and effective in relieving symptoms. Challenges were reported among students unfamiliar with spacers and more severe symptoms, and 71% indicated nebulizers should continue to be available for severe distress or children challenged to use the disposable spacer effectively. Conclusions:A strong majority of staff reported the disposable spacers were easy to use and effective for themselves and students. However, a majority also expressed a preference for having a nebulizer available for emergencies. This analysis is ongoing. Despite limitations, the study provides preliminary insights and a foundation for further research to support the effective implementation of national guidelines for school asthma programs.Item Asthma411: Integrating Evidence Based Medicine and Rapid Review Methodology into a School Health Collaboration(2022) Rogers, Joshua; Nguyen, Jaimee; Chamblee, Tracy; Allsopp, Leslie C.Purpose: Asthma411 is a school program that provides resources and asthma education to families and school nurses in Tarrant County. Asthma411 includes the provision of stock albuterol in schools to aid students experiencing acute asthma exacerbations. For decades, accepted practice for the management of mild-intermittent asthma was largely based on short-acting beta-2 agonists (SABA), primarily albuterol. This changed in 2019 when recommendations from the Global Initiative for Asthma (GINA) no longer supported the use of SABA-only treatment. In 2020, the National Institute of Health Expert Panel Report 4 (EPR-4) also scaled back recommendations for SABA monotherapy. Additionally, there was concern that COVID-19 might be spread by the nebulizers previously used for the administration of albuterol at school. Instead, metered-dose inhalers (MDIs) with spacers were recommended, which also required the use of a common canister (shared MDI) and disposable spacer. The objective for this project was to review the best available evidence to answer three questions: (Q1) Is the provision of short-acting beta-2 agonists (SABA), through standing delegation orders, a best practice given the most recent guidelines from the EPR-4 and GINA (Q2) Does the evidence suggest there may be instances that a nebulizer should be available in addition to an MDI and spacer, to assure effective administration of medication? (Q3) Does sanitizing common canisters with alcohol pads in between users provide acceptable protection against the transmission of infectious agents in school settings? Methods: We conducted a rapid, systematic review using 3 major databases: PubMed, SCOPUS, and CINAHL. Search terms, inclusion, and exclusion criteria were developed and applied for each question. We also conducted an expanded search of national recommendations, from the National Heart, Lung, and Blood Institute, American Academy of Allergy, Asthma, and Immunology, and the American Lung Association. Results: Our initial search yielded 381 articles. After removing duplicates and screening the articles, 31 unique and relevant articles remained. 15 of these articles were applicable to Q1. 21 articles were applicable to Q2, and 6 articles were applicable to Q3. Conclusion: For Q1) regarding the use of stock albuterol and the recent guideline changes, evidence supports the continued use of SABA in the school setting for isolated acute exacerbations as a best practice. For Q2) regarding MDI with a spacer vs. nebulizers, evidence supports the use of MDIs with a spacer as best practice. However, the spacers used in published studies differ substantially from those available for administration of SABA at school. The latter devices are disposable, collapsible chambers constructed of cardboard. A 2021 survey of Asthma411 school nurses indicated that some students had difficulty using disposable devices. Therefore, nebulizers may be considered in emergencies where disposable spacers cannot be effectively used by a student. For Q3) evidence supports the use of 70% isopropyl alcohol to sanitize a common canister used in a school setting. This application of evidence-based medicine and rapid-review methodology has informed Asthma 411 policies and exemplifies approaches to strengthen best practices in school health.Item Consecutive Missed School Days in Relationship with Asthma Status and Environmental Air Quality: Findings from a School based Asthma Initiative(2015-03) Jegede, Opeyemi; Allsopp, Leslie C.; Mudasiru, Omobola; Sterling, DavidObjectives: Compare the rate of sets of consecutive missed school days between children with and without asthma. Determine the relationship between exposure to poor environmental air quality measures and missed school days. Methodology: Data containing the number of school days missed, actual absence dates (N = 14936), and demographics were collected from students (N = 1628) in an elementary and middle school in Fort Worth, Texas. Counts of sets of consecutive missed school days were modeled using negative binomial regression. Partial correlation analysis is being used to identify the relationship between exposure to poor ambient air quality and missed school days. All analyses are conducted using SAS 9.3. Results: For both types of sets of missed days analyzed, children with asthma have adjusted rate ratios of 1.26 (p-value = .050) and 1.24 (p-value = .098) for sets of consecutive missed school days. We hypothesize a positive correlation between absences and poor ambient air quality, with a lag period of 2 days, although we will also evaluate lags of 0, 1, and 3 days. Conclusion: Policies are needed to reduce the impact of asthma on children’s school experience, such as measures to strengthen school asthma services and reduce exposures to environmental triggers.Item Dissemination and Implementation of School-Based Asthma Initiatives: The Asthma 411 Pilot(2019-03-05) Aryal, Subhash; Sterling, David; Spence-Almaguer, Emily; Allsopp, Leslie C.Purpose: The dissemination and implementation (D&I) of evidence based practices (EBIs) has been identified as one of the most critical barriers to improvement of the public’s health. The Asthma 411 EBI was developed, implemented and evaluated in St. Louis, MO from 2002-2008; Asthma 411 was disseminated, adapted, and piloted in Fort Worth, TX from 2013-2015. The evaluation of the pilot was designed to examine processes and outcomes of the program’s dissemination, inform ongoing expansion, and identify approaches that may support dissemination of other school health EBIs. Methods: In 2013, an engaged process was used to retain core components of Asthma 411 while adapting peripheral program elements. The pilot was implemented in one elementary (n=567) and 1 middle school (n=791). Three service categories were included: 1) access to rescue medication through standing orders; 2) support for enhanced school asthma services; and 3) support for communication with parents and health care providers to support comprehensive, prevention oriented care. Data collected included 1) school day EMS calls one year prior and both years of the program, 2) logs of aggregated nursing services, 3) individual level school absence and demographic data, 4) availability of medication provided through existing policies, and 5) informal interviews. Results: The pilot was positively received by schools and parents. During the pre-implementation year, there were 19 asthma-related EMS calls from the pilot schools. During the two years of the pilot, school day, asthma-related EMS calls were eliminated. Across the two year study, there was an increase in documented asthma self-management education, use of Asthma Control Tests, proportion of students with asthma that have authorization for rescue medication, and documented efforts to communicate with parents and health providers. Evaluation of absences was limited by the lack of pre-implementation data, small numbers, large variance, and short duration. Between year 1 and year 2, the gap between unadjusted, weighted absences among students with and without asthma was reduced 1.1 day. However, this difference was not seen in a fully adjusted negative, binomial regression analysis which provided a modeled mean difference of 1.28 absence days between children with and without asthma (95%CI 1.10, 1.50, p = .002) during year one, and 1.24 days (95% CI 1.07, 1.47, p = .006) in year two. Conclusions: The Asthma 411 case study identifies important characteristics of interventions, interventionists, contextual factors, and processes that may support effective dissemination of school based health initiatives. More research is needed to clarify impacts on absenteeism, and to determine if observed benefits are sustained.Item Health Champions for Health Equity, a Rapid Review(2023) Valdez, Alia; Vu, Patrick; Mahasamudram, Prathyusha; Phu, Daniel; Allsopp, Leslie C.Purpose This study aimed to synthesize existing knowledge from peer-reviewed literature on the usage of "health champions” in K-12 settings to improve health outcomes. Traditionally, community health initiatives aimed at K-12 students have been led by outside adults or appointed school leaders. While successful, one of the limitations frequently encountered was a disconnect between the leader and the target audience. To determine whether this issue could be addressed using peer-led interventions, a rapid literature review was conducted. Methods A Cochran Rapid Review was conducted due to time and resource constraints. A consultation with a research librarian generated a search strategy suitable for the scope of this project. Using databases ERIC, PubMed, and SCOPUS, an initial list of 602 articles was systematically reduced to 18 publications. The inclusion criteria included studies done in the United States in the past 10 years (2012-2022) to maintain relevance. After applying these criteria, an initial screening of the title/abstract and full-text analysis was performed to develop the final reference list. A data extraction tool was then used to yield the following results. Results The majority of health champions were students from their respective schools. Nutrition based interventions were the most common at the elementary school level. High school students had the widest array of interventions such as mental health improvement and tobacco usage reduction. Overall, peer health champions lead to better health intervention objective learning, more participation in the programs, and more student satisfaction. Conclusion Findings suggest that peer led interventions targeted at K-12 students are effective in improving participation in program activities. Students had more exposure to the learning material when the program utilized peer mentorship components which resulted in better objectives achievement. Additionally, having university or professional school students as mentors increased community involvement. Creating a working relationship between both K-12 educators and students from universities and higher education facilities is vital in building support for schools with limited resources.Item Investigating Geographic Information System integration of health service, community resource, and medical education data for collaboration to improve rural pediatric asthma outcomes(2023) De Arrigunaga, Juan; Allsopp, Leslie C.; Tadesse, MeronPurpose: Rural children are at a disadvantage when it comes to health, health care accessibility, education, environmental exposures, and socioeconomic status (SES). These factors contribute to rural-urban disparities in pediatric chronic health conditions such as obesity and asthma. With respect to asthma, emergency department (ED) visits are adverse outcomes that indicate poor control and inadequate preventive care. Community asthma programs are effective at enhancing services to improve asthma outcomes, but evidence suggests there is a lack of such programs in rural areas. Geographic Information Systems (GIS) are recognized as potentially powerful tools to guide the development of community health interventions, but there has been limited application of this method to address pediatric asthma disparities, especially in rural areas. The purpose of this study is to investigate the application of GIS to integrate pediatric asthma ED visit rates, community health resources, and Rural Osteopathic Medicine Clinical Training Sites (ROME) to identify potential sites for collaborative initiatives to improve rural pediatric asthma outcomes. Methods: This study utilized ESRI ArcGIS software for mapping and preliminary spatial analysis. Through the Texas Department of State Health Services and internal resources, we obtained 2020, age-adjusted child and adolescent asthma emergency department visit rates (per 10,000), Rural Osteopathic Medical Education (ROME) Clinical Training and Preceptor Sites, current Community Health Worker (CHW) Training Sites, and location of Texas Critical Access Hospitals (CAHs). Using GIS spatial analysis tools, statistically significant areas with high pediatric asthma ED rates were identified. ROME and CHW within these areas were then located for potential collaboration. Results: Through mapping visualization, the counties of Johnson, Coryell, Bell, McLennan, Lubbock, and Hale were identified as potential sites for collaboration to improve pediatric asthma. Conclusion: Application of GIS can be utilized to identify spatial health inequalities and form coalitions for improvement. This study has identified potential ROME Clinical Training Sites and Community Health Worker Training Sites that are in areas with elevated rates of inadequate pediatric asthma management and adverse outcomes. Visualization of elevated pediatric asthma ED rates (suggesting a prevalence of uncontrolled pediatric asthma) helps to prioritize collaboration to improve rural pediatric asthma outcomes.Item Review of an Advanced Case of Psoriatic Arthritis and Barriers to Management of Chronic Disease in the West Texas Region(2023) Martin, Delaney; Joseph, Matthew; Iloani, Nwamaka Amy; Tadesse, Meron; Hadley, Lesca; Allsopp, Leslie C.Background: Psoriatic arthritis is a debilitating, inflammatory musculoskeletal spondyloarthritis associated with the skin condition psoriasis that affects the hands, feet, spine, and other parts of the body. Nearly 80% of patients develop the associated arthritis after skin lesions of psoriasis develop. Management of psoriatic arthritis can be difficult, with severe variants recommended to receive specialized care from a rheumatologist for optimal treatment. The clinical case that will be discussed refers to a patient presenting with psoriatic exacerbation, which progressed from skin lesions to psoriatic arthritis with unmanaged pain. Despite the severity of this progression, he received minimal education on psoriatic arthritis management. Case Presentation: A 34-year-old male presented to clinic with a primary complaint of pain for uncontrolled psoriatic arthritis that had been diagnosed one year prior, two years after an original diagnosis of psoriasis. He reports the diagnosis of psoriatic arthritis was made after diffuse rashes spread over his body and extensor surfaces with increasing joint pain. At the clinic, the patient complained of weakness in his extremities; severe pain at elbow, ankle, knee, and toe joints bilaterally; a diffuse erythematous rash particularly at the ankles; and difficulty with daily activity due to pain. Notable physical exam findings included a personal history of psoriasis, joint pain, nodules growing past the distal interphalangeal joint of his hands and feet along with dactylitis and nail dystrophy consistent with psoriatic arthritis. Based on Classification for Psoriatic Arthritis criteria (CASPAR), he would be due to a score above 5 classified as having psoriatic arthritis. He has a known history of epilepsy, spinal stenosis, generalized anxiety disorder, chronic PTSD, and type 1 bipolar disorder. Patient reported recurrent methamphetamine use along with frequent use of marijuana for pain control. His social history was significant for lack of employment and symptoms worsening while uninsured. He stated an inability to attend scheduled appointments due to lack of transportation, the distance from Terlingua to the clinic in Alpine, TX, and inability to obtain telemedicine visits with his current provider. Conclusion: This case study on management of advanced psoriatic arthritis examines the health disparities faced by patients in rural west Texas regions, including lack of patient education, access to qualified rheumatologists, and adequate resources to manage disease exacerbation. A literature search on PubMed was conducted to clarify the current standard of care for treatment of advanced psoriatic arthritis, as well as current restrictions in management within the West Texas area. For social determinant factors, the social vulnerability index for west Texas regions was reviewed using public Center for Disease Control and Prevention data to note qualified health centers for this level of need and found appropriate services are lacking within the town of Terlingua and its neighboring areas. In addition to the healthcare team, an appropriate and safe environment for those suffering with psoriatic arthritis also includes stable infrastructure, social support, and public transportation. Without public health measures and capable providers, there are increased barriers to care of chronic disease for those living in rural areas like Terlingua.Item THE USE OF FOCUS GROUP RESEARCH TO EXPLORE COMMUNITY ATTITUDES TOWARD AIR QUALITY(2014-03) Allsopp, Leslie C.; Sterling, David A.; Franklin, Gillian; Adamie, DeniseThe purpose of this study is to explore community perspectives on air quality, through focus group research. North Central Texas is in nonattainment with National Ambient Air Quality Ozone Standards. One health impact of this is seen in Tarrant County’s asthma prevalence which is twice the national average. Community involvement is needed to address air pollution, but there is limited information about residents’ perspectives on these issues. The UNTHSC School of Public Health collaborated with the Fort Worth League of Neighborhood Associations to hold air quality focus groups. Three geographic clusters of neighborhood associations were identified which included a range of emission sources and diverse population demographics. One focus group was formed within each area. Questions were asked regarding air quality concerns, preferred methods for receiving and responding to information, and potential uses of information to improve air quality. Transcripts of the focus groups were reviewed by an advisory group from the Fort Worth League of Neighborhood Associations. Themes and keywords were identified and structured according to a social-environmental model. Mixed method content analysis is being conducted through NVivo. The initial analysis of the transcripts reveal a high concern regarding air pollution and toxic emissions, and an unmet need for air quality information from trusted sources. However, participants were uncertain of how they might use this information to improve air quality and reduce their exposure to pollutants. Focused information from trusted sources is needed by communities to support neighborhood level approaches to air pollution, and reduce exposure to airborne pollutants. Purpose (a): The purpose of this study is to explore community perspectives on air quality, through focus group research. Methods (b): North Central Texas is in nonattainment with National Ambient Air Quality Ozone Standards. One health impact of this is seen in Tarrant County’s asthma prevalence which is twice the national average. Community involvement is needed to address air pollution, but there is limited information about residents’ perspectives on these issues. The UNTHSC School of Public Health collaborated with the Fort Worth League of Neighborhood Associations to hold air quality focus groups. Three geographic clusters of neighborhood associations were identified which included a range of emission sources and diverse population demographics. One focus group was formed within each area. Questions were asked regarding air quality concerns, preferred methods for receiving and responding to information, and potential uses of information to improve air quality. Transcripts of the focus groups were reviewed by an advisory group from the Fort Worth League of Neighborhood Associations. Themes and keywords were identified and structured according to a social-environmental model. Mixed method content analysis is being conducted through NVivo. Results (c): The initial analysis of the transcripts reveal a high concern regarding air pollution and toxic emissions, and an unmet need for air quality information from trusted sources. However, participants were uncertain of how they might use this information to improve air quality and reduce their exposure to pollutants. Conclusions (d): Focused information from trusted sources is needed by communities to support neighborhood level approaches to air pollution, and reduce exposure to airborne pollutants.Item Utility of Geospatial Visualization and Social Vulnerability Index to Inform the Dissemination of School-Based Asthma Initiative(2021) Ly, Connie; Felicitas, Arianne; Allsopp, Leslie C.; Zielke, CameronPurpose: The contributors to pediatric asthma disparities are multifactorial; low-income and minority students face higher risks of school absences, hospitalization, and mortality. The CDC has recognized the Asthma 411 Model as an evidence-based program to improve asthma outcomes. In 2017, a Consortium was formed to enable Tarrant County school districts (ISDs) to adopt and implement Asthma 411. This study's objective is to determine whether ISD adoption of Asthma 411 reaches students at great risk for adverse outcomes. Methods: The independent variable is a three-level, categorical indicator of Asthma 411 adoption by ISDs: primary adopters (initiated 2017), secondary adopters (initiated 2018-2020), non-adopters. ArcGIS, a Geographic Information System (GIS) platform, was used to map the independent variable. A data layer was added with CDC's 2018 Social Vulnerability Index (SVI). The SVI includes American Community Survey census tract data organized around four distinct themes associated with disparities: Socioeconomic status, Household Composition & Disability, Minority Status and Language, and Housing Type & Transportation. Results: Visually, primary adopters appear to include communities with higher risk as defined by SVIs. Non-adopters appear to include less socially vulnerable communities but do include pockets of students at risk. Conclusion: The Asthma 411 Consortium appears to reach the majority of communities at risk but targeted expansion may be beneficial. GIS may assist public health planning by visualizing access to services. Application of spatial statistics and further investigation of the SVI as a measure of risk will strengthen the analysis and better inform dissemination.