The potential role of wildlife in the spread and control of foot and mouth disease in an extensive livestock management system

Foot and mouth disease (FMD) is a highly contagious viral infection that affects all Artiodactyls (cloven-hoofed) species. The United States has been free of FMD since 1929, and the entire population of cloven-hoofed species is therefore susceptible to FMD virus infection. In the face of an outbreak, it is crucial that appropriate control measures be applied rapidly to control the disease. However, in most cases decisions on mitigation strategies must be made with little current or empirical data and in the context of political, economic and social pressures. Disease spread models can be used to evaluate the design of optimal control strategies, for policy formulation, for gap analysis and to develop and refine research agendas when disease is not present. This research project is designed to investigate the potential role of wildlife (deer) in the transmission and spread of FMD in an extensive livestock management system in southern Texas. The spread of FMD was simulated in white tailed deer populations using a Geographic Automata model. Past research has focused primarily on modeling the spread of FMD in livestock populations. There has been limited research into the potential role of wildlife in the spread and maintenance of FMD, specifically in the United States and using a spatial modeling approach. The study area is a nine-county area located in southern Texas, bordering Mexico. It is a region of concern for the introduction of foreign animal diseases, particularly through the movement of wild and feral animal species. It is both a strategic location and is generally representative of the many similar eco-climatic regions throughout the world. It is an ideal model landscape to simulate FMD incursions. In this research project, the potential spread of FMD is simulated based on various spatial estimates of white tailed deer distribution, various estimates of critical model parameters (such as the latent and infectious periods), seasonal population variability and in the face of potential pre-emptive mitigation strategies. Significant differences in the predicted spread were found for each group of simulations. The decision-support system developed in the studies described in this dissertation provide decision-makers and those designing and implementing disease response and control policy with information on the potential spread of a foreign animal disease incursion with a likely wildlife reservoir. Use of such a decision-support system would enhance the disease incursion preparedness and response capacity of the United States

Economics analysis of mitigation strategies for FMD introduction in highly concentrated animal feeding regions

Outbreaks of infectious animal diseases can lead to substantial losses as evidenced by 2003 US BSE (Bovine Spongiform Encephalopathy) event with consequent loss of export markets, and the 2001 UK FMD (Foot and Mouth Disease) outbreak that has cost estimates in the billions. In this paper we present a linked epidemiologic-economic modeling framework which is used to investigate several FMD mitigation strategies under the context of an FMD outbreak in a concentrated cattle feeding region in the US. In this study we extend the literature by investigating the economic effectiveness of some previously unaddressed strategies including early detection, enhanced vaccine availability, and enhanced surveillance under various combinations of slaughter, surveillance, and vaccination. We also consider different disease introduction points at a large feedlot, a backgrounder feedlot, a large grazing herd, and a backyard herd all in the Texas High Plains. In terms of disease mitigation strategies we evaluate the economic effectiveness of: 1. Speeding up initial detection by one week from day 14 to day 7 after initial infection; 2. Speeding up vaccine availability from one week post disease detection to the day of disease detection; 3.Doubling post event surveillance intensity. To examine the economic implications of these strategies we use a two component stochastic framework. The first component is the epidemiologic model that simulates the spread of FMD as affected by control policies and introduction scenarios. The second component is an economics module, which calculates an estimate of cattle industry losses plus the costs of implementing disease control. The results show that early detection of the disease is the most effective mechanism for minimizing the costs of outbreak. Under some circumstances enhanced surveillance also proved to be an effective strategy.Livestock Production/Industries,

Development, Implementation, and Evaluation of Teach Back Curriculum For Community Health Workers

Teach Back is a commonly used communication method to improve patient understanding and retention of health information. The method has been shown to be effective in improving patient and healthcare system outcomes, including patient health literacy and hospital readmissions. Community health workers (CHWs) are frontline healthcare workers who can help address patient health and social needs associated with hospital readmissions. However, a gap exists in Teach Back curricula and training methods reflecting the scope of work for CHWs. The objective of this training was to provide CHWs with didactic information and skill building practice curriculum focused on the integration of Teach Back into clinical patient interactions, care coordination, and follow-up support. A multidisciplinary team of academic and clinical partners at a large academic health university developed, implemented, and evaluated a 3-week pilot Teach Back training with CHWs through a quality improvement approach. The CHWs reported overall satisfaction with the training and instructors. The academic clinical partnership allowed the training to be tailored to the daily clinical workflow as reflected in the CHWs agreement that the training was relevant and practical. With the repeated exposure to Teach Back each week, the CHWs also reported an increase in confidence and conviction in using Teach Back. Additional implementation and evaluation of the training curriculum for CHWs is needed to gain further insights into Teach Back and training best practices and translation into practice

Development of Training Curriculum to Improve Patient Communication Skills and Social Support among Community Health Workers

BACKGROUND: Effective provider communication skills are important for patient decision-making and understanding, particularly for those with low health literacy. A gap exists in training methods and curriculum for community health workers (CHWs). Brief description of activity: Through a clinical and academic partnership, pilot training curriculum focused on patient communication skills was developed to align with CHW scope of work. IMPLEMENTATION: The curriculum was implemented in three 2-hour training sessions over WebEx with seven state-certified CHWs. The goal was for CHWs to understand the key elements and application of active listening, Teach Back, and action planning in a clinical setting. The sessions included didactic and skills practice modules for each skill. RESULTS: A survey was distributed to CHWs to evaluate knowledge, skills, and attitudes and reactions to training methods, instructors, and relevance using the Kirkpatrick\u27s evaluation model (Reaction and Learning). Although CHWs agreed that they had actively participated in the training and that the instructors were well-prepared, there was less agreement that the course was relevant. CHWs reported an increase in understanding of active listening and action planning, capability of using Teach Back and providing social support, and ability to teach, whereas a decrease was reported in the capability to use action planning. When probed about training relevance, CHWs felt action listening and Teach Back were relevant, but that action planning was not relevant to their responsibilities. This gap in responsibilities was also acknowledged by the clinical leadership. LESSONS LEARNED: The training allowed the CHWs to build on subsequent skills from previous sessions and to discuss struggles. A need for tools for integrating the skills in the clinical workflow were requested by CHWs and clinical leadership. These tools offer the opportunity to tailor future trainings on communication skills or patient scenarios. Future trainings should include CHWs to provide insight into scope of work.

Association of Social Needs and Healthcare Utilization among Medicare and Medicaid Beneficiaries in the accountable Health Communities Model

BACKGROUND: Integration of health-related social needs (HRSNs) data into clinical care is recognized as a driver for improving healthcare. However, few published studies on HRSNs and their impact are available. CMS sought to fill this gap through the Accountable Health Communities (AHC) Model, a national RCT of HRSN screening, referral, and navigation. Data from the AHC Model could significantly advance the field of HRSN screening and intervention in the USA. OBJECTIVE: to present data from the Greater Houston AHC (GH-AHC) Model site on HRSN frequency and the association between HRSNs, sociodemographic factors, and self-reported ED utilization using a cross-sectional design. Analyses included descriptive statistics and multinomial logistic regression. PARTICIPANTS (OR PATIENTS OR SUBJECTS): All community-dwelling Medicare, Medicaid, or dually covered beneficiaries at participating GH-AHC clinical delivery sites were eligible. MAIN MEASURES: Self-reported ED utilization in the previous 12 months served as the outcome; demographic characteristics including race, ethnicity, age, sex, income, education level, number of people living in the household, and insurance type were treated as covariates. HRSNs included food insecurity, housing instability, transportation, difficulty paying utility bills, and interpersonal safety. Clinical delivery site type was used as the clustering variable. KEY RESULTS: Food insecurity was the most common HRSN identified (38.7%) followed by housing instability (29.0%), transportation (28.0%), and difficulty paying utility bills (26.7%). Interpersonal safety was excluded due to low prevalence. More than half of the beneficiaries (56.9%) reported at least one of the four HRSNs. After controlling for covariates, having multiple co-occurring HRSNs was strongly associated with increased risk of two or more ED visits (OR 1.8-9.47 for two to four needs, respectively; p \u3c 0.001). Beneficiaries with four needs were at almost 10 times higher risk of frequent ED utilization (p \u3c 0.001). CONCLUSIONS: to our knowledge, this is only the second published study to report screening data from the AHC Model. Future research focused on the impact of multiple co-occurring needs on health outcomes is warranted

Stakeholder Engagement in adoption, Implementation, and Sustainment of an Evidence-Based intervention to increase Mammography adherence among Low-income Women

Multi-level organizational stakeholder engagement plays an important role across the research process in a clinical setting. Stakeholders provide organizational specific adaptions in evidence-based interventions to ensure effective adoption, implementation, and sustainability. Stakeholder engagement strategies involve building mutual trust, providing clear communication, and seeking feedback. Using constructs from the Consolidated Framework for Implementation Research and The International Association for Public Participation spectrum, a conceptual framework was created to guide stakeholder engagement in an evidence-based intervention to increase mammography appointment adherence in underserved and low-income women. A document review was used to explore the alignment of the conceptual framework with intervention activities and stakeholder engagement strategies. The results indicate an alignment with the conceptual framework constructs and a real-world application of stakeholder engagement in a mammography evidence-based intervention. The conceptual framework and stakeholder engagement strategies can be applied across a range of community-based cancer programs and interventions, organizations, and clinical settings

The impact of seasonal variability in wildlife populations on the predicted spread of foot and mouth disease

Modeling potential disease spread in wildlife populations is important for predicting, responding to and recovering from a foreign animal disease incursion such as foot and mouth disease (FMD). We conducted a series of simulation experiments to determine how seasonal estimates of the spatial distribution of white-tailed deer impact the predicted magnitude and distribution of potential FMD outbreaks. Outbreaks were simulated in a study area comprising two distinct ecoregions in South Texas, USA, using a susceptible-latent-infectious-resistant geographic automata model (Sirca). Seasonal deer distributions were estimated by spatial autoregressive lag models and the normalized difference vegetation index. Significant (P < 0.0001) differences in both the median predicted number of deer infected and number of herds infected were found both between seasons and between ecoregions. Larger outbreaks occurred in winter within the higher deer-density ecoregion, whereas larger outbreaks occurred in summer and fall within the lower deer-density ecoregion. Results of this simulation study suggest that the outcome of an FMD incursion in a population of wildlife would depend on the density of the population infected and when during the year the incursion occurs. It is likely that such effects would be seen for FMD incursions in other regions and countries, and for other diseases, in cases in which a potential wildlife reservoir exists. Study findings indicate that the design of a mitigation strategy needs to take into account population and seasonal characteristics

Geographically-weighted regression of knowledge and behaviour determinants to anti-malarial recommending and dispensing practice among medicine retailers in western Kenya: capacitating targeted interventions

Background Most patients with malaria seek treatment first in retail drug shops. Myriad studies have examined retailer behaviours and characteristics to understand the determinants to these behaviours. Geospatial methods are helpful in discovering if geographic location plays a role in the relationship between determinants and outcomes. This study aimed to discover if spatial autocorrelation exists in the relationship between determinants and retailer behaviours, and to provide specific geographic locations and target behaviours for tailoring future interventions. Methods Retailer behaviours and characteristics captured from a survey deployed to medicine retailers in the Webuye Demographic and Health Surveillance Site were analysed using geographic weighted regression to create prediction models for three separate outcomes: recommending the first-line anti-malarial therapy to adults, recommending the first-line anti-malarial therapy to children, and selling that therapy more than other anti-malarials. The estimated regression coefficients for each determinant, as well as the pseudo R2 values for each final model, were then mapped to assess spatial variability and local areas of best model fit. Results The relationships explored were found to be non-stationary, indicating that spatial heterogeneity exist in the data. The association between having a pharmacy-related health training and recommending the first-line anti-malarial treatment to adults was strongest around the peri-urban centre: comparing those with training in pharmacy to those without training (ORæ=æ5.75, pæ=æ0.021). The association between knowing the first-line anti-malarial and recommending it to children was strongest in the north of the study area compared to those who did not know the MOH-recommended anti-malarial (ORæ=æ2.34, pæ=æ0.070). This is also the area with the strongest association between attending a malaria workshop and selling the MOH-recommended anti-malarial more than other anti-malarials, compared to retailers who did not attend a workshop (ORæ=æ2.38, pæ=æ0.055). Conclusion Evidence suggests that spatial heterogeneity exists in these data, indicating that the relationship between determinants and behaviours varies across space. This is valuable information for intervention design, allowing efforts to focus on those factors that have the strongest relationship with their targeted behaviour within that geographic space, increasing programme efficiency and cost-effectiveness

Pediatric wound care: Establishing a consensus group to develop clinical practice guidelines

Introduction. Wound care practices for neonatal and pediatric patients have created a lack of standardized evidence-based guidelines for treatments in clinical practices. Unfortunately, published clinical guidelines for the evaluation and management of wounds in pediatric populations is limited. Consensus groups are used to develop clinical guidelines which define key aspects of the quality of health care, particularly appropriate indications for interventions. The aim of this initiative was to conduct the first two steps of the guideline development process, and to report on the findings from the expert consensus group for pediatric wound care. Methods. The goal was to recruit a multidisciplinary team that consisted of board certified Pediatric Plastic and Pediatric General Surgeons, WOCN, and research specialists active in the International Society of Pediatric Wound Care (ISPEW). All recruited individuals were emailed and invited to participate. For this study, an adapted questionnaire was created to assess eligibility criteria, information sources, systematic review database search strategies, study selection criteria including keywords. Data was collected on the clinical consensus group’s experience with clinical guideline development, and other clinically significant domains for which the the evidence should be evaluated. Results. All six invited individuals agreed to participate. 100% of respondents provided the number of years in their current role within their respective institutions and their length of experience with pediatric wound care management. 17% of respondents had 7 to 10 years in their current role, while 66% had more than 10 years practice in pediatric wound care. Domains identified as important to consider included: Cost of Product/Treatment Duration of Treatment, Ease of Applying Product/Performing Treatment, Accessibility of Product, Storage of Product, Length of Time to Apply Product/Perform Treatment. Discussion. The agreed-upon domains from our study align with previously published consensus group studies. We identified several domains to inform a future systematic review. At this time, no systematic review has been published that has been guided by consensus group domains and search terms for pediatric wound care. Conclusion. Through the use of this consensus group and conducted surveys, we identified the primary domains necessary to complete a practice-informed systematic review, as well as other key domains that are important in clinical pediatric wound care management

Cultural Context Index: A Geospatial Measure of Social Determinants of Health in the United States

Minority populations will continue to grow in the United States. Such pluralism necessitates iterative, geospatial measurements of cultural contexts. Our objective in this study was to create a measure of social determinants of health in geographic areas with varying ethnic, linguistic, and religious diversity in the United States. We extracted geographic information systems data based on community characteristics that have known associations with population health disparities from 2015 to 2019. We used principal component analysis to construct a Cultural Context Index (CCI). We created the CCI for 73,682 census tracts across 50 states and five inhabited territories. We identified hot and cold spots that are the highest and lowest CCI quintile, respectively. Hot spots census tracts were mostly located in metropolitan areas (84.8%), in the Southern census region (41.5%), and also had larger Black and Hispanic populations. The census tracts with the greatest need for culturally competent health care also had the sickest populations. Census tracts with a CCI rank of 5 (\u27greatest need\u27) had higher prevalences of self-reported poor physical health (17.2%) and poor mental health (17.4%), compared to either the general population (13.9% and 14.5%) or to CCI rank of 1 (\u27lowest need\u27) (11.9% and 10.8%). The CCI can pinpoint census tracts with a need for culturally competent health care and inform supply-side policy planning as healthcare and social service providers will inevitably come in contact with consumers from different backgrounds