Dissemination of Evidence-Based School Asthma Management Programs: Piloting Asthma 411 in an Urban Texas School District.

BACKGROUND: The dissemination and implementation (D&I) of evidence-based initiative (EBIs) is critical to improved public health. The Asthma 411 EBI was piloted in Texas from 2013 to 2015. The pilot's evaluation assessed its effectiveness and identified approaches to support D&I of school-health EBIs. METHODS: The pilot study was conducted in two schools; service categories included: a consulting physician, enhanced school asthma services, and support for links to community health resources. Data was collected on Emergency Medical Service (EMS) calls, aggregated nursing services, demographic characteristics, availability of medication provided through existing policies, and informal interviews. RESULTS: During the pilot, school-day asthma-related Emergency Medical Service (EMS) calls were eliminated. Documented asthma self-management education, authorization for rescue medication, and efforts to communicate with parents and health providers increased. Between year-1 and year-2, the gap between unadjusted, weighted mean absences among students with and without asthma was reduced by 1.1 days. However, this difference was not seen in a fully adjusted negative, binomial regression model. CONCLUSIONS: Evaluation of the Asthma 411 pilot suggests many EBI benefits were retained and identifies factors that may facilitate D&I of school health EBIs. Future research will clarify impacts on absenteeism and determine if observed benefits are sustained.

Using machine learning to examine the relationship between asthma and absenteeism.

In this study, we found that machine learning was able to effectively estimate student learning outcomes geo-spatially across all the campuses in a large, urban, independent school district. The machine learning showed that key factors in estimating the student learning outcomes included the number of days students were absent from school. In turn, one of the most important factors in estimating the number of days a student was absent was whether or not the student had asthma. This highlights the importance of environmental public health for student learning outcomes.

Painful bone metastases: a prospective observational cohort study.

Incident pain related to bone metastases is a problematic symptom to treat. The difficulty in treating this type of pain is reflected in the wide variety of treatment modalities recommended. The aims of this prospective observational study were to determine the patterns of pain severity at rest and on movement over time and which treatment modalities are employed. In addition, we were interested in ascertaining any correlations between bone pain at rest, bone pain on movement and functional ability. Thirty-two patients were followed up for a mean of 22 weeks (range: 2-52). In total, there were 704 patient follow-up weeks. Patients were followed up for one year or until death. A total of 19 different treatment modalities were employed. There were strong correlations between pain at rest and pain on movement. There were no significant correlations between functional ability and pain at rest or movement. Our study demonstrates the complex management of patients with bone pain. This is the first study that highlights the correlation between pain at rest and pain on movement in patients with bone metastases in a palliative care population. It highlights the need for intensive follow-up of these patients, as they require multiple interventions to help control their pain. These data can also be used to power further interventional studies.