This question is being answered by a transdisciplinary team of researchers from engineering, nursing, medicine, and biological sciences. While the past year has been unusual, even in “normal times” most human beings spend between 70% – 90% of their day inside built environments, thus making their homes, offices/workplaces, and schools the most common source of environmental exposures to allergens, dust, viruses, bacteria and molds. Because of their smaller physical size and less mature pulmonary systems, young children are particularly vulnerable to pollution in the air they breathe: This vulnerability is worse for children who have asthma. Drs. Kerry Kinney and Juan Pedro Maestre (Civil, Environmental & Architectural Engineering) have developed a novel means for measuring indoor air pollutants by using filters placed in central heat and air conditioning (AC) systems to collect samples from indoor air – a technique they call “Filter Forensics.” With funding from the Department of Housing & Urban Development (HUD), and collaborating with Dr. Sharon Horner (Nursing) long-time researcher of childhood asthma, they tested this ‘filter forensics’ approach in a rural central Texas community in the homes of families who have school-aged children: Half of the families had a child with asthma and half did not. The researchers found differences in the AC filter samples taken from homes of children who had asthma when compared to those who did not have asthma. In general, the microorganisms recovered from the AC filters in the homes of children without asthma were consistent with other studies that have started to identify protective biological exposures, whereas the AC filters in homes of children with asthma yielded more biological factors that are known to trigger or stimulate asthma symptoms.

Drs. Kinney, Maestre, Horner have expanded this work through a second HUD grant and are working with Drs. Matsui (Medicine), Rivera-Mariani (Biomedical Sciences), and Thomaz (Electrical & Computer Engineering) to expand this approach across Texas cities. Starting in Austin in the first year, they tested their remote data collection procedures that they will use in homes across Texas. Notably, this work occurred in the year before the COVID-19 pandemic. The goal of the current Healthy Homes-Texas study is to evaluate the relationships between environmental contaminants in AC filter dust, home characteristics (type of flooring, cleaning practices, home ventilation practices), and asthma severity and asthma control factors in school-aged children. Understanding the microorganisms and chemicals present in homes is an essential step toward understanding the effects these exposures have on the prevalence and severity of asthma and allergy in children. The Healthy Homes-Texas study is currently recruiting for its second phase and looking for 100 families with school-aged children who have asthma and a comparison group of children who do not have asthma.

If you know someone who would be interested in participating in this study, contact the team through their webpage by clicking the following button:
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Authors:

Kerry Kinney, Ph.D., holds the L.P. Gilvin Centennial Professorship in Civil Engineering in The University of Texas at Austin Department of Civil, Architectural and Environmental Engineering and is a courtesy professor in the Department of Population Health. Dr. Kinney’s cross-disciplinary research in environmental engineering and molecular biology centers on the investigation of microorganisms and contaminants in engineered systems including buildings, residential water systems and municipal wastewater systems.
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Juan Pedro Maestre, Ph.D., is a research associate and lecturer in Environmental Engineering and Microbiology at The University of Texas at Austin. Dr. Maestre specialized in microbiology of the Built Environment, COVID19, and Indoor Air Quality, using molecular biology tools and low-cost sensors for solving problems in natural and human-made systems.
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Sharon Horner, Ph.D., RN, FAAN, is a professor and researcher in School of Nursing at The University of Texas at Austin and holds the Dolores V. Sands Chair in Nursing Research and is a Fellow in the American Academy of Nursing. Dr. Horner’s research is focused on improving health of families with children.
For more information on Dr. Maestre press the following button:
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Welcome to the first edition of our newly formatted TCRSS newsletter. The shared goal of our center and our many community partnerships is to enhance widespread community immunity. We approach this goal by first listening to the community and identifying their health needs. We then work together to build on this knowledge to both enhance and provide quality care, while at the same time empowering individuals to better manage aspects of their health that are within their control.

When working with underserved communities, we must aim to better understand their specific needs and how they are both coping and suffering. With COVID-19 many people may experience serious physical and mental health consequences from social isolation and the disruption of daily routines. Although the COVID-19 pandemic will cease in time, this crisis highlights potential problems in our community health infrastructure and persistent inequalities in the US health care system.

Assisting community members to find solutions they can implement on their own and strategies to navigate our complex healthcare system can make a huge difference—a term we call “self-management.” For the past six years, our team at the Center for Transdisciplinary Collaborative Research on Self-Management Science (TCRSS) at the University of Texas at Austin School of Nursing has been working on multiple projects to find effective solutions for people with multiple chronic conditions who also struggle with complex social determinants of health. For example, our African American Mental Health and Wellness Project (AMEN) partners with churches to provide education and access to mental health resources andbservices. Our Community Health Worker Institute trains non-medical people in their community—people who share the same culture and language–to serve as advocates, educators, resource navigators, and bridges to health care in underprivileged populations.

In addition, we are working on incorporating technological innovations and big data science to propel self-management science forward. Focusing on the development of personalized solutions informed by data from individuals, systems, and populations will help us find solutions that fit individuals—whatever their respective resources.

Stay tuned for stories from the researchers, clinicians, clients, and community members that highlight our vision.

Miyong Kim, PhD, RN, FAAN
Director, Center for TCRSS

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For 50 years, the American Public Health Association has been the driving force in highlighting the vital role of the community health worker (CHW) in underserved communities. CHWs are trained, non-medical professionals who live in the communities they serve—they are experts in their respective languages, cultures, values, and perceptions of interacting with health care personnel. They also assist community members in navigating our complex health care system, making medical information understandable, and advocating for vulnerable populations who do not have a voice of their own. Both state and the federal government have recognized their invaluable contributions to public health. However, to maximize their abilities and impact, CHWs require high quality training informed by valid research.

In 2016 TCRSS and the Michael & Susan Dell Foundation joined forces to create TCRSS’s Community Health Worker Institute. The institute focuses on workforce research to explore the impact and needs of these health care heroes, which will inform trainings across the state that include the latest evidence-based practice and technology.

FOR UPDATES AND RESEARCH FINDINGS VISIT
https://nursing.utexas.edu/research/chw

We talked to Gayle M. Timmerman, a researcher at the University of Texas at Austin School of Nursing about her latest research and how she contributes to the mission of TCRSS.

Gayle M. Timmerman, PhD, CNS, FNAP, FAAN is a professor and associate dean at the University of Texas at Austin School of Nursing. She is also a lead researcher for TRCSS. We talked to her about her latest research and how she contributes to the mission of TCRSS.

Until recently, Gayle Timmerman didn’t really think of herself as a self-management scientist. She is best known in the academic community and popular press for her seminal research on mindful restaurant eating in perimenopausal women who wanted to lose weight. “This research is really about guiding people through a process of behavior change. In this case, we helped study subjects learn to slow down and think about what they were eating and why they were eating it. For example, are you finishing the French fries on your plate because they taste good and you want them, or just because they happen to be sitting there?” explains Dr. Timmerman. Then, she was approached by Miyong Kim, PhD, director of TCRSS, to pilot a study on dietary self-management in chronic kidney disease (CKD) patients. “I’d never studied kidney disease—I’d always thought of myself as a food and behavior change researcher. But it occurred to me that implementing an intervention that provides study participants with tools and information they can use to make better decisions about managing their disease is about behavior change—and ultimately, a part of self-management science.” Her article appeared in the Journal of Behavioral Medicine; click the image to access the article.

Chronic kidney disease affects 31,000,000 Americans. In its early stages, it is often without symptoms, so many people are diagnosed when the disease has already caused end organ damage. It often occurs with other chronic illnesses–obesity, hypertension, and Type 2 diabetes—all of which negatively impact kidney function. “Dietary adjustments are often aimed at better managing chronic diseases that contribute to CKD. Common changes are reducing sodium and adjusting protein intake. Some patients may need to watch their potassium intake—others may not, so recommendations are not going to be the same for all,” says Dr. Timmerman. Another goal of dietary change in renal disease is to reduce wear and tear on the kidneys by limiting amount of filtered waste. For example, altering protein intake to fit body size and kidney function reduces the amount of waste processed through the renal (kidney) system. Decreasing sodium intake also lessens renal workload. It may also lower hypertension, which strains the renal vascular system.

But changing habits—dietary or otherwise—is never a straightforward process. That’s where self-management and mindfulness come in. The purpose of self-management in chronic illness is not only to educate patients, but to provide them with a sense of control and empowerment that allows them to implement changes on their own. Mindfulness is the practice of bringing one’s attention to the present moment; for the purpose ofthis study, its aim was to assist clients in dietary decision making. The two concepts naturally support each other—mindfulness supports the patient in making beneficial self-management decisions.

Dr. Timmerman collaborated with local providers and colleagues from the University of Texas at Austin’s schools of pharmacy and nutrition to devise a six-session nutritional education intervention designed for 19 early stage CKD patients. Outcome measures included weight, body mass index (BMI), eGFR (a measure of kidney function), and serum carotenoid levels (a measure of fruit and vegetable intake). The intervention had several components: information and problem-solving strategies on how to improve dietary practices, behavioral change strategies to improve self-management activities, such as reading food labels, as well as mindful eating and mindful eating meditations.

Dr. Timmerman developed the education modules and conducted the sessions herself. “Participants really seemed to enjoy the sessions—only 10 percent left the study. And the outcome measures demonstrated some positive change, particularly in terms of weight and body mass index (BMI). Nearly half of participants lost an average of 8.4 pounds, and plasma carotenoid levels reflected a significant increase in fruit and vegetable consumption.” More research is needed to determine the generalizability of the intervention, but this study is paving the way for further exploration in helping people with CKD to help themselves.

To learn more about Dr.Timerman’s research visit:
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