Outcomes of the Montana Asthma Home Visiting Program: A home-based asthma education program.

OBJECTIVE: Asthma is a common disease in children. Home-based, multi-trigger, multi-component interventions with an environmental focus have been shown to be effective to address asthma in children. The objective of this study was to assess the outcomes and feasibility of implementing a specific asthma home visiting (HV) program in a rural area. METHODS: Children aged 0-17 years with uncontrolled asthma were enrolled in an asthma HV program that included six contacts over a 12-month period delivered by a registered nurse specifically trained in asthma education and trigger removal in eleven counties in the rural state of Montana. Between June 2010 and December 2016, data on asthma symptoms and asthma self-management skills were collected at baseline and throughout the program. In June 2017, they were analyzed to assess changes in asthma control and quality of life over time among participants completing all six contacts. RESULTS: Since June 2010, 152 of 338 enrolled children completed all six contacts outlined in the program (45%). Participants who completed the program reported significant improvements in asthma control test scores, self-management skills, and self-efficacy related to asthma management. These results improved the longer participants remained in the program. CONCLUSIONS: These findings suggest that it is feasible to implement a 12-month HV program using local public health resources in a rural area as outcomes improved over this time period.

Water turnover and changes in body composition during arduous wildfire suppression.

INTRODUCTION: Our lab has recently documented the total energy expenditure during arduous wildfire suppression using the doubly labeled water methodology. The elevated rates of isotopic elimination indicate an arduous working environment that may often compromise energy balance and overall hydration. PURPOSE: The purpose of this investigation was to determine the effects of arduous wildfire suppression on water turnover and changes in body composition in wildland firefighters (WLFF). METHODS: WLFF (N = 14) were studied during a 5-d period of arduous fire suppression work. A comparison group (N = 13) of recreationally active college students (RACS) was also studied. Water turnover was measured from rates of 2H elimination (rH2O). Urine osmolality, specific gravity, and skinfold measures were also collected. RESULTS: WLFF demonstrated a decrease in nude body weight (pre = 71.9 +/- 10.4 kg, post = 70.9 +/- 10.2 kg, P = 0.0001) and total body water (pre = 42.9 +/- 7.2 kg, post = 42.0 +/- 6.7 kg, P = 0.0046). RACS maintained total body water and body weight during the experimental period. Isotope (2H2O) dilution demonstrated that rH2O was significantly higher for the WLFF (rH2O = 6.7 +/- 1.4 and 3.8 +/- 1.0 L.24 h-1 for the WLFF and RACS, respectively). CONCLUSION: These results demonstrate an arduous work environment that threatens hydration, energy balance, and perhaps normal glycogen status.

Total energy expenditure during arduous wildfire suppression.

PURPOSE: The purpose of this investigation was to determine the total energy expenditure (TEE) by using the doubly labeled water (DLW) methodology during 5 d of wildfire suppression in Montana, California, Florida, Washington, and Idaho. METHODS: Seventeen wildland firefighters (from three Interagency Hot Shot crews, N = 8 men, height = 177 +/- 7 cm, weight = 74.6 +/- 6.4 kg, age = 24.5 +/- 1.8 yr; N = 9 women, height = 170 +/- 7 cm, weight = 65.2 +/- 8.0 kg, age = 25.0 +/- 1.3 yr) served as subjects. Before wildland fire suppression, each subject was given an oral dose of 2H2O and H218O (approximately 0.23 g 2H2O.kg estimated TBW-1 and 0.39 g H218O.kg estimated TBW-1). Urine samples were collected between 0400 and 0600 daily. TEE was calculated using the two-point method for days 1-3 and 1-5, with the TEE for days 4-5 calculated by extrapolation. Urine samples from other crew members not participating in the DLW protocol were collected at the same times and used to adjust calculations of isotopic elimination for background shifts. RESULTS: TEE was 17.4 +/- 3.7 and 17.5 +/- 6.9 MJ.d-1 during days 1-3 and 4-5, respectively. The energy expenditure associated with physical activity (EEA) was 8.8 +/- 3.0 and 8.9 +/- 6.1 MJ.d-1 for days 1-3 and 4-5, respectively. CONCLUSION: The current data demonstrate consistently high daily energy expenditure in the wildland firefighter. These data also demonstrate that the doubly labeled water methodology is an appropriate methodology for the measure of TEE during unpredictable field operations if adjustments are made for changes in background enrichment and elevated water turnover.