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The Rural Health Messenger Summer 2005 Vol.3/No.3 Federal funding for Title VII Programs is in question Funding for the West Texas Area Health Education Center (AHEC) Program as well as all AHEC programs
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The Rural Health Messenger Summer 2005 Vol.3/No.3 Federal funding for Title VII Programs is in question Funding for the West Texas Area Health Education Center (AHEC) Program as well as all AHEC programs across the country is in question. In mid-june the U.S. House appropriations committee voted to virtually eliminate federal funding a 97 % reduction for Title VII programs. The money is administered by the Health Resources and Services Administration and supports a variety of programs that address health disparities. Texas Tech University Health Sciences Center will lose $2 million annually in federal funding for its health education training programs funds that go back into communities across the region. The impact of the loss of Title VII funding is significant to the West Texas region, says Pam Danner, program director for the West Texas AHEC Program. With the loss of these dollars, Texas Tech University Health Sciences Center (TTUHSC) and its AHEC center partners lose much of their ability to do outreach into communities, providing opportunities for young people to learn more about health careers and for health professions students to gain valuable experience in rural communities. The bottom line, she says, is that the loss of funds impacts the long-term ability of West Texas communities to sustain its health care work force. While the House version of the federal budget has significantly cut funding for Title VII programs, there is opportunity for the Senate to restore the funding to its version of the budget. Through the National AHEC Organization and its members, work is ongoing to educate lawmakers about the role Title VII programs play in the health care safety net across the country. Forty-six states have AHEC programs, and 12 states have Health Education Center Training programs (HETC). The HETC program, a sister program to AHEC, focuses on special populations particularly border populations. The purpose of the programs is to help communities develop T E X A S T E C H U N I V E R S I T Y H E A L T H S C I E N C E S C E N T E R A publication of the Office of Rural and Community Health cont d on page 3 Summer camps promote health careers to area teens Left: Camp participants get hands-on experience at Panhandle AHEC s M.A.S.H. Camp in Canyon, Texas. Here, Ketan Wyatt serves as the volunteer athlete, while Trent Britten checks his blood pressure and heart rate. Participants were learning about exercise sciences and how this career field helps athletes improve their performance. See story on page 7 A Word from Texas Tech By Patti Patterson, MD, MPH Vice President of Rural and Community Health Childhood Obesity: What s a parent to do? The rate of childhood obesity for children ages 6-11 years has more than tripled in the past three decades in the United States. While there are numerous factors that may be contributing to this epidemic, it always comes down to the fact that obesity occurs when more calories are taken in than are used. There are numerous factors in our society, which are contributing to this epidemic, including ready availability of high-calorie, low-nutrition fast foods and the fact that children are spending more time in front of screens. Research studies have shown a clear link between the amount of time children spend watching television and obesity rates. Use of computers, video games, along with television viewing often occupies a large percentage of children s leisure time; thus influencing their levels of physical activity. National data show that children that watch four or more hours of television per day have higher weights for height (body mass index) and body fatness than children who watched fewer than two hours per day. Having a television in a child s bedroom is also a strong predictor of being overweight even among preschool aged children. There are several different ways that excessive television viewing can contribute to obesity in children. First, it can take the place of more activities which require more physical exertion. Second, children tend to eat high-calorie foods while they watch television and thirdly, children are exposed to numerous commercials advertising high-calorie foods. A big step in prevention of obesity in your child may be turning off the TV. The American Academy of Pediatrics recommends that parents limit children s total media time to no more than one or two hours of quality programming per day. They also recommend removing televisions from children s bedrooms. Taking steps now to improve your child s health will yield a lifetime of healthful habits. EXPORT studies focus on vector-borne diseases In its first cycle of funding for studies on health disparities, the West Texas Rural EXPORT Center is sponsoring two innovative projects dealing with diseases that can be transmitted from animals. To a greater extent than city dwellers, residents of rural communities can be exposed to diseases such as West Nile virus, rabies, plague, and hantavirus pulmonary syndrome. One study, led by Raymond S. Matlack at West Texas A&M University in Canyon, is looking at the ecology of small and mid-sized mammals in areas where rabies, hantavirus and plague are prevalent. Dr. Matlack and his students are focusing on the alleys and vacant lots in small towns in the Panhandle region. From their work, future researchers will be able better to describe factors in the environment that are associated with increased incidence of disease among both animals and humans. Another study, led by Robert Bradley and Charles Fulhorst, is concentrating on the role of grasslands in the transmission of hantavirus. Once marked by vast areas of prairie grassland, the West Texas landscape has been modified by agriculture over the past century. In recent years large areas of farmland have been returned to native grasses under the U.S. Department of Agriculture s Conservation Rotation Program (CRP). These grasslands create an oasis effect and provide habitat for rodents. Dr. Bradley, from the Texas Tech University Department of Biology, is a specialist in mammalian systematics and molecular evolution. His colleague at the Pathology Department at the University of Texas Medical Branch at Galveston, Dr. Fulhorst, is an expert in determining genetic diversity among viruses. Drs. Bradley and Fulhorst, and students working under their supervision, are collecting samples and performing assays on host species. From this work future researchers will be able to determine the frequency of hantaviruspositive rodents occupying a variety of CRP sites and develop a dataset reflecting the genetic relatedness of the rodent hosts for different strains of hantavirus. EXPORT, standing for Excellence in Partnerships for Community Outreach, Research on Health Disparities and Training, is a research initiative of the National Institutes of Health. Dr. Patti Patterson, principal investigator of the EXPORT grant, says that the studies will lead to major research grant proposals. Diseases transmitted from animals are a real concern for residents of rural communities throughout West Texas. From the studies by Professors Matlack, Bradley and Fulhorst we will improve our capabilities for predicting outbreaks and improving public health responses. Rabies a concern for show livestock This year, Texas has experienced a higher than usual outbreak of rabies across the state. Dr. James Alexander, regional veterinarian at the Texas Department of State Health Services (formerly Texas Department of Health), says that it is critical for residents to be aware of the situation, particiularly those who work with livestock in FFA and 4-H Clubs. Due to the amount of human contact, usually involving children and teens, associated with FFA and 4-H club animals such as steers, goats, and lambs, DSHS Zoonosis Control officials strongly recommend that these animals be vaccinated for rabies. A product specifically labeled for use in the species being vaccinated should be used. For a species which does not have a vaccine specifically labeled for it, it is recommended that the vaccine with the broadest spectrum of species approval be used. In addition, immunization of frequently used, or extremely valuable horses and other equidae is strongly recommended. Faith communities role in social services support studied The West Texas Rural EXPORT Center is funding an innovative study of the role of faith communities in providing social service assistance. Led by Paul Johnson and Adam Rafalovich of the Texas Tech University Department of Sociology, Anthropology, and Social Work, this study is creating the foundation for extensive surveys of the challenges facing many rural communities in the region. Many rural and small-town communities are experiencing declines in population, economic pressures, and increases in the number of elderly citizens. This creates a bind: medical needs of an aging population are rising at the same time that communities find it more difficult to sustain existing health care facilities. Churches and other religious groups are also vulnerable to declining and aging memberships and decreasing economic resources. Those that are able to sustain themselves may be considered an important potential source of informal social service assistance for residents faced with various medical, social, and economic needs. This role has been a focus of attention at the national level in government policies designed to encourage faith-based social service programs. The study by Drs. Johnson and Rafalovich is focusing on this social service role among long-time residents of rural and small-town communities where traditions of helpfulness and neighborliness have long been wellestablished. In their initial phase of work, Drs. Johnson and Rafalovich, and their graduate students are identifying key variables that can be used to document health and healthcare disparities as well as informal social services provided by faith-based communities. Churches are pillars of rural life, says Dr. Patti Patterson, Principal Investigator of the EXPORT grant. This multidisciplinary study will lead to major research proposals in a very important range of subjects. From this work we hope to better understand how faith-based groups assess social service needs in their communities and how they collaborate with one another and with public agencies of various types in seeking to meet these needs. Title VII federalfunding cont d from page 1 their health professional work force. Texas is served by three AHEC programs East Texas AHEC, South Texas AHEC and West Texas AHEC as well as the Health Education Center Alliance of Texas. The West Texas AHEC serves 105 counties, with offices in Abilene, Amarillo, Midland and Plainview. A fifth center was planned for El Paso. The possible funding cuts come at a time when the West Texas AHEC is in its infancy, says Dr. Patti Patterson, vice president of Rural and Community Health at the Health Sciences Center. The AHEC is the operational arm for rural health at Texas Tech. With four AHEC centers now fully functioning, we are just getting to the place where we make a difference. These programs usually get federal funding over two three-year periods for startup. During that time, the program office finds other sources of funding as they are weaned off of federal funding. Since Texas Tech University Health Sciences Center s program is only two years old, adequate alternative funding has not yet been secured. Focus On C O M M U N I T Y H E A L T H C O M M U N I - T Y H E A LT H Senior citizens in Ochiltree County have reaped the benefits of that community s commitment to improving access to care. Ochiltree General Hospital, through its Senior Pharmacy Project, has assisted seniors with low or restricted incomes with their pharmaceutical needs. The hospital s licensed social worker, Candie Pickett, works with pharmaceutical companies to get qualified seniors enrolled in their prescription assistance programs. Each company has different requirements and application processes, says Pickett, but eligible participants must have no other prescription coverage and must have a limited income. Generally, the annual income for an individual must be less than $17,000 and for a married couple must be less than $31,000. In 2004, a total of 1,113 qualified inpatients and citizens of Ochiltree County received $497,260 worth of medications. And the program is on tap to exceed that amount in In May 2005 alone, $63,409 worth of medications was provided for enrolled seniors. The benefits of the project have included improving access to medications that otherwise might not have been available due to high costs, reducing time spent by doctors offices to handle the application process, and preventing unnecessary hospitalizations due to medication issues. Ochiltree General Hospital has provided the primary support for this project, including project costs and staff time to identify and complete applications for enrollment, which must be done quarterly. This project has been a tremendous support to our elderly citizens, says Pickett. Many of them would choose not to purchase needed medications if this service were not available to them, resulting in declining health. Our goal is to improve the quality of life of our elderly citizens. Telemedicine Report Advanced Health Care Through Advanced Technolog y Telemedicine in Neighboring New Mexico Enhances Rural Access to Care While the Texas Tech telemedicine program is one of the leaders in the country, the neighboring State of New Mexico also boasts one of the top programs. The University of New Mexico Health Sciences Center began their TeleHealth program ten years ago with a state allocation from the legislature to develop a strategic plan for implementing telehealth to help meet the state s health and education needs. Like West Texas, much of New Mexico is rural and communities face limitations in health care access. In fact, UNM Health Sciences Center came to Texas Tech to learn how telemedicine was utilized in West Texas and take back with them features that would work in their state. Telehealth services made sense in our state for several reasons, says Dr. Dale Alverson, medical director of the Center for TeleHealth. The UNM Health Sciences Center is the only medical school in the state, and with many of our communities being long distances from advanced health care services, we had to find a way to expand our educational and health care delivery system to benefit the entire state. In New Mexico, the statewide average of 194 physicians per 100,000 population falls below the national average of 226 physicians. In addition, 64% of physicians practice in Bernalillo, Los Alamos, and Santa Fe counties, while only 39% of the state s population lives in those counties. And 29 of the 33 counties are full or partial Health Professional Shortage Areas, which is an underserved designation of the federal government. The UNM Health Sciences Center current telehealth focus includes researching advanced technologies that can support distant education and patient care services over the next generation of the Internet. In addition, virtual reality training for medical students is being incorporated to expand exposure to a variety of patient care scenarios independent of student and patient location. A virtual simulation case has just been completed between UNM and Perth, Australia. The UNM Health Sciences Center does not operate the only telehealth network in the state. Instead, they have focused on creating an alliance of all the networks in the state, called the New Mexico Telehealth Alliance, to share resources. The Alliance helps to develop a neutral territory for public/private partnerships. We re developing infrastructure that is interoperable between the different networks, which allows each network to utilize the services available from other networks, says Alverson. The Alliance has the bigger picture of community needs and what resources can be brought to bear to most efficiently address issues. This careful consideration makes the system much more sustainable. UNM connects to 30 communities for patient care and education. In 2004, they conducted 550 patient consults and had more than 2,450 non-patient interactions. Similar to Texas, in New Mexico physicians outside of the state can get a telemedicine-specific license to provide telehealth services in the state. New Mexico is also working on increasing inter-state collaboration, forming the Four Corners Telehealth Consortium with Arizona, Utah, and Colorado. For more information about the UNM Health Sciences Center s Center for TeleHealth, go to telemedicine. Correctional telemedicine continues to be mainstay While Texas Tech University Health Sciences Center (TTUHSC) has made great strides in utilizing technology to extend access to health care to rural populations in creative ways, particularly with its telepharmacy and teleburn projects, the mainstay of the TTUHSC telemedicine system continues to be its use in the correctional environment. For over twelve years, the Health Sciences Center has been responsible for providing medical care in the western half of Texas to inmates in the Texas Department of Criminal Justice and has been using telemedicine in the correctional setting since Currently, correctional telemedicine use accounts for 74 percent of all telemedicine consultations at the Health Sciences Center. Today, TTUHSC conducts more than 2,000 prison telemedicine consultations a year for the 32,000 inmates that are housed in the 23 prison units for which TTUHSC is contracted to provide medical care. Before the implementation of telemedicine, most of the inmates needing medical care were taken out of the prison to visit a specialist, Right: Dr. Frank Saporito, a dermatologist at TTUHSC-Lubbock, examines a patient at the Formby Unit in Plainview, using the telemedicine system. hospital, or other facility. Each trip from the correctional unit to the regional medical facility can cost taxpayers between $200 and $1,000, depending on the location, says Don McBeath, director of Telemedicine and Rural Health at TTUHSC. With telemedicine, however, many of these trips have been eliminated, thus saving taxpayers thousands of dollars annually. In 2004, 59 percent of the telemedicine consults resulted in inmates remaining in their correctional unit, able to receive needed health care through the telemedicine support. Besides specialty medical care, TTUHSC provides extensive psychiatry and psychology services to inmates via telemedicine, says Debbie Voyles, assistant director of telemedicine. Over one-third of all telemedicine consults are for psychiatric care. Some of the benefits of using telemedicine in the correctional health care setting include Reducing inmate transfers out of prison clinics for specialty care; Improving public safety and reducing escape risk by treating more inmates in the secure prison setting; Discouraging false medical claims by inmates, which has resulted in more efficient utilization of the prison medical staff s time; and Providing inmates with a high standardized level of medical care, thus reducing the risk of litigation. Much of our understanding of how telemedicine technology can best be utilized to meet patient care needs in isolated areas with limited access to health care has been developed from our experience in the correctional setting, adds McBeath. Because of correctional telemedicine, we ve been able to more effectively develop rural technology applications. Rural Health and Economic Development Summit August 30 September 1, 2005 Austin, Texas The annual Summit, which is hosted by Texas Rural Health Association and Texas Rural Partners, Inc., will present the latest information on health care and economic development issues and opportunities facing rural Texas communities. For more information, go to Call Texas Rural Health Association
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