Surveying the Knowledge and Practices of Primary Care Residents in Managing Adult Patients with Obesity.

BACKGROUND: The prevalence of obesity is increasing worldwide at an alarming rate, yet obesity remains under-addressed during clinic encounters. A lack of training in how to treat obesity is one crucial factor contributing to this deficiency. OBJECTIVE: This study explored resident physicians' perceptions of their education on obesity and its relationship with confidence and practice behaviors when caring for patients with obesity. DESIGN: A survey was distributed to residency directors to share with residents in their programs. Participation was voluntary and anonymous. Data was collected over a 3-month period. PARTICIPANTS: Residents in Family Medicine and Internal Medicine programs in West Virginia and Indiana who saw adult patients in an ambulatory care setting. MAIN MEASURES: The electronic survey queried the presence of a formal curriculum on Obesity Medicine (OM) and each resident's knowledge, confidence, practice behaviors, and attitudes pertaining to OM. KEY RESULTS: The survey was distributed to 490 residents in 12 programs. Response rate was 22.9% (112 resident physicians). All respondents felt that medical training in obesity should be strengthened. Residents who reported having a formal curriculum on OM were more likely than those without a curriculum to rate their confidence as "high" when discussing weight (35.0% vs. 16.7%, p = 0.03) and when counseling patients about diet and nutrition (37.5% vs. 18.1%, p = 0.02). They also more frequently reported learning enough from faculty to manage obesity (65.0% vs. 29.2%, p < 0.001). Residents with an OM curriculum reported discussing obesity as a problem with patients (100.0% vs. 86.1%, p = 0.01), and completing motivational interviews (90.0% vs. 58.3%, p = < 0.001), more frequently than their peers without a curriculum. CONCLUSIONS: Residents with a formal OM curriculum were more confident in addressing and discussing obesity with patients. Formal training in OM will strengthen resident training to better address and treat patients with obesity.

"They either leave you or they get involved in it": Familial factors influencing drug use amongst Appalachian people.

West Virginia, the only state entirely in Appalachia, is considered the epicenter of the opioid crisis. Children raised in families affected by opioid use disorder can develop their own substance use disorder later in life. The continuing opioid crisis coupled with social and health disparities suggest families in West Virginia are vulnerable to generational cycles of substance misuse. This qualitative study uses content analysis to present emergent themes discerned from participant interviews on the opioid epidemic and impacts of a restrictive opioid prescribing law in West Virginia. Participants in this study described how using opioids has impacted their lives, their family, and community. They recognized drug use was embedded along familial groups and influenced by significant others such as partners or peers. Parents described how children were a strong motivator for recovery and how they felt remorse for exposing their children to their drug use. This study highlights the importance of community engagement, parental support, and early identification of vulnerable young people to lessen the intergenerational continuance of substance use.

Twitter and Communicating Stigma about Medications to Treat Obesity.

In North America, stigma remains a significant barrier to treating obesity. Many candidates for medical weight management do not seek treatment, possibly related to anticipated and internalized stigma and weight bias. Pharmacologic treatment of obesity remains highly stigmatized, despite advances in drug development and medical weight management programs. People contemplating medical weight management are likely to see information about "diet pills" on social media sites, such as Twitter. However, Twitter has been found to contain false and stigmatizing information. This study examines a sample of 2170 Tweets to better understand the content through the lens of obesity stigma. Tweets were collected over a seven-day period containing general terms such as "diet pills," "weight loss pills," or "fat burner" using the Twitter advanced search option. The analysis revealed that almost 50% of Tweets containing "diet pills" contained stigmatizing language. The most common elements of stigma communication were taking personal blame for obesity and the perils associated with taking medications for weight loss. Further analysis revealed sub-themes such as profiting from social pressures to lose weight, distrust of physicians and the practice of obesity medicine, lack of efficacy of medications, and the use of social media to disseminate stigma. Most Tweets were from personal accounts followed by direct sales of weight loss supplements. The findings have potential implications for medically supervised weight management programs and may drive the need for more evidence-based social media messaging around obesity related healthcare.

"You didn't have a choice, but to be on your train. The train was moving": West Virginia pharmacists' perspectives on opioid dispensing during the evolution of the opioid crisis.

BACKGROUND: West Virginia (WV) has been at the forefront of the opioid crisis in the United States, with the highest rate of opioid overdose mortality involving prescription opioids in the country. To curb the crisis, the state government implemented a restrictive opioid prescribing law in March 2018, Senate Bill 273 (SB273), to decrease opioid prescribing. However, sweeping changes in opioid policy can have downstream effects on stakeholders such as pharmacists. This study is part of a sequential mixed methods investigation of the impact of SB273 in WV in which we interviewed various stakeholders-including pharmacists-about the impact of the law. OBJECTIVES: This paper aims to explore how pharmacy practice during the opioid crisis impacted the need for restrictive legislation and how SB273 impacted subsequent pharmacy practice in WV. METHODS: Semi-structured interviews were conducted with 10 pharmacists who were practicing in counties that had been designated as high-prescribing counties based upon county-level prescribing/dispensing data from state records. Analysis of the interviews was informed by the methodological orientation of content analysis to identify emerging themes. RESULTS: Participants described confronting questionable opioid prescriptions, treatment costs, and insurance coverage driving opioids as a first-line choice for pain management, as well as the influence of corporate policies and the immense responsibility of being the "last line of defense" in the opioid crisis. A central impediment to the care of patients was the inability of the pharmacists to effectively communicate their concerns to prescribers, making improved prescriber-dispenser communication an essential next step in minimizing opioid care gaps. CONCLUSION: This is one of few qualitative studies that have explored pharmacists' experiences, perceptions, and role in the opioid crisis leading up to and during the enactment of a restrictive opioid prescribing law. In light of the difficulties they faced, a restrictive opioid prescribing law was viewed positively by pharmacists.

Using an Implementation Research Framework to Identify Facilitators and Barriers to Physical Activity and Weight Loss in Appalachia.

OBJECTIVES: West Virginia (WV) is the only state entirely located in Appalachia, a large, mostly rural area in the eastern United States. WV has the highest adult obesity rate in the United States, as well as one of the highest physical inactivity rates. Obesity has been found to be significantly higher in rural counties than in urban counties, and many rural communities do not have the resources to address this growing health concern. It is well documented that healthy eating and becoming more physically active can be successful in reducing weight and managing obesity-related illness. Despite this overwhelming evidence, obesity rates in WV continue to climb. The purpose of this study was to understand the factors associated with obesity in WV and identify what influences the behavior of people in regard to weight loss and exercise. METHODS: Four focus groups were conducted across the state of WV, transcribed, and thematically analyzed to examine the facilitators and barriers associated with healthy behaviors. The Consolidated Framework for Implementation Research (CFIR) was used as an approach to classify characteristics and plan implementation strategies integrating five domains. The CFIR has been used to identify potential barriers and facilitators to interventions and can be used before or during an intervention. In addition, the CFIR has been used as a framework to guide analysis and provide a means to organize intervention stakeholders' perceptions of barriers and facilitators to successful interventions. RESULTS: Participants identified barriers and facilitators across all 5 major domains of the CFIR-intervention characteristics, outer setting (eg, cultural norms, infrastructure), inner setting (eg, access to knowledge), characteristics of individuals, and the implementation process-and 16 subdomains. Participants discussed how socioeconomic, cultural, and environmental factors influenced diet and exercise. Cost, family culture, and limited access to resources (eg, healthy foods, community-based fitness programs, health care) were common themes expressed by participants. CONCLUSIONS: The results of this study identify how individuals living in rural Appalachian view lifestyle changes and what influences their ability to pursue physical activity and healthy eating. Future programs to encourage healthy lifestyles in Appalachia need to consider the characteristics of the given community to achieve the goal of a tailored lifestyle intervention program that is feasible and effective. In addition, the findings suggest that the CFIR can be used to implement and refine intervention strategies that can be used in the real world.

Impact of Diffuse Large B-Cell Lymphoma on Mammography and Bone Density Testing in Women.

Women with diffuse large B-cell lymphoma (DLBCL) are at an increased risk of mortality from breast cancer and osteoporosis. However, the impact of DLBCL on rates of mammography and bone density testing (BDT) is unknown. We compared female DLBCL and non-cancer patients utilizing the Surveillance, Epidemiology, and End Results-Medicare dataset to analyze the predictors of mammography and BDT. Guided by the Social Ecological Model (SEM), we used multivariable logistic regressions with inverse probability treatment weighting to examine the association of intrapersonal, interpersonal, healthcare system, and community factors with mammography and BDT. The rates of mammography (59.8%) and BDT (18.5%) in women with DLBCL were similar to those without cancer (60.2% and 19.6%, respectively). After adjusting for the SEM factors, DLBCL patients were less likely to get mammography and BDT than non-cancer patients. The treatments of radiotherapy and stem cell transplant were not associated with either mammography or BDT. DLBCL diagnosis was associated with lower rates of mammography and BDT rates among women with DLBCL, as compared to non-cancer patients. To reduce the morbidity and mortality from breast cancer and fractures in women with DLBCL, providers should increase their recommendations for mammography in those receiving radiotherapy and BDT in stem cell transplant patients.

Identifying community physical activity and health resources for treatment of back pain by utilizing members of a physical activity network.

BACKGROUND: Back pain is one of the leading causes of health care expenditure in the US and is linked to an increased body mass index. Many evidence-based modalities for the prevention and treatment of back pain closely mirror recommendations for weight loss and include physical activity and health maintenance activities (PAHM). The primary aim of this study was to ascertain community assets, and perceptions of the use of PAHM in the treatment of back pain by West Virginia Physical Activity Network (WVPAN) members. METHODS: Participants for the study were recruited from the West Virginia Physical Activity Network. This grassroots organization is filled with volunteers from various sectors who were recruited from various workshops, conferences, or coalition meetings over a period of several years. This network was purposely selected as the study population because of the statewide reach and their familiarity with resources in their local communities. A brief survey instrument was designed to gather their scaled perceptions about various treatment modalities related to back pain, and to gather their local knowledge related to specific providers in their communities. In addition, participants were given a free text box to list any local assets or resources for the nine treatments listed, and county of residence, and the nature of their connection to the physical activity network. Descriptive analyses were used to describe overall patterns of survey data. The qualitative data were compiled manually by the research team to show themes of specific treatments mentioned across different parts of the state. RESULTS: Participants overwhelmingly supported physical therapy, flexibility training, yoga, and core strengthening as treatments for back pain. The majority of respondents were "undecided" about other treatments such as cognitive behavioral therapies and acupuncture. CONCLUSIONS: The implementation of PAHM interventions in communities could help treat patients with back pain, and may reduce reliance on the pharmacological treatment for back pain. The current study's data support the potential of such approaches in many West Virginia counties. Also, local resources, and context can be gleaned from community leader surveys utilizing previously developed infrastructure for PAHM promotion.

Mobile Health (mHealth) Use or Non-Use by Residents of West Virginia.

OBJECTIVE: To compare mobile health (mHealth) usage by residents of West Virginia with national estimates. METHODS: Pew Research Center data from its Internet and American Life Project were accessed for secondary data analysis. These data, available to the public, are a probability sample of Internet use in the United States, differences in use based on selected variables (eg, education, household income), and how usage affects the lives of Americans. Using SAS software, diagnostics were performed on the data, revealing that the variables of interest were prepared and represented without any need for information. Data were used as is, with categorical and continuous characteristics and stipulations being provided in accompanying documents from the Pew Research Center. RESULTS: The national sample consisted of 509 men and 557 women with an average age of 51.02 years (standard deviation 17.04). The 30 West Virginia residents included 19 women and 11 men (mean for age 48.10, standard deviation 15.30). When controlling for socioeconomic and demographics factors, the odds of a West Virginia resident using an mHealth device were 82% less than the rest of the country, a statistically significant association. Women in West Virginia were 52% more likely to access mHealth information than men, and an increase in age corresponded with increased mHealth usage. CONCLUSIONS: The lack of mHealth use by residents in West Virginia represents an opportunity for clinicians and scientists. The high rates of preventable diseases in the region could be more effectively managed with greater use of these technologies.

Residents' Views on Research and Quality Improvement Training Can Guide Practice-Based Research Network Collaboration.

BACKGROUND AND OBJECTIVES: This study was conducted by the West Virginia Practice-Based Research Network Learning Collaborative to assess research activity, confidence, and attitudes toward residency programs' research and quality improvement requirements and inform the integration of the state-wide practice-based research network (PBRN) as mentors to support practice transformation implementation initiatives across various resident training sites in West Virginia. METHODS: This pilot study assessed residents' attitudes regarding (1) research activity, (2) confidence and (3) requirements of their program in research and quality improvement training by using an anonymous survey, administered during regular residency meetings. RESULTS: Of the 68 residents,representing four DO and MD Family Medicine residency programs in West Virginia, 40 (58.8%) responded to the survey. About 64 percent of residents had worked on a quality improvement project, and more than half of residents (52.5%) submitted a research project for a competitive presentation within the most recent year. Sixty-five percent felt satisfied with the residency program's research and quality improvement curriculum. However, only 55 percent felt confident to perform a project and 52 percent submitted a project to a competitive forum. CONCLUSION: Only half of the residents demonstrate activity and confidence in research and quality improvement. This shows an opportunity to assess current curriculums and provide new strategies to enhance their ability to conduct practice transformation initiatives.

Family Medicine-Specific Practice-Based Research Network Productivity and Clinical and Translational Sciences Award Program Affiliation.

OBJECTIVE: Practice-based research networks (PBRNs) are groups of practices that work together to conduct research. Little is known about the degree to which PBRNs may be achieving success. This is the first general survey of family medicine-based PBRN directors in the United States and Canada to examine research productivity outcomes of PBRNs and explore the association between Clinical and Translational Science Awards (CTSA) program affiliation and PBRN outcomes. METHODS: The Council of Academic Family Medicine Educational Research Alliance conducted the survey and e-mailed it to 102 PBRN directors from the Agency for Healthcare Research and Quality's registration. RESULTS: A total of 54 (56%) PBRN directors responded to the survey. PBRNs with an affiliation with a CTSA program were more likely to report completion of quality improvement research and participation in multiple PBRN collaboration research projects. PBRNs affiliated with CTSA programs were less likely to report maintaining funding as a significant barrier. CONCLUSIONS: CTSA involvement with PBRNs results in family physician scientists' completing research and disseminating this research through publication. Also, PBRNs with CTSA partnerships have more funding availability. PBRN partnership with a CTSA is beneficial in furthering research in family medicine.

Patient Attitudes toward Weight Related Discussions in Rural Appalachian Primary Care Clinics.

PURPOSE: West Virginia (WV) consistently has one of the highest rates of obesity, nationally, yet previous studies suggest that conversations about weight with providers are infrequent. This study's aim was to determine frequency and type of weight-related discussions occurring in WV primary care clinics and whether discussions differed according to weight status. METHODS: A cross-sectional survey was completed by patients in rural primary care practices. Participants answered questions related to demographics, obesity related illnesses, experience receiving a physician mediated discussion, and attitude and beliefs related to weight. RESULTS: Among the total of 490 surveys collected, a little more than half of the participants (56.9%) have discussed weight with their physician; a majority of participants (89.5%) thought a physician should tell risks associated with an unhealthy weight; 78.3% participants felt weight loss is important to them; 86.1% participants believed weight affects their health. Participants with obesity were more likely than participants who are overweight to discuss weight with their physician (71.8 vs.44.0%, p<0.0001), and believed that their physicians helped them lose weight previously (29.4% vs 9.9%, p<0.0001) and can help them lose weight in the future (92.9% vs. 71.1, p<0.0001). CONCLUSION: Physicians are often having weight related discussions with patients with obesity however this discussion happens less with overweight patients. Practitioners may want to be more attentive to addressing weight related issues in overweight patients.

Back Pain in the Era of Opioid Restriction and Implications for Neurosurgeons Based on Qualitative Findings From a Rural State.

Historically, back pain has been an inciting complaint for the initiation of opioids. Aggressive marketing of opioids to treat back pain coupled with the initiation of pain being treated as "the fifth vital sign" contributed to the emerging opioid crisis in the USA. West Virginia (WV) has long been considered the epicenter of the crisis. In 2018, the WV legislature passed a bill that placed prescribing limits on opioids. Our group set out to investigate the impacts of opioid prescribing restrictions through a sequential, mixed methods study evaluating prescription trends and stakeholder experiences. These stakeholder experiences generated emergent themes regarding the evolution of the opioid crisis up to and beyond the implementation of the bill, which is of relevance to neurosurgeons and back pain treatment. This study explores those findings for a neurosurgical audience. This study consisted of open-ended, semi-structured interviews with a purposive sample of 50 physicians, pharmacists, and patients in WV. Interviews were recorded and transcribed verbatim. Content analysis was utilized as the methodological orientation. Five theoretical domains relevant to the treatment of back pain emerged, describing the prevalence of opioid use, barriers to access care, the importance of opioids for function in resource-poor rural areas, disconnected and siloed care, and patient views on the impacts of pain care gaps and solutions. Spinal pain care in rural WV is complex due to identified challenges. Care siloing factors in suboptimal spinal pain care. Future work should define, implement, and assess the real-world effectiveness of treatment paradigms for the full spectrum of surgical and non-surgical back pain complaints. Neurosurgeons should be present in this arena.

Using Medical Cannabis for Chronic Pain: A Social-Ecological Framework.

Early studies suggest medical cannabis (MC) has the potential to benefit people who suffer from chronic pain by offering a less addictive alternative to opioids; however, most investigators agree more research is indicated. Today, in 2023, cannabis remains a Schedule I drug and is an illegal substance in the United States under the Controlled Substances Act of 1970. Despite this designation, as of February 2022, 37 states, three territories, and the District of Columbia allowed using cannabis products to treat certain painful medical conditions. The contradictory status of federal and state legislation regarding cannabis use has resulted in delays and restrictions on relevant research. As a result, an inadequate foundation of knowledge exists needed to inform policy, program, and practice decisions concerning MC to treat pain. Implementing and controlling access to MC is influenced by overlapping individual, interpersonal, community, and organizational influences that all fall under the umbrella of federal and state policies. Increasingly, the legalization and expanded access to MC necessitates the integration of evidence, policy, and social-ecological reality. To adequately delineate these complex factors to anticipate and plan future interventions at multiple levels, we propose a social-ecological framework (SEF) for using MC to treat pain. This SEF assumes the transactional relationship between the individual and the environment and that no single factor can predict behavior or health outcomes. Our framework illustrates five dynamic levels of analysis that interact between dimensions. Key elements and intersections are discussed at the intrapersonal, interpersonal, institutional, community, and policy levels.

A qualitative study of chronic pain and opioid use: The impact of restrictive prescribing.

OBJECTIVES: To explore the continuum of pain and addiction for patients with chronic pain (CP) who used opioids during a time of restrictive opioid prescribing in West Virginia. DESIGN: This qualitative descriptive study used a content analysis of semistructured interviews. Themes were identified through a reflective, iterative coding process. Consolidated criteria for reporting qualitative research guidelines were followed. SETTING: West Virginia. PARTICIPANTS: Twenty people who used opioids to treat a CP condition, 10 pharmacists, 10 primary care providers, and 10 specialists. INTERVENTION: Semistructured interviews. MAIN OUTCOME MEASURE: To better understand the impact of restrictive prescribing measures on people who used opioids for CP. RESULTS: Patients initiated opioids for acute, painful conditions and described how long-term use led to physical dependence and, for some, opioid use disorder. Restrictive opioid prescribing laws led to care interruptions and decreased access and availability of prescribed opioid pain medication, driving some patients to seek illicit drugs. Economic considerations influenced drug use as the price of purchasing prescription opioids on the street went up, making heroin a cheaper alternative. Patients who transitioned to buprenorphine/naloxone as a treatment for pain or opioid use disorder viewed it as a positive change and a "life saver." CONCLUSIONS: Opioid use for CP is complex and multifaceted. The continuum of pain and opioid use disorder can begin with a prescription for acute pain and continue for the treatment of CP. Patients described how continued opioid use was not to "get high" but for pain control to improve their quality of life, continue to work, and be productive. For those who experience physical dependence on opioids, access to treatment is vital to recovery and pain management. KEY MESSAGE: Without individualized managed care, people confronted with a sudden interruption in prescription opioids may turn to illicit drugs to mitigate symptoms of opioid withdrawal and physical dependence.

Significant symptom resolution of spinal lipomatosis with weight loss.

71-year-old male with epidural spinal lipomatosis and spondylolisthesis. Conservative treatment failed, and a spinal fusion and laminectomy were performed. Postoperatively, the patient reported a reduction in pain; however, the pain recurred soon after surgery. After losing 53 pounds with medical management, the patient reported a complete absence of pain. Epidural spinal lipomatosis is a rare condition characterized by the deposition and hypertrophy of adipose tissue in the spinal canal, sometimes resulting in stenosis or compression of the dural sac and nerve roots (Glob Spine J. 2018;9:658). Although several factors are considered to precipitate the disease, steroid use (J Am Acad Dermatol. 2017;76:1) and obesity (Neurosurg Focus. 2004;16:1) are considered among the most prevalent, with obesity controversially being listed under "idiopathic" causes occasionally (Glob Spine J. 2018;9:658). Weight reduction and decreased steroid use are first-line treatments for this disorder, and usually surgery is considered only when conservative treatment is ineffective (Glob Spine J. 2018;9:658). To describe a case of treating spinal lipomatosis within an evidence-based multidisciplinary medical weight management clinic.

The Effects of Cannabidiol on the Driving Performance of Healthy Adults: A Pilot RCT.

Introduction: A common side effect of cannabidiol is drowsiness, which could impact safe driving. This study's purpose was to determine the feasibility and whether cannabidiol impacts simulated driving performance. Methods: This was a randomized, parallel-group, sex-stratified, double-blind, pilot trial that consisted of a volunteer sample of healthy, currently driving college students. Participants were randomized and allocated to receive a placebo (n=19) or 300 mg cannabidiol (n=21) by oral syringe. Participants completed a ~40-minute driving simulation. A post-test survey assessed acceptability. The primary outcomes were mean SD of lateral position, total percent time the individual drove outside travel lanes, total collisions, time to initial collision, and mean brake reaction time. Outcomes were compared between groups using Student's t-tests and Cox proportional hazards models. Results: None of the relationships were statistically significant, but the study was underpowered. Those receiving cannabidiol experienced slightly more collisions (0.90 vs 0.68, p=0.57) and had slightly higher mean SD of lateral position and slower brake reaction times (0.60 vs 0.58 seconds, p=0.61) than those who received placebo. Participants were satisfied with their experiences. Conclusions: The design was feasible. Larger trials may be warranted because it is unclear whether the small differences in performance seen in the cannabidiol group were clinically relevant.

The effects of cannabidiol on subjective states, cognition, and psychomotor function in healthy adults: A randomized clinical trial.

Despite being added to numerous products, little is known about cannabidiol. Drowsiness is a self-reported side effect, which could impact cognitive functioning. To determine whether cannabidiol impacts cognition and psychomotor function, a volunteer sample of healthy, college students were recruited for this randomized, parallel-group, double-blind, feasibility trial from April-November 2021. Participants completed a baseline survey, the Stanford Sleepiness Scale, Visual Analog Mood Scale, Digit Symbol Substitution Test, Trail Making Test, Psychomotor Vigilance Test, and Simple Reaction Time Tests. Participants were then randomized and allocated to receive 300 mg cannabidiol oil (N = 21) or placebo (N = 19). After 120 min, participants retook the tests. Performance between groups was compared using Analysis of Covariance and multi-level Negative Binomial regression. Participants averaged 21 ± 3 years of age, and 52% were female. Self-reported anxiety did not change posttreatment. Performances on the Stanford Sleepiness Scale, Visual Analog Mood Scale, and Psychomotor Vigilance Test increased for both groups. After accounting for baseline scores, attention lapse duration significantly increased for those receiving cannabidiol compared to placebo in the Psychomotor Vigilance Test (76 vs. 66 ms; p = 0.02). Auditory reaction time improved in the cannabidiol group versus placebo for one sound emitted during the Simple Reaction Time Test (241 vs. 245 ms; p = 0.02), but the number of early responses increased from 0.3 to 0.8 for those receiving cannabidiol. While performance on most tests was similar between those receiving cannabidiol and placebo, cannabidiol might affect certain aspects of vigilance. More research and larger trials are needed.

Understanding the Intersectional Relationship of Pain Stigma, Weight Bias Internalization, and Clinical Indicators in a Rural Population with Back Pain: A Survey-Based Study.

BACKGROUND: Stigma is understood to be intersectional, meaning multiple characteristics can be stigmatizing, and they may be both overlapping and coconstitutive. Chronic pain and overweight are common complaints in the spinal surgery clinic. Since being overweight may relate to back pain in a complex fashion, we sought to understand if there is a moderating effect between weight bias and pain stigma. METHODS: This study involves a survey-based, quantitative, cross-sectional, observational design using previously validated measures and demographic and clinical information. There were 192 participants. Statistical calculations were done with statistical package for the social sciences. RESULTS: Pain stigma was not significantly correlated with BMI (body mass index), and weight bias was not significantly correlated with back pain. There was a strong positive correlation between weight bias and pain stigma. There was a strong positive correlation between weight bias and BMI when pain stigma was also high. CONCLUSIONS: Given the relationship between weight stigma and pain, the intersection of weight and pain stigma is important because it indicates the vulnerability of patients with higher BMI to other forms of stigma, such as stigma for their pain complaints. Clinicians should be mindful of expressing pain stigma more significantly amongst patients with higher BMI.

mHealth impact on secondary stroke prevention: a scoping review of randomized controlled trials among stroke survivors between 2010-2020.

Background: A fundamental gap between clinical prevention and self-management awareness heightens the risk for stroke recurrence in approximately one-fourth of the highest risk stroke survivors annually. Secondary stroke prevention has the potential to be promoted by mobile health (mHealth) applications for effective real-world adoption of vascular risk factor mitigation. This scoping review aims to evaluate the impact of mHealth interventions and their effectiveness to reduce recurrent stroke rates among stroke survivors in randomized controlled trials (RCTs). Methods: Scoping review in Ovid Medline, Cochrane Library, CINAHL, and Scopus for RCT literature employing mHealth among stroke populations published in English from 2010 to November 19, 2020. Small or pilot studies that included randomized design were included. Results: A total of 352 abstracts met inclusion criteria; 31 full-text articles were assessed and 18 unique RCTs involving 1,453 patients ultimately fulfilled criteria. Twelve of 18 met the pre-defined primary outcome measure, including 2 studies evaluating feasibility. Eight of 18 only addressed recovery from index stroke deficits. Most outcomes focused on self-reported functional status, mood, quality of life or compliance with intervention; primary outcome was an objective metric in 4/18 (blood pressure readings, step number, obstructive sleep apnea support compliance). Intervention duration 2-12 months, with a median 9 weeks. Conclusions: No high-quality evidence supporting mHealth applications to reduce recurrent stroke was found in this scoping review. Overall, most studies were relatively small, heterogenous, and employed subjective primary outcome measures. mHealth's potential as an effective tool for stroke stakeholders to reduce recurrent stroke rates has not been sufficiently demonstrated in this review. Future randomized studies are needed that explicitly evaluate stroke recurrence rate.

Longitudinal assessment of a Dental and Medical Student Service program in Appalachia: Successes and lessons learned.

OBJECTIVES: Recruiting/retaining healthcare professionals within rural and underserved communities in the United States remains a challenge. The West Virginia University Institute for Community and Rural Health implemented a service scholarship program in 2011 to address a lack of dental and primary care. METHODS: Dental and medical students commit to practice 12-months full time following graduation in a Health Profession Shortage Area (HPSA) or Rural Urban Commuting Area (RUCA) in West Virginia for each $25,000 received. RESULTS: Since inception of the program, 20 of 23 (87 percent) dental recipients had completed their service commitment, 17 (85 percent) are still practicing in WV, and 3 (13 percent) are fulfilling their commitment. Four of 20 medical recipients have repaid (2) or fulfilled (2) program commitments and 16 are completing commitments or deferred during training. Retention rate is 82 percent for both dental and medical professionals following program completion. CONCLUSIONS: Service scholarships effectively engage students to provide care in rural/underserved areas and remain there after program completion.