Identifying Co-Exposure to Opiates and Gabapentin During Pregnancy.

Neonatal withdrawal can be difficult to treat in infants with co-exposure to opiates and gabapentin. Because maternal self-report can underestimate exposures, we evaluated the effect of universal toxicology screening for gabapentin. Identification of co-exposure to opiates and gabapentin increased after implementation of toxicology screening, with implications for improved neonatal care.

Robotic mitral valve operations by experienced surgeons are cost-neutral and durable at 1 year.

BACKGROUND: Robotic mitral valve surgery has potential advantages in patient satisfaction and 30-day outcome. Cost concerns and repair durability limit wider adoption of robotic technology. This study examined detailed cost differences between robotic and sternotomy techniques in relation to outcomes and durability following robotic mitral program initiation. METHODS: Between April 2013 and October 2015, 30-day and 1-year outcomes of 328 consecutive patients undergoing robotic or sternotomy mitral valve repair or replacement by experienced surgeons were examined. Multivariable logistic regression informed propensity matching to derive a cohort of 182 patients. Echocardiographic follow-up was completed at 1 year in all robotic patients. Detailed activity-based cost accounting was applied to include direct, semidirect, and indirect costs with special respect to robotic depreciation, maintenance, and supplies. A quantitative analysis of all hospital costs was applied directly to each patient encounter for comparative financial analyses. RESULTS: Mean predicted risk of mortality was similar in both the robotic (n = 91) and sternotomy (n = 91) groups (0.9% vs 0.8%; P > .431). The total costs of robotic mitral operations were similar to those of sternotomy ($27,662 vs $28,241; P = .273). Early direct costs were higher in the robotic group. There was a marked increase in late indirect cost with the sternotomy cohort related to increased length of stay, transfusion requirements, and readmission rates. Robotic repair technique was associated with no echocardiographic recurrence greater than trace to only mild regurgitation at 1 year. CONCLUSIONS: Experienced mitral surgeons can initiate a robotic program in a cost-neutral manner that maintains clinical outcome integrity as well as repair durability.

Development of an International Clinical Education Extracurricular Experience Through a Collaborative Partnership.

Background and Purpose: Participating in global health care through international clinical education may enhance the development of cultural competence and professionalism. Many logistical issues need to be resolved in the development of international clinical education experiences that meet program requirements. The purpose of this case report is to describe how a university developed such an experience for students by partnering with Amizade Global Service-Learning (Amizade), an organization that facilitates global learning experiences. Case Description: Medical, nursing, and pharmacy students were already participating in a 4-week international health-related service learning rotation through Amizade. The preexisting relationship and contractual agreement with the university provided the necessary legal framework. Amizade staff assisted in finding a physical therapist qualified and willing to host a student. The academic coordinator for clinical education at the university and Amizade liaisons determined living arrangements, schedule, clinical settings, and patient population. The selected student had expressed interest and had met all clinical education placement requirements. The academic coordinator for clinical education had ongoing electronic communications with all parties. Outcomes and Discussion: The student demonstrated predicted attributes of cultural competence and professionalism; through the partnership with Amizade, the student was exposed to several unique interprofessional experiences. The steps used by the university faculty in developing this interprofessional, international clinical education experience through a collaborative partnership may provide guidance for other institutions.

Is there an association of circulatory hospitalizations independent of mining employment in coal-mining and non-coal-mining counties in west virginia?

OBJECTIVE: Exposures associated with coal mining activities, including diesel fuel exhaust, products used in coal processing, and heavy metals and other forms of particulate matter, may impact the health of nearby residents. We investigated the relationships between county-level circulatory hospitalization rates (CHRs) in coal and non-coal-mining communities of West Virginia, coal production, coal employment, and sociodemographic factors. METHODS: Direct age-adjusted CHRs were calculated using West Virginia hospitalizations from 2005 to 2009. Spatial regressions were conducted to explore associations between CHR and total, underground, and surface coal production. RESULTS: After adjustment, neither total, nor surface, nor underground coal production was significantly related to rate of hospitalization for circulatory disease. CONCLUSIONS: Our findings underscore the significant role sociodemographic and behavioral factors play in the health and well-being of coal mining communities.

Effect of web-based training for Department of Motor Vehicle staff on donor designation rates: results of a statewide randomized trial.

On approach to addressing the continual shortage of organ donors is to encourage people to join a state donor registry. Joining the registry saves time and assures family members that organ donation is what their loved one would want. However, fewer than half of adults have taken this step. We tested a brief, web-based training program for department of motor vehicles (DMV) staff that educates them about organ and tissue donation and also models the correct way to interact with customers. The intervention was developed with extensive input and active participation from DMV staff. After a small-scale pilot test, all DMV offices across the state of West Virginia (WV) were randomized to receive the training or serve as a comparison group. The results showed that customers of DMV staff who had received the training were 7.5% more likely to register as organ donors. A conservative estimate is that this generates approximately 800 additional donor designations per month. An important aspect of web-based training is that once it has been deployed, it can continue to be used without incurring additional cost; the state of WV currently requires all new employees to complete the training program. This type of training can be adopted nationwide.

The association of respiratory hospitalization rates in WV counties, total, underground, and surface coal production and sociodemographic covariates.

BACKGROUND: Exposures associated with coal mining have long been linked to occupational disease. More recently, investigators have suggested that this industry may affect community health. METHODS: We explored associations between age-adjusted, county-level respiratory disease hospitalization rates (RHRs) in West Virginia and total, surface, and underground coal production, taking into account relevant sociodemographic and behavioral covariates. RHRs were calculated for 2005 to 2009, and analyses were performed to assess the effect of coal production after adjusting for sociodemographic factors. RESULTS: After controlling for percent below poverty, percent urban, and smoking, neither total nor underground tonnage was associated with RHR. Surface coal production, however, was significantly related with RHR (P < 0.05). CONCLUSIONS: Surface coal production makes a small but significant contribution to RHR in West Virginia after accounting for other important sociodemographic and behavioral determinants of health.

Association between birth characteristics and coronary disease risk factors among fifth graders.

OBJECTIVE: To evaluate the associations between selected birth characteristics-prematurity and poor intrauterine growth-and risk factors for coronary artery disease detected among children enrolled in the fifth grade. STUDY DESIGN: Children (n = 3054) with matched birth and fifth grade health screening data on body mass index (BMI), systolic blood pressure, and fasting lipid profiles were analyzed using MANOVA with the following independent variables of weight gain by the fifth grade: BMI percentile, normal or overweight/obese (BMI ≥ 85 th percentile), prematurity, and intrauterine growth (ie, small for gestational age [SGA], appropriate for gestational age [AGA], or large for gestational age [LGA]). RESULTS: LGA status at birth was associated with overweight/obesity later in life. In fifth grade, overweight/obese children had elevated systolic blood pressure and abnormal levels of most fasting serum lipids compared with normal-weight children regardless of birth characteristics. Beyond the effects of BMI percentile, preterm infants had higher levels of triglycerides (TG) than term infants by the fifth grade (P < .05). SGA infants who become overweight/obese had higher levels of TGs and very low-density lipoproteins compared with AGA and LGA infants, whether overweight or normal weight (P < .05). CONCLUSION: BMI ≥ 85 th percentile in the fifth grade is associated with abnormalities in most coronary artery risk factors regardless of birth characteristics. Beyond the effects of BMI percentile in the fifth grade, preterm infants had higher TG levels than term infants. SGA infants who were overweight/obese in the fifth grade had higher TG and very low-density lipoprotein levels compared with AGA and LGA infants who were overweight/obese or of normal weight in the fifth grade.

Health status of migrant farmworkers in the Shenandoah Valley.

The purpose of this study is to describe the characteristics and health status of a sample of migrant farmworkers in the Shenandoah Valley. The methodology for this study is a retrospective record review and analysis of data on 390 male migrant farmworkers. The group included men from Mexico (57. 2%), Jamaica (26. 9%), and Haiti (13. 0%) with a mean age of 38.5 years. The most common health problems reported were work-related and included musculoskeletal pain, irritated eyes, and respiratory symptoms. This study identifies areas for community and public health nurses to target interventions to address health promotion/disease prevention efforts.

Stories from the field.

"Stories From the Field" is a series of short profiles of tobacco control programs and their leaders, showcasing promising technical assistance and training models in Louisiana, Puerto Rico, the Cherokee Nation, West Virginia, the Pacific Islands, and the Virgin Islands. The series illuminates key themes of collaboration with diverse stakeholders, elimination of health disparities, building tobacco control coalitions, engaging youth to reduce commercial tobacco use, sustaining tobacco control efforts, and the use of the media to raise public awareness that are highlighted in the Health Promotion Practice Supplement Theme Issue, Training and Technical Assistance: Lessons Learned to Sustain Social Norm Changes in Tobacco Control. Common tobacco control strategies bind the stories together. Local knowledge, coalition building, community involvement, innovative partnerships, and educational outreach are at the core of all of these tobacco control projects.

Influence of representation targets on the total area of conservation-area networks.

Systematic conservation planning typically requires specification of quantitative representation targets for biodiversity surrogates such as species, vegetation types, and environmental parameters. Targets are usually specified either as the minimum total area in a conservation-area network in which a surrogate must be present or as the proportion of a surrogate's existing spatial distribution required to be in the network. Because the biological basis for setting targets is often unclear, a better understanding of how targets affect selection of conservation areas is needed. We studied how the total area of conservation-area networks depends on percentage targets ranging from 5% to 95%. We analyzed 12 data sets of different surrogate distributions from 5 regions: Korea, Mexico, Québec, Queensland, and West Virginia. To assess the effect of spatial resolution on the target-area relationship, we also analyzed each data set at 7 spatial resolutions ranging from 0.01 degrees x 0.01 degrees to 0.10 degrees x 0.10 degrees. Most of the data sets showed a linear relationship between representation targets and total area of conservation-area networks that was invariant across changes in spatial resolution. The slope of this relationship indicated how total area increased with target level, and our results suggest that greater surrogate representation requires significantly more area. One data set exhibited a highly nonlinear relationship. The results for this data set suggest a new method for setting targets on the basis of the functional form of target-area relationships. In particular, the method shows how the target-area relationship can provide a rationale for setting targets solely on the basis of distributional information about surrogates.

Chronic gastrointestinal symptoms of Thomas "Stonewall" Jackson following Mexican-American War exposure: a medical hypothesis.

In a recent study, a large proportion of veterans seen for chronic heartburn or dyspepsia after the Persian Gulf War had evidence for Helicobacter pylori. Thomas Jackson was born and raised in an area of West Virginia that has a high prevalence of H. pylori. He suffered chronic dyspeptic symptoms following his service in the Mexican-American War. Therapies that he tried included treatment with a variant of the Sippy diet. Following a bullet wound to the left arm at the battle of Chancellorsville on Saturday, May 2, 1863, Thomas Jackson underwent amputation of the left arm below the left shoulder. He died 1 week later with a diagnosis of pleuropneumonia. The records of the postsurgical course are incomplete. The available clinical information raises the hypothesis that his chronic dyspepsia and his cause of death could have been related to chronic peptic ulcer disease due to gastric H. pylori infection.