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1.
Med Educ Online ; 29(1): 2372919, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-38954754

RESUMO

The importance of culinary and lifestyle medicine education to combat the growing burden of chronic disease is gaining recognition in the United States. However, few medical schools offer in-depth training with a 4-year longitudinal track. The Culinary and Lifestyle Medicine Track (CLMT) is a 4-year curriculum thread created at West Virginia University School of Medicine to address the need for comprehensive culinary and lifestyle medicine education. CLMT teaches concepts of healthy nutrition, physical activity, stress management, and restorative sleep. CLMT students complete approximately 300 h of in-person and virtual culinary and lifestyle medicine education, including hands-on teaching kitchens, distributed over the preclinical and clinical years. Students are selected into the track prior to matriculation after an application and interview process. The students have exceeded expectations for scholarly and community activity. Track graduates have entered into primary care as well as specialty and surgical residencies, demonstrating that lifestyle education plays a role for students interested in a wide range of careers. Exit survey responses from learners reflected tangible and intangible benefits of participation and offered constructive feedback for improvement. Presented here are the components of the curricular design, implementation, and initial outcomes.


Assuntos
Currículo , Educação de Graduação em Medicina , Estilo de Vida , Humanos , Educação de Graduação em Medicina/organização & administração , Culinária , Estudantes de Medicina/psicologia , West Virginia , Exercício Físico , Estudos Longitudinais
2.
Occup Environ Med ; 81(6): 296-301, 2024 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-38886046

RESUMO

OBJECTIVES: Spirometry is the primary lung function test utilised for medical surveillance and disability examination for coal mine dust lung disease. However, spirometry likely underestimates physiologic impairment. We sought to characterise abnormalities of single-breath diffusing capacity for carbon monoxide (DLCO) among a population of former coal miners. METHODS: Data from 3115 former coal miners evaluated at a West Virginia black lung clinic between 2006 and 2015 were retrospectively analysed to study the association between diffusion impairment (abnormally low DLCO), resting spirometry and the presence and severity of coal workers' pneumoconiosis on chest radiography. We developed ordinary least squares linear regression models to evaluate factors associated with per cent predicted DLCO (DLCOpp). RESULTS: Diffusion impairment was identified in 20.2% of subjects. Ten per cent of all miners with normal spirometry had diffusion impairment including 7.4% of never smokers. The prevalence of diffusion impairment increased with worsening radiographic category of pneumoconiosis. Mean DLCOpp decreased with increasing small opacity profusion subcategory in miners without progressive massive fibrosis. Linear regression analysis also showed significant decreases in DLCOpp with increasing small opacity profusion and presence of large opacities. CONCLUSIONS: Diffusion impairment is common among former coal miners, including among never smokers, miners without radiographic pneumoconiosis and miners with normal spirometry. These findings demonstrate the value of including DLCO testing in disability examinations of former coal miners and an important role for its use in medical surveillance of working miners to detect early chronic lung disease.


Assuntos
Antracose , Minas de Carvão , Capacidade de Difusão Pulmonar , Espirometria , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Antracose/fisiopatologia , Antracose/epidemiologia , Idoso , Avaliação da Deficiência , West Virginia/epidemiologia , Feminino , Adulto , Pulmão/fisiopatologia , Pulmão/diagnóstico por imagem , Exposição Ocupacional/efeitos adversos , Modelos Lineares
4.
Health Aff (Millwood) ; 43(5): 651-658, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38709971

RESUMO

Guaranteed small cash incentives were widely employed by policy makers during the COVID-19 vaccination campaign, but the impact of these programs has been largely understudied. We were the first to exploit a statewide natural experiment of one such program implemented in West Virginia in 2021 that provided a $100 incentive to fully vaccinated adults ages 16-35. Using individual-level data from the Census Bureau's Household Pulse Survey, we isolated the policy effect through a difference-in-discontinuities design that exploited the discontinuity in incentive eligibility at age thirty-five. We found that the $100 incentive was associated with a robust increase in the proportion of people ever vaccinated against COVID-19 and the proportion who completed or intended to complete the primary series of COVID-19 vaccines. The policy effects were also likely to be more pronounced among people with low incomes, those who were unemployed, and those with no prior COVID-19 infection. The guaranteed cash incentive program may have created more equitable access to vaccines for disadvantaged populations. Additional outreach may also be needed, especially to unvaccinated people with prior COVID-19 infections.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Motivação , Humanos , West Virginia , COVID-19/prevenção & controle , Adulto , Masculino , Adulto Jovem , Feminino , Vacinas contra COVID-19/economia , Vacinas contra COVID-19/provisão & distribuição , Adolescente , Programas de Imunização/economia , Vacinação/estatística & dados numéricos , Vacinação/economia , SARS-CoV-2
5.
Int J Pediatr Otorhinolaryngol ; 181: 111988, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38795462

RESUMO

BACKGROUND: Increasing evidence suggests that autoimmune disorders and their immunomodulating medications may increase the risk of rhinosinusitis. The goal of this study is to determine if autoimmune and autoinflammatory diseases are associated with increased risk of chronic rhinosinusitis (CRS) in children. METHODS: A retrospective case-control study of pediatric patients (age 2-18 years) seen in the West Virginia University Hospitals System in the past 10 years was performed. Cases were children with autoimmune or autoinflammatory diseases. Controls were children without any autoimmune or autoinflammatory disorders. Query of our electronic medical record (Epic) was performed using ICD-10 codes. Univariate (unadjusted) and multivariate (adjusted) logistic regression were used to calculate the strength of association of autoimmune or autoinflammatory disorders with CRS and the other airway disorders while adjusting for age, sex, and race. RESULTS: 420582 pediatric patients were queried with mean age of 10.8 years (SD of 4.8, range of 2-18 years), and 47.9% being female. 1956 (0.5%) had autoimmune disorders and 293 (0.07%) had autoinflammatory disorders. Both autoimmune and autoinflammatory disorders increase the odds of having CRS in the unadjusted [OR = 3.36, p < 0.001 and 5.69, p < 0.001 for the respectively] and the adjusted [OR = 2.90, p < 0.001 and OR = 5.07, p < 0.001 respectively after adjusting for age, sex, and race] models. CONCLUSION: Autoimmune and autoinflammatory disorders increase the risk of CRS and chronic rhinitis in children.


Assuntos
Doenças Autoimunes , Rinite , Sinusite , Humanos , Sinusite/epidemiologia , Criança , Feminino , Masculino , Rinite/epidemiologia , Adolescente , Doença Crônica , Estudos Retrospectivos , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/complicações , Pré-Escolar , Estudos de Casos e Controles , West Virginia/epidemiologia , Fatores de Risco , Rinossinusite
6.
Soc Sci Med ; 350: 116926, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38696937

RESUMO

Obituaries are often the only published record of an individual's life and elicit community reactions, including stigmatization. Because obituaries are typically written by the bereaved, their content reflects the writer's perceptions of mores governing the social context of the next-of-kin and decedent. When a cause of death is stigmatized, it can influence the way the bereaved write the obituary. However, what constitutes a stigmatized cause of death may change as larger societal discourses of morality shift and conditions or events become framed differently. Using a sample of obituaries (N = 210) from obituary aggregator Legacy.com of "off-time," or premature, deaths in West Virginia from 2010, 2015, 2017, and 2019, this article explores whether the presentation of overdose deaths in obituaries changes alongside the shift in the public framing of the opioid crisis as medical rather than criminal. I find obituaries including terms associated with drug use and overdose become both more common and explicit over the course of the study period. This suggests that the shift in public framing of the opioid crisis from criminalization to medicalization corresponds with a decrease in drug stigmatization in obituaries. Obituary analysis can be a useful means of exploring the stigmatization of other controversial causes of death, such as suicide, cirrhosis, and lung cancer.


Assuntos
Overdose de Drogas , Estigma Social , Humanos , Overdose de Drogas/psicologia , West Virginia
7.
J Investig Med High Impact Case Rep ; 12: 23247096241244729, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38577759

RESUMO

This case centers on a 76-year-old male experiencing exertional dyspnea and hemoptysis, with a medical history marked by recurrent pulmonary embolism and chronic obstructive pulmonary disease (COPD). Notably, he resides in a histoplasmosis-endemic area. A computed tomography (CT) pulmonary embolism scan revealed notable findings, including an enlarged right lower pulmonary artery, vascular congestion, atelectasis, and a mass exerting pressure on the right lower pulmonary vein. Biopsy results identified the mass as fibrosing mediastinitis, likely attributed to histoplasmosis. A transthoracic echocardiogram indicated right ventricular dilatation, impaired function, and a right ventricular systolic pressure of 63 mm Hg. During right heart catheterization, the patient displayed disparate pulmonary artery wedge pressures (PAWPs) between the right and left sides. This discrepancy was linked to a blunted back wave from the left atrium to the catheter, induced by pulmonary vein compression. Although an infrequent phenomenon, the recorded asymmetry in PAWPs played a crucial role in guiding accurate patient management. The absence of subsequent evaluation of PAWP on the left side could have altered the treatment plan, potentially delaying appropriate patient care. This case emphasizes the necessity of thorough exploration with right heart catheterization when clinical symptoms warrant, highlighting the importance of standardized practices in such procedures.


Assuntos
Histoplasmose , Mediastinite , Embolia Pulmonar , Esclerose , Estenose de Veia Pulmonar , Idoso , Humanos , Masculino , Fibrose , Histoplasmose/complicações , Mediastinite/complicações , Mediastinite/diagnóstico , Embolia Pulmonar/complicações , Estenose de Veia Pulmonar/diagnóstico , Estenose de Veia Pulmonar/diagnóstico por imagem , West Virginia
8.
J Wildl Dis ; 60(3): 745-752, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38685759

RESUMO

Wildlife translocation and cross-species transmission can impede control and elimination of emerging zoonotic diseases. Tracking the geographic origin of both host and virus (i.e., translocation versus local infection) may help determine the most effective response when high-risk cases of emerging pathogens are identified in wildlife. In May 2022, a coyote (Canis latrans) infected with the raccoon (Procyon lotor) rabies virus variant (RRV) was collected in Lewis County, West Virginia, USA, an area free from RRV. We applied host population genomics and RRV phylogenetic analyses to determine the most likely geographic origin of the rabid coyote. Coyote genomic analyses included animals from multiple eastern states bordering West Virginia, with the probable origin of the rabid coyote being the county of collection. The RRV phylogenetic analyses included cases detected from West Virginia and neighboring states, with most similar RRV sequences collected in a county 80 km to the northeast, within the oral rabies vaccination zone. The combined results suggest that the coyote was infected in an RRV management area and carried the RRV to Lewis County, a pattern consistent with coyote local movement ecology. Distant cross-species transmission and subsequent host movement presents a low risk for onward transmission in raccoon populations. This information helped with emergency response decision-making, thereby saving time and resources.


Assuntos
Coiotes , Filogenia , Vírus da Raiva , Raiva , Animais , Coiotes/virologia , West Virginia/epidemiologia , Raiva/veterinária , Raiva/epidemiologia , Vírus da Raiva/genética , Vírus da Raiva/isolamento & purificação , Vírus da Raiva/classificação , Guaxinins/virologia , Animais Selvagens
9.
Traffic Inj Prev ; 25(4): 579-588, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38572915

RESUMO

OBJECTIVES: The purpose of this study was to assess sociodemographic and behavioral risk factors associated with driving after marijuana use (DAMU) among West Virginia college students. METHODS: Participants were recruited from West Virginia University between September and November 2022. The study sample was restricted to students who were ≥18 years of age; reported recently driving; possessed a current, valid driver's license from any US state; and were enrolled for at least one credit hour in the Fall 2022 semester. RESULTS: Among respondents (N = 772), 28.9% reported DAMU. Students who had a GPA of B (adjusted odds ratio [AOR]: 2.17, 95% confidence interval [CI]: 1.06-4.42), smoked or ingested marijuana in the past year (AOR: 26.51, 95% CI: 10.27-68.39), drove after drinking (AOR: 2.38, 95% CI: 1.18-4.79), and used both marijuana and alcohol concurrently and then drove (AOR: 10.39, 95% CI: 2.32-46.54) associated with DAMU. Individuals who felt the behavior was somewhat dangerous or not dangerous or thought their peers approved of DAMU showed significant associations with DAMU. CONCLUSIONS: As DAMU was prevalent, future interventions that raise awareness of the danger and potential consequences of DAMU may be needed to reduce this risky behavior on college campuses.


Assuntos
COVID-19 , Uso da Maconha , Transtornos Relacionados ao Uso de Substâncias , Humanos , Uso da Maconha/epidemiologia , Pandemias , West Virginia/epidemiologia , Consumo de Bebidas Alcoólicas/epidemiologia , Acidentes de Trânsito , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estudantes , Universidades
10.
Int J Cardiovasc Imaging ; 40(6): 1305-1317, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38625628

RESUMO

Breast cancer chemotherapy/immunotherapy can be associated with treatment-limiting cardiotoxicity. Radiomics techniques applied to ultrasound, known as ultrasomics, can be used in cardio-oncology to leverage echocardiography for added prognostic value. To utilize ultrasomics features collected prior to antineoplastic therapy to enhance prediction of mortality and heart failure (HF) in patients with breast cancer. Patients were retrospectively recruited in a study at the West Virginia University Cancer Institute. The final inclusion criteria were met by a total of 134 patients identified for the study. Patients were imaged using echocardiography in the parasternal long axis prior to receiving chemotherapy. All-cause mortality and HF, developed during treatment, were the primary outcomes. 269 features were assessed, grouped into four major classes: demographics (n = 21), heart function (n = 7), antineoplastic medication (n = 17), and ultrasomics (n = 224). Data was split into an internal training (60%, n = 81) and testing (40%, n = 53) set. Ultrasomics features augmented classification of mortality (area under the curve (AUC) 0.89 vs. 0.65, P = 0.003), when compared to demographic variables. When developing a risk prediction score for each feature category, ultrasomics features were significantly associated with both mortality (P = 0.031, log-rank test) and HF (P = 0.002, log-rank test). Further, only ultrasomics features provided significant improvement over demographic variables when predicting mortality (C-Index: 0.78 vs. 0.65, P = 0.044) and HF (C-Index: 0.77 vs. 0.60, P = 0.017), respectively. With further investigation, a clinical decision support tool could be developed utilizing routinely obtained patient data alongside ultrasomics variables to augment treatment regimens.


Assuntos
Neoplasias da Mama , Cardiotoxicidade , Causas de Morte , Insuficiência Cardíaca , Valor Preditivo dos Testes , Humanos , Feminino , Pessoa de Meia-Idade , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/diagnóstico por imagem , Neoplasias da Mama/mortalidade , Neoplasias da Mama/tratamento farmacológico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Idoso , Antineoplásicos/efeitos adversos , Adulto , West Virginia , Fatores de Tempo , Ecocardiografia , Prognóstico , Função Ventricular Esquerda
11.
Poult Sci ; 103(5): 103576, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38430779

RESUMO

Chicken and chicken products have been associated with foodborne pathogens such as Salmonella, Campylobacter, and Escherichia coli (E. coli). Poultry comprises an important segment of the agricultural economy (75 million birds processed as of 2019) in West Virginia (WV). The risk of pathogens on processed chickens has risen with the increased popularity of mobile poultry processing units (MPPUs). This study evaluated the microbial safety of broilers processed in a MPPU in WV. This study assessed aerobic plate counts (APCs), E. coli counts and the presence/absence of Salmonella and Campylobacter on 96 broiler carcasses following each MPPU step of scalding, eviscerating, and chilling. Samples were either chilled in ice water only (W) or ice water with 5 ppm chlorine (CW). The highest number of bacteria recovered from carcasses were APCs (4.21 log10CFU/mL) and E. coli (3.77 log10CFU/mL; P = 0.02). A total reduction of 0.30 (P = 0.10) and 0.63 (P = 0.01) log10CFU/mL for APCs and E. coli, respectively, occurred from chilling carcasses in CW. Overall, results show that E. coli, Salmonella, and Campylobacter were significantly (P < 0.05) reduced from the initial scalding to the chilling step. However, Salmonella frequency doubled (15.63-34.38%) after the evisceration step, indicating that washing carcasses after evisceration may be a critical control point in preventing cross-contamination by Salmonella. Proper chilling is also an important microbial mitigation step in MPPU processing. Results indicate that Campylobacter was more resistant to chilling than Salmonella. Campylobacter was not completely inactivated until carcasses were chilled in CW, whereas W was sufficient to reduce Salmonella on carcasses. The results led to the conclusion that although 5 ppm chlorine (Cl2) achieved more bacterial reductions than water alone, the reductions were not always significant (P > 0.05). Further MPPU studies are needed to verify more effective chilling and processing strategies.


Assuntos
Campylobacter , Galinhas , Escherichia coli , Manipulação de Alimentos , Microbiologia de Alimentos , Salmonella , Animais , Galinhas/microbiologia , Campylobacter/isolamento & purificação , Manipulação de Alimentos/métodos , Salmonella/isolamento & purificação , Escherichia coli/isolamento & purificação , Escherichia coli/fisiologia , West Virginia , Carne/microbiologia , Carne/análise
12.
Harm Reduct J ; 21(1): 57, 2024 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-38443903

RESUMO

BACKGROUND: Co-use of methamphetamine (MA) and opioids (pharmaceutical pills, heroin and fentanyls) has increased in the United States and is represented in rising mortality. Although coinciding with the import of low cost, high potency and purity methamphetamine, the relationship between supply and demand in propelling this polydrug use is not well understood. We consider the influence of macro changes in supply on the uptake of opioid and methamphetamine co-use by injection at the level of individual drug and injection initiation in West Virginia, a state which leads the US in drug overdose mortality. METHOD: We recruited n = 30 people for semi-structured interviews who self-reported injecting heroin/fentanyl and using methamphetamine by any route at a West Virginia syringe service program and through snowball sampling. Interviews were recorded and transcripts analyzed using a thematic approach. Ethnographic observation was also conducted and recorded in fieldnotes. Sequence of substance and mode of use initiation and use trajectories for opioids and stimulants were charted for each participant. RESULTS: A clear pattern of individual drug initiation emerged that matched each successive supply wave of the US overdose epidemic: 25 participants had initiated opioid use with pills, followed by heroin, often mixed with/replaced by fentanyl, and subsequently added methamphetamine use. For participants, the supply and consumption of opioid analgesics had set in motion a series of steps leading to the addition of stimulant injection to existing opioid injecting repertoires. Unlike other studies that have found a birth cohort effect in patterns of initiation, participants showed the same sequence across age groups. Considerations of economy, availability, dependence, tolerance and the erosion of taboos that marked transitions from opioid pills to heroin injection influenced these subsequent trajectories in novel ways. The form, timing and extent of opioid and stimulant consumption was influenced by four stages of the changing drug supply, which in turn reflected back on demand. CONCLUSION: Transformations in the social meaning and supply of methamphetamine enabled these transitions while other desired, non-injectable drugs were difficult to obtain. We discuss policy implications of injectable drugs' market dominance at this location and possible interventions.


Assuntos
Overdose de Drogas , Metanfetamina , Humanos , Analgésicos Opioides , Heroína , Fentanila , West Virginia
13.
J Expo Sci Environ Epidemiol ; 34(3): 512-517, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38448680

RESUMO

Self-reported distances to industrial sources have been used in epidemiology as proxies for exposure to environmental hazards and indicators of awareness and perception of sources. Unconventional oil and gas development (UOG) emits pollutants and has been associated with adverse health outcomes. We compared self-reported distance to the nearest UOG well to the geographic information system-calculated distance for 303 Pennsylvania, Ohio, and West Virginia residents using Cohen's Weighted Kappa. Agreement was low (Kappa = 0.18), and self-reports by Ohioans (39% accuracy) were more accurate than West Virginians (22%) or Pennsylvanians (13%, both p < 0.05). Of the demographic characteristics studied, only educational attainment was related to reporting accuracy; residents with 12-16 years of education were more accurate (31.3% of group) than those with <12 or >16 years (both 16.7%). Understanding differences between objective and subjective measures of UOG proximity could inform studies of perceived exposures or risks and may also be relevant to adverse health effects. IMPACT: We compared objective and self-reported measures of distance to the nearest UOG well for 303 Appalachian Basin residents. We found that residents' self-reported distance to the nearest UOG well had limited agreement with the true calculated distance category. Our results can be used to inform the collection and contextualize the use of self-reported data in communities exposed to UOGD. Self-reported metrics can be used in conjunction with objective assessments and can be informative regarding how potentially exposed populations perceive environmental exposures or risks and could provide insights into awareness of distance-related policies, such as setbacks.


Assuntos
Exposição Ambiental , Campos de Petróleo e Gás , Autorrelato , Humanos , West Virginia , Pennsylvania , Ohio , Exposição Ambiental/análise , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Sistemas de Informação Geográfica , Idoso , Adolescente , Adulto Jovem , Indústria de Petróleo e Gás
14.
Telemed J E Health ; 30(6): e1798-e1804, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38512469

RESUMO

Objective: To examine how specialist-to-pediatric primary care provider (PPCP) consultative support may impact PPCP comfort in providing gender-affirming care. Methods: PPCPs in West Virginia completed an electronic survey. T-tests compared comfort providing gender-affirming care and rank-sum tests compared the practicality of four consultative support modalities by time in practice and specialty. Results: Of 51 participants, 47.1% had been in practice for <10 years and 59.6% were trained in pediatrics. PPCPs with <10 years in practice and those trained in pediatrics were more comfortable providing gender-affirming care than those in practice >10 years and those trained in family medicine. PPCPs felt that telemedicine was more practical than tele-education, although they reported all consultative support modalities would increase comfort providing this care. Conclusions: Access to consultative support can increase PPCP comfort providing gender-affirming care, although certain modalities may be more effective for PPCPs with varying levels of experience and specialty training.


Assuntos
Atenção Primária à Saúde , Humanos , Feminino , Masculino , Atenção Primária à Saúde/organização & administração , West Virginia , Adulto , Pediatria/educação , Encaminhamento e Consulta , Telemedicina/organização & administração , Atitude do Pessoal de Saúde , Pessoa de Meia-Idade , Pessoas Transgênero/psicologia , Serviços de Saúde Rural/organização & administração , Assistência à Saúde Afirmativa de Gênero
15.
Subst Use Misuse ; 59(8): 1174-1181, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38509704

RESUMO

BACKGROUND: Community concerns surrounding syringe waste are a common barrier to syringe services program (SSP) implementation. In Kanawha County, West Virginia, community opposition to SSPs resulted in the closure of needs-based SSPs prior to and during an HIV outbreak among persons who inject drugs (PWID). This qualitative analysis examines views of PWID and community partners on syringe waste and disposal associated with needs-based SSPs. METHODS: Qualitative interviews with 26 PWID and 45 community partners (medical and social service providers, law enforcement personnel, policymakers, and religious leaders) were conducted. Interviews were recorded, transcribed, and coded. Code summaries described participants' views on syringe waste and disposal and needs-based SSPs. RESULTS: Community partners and PWID who favored needs-based SSPs reported that needs-based SSPs had not affected or reduced syringe waste. Conversely, community partners who favored one-to-one exchange models and/or barcoded syringes described needs-based SSPs increasing syringe waste. Community partners often cited pervasive community beliefs that SSPs increased syringe waste, risk of needlesticks, drug use, and crime. Community partners were unsure how to address syringe waste concerns and emphasized that contradictory views on syringe waste posed barriers to discussing and implementing SSPs. CONCLUSIONS: Participants' views on whether syringe waste was associated with needs-based SSPs often aligned with their support or opposition for needs-based SSPs. These differing views resulted in challenges finding common ground to discuss SSP operations amid an HIV outbreak among PWID. SSPs might consider addressing syringe waste concerns by expanding syringe disposal efforts and implementing community engagement and stigma reduction activities.


Assuntos
Programas de Troca de Agulhas , Abuso de Substâncias por Via Intravenosa , Humanos , Abuso de Substâncias por Via Intravenosa/psicologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Feminino , Masculino , Adulto , Seringas , Infecções por HIV/prevenção & controle , West Virginia/epidemiologia , Pessoa de Meia-Idade , Pesquisa Qualitativa
16.
Am J Health Syst Pharm ; 81(14): 615-621, 2024 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-38373082

RESUMO

PURPOSE: The need for monitoring and standardization of anticoagulation management has garnered the attention of national organizations, driving the implementation of antithrombotic stewardship programs (ASPs). Established ASPs have highlighted interdisciplinary collaboration between physicians, nurses, and pharmacists and demonstrated financial benefits and positive patient care outcomes. While pharmacy technicians are key members of the pharmacy profession, they are rarely utilized to expand clinical programs. The aim of this report is to describe the impact of adding a pharmacy technician to an ASP at an academic medical center. SUMMARY: The departments of pharmacy and quality at West Virginia University Hospitals (WVUH) developed a business plan and financially justified an ASP. The ASP was implemented in January 2022 and consisted of 2 full-time clinical pharmacist specialists, 1 full-time clinical pharmacy technician, 2 full-time clinical nurse specialists, and 1 part-time physician medical director. The clinical pharmacy technician's primary role was to review patients' sequential compression device (SCD) compliance and newly started oral anticoagulants prior to discharge. The clinical nurse specialists educated patients newly started on oral anticoagulants within 24 hours of discharge and triaged any postdischarge medication access issues. The medical director provided high-level program oversight and acted as a clinical consultant on complex patient cases. In the first 6 months after the program's implementation, the clinical pharmacy technician made 174 recommendations to the clinical pharmacist specialists regarding discharge transitions of care and assessed SCD compliance in 246 patients. Of the 246 patients assessed, 217 patients (88%) were deemed to be noncompliant. CONCLUSION: The pharmacy department at WVUH successfully justified and implemented an interprofessional ASP at an academic medical center, which is the first ASP to date to incorporate a clinical pharmacy technician.


Assuntos
Centros Médicos Acadêmicos , Anticoagulantes , Serviço de Farmácia Hospitalar , Técnicos em Farmácia , Papel Profissional , Humanos , Técnicos em Farmácia/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Farmacêuticos/organização & administração , West Virginia , Equipe de Assistência ao Paciente/organização & administração , Fibrinolíticos/uso terapêutico , Fibrinolíticos/administração & dosagem , Relações Interprofissionais
17.
J Adolesc Health ; 74(6): 1088-1094, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38323962

RESUMO

PURPOSE: Pediatric primary care providers (PPCPs) often care for gender diverse youth (GDY), particularly in rural areas, but little is known about their relevant knowledge, attitudes, or educational experiences regarding caring for this population. METHODS: This study surveyed PPCPs throughout the rural state of West Virginia using an online survey assessing 1) demographics, 2) knowledge, 3) attitudes, and 4) educational experiences. Knowledge and attitude scores were calculated and proportion-tests and t-tests were used to compare these scores by PPCP characteristics including age, time in practice, and training background. RESULTS: In total, 51 PPCPs from throughout the state completed the survey and 82% had cared for GDY in the prior year. Younger providers (

Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Atenção Primária à Saúde , Humanos , West Virginia , Feminino , Masculino , Adulto , Inquéritos e Questionários , Atitude do Pessoal de Saúde , Pessoa de Meia-Idade , Pediatria/educação , Adolescente
18.
Diabetes Res Clin Pract ; 208: 111126, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38311246

RESUMO

OBJECTIVE: To examine the rate of gestational diabetes mellitus (GDM) prevalence before and during the COVID-19 pandemic. RESULTS: Analysis revealed that GDM prevalence was significantly higher during the COVID-19 pandemic compared to pre-pandemic (8.59 % vs 7.77 %). The risk of GDM was 12 % higher during the pandemic vs. pre-pandemic (aRR = 1.12, 95 % CI 1.06, 1.19) and the aRD = 0.95 % (95 % CI 0.56 %, 1.33 %) adjusting for maternal age and substance use in pregnancy. CONCLUSIONS: GDM rates in WV increased from the period directly before the COVID-19 pandemic to during the COVID-19 pandemic. More research is needed to understand the pathophysiological mechanisms of pandemics and pandemic-related risk factors for this observed association. Supporting pregnant individuals during such events is critical to both maternal and child health.


Assuntos
COVID-19 , Diabetes Gestacional , Gravidez , Criança , Feminino , Humanos , Diabetes Gestacional/epidemiologia , COVID-19/epidemiologia , Pandemias , West Virginia/epidemiologia , Fatores de Risco
19.
AIDS Behav ; 28(2): 669-681, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38165598

RESUMO

In response to an increase in HIV diagnoses among persons who inject drugs (PWID) in Kanawha County, West Virginia, West Virginia Bureau for Public Health and CDC conducted a qualitative assessment in Kanawha County to inform HIV outbreak response activities. Interviews with 26 PWID and 45 community partners were completed. Transcribed interviews were analyzed to identify barriers to accessing HIV prevention services among PWID using the risk environment framework. Participants identified numerous political, physical, social, and economic community-level barriers that influenced access to HIV prevention services among PWID. Political factors included low community support for syringe services programs (SSPs); physical factors included low SSP coverage, low coverage of HIV testing outreach events, low HIV preexposure prophylaxis availability, and homelessness; social factors included stigma and discrimination; economic factors included community beliefs that SSPs negatively affect economic investments and limited resources for HIV screening in clinical settings. Individual-level barriers included co-occurring acute medical conditions and mental illness. Community-level interventions, such as low-barrier one-stop shop models, are needed to increase access to sterile syringes through comprehensive harm reduction services.


Assuntos
Usuários de Drogas , Infecções por HIV , Abuso de Substâncias por Via Intravenosa , Humanos , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , West Virginia/epidemiologia , Surtos de Doenças , Programas de Troca de Agulhas
20.
Prev Sci ; 25(4): 590-602, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38214789

RESUMO

Sexual violence (SV) on college campuses disproportionately affects cisgender (nontransgender) women, sexual minorities (e.g., gays/lesbians, bisexuals), and gender minority (e.g., transgender/nonbinary) people. This study investigates gender and sexual behavior differences in common SV intervention targets-SV-related knowledge, prevention behaviors, and care-seeking. We analyzed cross-sectional survey data, collected in 9/2015-3/2017, from 2202 students aged 18-24 years attending college health and counseling centers at 28 Pennsylvania and West Virginia campuses. Multivariable multilevel models tested gender and sexual behavior differences in SV history; recognition of SV; prevention behaviors (self-efficacy to obtain sexual consent, intentions to intervene, positive bystander behaviors); and care-seeking behaviors (knowledge of, self-efficacy to use, and actual use of SV services). Adjusting for lifetime exposure to SV, compared with cisgender men, cisgender women had higher recognition of SV and reproductive coercion, prevention behaviors, and care-seeking self-efficacy (beta range 0.19-1.36) and gender minority people had higher recognition of SV and intentions to intervene (beta range 0.33-0.61). Cisgender men with any same-gender sexual partners had higher SV knowledge (beta = 0.23) and self-efficacy to use SV services (beta = 0.52) than cisgender men with only opposite-gender partners. SV history did not explain these differences. Populations most vulnerable to SV generally have higher SV knowledge, prevention behaviors, and care-seeking behaviors than cisgender men with only opposite-gender sexual partners. Innovative SV intervention approaches are necessary to increase SV-related knowledge among heterosexual cisgender men and may need to target alternative mechanisms to effectively reduce inequities for sexual and gender minority people.


Assuntos
Delitos Sexuais , Humanos , Masculino , Feminino , Adulto Jovem , Adolescente , Estudos Transversais , Delitos Sexuais/prevenção & controle , Comportamento Sexual , Conhecimentos, Atitudes e Prática em Saúde , Minorias Sexuais e de Gênero , Pennsylvania , West Virginia , Universidades , Aceitação pelo Paciente de Cuidados de Saúde
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