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2.
Zootaxa ; 4624(2): zootaxa.4624.2.7, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31716226

RESUMO

Alloperla Banks, 1906 (Plecoptera: Chloroperlidae) is a speciose genus of spring- and summer-emergent stoneflies known from the Oriental, eastern Palearctic, and Nearctic realms. Over 50 species are currently recognized. Alloperla clarki sp. nov. is described herein from the adult male stage from a small geographic area in the Appalachian Mountains in Virginia and West Virginia, USA. Diagnostic characters are presented with scanning electron microscope (SEM) photomicrographs. Alloperla clarki sp. nov. most closely resembles A. biserrata Nelson Kondratieff, 1980, A. nanina Banks, 1911, and A. stipitata Surdick, 2004. These four species share similar characteristics of the male epiproct and appear to comprise a species group. The Alloperla nanina Group is formally proposed. Comparative SEM images are also provided for A. biserrata, A. nanina, and A. stipitata to assist with differentiating between these four species.


Assuntos
Insetos , Distribuição Animal , Animais , Região dos Apalaches , Masculino , Virginia , West Virginia
3.
Zootaxa ; 4651(1): zootaxa.4651.1.2, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31716920

RESUMO

The disjunct distribution of Cambarus monongalensis has led to speculation about its taxonomic status. An Appalachian Plateau population occurs in northern and central West Virginia and Southwestern Pennsylvania, and a mountain population occurs in the Allegheny Mountains and Ridge and Valley physiographic provinces of the Virginias. Herein we describe the mountain population as Cambarus fetzneri sp. nov. The two species differ genetically and morphologically, and have different color patterns. Specifically, C. fetzneri sp. nov. chelae lack extensive red coloration on the distal end of the propodus and dactyl, possess rostral margins that lack any red coloration, compared to C. monongalensis, which has extensive red coloration on the dactyl and propodus, as well as red rostral margins. Morphologically, the rostrum of C. fetzneri sp. nov. is shorter and wider than that of C. monongalensis. Also, adult C. fetzneri sp. nov. are considerably smaller in body size than those of C. monongalensis.


Assuntos
Astacoidea , Distribuição Animal , Animais , Região dos Apalaches , Virginia , West Virginia
4.
Oecologia ; 191(4): 971-981, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31617000

RESUMO

Nitrogen deposition in the northeastern US changed N availability in the latter part of the twentieth century, with potential legacy effects. However, long-term N cycle measurements are scarce. N isotopes in tree rings have been used as an indicator of N availability through time, but there is little verification of whether species differ in the strength of this signal. Using long-term records at the Fernow Experimental Forest in West Virginia, we examined the relationship between soil conditions, including net nitrification rates, and wood δ15N in 2014, and tested the strength of correlation between tree ring δ15N of four species and stream water NO3- loss from 1971 to 2000. Higher soil NO3- was weakly associated with higher wood δ15N across species, and higher soil net nitrification rates were associated with higher δ15N for Quercus rubra only. The δ15N of Liriodendron tulipifera and Q. rubra, but neither Fagus grandifolia nor Prunus serotina, was correlated with stream water NO3-. L. tulipifera tree ring δ15N had a stronger association with stream water NO3- than Q. rubra. Overall, we found only limited evidence of a relationship between soil N cycling and tree ring δ15N, with a strong correlation between the wood δ15N and NO3- leaching loss through time for one of four species. Tree species differ in their ability to preserve legacies of N cycling in tree ring δ15N, and given the weak relationships between contemporary wood δ15N and soil N cycle measurements, caution is warranted when using wood δ15N to infer changes in the N cycle.


Assuntos
Florestas , Quercus , Nitrogênio , Solo , West Virginia
5.
J Emerg Manag ; 17(4): 321-333, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31603522

RESUMO

The West Virginia water contamination crisis began on the morning of January 9, 2014, and left approximately 300,000 customers of the West Virginia American Water Company unable to use the water in their homes for any purpose other than flushing their toilets. Given the lack of appropriate response from the established organizations involved, many emergent organizations formed to help fill unmet informational and physical needs of the affected population. Crisis researchers have observed these ephemeral organizations for decades, but the recent proliferation of information communication technologies have made their activities more widespread and observable. In West Virginia, their activities were indispensable to the affected population and helped restore a sense of normalcy. This article analyzes four emergent organizations that formed in response to the West Virginia water contamination and the functions they performed in different phases of this crisis.


Assuntos
Vazamento de Resíduos Químicos , Mídias Sociais , Planejamento em Desastres , Organizações , Água , Abastecimento de Água/estatística & dados numéricos , West Virginia
7.
Int J Pediatr Otorhinolaryngol ; 126: 109617, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31398590

RESUMO

OBJECTIVE: To understand parent perceptions of types and severity of barriers to care within the pediatric otolaryngology patient population in WV. STUDY DESIGN: Descriptive survey. SETTING: University pediatric otolaryngology clinic, Morgantown, WV. SUBJECTS AND METHODS: Subjects were caretakers of pediatric patients in clinic. Subjects were asked to complete the modified validated Barriers to Care Questionnaire (BCQ) and to provide some demographic details.Each BCQ question response was reported as a Mean Total Score (MTS), ranging from 0 (complete barrier) to 100 (no barrier) and they were grouped into 5 BTC subscales. Demographic question responses were used to establish subgroups. Data for subscale groups was compared across the demographic subgroups using non-parametric methods. RESULTS: 301 parents provided responses. The overall mean BTC was 91.59 (95% CI 90.12-93.05). The Expectations and Pragmatics subscales were the two greatest barriers at 88.56 and 90.80, respectively. 26.7% reported no barriers to care. No statistically significant association was found among subscale scores and demographic subgroups. CONCLUSIONS: Parents of pediatric otolaryngology patients in WV demonstrate low expectations of the healthcare system. There are concerns about pragmatics that could create barriers. Our hope is to spur scientific interest in this understudied healthcare topic. Future studies should be conducted to identify association/causation and help establish a framework for addressing potential barriers to care in the pediatric population.


Assuntos
Acesso aos Serviços de Saúde , Otolaringologia , Adolescente , Instituições de Assistência Ambulatorial , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pais , Inquéritos e Questionários , West Virginia
8.
Cancer Causes Control ; 30(10): 1087-1100, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31435875

RESUMO

PURPOSE: This study examined targeted genomic variants of transforming growth factor beta (TGFB) signaling in Appalachian women. Appalachian women with cervical cancer were compared to healthy Appalachian counterparts to determine whether these polymorphic alleles were over-represented within this high-risk cancer population, and whether lifestyle or environmental factors modified the aggregate genetic risk in these Appalachian women. METHODS: Appalachian women's survey data and blood samples from the Community Awareness, Resources, and Education (CARE) CARE I and CARE II studies (n = 163 invasive cervical cancer cases, 842 controls) were used to assess gene-environment interactions and cancer risk. Polymorphic allele frequencies and socio-behavioral demographic measurements were compared using t tests and χ2 tests. Multivariable logistic regression was used to evaluate interaction effects between genomic variance and demographic, behavioral, and environmental characteristics. RESULTS: Several alleles demonstrated significant interaction with smoking (TP53 rs1042522, TGFB1 rs1800469), alcohol consumption (NQO1 rs1800566), and sexual intercourse before the age of 18 (TGFBR1 rs11466445, TGFBR1 rs7034462, TGFBR1 rs11568785). Interestingly, we noted a significant interaction between "Appalachian self-identity" variables and NQO1 rs1800566. Multivariable logistic regression of cancer status in an over-dominant TGFB1 rs1800469/TGFBR1 rs11568785 model demonstrated a 3.03-fold reduction in cervical cancer odds. Similar decreased odds (2.78-fold) were observed in an over-dominant TGFB1 rs1800469/TGFBR1 rs7034462 model in subjects who had no sexual intercourse before age 18. CONCLUSIONS: This study reports novel associations between common low-penetrance alleles in the TGFB signaling cascade and modified risk of cervical cancer in Appalachian women. Furthermore, our unexpected findings associating Appalachian identity and NQO1 rs1800566 suggests that the complex environmental exposures that contribute to Appalachian self-identity in Appalachian cervical cancer patients represent an emerging avenue of scientific exploration.


Assuntos
Fator de Crescimento Transformador beta1/genética , Neoplasias do Colo do Útero/genética , Adulto , Idoso , Alelos , Feminino , Interação Gene-Ambiente , Humanos , Kentucky/epidemiologia , Modelos Logísticos , Pessoa de Meia-Idade , NAD(P)H Desidrogenase (Quinona)/genética , Ohio/epidemiologia , Receptor do Fator de Crescimento Transformador beta Tipo I/genética , Fatores de Risco , Transdução de Sinais , Neoplasias do Colo do Útero/epidemiologia , West Virginia/epidemiologia , Adulto Jovem
9.
Health Care Manag (Frederick) ; 38(3): 258-266, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31261194

RESUMO

West Virginia's opioid epidemic has been the cause of more than 42 000 deaths each year. Opioid abuse has become an issue among pregnant mothers and has increased the effects of neonatal abstinence syndrome (NAS) in infants. The purpose of this study was to evaluate the participation of prenatal opioid maintenance to determine whether it has decreased the amount of treatment needed for NAS in infants in West Virginia. The methodology utilized a literature review complemented with a semistructured interview. Thirty-six sources were referenced for this literature review. It was found that buprenorphine maintenance therapy had the most positive effect on NAS after birth. This review also reported a lack of availability for addicted pregnant women to enroll in maintenance programs and a high dropout rate. Opioid maintenance therapy has permitted pregnant women to refrain from illicit drug use without experiencing withdrawal symptoms, and it has allowed the opportunity for their infants to have better health after birth.


Assuntos
Analgésicos Opioides/administração & dosagem , Buprenorfina/administração & dosagem , Síndrome de Abstinência Neonatal/tratamento farmacológico , /tendências , Adulto , Analgésicos Opioides/efeitos adversos , Buprenorfina/efeitos adversos , Feminino , Humanos , Lactente , Recém-Nascido , Transtornos Relacionados ao Uso de Opioides , Gravidez , Estados Unidos , West Virginia
10.
BMC Public Health ; 19(1): 779, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221120

RESUMO

BACKGROUND: Mini-grants have been used to stimulate multisector collaboration in support of public health initiatives by funding non-traditional partners, such as economic development organizations. Such mini-grants have the potential to increase access to healthy foods and places for physical activity through built environment change, especially in small and rural towns in the United States. Although a promising practice, few mini-grant evaluations have been done. Therefore, our purpose was to conduct an Evaluability Assessment (EA), which is a process that can help promising programs that lack evidence advance toward full-scale evaluation. Specifically, we conducted an Evaluability Assessment of a statewide mini-grant program, called "Growing Healthy Communities" (GHC), to determine if this program was ready for evaluation and identify any changes needed for future implementation and evaluation that could also inform similar programs. METHODS: Telephone interviews with directors of six past mini-grant recipient organizations were conducted to assess implementation and evaluability. The six interviews were split equally among agencies receiving funding for food-oriented projects and physical activity-oriented projects. Within- and cross-case thematic analyses of interview transcripts were conducted. RESULTS: Organizational capacity was a universal theme, reflecting other key themes (described in detail in the manuscript) that affected program implementation and evaluation, including collaboration, limited time and measurement integration. CONCLUSIONS: The EA process provided pilot data that suggest that other state, regional, and national funders should provide centralized assistance for data collection and evaluation from the outset of a mini-grant award program.


Assuntos
Ambiente Construído/estatística & dados numéricos , Organização do Financiamento , Saúde Pública/economia , Planejamento Social , Exercício , Abastecimento de Alimentos/estatística & dados numéricos , Humanos , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , West Virginia
12.
J Opioid Manag ; 15(2): 103-109, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31057342

RESUMO

Objective: Pilot study to assess utility in opioid use disorder (OUD) of a panel of single nucleotide polymorphisms in genes previously related to substance use disorder (SUD) and/or phenotypes that predispose individuals to OUD/SUD. Design: Genetic association study. Setting: West Virginia University's Chestnut Ridge Center Comprehensive Opioid Abuse Treatment (COAT) clinic for individuals diagnosed with OUD. Patients: Sixty patients 18 years of age or older with OUD undergoing medication (buprenorphine/naloxone)-assisted treatment (MAT); all sixty patients recruited contributed samples for genetic analysis. Outcome Measures: Minor allele frequencies for single nucleotide polymorphisms. Results: Four of the fourteen single nucleotide polymorphisms examined were present at frequencies that are statistically significantly different than in a demographically-matched general population. Conclusions: For the purposes of testing WV individuals via genetic means for predisposition to OUD, at least four single nucleotide polymorphisms in three genes are likely to have utility in predicting susceptibility. Additional studies with larger populations will need to be conducted to confirm these results before use in a clinical setting.


Assuntos
Transtornos Relacionados ao Uso de Opioides/genética , Polimorfismo de Nucleotídeo Único , Adolescente , Adulto , Analgésicos Opioides , Estudos de Associação Genética , Humanos , Projetos Piloto , West Virginia
13.
J Am Dent Assoc ; 150(6): 540-548, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31133175

RESUMO

BACKGROUND: Mothers play a primary role in the health of their children. This role may be of particular importance for children in Appalachia who have increased caries relative to children in other regions of the United States. The authors examined the degree to which a child's caries experience was in concordance with the mother's perception of the health of her child's teeth, and how concordance varied by sociodemographic factors. METHODS: The authors obtained cross-sectional data on mother-child dyads with children younger than 6 years through the Center for Oral Health Research in Appalachia study. They interviewed and clinically examined a community-based sample of 815 mother-child dyads from Pennsylvania and West Virginia. They used an unadjusted zero-inflated negative binomial model to estimate the association between a mother's perception of her child's oral health status and her child's caries. The authors compared sociodemographic factors between concordant and nonconcordant mother-child dyads using χ2 tests. RESULTS: The mother's perception of her child's oral health status was associated with the child's caries experience (P < .001). Two-thirds of mother-child dyads showed concordance between the mother's perception of her child's oral health status and the child's caries experience (n = 522, 64%). Concordance was associated with younger child age and the child having dental insurance (P < .01). CONCLUSIONS AND PRACTICAL IMPLICATIONS: On average, mothers accurately perceived their child's caries experience. This accuracy was higher for younger children and children with dental insurance. The mother's awareness of her child's oral health status could be used to develop effective prevention and treatment strategies, particularly for young children vulnerable to caries.


Assuntos
Cárie Dentária , Mães , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Saúde Bucal , West Virginia
14.
Sci Total Environ ; 677: 362-372, 2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31059879

RESUMO

Organic chemicals from industrial, agricultural, and residential activities can enter surface waters through regulated and unregulated discharges, combined sewer overflows, stormwater runoff, accidental spills, and leaking septic-conveyance systems on a daily basis. The impact of point and nonpoint contaminant sources can result in adverse biological effects for organisms living in or near surface waters. Assessing the adverse or toxic effects that may result when exposure occurs is complicated by the fact that many commonly used chemicals lack toxicity information or water quality standards. To address these challenges, an exposure-activity ratio (EAR) screening approach was used to prioritize environmental chemistry data in a West Virginia watershed (Wolf Creek). Wolf Creek is a drinking water source and recreation resource with documented water quality impacts from point and nonpoint sources. The EAR screening approach uses high-throughput screening (HTS) data from ToxCast as a method of integrating environmental chemical occurrence and biological effects data. Using water quality schedule 4433, which targets 69 organic waste compounds typically found in domestic and industrial wastewater, chemicals were screened for potential adverse biological affects at multiple sites in the Wolf Creek watershed. Cumulative EAR mixture values were greatest at Sites 2 and 3, where bisphenol A (BPA) and pentachlorophenol exhibited maximum EAR values of 0.05 and 0.002, respectively. Site 2 is downstream of an unconventional oil and gas (UOG) wastewater disposal facility with documented water quality impacts. Low-level organic contaminants were found at all sample sites in Wolf Creek, except Site 10, where Wolf Creek enters the New River. The application of an EAR screening approach allowed our study to extend beyond traditional environmental monitoring methods to identify multiple sites and chemicals that warrant further investigation.


Assuntos
Disruptores Endócrinos/análise , Monitoramento Ambiental/métodos , Ensaios de Triagem em Larga Escala/métodos , Rios , Águas Residuárias/análise , Poluentes Químicos da Água/análise , Água Potável/análise , Qualidade da Água , West Virginia
15.
Drug Alcohol Depend ; 199: 1-9, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30954863

RESUMO

BACKGROUND: Comprehensive mandatory use laws for prescription drug monitoring programs (PDMPs) have been implemented in a number of states to help address the opioid overdose epidemic. These laws may reduce opioid-related overdose deaths by increasing prescribers' use of PDMPs and reducing high-risk prescribing behaviors. METHODS: We used state PDMP data to examine the effect of these mandates on prescriber registration, use of the PDMP, and on prescription-based measures of patient risk in three states-Kentucky, Ohio, and West Virginia-that implemented mandates between 2010 and 2015. We conducted comparative interrupted time series analyses to examine changes in outcome measures after the implementation of mandates in the mandate states compared to control states. RESULTS: Mandatory use laws increased prescriber registration and utilization of the PDMP in the mandate states compared to controls. The multiple provider episode rate, rate of opioid prescribing, rate of overlapping opioid prescriptions, and rate of overlapping opioid/benzodiazepine prescriptions decreased in Kentucky and Ohio. Nevertheless, the magnitude of changes in these measures varied among mandates states. CONCLUSIONS: These findings indicate that PDMP mandates have the potential to reduce risky opioid prescribing practices. Variation in the laws may explain why the effectiveness varied between states.


Assuntos
Pessoal de Saúde/legislação & jurisprudência , Prescrição Inadequada/legislação & jurisprudência , Padrões de Prática Médica/legislação & jurisprudência , Programas de Monitoramento de Prescrição de Medicamentos/legislação & jurisprudência , Analgésicos Opioides/uso terapêutico , Benzodiazepinas/uso terapêutico , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Pessoal de Saúde/normas , Humanos , Prescrição Inadequada/prevenção & controle , Análise de Séries Temporais Interrompida/legislação & jurisprudência , Análise de Séries Temporais Interrompida/métodos , Kentucky/epidemiologia , Morfolinas/uso terapêutico , Ohio/epidemiologia , Padrões de Prática Médica/normas , Programas de Monitoramento de Prescrição de Medicamentos/normas , West Virginia/epidemiologia
16.
J Dent Hyg ; 93(2): 34-40, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31015306

RESUMO

Purpose: Children in West Virginia have a high prevalence of missing permanent teeth when compared to children in the rest of the nation. The purpose of this study is to determine the prevalence of permanent tooth hypodontia/oligodontia/anodontia in West Virginia children and to compare the prevalence by sex.Methods: Five hundred panoramic radiographs of West Virginia children, ages 6-11 years, were examined for missing permanent tooth buds/permanent teeth. Data analyses included frequency determinations, Chi square analyses, and logistic regression.Results: Sixty children (12.0%, n=500) had at least one missing permanent tooth bud/permanent tooth. There were 15.5% of females and 8.8% of males who had at least one missing permanent tooth bud/permanent tooth. In adjusted logistic regression on at least one missing permanent tooth bud/permanent tooth, females had an adjusted odds ratio of 2.11 [95% Confidence Interval: 1.18, 3.75; p = .011] compared with males. Other variables in the analysis failed to reach significance.Conclusion: In this sample of West Virginia children, females were more likely to have at least one missing permanent tooth bud/permanent tooth compared to males. Early recognition and treatment planning for dental care is needed for children with hypodontia/oligodontia/anodontia.


Assuntos
Anodontia , Região dos Apalaches , Criança , Dentição Permanente , Feminino , Humanos , Masculino , Prevalência , West Virginia
17.
Community Dent Oral Epidemiol ; 47(4): 283-290, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30993747

RESUMO

OBJECTIVES: Dental utilization is an important determinant of oral health and well-being. The aim of this study was to evaluate potential associations between a variety of biopsychosocial factors and dental utilization in north-central Appalachia, USA, a region where oral health disparities are profound. METHODS: This study used household-based data from the Center for Oral Health Research in Appalachia (COHRA1) study in north-central Appalachia, including 449 families with 868 adults. The generalized estimating equation (GEE) approach was used to determine the best-fitting predictor model for dental utilization among adult family members. RESULTS: On average across West Virginia and Pennsylvania, having dental insurance was associated with greater dental utilization over a 3-year time period (OR = 2.20, 95% CI = 1.54, 3.14). When stratified by state, the association held for only West Virginia (OR = 2.41, 95% CI = 1.54, 3.79) and was nonsignificant for Pennsylvania residents (OR = 1.50, 95% CI = 0.80, 2.79). Individuals from Pennsylvania were more likely to utilize dental care and participants from West Virginia less so (2.31, 95% CI = 1.57, 3.40). Females from Pennsylvania were more likely than males to regularly seek dental care (OR = 1.44, 95% CI = 1.00, 2.05), and a higher income was associated with greater frequency of regular dental visits (OR = 1.21, 95% CI = 1.09, 1.34) in West Virginia. Individuals from Pennsylvania who scored higher on the Physiological Arousal subscale of the Dental Fear Survey were more likely to attend routine care visits (OR = 1.18, 95% CI = 1.03, 1.35). Across both states, more fatalistic beliefs related to oral health care also predicted less routine care (OR = 0.87, 95% CI = 0.81, 0.94), and more investment in or more positive attitudes towards one's oral health also was associated with higher utilization (OR = 1.18, 95% CI = 1.13, 1.23). CONCLUSIONS: Overall, the findings of this study suggest state residency, sex, insurance, income, fatalistic beliefs, health values, and aspects of dental care-related anxiety and fear predicted dental care utilization in north-central Appalachia. These findings reinforce the need to address insurance and other economic factors affecting utilization and to consider how individual-level fatalistic beliefs and oral health values may affect utilization of routine oral health care.


Assuntos
Assistência Odontológica/estatística & dados numéricos , Serviços de Saúde Bucal/estatística & dados numéricos , Seguro Odontológico/estatística & dados numéricos , Saúde Bucal , População Rural/estatística & dados numéricos , Adulto , Região dos Apalaches , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pennsylvania , West Virginia
19.
Ann Epidemiol ; 34: 12-17, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30967302

RESUMO

PURPOSE: To investigate HIV transmission potential from a cluster of HIV infections among men who have sex with men to persons who inject drugs in 15 West Virginia counties. These counties were previously identified as highly vulnerable to rapid HIV dissemination through injection drug use (IDU) associated with high levels of opioid misuse. METHODS: We interviewed persons with 2017 HIV diagnoses about past-year risk behaviors and elicited sexual, IDU, and social contacts. We tested contacts for HIV and assessed risk behaviors. To determine HIV transmission potential from persons with 2017 diagnoses to persons who inject drugs, we assessed viral suppression status, HIV status of contacts, and IDU risk behaviors of persons living with HIV and contacts. RESULTS: We interviewed 78 persons: 39 with 2017 diagnoses and 39 contacts. Overall, 13/78 (17%) injected drugs in the past year. Of 19 persons with 2017 diagnoses and detectable virus, 9 (47%) had more than or equal to 1 sexual or IDU contacts of negative or unknown HIV status. During the past year, 2/9 had injected drugs and shared equipment, and 1/9 had more than or equal to 1 partner who did so. CONCLUSIONS: We identified IDU risk behavior among persons with 2017 diagnoses and their contacts. West Virginia HIV prevention programs should continue to give high priority to IDU harm reduction.


Assuntos
Usuários de Drogas/estatística & dados numéricos , Infecções por HIV/diagnóstico , Infecções por HIV/transmissão , Abuso de Substâncias por Via Intravenosa/complicações , Sexo sem Proteção/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Busca de Comunicante , Feminino , Infecções por HIV/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Vigilância da População , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Populações Vulneráveis , West Virginia/epidemiologia , Adulto Jovem
20.
Int Wound J ; 16(2): 550-555, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30864302

RESUMO

Pressure ulcers (PUs) are a serious health care problem for nursing home residents and a key quality metric for regulators. Three initiatives were introduced at a 128-bed facility to improve PU prevention. First, a Quality Assurance and Performance Improvement project and a Root Cause Analysis were conducted to improve the facility's wound care programme. Second, a digital wound care management solution was adopted to track wound management. Third, the role of skin integrity coordinator was created as a central point of accountability for wound care-related activities and related performance metrics. Improvements in PU prevention were tracked using Centers of Medicare and Medicaid data, specifically (a) the percentage of long-stay high-risk residents with PUs and (b) the percentage of short-stay residents with PUs that are new or have worsened. PU prevalence for long-stay high-risk residents was 12.99% (Q4 2016), and upon implementation of these initiatives, the facility saw continued reductions in PU prevalence to 2.9% (Q4 2017), while PUs for short-stay residents were maintained at zero throughout this period. This study highlights the power of effective management combined with real-time data analytics, as enabled by digital wound care management, to make significant improvements in health care delivery.


Assuntos
Casas de Saúde/normas , Guias de Prática Clínica como Assunto , Lesão por Pressão/enfermagem , Lesão por Pressão/prevenção & controle , Qualidade da Assistência à Saúde/normas , Instituições de Cuidados Especializados de Enfermagem/normas , Higiene da Pele/normas , Humanos , West Virginia
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