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1.
AIDS Behav ; 26(Suppl 1): 165-170, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35028793

RESUMO

In 2019, the West Virginia Bureau for Public Health (WV BPH), Cabell-Huntington Health Department (CHHD), and CDC collaborated to respond to an HIV outbreak among people who inject drugs (PWID). CDC, WV BPH, and CHHD formed a cross-agency communications team to establish situational awareness, identify knowledge gaps, and establish key audiences for messages, including the general population, PWID, and clinical and social service providers. The team disseminated up-to-date information about the outbreak, and prioritized messages addressing stigma related to drug use, syringe services programs, and HIV. Messages were continually updated to address the evolving situation and to resonate with local values. Messages were disseminated via advertisements, local news media, and directly to PWID, people experiencing homelessness, and providers. The response supplemented CHHD's assets, including strong relationships and community knowledge, with staff capacity and expertise from state and federal agencies. This collaborative approach is a useful model to address communication needs.


Assuntos
Usuários de Drogas , Infecções por HIV , Abuso de Substâncias por Via Intravenosa , Surtos de Doenças , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Abuso de Substâncias por Via Intravenosa/epidemiologia , West Virginia/epidemiologia
2.
MMWR Morb Mortal Wkly Rep ; 71(2): 66-68, 2022 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-35025854

RESUMO

During October 2019, the West Virginia Bureau for Public Health (WVBPH) noted that an increasing number of persons who inject drugs (PWID) in Kanawha County received a diagnosis of HIV. The number of HIV diagnoses among PWID increased from less than five annually during 2016-2018 to 11 during January-October 2019 (Figure). Kanawha County (with an approximate population of 180,000*) has high rates of opioid use disorder and overdose deaths, which have been increasing since 2016,† and the county is located near Cabell County, which experienced an HIV outbreak among PWID during 2018-2019 (1,2). In response to the increase in HIV diagnoses among PWID in 2019, WVBPH released a Health Advisory§; and WVBPH and Kanawha-Charleston Health Department (KCHD) convened an HIV task force, conducted care coordination meetings, received CDC remote assistance to support response activities, and expanded HIV testing and outreach.


Assuntos
Surtos de Doenças , Usuários de Drogas , Infecções por HIV/epidemiologia , Adulto , Feminino , Humanos , Masculino , Abuso de Substâncias por Via Intravenosa/epidemiologia , West Virginia/epidemiologia
3.
PLoS One ; 16(11): e0259538, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34731188

RESUMO

During the COVID-19 pandemic, West Virginia developed an aggressive SARS-CoV-2 testing strategy which included utilizing pop-up mobile testing in locations anticipated to have near-term increases in SARS-CoV-2 infections. This study describes and compares two methods for predicting near-term SARS-CoV-2 incidence in West Virginia counties. The first method, Rt Only, is solely based on producing forecasts for each county using the daily instantaneous reproductive numbers, Rt. The second method, ML+Rt, is a machine learning approach that uses a Long Short-Term Memory network to predict the near-term number of cases for each county using epidemiological statistics such as Rt, county population information, and time series trends including information on major holidays, as well as leveraging statewide COVID-19 trends across counties and county population size. Both approaches used daily county-level SARS-CoV-2 incidence data provided by the West Virginia Department Health and Human Resources beginning April 2020. The methods are compared on the accuracy of near-term SARS-CoV-2 increases predictions by county over 17 weeks from January 1, 2021- April 30, 2021. Both methods performed well (correlation between forecasted number of cases and the actual number of cases week over week is 0.872 for the ML+Rt method and 0.867 for the Rt Only method) but differ in performance at various time points. Over the 17-week assessment period, the ML+Rt method outperforms the Rt Only method in identifying larger spikes. Results show that both methods perform adequately in both rural and non-rural predictions. Finally, a detailed discussion on practical issues regarding implementing forecasting models for public health action based on Rt is provided, and the potential for further development of machine learning methods that are enhanced by Rt.


Assuntos
COVID-19/epidemiologia , Previsões/métodos , Aprendizado de Máquina , Teste para COVID-19/estatística & dados numéricos , Humanos , Incidência , Modelos Estatísticos , Valor Preditivo dos Testes , População Rural , West Virginia/epidemiologia
4.
Am J Prev Med ; 61(5 Suppl 1): S143-S150, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34686283

RESUMO

INTRODUCTION: In January 2019, the West Virginia Bureau for Public Health detected increased HIV diagnoses among people who inject drugs in Cabell County. Responding to HIV clusters and outbreaks is 1 of the 4 pillars of the Ending the HIV Epidemic in the U.S. initiative and requires activities from the Diagnose, Treat, and Prevent pillars. This article describes the design and implementation of a comprehensive response, featuring interventions from all pillars. METHODS: This study used West Virginia Bureau for Public Health data to identify HIV diagnoses during January 1, 2018-October 9, 2019 among (1) people who inject drugs linked to Cabell County, (2) their sex or injecting partners, or (3) others with an HIV sequence linked to Cabell County people who inject drugs. Surveillance data, including HIV-1 polymerase sequences, were analyzed to estimate the transmission rate and timing of infections using molecular clock phylogenetic analysis. Federal, state, and local partners designed and implemented a comprehensive response during January 2019-October 2019. RESULTS: Of 82 people identified in the outbreak, most were male (60%), were White (91%), and reported unstable housing (80%). In a large molecular cluster containing 56 of 60 (93%) available sequences, 93% of inferred transmissions occurred after January 1, 2018. HIV testing, HIV pre-exposure prophylaxis, and syringe services were rapidly expanded, leading to improved linkage to HIV care and viral suppression. CONCLUSIONS: Evidence of rapid transmission in this outbreak galvanized robust collaboration among federal, state, and local partners, leading to critical improvements in HIV prevention and care services. HIV outbreak response requires increased coordination and creativity to improve service delivery to people affected by rapid HIV transmission.


Assuntos
Infecções por HIV , Abuso de Substâncias por Via Intravenosa , Surtos de Doenças , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Masculino , Filogenia , Abuso de Substâncias por Via Intravenosa/epidemiologia , West Virginia/epidemiologia
5.
Traffic Inj Prev ; 22(7): 501-506, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34410833

RESUMO

OBJECTIVE: Little is known about the relationship between Stay-At-Home orders issued by state governments due to the COVID-19 pandemic and their impacts on motor vehicle-related injuries. The purpose of this study was to determine whether the presence of a Stay-At-Home order was associated with lower rates of motor vehicle-related injuries requiring emergency medical treatment among population sub-groups in West Virginia (i.e., males, females, 0-17, 18-25, 26-45, 46-65, ≥66 years old). METHODS: A Stay-At-Home order was in effect in West Virginia from March 23-May 4, 2020. Counts of individuals who incurred motor-vehicle-related injuries that required emergency medical treatment were obtained from the Centers for Disease Control and Prevention's National Syndromic Surveillance Program from January 1 thru September 6 of 2019 and 2020. Counts were obtained by week-year and by population sub-group in West Virginia. The presence of the Stay-At-Home order was binary coded by week. Negative binomial regression was used to assess the relationship between the presence of a Stay-At-Home and injury rates. 2019 population sub-group estimates were obtained from the United States Census Bureau and used as offsets in the models. Models were also adjusted for year and vehicle miles traveled by week-year. RESULTS: There were 23,418 motor-vehicle related injuries during the study period. The presence of the Stay-At-Home order was associated with 44% less injuries overall [Incident Rate Ratio (IRR)=0.56, 95% CI 0.48, 0.64]. Females experienced fewer injuries than males (IRR = 0.49 vs 0.63, respectively) and the number of injuries decreased with age (p-value 0.031) when comparing time periods when the Stay-At-Home was in effect compared to times when it was not. CONCLUSIONS: West Virginia's Stay-At-Home order was associated with lower motor-vehicle injury rates requiring medical treatment across all population sub-groups. Most population sub-groups likely altered their travel behaviors which resulted in lower motor-vehicle injury rates. These findings may inform future policies that impose emergency travel restrictions in populations.


Assuntos
Acidentes de Trânsito , COVID-19 , Pandemias , Saúde Pública , Ferimentos e Lesões , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Saúde Pública/legislação & jurisprudência , West Virginia/epidemiologia , Ferimentos e Lesões/epidemiologia , Adulto Jovem
6.
Harm Reduct J ; 18(1): 90, 2021 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-34419045

RESUMO

BACKGROUND: The substance use epidemic in the United States continues to drive high levels of morbidity and mortality, particularly among people who inject drugs (PWID). Poor access to food often co-occurs with drug use and contributes to associated sequelae, such as risks for HIV and diabetes. The objective of this study was to examine factors associated with adequate food access among PWID in a rural Appalachian community. METHODS: Cross-sectional surveys were used to collect data among PWID aged 18 and older in Cabell County, West Virginia. Frequency of hunger and sociodemographic, structural and drug use characteristics were measured. Adequate food access was defined as reporting 'never' going to bed hungry at night in the past six months. Pearson's χ2 and t-tests and multivariable logistic regression were used to identify factors associated with food access. RESULTS: Only 71 individuals (17%) reported never going to bed hungry at night in the past six months. Adjusted odds of having adequate food access were higher among PWID who completed high school (aOR 2.94; P = 0.010) and usually used drugs alone (aOR 1.97; P = 0.025), and lower among PWID who were female (aOR 0.51; P = 0.037), experienced homelessness (aOR 0.23, P < 0.001), were recently arrested (aOR 0.50 P = 0.047), and engaged in receptive sharing of injection equipment (aOR 0.52, P = 0.035). CONCLUSIONS: We found extremely low food access in a population of PWID in Appalachia who are vulnerable to overdose and infectious disease transmission. Integrated interventions promoting food access are needed to improve the public health and wellbeing of people who inject drugs in Appalachia.


Assuntos
Overdose de Drogas , Infecções por HIV , Preparações Farmacêuticas , Abuso de Substâncias por Via Intravenosa , Estudos Transversais , Feminino , Humanos , Abuso de Substâncias por Via Intravenosa/tratamento farmacológico , Abuso de Substâncias por Via Intravenosa/epidemiologia , West Virginia/epidemiologia
7.
Prog Community Health Partnersh ; 15(2): 235-242, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248067

RESUMO

BACKGROUND: Limited specialty care access is a major contributor to rural health disparities. Extensions for Community Healthcare Outcomes (ECHO) is an innovative training and education strategy to address the need for trained specialty care in rural areas, such as West Virginia (WV). This article describes the successful implementation of ECHO projects in diverse subject areas facilitated by unique partnerships between the WV Clinical and Translational Science Institute (WVCTSI) and its practice partners. WV Project ECHO aims to provide education and training in specialty areas through the use of technology and partnerships. METHODS: A case-based session coupled with a brief relevant didactic presentation is used to amplify rural provider specialty expertise through education of primary care physicians (PCPs) in specific clinical areas. Foundational partnerships and impact are described. CONCLUSIONS: Key lessons learned include leveraging existing partnerships and implementing projects based on provider needs. A unique result of WV Project ECHO is WV Medicaid's decision to accept case presentations made during the Hepatitis C ECHO session as the specialty consultation requirement (e.g., hepatologist or infectious diseases) for Medicaid coverage of hepatitis C drugs, thus increasing the number of patients receiving Hepatitis C treatment. A multi-partnered community approach facilitated by the widespread use of a technology-based provider education platform has facilitated the availability of curative therapy for a potentially fatal disease.


Assuntos
Pesquisa Participativa Baseada na Comunidade , População Rural , Humanos , Estados Unidos , West Virginia
8.
Subst Use Misuse ; 56(12): 1776-1784, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34311667

RESUMO

BACKGROUND: Syringe services programs (SSPs) are evidence-based interventions that provide essential overdose and infectious disease prevention resources to people who inject drugs (PWID). Little research has examined factors associated with sterile syringe acquisition at SSPs among rural PWID populations. OBJECTIVES: We aim to identify factors associated with PWID in a rural county in West Virginia having recently acquired sterile syringes at an SSP. METHODS: PWID (n = 420) completed a survey that included measures related to sociodemographics, structural vulnerabilities, and substance use. We used multivariable Poisson regression with robust variance estimation to examine independent associations with sterile syringe acquisition at an SSP. RESULTS: Sixty-five percent of our sample reported having recently acquired sterile syringes at an SSP. Factors associated with recent sterile syringes acquisition at an SSP included: being older (aPR [adjusted prevalence ratio]: 1.011, 95% CI: 1.003-1.019), single (aPR: 0.862, 95% CI: 0.755-0.984), experiencing food insecurity (aPR: 1.233, 95% CI: 1.062-1.431), recently injecting fentanyl (aPR: 1.178, 95% CI: 1.010-1.375) and prescription opioid pain relievers (aPR: 0.681, 95% CI: 0.551-0.842), and recent naloxone acquisition (aPR: 1.360; 95% CI: 1.178-1.569). Receptive syringe sharing was inversely associated with acquiring sterile syringes at an SSP (aPR: 0.852; 95% CI: 0.741-0.979). CONCLUSION: PWID accessing sterile syringes at an SSP was associated with several sociodemographic, structural, and substance use factors. Ensuring rural SSP operations are tailored to local PWID population-level needs is paramount to the prevention of infectious disease outbreaks and overdose fatalities.


Assuntos
Infecções por HIV , Preparações Farmacêuticas , Abuso de Substâncias por Via Intravenosa , Humanos , Programas de Troca de Agulhas , Abuso de Substâncias por Via Intravenosa/epidemiologia , Seringas , West Virginia/epidemiologia
9.
Viruses ; 13(5)2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-34063160

RESUMO

This study examines the clinical characteristics, outcomes and types of management in SARS-CoV-2 infected patients, in the hospitals affiliated with West Virginia University. We included patients from West Virginia with SARS-CoV-2 infection between 15 April to 30 December 2020. Descriptive analysis was performed to summarize the characteristics of patients. Regression analyses were performed to assess the association between baseline characteristics and outcomes. Of 1742 patients, the mean age was 47.5 years (±22.7) and 54% of patients were female. Only 459 patients (26.3%) reported at least one baseline symptom, of which shortness of breath was most common. More than half had at least one comorbidity, with hypertension being the most common. There were 131 severe cases (7.5%), and 84 patients (4.8%) died despite treatment. The mean overall length of hospital stay was 2.6 days (±6.9). Age, male sex, and comorbidities were independent predictors of outcomes. In this study of patients with SARS-CoV-2 infection from West Virginia, older patients with underlying co-morbidities had poor outcomes, and the in-hospital mortality was similar to the national average.


Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Adulto , Idoso , COVID-19/mortalidade , Comorbidade/tendências , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/metabolismo , SARS-CoV-2/patogenicidade , Resultado do Tratamento , West Virginia/epidemiologia
10.
Pediatr Infect Dis J ; 40(7): e272-e274, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34097664

RESUMO

The estimated severe acute respiratory syndrome coronavirus 2 seroprevalence in children was found to be 9.46% for the Washington Metropolitan area. Hispanic/Latinx individuals were found to have higher odds of seropositivity. While chronic medical conditions were not associated with having antibodies, previous fever and body aches were predictive symptoms.


Assuntos
Anticorpos Antivirais/sangue , Teste Sorológico para COVID-19 , COVID-19/epidemiologia , Adolescente , COVID-19/etnologia , Criança , Pré-Escolar , Doença Crônica/epidemiologia , District of Columbia/epidemiologia , Feminino , Voluntários Saudáveis , Humanos , Imunoglobulina G/sangue , Lactente , Recém-Nascido , Masculino , Maryland/epidemiologia , Estudos Soroepidemiológicos , Virginia/epidemiologia , West Virginia/epidemiologia , Adulto Jovem
11.
J Prim Care Community Health ; 12: 21501327211023706, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34109858

RESUMO

PURPOSE: Long term care facility (LTCF) residents are at high risk for severe COVID-19 symptoms, but those in rural and resource-limited areas, such as West Virginia (WV) and the larger Appalachian region, may experience delays in obtaining higher levels of medical care due to isolated geography and limited transportation. The study examined the outcomes between residents from 1 LCTF in WV who were moved to a hospital as compared to those remaining in the facility. METHODS: This cohort study compares mortality outcomes among severely symptomatic residents desiring hospitalization and those electing to stay at the facility receiving palliative opioids with supplemental oxygen. FINDINGS: Forty residents tested positive for COVID-19 with 11 developing severe respiratory symptoms. Eight residents elected to receive care at the LTCF while 3 desired hospitalization. Mortality was assessed at 4 time points and was not statistically different between those who were hospitalized versus those who received palliative opioids at the LTCF. Although not significant, the difference in mortality between those hospitalized (66.7%) and those receiving opioids at the LTCF (12.5%) in the acute phase trended toward significance (P = .072). Overall mortality at the 6-month time point among all residents who developed severe respiratory symptoms at this LTCF was 54.5%. CONCLUSIONS: LTCF residents choosing different levels of therapeutic intervention for severe COVID-19 symptoms had no mortality difference. Palliative opioids may be an effective treatment for LTCF residents with severe COVID-19 and also a bridge to care in rural areas with limited resources until more advanced treatments can be accessed.


Assuntos
Analgésicos Opioides , COVID-19 , Analgésicos Opioides/uso terapêutico , Região dos Apalaches , Estudos de Coortes , Humanos , Assistência de Longa Duração , SARS-CoV-2 , West Virginia
12.
Front Public Health ; 9: 601890, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34123982

RESUMO

In the United States, single smokeless tobacco use continues to increase in conjunction with the dual use of smokeless tobacco and other nicotine products. Problematically, much of the tobacco prevention literature and funding inundates tobacco users with smoking tobacco information while neglecting to provide them any information about smokeless tobacco. Meanwhile, American tobacco companies continually market new and dissolvable tobacco products targeted at non-smokers. New data suggests that smokeless tobacco use is, also, increasing in West Virginia and, in order to address this increased use, the West Virginia Extension Service recently partnered with the Division of Tobacco Prevention in the West Virginia Department of Health and Human Resources to develop a comprehensive spit tobacco curriculum for West Virginia students between third and sixth grade. This article details the development and assessment of the spit tobacco prevention curriculum and the resulting report from the initial pilot of the program. The curriculum was piloted across six counties with the participation of schools, after-school programs and 4-H clubs. After implementation, survey results demonstrate that youth have increased awareness of the health effects of smokeless tobacco. Throughout the article, we explore West Virginia's Cooperative Extension Service's response to this emerging public health issue and release a call to action for the National Cooperative Extension Services to join us in spit tobacco prevention.


Assuntos
Produtos do Tabaco , Tabaco sem Fumaça , Adolescente , Humanos , Fumar , Uso de Tabaco/epidemiologia , Tabaco sem Fumaça/efeitos adversos , Estados Unidos/epidemiologia , West Virginia/epidemiologia
14.
J Trauma Acute Care Surg ; 91(1): 148-153, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34144562

RESUMO

BACKGROUND: Geriatric ground level fall is a common admission diagnosis for trauma centers in the United States. Visual health has been linked to fall risk reduction in older adult but is rarely fully evaluated during a trauma admission. Using a commercial application and a questionnaire, we developed and tested a trauma provider eye examination (TPEE) to screen visual health. This study used the TPEE to (1) evaluate the prevalence of undiagnosed or undertreated visual disease in geriatric trauma patients and (2) determine the feasibility and reliability of the TPEE to screen for vision disease. METHODS: This prospective study included patients older than 60 years evaluated by the trauma service from June 2019 to May 2020. Patients with ocular or globe trauma were excluded. The primary outcome was significant abnormal vision (SAV) found using the TPEE. Ophthalmology performed a dilated examination as the criterion standard for comparison. We assessed the feasibility and reliability of the TPEE. Fisher's exact test and logistic model were used in the data analysis. RESULTS: Enrollment concluded with 96 patients. Mean age was 75 years, and fall (79%) was the most common mechanism of injury. Significant abnormal vision was common: undiagnosed disease was found in 39% and undertreated in 14%. Trauma provider examination was 94% sensitive and 92% specific for SAV cases. Congruence between TPEE and ophthalmology examination was highest in pupil examination (86%), visual fields (58%), and Amsler grid (52%). Multivariate analysis found that a combination of an abnormal Amsler test and abnormal visual field defect was significantly associated with SAV (odds ratio, 4.1; p = 0.03). CONCLUSION: Trauma provider eye examination screening can identify patients with visual deficits. Given the association between visual deficits and fall risk, older adults may benefit from such a screening or a formal ophthalmology referral. LEVEL OF EVIDENCE: Therapeutic/Care Management, level II.


Assuntos
Transtornos da Visão/epidemiologia , Seleção Visual/métodos , Ferimentos e Lesões/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Projetos Piloto , Estudos Prospectivos , Índices de Gravidade do Trauma , Acuidade Visual , West Virginia/epidemiologia
15.
Perspect Health Inf Manag ; 18(Spring): 1l, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34035793

RESUMO

Addressing diabetes, prediabetes, and related health conditions such as high blood pressure, high cholesterol, obesity, and physical inactivity are critical public health priorities for the United States, particularly West Virginia. Preventing chronic conditions through early identification of risk and intervention to reduce risk is essential. Primary care and community-based programs need a more connected informatics system by which they work in tandem to identify, refer, treat, and track target populations. This case study in quality improvement examines the effectiveness of national diabetes prevention programming in West Virginia via the West Virginia Health Connection initiative, which was designed to provide such an informatics structure. Cohort analysis reveals an average weight loss of 13.6 pounds-or 6.3 percent total body weight loss-per person. These changes represent decreased risk of diabetes incidence and increased healthcare savings. Lessons learned are applicable to other areas aiming to build and sustain a data-informed health analytics network.


Assuntos
Informática Aplicada à Saúde dos Consumidores , Diabetes Mellitus/prevenção & controle , Promoção da Saúde , Humanos , Programas de Rastreamento , Avaliação de Programas e Projetos de Saúde , Encaminhamento e Consulta , Estados Unidos , West Virginia
18.
AIDS Behav ; 25(10): 3377-3385, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33886011

RESUMO

Ensuring people who inject drugs (PWID) have ≥ 100% sterile syringe coverage (i.e., persons have access to a sterile syringe for all injections) is optimal for HIV prevention. Existing syringe coverage literature is informative, yet little work has examined syringe coverage among PWID in rural communities. Using data from a 2018 PWID population estimation study conducted in a rural county in West Virginia, we used logistic regression to identify correlates of adequate sterile syringe coverage (at least 100%). A minority (37%) of PWID reported having adequate syringe coverage. Factors inversely associated with adequate syringe coverage included having recently (past 6 months): engaged in transactional sex work, shared syringes, and injected fentanyl. Having exclusively acquired syringes from a syringe services program was associated with increased odds of adequate syringe coverage. Rural PWID may benefit from tailored interventions designed to increase sterile syringe access.


Assuntos
Infecções por HIV , Preparações Farmacêuticas , Abuso de Substâncias por Via Intravenosa , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Programas de Troca de Agulhas , Abuso de Substâncias por Via Intravenosa/epidemiologia , Seringas , West Virginia/epidemiologia
19.
Ann Epidemiol ; 59: 44-49, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33812965

RESUMO

PURPOSE: Social determinants of health and racial inequalities impact healthcare access and subsequent coronavirus testing. Limited studies have described the impact of these inequities on rural minorities living in Appalachia. This study investigates factors affecting testing in rural communities. METHODS: PCR testing data were obtained for March through September 2020. Spatial regression analyses were fit at the census tract level. Model outcomes included testing and positivity rate. Covariates included rurality, percent Black population, food insecurity, and area deprivation index (a comprehensive indicator of socioeconomic status). RESULTS: Small clusters in coronavirus testing were detected sporadically, while test positivity clustered in mideastern and southwestern WV. In regression analyses, percent food insecurity (IRR = 3.69×109, [796, 1.92×1016]), rurality (IRR=1.28, [1.12, 1.48]), and percent population Black (IRR = 0.88, [0.84, 0.94]) had substantial effects on coronavirus testing. However, only percent food insecurity (IRR = 5.98 × 104, [3.59, 1.07×109]) and percent Black population (IRR = 0.94, [0.90, 0.97]) displayed substantial effects on the test positivity rate. CONCLUSIONS: Findings highlight disparities in coronavirus testing among communities with rural minorities. Limited testing in these communities may misrepresent coronavirus incidence.


Assuntos
Teste para COVID-19 , Insegurança Alimentar , Região dos Apalaches , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Humanos , West Virginia/epidemiologia
20.
J Manipulative Physiol Ther ; 44(4): 330-343, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33896602

RESUMO

OBJECTIVE: In this cross-sectional study, we examined correlates of manual therapy (spinal manipulation, massage therapy) and/or acupuncture use in a population engaging in conventional pain care in West Virginia. METHODS: Participants were patients (aged 18+ years) from 4 Appalachian pain and rheumatology clinics. Of those eligible (N = 343), 88% completed an anonymous survey including questions regarding health history, pain distress (Short Form Global Pain Scale), prescription medications, and current use of complementary health approaches for pain management. We used age-adjusted logistic regression to assess the relation of sociodemographic, lifestyle, and health-related factors to use of manual therapies and/or acupuncture for pain (complete-case N = 253). RESULTS: The majority of participants were white (92%), female (56%), and middle aged (mean age, 54.8 ± 13.4 years). Nearly all reported current chronic pain (94%), and 56% reported ≥5 comorbidities (mean, 5.6 ± 3.1). Manual therapy and/or acupuncture was used by 26% of participants for pain management (n = 66). Current or prior opioid use was reported by 37% of those using manual therapies. Manual therapy and/or acupuncture use was significantly elevated in those using other complementary health approaches (adjusted odds ratio, 3.0; 95% confidence interval, 1.5-5.8). Overall Short Form Global Pain Scale scores were not significantly associated with use of manual therapies and/or acupuncture after adjustment (adjusted odds ratio per 1-point increase, 1.01; 95% confidence interval, 1.00-1.03). CONCLUSION: We found no evidence for an association of pain-related distress and use of manual therapies and/or acupuncture, but identified a strong association with use of dietary supplements and mind-body therapies. Larger studies are needed to further examine these connections in the context of clinical outcomes and cost-effectiveness in rural adults given their high pain burden and unique challenges in access to care.


Assuntos
Terapia por Acupuntura/estatística & dados numéricos , Dor Crônica/terapia , Dor Lombar/terapia , Manipulação da Coluna/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Massagem/estatística & dados numéricos , Pessoa de Meia-Idade , Manejo da Dor , Inquéritos e Questionários , West Virginia , Adulto Jovem
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