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1.
J Public Health Manag Pract ; 29(2): E37-E43, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36715601

RESUMO

West Virginia has struggled with an overdose epidemic for many years and continues to have the highest overdose death rate in the nation. However, through successful collaboration between the West Virginia Board of Pharmacy and the West Virginia Department of Health via its Violence and Injury Prevention Program, West Virginia has improved data quality, enhanced program development and implementation, and developed strategies to address the overdose epidemic. This multiagency collaboration plays an important role in addressing the overdose epidemic and promotes lasting interagency relationships. One strategy is overcoming barriers to maximizing and utilizing the Prescription Drug Monitoring Program, or PDMP. This strategy allows for a better understanding of a patient's prescription history and ensures safer prescribing practices. In addition, this strategic partnership facilitates the use of PDMP data for epidemiologic studies and public health surveillance, which results in sustainable analyses and dissemination of actionable data that are now driving public health action in West Virginia.


Assuntos
Overdose de Drogas , Programas de Monitoramento de Prescrição de Medicamentos , Humanos , West Virginia/epidemiologia , Vigilância em Saúde Pública , Overdose de Drogas/epidemiologia , Overdose de Drogas/prevenção & controle , Tomada de Decisão Clínica
2.
J Health Care Poor Underserved ; 33(4S): 173-179, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36533465

RESUMO

Lung cancer screening is underused nationwide, particularly in rural areas where incidence and mortality rates are high, suggesting the need for innovative methods to reach underserved populations. Partners from national, state, and community positions can combine the service and science needed to save lives with mobile lung cancer screening.


Assuntos
Neoplasias Pulmonares , Humanos , West Virginia/epidemiologia , Neoplasias Pulmonares/epidemiologia , Detecção Precoce de Câncer , Área Carente de Assistência Médica , Incidência
4.
Artigo em Inglês | MEDLINE | ID: mdl-36429803

RESUMO

The devastating impact of the opioid crisis on children and families in West Virginia was compounded by the COVID-19 pandemic and brought to light the critical need for greater mental health services and providers in the state. Parent-Child Interaction Therapy (PCIT) is an evidence-based treatment for child externalizing symptoms that teaches parents positive and appropriate strategies to manage child behaviors. The current qualitative study details barriers and facilitators to disseminating and implementing PCIT with opioid-impacted families across West Virginia during the COVID-19 pandemic. Therapists (n = 34) who participated in PCIT training and consultation through a State Opioid Response grant were asked to provide data about their experiences with PCIT training, consultation, and implementation. Almost all therapists (91%) reported barriers to telehealth PCIT (e.g., poor internet connection, unpredictability of sessions). Nearly half of therapists' cases (45%) were impacted directly by parental substance use. Qualitative findings about the impact of telehealth and opioid use on PCIT implementation are presented. The dissemination and implementation of PCIT in a state greatly impacted by poor telehealth capacity and the opioid epidemic differed from the implementation of PCIT training and treatment delivery in other states, highlighting the critical importance of exploring implementation factors in rural settings.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , Analgésicos Opioides/uso terapêutico , Epidemia de Opioides , West Virginia/epidemiologia , Pandemias , Relações Pais-Filho
5.
Am J Public Health ; 112(S9): S892-S895, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36265093

RESUMO

This project addressed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing barriers in rural West Virginia by providing testing enhancements that included (1) a flexible testing staff, (2) mobile testing, (3) essential supplies, and (4) specialized testing in communities of color. A total of 142 775 polymerase chain reaction tests were performed from December 2021 through February 2022; positivity rates were 21% and 17% in clinics and mobile testing venues, respectively. The project results showed that, within a statewide network of health care clinics, administrators quickly identified and distributed enhancements and thus reduced testing barriers. (Am J Public Health. 2022;112(S9):S892-S895. https://doi.org/10.2105/AJPH.2022.307004).


Assuntos
Teste para COVID-19 , COVID-19 , Humanos , SARS-CoV-2 , Populações Vulneráveis , West Virginia/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia
6.
J Am Board Fam Med ; 35(5): 940-950, 2022 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-36257694

RESUMO

PURPOSE: Opioid use disorder has caused significant morbidity and mortality resulting in opioid prescribing limiting laws, such as State Bill 273 in West Virginia. The purpose of this study is to explore the impacts of a restrictive opioid prescription law on physicians in medical practice in West Virginia. METHODS: A qualitative study with open-ended semistructured interviews with a purposive sample of physicians in West Virginia. Interviews were recorded and transcribed verbatim. A preliminary code book was developed by 3 coinvestigators. Interview transcriptions were analyzed with a code-based text search query. Content analysis was utilized as the methodological orientation underpinning for the current work. RESULTS: Interviews were conducted with 20 physicians (10 primary care physicians and 10 specialty physicians) in practice in West Virginia. Physicians identified 5 theoretical domains related to SB273: changing opioid prescribing and documentation requirements; rural socioeconomic disparities; a continuum between chronic pain and substance use disorder; difficulty in balancing patient needs and the concern for diversion; lack of available alternatives to opioids for chronic. CONCLUSION: Prescribing opioids in rural West Virginia is complex due to identified challenges. Recommendations for opioids prescribing legislation include clear messaging of guidelines and recommendations, efforts to address socioeconomic disparities of health and pain, and improved accessibility for treatment of both pain and dependence in rural communities are important areas of growth in the rural health care environment.


Assuntos
Dor Crônica , Epidemia de Opioides , Humanos , Epidemia de Opioides/prevenção & controle , Analgésicos Opioides/efeitos adversos , Manejo da Dor , West Virginia/epidemiologia , Padrões de Prática Médica , Dor Crônica/tratamento farmacológico
7.
JAMA Netw Open ; 5(9): e2231334, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-36098966

RESUMO

Importance: West Virginia prioritized SARS-CoV-2 vaccine delivery to nursing home facilities because of increased risk of severe illness in elderly populations. However, the persistence and protective role of antibody levels remain unclear. Objective: To examine the persistence of humoral immunity after COVID-19 vaccination and the association of SARS-CoV-2 antibody levels and subsequent infection among nursing home residents and staff. Design, Setting, and Participants: In this cross-sectional study, blood samples were procured between September 13 and November 30, 2021, from vaccinated residents and staff at participating nursing home facilities in the state of West Virginia for measurement of SARS-CoV-2 antibody (anti-receptor binding domain [RBD] IgG). SARS-CoV-2 infection and vaccination history were documented during specimen collection and through query of the state SARS-CoV-2 surveillance system through January 16, 2022. Exposure: SARS-CoV-2 vaccination (with BNT162b2, messenger RNA-1273, or Ad26.COV2.S). Main Outcomes and Measures: Anti-RBD IgG levels were assessed using multivariate analysis to examine associations between time since vaccination or infection, age, sex, booster doses, and vaccine type. Antibody levels from participants who became infected after specimen collection were compared with those without infection to correlate antibody levels with subsequent infection. Results: Among 2139 SARS-CoV-2 vaccinated residents and staff from participating West Virginia nursing facilities (median [range] age, 67 [18-103] years; 1660 [78%] female; 2045 [96%] White), anti-RBD IgG antibody levels decreased with time after vaccination or infection (mean [SE] estimated coefficient, -0.025 [0.0015]; P < .001). Multivariate regression modeling of participants with (n = 608) and without (n = 1223) a known history of SARS-CoV-2 infection demonstrated significantly higher mean (SE) antibody indexes with a third (booster) vaccination (with infection: 11.250 [1.2260]; P < .001; without infection: 8.056 [0.5333]; P < .001). Antibody levels (calculated by dividing the sample signal by the mean calibrator signal) were significantly lower among participants who later experienced breakthrough infection during the Delta surge (median, 2.3; 95% CI, 1.8-2.9) compared with those without breakthrough infection (median, 5.8; 95% CI, 5.5-6.1) (P = .002); however, no difference in absorbance indexes was observed in participants with breakthrough infections occurring after specimen collection (median, 5.9; 95% CI, 3.7-11.1) compared with those without breakthrough infection during the Omicron surge (median, 5.8; 95% CI, 5.6-6.2) (P = .70). Conclusions and Relevance: In this cross-sectional study, anti-RBD IgG levels decreased after vaccination or infection. Higher antibody responses were found in individuals who received a third (booster) vaccination. Although lower antibody levels were associated with breakthrough infection during the Delta surge, no significant association was found between antibody level and infection observed during the Omicron surge. The findings of this cross-sectional study suggest that among nursing home residents, COVID-19 vaccine boosters are important and updated vaccines effective against emerging SARS-CoV-2 variants are needed.


Assuntos
COVID-19 , Vacinas , Ad26COVS1 , Idoso , Anticorpos Antivirais , Vacina BNT162 , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Estudos Transversais , Feminino , Humanos , Imunoglobulina G , Masculino , Casas de Saúde , SARS-CoV-2 , Vacinação , West Virginia/epidemiologia
8.
Surg Endosc ; 36(11): 8515-8519, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36042042

RESUMO

INTRODUCTION: Obesity is one of the leading public health concerns with over half a million Americans being classified as obese and almost two billion classified as overweight. This has an impact on overall health of the individual, with increased comorbidities and premature death, as well as increased economic cost. This study evaluates the weight loss of patients with limited societal support and resources cared for at a single bariatric center of excellence, The Center for Surgical Weight Control, in Cabell County, West Virginia. METHODS: Retrospective review of patients that have undergone either a Vertical Sleeve Gastrectomy (VSG) or a Roux-en-Y gastric bypass (RNYGB) between the years of 2017 and 2018 At the Center for Surgical Weight Control. Weight loss was evaluated at 6 months, 1 year, and 2 years. RESULTS: There were 290 patients between 2017 and 2018. On average, the VSG group lost 46% of excess body weight (EBW) at 6 months, 57% of EBW at 1 year, and 61% of EBW at 2 years. In the RNYGB group patients lost on average 54% of EBW at 6 months, 65% of EBW at 1 year, and 88% of EBW at 2 years. DISCUSSION: A loss of 5-15% of EBW can improve obesity-related comorbidities. These comorbidities include diabetes, hypertension, hyperlipidemia, gastroesophageal reflux disease, and obstructive sleep apnea. Improvement in these comorbidities not only benefits each patient individually, but will also help improve the effects on society as a whole. CONCLUSION: Obesity is a debilitating and deadly disease, thus makes it very important to address in order to reduce burden on both patients and society as a whole. There is an expected amount of weight loss a patient should have depending on the type of surgery they undergo. Our patients were successful at meeting and exceeding the expected percentage of EBW loss after both VSG and RNYGB.


Assuntos
Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Humanos , Obesidade Mórbida/cirurgia , West Virginia/epidemiologia , Redução de Peso , Gastrectomia , Estudos Retrospectivos , Resultado do Tratamento
9.
Sci Total Environ ; 850: 158029, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-35973544

RESUMO

Forest species composition mediates evapotranspiration and the amount of water available to human-use downstream. In the last century, the heavily forested Appalachian region has been undergoing forest mesophication which is the progressive replacement of xeric species (e.g. black oak (Quercus velutina)) by mesic species (e.g. sugar maple (Acer saccharum)). Given differences between xeric and mesic species in water use efficiency and rainfall interception losses, investigating the consequences of these species shifts on water cycles is critical to improving predictions of ecosystem responses to climate change. To meet this need, we quantified the degree to which the sap velocities of two dominant broadleaved species (sugar maple and black oak) in West Virginia, responded to ambient and experimentally altered soil moisture conditions using a throughfall exclusion experiment. We then used these data to explore how predictions of future climate under two emissions scenarios could affect forest evapotranspiration rates. Overall, we found that the maples had higher sap velocity rates than the oaks. Sap velocity in maples showed a stronger sensitivity to vapor pressure deficit (VPD), particularly at high levels of VPD, than sap velocity in oaks. Experimentally induced reductions in shallow soil moisture did not have a relevant impact on sap velocity. In response to future climate scenarios of increased vapor pressure deficits in the Central Appalachian Mountains, our results highlight the different degrees to which two important tree species will increase transpiration, and potentially reduce the water available to the heavily populated areas downstream.


Assuntos
Acer , Quercus , Acer/fisiologia , Secas , Ecossistema , Humanos , Quercus/fisiologia , Solo , Árvores/fisiologia , Água , West Virginia
10.
Sex Reprod Healthc ; 33: 100765, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36037669

RESUMO

OBJECTIVE: Access to levonorgestrel (LNG) emergency contraception (EC) has increased since the FDA removed age restrictions on over-the-counter (OTC) LNG EC in 2013, but availability is highly variable and numerous barriers to access remain. The purpose of this study was to assess availability and accessibility of LNG EC at community pharmacies in West Virginia (WV). METHODS: A mystery caller cross-sectional study was conducted to assess availability and accessibility of LNG EC. Inquiries were made by identified 'research' staff and by staff presenting as a 16 y/o. RESULTS: Nearly half of community pharmacies reported having LNG EC in stock. Pharmacy staff were significantly more likely to tell research callers LNG EC was in stock (53%) and more likely to report willingness to order it (50%) than 'teen' callers (45% and 34%, respectively). There was no significant difference between caller types on the five barriers assessed. CONCLUSION: Lack of availability may contribute to teen and unintended pregnancies.


Assuntos
Anticoncepção Pós-Coito , Farmácias , Adolescente , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde , Humanos , Levanogestrel , Medicamentos sem Prescrição , Gravidez , West Virginia
11.
Science ; 377(6605): 450, 2022 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-35901147

RESUMO

As threats from climate change become more urgent, the US Supreme Court has responded by erecting a new roadblock to effective climate policy. Last month, it struck down the Clean Power Plan, the Obama administration's never-implemented regulation of greenhouse gas emissions from existing power plants. The ruling [West Virginia v. Environmental Protection Agency (EPA)] is a blow to climate action and could signal the court's hostility to a wide range of future regulations within and beyond the climate and environmental sphere, including those related to consumer protection and worker safety. Although the immediate effects on US climate policy aren't pervasive, EPA now needs to evaluate the emissions-reduction potential and legal risks of alternative regulatory approaches for the power sector.


Assuntos
Mudança Climática , Efeito Estufa , Gases de Efeito Estufa , United States Environmental Protection Agency , Efeito Estufa/legislação & jurisprudência , Estados Unidos , West Virginia
12.
PLoS One ; 17(7): e0271510, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35839224

RESUMO

INTRODUCTION: Life-threatening infections such as infective endocarditis (IE) are increasing simultaneously with the injection drug use epidemic in West Virginia (WV). We utilized a newly developed, statewide database to describe epidemiologic characteristics and healthcare utilization among patients with (DU-IE) and without (non-DU-IE) drug use-associated IE in WV over five years. MATERIALS AND METHODS: This retrospective, observational study, incorporating manual review of electronic medical records, included all patients aged 18-90 years who had their first admission for IE in any of the four university-affiliated referral hospitals in WV during 2014-2018. IE was identified using ICD-10-CM codes and confirmed by chart review. Demographics, clinical characteristics, and healthcare utilization were compared between patients with DU-IE and non-DU-IE using Chi-square/Fisher's exact test or Wilcoxon rank sum test. Multivariable logistic regression analysis was conducted with discharge against medical advice/in-hospital mortality vs. discharge alive as the outcome variable and drug use as the predictor variable. RESULTS: Overall 780 unique patients had confirmed first IE admission, with a six-fold increase during study period (p = .004). Most patients (70.9%) had used drugs before hospital admission, primarily by injection. Compared to patients with non-DU-IE, patients with DU-IE were significantly younger (median age: 33.9 vs. 64.1 years; p < .001); were hospitalized longer (median: 25.5 vs. 15 days; p < .001); had a higher proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates (42.7% vs. 29.9%; p < .001), psychiatric disorders (51.2% vs. 17.3%; p < .001), cardiac surgeries (42.9% vs. 26.6%; p < .001), and discharges against medical advice (19.9% vs. 1.4%; p < .001). Multivariable regression analysis showed drug use was an independent predictor of the combined outcome of discharge against medical advice/in-hospital mortality (OR: 2.99; 95% CI: 1.67-5.64). DISCUSSION AND CONCLUSION: This multisite study reveals a 681% increase in IE admissions in WV over five years primarily attributable to injection drug use, underscoring the urgent need for both prevention efforts and specialized strategies to improve outcomes.


Assuntos
Endocardite Bacteriana , Endocardite , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Transtornos Relacionados ao Uso de Substâncias , Adulto , Endocardite Bacteriana/epidemiologia , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Retrospectivos , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/complicações , West Virginia/epidemiologia
13.
Int Ophthalmol ; 42(10): 3153-3163, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35606624

RESUMO

PURPOSE: To report the microbiological spectrum, antimicrobial resistance patterns, and visual outcomes in patients with endogenous endophthalmitis (EE). METHODS: This was a retrospective study of 50 patients with culture-positive EE managed in a tertiary referral center between October 2009 and 2019. Clinical, microbiology analysis, and antimicrobial resistance were reviewed. A multivariable linear regression analysis was used for identifying risk factors associated with worse visual outcomes. RESULTS: Fifty organisms were identified, 62% bacterial and 38% fungal. The most common bacterial organism was Staphylococcus aureus (75% methicillin resistant), and Candida was the most common fungal species. Multidrug resistance was observed in methicillin-resistant Staphylococcus aureus (MRSA) isolates against clindamycin, daptomycin, and fluoroquinolones. The distributions of the final visual acuity (VA) between the bacterial and fungal groups were significantly different, and the visual outcomes in the bacterial group tended to be worse (p = 0.01). The distributions of enucleation status were significantly higher in bacterial EE (35%) than fungal EE (5.3%) (p = 0.02). Results from the multivariable linear regression analysis revealed that older age was significantly associated with worse visual outcome (coef = 0.03; p = 0.02), while fungal infections were associated with better outcomes (coef = - 0.87; p = 0.01). Intravenous drug use (coef = 0.87; p = 0.054) was a marginally significant factor associated with worse visual outcomes. CONCLUSION: There was a higher prevalence of bacterial organisms than fungal species among EE. Bacterial EE was associated with worse visual outcomes and higher enucleation rates than fungal EE. Multidrug resistance was prevalent among MRSA isolates. Older age and intravenous drug use may be factors associated with poor prognosis.


Assuntos
Daptomicina , Endoftalmite , Infecções Oculares Bacterianas , Infecções Oculares Fúngicas , Staphylococcus aureus Resistente à Meticilina , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bactérias , Clindamicina/uso terapêutico , Daptomicina/uso terapêutico , Farmacorresistência Bacteriana , Endoftalmite/tratamento farmacológico , Endoftalmite/epidemiologia , Endoftalmite/microbiologia , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/epidemiologia , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Fúngicas/tratamento farmacológico , Infecções Oculares Fúngicas/epidemiologia , Infecções Oculares Fúngicas/microbiologia , Fluoroquinolonas , Humanos , Estudos Retrospectivos , West Virginia
14.
Front Public Health ; 10: 811397, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35462820

RESUMO

Background: Emergency room nurses have a strong influence on the population of smokeless tobacco users. If healthcare providers address patient's tobacco use by using a brief intervention strategy (one minute or less), it increases the quit attempt rate threefold. The object of this study is to assess the effectiveness of asynchronous internet based brief tobacco intervention training with rural emergency room nurses. Methods: A 1-h asynchronous training session on smokeless tobacco use and the 2-A and 1-R (Ask, Advise, and Refer) brief tobacco intervention strategy were given to 13 emergency room nurses at a rural acute care hospital in West Virginia. Paired sample t-tests were used to compare the pre-and post-test results. Results: The 1-h training session produced significant and positive increases in all items measured: increased motivation to assist patients in quitting; increased knowledge of smokeless tobacco use, its dangers, and cessation processes; increased self-efficacy in implementing brief interventions; increased perception of tobacco cessation as important; increased perception of the effectiveness of tobacco cessation interventions; and increased acknowledgment of barriers and an awareness of how to deal with them. Conclusions: The results suggest that there is a significant potential benefit from training emergency room nurses. Brief tobacco interventions should be conducted by clinical staff during the medical history check, physical examination, or discharge phases of the emergency room visit.


Assuntos
Abandono do Hábito de Fumar , Abandono do Uso de Tabaco , Tabaco sem Fumaça , Serviço Hospitalar de Emergência , Humanos , Abandono do Hábito de Fumar/métodos , Abandono do Uso de Tabaco/métodos , Tabaco sem Fumaça/efeitos adversos , West Virginia
15.
J Med Virol ; 94(8): 4015-4022, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35451090

RESUMO

Progressive multifocal leukoencephalopathy (PML) is an increasingly common and rapidly fatal demyelinating infection of central nervous system caused by the highly prevalent John Cunningham (JC) virus in immunocompromised individuals belonging to all age groups and genders. Human immunodeficiency virus (HIV) is the most common predisposing factor among other immunodeficient conditions leading to reactivation and multiple neurological symptoms. It has varied findings on magnetic resonance imaging (MRI) and diagnosis is confirmed by positive JC virus in cerebrospinal fluid (CSF). We report 12 confirmed cases of PML from a single academic center. We comprehensively described clinical presentations, risk factors, CSF and neuroimaging findings, treatment and outcome for these cases of PML, a rare disease. The cases were almost equivalently distributed among young and old age groups and both genders. Positive JC virus on CSF was present in the majority of cases along with mild to severe reduction in lymphocyte counts. Significant MRI changes were present in all cases ranging from T2 hypertense signals to white matter lesions in various regions. Treatment with the reversion of immune-modulators, optimization of antiviral therapy (ART), plasmapheresis (PLEX), IVIG, Mirtazapine, oral steroids, and others was started as soon as the diagnosis was made in the majority of the cases. However, PML is a rapidly fatal illness and hence, survival was only seen in 4 cases in our study. The objective of this article is to highlight the importance of early diagnosis of PML with CSF findings and neuroimaging, early reversion of immunosuppressive medications, and careful monitoring and treatment of HIV cases with goals to reduce mortality, long-term morbidity, and deficits.


Assuntos
Infecções por HIV , Vírus JC , Leucoencefalopatia Multifocal Progressiva , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Leucoencefalopatia Multifocal Progressiva/diagnóstico por imagem , Leucoencefalopatia Multifocal Progressiva/tratamento farmacológico , Masculino , Neuroimagem/efeitos adversos , Universidades , West Virginia
16.
Perspect Health Inf Manag ; 19(1): 1j, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35440923

RESUMO

This case study describes use of health information technology for enhanced team-based care and care coordination between primary care providers and infectious disease specialists for curing and eventually eliminating hepatitis C in West Virginia. This program, the West Virginia Hepatitis Academic Mentoring Partnership, aims to improve outcomes of West Virginians with chronic hepatitis C infection by training and supporting primary care providers to screen, diagnose, evaluate, treat, cure, and follow patients in the community rather than referring them to distant specialists with long wait times. This initiative supports health equity by increasing access to quality care in severely under-resourced rural areas. Primary care providers engage with hepatitis C experts in a web-based training and mentoring process, combined with informatics training in use of a customized Research Electronic Data Capture (REDCAP) platform for secure data tracking and bidirectional communication. This use of an informatics platform available to all partners supports shared decision-making between primary care providers and specialists, fostering a primary care learning network for improved hepatitis C care in West Virginia.


Assuntos
Hepatite C , Informática Médica , Comunicação , Hepatite C/diagnóstico , Hepatite C/terapia , Humanos , West Virginia
17.
J Agromedicine ; 27(3): 329-338, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35442173

RESUMO

OBJECTIVE: The Northeast Center for Occupational Health and Safety conducted a survey in December 2020 to understand the impact of the coronavirus disease 2019 (COVID-19) and the Androscoggin Mill explosion among loggers in six states: Maine, New Hampshire, Vermont, New York, Pennsylvania, and West Virginia. METHODS: Logger mailing addresses were aggregated with the assistance of state logging organizations. A paper survey, including a self-addressed return envelope was mailed to the loggers in December 2020. RESULTS: The mailed survey had a response rate of 13.3% and captured data on 484 loggers. The majority knew someone (including themselves) who tested positive for COVID-19 (71.9%). Less than half (43%) received employer training about COVID-19 prevention measures, though 73% received some form of COVID-19 personal protective equipment from their employers. The health department, Centers for Disease Control and Prevention (CDC), and health care providers were the most trusted sources of health information. Nearly half acknowledged significant change in their home lives and work responsibilities due to the pandemic. The explosion of the Androscoggin Mill affected the business of 80% of Maine loggers, and 18% of loggers that resided outside Maine. CONCLUSION: The lessons learned can be used to enhance trust in public health institutions and future public health response to this unique occupational group.


Assuntos
COVID-19 , Saúde do Trabalhador , COVID-19/epidemiologia , COVID-19/prevenção & controle , Humanos , Maine/epidemiologia , Pandemias/prevenção & controle , West Virginia/epidemiologia
18.
Environ Monit Assess ; 194(5): 368, 2022 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-35426571

RESUMO

We sampled headwater streams to characterize impacts of unconventional shale gas development (SGD) on aquatic ecosystems. The study area was relatively un-impacted by confounding activities. Intensity of SGD over the study decreased then increased again but not to levels seen the first year. Shale gas development was associated with increased, but non-impaired, water pH and specific conductance during the latter part of the study. Metrics summarizing macroinvertebrate assemblages were better on average in un-impacted reaches. A genus-level multimetric index of biotic integrity was statistically lower downstream of impacts compared to upstream, but only in the year when SGD activity was most intense. Multivariate analyses indicated that assemblages diverged in similarity downstream compared to upstream of impacts in the first and last years of the study when SGD activity was elevated. Assemblage divergence was related to variation in water quality. Indicator species analysis linked a few key taxa to un-impacted conditions in the first year of the study; tolerant taxa were indicators for impacted conditions later in the study. Our study links SGD to weak negative changes in water quality and benthic macroinvertebrates, which may have negative consequences to food quality for wildlife that rely on aquatic prey within forested systems.


Assuntos
Invertebrados , Gás Natural , Animais , Ecossistema , Monitoramento Ambiental , West Virginia
19.
Clin Cardiol ; 45(5): 536-539, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35266180

RESUMO

BACKGROUND AND OBJECTIVES: Compare proportion of all-cause and cause-specific mortality among West Virginia Medicaid enrollees who were discharged from infective endocarditis (IE) hospitalization with and without opioid use disorder (OUD) diagnosis. METHODS: The proportions of cause-specific deaths among those who were discharged from IE-related hospitalizations were compared by OUD diagnosis. RESULTS: The top three underlying causes of death discharged from IE hospitalization were accidental drug poisoning, mental and behavioral disorders due to polysubstance use, and cardiovascular diseases. Of the total deaths occurring among patients discharged after IE-related hospitalization, the proportion has increased seven times from 2016 to 2019 among the OUD deaths while it doubled among the non-OUD deaths. DISCUSSION AND CONCLUSIONS: Of the total deaths occurring among patients discharged after IE-related hospitalization, the increase is higher in those with OUD diagnosis. OUD is becoming a significantly negative impactor on the survival outcome among IE patients. It is of growing importance to deliver medication for OUD treatment and harm reduction efforts to IE patients in a timely manner, especially as the COVID-19 pandemic persists.


Assuntos
COVID-19 , Endocardite Bacteriana , Endocardite , Transtornos Relacionados ao Uso de Opioides , Causas de Morte , Endocardite/diagnóstico , Hospitalização , Humanos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Pandemias , Alta do Paciente , Estudos Retrospectivos , Estados Unidos , West Virginia/epidemiologia
20.
Subst Abuse Treat Prev Policy ; 17(1): 19, 2022 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-35272687

RESUMO

BACKGROUND: West Virginia has one of the highest rates of opioid overdose related deaths and is known as the epicenter of the opioid crisis in the United States. In an effort to reduce opioid-related harms, SB 273 was signed in 2018, and aimed to restrict opioid prescribing in West Virginia. SB 273 was enacted during a time when physician arrests and convictions had been increasing for years and were becoming more prevalent and more publicized. This study aims to better understand the impact of the legislation on patients and providers. METHODS: Twenty semi-structured interviews were conducted with opioid-prescribing primary care physicians and specialists practicing throughout West Virginia. RESULTS: Four themes emerged, 1. Fear of disciplinary action, 2. Exacerbation of opioid prescribing fear due to restrictive legislation, 3. Care shifts and treatment gaps, and 4. Conversion to illicit substances. The clinicians recognized the harms of inappropriate prescribing and how this could affect their patients. Decreases in opioid prescribing were already occurring prior to the law implementation. Disciplinary actions against opioid prescribers resulted in prescriber fear, which was then exacerbated by SB 273 and contributed to shifts in care that led to forced tapering and opioid under-prescribing. Providers felt that taking on patients who legitimately required opioids could jeopardize their career. CONCLUSION: A holistic and patient-centered approach should be taken by legislative and disciplinary bodies to ensure patients are not abandoned when disciplinary actions are taken against prescribers or new legislation is passed.


Assuntos
Analgésicos Opioides , Overdose de Opiáceos , Analgésicos Opioides/efeitos adversos , Medo , Humanos , Padrões de Prática Médica , Estados Unidos , West Virginia
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