Southwest Virginia Research Articles

Forest Farming: Who Wants In?

AbstractForest farming is an agroforestry practice defined as the intentional cultivation of nontimber forest products (NTFPs) underneath a forest canopy. Forest farming perspectives and preferences among family forest owners are generally understudied, particularly in Appalachia, where many marketable native NTFPs species are found. We surveyed Appalachian family forest owners in 14 Southwest Virginia counties about their interest in forest farming and likelihood of leasing land for this purpose. We also asked about the owner’s residency and historical connection to the region as well as contemporary land uses, and identified the following types of uses: absentee and vacationers, newcomers, longtime farming residents, and longtime nonfarming residents. We mailed 1,040 surveys and 293 were returned (28.9%). Forty-five percent were interested or extremely interested in forest farming and 36% were likely or extremely likely to lease land. Rates of interest in forest farming and leasing were similar across owner types, suggesting broad appeal among family forest owners.

Discrepancies in Stroke Distribution and Dataset Origin in Machine Learning for Stroke

BackgroundMachine learning algorithms depend on accurate and representative datasets for training in order to become valuable clinical tools that are widely generalizable to a varied population. We aim to conduct a review of machine learning uses in stroke literature to assess the geographic distribution of datasets and patient cohorts used to train these models and compare them to stroke distribution to evaluate for disparities. Aims582 studies were identified on initial searching of the PubMed database. Of these studies, 106 full texts were assessed after title and abstract screening which resulted in 489 papers excluded. Of these 106 studies, 79 were excluded due to using cohorts from outside the United States or being review articles or editorials. 27 studies were thus included in this analysis. Summary of reviewOf the 27 studies included, 7 (25.9%) used patient data from California, 6 (22.2%) were multicenter, 3 (11.1%) were in Massachusetts, 2 (7.4%) each in Illinois, Missouri, and New York, and 1 (3.7%) each from South Carolina, Washington, West Virginia, and Wisconsin. 1 (3.7%) study used data from Utah and Texas. These were qualitatively compared to a CDC study showing the highest distribution of stroke in Mississippi (4.3%) followed by Oklahoma (3.4%), Washington D.C. (3.4%), Louisiana (3.3%), and Alabama (3.2%) while the prevalence in California was 2.6%. ConclusionsIt is clear that a strong disconnect exists between the datasets and patient cohorts used in training machine learning algorithms in clinical research and the stroke distribution in which clinical tools using these algorithms will be implemented. In order to ensure a lack of bias and increase generalizability and accuracy in future machine learning studies, datasets using a varied patient population that reflects the unequal distribution of stroke risk factors would greatly benefit the usability of these tools and ensure accuracy on a nationwide scale.

Environmental Correlates of Lyme Disease Emergence in Southwest Virginia, 2005-2014.

Lyme disease is the most common tick-borne disease in North America. Though human infection is mostly transmitted in a limited geography, the range has expanded in recent years. One notable area of recent expansion is in the mountainous region of southwestern Virginia. The ecological factors that facilitate or constrain the range of human Lyme disease in this region remain uncertain. To evaluate this further, we obtained ecological data, including remotely sensed data on forest structure and vegetation, weather data, and elevation. These data were aggregated within the census block groups of a 9,153 km2 area around the cities of Blacksburg and Roanoke, VA, an area with heterogeneous Lyme disease transmission. In this geographic area, 755 individuals were reported to have Lyme disease in the 10 yr from 2006 to 2015, and these cases were aggregated by block group. A zero-inflated negative binomial model was used to evaluate which environmental variables influenced the abundance of Lyme disease cases. Higher elevation and higher vegetation density had the greatest effect size on the abundance of Lyme disease. Measures of forest edge, forest integrity, temperature, and humidity were not associated with Lyme disease cases. Future southward expansion of Lyme disease into the southeastern states may be most likely in ecologically similar mountainous areas.

Evaluation of an Interprofessional Learning Experience for Telephone Consultations.

Background and PurposeThere is limited training for healthcare students in the performance of telephone consultations. To facilitate communication between healthcare professionals when face-to-face interactions are not possible, a telephone consultation simulation was developed. The simulation involved students in a doctor of physical therapy program and senior medical students. This study aimed to explore the development and suitability of a simulated case with a focus on interprofessional telephone consultation.MethodsA convenience sample of 28 physical therapy students and 38 medical students from two institutions in southwest Virginia participated in the simulation experience. To assess the outcomes of the simulation on interprofessional communication, the IPASS verbal handoff assessment was performed by the participants and focus group interviews occurred immediately following the experience. In addition, an assessment of key information provided during the conversation was performed for each of the seven interprofessional groups.ResultsStudents demonstrated near perfect agreement on the IPASS assessment. Five of the seven interprofessional groups perceived that they were able to communicate key information and collectively agree upon a recommendation for the continuation of the patient assessment. The two groups that demonstrated more difficulty with communication appeared to struggle with communicating the patient’s past medical history relevant to the current situation, despite the majority of students feeling confident in their communications. In addition, two themes were presented during the interprofessional focus group interviews: 1) clear communication to maintain patient safety and 2) efficiently conveying the patient’s background.DiscussionThe health professions students participating in the scenario were able to consistently note the communication skills observed and reflect upon the need for clear communication between providers during a patient consultation. Key components of an efficient telephone consultation were identified, along with opportunities to improve this type of interaction between health professionals.

Applying the socio-ecological model to understand factors associated with sugar-sweetened beverage behaviours among rural Appalachian adolescents.

The objective of the current study was to identify factors across the socio-ecological model (SEM) associated with adolescents' sugar-sweetened beverage (SSB) intake. This cross-sectional study surveyed adolescents using previously validated instruments. Analyses included descriptive statistics, ANOVA tests and stepwise nonlinear regression models (i.e., two-part models) adjusted to be cluster robust. Guided by SEM, a four-step model was used to identify factors associated with adolescent SSB intake - step 1: demographics (i.e., age, gender), step 2: intrapersonal (i.e., theory of planned behaviour (attitudes, subjective norms, perceived behavioural control, behavioural intentions), health literacy, media literacy, public health literacy), step 3: interpersonal (i.e., caregiver's SSB behaviours, caregiver's SSB rules) and step 4: environmental (i.e., home SSB availability) level variables. Eight middle schools across four rural southwest Virginia counties in Appalachia. Seven hundred ninety seventh grade students (55·4 % female, 44·6 % males, mean age 12 (sd 0·5) years). Mean SSB intake was 36·3 (sd 42·5) fluid ounces or 433·4 (sd 493·6) calories per day. In the final step of the regression model, seven variables significantly explained adolescent's SSB consumption: behavioural intention (P < 0·05), affective attitude (P < 0·05), perceived behavioural control (P < 0·05), health literacy (P < 0·001), caregiver behaviours (P < 0·05), caregiver rules (P < 0·05) and home availability (P < 0·001). SSB intake among adolescents in rural Appalachia was nearly three times above national mean. Home environment was the strongest predictor of adolescent SSB intake, followed by caregiver rules, caregiver behaviours and health literacy. Future interventions targeting these factors may provide the greatest opportunity to improve adolescent SSB intake.

Impact of pharmacist counseling to enhance the accessibility of naloxone nasal spray to patients in a community pharmacy setting

BackgroundThe Centers for Disease Control and Prevention guidelines recommend naloxone for every high-dose opioid prescription; in 2018, only 1 naloxone prescription was dispensed for every 69 high-dose opioid prescriptions. In Virginia, strategies for creating awareness and availability include the REVIVE! training and the standing protocol for pharmacists to dispense naloxone. ObjectivesTo evaluate if a proactive offer for counseling by pharmacists improves the percent change of patients who receive a prescription for naloxone nasal spray compared with the previous year’s naloxone nasal spray fill history and to determine if the pharmacist’s counseling affects a patient’s confidence with opioid overdose and naloxone use. MethodsProspective 4-month, interventional study in southwest Virginia conducted at 5 geographically similar large community chain pharmacies. A National Drug Code activity report within each store was used to identify patients, aged 18-64 years, filling opioid medication without naloxone. A pharmacist recommended naloxone to patients at the point of care. Patients accepting the recommendation for naloxone received pharmacist counseling from a standardized counseling script and by using a naloxone nasal spray demo kit. All eligible patients were provided a postintervention survey assessing their confidence with naloxone, if naloxone had been recommended before, and if they were picking up naloxone on the basis of the pharmacist’s recommendation. Results were analyzed using univariate and bivariate analyses. ResultsA total of 121 naloxone prescriptions were dispensed; an increase of 36% compared with the same period during the previous year. In total, 38 patients completed the postintervention survey. After receiving pharmacist counseling, patients indicated being very confident with administering naloxone correctly and for recognizing an opioid overdose, 73.9% and 65.2%, respectively. Of the patients who completed the survey, 60.5% received naloxone and accepted counseling from the pharmacist. ConclusionAfter pharmacist counseling, naloxone dispensing increased, and patients were confident with both administration and recognition.

12 Artificial insemination and embryo transfer results in ewes during a long daylength period

Sheep are polyestrous, short-day breeders (∼11h of daylength), and exhibit oestrus approximately every 16–17 days during the breeding season, usually in late September to late December in the Northern Hemisphere. Progressive sheep producers often use assisted reproductive techniques such as laparoscopic AI and ovarian hyper-stimulation, embryo collection, and embryo transfer (ET) to increase genetic gain, and strive to have early December lambs to target specific show markets, which dictates AI or ET during the late summer. This field trial compared pregnancy rates following AI or ET in July and August (∼14h of daylength) in southwest Virginia (36–38′12″ N). Ewes (AI, n=83; ET recipients, n=33) were synchronized using a modified Ovsynch protocol involving intravaginal progesterone implants for 14 days, prostaglandin F2α (intramuscular) 48h before expected oestrus, and PG600 (IM) and gonadotrophin-releasing hormone (intramuscular) 52 to 54h and 16h before AI, respectively. Ewes were subjected to AI (frozen/thawed semen) regardless of whether they displayed signs of oestrus, and ewes selected as embryo recipients were subjected to a similar protocol but instead received 1 or 2 embryos (based upon the number of viable embryos produced per embryo donor) 6 days following the AI of the embryo donors. Ovarian hyper-stimulation of the embryo donors (n=13) was enabled by twice-daily FSH injections [totalling 350–455IU of Folltropin V (10–13mL)] for the 4 days before AI. Six days following AI, embryos were recovered surgically from the embryo donors (n=13) and yielded an average (±s.e.m.) of 6.6±1.2 total ova, 4.7±1.1 transferable quality embryos, and 1.9±0.8 unfertilized ova per collection. Pregnancy was detected using transrectal ultrasonography at ∼30 days of gestation and the pregnancy rates were analysed using Chi-squared. There was a tendency (P=0.092) for more pregnancies to be established following ET (22/33; 66%) compared with AI (41/83; 49%). There was no statistical relationship between AI ewes or ET recipient ewes that became pregnant relative to whether they displayed signs of oestrus or not. Embryo transfer was a more successful approach to produce pregnancies in ewes compared with AI during long daylength periods in this field trial. Further, ova from hyper-stimulated embryo donor ewes experienced a very high fertilization rate. Future studies will evaluate the ova capability directly via laparoscopic aspiration of ovarian follicles and IVF and evaluation of hyper- and non-hyper-stimulated follicular waves (using transrectal ultrasonography) and endocrine dynamics during different long and short daylength periods. Extending the opportunity to generate embryos and offspring regardless of daylength will assist aggressive sheep producers in reaching their reproductive, financial, and genetic goals.

159 The effect of sire FEC EBV on parasitism and survivability in grazing Katahdin lambs

Abstract Selection for reduced fecal egg count (FEC) is an important management tool to combat anthelmintic resistance in worm populations. To understand consequences of selection for parasite resistance, a divergent mating scheme was established whereby Katahdin rams with high (HiFEC; n = 4) or low fecal egg count (LoFEC; n = 4) estimated breeding values (EBV) were randomly mated to ewes at the Southwest Virginia AREC. Mid-March born lambs (n = 199) were managed as one group until approximately 120 days of age (Weaning: June 4). Beginning at 45 days of age, BW and FAMACHA scores were collected weekly. Deworming occurred as necessary (FAMACHA ≥ 3) and fecal egg counts were taken biweekly. Statistical analysis was performed using SAS with fixed effects of sire EBV type. Fecal egg count was significantly higher in HiFEC-sired lambs one week prior to weaning (665 vs. 427 eggs/g, P &amp;lt; 0.05) and again at three (3398 vs. 2175 eggs/g, P &amp;lt; 0.01) and five (3596 vs. 2209 eggs/g, P &amp;lt; 0.01) weeks post-weaning. These FEC differences corresponded to differences in lamb weaning and post-weaning FEC EBV (43% vs. -43%, P &amp;lt; 0.05 and 82% vs. -66%, P &amp;lt; 0.01; respectively). Lambs sired by HiFEC-rams required more anthelmintic treatment than LoFEC-selected lambs (76% vs. 61%, P &amp;lt; 0.05). The weaning and post-weaning FEC EBV of HiFEC-sired lambs was greater in lambs that died than those that survived to 120 d (37% vs. 83%, P &amp;lt; 0.01 and 73% vs. 138%, P &amp;lt; 0.01; respectively); however, this phenomenon did not occur in LoFEC-sired lambs. Taken together, these data indicate that LoFEC-sired lambs have reduced parasite burden and are more likely to survive to weaning. Thus, sire selection for low FEC EBV can have indirect effects on lamb survival and general immunity.

Faking It: How performed versus authentic southern accents impact word recognition

While listeners are not necessarily good at distinguishing performed versus real regional dialects (e.g., Heaton, 2019), there is also evidence that performed dialects can be inaccurate, limited to salient variables, and/or phonetically exaggerated (e.g., Schilling-Estes, 1998; Zetterholm, 2003; Bell &amp; Gibson, 2011). In this study we investigate how performed speech impacts word recognition, comparing listener responses to performed Southern dialects in one auditory lexical decision study versus native Southern dialects in another. In both studies, stimuli included monosyllabic words with vowels from the PRIZE, KIT, DRESS, THOUGHT, STRUT and FACE lexical sets, which have been shown to be strong markers of Southern US English (e.g., Gunter et al., 2017). 123 native speakers of US English (46 Southern) heard Southern tokens from 4 women from Southwest Virginia, and 32 (15 Southern) heard Southern tokens from 6 actresses who did not identify as Southern. Interactions between the dialect of the speaker (real, performed), the dialect of the listener (Southern, Not-Southern), and the vowel in the word will be analyzed in terms of both accuracy and responses times.

Impact of Adherence Education and Monitoring on Community Pharmacy Performance Scores and Patient Satisfaction.

Adherence, specifically to noninsulin diabetes medications, statins, and renin-angiotensin system antagonists (i.e. angiotensin-converting-enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARBs), and aliskiren), is a measure tracked by the Centers for Medicare and Medicaid Services (CMS) to give Medicare Part D plans a star rating; pharmacies are impacted by these star ratings. The pharmacy is given a performance score based on the measure. Some pharmacies use a performance information management platform (PIMP) that allows pharmacies to better understand performance information to impact patient care. (1) To evaluate if a monthly adherence monitoring and education service impacts the percentage of patientsadherent determined by pharmacy performance scores; (2) To determine patient satisfaction with the service in a large community pharmacy chain. A six-month prospective interventional pilot study including patients with a proportion of days covered (PDC) of less than 80% for oral diabetes or renin-angiotensin system antagonists (RASA) medications was conducted in two pharmacies of a large community pharmacy chain in Southwest Virginia. Using pharmacy internal data analytics and PIMP data, the percentage of patients who are adherent to oral diabetes or RASA medications was determined including the baseline PDC for each patient. At the start of the study, the standard of care in this large community chain pharmacy was to address adherence, follow-up in one month and every three months thereafter. In this study, pharmacists provided monthly telephonic adherence monitoring and education for a six-month period. Each session was scripted for medication adherence history, education and data collection. The pharmacist provided guidance and counseling based on how the patient answered the questions. Pharmacists gathered information about adherence patterns and behaviors using a 14 item Likert-scale and multiple choice-based questionnaire during the first session. After completion of the final adherence monitoring and education session, pharmacists gathered patient satisfaction information using an eight item Likert-scale questionnaire. At the end of the six-month period, using PIMP data, the percentage of patients adherent to oral diabetes or RASA medications was determined based on pharmacy performance scores. The data was analyzed using uni-variate and bi-variate statistics to determine if there was a difference in pharmacy performance scores from the pre-study analysis. The adherence patterns and behaviors, as well as patient satisfaction with the program was evaluated to determine factors influencing nonadherence. A total of 55 patients were identified in two pharmacies, ten of which were excluded or declined involvement, leaving 45 enrolled in the adherence monitoring and education service. Of the 45 enrolled patients, ten completed the adherence patterns and behaviors questionnaire. About half of the patients were men (50.95%) with an average age of 71.17 years and taking an average of 6.55 prescription medications. All patients had Medicare Part D insurance and majority had a yearly income of less than $40,000. The average baseline PDC was 68.92. In pharmacy 1, the average performance score for oral diabetes medications trended down and the average performance score for hypertension medications trended up over the study period. In pharmacy 2, the average performance score for oral diabetes medications trended up and the average performance score in hypertension medications trended up over the study period. The adherence patterns and behaviors questionnaire revealed the majority of patients rarely forgot to take medications or run out of medications. Additionally, cost of medications did not seem to impact adherence and majority of patients knew the names and indications of their medications. Only one patient completed the patient satisfaction survey. An adherence monitoring and education service had mixed results in improving patient adherence and pharmacy performance scores. Only one patient completed the satisfaction survey, thus no conclusions can be made regarding patient satisfaction of the program. More research needs to be done regarding telephonic adherence programs.

Development of an Interdisciplinary Telehealth Model of Provider Training and Comprehensive Care for Hepatitis C and Opioid Use Disorder in a High-Burden Region.

BackgroundHepatitis C virus (HCV) and the opioid epidemic disproportionately affect the Appalachian region. Geographic and financial barriers prevent access to specialty care. Interventions are needed to address the HCV-opioid syndemic in this region.MethodsWe developed an innovative, collaborative telehealth model in Southwest Virginia featuring bidirectional referrals from and to comprehensive harm reduction (CHR) programs and office-based opioid therapy (OBOT), as well as workforce development through local provider training in HCV management. We aimed to (1) describe the implementation process of provider training and (2) assess the effectiveness of the telehealth model by monitoring patient outcomes in the first year.ResultsThe provider training model moved from a graduated autonomy model with direct specialist supervision to a 1-day workshop with parallel tracks for providers and support staff followed by monthly case conferences. Forty-four providers and support staff attended training. Eight providers have begun treating independently. For the telehealth component, 123 people were referred, with 62% referred from partner OBOT or CHR sites; 103 (84%) attended a visit, 93 (76%) completed the treatment course, and 61 (50%) have achieved sustained virologic response. Rates of sustained virologic response did not differ by receipt of treatment for opioid use disorder.ConclusionsProviders demonstrated a preference for an in-person training workshop, though further investigation is needed to determine why only a minority of those trained have begun treating HCV independently. The interdisciplinary nature of this program led to efficient treatment of hepatitis C in a real-world population with a majority of patients referred from OBOTs and CHR programs.

The Health Wagon Partners with the Virginia Department of Health to Provide COVID-19 Testing in Rural Southwest Virginia.

The Health Wagon has been providing care for the rural population of southwest Virginia for the past 40 years. The mission of the Health Wagon is to provide quality health care to the medically underserved people in the mountains of Appalachia. It has expanded to two stationary clinics, three mobile units, and a mobile dental unit, logging over 19,000 patients encounters in the past year.

Consumption of Added Sugars by Rural Residents of Southwest Virginia.

IntroductionNationally, rural residents have high consumption of added sugars, yet the top sources have not been explored. Characterizing added-sugar intake in high sugar-sweetened beverage (SSB) consumers in rural areas is an important step to help inform interventions and policies.PurposeThe objective of this study was to explore the top food and beverage sources of added sugar and to examine variations by sociodemographic characteristics.MethodsThis cross-sectional study analyzed data from a randomized-controlled trial to reduce SSB in eight rural Appalachian counties. Data were obtained from baseline demographic surveys and three 24-hour dietary recalls. Dietary analyses included deriving AS grams and percentage of total energy intake from added sugar from individual food categories.ResultsThis study had 301 participants, of which 93% were White (non-Hispanic), 81% were female, 49% were aged 35 to 54 years, 43% had an income of ≤$14,000, 33% had low health literacy, and 32% had < college education. Males and those with an income of ≤$14,000 had significantly higher consumption of added sugar. Added sugar contributed to 21% of total energy intake. The top source of added sugar was soda. SSB contributed to 66% of added sugar and 14% of total energy intake. Within SSB, soda contributed to 40% of added sugar, and 8% of total energy intake. Cola and citrus flavored drinks were the main varieties consumed.ImplicationsStudy findings can be used to adapt evidence-based interventions to reflect commonly consumed food and beverages and help inform food- and beverage-based dietary guidelines and policies specific to rural populations.

Faculty Perceptions of Research Assessment at Virginia Tech

In the spring of 2019, survey research was conducted at Virginia Polytechnic Institute and State University (Virginia Tech), a large, public, Carnegie-classified R1 institution in southwest Virginia, to determine faculty perceptions of research assessment as well as how and why they use researcher profiles and research impact indicators. The Faculty Senate Research Assessment Committee (FSRAC) reported the quantitative and qualitative results to the Virginia Tech Board of Visitors to demonstrate the need for systemic, political, and cultural change regarding how faculty are evaluated and rewarded at the university for their research and creative projects. The survey research and subsequent report started a gradual process to move the university to a more responsible, holistic, and inclusive research assessment environment. Key results from the survey, completed by close to 500 faculty from across the university, include: a.) the most frequently used researcher profile systems and the primary ways they are used (e.g., profiles are used most frequently for showcasing work, with results indicating that faculty prefer to use a combination of systems for this purpose); b.) the primary reasons faculty use certain research impact indicators (e.g., number of publications is frequently used but much more likely to be used for institutional reasons than personal or professional reasons); c.) faculty feel that research assessment is most fair at the department level and least fair at the university level; and d.) faculty do not feel positively towards their research being assessed for the allocation of university funding.

AWWA Water Science Author Spotlight

Having recently published an article in AWWA Water Science, Cristina Marcillo answered a few questions from its editor-in-chief Kenneth L. Mercer about the research. Small Towns, Big Challenges: Does Rurality Influence Safe Drinking Water Act Compliance? Cristina E. Marcillo and Leigh-Anne H. Krometis Cristina travels to Guatemala with many bags of sampling equipment. Photo courtesy of Cristina E. Marcillo Cristina samples a stream in Guatemala. © 2020 Richard E. Bishop. Printed with permission. My recent article in AWWA Water Science (AWS) was motived by the goal of understanding distinct violation patterns and subsequent contaminant exposure in urban and rural parts of Virginia. Part of my research goal is to contextualize water system violations to understand how compliance might be influenced by local factors like urban/rural status and how these local factors might be creating different climates of environmental health. One of my broader goals has been to analyze similar data accounting for service area demographics, and my recent publication in AWS was one step toward that goal. Cristina hikes Devil's Marbleyard near Natural Bridge Station, Va. Photo courtesy of Cristina E. Marcillo I am really excited by the research that I do, so it can be hard to strike a balance when research itself is fun. But in my free time, I like to hike along the many beautiful trails in southwest Virginia, read, meditate, volunteer, and visit local breweries with friends. To learn more about Cristina's research, see the abstract on page 21 of the February 2019 issue of Journal AWWA and read the entire article in AWWA Water Science, available online at https://doi.org/10.1002/aws2.1120.

Geologic evidence for an icehouse Earth before the Sturtian global glaciation.

Snowball Earth episodes, times when the planet was covered in ice, represent the most extreme climate events in Earth's history. Yet, the mechanisms that drive their initiation remain poorly constrained. Current climate models require a cool Earth to enter a Snowball state. However, existing geologic evidence suggests that Earth had a stable, warm, and ice-free climate before the Neoproterozoic Sturtian global glaciation [ca. 717 million years (Ma) ago]. Here, we present eruption ages for three felsic volcanic units interbedded with glaciolacustrine sedimentary rocks from southwest Virginia, USA, that demonstrate that glacially influenced sedimentation occurred at tropical latitudes ca. 751 Ma ago. Our findings are the first geologic evidence of a cool climate teetering on the edge of global glaciation several million years before the Sturtian Snowball Earth.

Improving Discussion on Nutrition Topics in a Rural Clinic Setting Between Primary Care Physicians and Pediatric Patients

Abstract Objectives This research, conducted in rural under served southwest Virginia, determined outcomes for the Healthy People 2020 Nutrition and Weight Status Objective to assess implementation of provider nutrition education in office visits to promote nutrition as a component of routine preventive medicine. Methods The authors' prior research, clinical experiences, familiarity with the region, along with agency reports identified the collaborating clinic as representative of the health disparity region characterized by high childhood obesity rates. Researchers distributed a 14 item survey to participants consenting to an IRB approved protocol, responding anonymously to the paper survey by depositing their completed form in a locked box. Results Participants (n = 384; 80% providing valid responses) were parents or guardians of children 2 to 18 years of age visiting a local pediatrician's office. All responded to have medical insurance, 98% were the primary caregiver of the child and 74% received government aid. Most (77%) caregivers “find fun and interesting way to introduce new foods”. Most (79%) caregivers agreed their child “likes to eat fruits and vegetables”. Caregivers disagreed (84%) to, “A healthy child is a fat child.” Responses by caregivers to, “How often does your provider discuss nutrition topics with you?” were very often (25%); sometimes (32%); occasionally (33%); and never (11%). Responses to, ‘How often would you like your provider to discuss these topics with you?’ were very often (19%); sometimes (30%); occasionally (43%); and never (7%). There was little to no correlation to age of the child on how caregivers responded to “…does your provider discuss nutrition topics with you”? (r = 0.14) and “…would you like your provider to discuss these topics with you?” (r = 0.12). Correlations indicated little to no relationship to children's ages. Conclusions Caregivers in a southwest Virginia clinic reported receiving nutrition education services at a rate exceeding Healthy People 2020 goals and recognized healthy nutrition guidelines. Our findings are consistent with our previous studies, confirming future interventions should target translation of caregivers’ knowledge to children's behaviors to ultimately improve healthy childhood development. This study was sponsored by a Paul Scholarship Program Award, Rachel Horn Mullins OMSIV. Funding Sources N/A.

Comparative Analysis between Thromboelastography and Routine Coagulation Test in Liver Disease

Virginia has the nation’s highest rate of obese children two to four years old enrolled in the federally supported Women, Infants and Children Nutrition program. Southwest Virginia consistently has higher rates of childhood obesity compared to the rest of the state. The researchers proposed that a discordance exists between caregivers’/parents’ knowledge, attitudes and behaviors related to childhood nutrition.

Assessing Healthy Eating Attitudes and Behaviors of Caregivers at a Pediatric Clinic in Southwest Virginia

Assessing Healthy Eating Attitudes and Behaviors of Caregivers at a Pediatric Clinic in Southwest Virginia

Proper Disposal of Prescription Opioids in Southwest Virginia: Assessment of Patient, Physician, and Medical Student Beliefs and Practices.

Southwestern Virginia demonstrates the highest regional mortality rate from prescription opioid overdoses. Nationally, 65% of patients misusing opioid medications received them from friends and family, underscoring the need for effective disposal of unused narcotics. (1) To understand patient, provider, and medical student beliefs and misconceptions regarding proper methods of opioid disposal; (2) to characterize discrepancies that exist between patient self-reported habits and medical student/provider perceptions of opioid usage, disposal, and diversion. Descriptive, cross-sectional, observational study. Large, nonprofit health care organization and allopathic medical school in Southwestern Virginia. All ambulatory patients 18 years or older presenting for elective consultation at health system orthopedics department; all institutionally employed physicians with active system e-mail addresses; and all current students at the associated medical school. Patients: The number who had received information regarding proper methods of opioid disposal, intended disposal method, methods of disposal considered appropriate, comfort level with opioid disposal, and demographic data. Physicians and Medical Students: The number who had received instruction regarding proper methods of opioid disposal, acceptable means of opioid disposal, most appropriate disposal method, disposal method most likely to be employed by patients, practice profile/prescribing data, and medical school year. In total, 64% of patients (n = 255/750) had never received instruction from a physician regarding opioid disposal; 56% of physicians (n = 212/732) and 78% (n = 80/171) of medical students indicated that they never received formal instruction regarding methods of disposal. The majority of physicians believed that their patients are most likely to use in-home methods of disposal or store prescription medications for future use; 61% of patients indicated a preference for accessible disposal facilities. The discrepancy between patient and physician responses highlights a lack of communication regarding disposal of unused opioid medications and is a target for future intervention.