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Rural Appalachian Women Will Suffer Disproportionately if Attempts to Further Restrict Emergency Contraception are Successful. 如果进一步限制紧急避孕的尝试成功,阿巴拉契亚农村妇女将遭受不成比例的损失。
Pub Date : 2023-04-01 eCollection Date: 2023-01-01 DOI: 10.12023/jah.0501.02
Amie M Ashcraft, Sarah Dotson, Sara Farjo, Courtney S Pilkerton, Pamela J Murray

The removal of federal abortion protection has incited fear that restrictions on contraception may be next. Many states now imposing abortion restrictions and bans are in the South and Appalachian Regions of the U.S., where rates of unplanned pregnancy and poor health outcomes are already disproportionately high. Numerous studies have documented variable access to levonorgestrel EC (LNG EC) in community pharmacies, with particularly low rates of access at independent pharmacies that are more likely to be located in rural communities than chain pharmacies. Since the overturn of Roe v. Wade, some large chain pharmacies and online retailers are restricting the purchase of LNG EC, limiting its availability. Some legislators and activists are calling for a ban on EC based on a misunderstanding about its mechanism of action, equating it with abortion. At a time when access to the full range of contraceptive options is more critical than ever, already limited access to LNG EC is worsening. Extensive data on LNG EC availability in 509 pharmacies and 400 health clinics across West Virginia, contextualized with socioeconomic demographics, illustrate existing disparities in LNG EC access.

联邦堕胎保护的取消激起了人们的恐惧,人们担心接下来可能会限制避孕。现在许多限制和禁止堕胎的州都在美国南部和阿巴拉契亚地区,那里的意外怀孕率和不良健康结果已经高得不成比例。大量研究表明,左炔诺孕酮EC (LNG EC)在社区药店的可及性存在差异,独立药店的可及性尤其低,这些药店更有可能位于农村社区,而不是连锁药店。自从罗伊诉韦德案被推翻以来,一些大型连锁药店和在线零售商限制了液化天然气EC的购买,限制了其可用性。一些立法者和活动家基于对EC的作用机制的误解,将其等同于堕胎,而呼吁禁止EC。在获得全方位避孕选择比以往任何时候都更加重要的时候,已经有限的液化天然气EC的获取正在恶化。西弗吉尼亚州509家药店和400家诊所的液化天然气EC可用性的广泛数据,与社会经济人口统计背景相结合,说明了液化天然气EC获取方面存在的差距。
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引用次数: 0
A Better Life: Factors that Help and Hinder Entry and Retention in MAT from the Perspective of People in Recovery. 更美好的生活:从康复者的角度来看,帮助和阻碍MAT进入和保留的因素。
Pub Date : 2023-04-01 eCollection Date: 2023-01-01 DOI: 10.13023/jah.0501.06
Adam D Baus, Martha Carter, Jennifer Boyd, Erin McMullen, Trey Bennett, Alexandra Persily, Danielle M Davidov, Christa Lilly

Introduction: Opioid addiction and opioid-related overdoses and deaths are serious public health problems nationally and in West Virginia, in particular. Medication-assisted treatment (MAT) is an effective yet underutilized treatment for opioid use disorder (OUD).

Purpose: Research examining factors that help individuals succeed in MAT has been conducted from provider and program perspectives, but little research has been conducted from the perspective of those in recovery.

Methods: This study, co-developed with individuals in recovery, took place in West Virginia-based MAT programs using an exploratory sequential mixed methods approach. The survey was open February through August 2021. Data were analyzed late 2021 through mid 2022.

Results: Respondents experienced many barriers to MAT entry and retention, including community bias / stigma, lack of affordable programming, and lack of transportation. Respondents sought MAT primarily for personal reasons, such as being tired of being sick, and tired of having to look for drugs every day. As one respondent shared, " I wanted to better my life, to get it under control."

Implications: Programs and policies should make it easy for individuals to enter treatment when ready, through affordable and accessible treatment options, reduced barriers to medications, focused outreach and education, individualized care, and reduced stigmatization.

导言:阿片类药物成瘾和与阿片类药物有关的过量使用和死亡是全国,特别是西弗吉尼亚州严重的公共卫生问题。药物辅助治疗(MAT)是一种有效但未充分利用的治疗阿片类药物使用障碍(OUD)的方法。目的:从提供者和项目的角度研究了帮助个人在MAT中取得成功的因素,但从康复者的角度进行的研究很少。方法:本研究与康复中的个体共同开发,采用探索性顺序混合方法在西弗吉尼亚州的MAT项目中进行。该调查于2021年2月至8月开放。数据分析于2021年底至2022年中期。结果:受访者在MAT进入和保留方面遇到了许多障碍,包括社区偏见/耻辱,缺乏负担得起的规划和缺乏交通。受访者寻求MAT主要是出于个人原因,例如厌倦了生病,厌倦了每天都要寻找药物。正如一位受访者所分享的,“我想改善我的生活,让它在我的控制之下。”意义:规划和政策应通过负担得起和可获得的治疗方案、减少药物障碍、重点推广和教育、个性化护理和减少污名化,使个人在准备好后更容易接受治疗。
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引用次数: 0
Providers' Stigmas and the Effects on Patients with Opioid Use Disorder: A Scoping Review. 提供者的耻辱感和对阿片类药物使用障碍患者的影响:范围审查。
Pub Date : 2023-01-01 DOI: 10.13023/jah.0403.06
Peyton Skaggs, Sarah Beth Bell, F Douglas Scutchfield, Lauren E Robinson

Introduction: One of the most prevalent, dangerous stigmas in health care is the complex bias toward patients with opioid use disorder (OUD). This stigma damages the vital patient-provider relationship, further perpetuating the opioid epidemic.

Purpose: Unfortunately, research on the relationship between OUD and provider stigma is greatly lacking. To fill this gap, the present in-depth study undertakes a scoping review of research on providers' stigma toward OUD in order to determine how enacted stigma affects treatment plans.

Methods: Four databases were used to identify articles published from 1999 to 2021. A comprehensive search strategy was developed through a collaborative process between the researchers and a medical librarian. The researchers used the methodological framework developed by Arksey and O'Malley (2005) and expanded upon by Levac et al.(2010) to chart study characteristics and themes.

Results: A total of 196 search items were retrieved. After de-duplication (n=31), remaining articles were screened based on the inclusion and exclusion criteria detailed in the protocol. After both a title/abstract review and full-text review, an additional 158 articles were removed. This yielded a total of seven articles. Three main themes were identified in the literature: (1) rural-urban differences in bias; (2) provider concern regarding legal implications and regulatory concerns; and (3) the belief that OUD is a moral failing rather than a medical diagnosis.

Implications: Additional research should further analyze prescribed treatment plans for patients with OUD and utilize this information to create future considerations aimed at reducing opioid-related stigma in healthcare in Appalachia.

在卫生保健中最普遍、最危险的耻辱之一是对阿片类药物使用障碍(OUD)患者的复杂偏见。这种耻辱损害了至关重要的医患关系,使阿片类药物的流行进一步延续。目的:遗憾的是,关于OUD与提供者耻辱感之间关系的研究非常缺乏。为了填补这一空白,本深入研究对提供者对OUD的耻辱感进行了范围审查,以确定制定的耻辱感如何影响治疗计划。方法:采用4个数据库对1999 - 2021年发表的文献进行检索。通过研究人员和医学图书管理员之间的协作过程,开发了一个全面的搜索策略。研究人员使用了由Arksey和O'Malley(2005)开发并由Levac等人(2010)扩展的方法框架来绘制研究特征和主题。结果:共检索到196个检索项。去重复后(n=31),根据方案中详细的纳入和排除标准筛选剩余的文章。在标题/摘要审查和全文审查后,又删除了158篇文章。这总共产生了七篇文章。在文献中确定了三个主要主题:(1)城乡偏见差异;(2)提供商对法律影响和监管问题的担忧;(3)认为OUD是一种道德上的失败,而不是医学诊断。意义:进一步的研究应进一步分析OUD患者的处方治疗方案,并利用这一信息来制定未来的考虑,旨在减少阿片类药物在阿巴拉契亚医疗保健中的耻辱感。
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引用次数: 0
Association between low health literacy and adverse health behaviors in North Carolina, 2016. 2016年北卡罗来纳州低健康素养与不良健康行为之间的关系
Pub Date : 2023-01-01 DOI: 10.13023/jah.0403.02
Manan Roy, Adam Hege, Erin D Bouldin

Introduction: Health literacy (HL) is an urgent public health challenge facing the U.S. HL is a critical factor in health inequities and exacerbates underlying social determinants of health.

Purpose: This study assesses the association between low HL (LHL) and adverse health behaviors, which contribute to poor health.

Methods: Researchers used North Carolina's 2016 Behavioral Risk Factor Surveillance System data, namely, the Health Literacy optional module which asks respondents to rate how difficult it is for them to get health-related advice or to understand medical information (verbal or written). Health behaviors analyzed were excessive alcohol consumption, lack of adequate exercise and sleep, and irregular medical and dental check-ups. The sample was divided into four age categories (18-49, 50-64, and 65-75, and 76 and older) for statistical comparisons. Stata 15 and a user-written Stata command, - psacalc-, were used to examine the relationships by addressing omitted variable bias in OLS regressions.

Results: Findings indicate that LHL has a direct robust relationship with not exercising, inadequate sleep, irregular health and dental checkup, and health screenings across different age groups. Among women, LHL is associated with getting a Pap test in 3 years as opposed to more than 3 years.

Implications: The adverse behaviors can explain the mechanisms underlying the link between LHL and adverse health outcomes. Further research on the causal relationship between LHL and adverse health behaviors using longitudinal data on a broader geographic region is warranted.

健康素养(Health literacy, HL)是美国面临的一项紧迫的公共卫生挑战。HL是卫生不公平的一个关键因素,并加剧了健康的潜在社会决定因素。目的:本研究评估低HL (LHL)与不良健康行为之间的关系,这些不良健康行为导致健康状况不佳。方法:研究人员使用了北卡罗来纳州2016年行为风险因素监测系统的数据,即健康素养可选模块,该模块要求受访者评估他们获得健康相关建议或理解医疗信息(口头或书面)的困难程度。分析的健康行为包括过度饮酒、缺乏足够的运动和睡眠、不规律的医疗和牙科检查。将样本分为18-49岁、50-64岁、65-75岁和76岁及以上四个年龄段进行统计比较。Stata 15和用户编写的Stata命令- psacalc-用于通过解决OLS回归中遗漏的变量偏差来检查关系。结果:研究结果表明,LHL与不运动、睡眠不足、不规律的健康和牙科检查以及不同年龄组的健康筛查有直接的密切关系。在女性中,LHL与3年内进行巴氏试验有关,而不是超过3年。意义:不良行为可以解释LHL与不良健康结果之间联系的潜在机制。有必要利用更广泛地理区域的纵向数据进一步研究LHL与不良健康行为之间的因果关系。
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引用次数: 0
Over the Hills and Through the Hollers: How One Program is Assisting Residents of Appalachian with Opioid Use Recovery. 越过山丘,穿过呼喊:一个项目如何帮助阿片类药物使用恢复的阿巴拉契亚居民。
Pub Date : 2023-01-01 DOI: 10.13023/jah.0403.05
Aubrey E Jones, Jayme E Walters, Aaron R Brown

Introduction: The consequences of increasing opioid misuse in the U.S. over the last two decades have been severe, contributing to hundreds of thousands of lives lost and heavy tolls on individuals, families, and society. The Appalachian Region has been hit particularly hard, with its predominantly rural landscape seeing disproportionate increases in opioid misuse and overdoses. These cases have been difficult to address due to poor treatment access and capacity constraints in many areas of Appalachia.

Purpose: The current study focuses on evaluating The Kentucky Access to Recovery Program (KATR), which provides services to individuals recovering from opioid addiction residing in several counties in Eastern Kentucky. Its purpose is to understand the impact of KATR on service recipients' access to recovery services and supports.

Methods: Semi-structured interviews were conducted with 12 service recipients, three service providers, and four vendors of support services related to housing, transportation, medical/dental care, employment, and childcare. Qualitative data were analyzed using thematic analysis.

Results: Themes related to individual-level impacts were identified and discussed, including behavioral changes related to recovery, physical and mental health improvements, relationship repair, regaining custody of children, provision of needed supports, and ability to gain employment and improve finances. Study findings showed that KATR had meaningful impacts on the lives of service recipients by helping meet needs and reducing barriers to their ongoing recovery.

Implications: Through its use of vouchers for support services and basic-needs provision, KATR demonstrates a potentially effective strategy for increasing access to health-related social services for persons in recovery in predominantly rural areas.

在过去的二十年里,美国阿片类药物滥用的后果越来越严重,导致成千上万的人丧生,给个人、家庭和社会造成了沉重的损失。阿巴拉契亚地区受到的打击尤其严重,其主要是农村地区,阿片类药物滥用和过量使用的情况不成比例地增加。由于阿巴拉契亚许多地区的治疗机会不足和能力限制,这些病例难以处理。目的:目前的研究重点是评估肯塔基州获得恢复计划(KATR),该计划为居住在肯塔基州东部几个县的阿片类药物成瘾患者提供服务。其目的是了解KATR对服务接受者获得恢复服务和支持的影响。方法:对12名服务对象、3名服务提供者和4名住房、交通、医疗/牙科保健、就业和儿童保育等支持服务提供者进行半结构化访谈。定性数据采用专题分析进行分析。结果:确定并讨论了与个人层面影响相关的主题,包括与康复、身心健康改善、关系修复、重新获得子女监护权、提供所需支持以及获得就业和改善财务状况的能力相关的行为改变。研究结果表明,KATR通过帮助满足需求和减少阻碍其持续康复的障碍,对服务接受者的生活产生了有意义的影响。影响:通过使用代金券提供支助服务和基本需求,KATR展示了一项潜在的有效战略,可以增加主要是农村地区康复者获得与健康有关的社会服务的机会。
{"title":"Over the Hills and Through the Hollers: How One Program is Assisting Residents of Appalachian with Opioid Use Recovery.","authors":"Aubrey E Jones, Jayme E Walters, Aaron R Brown","doi":"10.13023/jah.0403.05","DOIUrl":"https://doi.org/10.13023/jah.0403.05","url":null,"abstract":"<p><strong>Introduction: </strong>The consequences of increasing opioid misuse in the U.S. over the last two decades have been severe, contributing to hundreds of thousands of lives lost and heavy tolls on individuals, families, and society. The Appalachian Region has been hit particularly hard, with its predominantly rural landscape seeing disproportionate increases in opioid misuse and overdoses. These cases have been difficult to address due to poor treatment access and capacity constraints in many areas of Appalachia.</p><p><strong>Purpose: </strong>The current study focuses on evaluating The Kentucky Access to Recovery Program (KATR), which provides services to individuals recovering from opioid addiction residing in several counties in Eastern Kentucky. Its purpose is to understand the impact of KATR on service recipients' access to recovery services and supports.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 12 service recipients, three service providers, and four vendors of support services related to housing, transportation, medical/dental care, employment, and childcare. Qualitative data were analyzed using thematic analysis.</p><p><strong>Results: </strong>Themes related to individual-level impacts were identified and discussed, including behavioral changes related to recovery, physical and mental health improvements, relationship repair, regaining custody of children, provision of needed supports, and ability to gain employment and improve finances. Study findings showed that KATR had meaningful impacts on the lives of service recipients by helping meet needs and reducing barriers to their ongoing recovery.</p><p><strong>Implications: </strong>Through its use of vouchers for support services and basic-needs provision, KATR demonstrates a potentially effective strategy for increasing access to health-related social services for persons in recovery in predominantly rural areas.</p>","PeriodicalId":73599,"journal":{"name":"Journal of Appalachian health","volume":"4 3","pages":"71-86"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10655734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluating the Association Between Depressive Symptoms and Glycemic Control Among Residents of Rural Appalachia. 评估阿巴拉契亚农村居民抑郁症状与血糖控制之间的关系。
Pub Date : 2023-01-01 DOI: 10.13023/jah.0403.03
Brittany L Smalls, Adebola Adegboyega, Ellen Combs, Eli W Travis, Felipe De La Barra, Lovoria B Williams, Nancy Schoenberg

Introduction: Type 2 diabetes mellitus (T2DM) is associated with a range of co-morbid physical and psychological conditions, including depression. Yet there is a dearth of evidence regarding the prevalence of depression among those in Appalachia living with T2DM; this gap persists despite the higher regional prevalence of T2DM and challenging social determinants of health.

Purpose: This study aimed to provide greater detail about the relationships between T2DM and depressive symptoms in adults living in Appalachia Kentucky.

Methods: The present study was a cross-sectional analysis of baseline data derived from an ongoing study of Appalachia Kentucky adults living with T2DM. Outcome data included demographics, Center for Epidemiologic Studies Depression Scale, point-of-care HbA1c, and the Summary of Diabetes Self-Care Activities. Bivariate analysis was conducted using Pearson's correlation to determine the statistically significant relationships between variables which were then included in a multiple regression model.

Results: The sample (N=365), consisted primarily of women (n=230, 64.6%) of mean age 64 years (±10.6); almost all (98%) were non-Hispanic White (n=349), and most were married (n=208, 59.1%). The majority (47.2%) reported having two comorbid conditions (n=161), including T2DM, and the mean HbA1c was 7.7% (1.7). Nearly 90% were nonsmokers (n=319). Depressive symptoms were reported in 25% (n=90) of participants. A higher number of comorbid conditions, increased age, Medicaid insurance, tobacco use, lower financial status, female sex, and disability compared to fully employed status all were correlated with a higher rate of depressive symptoms (r ≤ 0.2). The regression indicated that depressive symptoms were associated with age (β = -0.010, p = 0.001); full-time employment status compared to those who are disabled (β = -.0209, p = 0.18); men compared to women (β = -0.122, p = 0.042), and those who smoke compared to nonsmokers (β = 0.175, p = 0.038).

Implications: Depressive symptoms were correlated with T2DM among this sample of Appalachian residents with poorly controlled T2DM, especially among women. Given the vast number of social determinants (e.g., poverty, food insecurity, and rurality) affecting this population, healthcare providers must assess for depression and consider its negative influence on the patient's ability to achieve glycemic control.

2型糖尿病(T2DM)与一系列共病的身体和心理状况相关,包括抑郁症。然而,关于阿巴拉契亚地区T2DM患者中抑郁症患病率的证据缺乏;尽管2型糖尿病的区域患病率较高,并且具有挑战性的健康社会决定因素,但这一差距仍然存在。目的:本研究旨在为居住在肯塔基州阿巴拉契亚地区的成年人提供更多关于2型糖尿病和抑郁症状之间关系的细节。方法:本研究是对正在进行的肯塔基州阿巴拉契亚地区T2DM成人研究的基线数据进行横断面分析。结果数据包括人口统计数据、流行病学研究中心抑郁量表、护理点HbA1c和糖尿病自我护理活动摘要。使用Pearson相关进行双变量分析,以确定变量之间的统计显著关系,然后将其纳入多元回归模型。结果:样本(N=365)主要为女性(N= 230,占64.6%),平均年龄64岁(±10.6);几乎所有(98%)是非西班牙裔白人(n=349),大多数已婚(n=208, 59.1%)。大多数(47.2%)报告有两种合并症(n=161),包括T2DM,平均HbA1c为7.7%(1.7)。近90%为不吸烟者(n=319)。25% (n=90)的参与者报告有抑郁症状。与充分就业状态相比,较高数量的合并症、年龄增加、医疗补助保险、吸烟、较低的经济状况、女性和残疾都与较高的抑郁症状发生率相关(r≤0.2)。回归分析显示抑郁症状与年龄相关(β = -0.010, p = 0.001);与残疾人的全职就业状况相比(β = -)。0209, p = 0.18);男性与女性的比较(β = -0.122, p = 0.042),吸烟者与不吸烟者的比较(β = 0.175, p = 0.038)。意义:在阿巴拉契亚地区T2DM控制不佳的居民中,抑郁症状与T2DM相关,尤其是女性。考虑到影响这一人群的大量社会决定因素(例如,贫困、粮食不安全和农村),医疗保健提供者必须评估抑郁症,并考虑其对患者实现血糖控制能力的负面影响。
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引用次数: 0
Differences in Distress Between Rural and Non-rural Appalachian Breast Cancer Patient/Caregiver Dyads During the First Year of Treatment. 农村和非农村阿巴拉契亚地区乳腺癌患者/护理者夫妇在治疗第一年的痛苦差异
Pub Date : 2023-01-01 DOI: 10.13023/jah.0403.04
Jordan Tasman, Callie D McAdams, Jillian Lloyd, Ashton J Brooks, Patricia Nola Eugene Roberson

Introduction: Breast cancer patients and their caregivers living in rural Appalachia face substantial health disparities compared to their non-rural Appalachian counterparts. However, there is limited research on how these specific health disparities in rural Appalachian communities may impact patient psychological distress and caregiver strain during the first year of breast cancer treatment.

Purpose: The purpose of the current study was to assess differences in patient psychological distress (depression and anxiety) and caregiver strain between rural non-rural Appalachian breast-cancer-affected dyads (patients and their caregivers) during the first year of treatment.

Methods: A total of 48 Appalachian breast cancer patients (with a Stage I through Stage III diagnosis) and their identified caregiver (together, 'dyads') were identified from The University of Tennessee Medical Center across 2019 to 2020. Dyads completed follow-up surveys throughout the first year of treatment. In this prospective pilot study, measures on anxiety, depression and caregiver strain were self-reported and then analyzed using RM-ANOVA.

Results: There was a statistically significant higher number of reports of patient depression and caregiver strain in rural-residing dyads compared to non-rural-residing dyads. However, there was not a statistically significant difference between rural and non-rural Appalachian dyads for patient-reported anxiety during the first year of treatment.

Implications: The higher reported patient depression and caregiver strain among rural-residing Appalachian patients may indicate the need for implementing remote (e.g., telehealth) Cognitive Behavioral Therapy (CBT) to address the psychological needs of rural-residing dyads. Additionally, greater education from physicians to rural dyads on what to expect during treatment could alleviate caregiver strain.

引言:与非阿巴拉契亚农村地区相比,生活在阿巴拉契亚农村地区的乳腺癌患者及其护理人员面临着巨大的健康差距。然而,关于阿巴拉契亚农村社区这些具体的健康差异如何影响乳腺癌治疗第一年患者心理困扰和护理人员压力的研究有限。目的:本研究的目的是评估农村非农村阿巴拉契亚地区乳腺癌患者(患者及其护理人员)在治疗第一年的患者心理困扰(抑郁和焦虑)和护理人员压力的差异。方法:2019年至2020年,在田纳西大学医学中心共确定了48名阿巴拉契亚乳腺癌患者(从I期到III期诊断)及其确定的护理人员(合称为“二人组”)。二人在治疗的第一年完成了随访调查。在这项前瞻性先导研究中,参与者自我报告焦虑、抑郁和照顾者压力的测量结果,然后使用RM-ANOVA分析。结果:与非农村居住的夫妇相比,农村居住的夫妇中患者抑郁和照顾者紧张的报告数量具有统计学意义。然而,在治疗的第一年,阿巴拉契亚农村地区和非农村地区的患者报告的焦虑没有统计学上的显著差异。含义:阿巴拉契亚农村居民中较高的患者抑郁和照顾者压力可能表明需要实施远程(如远程医疗)认知行为疗法(CBT)来解决农村居民夫妇的心理需求。此外,医生向农村夫妇提供更多关于治疗期间可能发生的事情的教育,可以减轻护理人员的压力。
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引用次数: 0
Connections Network: Harnessing the Collective Influence of Grassroots Leaders to Address Health-Related Problems in Hawkins and Hancock County, TN. 连接网络:利用基层领导人的集体影响力来解决与健康有关的问题在霍金斯和汉考克县,田纳西州。
Pub Date : 2023-01-01 DOI: 10.13023/jah.0403.08
Jodi L Southerland, Teresa Buttry, Connie Johnson, Sheldon Livesay, Lisa Nichols, Priscilla Rogers

In March 2021, grassroots leaders in two counties in northeast Tennessee formed a new network called Connections. Leaders are working to strengthen the capacity of the network and member organizations by promoting partnerships as vital to address effectively rural social determinants of health. Connections provides network members with capacity-building tools and resources, including two funding opportunities, to achieve their missions and sustain impact. Network members are also aligning around common goals to address the socioeconomic conditions affecting health outcomes. Connections will utilize findings from network activities and collaborations to identify synergies that can accelerate improvements in community health and well-being.

2021年3月,田纳西州东北部两个县的基层领导人组成了一个名为“连接”的新网络。领导人正在努力加强网络和成员组织的能力,促进伙伴关系,认为这对有效解决农村健康问题的社会决定因素至关重要。连接网络为网络成员提供能力建设工具和资源,包括两个筹资机会,以实现其使命并保持影响力。网络成员还围绕解决影响健康结果的社会经济条件的共同目标进行协调。联系将利用网络活动和协作的成果,确定能够加速改善社区健康和福祉的协同作用。
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引用次数: 1
Review of Storytelling in Queer Appalachia: Imagining the Unspeakable Other. 《阿巴拉契亚酷儿的故事叙述:想象不可言说的他者》述评。
Pub Date : 2023-01-01 DOI: 10.13023/jah.0403.07
Sandra L Cotton, Laurie A Theeke, James Messer

The Journal of Appalachian Health is committed to reviewing published media that relates to contemporary concepts affecting the health of residents of Appalachia. Improving the health in the region of Appalachia means knowing our people as they live and thrive in communities. The book reviewed here, Storytelling in Queer Appalachia: Imagining the Unspeakable Other (Edited by Glasby, Gradin, and Ryerson), is a must read for people who wish to gain insight on the real experience of being queer in Appalachia.

《阿巴拉契亚健康杂志》致力于审查与影响阿巴拉契亚居民健康的当代概念有关的出版媒体。改善阿巴拉契亚地区的健康状况意味着了解我们的人民在社区中生活和发展。这里的书评是《阿巴拉契亚酷儿的故事:想象无法言说的他者》(由格拉斯比、格拉丁和瑞尔森编辑),对于那些希望深入了解阿巴拉契亚酷儿真实经历的人来说,这是一本必读的书。
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引用次数: 0
The relationship between psychosocial factors, self-care, and blood sugar in an Appalachian population. 阿巴拉契亚地区人群的社会心理因素、自我保健和血糖的关系。
Pub Date : 2023-01-01 DOI: 10.13023/jah.0403.01
Brittany L Smalls, Tofial Azam, Madeline Dunfee, Philip M Westgate, Susan C Westneat, Nancy Schoenberg

Introduction: Appalachian residents are more likely than other populations to have Type 2 Diabetes Mellitus (T2DM) and to experience more severe complications from the disease, including excess and premature mortality.

Methods: This study examines health alongside sociodemographic factors, psychosocial factors (including knowledge, empowerment, social support/function, religiosity, distress), and perceived problems in diabetes management that may influence self-care and HbA1c among vulnerable rural residents. A survey of a community-based sample of 356 adults with diagnosed diabetes or HbA1c > 6.5 was conducted in six counties in Appalachian Kentucky.

Results: Findings suggest that neither religiosity nor social support/function mediate/moderate the relationship between psychosocial factors and dependent variables (problem areas in diabetes, T2DM self-care or HbA1c). Results also suggest that distress is a predictor of problem areas in diabetes, and both distress and empowerment are predictors of T2DM self-care.

Implications: This study addresses the gap in the literature concerning the influence of psychosocial factors on problem areas in diabetes, T2DM self-care and HbA1c among vulnerable rural residents, as well as the potential mediating/modifying effects of religiosity and social function/support. Future research is needed to inform strategies for identifying and addressing distress among vulnerable populations burdened by T2DM, including Appalachian adults.

阿巴拉契亚居民比其他人群更容易患2型糖尿病(T2DM),并经历更严重的并发症,包括过量和过早死亡。方法:本研究考察了健康、社会人口因素、心理社会因素(包括知识、赋权、社会支持/功能、宗教信仰、痛苦)以及糖尿病管理中可能影响自我保健和糖化血红蛋白的感知问题。在肯塔基州阿巴拉契亚州的六个县,对356名诊断为糖尿病或HbA1c > 6.5的成年人进行了社区抽样调查。结果:研究结果表明,无论是宗教信仰还是社会支持/功能,都不能调解/调节社会心理因素和因变量(糖尿病问题领域、T2DM自我保健或HbA1c)之间的关系。结果还表明,痛苦是糖尿病问题区域的预测因子,痛苦和赋权都是T2DM自我护理的预测因子。意义:本研究填补了社会心理因素对农村弱势群体糖尿病、2型糖尿病自我保健和糖化血红蛋白问题区影响的文献空白,以及宗教信仰和社会功能/支持的潜在中介/调节作用。未来的研究需要为识别和解决包括阿巴拉契亚成年人在内的易受2型糖尿病影响人群的痛苦提供策略。
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引用次数: 1
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Journal of Appalachian health
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