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Review of: Wide Neighborhoods: A Story of the Frontier Nursing Service 《宽阔的邻里:边疆护理服务的故事》综述
Pub Date : 2022-02-13 DOI: 10.13023/jah.0401.07
T. Gulley
The Journal of Appalachian Health is committed to reviewing published media that relates to contemporary concepts affecting the health of Appalachia. Access to care remains one of the biggest challenges to Appalachian Health. The book, Wide Neighborhoods: A Story of the Frontier Nursing Service by Mary Breckinridge, is a well-known title that seems as relevant today as it was in 1952.
《阿巴拉契亚健康杂志》致力于审查与影响阿巴拉契a健康的当代概念相关的已出版媒体。获得护理仍然是阿巴拉契亚健康面临的最大挑战之一。玛丽·布莱肯里奇(Mary Breckinridge)的《广阔的社区:边境护理服务的故事》(Wide Neighborhood:A Story of The Frontier Nursing Service)一书是一本著名的书名,在今天看来与1952年一样重要。
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引用次数: 0
Change Happens. 变化发生了。
Pub Date : 2022-02-13 eCollection Date: 2022-01-01 DOI: 10.13023/jah.0401.01
F Douglas Scutchfield

The Journal of Appalachian Health is going through some changes that are reflected in the masthead and banner. We say farewell to some colleagues and welcome to the new faces.

阿巴拉契亚健康杂志》正在经历一些变化,这些变化反映在刊头和横幅上。我们向一些同事道别,欢迎新面孔的加入。
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引用次数: 0
Changes in Adolescent Birth Rates within Appalachian Subregions and Non-Appalachian Counties in the United States, 2012-2018. 2012-2018年美国阿巴拉契亚地区和非阿巴拉契亚县青少年生育率变化
Pub Date : 2022-02-13 eCollection Date: 2022-01-01 DOI: 10.13023/jah.0401.05
Nathan Hale, Kathleen Tatro, Sylvester Olubolu Orimaye, Michael Smith, Michael Meit, Kate E Beatty, Amal Khoury

Background: Adolescent births are associated with numerous challenges. While adolescent birth rates have declined across the U.S., disparities persist, and little is known about the extent to which broader declines are seen within Appalachia.

Purpose: The purpose of this study was to examine the extent to which adolescent birth rates have declined across the subregions of Appalachia relative to non-Appalachia.

Methods: We conducted a retrospective study of adolescent birth rates between 2012 and 2018 using county-level vital records data. Differences were examined across the subregions of Appalachia and among non-Appalachian counties. Multiple regression models were used to examine changes in the rate of decline over time, adjusting for additional covariates of relevance.

Results: About 13.4% of all counties in the U.S. are within the Appalachian region. The rate of adolescent births decreased by 12.6 adolescent births per 1,000 females between 2012 and 2018 across the U.S. While all regions experienced declines in the rate of adolescent births, Central Appalachia had the largest reduction in adolescent births (18.5 per 1,000 females), which was also noted in the adjusted models when compared to the counties of non-Appalachia (b= -5.78, CI: -9.58, -1.97). Rates of adolescent birth were markedly higher in counties considered among the most socially and economically vulnerable.

Implications: This study demonstrates that the rates of adolescent births vary across the subregions of Appalachia but have declined proportional to rates in non-Appalachia. While adolescent birth rates remain higher in select subregions of Appalachia compared to non-Appalachia, the gap has narrowed considerably.

背景:青少年生育与许多挑战有关。虽然美国各地的青少年生育率都有所下降,但差距仍然存在,而且很少有人知道阿巴拉契亚地区的青少年生育率下降幅度更大。目的:本研究的目的是检查青少年生育率在阿巴拉契亚地区相对于非阿巴拉契亚地区下降的程度。方法:利用县级生命记录数据对2012 - 2018年青少年出生率进行回顾性研究。研究了阿巴拉契亚地区和非阿巴拉契亚地区各县之间的差异。使用多元回归模型来检查随时间下降率的变化,并对其他相关协变量进行调整。结果:美国约有13.4%的县位于阿巴拉契亚地区。2012年至2018年期间,美国青少年出生率下降了12.6 / 1000。虽然所有地区的青少年出生率都有所下降,但阿巴拉契亚中部地区的青少年出生率下降幅度最大(18.5 / 1000),与非阿巴拉契亚县相比,调整后的模型也注意到这一点(b= -5.78, CI: -9.58, -1.97)。在被认为是社会和经济最脆弱的县,青少年生育率明显较高。含义:这项研究表明,青少年生育率在阿巴拉契亚地区各分区域有所不同,但与非阿巴拉契亚地区的生育率成比例下降。虽然与非阿巴拉契亚地区相比,阿巴拉契亚部分地区的青少年生育率仍然较高,但差距已大大缩小。
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引用次数: 1
Prevalence and Types of Drugs Used Among Hepatitis A Patients During Outbreaks Associated with Person-to-Person Transmission, Kentucky, Michigan, and West Virginia, 2016-2019. 2016-2019年肯塔基州、密歇根州和西弗吉尼亚州人际传播相关暴发期间甲型肝炎患者的患病率和使用药物类型
Pub Date : 2022-02-13 eCollection Date: 2022-01-01 DOI: 10.13023/jah.0401.06
Megan G Hofmeister, Alice Asher, Christopher M Jones, Ryan J Augustine, Cole Burkholder, Jim Collins, Monique A Foster, Shannon McBee, Douglas Thoroughman, Erica D Thomasson, Mark K Weng, Phillip R Spradling

Background: People who use drugs are at increased risk for hepatitis A virus infection. Since 1996, the Advisory Committee on Immunization Practices has recommended hepatitis A vaccination for people who use drugs. Since 2016, the U.S. has experienced widespread hepatitis A outbreaks associated with person-to-person transmission.

Purpose: To describe the prevalence of drug use, route of use, and drugs used among hepatitis A outbreak-associated patients.

Methods: State outbreak and medical records were reviewed to describe the prevalence, type, and route of drug use among a random sample of 812 adult outbreak-associated hepatitis A patients from Kentucky, Michigan, and West Virginia during 2016-2019. Differences in drug-use status were analyzed by demographic and risk-factor characteristics using the X 2 test.

Results: Among all patients, residents of Kentucky (55.6%), Michigan (51.1%), and West Virginia (60.1%) reported any drug use, respectively. Among patients that reported any drug use, methamphetamine was the most frequently reported drug used in Kentucky (42.3%) and West Virginia (42.1%); however, opioids were the most frequently reported drug used in Michigan (46.8%). Hepatitis A patients with documented drug use were more likely (p<0.05) to be experiencing homelessness/unstable housing, have been currently or recently incarcerated, and be aged 18-39 years compared to those patients without documented drug use.

Implications: Drug use was prevalent among person-to-person hepatitis A outbreak-associated patients, and more likely among younger patients and patients experiencing homelessness or incarceration. Increased hepatitis A vaccination coverage is critical to prevent similar outbreaks in the future.

背景:吸毒者感染甲型肝炎病毒的风险增加。自1996年以来,免疫实践咨询委员会建议吸毒者接种甲型肝炎疫苗。自2016年以来,美国经历了与人际传播相关的广泛甲型肝炎疫情。目的:描述甲型肝炎暴发相关患者的药物使用情况、使用途径和药物使用情况。方法:回顾了2016-2019年期间肯塔基州、密歇根州和西弗吉尼亚州812名成人爆发相关甲型肝炎患者的疫情和医疗记录,以描述其流行程度、类型和药物使用途径。采用x2检验,通过人口学特征和危险因素特征分析药物使用状况的差异。结果:在所有患者中,肯塔基州(55.6%)、密歇根州(51.1%)和西弗吉尼亚州(60.1%)的居民分别报告有药物使用。在报告使用任何药物的患者中,甲基苯丙胺是肯塔基州(42.3%)和西弗吉尼亚州(42.1%)最常报告使用的药物;然而,阿片类药物是密歇根州使用最频繁的药物(46.8%)。有药物使用记录的甲型肝炎患者更有可能(p含义:药物使用在人与人之间的甲型肝炎爆发相关患者中普遍存在,在年轻患者和无家可归或被监禁的患者中更有可能。增加甲型肝炎疫苗接种覆盖率对于防止今后发生类似疫情至关重要。
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引用次数: 0
The Importance of Time, Place, and Person: Applying Elementary Epidemiology to COVID-19 Outcomes in Rural Appalachia 时间、地点和人的重要性:将基础流行病学应用于阿巴拉契亚农村的新冠肺炎结果
Pub Date : 2021-11-24 DOI: 10.13023/jah.0304.01
L. Alexander, F. Scutchfield
ABSTRACT:Since the 1800s this traditional triad of descriptive epidemiology has allowed for effective interventions to deal with epidemics. A focus on time, place, and person also provides a critical framework for interventions in controlling the epidemic by focusing on those populations with the highest risk for disease.
摘要:自19世纪以来,这种传统的描述性流行病学三元体系为应对流行病提供了有效的干预措施。对时间、地点和人员的关注也为控制疫情的干预措施提供了关键框架,重点关注那些疾病风险最高的人群。
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引用次数: 0
Risk Factors Associated with Passenger Vehicle Fatal Rollover Crashes in West Virginia, 2001-2018. 2001-2018年西弗吉尼亚州乘用车致命侧翻事故风险因素分析。
Pub Date : 2021-10-25 eCollection Date: 2021-01-01 DOI: 10.13023/jah.0304.05
Yuni Tang, Toni Marie Rudisill, Ruchi Bhandari

Background: Rollover crashes cause more injuries and fatalities than other types of motor vehicle crashes. West Virginia (WV) has high rates of drug overdose deaths and motor vehicle crash fatality. However, no studies have investigated risk factors associated with fatal rollover crashes in WV.

Purpose: The objective of this study is to evaluate whether drug use and other risk factors are associated with fatal rollover crash fatalities in WV.

Methods: This cross-sectional study utilized the Fatality Analysis Reporting System dataset from passenger vehicle crashes involving WV drivers ≥ 16 years of age with known drug test results who died within 2 hours after collision from 2001 to 2018. Risk factors associated with fatal rollover crashes were compared to non-rollover crashes using multivariable logistic regression.

Results: During the study period, 880 WV drivers died in rollover crashes. Driving ≥ 60 mph [adjusted odds ratio (aOR): 4.1; 95% confidence interval (CI): 2.4-6.8], alcohol use (aOR: 1.6; 95% CI: 1.1-2.1), rural areas (aOR: 1.4; 95% CI: 1.0-1.9), and the lack of airbag deployment (aOR: 2.7; 95% CI: 2.1-3.5) were associated with fatal rollover crashes in WV. However, drug use was not associated with fatal rollover crashes in the final multivariable logistic regression model (aOR:1.13; 95% CI: 0.9-1.5).

Implications: Findings of risk factors associated with rollover crash fatalities in WV can inform several public health interventions. Rapid and sensitive assessment tools and standardized toxicology testing are helpful to provide more comprehensive drug-impaired driving datasets for future analysis.

背景:侧翻事故比其他类型的机动车事故造成更多的伤害和死亡。西弗吉尼亚州(WV)的药物过量死亡率和机动车事故死亡率很高。然而,没有研究调查与WV致命侧翻事故相关的危险因素。目的:本研究的目的是评估药物使用和其他危险因素是否与WV的致命侧翻事故死亡有关。方法:本横断面研究利用了死亡分析报告系统数据集,该数据集来自2001年至2018年碰撞后2小时内死亡的年龄≥16岁的WV驾驶员,已知药物检测结果。使用多变量逻辑回归将与致命侧翻事故相关的危险因素与非侧翻事故进行比较。结果:在研究期间,880名WV司机死于侧翻事故。驾驶≥60 mph[调整优势比(aOR): 4.1;95%可信区间(CI): 2.4-6.8],酒精使用(aOR: 1.6;95% CI: 1.1-2.1),农村地区(aOR: 1.4;95% CI: 1.0-1.9),以及缺乏安全气囊展开(aOR: 2.7;95% CI: 2.1-3.5)与WV中致命的侧翻事故相关。然而,在最终的多变量logistic回归模型中,药物使用与致命的侧翻事故无关(aOR:1.13;95% ci: 0.9-1.5)。意义:发现与车辆侧翻事故死亡相关的危险因素可以为一些公共卫生干预措施提供信息。快速、灵敏的评估工具和标准化的毒理学测试有助于为未来的分析提供更全面的药物受损驾驶数据集。
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引用次数: 0
Comparisons of Cooking, Dietary, and Food Safety Characteristics of Food Secure and Food Insecure Sophomores at a University in Appalachia. 比较阿巴拉契亚地区一所大学中食物安全和食物不安全的大二学生的烹饪、饮食和食品安全特征。
Pub Date : 2021-10-25 eCollection Date: 2021-01-01 DOI: 10.13023/jah.0304.08
Hannah E Boone, Melissa D Gutschall, Alisha R Farris, Kimberly S Fasczewski, Donald Holbert, Laura H McArthur

Introduction: Food insecurity means lacking access to adequate, nutritious, and safe food. Collegiate food insecurity rates at ten Appalachian campuses range from 22.4% to 51.8% and have been associated with unfavorable health and academic outcomes.

Purpose: This study compared cooking, dietary, and food safety characteristics of food secure (FS) and food insecure (FI) sophomores at a university in Appalachia in the context of the USDA definition of food security.

Methods: Data were collected using an online questionnaire. Descriptive and inferential procedures compared FS and FI sophomores (p < 0.05).

Results: Participants (n = 226) were 65.0% females, 76.1% whites, and 46% FI. About 40% of on-campus and 50% of off-campus residents were FI, and 70% of FI students reported needing help accessing food. Cooking was undertaken "less often" by 61.5% of FS and 55.8% of FI sophomores. Mean cooking self-efficacy scores for FS and FI students were 44.9, vs 43.4, (p > 0.05) out of 52 points. Grains were consumed most often by 40% of FS and FI students and vegetables were consumed least often by 70% of both groups. Mean food safety test scores for FS and FI students were 6.2 1.60 vs 6.6 1.52 (p > 0.05) out of 11 points. Requested educational activities included making a budget and planning balanced meals.

Implications: The high rate of food insecurity reflects an ongoing need among sophomores for campus and community food assistance and for educational activities that teach purchasing and preparation of affordable, healthy and safe foods.

导言:食物不安全意味着无法获得充足、营养和安全的食物。目的:本研究根据美国农业部对食品安全的定义,比较了阿巴拉契亚地区一所大学的食品安全(FS)和食品不安全(FI)大二学生的烹饪、饮食和食品安全特征:方法:使用在线问卷收集数据。结果:参与者(n = 226 人)对美国农业部关于食品安全的定义进行了分析,并对食品安全和食品不安全的大二学生进行了描述性和推论性比较(P < 0.05):参与者(n = 226)中女性占 65.0%,白人占 76.1%,FI 占 46%。约 40% 的校内居民和 50% 的校外居民为家庭主妇,70% 的家庭主妇学生表示在获取食物方面需要帮助。61.5%的 FS 和 55.8% 的 FI 高二学生 "不太经常 "做饭。FS和FI学生的平均烹饪自我效能感得分分别为44.9分和43.4分(满分52分,P>0.05)。40%的FS和FI学生最常食用谷物,70%的FS和FI学生最不常食用蔬菜。在满分 11 分的测试中,FS 和 FI 学生的食品安全测试平均分分别为 6.2 1.60 和 6.6 1.52(P > 0.05)。要求开展的教育活动包括制定预算和平衡膳食计划:食物不安全的高发率反映了高二学生对校园和社区食物援助以及教育活动的持续需求,教育活动包括购买和准备经济实惠、健康安全的食物。
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引用次数: 0
Access to Health Care in Appalachia: Perception and Reality. 在阿巴拉契亚获得医疗保健:感知与现实。
Pub Date : 2021-10-25 eCollection Date: 2021-01-01 DOI: 10.13023/jah.0304.10
Michele Morrone, Cory E Cronin, Kristin Schuller, Shannon E Nicks

Introduction: Health disparities such as cancer and diabetes are well documented in Appalachia. These disparities contribute to health status, and by many indicators, Appalachian people are less healthy than those who live in other parts of the country. Access to health care is one factor that contributes to health disparities. Access to care is complex and involves both intrinsic and extrinsic aspects, including satisfaction with quality of care. This research sought to compare Appalachian to non-Appalachian communities in terms of perceptions of access to care.

Methods: We implemented a statewide survey to quantify perceptions of multiple components of access to care, including satisfaction with quality of care. We compared survey results to quantitative data from the County Health Rankings to document consistency with perceptions of access to care. We used chi-square analysis to compare Appalachian with non-Appalachian respondents.

Results: More than 600 people completed the survey. Results of the survey identify significant differences between Appalachian and non-Appalachian residents' perceptions of access to care and their satisfaction with health care. Specifically, Appalachian residents are less satisfied with convenience, information, quality, and courtesy of health care. They perceive providers relying on stereotypes when communicating with patients.

Implications: Examining and documenting perceptions of health care is important because it could lead to improving access by focusing on cultural competency in addition to more resource intensive strategies. Health disparities in Appalachia might be minimized by being more compassionate and understanding of people who live here.

在阿巴拉契亚,癌症和糖尿病等健康差异有很好的记录。这些差异影响健康状况,从许多指标来看,阿巴拉契亚人的健康状况不如生活在该国其他地区的人。获得保健服务是造成健康差距的一个因素。获得护理是复杂的,涉及内在和外在两个方面,包括对护理质量的满意度。这项研究试图比较阿巴拉契亚社区和非阿巴拉契亚社区在获得医疗服务方面的看法。方法:我们实施了一项全州范围的调查,以量化对获得护理的多个组成部分的看法,包括对护理质量的满意度。我们将调查结果与县健康排名的定量数据进行了比较,以记录对获得护理的看法的一致性。我们使用卡方分析比较阿巴拉契亚人和非阿巴拉契亚人的受访者。结果:超过600人完成了调查。调查结果表明,阿巴拉契亚居民和非阿巴拉契亚居民对获得医疗服务的看法及其对医疗服务的满意度存在显著差异。具体而言,阿巴拉契亚居民对医疗保健的便利性、信息、质量和礼貌程度较不满意。他们认为医疗服务提供者在与患者沟通时依赖于刻板印象。影响:检查和记录对卫生保健的看法很重要,因为除了更多的资源密集型战略外,它还可以通过关注文化能力来改善获取机会。阿巴拉契亚地区的健康差异可能会通过更多的同情和理解生活在这里的人们而最小化。
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引用次数: 0
Hearing Health Healthcare Disparities in Appalachia. 阿巴拉契亚地区的听力健康保健差异。
Pub Date : 2021-10-25 eCollection Date: 2021-01-01 DOI: 10.13023/jah.0304.02
Matthew L Bush

Hearing loss is a global public health issue with disproportionate negative impacts on those who live in rural regions, such as Appalachia. This commentary provides an overview of hearing health and healthcare disparities in rural regions along with discussion of the significance of recent research findings which highlight the incidence of hearing loss and the shortage of hearing specialists in Appalachia.

听力损失是一个全球性的公共健康问题,对生活在农村地区(如阿巴拉契亚)的人们造成了极大的负面影响。本评论概述了农村地区的听力健康和医疗保健差异,并讨论了最新研究成果的意义,这些研究成果强调了阿巴拉契亚听力损失的发生率和听力专家的短缺问题。
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引用次数: 0
Perceived Hearing Loss and Availability of Audiologists in Appalachia. 阿巴拉契亚地区的听力损失和听力学家的可用性。
Pub Date : 2021-10-25 eCollection Date: 2021-01-01 DOI: 10.13023/jah.0304.04
Charles Pudrith AuD, Ellyn Grider, Blythe Kitner AuD

Introduction: There is a high demand for audiologists throughout the United States. Previous research has supported an additional demand for these providers within Appalachia.

Purpose: The purpose of the study was to determine if Appalachia has a disproportionally high demand for audiologists compared to the rest of the United States.

Methods: A cross-sectional retrospective study was performed with population data from the Appalachian Regional Commission, the American Academy of Audiology, and the United States Census Bureau. County-level population-weighted averages of individuals with perceived hearing loss and number of audiologists per capita were compared between Appalachian and non-Appalachian counties.

Results: A mean weighted 5.76 % of individuals reported hearing loss within Appalachia, which was 1.1% higher than the rest of the United States. The 1.14 audiologists per 100,000 individuals in Appalachian counties was not significantly lower than the 1.32 audiologists per 100,000 individuals found in non-Appalachian counties. Audiologists per capita decreased with increases in Beale code and percent reporting hearing loss.

Conclusion: The high number of individuals reporting hearing loss supports an increased demand for audiologists in rural Appalachia. More research is needed to determine how to meet this demand or improve the efficacy of the limited number of providers.

导读:美国对听力学家的需求量很大。先前的研究支持了阿巴拉契亚地区对这些供应商的额外需求。目的:本研究的目的是确定与美国其他地区相比,阿巴拉契亚地区对听力学家的需求是否不成比例地高。方法:对来自阿巴拉契亚地区委员会、美国听力学学会和美国人口普查局的人口数据进行横断面回顾性研究。在阿巴拉契亚县和非阿巴拉契亚县之间比较了县级人口加权平均的听力损失和人均听力学家数量。结果:阿巴拉契亚地区平均加权5.76%的人报告听力损失,比美国其他地区高1.1%。阿巴拉契亚县每10万人中有1.14名听力学家,而非阿巴拉契亚县每10万人中有1.32名听力学家。人均听力学家随着比尔码和报告听力损失百分比的增加而下降。结论:大量的个人报告听力损失支持了阿巴拉契亚农村听力学家需求的增加。需要进行更多的研究,以确定如何满足这一需求或提高数量有限的提供者的效力。
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引用次数: 1
期刊
Journal of Appalachian health
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