BACKGROUND: Heart failure (HF) is a debilitating disease with worsening symptoms and family caregiving burden. HF affects more than 8 million Americans. West Virginia has the highest HF death rate in the U.S. and limited healthcare services. This study tested whether the family HF palliative and end-of-life care intervention (FamPALcare) improved patient and caregiver outcomes at 3- and 6-month study endpoints.
METHODS: This study used a randomized controlled trial design. Patients with HF and their caregivers were randomly assigned together to the intervention (n = 21) or control (n = 18) group. The intervention included five telephone coaching sessions on the HF home, palliative, and end-of-life care. The outcome data collected at baseline and at 3 and 6 months were from the patients\' (a) HF-related health status and depression/anxiety scale scores; and from caregivers\' (b) caregiving burden and depression/anxiety scale scores; and (c) anonymous ratings on the 11-item FamPALcare helpfulness scale, completed by the intervention participants.
RESULTS: The mean age of the patients was 65.66 (SD = 13.72) years, and 67% were White males. The mean age of the caregivers was 62.05 (SD = 13.14) years, and 77% were White females. Compared to the controls, patients in the intervention group had significantly greater scores for HF-related health status (p < .05) and lower depression/anxiety scores at 6 months, the study endpoint. The family caregivers in the intervention group had significantly lower scores on caregiving burden (p < .05) and depression/anxiety (p < .01) at 3 months. The mean helpfulness rating was M = 4.46 out of 5 (SD = 0.49).
CONCLUSIONS: The FamPALcare intervention was found to be effective at improving patient HF-related health status and reducing caregiver burden and improving both patient and caregiver depression and anxiety scores. The FamPALcare HF intervention was found feasible and consistently delivered (fidelity). The FamPALcare intervention\'s cost-effectiveness and helpfulness ratings information will be used to plan for subsequent clinical trials.
BACKGROUND: ClinicalTrials.gov NCT04153890, Registered on 4 November 2019, https://clinicaltrials.gov/ct2/show/NCT04153890 .

OBJECTIVE: The purpose of this study was to describe beliefs and attitudes that underpin vaccine confidence and hesitancy in nurses who chose not to vaccinate for COVID-19. The research question that guided this work was: What are the beliefs and attitudes of nurses who chose to not vaccinate for COVID-19?
METHODS: This study followed a focus group methodology to collect qualitative data from focused discussions to gather insights into the beliefs and attitudes of participants. Two focus groups consisting of 3 to 5 participants were conducted virtually.
RESULTS: Using open coding, six themes were generated. Based on descriptors provided by participants, two themes were focused on beliefs, and four were related to attitudes about the vaccine. Findings suggest that participants\' beliefs and attitudes were strengthened during this time in the pandemic. This event further divided nurses included in this study from their peers who chose to vaccinate and their employers who mandated inoculation.
CONCLUSIONS: Understanding the perceptions of this sample has given insight into the thoughts and feelings of nurses who chose not to vaccinate against COVID-19. This is a perspective that is often absent from scientific literature. Knowledge gained from this study may assist in supporting strategies such as open communication, conflict resolution, and collaboration in an effort to mitigate the divide within the nursing workforce, which may ultimately contribute to nursing retention in clinical settings.

UNASSIGNED: Rural underserved areas facing health disparities have unequal access to health resources. By the third and fourth waves of SARS-CoV-2 infections in the United States, COVID-19 testing had reduced, with more reliance on home testing, and those seeking testing were mostly symptomatic.
UNASSIGNED: This study identifies factors associated with COVID-19 testing among individuals who were symptomatic versus asymptomatic seen at a Rapid Acceleration of Diagnostics for Underserved Populations phase 2 (RADx-UP2) testing site in West Virginia.
UNASSIGNED: Demographic, clinical, and behavioral factors were collected via survey from tested individuals. Logistic regression was used to identify factors associated with the presence of individuals who were symptomatic seen at testing sites. Global tests for spatial autocorrelation were conducted to examine clustering in the proportion of symptomatic to total individuals tested by zip code. Bivariate maps were created to display geographic distributions between higher proportions of tested individuals who were symptomatic and social determinants of health.
UNASSIGNED: Among predictors, the presence of a physical (adjusted odds ratio [aOR] 1.85, 95% CI 1.3-2.65) or mental (aOR 1.53, 95% CI 0.96-2.48) comorbid condition, challenges related to a place to stay/live (aOR 307.13, 95% CI 1.46-10,6372), no community socioeconomic distress (aOR 0.99, 95% CI 0.98-1.00), no challenges in getting needed medicine (aOR 0.01, 95% CI 0.00-0.82) or transportation (aOR 0.23, 95% CI 0.05-0.64), an interaction between community socioeconomic distress and not getting needed medicine (aOR 1.06, 95% CI 1.00-1.13), and having no community socioeconomic distress while not facing challenges related to a place to stay/live (aOR 0.93, 95% CI 0.87-0.99) were statistically associated with an individual being symptomatic at the first test visit.
UNASSIGNED: This study addresses critical limitations to the current COVID-19 testing literature, which almost exclusively uses population-level disease screening data to inform public health responses.

Hierarchical command-style structures are commonplace in the management of disasters, though researchers have begun to recommend the exploration of networked approaches to incident management. Furthermore, few studies are explicitly looking at the rural context of disaster management. This study seeks to contribute to both topics by examining the motivations for emergent collaboration in the direction of the response and initial recovery to the coronavirus disease 2019 pandemic in a rural West Virginia community. Between March 2020 and March 2022, the primary investigator moderated regular briefings of a community task force convened to coordinate the pandemic response and recovery. As regular operations concluded, members completed a survey, and 10 randomly selected members participated in semistructured interviews regarding their experiences in the task force. Survey responses suggest that common motivations for collaboration in nondisaster contexts (as they appear in the scholarly literature) and potential benefits of networked approaches highlighted in the incident management literature could also serve as motivators within the disaster context. Qualitative interview data extend that discussion and identify the need to gain clear information regarding the concerned authorities and specific local information to better inform the expenditure of limited resources as two additional motivators for collaboration.

Rural areas in the US exhibit high rates of illicit substance use. This study aimed to investigate the Social Cognitive Theory factors associated with spontaneous attempts to quit illicit substance use in a sample of users. A cross-sectional survey was administered through face-to-face interviews. Data was collected from adult (≥ 18 years of age) current illicit substance users who were not receiving professional addiction treatment. Binary logistic regression analyses were utilized to answer the research question. Data from 230 illicit substance users met the eligibility criteria. The mean age was 38 years, whereas the average history of illicit substance use was 14 years. Users with a higher perceived value of quitting illicit substance use were significantly more likely to attempt to quit use spontaneously. Health behavior interventions that incorporate the perceived value of quitting illicit substance use can be effective in encouraging spontaneous attempts to quit illicit substance use.

The importance of culinary and lifestyle medicine education to combat the growing burden of chronic disease is gaining recognition in the United States. However, few medical schools offer in-depth training with a 4-year longitudinal track. The Culinary and Lifestyle Medicine Track (CLMT) is a 4-year curriculum thread created at West Virginia University School of Medicine to address the need for comprehensive culinary and lifestyle medicine education. CLMT teaches concepts of healthy nutrition, physical activity, stress management, and restorative sleep. CLMT students complete approximately 300 h of in-person and virtual culinary and lifestyle medicine education, including hands-on teaching kitchens, distributed over the preclinical and clinical years. Students are selected into the track prior to matriculation after an application and interview process. The students have exceeded expectations for scholarly and community activity. Track graduates have entered into primary care as well as specialty and surgical residencies, demonstrating that lifestyle education plays a role for students interested in a wide range of careers. Exit survey responses from learners reflected tangible and intangible benefits of participation and offered constructive feedback for improvement. Presented here are the components of the curricular design, implementation, and initial outcomes.

Produce prescription programs (PPPs) are place-based interventions at the intersection of public health and local food advocacy. These programs have expanded significantly across the United States since 2010, particularly taking off in the state of West Virginia. This article draws on a 4-y institutional ethnography of PPP programs and associated policy. Although the possibilities of building support for improving community health alongside the livelihoods of small-scale producers is compelling, there exists an overall decontextualization from broader social and political determinants of health. This article concludes that although programs are able to meet some acute needs for program participants and provide income for small-scale producers, this decontextualization results from a lack of consideration of wider systems within policy and program construction, leading to missed opportunities for food system transformation.

UNASSIGNED: The increasing rate of Hepatitis C virus (HCV) infection has been attributed to the substance use epidemic. There is limited data on the current rates of the paralleling HCV epidemic.
UNASSIGNED: To estimate the prevalence of maternal HCV infection in West Virginia (WV) and identify contributing factors.
UNASSIGNED: Population-based retrospective cohort study of all pregnant individual(s) who gave birth in WV between 01/01/2020 to 01/30/2024 (N = 69,925). Multiple log-binomial regression models were used to estimate the adjusted risk ratio (ARR) and the 95% confidence intervals (CI).
UNASSIGNED: The rate of maternal HCV infection was 38 per 1,000 deliveries. The mean age of pregnant individual(s) with HCV was 29.99 (SD 4.95). The risk of HCV was significantly higher in White vs. minority racial groups [ARR 1.93 (1.50, 2.49)], those with less than [ARR 1.57 (1.37, 1.79)] or at least high school [ARR 1.31 (1.17, 1.47)] vs. more than high school education, those on Medicaid [ARR 2.32 (1.99, 2.71)] vs. private health insurance, those residing in small-metro [ARR 1.32 (1.17, 1.48)] and medium-metro [ARR 1.41 (1.24, 1.61)], vs. rural areas, and those who smoked [ARR 3.51 (3.10, 3.97)]. HCV risk was highest for those using opioids [ARR 4.43 (3.95, 4.96)]; followed by stimulant use [ARR = 1.79 (1.57, 2.04)].
UNASSIGNED: Our findings highlight that maternal age, race, education, and type of health insurance are associated with maternal HCV infection. The magnitude of association was highest for pregnant individual(s) who smoked and used opioids and stimulants during pregnancy in WV.

OBJECTIVE: Spirometry is the primary lung function test utilised for medical surveillance and disability examination for coal mine dust lung disease. However, spirometry likely underestimates physiologic impairment. We sought to characterise abnormalities of single-breath diffusing capacity for carbon monoxide (DLCO) among a population of former coal miners.
METHODS: Data from 3115 former coal miners evaluated at a West Virginia black lung clinic between 2006 and 2015 were retrospectively analysed to study the association between diffusion impairment (abnormally low DLCO), resting spirometry and the presence and severity of coal workers\' pneumoconiosis on chest radiography. We developed ordinary least squares linear regression models to evaluate factors associated with per cent predicted DLCO (DLCOpp).
RESULTS: Diffusion impairment was identified in 20.2% of subjects. Ten per cent of all miners with normal spirometry had diffusion impairment including 7.4% of never smokers. The prevalence of diffusion impairment increased with worsening radiographic category of pneumoconiosis. Mean DLCOpp decreased with increasing small opacity profusion subcategory in miners without progressive massive fibrosis. Linear regression analysis also showed significant decreases in DLCOpp with increasing small opacity profusion and presence of large opacities.
CONCLUSIONS: Diffusion impairment is common among former coal miners, including among never smokers, miners without radiographic pneumoconiosis and miners with normal spirometry. These findings demonstrate the value of including DLCO testing in disability examinations of former coal miners and an important role for its use in medical surveillance of working miners to detect early chronic lung disease.

In this paper, we describe the Project Extension for Community Healthcare Outcomes+ (ECHO+) model and evaluation plan for incorporating changes to primary care delivery, improving patient and clinician outcomes, and making long-term system improvements.