Assessing Knowledge, Behavior, and Attitudes of Family Medicine Residents toward Opioid Prescribing in Rural South Central Appalachia Residency Program

Intro: Opioids and their role in medicine, their use and abuse, have become a topic of intense scrutiny and interest over the last several years. Since 1999, the number of opioid overdose deaths has quadrupled, while the amount of prescription opioids sold in the U.S has increased by the same factor. Federal lawmakers, law enforcement, pharmaceutical companies, and investigative journalists have all become involved in what is often called “the opioid epidemic”, a stage where the issues of pain management, drug abuse, regulation, and autonomy are in seeming opposition. Physicians are uniquely positioned on this stage, both as healers and healthcare providers, professionals tasked with managing pain, preventing and treating addiction and overdose, and advocating for the needs of the population they serve. Paradoxically, issues related to pain management, addiction, and abuse are widely underrepresented in the educational curricula of most physicians’ formal training. This study aims to assess the attitudes and knowledge related to opioids in family medicine residents in a rural Appalachian residency program; as well as measure how these attitudes and knowledge change in the cohort after a limited course of education in issues surrounding opioid use, prescription, and abuse. It is our hope that this intervention will edify the residents, and they will feel more prepared to confront issues surrounding opioids as they move forward in their careers. Methods: Residents were given a ten-item questionnaire that assessed their knowledge of current Tennessee and Virginia state laws with regards to the prescription of opioids: The questionnaire also included an open-ended question where residents were asked to express how they felt about prescribing opioids: opinions they had formed, things they learned, things that they wished were different. Responses were uniquely identified by a paired code that abstracted the identity of the respondent from subsequent analysis. After anonymous collection of the completed questionnaire and open-ended response, a 30 minute didactic session was administered by the authors outlining common issues with opioid prescriptions, an overview of current TN and VA state law regarding opioid prescription, clinic policy, and discussion with residents of current thinking regarding best practices. The questionnaire was then administered again, responses were anonymously gathered and paired with their pre-didactic identification number. The responses were then analyzed to assess the impact of the didactic on understanding of current opioid prescribing law, and the open ended responses were examined for common themes in residents’ perception of prescribing opioids while in residency. - Conclusions: In general, short and focused didactic education regarding current state laws regarding opioid prescription appears to benefit residents understanding of how to prescribe opioids appropriately. Residents generally find the processes surrounding opioid prescription challenging, medically and emotionally, and are interested in more education about the topic

An Examination of Consumer Willingness to Pay for Local Products

We use data from hypothetical and nonhypothetical choice-based conjoint analysis to estimate willingness to pay for local food products. The survey was administered to three groups: consumers from a buying club with experience with local and grass-fed production markets, a random sample of Maryland residents, and shoppers at a nonspecialty Maryland supermarket. We find that random-sample and supermarket shoppers are willing to pay a premium for local products but view local and grass-fed production as substitutes. Conversely, buying-club members are less willing to pay for local production than the other groups but do not confllate local and grass-fed production.Adalja1_An_examination.pdf: 443 downloads, before Aug. 1, 2020

An Examination of Consumer Willingness to Pay for Local Products

This paper uses data collected from hypothetical and non-hypothetical choice-based conjoint survey instruments to estimate willingness to pay for distance-based local food products. The survey was administered to three different groups of respondents: members of a consumer buying club with local and grass-fed market experience, a random sample of Maryland residents, and shoppers at a non-specialty suburban Maryland grocery store. We find that both the random sample of Maryland residents and the grocery store shoppers are willing to pay a premium for local products, but view local and grass-fed production as substitutes. Conversely, members of the consumer buying club are willing to pay significantly less for local than their counterparts, but do not conflate local with other premium attributes, such as grass-fed production

An Examination of Consumer Willingness to Pay for Local Products

We use data from hypothetical and nonhypothetical choice-based conjoint analysis to estimate willingness to pay for local food products. The survey was administered to three groups: consumers from a buying club with experience with local and grass-fed production markets, a random sample of Maryland residents, and shoppers at a nonspecialty Maryland supermarket. We find that random-sample and supermarket shoppers are willing to pay a premium for local products but view local and grass-fed production as substitutes. Conversely, buying-club members are less willing to pay for local production than the other groups but do not conflate local and grass-fed production

An Examination of Consumer Willingness to Pay for Local Products

This paper uses stated and revealed preference data from a choice-based conjoint survey instrument to estimate willingness to pay for distance-based local food products. The survey was administered to three different groups of respondents: members of a consumer buying club, a random sample of Maryland residents, and suburban Maryland grocery store shoppers. We find that both the random sample of Maryland residents and the grocery store shoppers are willing to pay a premium for local products, but view locality and production method as substitutes. Conversely, more selective shoppers, members of a consumer buying club, are willing to pay less for local than their counterparts, but do not conflate local with other premium attributes, such as grass-fed production

Longitudinal Metabolome-Wide Signals Prior to the Appearance of a First Islet Autoantibody in Children Participating in the TEDDY Study

Children at increased genetic risk for type 1 diabetes (T1D) after environmental exposures may develop pancreatic islet autoantibodies (IA) at a very young age. Metabolic profile changes over time may imply responses to exposures and signal development of the first IA. Our present research in The Environmental Determinants of Diabetes in the Young (TEDDY) study aimed to identify metabolome-wide signals preceding the first IA against GAD (GADA-first) or against insulin (IAA-first). We profiled metabolomes by mass spectrometry from children's plasma at 3-month intervals after birth until appearance of the first IA. A trajectory analysis discovered each first IA preceded by reduced amino acid proline and branched-chain amino acids (BCAAs), respectively. With independent time point analysis following birth, we discovered dehydroascorbic acid (DHAA) contributing to the risk of each first IA, and γ-aminobutyric acid (GABAs) associated with the first autoantibody against insulin (IAA-first). Methionine and alanine, compounds produced in BCAA metabolism and fatty acids, also preceded IA at different time points. Unsaturated triglycerides and phosphatidylethanolamines decreased in abundance before appearance of either autoantibody. Our findings suggest that IAA-first and GADA-first are heralded by different patterns of DHAA, GABA, multiple amino acids, and fatty acids, which may be important to primary prevention of T1D

Time to Peak Glucose and Peak C-Peptide During the Progression to Type 1 Diabetes in the Diabetes Prevention Trial and TrialNet Cohorts

OBJECTIVE To assess the progression of type 1 diabetes using time to peak glucose or C-peptide during oral glucose tolerance tests (OGTTs) in autoantibody-positive relatives of people with type 1 diabetes. RESEARCH DESIGN AND METHODS We examined 2-h OGTTs of participants in the Diabetes Prevention Trial Type 1 (DPT-1) and TrialNet Pathway to Prevention (PTP) studies. We included 706 DPT-1 participants (mean ± SD age, 13.84 ± 9.53 years; BMI Z-score, 0.33 ± 1.07; 56.1% male) and 3,720 PTP participants (age, 16.01 ± 12.33 years; BMI Z-score, 0.66 ± 1.3; 49.7% male). Log-rank testing and Cox regression analyses with adjustments (age, sex, race, BMI Z-score, HOMA-insulin resistance, and peak glucose/C-peptide levels, respectively) were performed. RESULTS In each of DPT-1 and PTP, higher 5-year diabetes progression risk was seen in those with time to peak glucose >30 min and time to peak C-peptide >60 min (P < 0.001 for all groups), before and after adjustments. In models examining strength of association with diabetes development, associations were greater for time to peak C-peptide versus peak C-peptide value (DPT-1: χ2 = 25.76 vs. χ2 = 8.62; PTP: χ2 = 149.19 vs. χ2 = 79.98; all P < 0.001). Changes in the percentage of individuals with delayed glucose and/or C-peptide peaks were noted over time. CONCLUSIONS In two independent at-risk populations, we show that those with delayed OGTT peak times for glucose or C-peptide are at higher risk of diabetes development within 5 years, independent of peak levels. Moreover, time to peak C-peptide appears more predictive than the peak level, suggesting its potential use as a specific biomarker for diabetes progression