Comeback of Appalachian Female Stroke Survivors: The Interrelationships of Cognition, Function, Self-Concept, Interpersonal, and Social Relationships.

The purpose of this descriptive correlational study was to examine the comeback phase of the Trajectory of Chronic Illness Management for Appalachian women stroke survivors. This study predicted comeback as a relationship between physical healing, biographical reengagement, and psychological coming to terms that was mediated by rehabilitation. The concepts were evaluated through investigation of function and cognitive abilities, self-assessment of recovery, health rating, ability to control life, relationship changes, physical and mental health, and limitations of activities due to poor physical or mental health. Data were collected using, the Stroke Impact Scale (3.0) (Duncan, Bode, Lia, & Perera, 2003), the Relationship Change Scale (Guerney, 1971), and the Health-Related-Quality-of-Life-4 Scale (Morarity, Zack, & Kobau, 2003). Descriptive statistics summarized patient characteristics. Continuous variables were analyzed using bivariate relationships expressed as Pearson correlation coefficients. The difference between groups (stroke severity and stroke type) and measurement variables were analyzed using independent ttest and ANOVA. Multiple linear regressions were completed to evaluate simultaneous effects of the independent variables. Forty-six English-speaking, Caucasian women ages 40-78 who had experienced stroke at least 1 year prior to enrollment and were independently living in their home environment participated. The mean age was 57 years with survivorship ranging from 1 to 36 years. Function and cognition scores were similar to the established test range for the SIS V 3.0. Women with moderate ischemic stroke scored statistically higher for recovery score (p Study findings suggest comeback can be predicted by the theoretical propositions of the Trajectory Theory of Chronic Illness Management: physical healing, biographical reengagement, and psychologically coming to terms (Corbin & Strauss, 1991). A strong relationship exists among the phases representative of comeback, while rehabilitation procedures and interpersonal relationships demonstrated only modest significance

Hepatitis C Virus Screening in Federally Qualified Health Centers in Rural Appalachia

The prevalence of Hepatitis C Virus (HCV) in the US is estimated at 3.5 million with 18,153 deaths in 2016. It is the most common bloodborne infection, with a higher age-adjusted mortality rate than Hepatitis B Virus or Human Immunodeficiency Virus. Without treatment, nearly 1.1 million people will die from HCV by 2060. About 41,200 new cases of HCV were reported in 41 states in the US in 2016. The reported cases of acute HCV in 2016 is 2.3 per 100,000 in Tennessee, which is more than twice the national goal set by Healthy People 2020. This is a descriptive study to ascertain the HCV prevalence and usefulness of screening in medical outreach settings (MO) compared to indigent healthcare clinics (IHC) in northeast Tennessee. This study period was from April 2017 – February 2019. Participants (n=250), were adults, who engaged in routine, opt-out HCV testing at 4 IHC and 3 MO sites in the Tri-Cities, TN region. During the screening, demographic information- age, gender, race- were collected and the de-identified data were analyzed using Statistical Analysis System (SAS 9.3) to perform a descriptive analysis. Also, several discrete Chi-Square tests of independence between the demographic variables, screening locations, and HCV antibody prevalence was conducted. A total of 250 clients were screened for HCV. The majority of clients screened were non-Hispanic whites 228 (91.20%); females 136 (54.40%); young adults 131 (52.40%) and at IHC clinics 187 (74.80%). Screening showed HCV antibody prevalence of 14.8%. The majority of positive cases were non-Hispanic whites 36 (97.30%; P=0.1561); females 19 (51.35%; P=0.6867) and young adults 23 (62.16%; P=0.286). The prevalence at the IHC clinics and MO settings were 36 (97.30%; P=0.0006) and 1(2.70%) respectively. This analysis shows the higher yield of targeted HCV screening at IHC clinics. Focused HCV screening is critical in the era of opioid epidemic, particularly when direct-acting antiviral agents (DAAs) which offer a Sustained Virologic Response (SVR) rate of more than 90% are available. The use of case control or cohort study designs to establish causality is recommended for improving focused HCV screening

Hepatitis C Virus Screening in Federally Qualified Health Centers in Rural Appalachia

Purpose of study: This is a descriptive study to ascertain the Hepatitis C Virus (HCV) prevalence and usefulness of screening in medical outreach settings (MO) compared to indigent healthcare clinics (IHC) in northeast Tennessee. Methods used: Between April 2017 – February 2019, routine, opt-out HCV testing was performed in 4 IHC and 3 MO sites in the Tri-Cities, TN region. During screening, demographic information was collected and the de-identified data were analyzed. Summary of results: Among 212 clients screened 26 (12.26%) were HCV antibody positive. Of all clients screened 107 (50.47%) were young adults, born after 1965 compared to 99 (46.7%) participants born between 1945-1965. The percentage of HCV antibody cases were 16 (61.54%) and 8(30.77%) for young adults and baby boomers respectively. The percentage of males and females screened were 46.7% and 53.3% respectively, with equal proportion of HCV antibody cases (50%; P=0.7186). Non-Hispanic whites and African Americans made up 90.57% and 9.43% respectively of all clients screened; 96.15% (P=0.2980) of the positive cases were ascribed to non-Hispanic whites. Screening occurredin seven testing locations, 3 MO events and 4 IHCs. A total of 25 (96.15%; P=0.0056) HCV-antibody positive cases were found in the IHCs compared to 1(3.85%) found in a MO event. Conclusion: This analysis shows the higher yield of targeted screening at IHCs. Targeted HCV screening is critical in the era of opioid epidemic especially since direct-acting antiviral agents (DAAs) who offer a Sustained Virologic Response (SVR) rate of more than 90% are available