Community Health Workers\u27 COVID-19 Vaccine Status and Concerns for Client Welfare in Appalachia

Community health workers (CHWs) make up a crucial part of the public health system by providing culturally-sensitive care in historically marginalized communities, such as those found throughout Appalachia. During the ongoing COVID-19 pandemic, CHWs have been less likely to accept the COVID-19 vaccine than other healthcare workers. It is important to understand if CHW vaccination status affects concern for their clients during the pandemic, as this may subsequently affect care delivery. Therefore, this study investigated the association between CHW vaccination status and concern for their clients given COVID-19 restrictions lifting. Secondary analysis was performed on data from an electronic survey administered in two Appalachian populations from October to December, 2021. In total, 71 CHWs were eligible for inclusion in the study. Fisher’s Exact Test was used to compare survey responses between CHWs who had received at least one dose of the COVID-19 vaccine and those who had not. 86% of CHWs had received at least one dose of the COVID-19 vaccine. Most CHWs, regardless of vaccination status, reported that client needs had changed during the pandemic. However, vaccinated CHWs were significantly more likely to have concerns for their clients with the lifting of COVID-19 restrictions than unvaccinated CHWs. A difference in concern by vaccination status may translate to a difference in care provided during the pandemic, as well. This is important to consider in creating and delivering training for CHWs so that they can provide the best possible care to communities in Appalachia

A Likelihood-Based Approach to Early Stopping in Single Arm Phase II Clinical Trials

Phase II studies in oncology have evolved over the previous several decades. Currently, the number of drugs in phase II development has increased, and patient eligibility has narrowed due to targeted agents, competing trials and curative therapies in the first-line setting. As a result of these changes, more attention needs to be focused toward conducting more efficient phase II trials. Given the increased difficulty in accruing patients to phase II studies and the ethical concern of treating patients with agents that are ineffective, there is significant motivation to stop a single arm trial early when the investigational agent shows evidence of a low response rate

Measuring the Impact of Biostatistical Methods on General Medical Research

Background: Novel statistical methods are constantly being developed within the context of biomedical research; however, the rate of diffusion of this knowledge into the field of general / internal medicine is unclear. This study highlights the statistical journal articles, the statistical journals, and the statistical methods that appear to be having the most direct impact on research in the field of general / internal medicine. Methods: Descriptive techniques, including analyses of articles’ keywords and controlled vocabulary terms, were used to characterize the articles published in statistics and probability journals that were subsequently referenced within general / internal medicine journal articles during a recent 10-year period (2000-2009). Results: From the 45 statistics and probability journals of interest, a total of 597 unique articles were identified as being cited by 900 (out of a total of about 10,501) unique general / internal medicine journal articles. The most frequently cited statistical topics included general/other statistical methods, followed by epidemiologic methods, randomized trials, generalized linear models, meta-analysis, and missing data. Conclusion: As statisticians continue to develop and refine techniques, the promotion and adoption of these methods should also be addressed so that their efforts spent in developing the methods are not done in vain

The Fecal Fermentation Profile of Infants with Different Feeding Modalities

Introduction/Background Research indicates nutrition and environment in the first year of a child\u27s life are crucial in their development and growth and can contribute to lower chances of developing obesity and other health concerns. Key factors that can determine these outcomes include the bacteria and resulting short chain fatty acids (SCFAs) present in the gut. This composition may be affected by feeding modality (formula feeding vs breastfeeding), exposure to the mother’s microbiota, weight status of the child, and type of delivery. This research aims to identify the impact of infant feeding modality on toddlers\u27 fecal fermentation profile, and if there are associations between weight status and microbiome, fecal fermentation profile. Methods/ Procedures Participants (n=40) were recruited during well-child pediatric appointments at ETSU’s Pediatric primary care clinic. Researchers explained the requirements of the study and participants were provided with a 90-question food frequency questionnaire (FFQ) for children ages 2-7, including 90 questions and asks about a child\u27s typical intake over the previous 6-month period. The food list was developed from NHANES III dietary recall data. The child’s history was obtained, including current age, birth length and weight, delivery type (C-section or vaginal), feeding method (breast, bottle fed, or both) and duration. The child’s weight and height were obtained, and body mass index (BMI) calculated. Participant-provided stool samples were freeze-dried and ground, and SCFAs were extracted using a procedure developed by Schwiertz et al. that was modified. One mL of the SCFA extraction solution, containing Oxalic acid (0.1 mol/L), Sodium Azide (40 mmol/L), and Caproic acid (0.1 mmol/L) (internal standard) was added to 80 mg of a freeze-dried stool sample in a 16 x 100 mm disposable culture tube, and analyzed using a Shimadzu GC2010 gas chromatograph with SigmaAldrich ZB-Wax Plus capillary column. Samples were run in duplicate, and values for each participant were averaged. Data analysis was generated using SAS software, Version 9.4 of the SAS System, Copyright © 2013 SAS Institute Inc. Results Initial findings showed no significant differences in the SCFA composition of obese vs non-obese toddlers in the sample. However, there were significant differences in the amount of specific SCFAs (isobutyrate, isovaleric acid, and octanoic acid) in toddlers who were formula fed as infants versus toddlers who were breastfed, and those fed a combination of breastmilk, and formula (p \u3c 0.05). Further analysis will determine if these initial results may be contributed to overall dietary intake, and more specifically fiber intake

Comparison of Short Chain Volatile Fatty Acids in the Breastmilk of Normal and Overweight/Obese Mothers

INTRODUCTION: Health professionals emphasize the importance of breastfeeding in the development of children up to 6-months of age. It is known that short chain volatile fatty acids (SCVFAs) are a byproduct of nutrient fermentation by gut microbiome. These SCVFAs interact with the gut/brain axis and are known to influence infant development. Therefore, a reflection of maternal gut microbiome could likely be found in breastmilk (BM) due to diffusion of SCVFAs across the gut wall into the blood. Previous research in our laboratory has shown differences in the SCVFA fecal fermentation profile between individuals with normal (N) versus overweight/obese (OWOB) body mass index (BMI). Therefore, our research question is: Is there a difference in the relative amount and diversity of SCVFAs in the BM of N compared to OWOB women? We hypothesized that women of N will have a more diverse SCVFA profile than OWOB women in their BM. BM samples (200 ml) were collected from 44 women (22 N (BMI 22.0) and 22 OWOB (BMI 33.7) p2 while OWOB participants had a pre-gravid BMI of greater than 25.0 kg/m2. To our knowledge, this is the first time that SCVFAs have been quantified in the milk of lactating women using GC with an FID detector. This data supports the argument that the pre-gravid BMI of a mother can correlate to the SCVFA profile of her BM. It is unknown if the concentration observed in the mother’s BM in this study has an influence on the neonate’s gut/brain axis and neurological signals, however, we have demonstrated that the SCVFA profile is more diverse in the N BMI mother. Further research is warranted on the influence of maternal BM SCVFA composition on the growth and neurological development of her infant

Telehealth Acceptance Among Appalachian Respondents During COVID 19: a Secondary Data Analysis

Purpose: The purpose of this study is to examine the relationship between telehealth use, telehealth satisfaction, and chronic medical conditions among residents living in Appalachian and non-Appalachian communities. Sample: A COVID-19 public health survey was distributed via social media and healthcare clinics in the tri-state region of central Appalachia. Survey responses were limited to adults aged ≥18 years who consented to participate in the survey that self-identified as an individual with one or more chronic medical conditions (n=195). Method: Simple descriptive statistics including frequencies, percentages, means, and standard deviations (SDs) were calculated for variables of interest both overall and by subgroups of interest. Chi-squared tests were used to compare categorical outcomes between groups of interest, while two-sample t-tests were used for continuous outcomes. Significance for all tests was determined using an α level of 0.05. Findings: There is no statistically significant relationship between respondents with regard to using telehealth services, satisfaction rates related to telehealth use, or reasons for electing not to use telehealth services during the COVID-19 pandemic. However, there was a trending statistical relationship between county status and the use of telehealth services in Appalachia with those counties doing economically better being more likely to use telehealth services as compared to those fairing less well (p=0.053). Findings also suggest that people living in urban areas of Appalachia were more likely to be satisfied using telehealth services than those living in non-urban areas of Appalachia (p=0.01). Conclusions: Research is still limited as to how the expansion of broadband capabilities during the COVID-19 pandemic has benefited those residing in Appalachia in terms of managing chronic health conditions. Future research should focus on expanding participation among Appalachian respondents looking for specific differences related to location within Appalachia, age, gender, ethnicity, and socioeconomic status

Tobacco use among blue collar workers in Nigeria: A survey of Construction Artisans in Ekiti state

The prevalence of tobacco use among blue-collar workers such as construction artisans is disproportionately higher than in the general population, yet very limited studies have been conducted about such workers in Nigeria, the most populous country in sub-Sahara African (SSA). Therefore, this study aims to assess the prevalence and the associated risk factors of tobacco use among construction artisans in Ekiti State, Nigeria. This cross-sectional study employed a multi-stage stratified sampling technique to select participants (carpenters and bricklayers) artisans, journeymen, and their apprentices who were working in Ekiti State. Chi-square and logistic regression were conducted to delineate factors that are associated with tobacco use in this population. The results show that the prevalence of ever-smoke amongst respondents was 19.3%, and multivariate analysis showed that artisans who were within the age range 31-40 years were four times more likely to use tobacco (aOR=3.410; CI=1.476-7.878), compared with those that are less than 20 years. Additionally, being in school (aOR 2.007; CI= 1.026-3.927) and divorced/separated (aOR4.240; CI=1.307-13.759) were associated with tobacco use, compared with the respective populations. The increased prevalence of tobacco use among construction artisans is noteworthy, and few self-reported cases of addiction amongst users demand action from communities and government at all levels. There is need to improved access of artisans to accurate information and tailored messages on dangers of tobacco use. Moreover, smoking and worksite regulations and policies would be needed to curtail the smoking tendencies of these worker

Motivating Students to Engage in Preparation for Flipped Classrooms by Using Embedded Quizzes in Pre-class Videos

Background: The success of flipped classrooms is dependent upon students’ preparation prior to class, the lack of which is the most common challenge associated with this teaching methodology. To mitigate this limitation, it is important to develop and assess methods of engaging learners during pre-class activities. Objective: To determine if quiz delivery method (embedded throughout versus after pre-class videos) affects students’ knowledge retention, grades, and video viewing behavior. Methods: Participating students were randomized to take quizzes, either during pre-class videos via Panopto™ (EQV) or after pre-class videos in the traditional manner via Moodle™ (TMM). Outcomes assessed included students’ knowledge retention, scores on pre- and post-class quizzes, and pre-class video viewing behavior (total views and minutes viewed per student) during a three-week period. Having experienced both quizzing modalities during the semester, the perceptions from students in the EQV group were surveyed. Results: Baseline assessment results of both groups (n = 27 per group) were comparable with a median score of 33% (IQR: 17, 50) in both groups. Performance was also similar on knowledge retention [TMM: 67% (50, 83) vs. EQV: 83% (50, 83)], pre-class quiz scores [TMM: 90% (87, 97) vs. EQV: 93% (90, 95)], and post-class quiz scores [TMM: 93% (80, 100) vs. EQV: 87% (80, 100)], while students in the EQV group had more total views [10 (8, 12)] vs. [5 (2, 11)] and minutes viewed [71 (36, 108) vs. 35 (15, 81)]. Results from the perception survey administered to students in the EQV group (74.1% response rate) indicated a preference for embedded quizzes overall (58%) and for class preparation (75%) when compared with post-video quizzes. Conclusion: Students’ knowledge retention and performance were similar in both EQV and TMM groups, though students in the EQV group were more engaged with videos and most of them preferred this quiz delivery. Using embedded quizzes for formative rather than summative assessment might be an appropriate mechanism to encourage students’ viewing of pre-class videos and their preparation for flipped classes