Introduction: Prevalence and morbidity of diabetes mellitus (DM), hypertension (HTN) and obesity (OB) are disproportionately higher in rural African Americans (AA). The Western Tidewater (WT) region in southeastern Virginia has a large, rural AA population. Our objective was to screen attendees of community health screenings in WT for DM, HTN, OB and identify associated risk factors.

Methods: We recruited 295 volunteers aged 18-80 and measured blood pressure (BP), POC hemoglobin A1c (HbA1c), self-reported weight and height, clinical information and social determinants of health data. Descriptive statistics, Chi-square tests, ANOVA and Stepwise regression were used.

Results: Of 295 individuals screened, 73% identified as AA. Self-reported DM diagnosis was present in 25% and prediabetes (preDM) in 12%. Using HbA1c criteria, 1 additional person (<1%) had DM, and 46 (16%) had preDM, bringing totals to 26% with DM and 27% with preDM. Self-reported HTN was noted in 62%, while 58% had at least stage 1 HTN (SBP > 130) at screening. Self-reported dyslipidemia was seen in 44%. OB affected 61%, and overweight 23%. Compared to national averages education levels and household incomes were low for many participants. ANOVA with Tukey pairwise test showed presence of DM/preDM was linked to higher age, weight, BMI, and SBP (P < 0.001).

Conclusion: Our screening in a rural AA community revealed high prevalence of DM/preDM, HTN, dyslipidemia and obesity, with dysglycemia significantly associated with age, weight, SBP and BMI. These findings indicate the need for larger representative studies focusing on preventive and interventional components to improve outcomes.

Background: While 70% of Sierra Leonean Healthcare Workers (HCWs) work in urban areas, rural clinics experience understaffing, limited resources, and inadequate facilities. Rural HCWs have fewer professional opportunities, difficult working conditions, and greater dissatisfaction and turnover. This study characterizes the experiences of rural HCWs and examines discrepancies between urban and rural HCW satisfaction in a low-income setting.

Methods: 86 surveys conducted with HCWs in urban and rural settings of Makeni, Sierra Leone assessed HCWs’ job satisfaction, access to resources, education, and patient relationships. Mann-Whitney tests and Spearman’s Rho tests were used to analyze survey data. 11 semi-structured interviews with HCWs from three rural villages in the Bombali district were conducted, and thematic analysis was used to identify salient domains.

Results: Rural HCWs reported significantly lower satisfaction with medical resources than urban HCWs (p<0.001). Despite similar career mobility, rural HCWs showed a stronger link between community belonging and patient relationships (rho=0.757, p<0.001), while urban HCWs had stronger links between professional learning, patient relationships, and satisfaction. Key themes from semi-structured interviews included occupational responsibilities, career advancement, healthcare barriers, and medical resources.

Conclusions: Significant disparities between rural and urban HCWs in Sierra Leone, particularly in resource availability, job fulfillment, and professional development, lead to dissatisfaction and high turnover rates for rural HCWs. These findings address the causes of high maternal mortality rates and health issues in rural Sierra Leone. Addressing the urban-rural healthcare gap is essential to directly improving maternal health outcomes and HCW satisfaction in Sierra Leone.

Background:
Rural Americans face significant disparities in cardiovascular health (CVH), defined as the eight metrics of the America Hearts Association's Life’s Essentials 8 [LE8]. Although low CVH among rural populations is well-documented, lacunae remain regarding the prevalence of CVH in ethnic minorities in these areas, disproportionately burdened with cardiovascular diseases. This study aims to review the existing literature on the CVH status and disparity among racial minorities residing in rural areas of the United States.

Methods:
We searched PubMed, CINAHL, PsycINFO, and Web of Science for U.S. studies (2015–2024) on CVH among rural ethnic minorities in July 2024. Records were deduplicated in Covidence. Two reviewers independently screened titles/abstracts/full texts; a third reviewer resolved conflicts. Data on rurality, CVH indicators (LE8), and outcomes were extracted using a standardized Excel form. Synthesized data were organized in themes involving the LE8.

Results:
Of 291 identified studies, 48 met the eligibility criteria. Studies, mostly observational, revealed severe CVH disparities, particularly in the Appalachian region. CVH Index scores, which range from 0 to 10, were as low as 3.30. African Americans faced the worst outcomes—one study of 316 participants in Arkansas found a 96% hypertension prevalence—exceeding the national average of 49%. While disparities affected multiple minority groups, Black women and children bore a disproportionate burden from comorbidities and socioeconomic factors.

Conclusion:
CVH disparities are significant among rural racial minorities, particularly in Black women and children exhibiting the lowest CVH levels. Targeted, community-driven interventions are essential to reduce the burden of cardiovascular disease in rural America.

Access to health care in rural communities is increasingly difficult –both in terms of medical services, and public health advocacy. Six agencies in Monroe County Tennessee, a rural county in the Eastern mountains, received a state Health Resiliency grant to support improve personal and population health status in this community. The consortium includes: Health Council, Prevention Network, Health Department, Senior Center, Access Medical Care, and Monroe Area Council for the Arts, (MACA) which are all working to enhance health and wellness throughout the life span.

Individuals can be recruited into the project through the primary care practice, or any of the community agencies. One objective is to determine whether primary care providers can increase adherence to personal health goals. All participants have access to an individualized health risk appraisal and goal setting, and are mentored by a community navigator. Their progress is monitored with data collected through a smart phone ap, available to all participants. Other forms of record keeping are also utilized.

The grant focuses on six objectives: improved nutrition, enhanced physical activities, decreased use of tobacco and other drugs, decreased stress, and improvement in hypertensive and diabetic health status. Involvement in family and community is an overarching aim of S.A.F.E.P.AT.H., and one that has been best addressed by MACA. The group has provided both online and in person programs. The Arts Council’s creative programming is providing an essential step towards achieving both personalized focus and a link to rejoin other ongoing community institutions and projects.

Introduction: Telehealth has become an essential component of healthcare delivery, especially in the wake of the COVID-19 pandemic. However, limited research has examined telehealth utilization while considering different health insurance status (e.g., Medicaid, Medicare, Private). In this study, we aim to examine the association between health insurance status and telehealth utilization among U.S. adults.

Methods: A cross-sectional analysis was conducted using data from the 2023 National Health Interview Survey. Weighted logistic regression models were employed to estimate the adjusted odds ratios (AORs) for telehealth use across different insurance categories while controlling for age and other demographic covariates.

Results: Among 28,019 eligible participants, telehealth utilization varied across health insurance status. Other insurance holders exhibited the highest utilization (31.1%), followed by Private insured (28.4%) and Medicaid (27.1%). Uninsured individuals had the lowest utilization rate (10.7%). Adjusted analysis revealed that individuals with Medicaid had slightly higher odds of telehealth use compared to private insurance holders (AOR 1.04, 95% CI: 0.91-1.19), while Medicare recipients had marginally lower odds (AOR 0.98, 95% CI: 0.86-1.13). Individuals with other insurance (CHIP, military related, Indian Health, or State sponsored health plans) had significantly higher odds of utilizing telehealth by 29% (AOR 1.29, 95% CI: 1.15-1.44). In contrast, uninsured individuals had the lowest likelihood of telehealth use by 56% (AOR 0.44, 95% CI: 0.37-0.53).

Conclusion: Significant differences exist among insurance status and telehealth utilization with uninsured having the lowest usage. Healthcare policies aimed at increasing telehealth accessibility for the uninsured holders may help bridge existing gaps in healthcare delivery.

BACKGROUND: Attention-Deficit/Hyperactivity Disorder (ADHD) was only recently recognized as a lifespan condition. An estimated 6.0% of adults in the US have an ADHD diagnosis; most were diagnosed as adults (55.9%).

Official US Guidelines for Adults with ADHD are expected within the next 1-2 years. However, the patient experience of seeking diagnosis and treatment for Adult ADHD has been under-researched. This study synthesizes the extant literature regarding the experience of adults seeking care for ADHD, to support development of a novel conceptual model and inform evaluation efforts.

METHODS: Following PRISMA-ScR principles, a bespoke Boolean string was used to search four databases. Relevant findings from the reviewed studies were extracted and organized according to an incipient conceptual model with six milestones along the patient journey from Awareness (1) to Maintenance (6).

RESULTS: The initial search yielded 368 results; n=5 remained after screening and selection. Variation in quality of care, the necessity of self-advocacy, and persistence in face of hesitant providers characterized the Seeking Diagnosis milestone (3). Difficulty finding a willing prescriber, and complexity related to comorbidities characterized Seeking Treatment milestone (4). Additional findings related to the remaining milestones will also be presented.

CONCLUSIONS: Further research is needed to understand experiences of adults seeking treatment and diagnosis of ADHD before the US Guidelines for Adults with ADHD are released. Such evidence is crucial for determining if quality of care and patient outcomes improve after implementation of the guidelines.

An often marginalized and underserved group of COVID-19 survivors are those suffering from post-acute sequelae of COVID-19 (PASC). Many of these individuals develop clinical syndromes which are remarkably similar to well described clinical entities such as postural orthostatic tachycardia syndrome (POTS). POTS is a complex form of dysautonomia that presents with abnormal autonomic reflexes upon standing, leading to symptoms such as lightheadedness, tachycardia, fatigue and cognitive impairment. We systematically reviewed the literature for existing high-quality evidence oral medications for the treatment of POTS, and further compared treatment options in the setting of POTS occurring as a PASC syndrome vs. POTS unrelated to COVID-19.

A systematic review of the literature was performed to identify studies of oral medications for the management of POTS. We searched for published manuscripts on the medical management of POTS through 6 April 2024 which met prespecified inclusion criteria. We conducted quality appraisal and assessed risk of bias before extracting the data and performing synthesis to determine the current state of the evidence; particularly in the context of PASC.

The study search and selection process identified 32 studies that met inclusion criteria. Most included studies were judged to be of moderate to high quality, with largely low risk of bias. The medications with the strongest evidence for use were beta-blockers, ivabradine, and midodrine. Limited evidence was available for PASC-associated POTS, but findings suggest that treatments may have similar efficacy in both PASC and non-PASC cases. Further study into treatment of POTS and other PASC conditions are needed.