Pregnancy-associated homicide, suicide and unintentional opioid-involved overdose deaths, North Carolina 2018-2019.

OBJECTIVE: Rates of death due to homicide, suicide and overdose during pregnancy and the first year postpartum have increased substantially in the USA in recent years. The aims of this study were to use 2018-2019 data on deaths identified for review by the North Carolina Maternal Mortality Review Committee (NC-MMRC), data from the North Carolina Violent Death Reporting System (NC-VDRS) and data from the Statewide Unintentional Drug Overdose Reporting System (NC-SUDORS) to examine homicide, suicide and unintentional opioid-involved overdose deaths during pregnancy and the first year postpartum. METHODS: We linked data from the 2018-2019 NC-MMRC to suicide and homicide deaths among women ages 10-50 years from the 2018-2019 NC-VDRS and to unintentional opioid-involved overdose deaths among women ages 10-50 years from the 2018-2019 NC-SUDORS. We conducted descriptive analyses to examine the prevalence of demographic characteristics and the circumstances surrounding each cause of death. RESULTS: From 2018 to 2019 in North Carolina, there were 23 homicides, nine suicides and 36 unintentional opioid-involved overdose deaths (9.7, 3.8 and 15.1 per 100 000 live births, respectively) during pregnancy and the first year postpartum. Most homicide deaths (87.0%) were by firearm, and more than half (52.5%) were related to intimate partner violence. More than two-thirds of women who died by suicide had a current mental health problem (77.8%). Less than one-fourth (22.2%) of those who died by unintentional opioid-involved overdose had a known history of substance use disorder treatment. CONCLUSION: Our approach to quantifying and describing these causes of pregnancy-associated death can serve as a framework for other states to inform data-driven prevention.

Collaborative Methods Foster Better Data: Insights From a Suicide Data Linkage Project in North Carolina.

The linking of surveillance data sets has increasingly become an essential public health activity. We compared a traditional method in North Carolina (NC) with a newer collaborative approach when linking Hospital Discharge Data (HDD) and NC Violent Death Reporting System (NC-VDRS) data. We found the collaborative approach to be superior, enabling wider ownership combined with subject matter expertise the traditional method lacked. We used Link Plus and Match*Pro software for linkage, which had similar matching results. However, the collaborative process using Match*Pro resulted in fewer matches requiring review and enabled better case adjudication and collaboration between partners. Of the 1361 unique suicides that matched to HDD, 44% (n = 599) had multiple prior hospitalizations. Public health needs to innovate and enable partners to foster solutions when traditional methods are dated and result in less reliable data. The process outlined builds consensus, increases trust, and ultimately saves time.

The Impact of the COVID-19 Pandemic on Disparities in Motor Vehicle Traffic Deaths and Injuries among North Carolina American Indians.

A Periodic Feature to Inform North Carolina Health Care Professionals About Current Topics in Health Statistics.

Employing Molecular Phylodynamic Methods to Identify and Forecast HIV Transmission Clusters in Public Health Settings: A Qualitative Study.

Molecular HIV surveillance is a promising public health strategy for curbing the HIV epidemic. Clustering technologies used by health departments to date are limited in their ability to infer/forecast cluster growth trajectories. Resolution of the spatiotemporal dynamics of clusters, through phylodynamic and phylogeographic modelling, is one potential strategy to develop a forecasting tool; however, the projected utility of this approach needs assessment. Prior to incorporating novel phylodynamic-based molecular surveillance tools, we sought to identify possible issues related to their feasibility, acceptability, interpretation, and utility. Qualitative data were collected via focus groups among field experts (n = 17, 52.9% female) using semi-structured, open-ended questions. Data were coded using an iterative process, first through the development of provisional themes and subthemes, followed by independent line-by-line coding by two coders. Most participants routinely used molecular methods for HIV surveillance. All agreed that linking molecular sequences to epidemiological data is important for improving HIV surveillance. We found that, in addition to methodological challenges, a variety of implementation barriers are expected in relation to the uptake of phylodynamic methods for HIV surveillance. The participants identified several opportunities to enhance current methods, as well as increase the usability and utility of promising works-in-progress.

Intimate Partner Homicides in North Carolina: 2011-2015.

BACKGROUND Research on intimate partner homicide (IPH), when someone is killed by a current or former intimate partner, in North Carolina is limited, making it difficult to understand the magnitude of IPHs and identify strategies for prevention.METHOD We used North Carolina Violent Death Reporting System (NC-VDRS) data to assess IPHs among North Carolina residents between 2011 and 2015. Homicides were considered IPHs if intimate partner violence was identified and the victim was the suspect's current or former intimate partner. Proportions and rates of demographic characteristics and circumstances were assessed.RESULTS Of the 2,299 homicides that occurred between 2011 and 2015, 350 were IPHs (0.9 per 100,000 person-years). Most (72.3%) IPH victims were female (n = 253). Among all female homicides almost half (48.2%) were IPHs, while only 5.4% of all male homicides were IPHs. The highest rate of IPH occurred among women aged 20-44 (2.1 per 100,000 person-years). Most victims were non-Hispanic (NH) white (54.0%, n = 189), although rates for NH American Indians and NH blacks were 1.8 and 2.0 times those among NH whites respectively. Most victims, 86.6% male and 82.6% female, were the suspect's current partner. Firearms were the most common weapon used (62.6%, n = 219).LIMITATIONS NC-VDRS data are not representative of all IPHs in the United States. Circumstance data were sometimes incomplete and categories of circumstance variables restrictive, limiting available information on IPHs.CONCLUSION Future interventions focused on women aged 20-44, NH American Indian and NH Black communities, and firearm access could be effective in preventing IPHs in North Carolina.

Rapid Identification and Investigation of an HIV Risk Network Among People Who Inject Drugs -Miami, FL, 2018.

Prevention of HIV outbreaks among people who inject drugs remains a challenge to ending the HIV epidemic in the United States. The first legal syringe services program (SSP) in Florida implemented routine screening in 2018 leading to the identification of ten anonymous HIV seroconversions. The SSP collaborated with the Department of Health to conduct an epidemiologic investigation. All seven acute HIV seroconversions were linked to care (86% within 30 days) and achieved viral suppression (mean 70 days). Six of the seven individuals are epidemiologically and/or socially linked to at least two other seroconversions. Analysis of the HIV genotypes revealed that two individuals are connected molecularly at 0.5% genetic distance. We identified a risk network with complex transmission dynamics that could not be explained by epidemiological methods or molecular analyses alone. Providing wrap-around services through the SSP, including routine screening, intensive linkage and patient navigation, could be an effective model for achieving viral suppression for people who inject drugs.

Correction to: Work-Related Stressors Among Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Home Visitors: A Qualitative Study.

The article "Work-Related Stressors Among Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Home Visitors: A Qualitative Study", written by Paige J. Alitz, Shana Geary, Pamela C. Birriel, Takudzwa Sayi, Rema Ramakrishnan, Omotola Balogun, Alison Salloum and Jennifer T. Marshall, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 31 May 2018 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 25 July 2018 to

Work-Related Stressors Among Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Home Visitors: A Qualitative Study.

Background The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program delivers evidence-based home visiting services to over 1400 families each year. Home visitors are integral in providing resources for families to promote healthy pregnancy, child development, family wellness, and self-sufficiency. Due to the nature of this work, home visitors experience work-related pressures and stressors that can impact staff well-being and retention. Objectives The purpose of this study was to understand primary sources of work-related stress experienced by home visitors, subsequent effects on their engagement with program participants, and to learn of coping mechanisms used to manage stress. Methods In 2015, Florida MIECHV program evaluators conducted ten focus groups with 49 home visitors during which they ranked and discussed their top sources of work-related stress. Qualitative analysis was conducted to identify emergent themes in work-related stressors and coping/supports. Results Across all sites, the burden of paperwork and data entry were the highest ranked work-related stressors perceived as interfering with home visitors' engagement with participants. The second-highest ranked stressors included caseload management, followed by a lack of resources for families, and dangerous environments. Home visitors reported gratification in their helping relationships families, and relied on coworkers or supervisors as primary sources of workplace support along with self-care (e.g. mini-vacations, recreation, and counseling). Conclusions for practice Florida MIECHV home visitors across all ten focus groups shared similar work-related stressors that they felt diminished engagement with program participants and could impact participant and staff retention. In response, Florida MIECHV increased resources to support home visitor compensation and reduce caseloads, and obtained a competitive award from HRSA to implement a mindfulness-based stress reduction training statewide.