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N C Med J ; 81(1): 24-27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908328


In working to improve the health of North Carolinians, a critical focus starts with our mothers and infants and their surrounding communities. North Carolina's perinatal outcomes, as evidenced by maternal morbidity and mortality, infant mortality, preterm births, and the larger context of lifelong physical and mental health of our citizens, offer areas for improvement and policy implications. In addition, the unacceptable disparities that remain despite some overall improvement in outcomes warrant full attention. This issue of the NCMJ highlights the state of perinatal health in North Carolina; the importance of a risk-appropriate perinatal system of care; the opportunities for supporting our parents, children, and families; and how we as a state and as a community can come together to improve the safety and experience of giving birth in North Carolina and beyond.

Saúde do Lactente/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Mortalidade Materna/tendências , North Carolina/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia
N C Med J ; 79(4): 235-239, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29991615


In North Carolina, our public health infrastructure consists of a state health department and 85 local health departments representing all 100 counties. The state health department, local health departments, health systems, and clinical providers work literally and figuratively as a team to improve the health of our citizens. In this article, we provide examples of the critical role of public health practitioners as part of the broader team addressing health, specifically in the areas of chronic disease, communicable disease, oral health, environmental health, and maternal and child health.

Doença Crônica/prevenção & controle , Equipe de Assistência ao Paciente/organização & administração , Saúde Pública , Controle de Doenças Transmissíveis/organização & administração , Serviços de Saúde Bucal/organização & administração , Humanos , Serviços de Saúde Materno-Infantil/organização & administração , North Carolina , Papel (figurativo)
N C Med J ; 79(2): 95-98, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29563302


In working to improve the health of North Carolinians, a broader emphasis has been placed on determinants of health, or non-medical drivers of health. Critical examples of health determinants are adverse childhood experiences, or ACEs, that affect early brain development and lifelong health and function. Multiple organizations and communities have come together to acknowledge the importance of prevention, address toxic stress and trauma in childhood, promote resiliency and trauma-informed care, and invest in the future of North Carolina through its children. This issue of the NCMJ highlights the prevalence and magnitude of ACEs in North Carolina and the effects on our children and the impact into adulthood, and how people and communities can come together to improve public health over the life course by addressing ACEs.

Maus-Tratos Infantis , Saúde da Criança , Bem-Estar da Criança , Saúde Pública , Criança , Maus-Tratos Infantis/prevenção & controle , Maus-Tratos Infantis/psicologia , Maus-Tratos Infantis/reabilitação , Humanos , North Carolina
Rev Recent Clin Trials ; 12(4): 290-297, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28814257


BACKGROUND: Concerns about the costs and quality of hospital care have led to increased interest in hospital readmissions in children. Children with medical complexity account for high proportions of inpatient utilization and have a higher risk of hospital readmission. OBJECTIVE: To identify studies of discharge interventions to prevent hospital readmissions in children with medical complexity. METHODS: We conducted a search to identify studies of discharge interventions. Included studies 1) described an intervention or modifiable risk factor around the time of hospital discharge 2) included pediatric patients with chronic illness and/or medical complexity and 3) reported subsequent hospital utilization. RESULTS: We identified ten studies testing the following interventions: multi-faceted discharge bundle (including medication review, discharge education, and follow-up appointments) (s=1), post-discharge follow-up clinic visits (s=3), post-discharge phone calls (s=2), intensive follow-up interventions for very low birth weight infants (s=2), and education interventions in children hospitalized with asthma (s=2). Four studies reported reductions in readmissions. The discharge bundle correlated with an 11.1% decrease in 30-day readmission (9.9% vs. 8.8%, p<0.05). All three studies of post discharge follow-up clinic visits reported a decrease in 30-day readmission risk among children with follow-up scheduled within 30 days, though one study also reported that medically complex children with follow- up within three days had increased readmission risk. CONCLUSION: Evidence supporting discharge interventions for children with medical complexity is limited. Multi-faceted discharge interventions and post-discharge clinic visits may be effective.

Estado Terminal/terapia , Readmissão do Paciente/tendências , Medição de Risco , Criança , Estado Terminal/epidemiologia , Humanos , Incidência , Fatores de Risco
Clin Pediatr (Phila) ; 53(7): 632-8, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24550559


OBJECTIVE: To compare abnormal screening rates of 2 different Spanish versions of the Modified Checklist for Autism in Toddlers (M-CHAT) in US Spanish-speaking patients. METHOD: Quasi-experimental design was used with historical and English language controls. Abnormal screening rates were compared between Spain and Western-hemisphere Spanish versions, as well as to English controls during the same time periods using chi square analysis. RESULTS: M-CHAT questionnaires were scored from 589 subjects (English n = 415, Spanish n = 174). There was little difference between Spanish versions. Overall, the Spanish abnormal screening rate was double that of English (23.6% vs 11.3%, P < .001). CONCLUSIONS: Spanish M-CHAT questionnaires are abnormal more often than those in English even after changing to appropriate translation, despite lower prevalence of autism in Latinos. Issues with translation, interpretation, or cultural understanding of behaviors may contribute. Given abnormal screening rates for Latinos, the use of the M-CHAT follow-up interview in Spanish-speaking patients is beneficial but may be more time-consuming.

Transtorno Autístico/diagnóstico , Barreiras de Comunicação , Hispano-Americanos , Transtorno Autístico/etnologia , Lista de Checagem , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Programas de Rastreamento , Estudos Prospectivos , Inquéritos e Questionários