Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 16.342
Filtrar
1.
N C Med J ; 81(6): 381-385, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33139470

RESUMO

The Affordable Care Act played a major role in transitioning American health care away from fee-for-service payment. We explore the spread of payment reforms since the implementation of the ACA, both nationally and in North Carolina; the corresponding effects on health care costs and quality; and further steps needed to achieve greater transformation.


Assuntos
Custos de Cuidados de Saúde/tendências , Reforma dos Serviços de Saúde/economia , Patient Protection and Affordable Care Act/economia , Betacoronavirus , Infecções por Coronavirus , Humanos , North Carolina , Pandemias , Pneumonia Viral , Estados Unidos
2.
MMWR Morb Mortal Wkly Rep ; 69(46): 1743-1747, 2020 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-33211678

RESUMO

On university campuses and in similar congregate environments, surveillance testing of asymptomatic persons is a critical strategy (1,2) for preventing transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). All students at Duke University, a private research university in Durham, North Carolina, signed the Duke Compact (3), agreeing to observe mandatory masking, social distancing, and participation in entry and surveillance testing. The university implemented a five-to-one pooled testing program for SARS-CoV-2 using a quantitative, in-house, laboratory-developed, real-time reverse transcription-polymerase chain reaction (RT-PCR) test (4,5). Pooling of specimens to enable large-scale testing while minimizing use of reagents was pioneered during the human immunodeficiency virus pandemic (6). A similar methodology was adapted for Duke University's asymptomatic testing program. The baseline SARS-CoV-2 testing plan was to distribute tests geospatially and temporally across on- and off-campus student populations. By September 20, 2020, asymptomatic testing was scaled up to testing targets, which include testing for residential undergraduates twice weekly, off-campus undergraduates one to two times per week, and graduate students approximately once weekly. In addition, in response to newly identified positive test results, testing was focused in locations or within cohorts where data suggested an increased risk for transmission. Scale-up over 4 weeks entailed redeploying staff members to prepare 15 campus testing sites for specimen collection, developing information management tools, and repurposing laboratory automation to establish an asymptomatic surveillance system. During August 2-October 11, 68,913 specimens from 10,265 graduate and undergraduate students were tested. Eighty-four specimens were positive for SARS-CoV-2, and 51% were among persons with no symptoms. Testing as a result of contact tracing identified 27.4% of infections. A combination of risk-reduction strategies and frequent surveillance testing likely contributed to a prolonged period of low transmission on campus. These findings highlight the importance of combined testing and contact tracing strategies beyond symptomatic testing, in association with other preventive measures. Pooled testing balances resource availability with supply-chain disruptions, high throughput with high sensitivity, and rapid turnaround with an acceptable workload.


Assuntos
Doenças Assintomáticas/epidemiologia , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Vigilância em Saúde Pública/métodos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/prevenção & controle , Humanos , North Carolina/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Desenvolvimento de Programas , Universidades , Carga Viral
3.
N C Med J ; 81(6): 348-354, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33139462

RESUMO

BACKGROUND Resettled refugees are at increased risk of poor health outcomes due to acculturation challenges, logistical barriers, experiences of trauma, and other barriers to care that are poorly understood. Refugee children may be particularly vulnerable due to disruptions in health, well-being, education, and nutrition during the resettlement process.METHOD To describe the health care barriers facing refugees in the North Carolina Triangle area (comprised of Durham, Chapel Hill, Raleigh, and their surrounding areas), we conducted three focus group interviews (in Arabic, French, and Swahili) with 25 refugee parents from Syria, Iraq, Central African Republic, the Democratic Republic of the Congo, and Chad. We also administered a survey to nine organizations that provide services for refugees.RESULTS Focus group responses highlighted the multidimensional nature of health care barriers for refugee families and children, encompassing challenges with acculturation, communication, transportation, finances, and health literacy. Organizations emphasized similar challenges and described their efforts to improve access to services through increased communication, coordination, and seeking new financial support for programs.LIMITATIONS Given the geographic focus of the study, results may not be generalizable to other populations and settings. Men spoke more than women in some focus groups, and participants may have been influenced by more vocal contributors. Furthermore, this study is limited by a lack of health outcomes data.CONCLUSIONS This study suggests that the health care needs of refugees living in the North Carolina Triangle area can be better met by providing comprehensive, coordinated, and culturally relevant care. This could include minimizing the number of visits by integrating multiple services under one roof, providing trauma-informed interpreters, and offering accessible transportation services.


Assuntos
Acesso aos Serviços de Saúde , Refugiados , Criança , Família , Feminino , Grupos Focais , Humanos , Masculino , North Carolina
4.
N C Med J ; 81(6): 355-362, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33139463

RESUMO

BACKGROUND Deaths from unintentional opioid overdose have increased markedly over the last decade in North Carolina. In 2017 the state created a North Carolina Opioid Action Plan, which laid out a multisectoral response to the crisis that included the medical community, law enforcement, emergency medical services, and treatment professionals. It also created a website providing county-level data associated with the crisis. Using this publicly available data, we examine trends and associations between opioid-related mortality and strategies to reduce opioid prescriptions, reduce fatality of overdose, and improve treatment and recovery.METHOD We examine yearly trends from 2010-2017 for statewide unintentional opioid-related death rates, prescription of opioid pills, buprenorphine prescription rates, naloxone administrations, and number of Certified Peer Support Specialists. We compare recent opioid-related death rates for 2015-2017 with an earlier period (2010-2012) at the county level, and examine the association between death rates and rates of the supply, treatment, and recovery metrics.RESULTS Trends for all metrics increased from 2010-2017, although the number of opioid pills per capita has declined since 2015. Between 2010 and 2017, 84 of the state's 100 counties experienced an increase in opioid-related mortality. County-level mortality was positively associated with opioid prescription rate (r = +0.12, P = 0.24) and with naloxone administrations (r = +0.20, P = 0.05). Prescription of buprenorphine was associated with a reduction in opioid mortality (r = -0.27, P = 0.01). The effect of Certified Peer Support Specialists was not discernable.LIMITATIONS Data are available for only eight years and aggregated at the county level. Mortality data are based on death certificates using ICD-10 codes from the North Carolina State Center for Health Statistics, Vital Statistics, which may not capture all opioid-related fatalities. Drug-related deaths may involve multiple non-opioid substances; in addition, determining the intent of the deceased individual may be difficult (suicide versus unintentional). Naloxone administration data only includes data from emergency medical services, not community-administered naloxone, because that data was only available for 2013 and later and is based only on self-reports.CONCLUSIONS The potential efficacy of buprenorphine is promising and should be further explored. All interventions should be monitored.


Assuntos
Epidemia de Opioides , Analgésicos Opioides/envenenamento , Benchmarking , Overdose de Drogas/tratamento farmacológico , Overdose de Drogas/mortalidade , Humanos , North Carolina/epidemiologia , Epidemia de Opioides/prevenção & controle , Epidemia de Opioides/tendências
5.
N C Med J ; 81(6): 364-369, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33139465

RESUMO

This issue of the North Carolina Medical Journal focuses on the 10-year anniversary of the Patient Protection and Affordable Care Act (ACA), signed into law on March 23, 2010. Since its inception, the ACA has been highly controversial. Yet, it has contributed to positive improvements in our health care system. The ACA expanded health insurance coverage to more of the uninsured, made investments in prevention and in improving quality of care, and started our journey toward value-based care. This issue brief touches on how the law has been implemented in North Carolina, along with an assessment of the successes and failures of the law. It is followed by more detailed commentaries on specific aspects of the law and its implementation in our state. While much has been accomplished in the last 10 years, more is needed to achieve our goals of an affordable, equitable, and accessible health care system-one that promotes positive health outcomes while reducing unnecessary costs.


Assuntos
Patient Protection and Affordable Care Act , Aniversários e Eventos Especiais , Humanos , North Carolina , Estados Unidos
6.
N C Med J ; 81(6): 370-376, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33139466

RESUMO

Prior to the passage of the Affordable Care Act, many individuals across the state and country faced numerous barriers to accessing affordable and quality health care. This paper provides a review of health coverage in North Carolina before the ACA, the impact the ACA has had on access to health care, and how North Carolina could continue to benefit from "complete" implementation of the ACA.


Assuntos
Patient Protection and Affordable Care Act , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , North Carolina , Estados Unidos
7.
N C Med J ; 81(6): 377-380, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33139469

RESUMO

The passage of the Affordable Care Act had a great impact on the landscape of public health programming and clinical preventive care in North Carolina. Large funding measures have supported community-based prevention efforts and led to policy, systems, and environmental changes to support a healthier population.


Assuntos
Patient Protection and Affordable Care Act , Saúde Pública , Aniversários e Eventos Especiais , Humanos , North Carolina , Estados Unidos
8.
N C Med J ; 81(6): 389-393, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33139472

RESUMO

The Patient Protection and Affordable Care Act has resulted in benefits for North Carolina hospitals and the patients they serve. The impact of the ACA is not as great as it might have been due to lack of Medicaid expansion and exigent challenges at the state and local level.


Assuntos
Hospitais , Patient Protection and Affordable Care Act , Humanos , Governo Local , Medicaid/organização & administração , North Carolina , Governo Estadual , Estados Unidos
10.
N C Med J ; 81(6): 394-397, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33139474

RESUMO

The Affordable Care Act made direct and indirect investments in community health centers. Ten years later, more North Carolinians benefit from a stronger primary care safety net that provides a broader scope of comprehensive services, but missed policymaking opportunities leave work to be done to achieve a healthier, more equitable state.


Assuntos
Centros Comunitários de Saúde , Patient Protection and Affordable Care Act , Aniversários e Eventos Especiais , Humanos , North Carolina , Formulação de Políticas , Atenção Primária à Saúde , Estados Unidos
12.
MMWR Morb Mortal Wkly Rep ; 69(39): 1416-1418, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33001871

RESUMO

Preventing transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), in institutes of higher education presents a unique set of challenges because of the presence of congregate living settings and difficulty limiting socialization and group gatherings. Before August 2020, minimal data were available regarding COVID-19 outbreaks in these settings. On August 3, 2020, university A in North Carolina broadly opened campus for the first time since transitioning to primarily remote learning in March. Consistent with CDC guidance at that time (1,2), steps were taken to prevent the spread of SARS-CoV-2 on campus. During August 3-25, 670 laboratory-confirmed cases of COVID-19 were identified; 96% were among patients aged <22 years. Eighteen clusters of five or more epidemiologically linked cases within 14 days of one another were reported; 30% of cases were linked to a cluster. Student gatherings and congregate living settings, both on and off campus, likely contributed to the rapid spread of COVID-19 within the university community. On August 19, all university A classes transitioned to online, and additional mitigation efforts were implemented. At this point, 334 university A-associated COVID-19 cases had been reported to the local health department. The rapid increase in cases within 2 weeks of opening campus suggests that robust measures are needed to reduce transmission at institutes of higher education, including efforts to increase consistent use of masks, reduce the density of on-campus housing, increase testing for SARS-CoV-2, and discourage student gatherings.


Assuntos
Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Pneumonia Viral/epidemiologia , Universidades , Adolescente , Adulto , Infecções por Coronavirus/transmissão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Pandemias , Pneumonia Viral/transmissão , Características de Residência , Comportamento Social , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Adulto Jovem
13.
J Med Libr Assoc ; 108(4): 651-655, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33013227

RESUMO

Migrant and seasonal farmworkers, who are essential workers in the coronavirus global public health emergency, face unique risks to their health as well as longstanding health inequities. This commentary highlights these risks and argues that Internet access represents an underappreciated but critical part of the public health response. The authors first discuss the unique risks farmworkers face. We note the importance of Internet access in the time of physical distancing, the fact that many health outreach workers are no longer visiting camps, the need for telemedicine infrastructure, and the role of Internet access in providing connections to families in communities of origin. We describe existing efforts that have been implemented in North Carolina to raise awareness among public health and health promotion practitioners and researchers. The current coronavirus pandemic demands the attention of medical libraries, public health practitioners, and policy makers to address the digital divide for farmworkers and their families.


Assuntos
Relações Comunidade-Instituição , Fazendeiros , Acesso à Internet , Bibliotecas Médicas , População Rural , Migrantes , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Humanos , North Carolina , Pandemias , Pneumonia Viral/epidemiologia
14.
MMWR Morb Mortal Wkly Rep ; 69(38): 1360-1363, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32970654

RESUMO

Contact tracing is a strategy implemented to minimize the spread of communicable diseases (1,2). Prompt contact tracing, testing, and self-quarantine can reduce the transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (3,4). Community engagement is important to encourage participation in and cooperation with SARS-CoV-2 contact tracing (5). Substantial investments have been made to scale up contact tracing for COVID-19 in the United States. During June 1-July 12, 2020, the incidence of COVID-19 cases in North Carolina increased 183%, from seven to 19 per 100,000 persons per day* (6). To assess local COVID-19 contact tracing implementation, data from two counties in North Carolina were analyzed during a period of high incidence. Health department staff members investigated 5,514 (77%) persons with COVID-19 in Mecklenburg County and 584 (99%) in Randolph Counties. No contacts were reported for 48% of cases in Mecklenburg and for 35% in Randolph. Among contacts provided, 25% in Mecklenburg and 48% in Randolph could not be reached by telephone and were classified as nonresponsive after at least one attempt on 3 consecutive days of failed attempts. The median interval from specimen collection from the index patient to notification of identified contacts was 6 days in both counties. Despite aggressive efforts by health department staff members to perform case investigations and contact tracing, many persons with COVID-19 did not report contacts, and many contacts were not reached. These findings indicate that improved timeliness of contact tracing, community engagement, and increased use of community-wide mitigation are needed to interrupt SARS-CoV-2 transmission.


Assuntos
Busca de Comunicante/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Humanos , Incidência , North Carolina/epidemiologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-32887328

RESUMO

The Supplemental Nutrition Assistance Program (SNAP) is a critical program that helps reduce the risk of food insecurity, yet little is known about how SNAP addresses the needs of rural, food-insecure residents in the United States (U.S.). This study examines how rural, food-insecure residents perceive SNAP. Semi-structured interviews were conducted with 153 individuals living in six diverse rural regions of Arkansas, Montana, North Carolina, Oregon, Texas, and West Virginia. SNAP was described as a crucial stop-gap program, keeping families from experiencing persistent food insecurity, making food dollars stretch when the family budget is tight, and helping them purchase healthier foods. For many rural residents interviewed, SNAP was viewed in a largely positive light. In efforts to continue improving SNAP, particularly in light of its relevance during and post-coronavirus (COVID-19) pandemic, policymakers must be aware of rural families' perceptions of SNAP. Specific improvements may include increased transparency regarding funding formulas, budgeting and nutrition education for recipients, effective training to improve customer service, connections among social service agencies within a community, and increased availability of automation to streamline application processes.


Assuntos
Assistência Alimentar , Abastecimento de Alimentos , Pobreza , Arkansas , Infecções por Coronavirus/epidemiologia , Humanos , Montana , North Carolina , Oregon , Pandemias , Pneumonia Viral/epidemiologia , Texas , West Virginia
16.
Plant Dis ; 104(11): 2928-2939, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32900293

RESUMO

The duration of wheat susceptibility to Fusarium infection has implications for risk forecasting, fungicide timing, and the likelihood that visible kernel damage may underpredict deoxynivalenol (DON) contamination. A field experiment was conducted to explore the impact of varying infection timings on Fusarium head blight (FHB) development in winter wheat. Trials in four successive years (2010 to 2013) in North Carolina utilized one susceptible and one moderately resistant cultivar possessing similar maturity, stature, and grain quality. Inoculum was applied in the form of sprayed Fusarium graminearum conidia. In the first year, the nine infection timings were from 0 to 21 days after anthesis (daa), whereas in the following 3 years, they ranged from 0 to 13 daa. Infection progression was compared among inoculation timings by sampling spikes five to six times during grain-fill. Based on DON, percent kernel damage and kernel infection, and fungal spread as assayed via qPCR, the moderately resistant cultivar had at least a 2- to 3-day shorter window of susceptibility to damaging FHB infection than the susceptible cultivar. The results suggest that duration of susceptibility is an important aspect of cultivar resistance to FHB. In 2012, the window of susceptibility for both cultivars was extended by cold snaps during anthesis. After debranning in one year, the majority of DON was found to be in the bran fraction of kernels; there was also a trend for later infections to lead to a higher percentage of DON in the nonbran fraction, as well as a higher ratio of DON to FDK.


Assuntos
Fusarium , Tricotecenos , North Carolina , Doenças das Plantas , Triticum
19.
N C Med J ; 81(5): 284-292, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32900886

RESUMO

BACKGROUND Women are less likely than men to be physically active and more likely to reduce their physical activity as they age. The objective of this research was to understand barriers that might prevent North Carolina women from being physically active after retirement as well as aspects of retirement that might facilitate a more physically active lifestyle to inform intervention strategies applicable to retired women.METHOD Semi-structured interviews were conducted with 15 recently retired women living in North Carolina. Interviews were recorded and transcribed. Content analysis was used to identify themes related to barriers and facilitators of physical activity after retirement.RESULTS Six themes were identified. One theme was the development of leisure-time physical activity habits over the lifespan. Five other themes described how physical activity after retirement was influenced by prior occupational physical activity, concurrent life transitions (e.g., becoming a caregiver), health, social support, and the community environment.LIMITATIONS Women in this study were active participants in community organizations, which might make their experiences unique from those of women who are not engaged with their communities. However, similarities in themes in this and other qualitative studies corroborate the broader transferability of findings.CONCLUSION Interventions to promote physical activity among retired North Carolina women should consider emphasizing health benefits of physical activity and improving walking environments and access to physical activity facilities. Local residents should be involved in intervention design to address unique barriers among women who retire from physically demanding jobs or become caregivers.


Assuntos
Exercício Físico , Aposentadoria , Feminino , Humanos , North Carolina , Pesquisa Qualitativa
20.
N C Med J ; 81(5): 301-306, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32900889

RESUMO

Over the past century, anthropogenic activities have resulted in high levels of greenhouse gases in our environment, creating a warming effect on the Earth. As a result, global temperatures have risen, shifting climatic zones, influencing weather patterns, and intensifying storms. These changes include heavy precipitation, drought, wildfires, hurricanes, heat waves, and coastal flooding. The impacts from this climatic activity continue to contribute negatively to our environment while influencing human health.In this special issue of the North Carolina Medical Journal, authors from universities, governmental agencies, and not-for-profit organizations address how the global impacts of climate change are affecting the health of communities across our beautiful state. This issue offers our readers research and real-life stories that underscore the need for keeping the issue of climate change at the forefront of public health for North Carolina. The information provided in these articles gives policymakers and health care providers a deeper understanding of the public health implications and challenges of climate change while highlighting the health risks to our most susceptible populations.Because there are no direct clinical symptoms or signs, the effects of climate change are difficult to assess at the individual level. However, an abundance of peer-reviewed climate health research studies provides overwhelming scientific evidence that climate change is impacting population health with generalizable results. Mitigation and adaptability strategies are necessary for reducing carbon emissions and building climate-resilient communities. Policymakers and health care providers are in key positions for educating others, helping protect our planet, improving health outcomes, and moving North Carolina toward more sustainable solutions.


Assuntos
Mudança Climática , Saúde Pública , Humanos , North Carolina
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA