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1.
N C Med J ; 83(1): 5-10, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34980644

RESUMO

To achieve a healthier North Carolina, first we must increase the racial and gender diversity of the state's scalable entrepreneurial pipeline, from both native and in-recruited firms, across all key industries. Then we must increase the scale and diversity of capital available to those racially and gender diverse entrepreneurs and businesses. Next, we must expand the place and space of the state's racial and gender diverse entrepreneurs and businesses-in both the physical and virtual marketplaces-to ensure that they are all taking advantage of our economically expanding state. Finally, we must remove as many barriers-natural and artificial-to success as we can for racial and gender diverse businesses and entrepreneurs. These proactive efforts are not against anyone, but instead are for a healthy and whole state becoming what it should: to be, rather than to seem.


Assuntos
Nível de Saúde , Humanos , North Carolina
2.
N C Med J ; 83(1): 17-21, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34980647

RESUMO

Gale-force demographic disruptors such as unequal population growth can potentially prevent our state from achieving the exemplary goals and targeted outcomes set forth in Healthy North Carolina 2030 These forces also present opportunities if carefuly addressed. Policy prescriptions and strategic investments required to ensure success are outlined here, following an overview of demographic drivers that create public health vulnerabilities.


Assuntos
Equidade em Saúde , Vento , Demografia , Humanos , North Carolina , Saúde Pública
3.
N C Med J ; 83(1): 26-28, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34980649

RESUMO

The Pathways to Grade-Level Reading initiative created partnerships among North Carolina's early learning and education, public agency, policy, philanthropic, and business leaders to define a common vision, shared measures of success, and coordinated strategies to support the optimal development of all North Carolina children beginning at birth to reach third-grade reading profiency.


Assuntos
Alfabetização , Leitura , Criança , Família , Humanos , Recém-Nascido , Aprendizagem , North Carolina
4.
N C Med J ; 83(1): 22-25, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34980648

RESUMO

Given the extensive research on the impact of paid leave on increased access, decreased disparities, and improvement in health and economic outcomes, passing a universal statewide program that covers all working North Carolinians would promote Healthy North Carolina 2030 targets.


Assuntos
Políticas , Humanos , North Carolina
5.
N C Med J ; 83(1): 33-36, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34980651

RESUMO

Achieving health equity for Black people and other people of color in America will be an impossible feat without dismantling racist systems and replacing them with new inclusive systems that create success for everyone. This article highlights activities in Rocky Mount, North Carolina, and the efforts of a community-based nonprofit, OIC, in collaboration with residents, community, and government partners to craft sustainable and replicable solutions.


Assuntos
Equidade em Saúde , Humanos , North Carolina
6.
N C Med J ; 83(1): 29-32, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34980650

RESUMO

Steadfast leadership from key advocacy groups and individuals working to eliminate disparities in the care and treatment of incarcerated pregnant people in North Carolina jails and prisons led to the passage of HB608, Dignity for Women Who are Incarcerated, in 2021.


Assuntos
Prisioneiros , Feminino , Humanos , North Carolina , Gravidez , Prisões
7.
N C Med J ; 83(1): 48-57, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34980656

RESUMO

BACKGROUND Residential segregation is a spatial manifestation of structural racism. Racial disparities in emergency department (ED) utilization mirror social inequity in the larger community. We evaluated associations between residential segregation and ED utilization in a community with known disparities and geographically concentrated social and health risk.METHODS Cross-sectional data were collected from electronic medical records of 101 060 adult ED patients living in Mecklenburg County, North Carolina in 2017. Community context was measured as residential segregation using the dissimilarity index, categorized into quintiles (Q1-Q5) using 2013-2017 American Community Survey estimates, and residency in a public health priority area (PHPA). The outcome was measured as total ED visits during the study period. Associations between community context and ED utilization were modeled using Anderson's behavioral model of health service utilization, and estimated using negative binomial regression, including interaction terms by race.RESULTS Compared to areas with the lowest proportions of Black residents (Q1), living in Q4 was associated with higher rates of ED utilization among Black/Other (AME = 0.11) and White (AME = 0.23) patients, while associations with living in Q5 were approximately equivalent (AME = 0.12). PHPA residency was associated with higher rates of ED utilization among Black/Other (AME = 0.10) and White patients (AME = 0.22).LIMITATIONS Associations should not be interpreted as causal, or be generalized to the larger community without ED utilization. Health system leakage is possible but limited.CONCLUSIONS Residential segregation is associated with higher rates of ED utilization, as are PHPA residency and other individual-level determinants.


Assuntos
Segregação Social , Adulto , Estudos Transversais , Serviço Hospitalar de Emergência , Humanos , North Carolina , Características de Residência
8.
N C Med J ; 83(1): 37-39, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34980652

RESUMO

Childhood trauma can have lasting impact throughout the life course, affecting both physical and mental health. But it doesn't have to be this way. To better understand the role of adverse childhood experiences (ACEs) as indicators of health, the North Carolina Medical Journal sat down with George (Tripp) Ake, PhD, and Lisa Amaya-Jackson, MD, MPH, two state experts in child traumatic stress.


Assuntos
Experiências Adversas da Infância , Criança , Medicina Baseada em Evidências , Humanos , Acontecimentos que Mudam a Vida , Saúde Mental , North Carolina
9.
N C Med J ; 83(1): 67-74, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34980658

RESUMO

BACKGROUND The Comprehensive Addiction and Recovery Act (CARA) of 2016 amended the Child Abuse Prevention and Treatment Act (CAPTA), reinforcing and revising the requirement that states develop policies and procedures to address the needs of substance-affected infants and their caregivers. North Carolina's program, the North Carolina Plan of Safe Care (NC POSC), was implemented in August 2017 and involves coordination between multiple agencies.METHODS We conducted a quality improvement project to assess implementation of the North Carolina Plan of Safe Care in Wake County through interviews with key stakeholders involved in program delivery including health care providers (n = 7), child protective services social workers (CPS; n = 14), and care managers at Care Coordination for Children (CC4C; n = 10). We also analyzed data on Plan of Safe Care notifications to Wake County CPS from January 2018 to October 2019.RESULTS Several key themes emerged in stakeholder interviews, including 1) lack of awareness of the program among health care providers; 2) gaps in information sharing and communication between agencies; 3) concerns regarding CPS notifications for all substance exposure types, including prenatal exposure to medication for opioid use disorder (MOUD); 4) common family needs and service referrals; 5) challenges engaging with families; 6) lack of knowledge among health care providers and CPS social workers regarding CC4C; and 7) benefits of the program for infants and families. From January 2018 to October 2019, 91% of notifications for substance-affected infants received by Wake County CPS as part of the NC POSC were screened-in for a maltreatment assessment. Of those screened-in, more than two-thirds (70%) involved prenatal marijuana exposure only.LIMITATIONS This project was limited to one county.CONCLUSIONS As NC POSC implementation continues, further consideration of the infrastructure and guidance available to address the implementation challenges identified by stakeholders will be essential to meeting family needs and promoting infant safety and well-being.


Assuntos
Transtornos Relacionados ao Uso de Opioides , Encaminhamento e Consulta , Criança , Feminino , Pessoal de Saúde , Humanos , Lactente , North Carolina , Gravidez
10.
N C Med J ; 83(1): 58-66, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34980657

RESUMO

BACKGROUND Although use of contraceptives has increased among young women in the United States, more than half of pregnancies remain unplanned. The goal of this study was to examine the association between insurance status and receipt of contraceptives among young women receiving care within a large integrated health care system in the Southeastern United States to better inform strategies for increasing access to contraception.METHODS This retrospective study used electronic medical record data from an integrated health care system based in Charlotte, North Carolina. Data were analyzed for 51,900 women aged 18-29 who lived in Mecklenburg County and had at least 1 primary care visit between 2014 and 2016. Contraceptive orders were identified by service and procedure codes and grouped into long-acting reversible contraceptives (LARC) and non-LARC categories. Adjusted multinomial logistic regression models were used to assess the association between receipt of contraceptives and insurance status.RESULTS Compared to non-Hispanic White women with commercial insurance, non-Hispanic Black (OR = 1.25; 95% CI, 1.13-1.38) and Hispanic (OR = 2.25; 95% CI, 1.93-2.61) women with Medicaid had higher odds of receiving LARC. Similar variations by insurance and race/ethnicity were observed for the non-LARC group.LIMITATIONS Data were limited to a single health care system and did not capture contraceptive orders by unaffiliated providers. Analyses used the most frequent payor and did not account for changes in insurance status.CONCLUSION Findings indicate an important role of race/ethnicity and insurance coverage in contraceptive care. Higher receipt of LARC among Black and Hispanic women also suggests that implicit biases may influence contraception counseling and promotion practices. Future study is warranted to further delineate these relationships.


Assuntos
Anticoncepcionais , Feminino , Humanos , Cobertura do Seguro , North Carolina , Gravidez , Estudos Retrospectivos , Estados Unidos
14.
Sci Total Environ ; 806(Pt 1): 150448, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34563909

RESUMO

Private well users are potentially exposed to a range of chemical contaminants through their drinking water. Point-of-use (POU) water treatment represents one potential solution to reduce harmful exposures through well water, but well users frequently do not adopt household treatment even if they learn their water is contaminated. This study elucidates the experiences, perceptions, and beliefs of 17 households on private wells in North Carolina that participated in a pilot-scale POU water treatment intervention to better understand the drivers and barriers of POU treatment adoption among well users. The intervention consisted of an under-sink activated carbon block POU filter designed to remove lead and two long-chain perfluoroalkyl acids. Filter effluents and influents were tested monthly for eight months. Questionnaires administered before and after the intervention showed a significant decrease in participants' perceived vulnerability to well water contamination, with 77% feeling vulnerable to poor well water quality before, compared to 23% after the filter was installed. However, the POU filters did not fully eliminate feelings of water insecurity (for example, concerns about exposure to contaminants when bathing remained). Lack of knowledge and skills associated with installing and maintaining POU treatment were important barriers to adoption for some well users. Perceptions of POU treatment were also significantly correlated with the intent to implement other well stewardship behaviors such as well water testing. The results highlight the need for strengthened outreach and support programs that provide technical assistance, education, and financial support for households relying on private wells.


Assuntos
Água Potável , Purificação da Água , Carvão Vegetal , Humanos , North Carolina , Poluição da Água , Qualidade da Água , Abastecimento de Água , Poços de Água
15.
PLoS One ; 16(11): e0248542, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34723973

RESUMO

BACKGROUND: In the United States, underserved communities including Blacks and Latinx are disproportionately affected by COVID-19. This study sought to estimate the prevalence of COVID-19 vaccine hesitancy, describe attitudes related to vaccination, and identify correlates among historically marginalized populations across 9 counties in North Carolina. METHODS: We conducted a cross-sectional survey distributed at free COVID-19 testing events in underserved rural and urban communities from August 27 -December 15, 2020. Vaccine hesitancy was defined as the response of "no" or "don't know/not sure" to whether the participant would get the COVID-19 vaccine as soon as it became available. RESULTS: The sample comprised 948 participants including 27.7% Whites, 59.6% Blacks, 12.7% Latinx, and 63% female. 32% earned <$20K annually, 60% owned a computer and ~80% had internet access at home. The prevalence of vaccine hesitancy was 68.9% including 62.7%, 74%, and 59.5% among Whites, Blacks, and Latinx, respectively. Between September and December, the largest decline in vaccine hesitancy occurred among Whites (27.5 percentage points), followed by Latinx (17.6) and only 12.0 points among Blacks. 51.2% of respondents reported vaccine safety concerns, 23.7% wanted others to get vaccinated first, and 63.1% would trust health care providers about the COVID-19 vaccine. Factors associated with hesitancy in multivariable logistic regression included being female (OR = 1.90 95%CI [1.36, 2.64]), being Black (OR = 1.68 1.16, 2.45]), calendar month (OR = 0.76 [0.63, 0.92]), safety concerns (OR = 4.28 [3.06, 5.97]), and government distrust (OR = 3.57 [2.26, 5.63]). CONCLUSIONS: This study engaged the community to directly reach underserved minority populations at highest risk of COVID-19 that permitted assessment of vaccine hesitancy (which was much higher than national estimates), driven in part by distrust, and safety concerns.


Assuntos
Vacinas contra COVID-19/uso terapêutico , COVID-19/prevenção & controle , Adolescente , Adulto , COVID-19/imunologia , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , North Carolina , Adulto Jovem
16.
N C Med J ; 82(6): 373-374, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34750209

RESUMO

A periodic feature that recognizes individuals whose efforts-often unsung-enhance the health of North Carolinians.


Assuntos
Atenção à Saúde , Humanos , North Carolina
17.
N C Med J ; 82(6): 377-383, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34750210

RESUMO

BACKGROUND Unintended pregnancy rates remain higher than the national average in North Carolina. Although long-acting reversible contraception (LARC) use has reduced rates of unintended pregnancy, this contraceptive method is widely underused, often due to low community awareness. Boot Camp Translation is a community engagement process that promotes community awareness of evidence-based medical recommendations by designing culturally meaningful messages.METHODS We tested the feasibility of the Boot Camp Translation process to expand awareness about LARC in 2 rural Western North Carolina counties. After our intervention, we conducted surveys at 4 local clinics, asking patients if and where they saw LARC messages.RESULTS The recruited community members had a participation rate of 93% throughout the intervention. A local nurse practitioner, health department nursing supervisor, health educator, and pre-medical student collaborated with local community members to disseminate culturally meaningful messages about LARC through social media, a website, promotional items, posters, and sexual education talks at local schools. Among women surveyed, 48.9% saw LARC campaign messages and of those, 57% saw messages through social media posts. Post-intervention, 6 local schools implemented a comprehensive sexual education curriculum.LIMITATIONS Our pilot project was not designed to quantitatively assess the community reception to our intervention, our intervention's impact on community knowledge about LARC methods, or changes in contraception practices.CONCLUSIONS We have demonstrated the feasibility of implementing Boot Camp Translation as a tool to enhance public awareness of contraception. This community engagement method underscores the benefit of empowering community members in public health projects.


Assuntos
Contracepção Reversível de Longo Prazo , Mídias Sociais , Anticoncepção , Feminino , Humanos , North Carolina , Gravidez , Gravidez não Planejada
18.
N C Med J ; 82(6): 384-392, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34750211

RESUMO

BACKGROUND In August 2019, the North Carolina Division of Public Health (NCDPH) began investigating e-cigarette, or vaping, product use-associated lung injury (EVALI) cases as part of a national response. We describe clinical, epidemiologic, and laboratory findings of North Carolina EVALI patients.METHODS NCDPH requested that physicians report cases of respiratory illness or bilateral pulmonary infiltrates or opacities in patients who reported using e-cigarette, or vaping, products and had no infection or alternative plausible diagnoses. We reviewed medical records, interviewed patients, and tested vaping products for substances.RESULTS During August 13, 2019-February 18, 2020, 78 EVALI cases were reported in North Carolina. Median age of cases was 24 years (range: 13-72 years); 49 (63%) patients were male. Symptoms included cough (n = 70; 90%), shortness of breath (n = 66; 85%), and gastrointestinal symptoms (n = 63; 81%). Seventy-five patients (96%) were hospitalized, 32 (41%) required intensive care, and 12 (16%) required mechanical ventilation; none died. Among 20 patients interviewed, most reported using tetrahydrocannabinol (THC) (n = 16; 80%) or nicotine-containing products (n = 14; 70%). All obtained THC-containing products from informal sources, such as family, friends, or dealers, as THC is illegal in North Carolina. Among 82 products tested, 74 (90%) contained THC, cannabidiol, or cannabinol; 54 (66%) contained vitamin E acetate.LIMITATIONS In North Carolina, EVALI is not reportable by law, and THC is illegal. Thus, cases and exposures are likely underreported.CONCLUSIONS THC-containing products, particularly those containing vitamin E acetate, are associated with EVALI. Persons should not use these products, particularly from informal sources. Continued communication of health risks to persons who use e-cigarette, or vaping, products is essential.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Lesão Pulmonar , Vaping , Adolescente , Adulto , Idoso , Surtos de Doenças , Humanos , Lesão Pulmonar/epidemiologia , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Vaping/efeitos adversos , Adulto Jovem
20.
N C Med J ; 82(6): 398-405, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34750214

RESUMO

Among the eight tribes within North Carolina, American Indian communities experience disparate rates of poverty, low education, chronic disease, low access to health care, and low quality of life. Addressing inequities and knowledge gaps will require novel and culturally appropriate approaches designed in partnership with AI communities, and should be underscored by the cultural assets those communities possess.


Assuntos
Pesquisa Participativa Baseada na Comunidade , Índios Norte-Americanos , Humanos , North Carolina , Qualidade de Vida
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