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1.
N C Med J ; 81(1): 5-13, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908325

RESUMO

BACKGROUND In 2016, the North Carolina Division of Public Health (DPH) launched the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) program to provide 5 local health departments (LHDs) with financial resources and technical assistance to address 3 aims: improve birth outcomes, reduce infant mortality, and improve health for children from birth to 5 years.METHOD: State legislation established an academic-practice partnership between NCDPH and the University of North Carolina at Chapel Hill (UNC) to provide program evaluation and implementation coaching to LHDs. ICO4MCH used a collective impact framework, principles of implementation science, and a health equity approach to implement evidence-based strategies to address the program's aims.RESULTS: A shared measurement system was developed by an evaluation stakeholders group led by the NCDPH and UNC in which LHDs reported data on a quarterly basis and the evaluators returned reports to drive improvements. Structured assessments and technical assistance provided by implementation coaches helped grantees address barriers to implementation including cultivating and sustaining a diverse community action team, addressing staff turnover, and using data to drive improvements.LIMITATIONS: It was challenging for grantees to balance community needs and build partnerships in the first year while integrating data from multiple assessments into action plans to meet the performance measures. It was necessary to streamline assessments and reduce indicators to make data more actionable.CONCLUSION: An academic-practice partnership was integral to successful implementation of the ICO4MCH program and may serve as a model for moving evidence-based maternal child health programs to practice in LHDs.


Assuntos
Saúde da Criança , Promoção da Saúde/organização & administração , Relações Interinstitucionais , Saúde Materna , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , North Carolina , Gravidez , Avaliação de Programas e Projetos de Saúde
2.
N C Med J ; 81(1): 14-22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908326

RESUMO

BACKGROUND The Zika virus (ZIKV) epidemic that began in 2015 presented a risk for ZIKV infection among persons who traveled to ZIKV-affected countries. Latinas in North Carolina and their sexual partners may be exposed to ZIKV when traveling to these regions.METHODS We administered a cross-sectional survey, measuring ZIKV risk and knowledge, to a convenience sample of 262 reproductive-age Latinas attending a Federally Qualified Health Center in rural North Carolina. We described ZIKV risk and knowledge in the sample, and compared responses between those who were pregnant or recently pregnant, and those who were not pregnant. We further identified factors associated with 1) awareness of ZIKV and 2) high knowledge of ZIKV sequelae and prevention among those who were aware of ZIKV, using log-binomial regression.RESULTS Two-thirds of participants had ever heard of ZIKV, which was positively associated with educational attainment. Most participants aware of ZIKV had moderate/high knowledge of ZIKV transmission (92.5%) and symptoms (73.2%), but knowledge of preventing sexual and congenital transmission was limited. Travel was infrequent among pregnant or recently pregnant participants (5.4%) and their partners (7.1%). Despite low risk for ZIKV infection, participants were willing to practice ZIKV prevention.LIMITATIONS Our study is limited by a lack of generalizability to Latinas in other regions of the country, self-reporting bias, and lack of survey validation as an indicator of English language proficiency.CONCLUSIONS Providers should identify patients likely to become pregnant and travel to high-risk areas, inquire about partner travel history, and offer culturally appropriate ZIKV risk counseling.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hispano-Americanos/psicologia , Doença Relacionada a Viagens , Infecção por Zika virus/etnologia , Estudos Transversais , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , North Carolina , Gravidez , Fatores de Risco , Serviços de Saúde Rural
3.
N C Med J ; 81(1): 24-27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908328

RESUMO

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.


Assuntos
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
4.
N C Med J ; 81(1): 28-31, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908329

RESUMO

This commentary evaluates access and barriers to perinatal care in North Carolina utilizing key goals the state has identified in its strategic plans, such as expanding health care access for North Carolinians, increasing access to preconception care for women and men, improving access to prenatal care, and undoing racism.


Assuntos
Acesso aos Serviços de Saúde , Mortalidade Infantil/tendências , Assistência Perinatal , Qualidade da Assistência à Saúde , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , North Carolina/epidemiologia , Gravidez
5.
N C Med J ; 81(1): 32-35, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908330

RESUMO

Since its inception in the 1970s, the stratification of perinatal health care into complexity-based levels has resulted in improved outcomes. Recent trends toward de-regionalization based on financial incentives, however, threaten to undermine these gains and should be addressed.


Assuntos
Assistência Perinatal/organização & administração , Feminino , Humanos , Recém-Nascido , North Carolina , Gravidez
6.
N C Med J ; 81(1): 36-40, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908332

RESUMO

North Carolina has been at the forefront of offering treatment for perinatal substance use disorders for over 25 years. Wraparound services, understanding of the fourth trimester, the importance of medication-assisted treatment, and learning from past false predictions regarding illicit prenatal exposure contribute to a nurturing, supportive approach for the mother, child, and families.


Assuntos
Assistência Perinatal , Transtornos Relacionados ao Uso de Substâncias/terapia , Feminino , Humanos , North Carolina , Gravidez
7.
N C Med J ; 81(1): 41-44, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908333

RESUMO

Navigating perinatal specialty care requires access for both patients and their clinicians. Convenience and availability of regional resources, especially in predominantly rural areas, impact the ability to provide care in the ideal setting for each patient's individualized medical needs.


Assuntos
Acesso aos Serviços de Saúde , Assistência Perinatal/organização & administração , Feminino , Humanos , Recém-Nascido , North Carolina , Gravidez
8.
N C Med J ; 81(1): 51-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908336

RESUMO

Medicaid is an essential source of health coverage that finances more than half of all births in North Carolina. This paper examines current eligibility for pregnant women and its impacts on health outcomes for mothers and children. The authors provide suggestions to increase access to this vital health insurance program and better promote the health of North Carolina's families.


Assuntos
Cobertura do Seguro/estatística & dados numéricos , Medicaid , Criança , Saúde da Criança , Definição da Elegibilidade , Feminino , Humanos , Saúde Materna , North Carolina , Gravidez , Estados Unidos
9.
N C Med J ; 81(1): 55-62, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908337

RESUMO

Maternal mortality in North Carolina remains a challenge to families, health systems, and communities. The Maternal Mortality Review Committee is part of the process required to prevent these events. In this commentary, we present an abbreviated description of the 2014-2015 Maternal Mortality Review Committee report, set for publication in December, 2019.


Assuntos
Morte Materna/prevenção & controle , Comitês Consultivos , Feminino , Humanos , Mortalidade Materna , North Carolina/epidemiologia , Gravidez
10.
JAMA Netw Open ; 3(1): e1919954, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31995214

RESUMO

Importance: The number of patients presenting to emergency departments (EDs) for psychiatric care continues to increase. Psychiatrists often make a conservative recommendation to admit patients because robust outpatient services for close follow-up are lacking. Objective: To assess whether the availability of a 45-day behavioral health-virtual patient navigation program decreases hospitalization among patients presenting to the ED with a behavioral health crisis or need. Design, Setting, and Participants: This randomized clinical trial enrolled 637 patients who presented to 6 EDs spanning urban and suburban locations within a large integrated health care system in North Carolina from June 12, 2017, through February 14, 2018; patients were followed up for up to 45 days. Eligible patients were aged 18 years or older, with a behavioral health crisis and a completed telepsychiatric ED consultation. The availability of the behavioral health-virtual patient navigation intervention was randomly allocated to specific days (Monday through Friday from 7 am to 7 pm) so that, in a 2-week block, there were 5 intervention days and 5 usual care days; 323 patients presented on days when the program was offered, and 314 presented on usual care days. Data analysis was performed from March 7 through June 13, 2018, using an intention-to-treat approach. Interventions: The behavioral health-virtual patient navigation program included video contact with a patient while in the ED and telephonic outreach 24 to 72 hours after discharge and then at least weekly for up to 45 days. Main Outcomes and Measures: The primary outcome was the conversion of an ED encounter to hospital admission. Secondary outcomes included 45-day follow-up encounters with a self-harm diagnosis and postdischarge acute care use. Results: Among 637 participants, 358 (56.2%) were men, and the mean (SD) age was 39.7 (16.6) years. The conversion rates were 55.1% (178 of 323) in the intervention group vs 63.1% (198 of 314) in the usual care group (odds ratio, 0.74; 95% CI, 0.54-1.02; P = .06). The percentage of patient encounters with follow-up encounters having a self-harm diagnosis was significantly lower in the intervention group compared with the usual care group (36.8% [119 of 323] vs 45.5% [143 of 314]; P = .03). Conclusions and Relevance: Although the primary result did not reach statistical significance, there is a strong signal of potential positive benefit in an area that lacks evidence, suggesting that there should be additional investment and inquiry into virtual behavioral health programs. Trial Registration: ClinicalTrials.gov identifier: NCT03204643.


Assuntos
Terapia Comportamental/métodos , Serviço Hospitalar de Emergência , Transtornos Mentais/terapia , Admissão do Paciente/estatística & dados numéricos , Telemedicina/organização & administração , Adulto , Medicina do Comportamento/métodos , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , North Carolina , Autogestão/educação , Resultado do Tratamento , Adulto Jovem
11.
Water Res ; 169: 115248, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31706125

RESUMO

The effect of watershed characteristics (land use land cover and morphology) on spatial variability in dissolved organic matter (DOM) composition, and concentrations of dissolved organic carbon [DOC] and nitrogen [DON] was assessed in a coastal river basin draining into Pamlico Sound in eastern North Carolina, USA. Understanding the factors that influence DOM concentration and composition i.e., structurally complex molecules with high molecular weight versus low molecular weight, simple molecules can provide insights on DOM cycling and water composition implications. Such information is imperative for large coastal river networks undergoing rapid and intense land use and land cover (LULC) changes. DOM composition was estimated using optical indices calculated from DOM absorbance and fluorescence measurements. DOM was derived from terrestrial sources, and ordination analysis indicated that LULC, in particular, % wetland area was the most significant control on DOM composition and concentration. Wetland and agricultural coastal streams were abundant in humic and complex DOM, whereas forested and urban streams were least abundant in humic DOM. We speculate that greater availability of mobilizable DOM in wetland and agricultural watersheds contributed to this observation. In comparison, mixed urbanized and forested streams in North Carolina's Piedmont region were abundant in [DOC], less complex, low molecular weight DOM, as well as greater amounts [DON] due to higher urban runoff and elevated DOM production in these streams. Our results indicated that physiographic transition from Piedmont to coastal plain and varying LULC influenced the spatial variability in DOM composition and concentration. Our findings highlight that increasing anthropogenic alterations might increase the abundance of reactive DOM in coastal rivers and estuaries resulting in severe water quality issues. This information is important for monitoring and developing land use policies.


Assuntos
Rios , Qualidade da Água , Agricultura , Estuários , North Carolina
12.
Sci Total Environ ; 694: 133744, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31756798

RESUMO

Out-of-hospital sudden unexpected deaths are non-accidental deaths that occur without obvious underlying causes and may account for 10% of natural deaths before age 65. Short-term exposure to ambient air pollution is associated with all-cause (non-accidental) and cause-specific (e.g., cardiovascular) mortality, and with immediate exposures often yielding the highest magnitude risk estimates. Few studies have focused on short-term exposure to air pollution and sudden unexpected deaths. Using the University of North Carolina Sudden Unexpected Death in North Carolina population, we examine associations between short-term criteria air pollutant exposures with sudden unexpected deaths using a time-stratified case-crossover design, with data on criteria air pollutants from the Environmental Protection Agency's Air Quality System. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression with air pollutant exposures scaled to roughly inter-quartile ranges; models were adjusted for average temperature and relative humidity on event day and preceding 3 days. Potential for confounding by co-pollutants were examined in two pollutant models. ORs for PM2.5 at lag day 1 were elevated (adjusted OR for 5 µg/m3 increase: 1.17 (0.98, 1.40)), and were robust to co-pollutant adjustment. Elevated odds were observed for SO2 at lag day 0, and reduced odds for O3 at lag day 0; however, these associations were somewhat attenuated toward the null (SO2) or were not robust (O3) to co-pollutant adjustment. This analysis in a racially and socioeconomically diverse cohort, with a more inclusive definition of sudden unexpected death than is typically employed offers evidence that PM2.5 may be a clinically relevant trigger of sudden unexpected deaths in susceptible individuals.


Assuntos
Poluição do Ar/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Mortalidade/tendências , Humanos , North Carolina
13.
N C Med J ; 80(6): 325-331, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31685563

RESUMO

BACKGROUND Children may be placed in either kinship or foster care, forms of out-of-home placement (OHP), if maltreatment is suspected. The American Academy of Pediatrics has identified them as children with special health needs requiring elevated care. While North Carolina has increased support for foster care, it is unclear whether similar support exists for kinship care. Child abuse medical providers (CAMPs) were interviewed regarding their understanding and assessment of the state of the kinship care system in North Carolina, and how it can be improved.METHODS CAMPs were individually interviewed using a semi-structured, open-ended question guide to assess their perspectives on kinship versus foster care in North Carolina. Data were coded, and the analysis was conducted in an inductive manner, allowing themes and then recommendations to emerge from interviews.RESULTS The following three themes were identified: 1) providers have a foundational understanding of the kinship care system, marked by knowledge gaps; 2) children in kinship care and foster care have equivalent, elevated health needs, but children in kinship care do not receive the same level of care; 3) individual and structural changes have to be made to the interprofessional teams working within the OHP system.LIMITATIONS The study sample was small, including eight CAMPs who had relatively homogenous demographic characteristics. CAMPs typically see the worst cases of maltreatment, which may bias responses. Additionally, the majority of children in kinship care are unknown to CAMPs and may not be fully represented in responses.CONCLUSION CAMPs' responses were summarized into a set of recommendations targeting four different components of the OHP team: the general interprofessional team, policymakers and state leaders, medical providers, and social workers.


Assuntos
Maus-Tratos Infantis/terapia , Cuidados no Lar de Adoção/métodos , Pessoal de Saúde/psicologia , Criança , Humanos , North Carolina , Pesquisa Qualitativa
14.
N C Med J ; 80(6): 332-337, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31685564

RESUMO

BACKGROUND In the United States each year nearly 570,000 people return from state prisons to the community. Prevalence data of chronic health problems for this population are lacking, impeding planning of health care programs to serve people with chronic conditions who are re-entering the community.METHOD We used medication dispensing records as a proxy for diagnoses in assessing the prevalence of 10 major and 20 substituent health conditions among incarcerated people released from the North Carolina state prison system from July 2015 through June 2016.RESULTS Among 20,585 released people, 13% were female; 50% were black; 43% were white; and 4% were aged 55 years or older. Thirty-three percent had ≥ 1 condition and 13% had two or more. The prevalence of chronic health conditions was the following: psychiatric, 15%; cardiovascular, 15%; neurologic, 7%; pulmonary, 6%; diabetes mellitus, 3%; and infectious, 3%. Seventy-one percent of those aged 55 years or older had a chronic medical condition. Among those with a psychiatric condition, 56% had another chronic illness.LIMITATIONS We could not identify unmedicated health conditions; medications prescribed across multiple disease categories were excluded from our analysis.CONCLUSION In North Carolina, at least one in three people released from the state prison system had a chronic health condition, and among those with psychiatric conditions, most had comorbid medical disease. Coordination of health care after release from incarceration is essential to avoid preventable complications and unnecessary utilization of acute care services. Greater eligibility for Medicaid is needed to scale up transition programs for this population.


Assuntos
Doença Crônica/epidemiologia , Prisioneiros/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Prevalência
15.
N C Med J ; 80(6): 339-343, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31685566

RESUMO

AJ was a 34-year-old African American male who was incarcerated for eight years for drug-related convictions. He suffered from diabetes, hypertension, chronic kidney failure, depression, and substance use disorder. Upon release from prison he was not connected with health services and he was uninsured, which was an additional barrier to accessing medical care. His own perceived need for care was limited as he had significant cognitive deficits with extremely low health literacy. Two years following his release from prison, an aunt concerned about his health brought him to clinic. His clinical course was fraught with complications that would likely have been preventable if he had been connected to care upon release. With treatment, his depression eventually improved and his substance use disorder was under better control. However, he endured multiple amputations from diabetic foot infections, partial vision loss, severe pain from diabetic neuropathy, temporary dialysis for end stage kidney disease, and two months of a feeding tube for severe gastroparesis. AJ's story is not unique, and it highlights the terrible personal costs of inadequately addressing the health needs of people during periods of incarceration and following their release.


Assuntos
Continuidade da Assistência ao Paciente , Necessidades e Demandas de Serviços de Saúde , Prisioneiros , Adulto , Humanos , Masculino , North Carolina
16.
N C Med J ; 80(6): 344-347, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31685567

RESUMO

North Carolina has approximately 36,500 prisoners. As the population becomes more complex, the Department of Public Safety still has the responsibility to provide medical care to all those in its custody. Despite staffing shortages, limited financial resources, and logistical challenges the state must continue to provide access to care.


Assuntos
Assistência à Saúde/organização & administração , Acesso aos Serviços de Saúde , Prisioneiros , Prisões/organização & administração , Humanos , North Carolina
18.
N C Med J ; 80(6): 348-351, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31685569

RESUMO

Many incarcerated patients will require in-hospital care outside prison facilities. Often, this care is provided by clinicians unfamiliar with the correctional context. In this article, we reflect on our experiences caring for incarcerated inpatients in non-carceral settings in North Carolina and highlight sources of misunderstanding and potential conflicts that arise in the care of these patients.


Assuntos
Assistência à Saúde/organização & administração , Hospitalização , Prisioneiros , Prisões/organização & administração , Comunicação , Humanos , Relações Interprofissionais , North Carolina
19.
N C Med J ; 80(6): 356-362, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31685571

RESUMO

There has been a dramatic increase in the number of individuals incarcerated in the United States during the past several decades. Providing behavioral health care services to incarcerated people within North Carolina's prison system presents several challenges, and progress is being made to deliver care that is consistent with accepted community standards.


Assuntos
Serviços de Saúde Mental/organização & administração , Prisões/organização & administração , Humanos , Transtornos Mentais/terapia , North Carolina , Prisioneiros/psicologia
20.
N C Med J ; 80(6): 352-355, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31685570

RESUMO

Prisoners in the United States are disproportionately affected by hepatitis C. Addressing the disease behind bars is crucial for curtailing the epidemic in the greater population. Effective strategies for testing and treatment are elucidated here. Recommendations for changes in hepatitis C health care policy in North Carolina prisons are also described.


Assuntos
Política de Saúde , Hepatite C/terapia , Prisioneiros , Humanos , North Carolina , Estados Unidos
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