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King, Jennifer, and Mark Holmes. "Shaping Health Workforce Policy Through Data-Driven Analyses: The North Carolina Health Professions Data System." North Carolina Medical Journal 69, no. 2 (March 2008): 139–41. http://dx.doi.org/10.18043/ncm.69.2.139.
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Lee, Min Jee, Ramzi Salloum, and Arun Sharma. "Marijuana use among US adults with cancer: Findings from the 2018-2019 Behavioral Risk Factor Surveillance System." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 12088. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.12088.
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12088 Background: Cancer survivors experiencing adverse effects from their cancer and treatment report decreased symptom burden with marijuana use. An increasing number of U.S. states have legalized marijuana use for both medical and recreational purposes. This study aimed to assess the prevalence of current marijuana use and to identify the factors associated with its use among US adults with cancer living in 17 U.S. states and territories. Methods: Data from the 2018-2019 Behavioral Risk Factor Surveillance System Marijuana Use module were analyzed. In 2018, 13 states (California, Florida, Idaho, Maryland, Minnesota, Montana, New Hampshire, North Dakota, Ohio, South Carolina, Tennessee, West Virginia, and Wyoming) and 2 territories (Guam and Puerto Rico) participated in the optional marijuana use module. In 2019, 12 states (California, Idaho, Illinois, Maryland, Minnesota, New Hampshire, North Dakota, South Carolina, Tennessee, Utah, West Virginia, and Wyoming) and 1 territory (Guam) participated in the optional marijuana use module. The analytic sample included 13,174 adults with cancer. The analysis was weighted to account for BRFSS’s complex survey design. The primary outcome was current marijuana use (in the past 30-days). Multivariable logistic regression was used to identify demographic, socioeconomic, clinical, and behavioral factors associated with marijuana use among US adults with cancer. Results: Overall, 9.2% of adult cancer survivors (n = 13,174; weighted 5.7 million; 37.9% men) reported marijuana recently current use, 51.3% of whom used it for medical reasons only, with 65.2% reporting smoking as the main method of administration. Adult cancer survivors were significantly more like to use marijuana if they were younger (odds ratio [OR] for 55-64 versus 18-44 years old: 0.60; 95% CI: 0.38-0.93; P < 0.01); male (OR for female versus male: 0.65; 95% CI: 0.48-0.87; P < 0.01); non-Hispanic Black race/ethnicity (OR: 2.00; 95% CI: 1.21-3.33; P < 0.01); having depression (OR: 1.58; 95% CI: 1.17-2.14; P < 0.01) and current (OR: 3.23; 95% CI: 2.20-4.74; P < 0.01) or former tobacco smoker (OR: 2.40; 95% CI: 1.70-3.38; P < 0.01) and binge drinker (OR: 2.25; 95% CI: 1.53-3.29; P < 0.01). Conclusions: Among a large cohort of US adults with cancer, marijuana use was commonly reported and certain subgroups were at higher risk for marijuana use. Health professionals should identify the risk factors for elevated marijuana use, especially as more states legalize medical and recreational marijuana use despite uncertain health risks.
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Spees, Lisa, Michaela Ann Dinan, Bradford E. Jackson, Christopher Baggett, Lauren E. Wilson, Melissa A. Greiner, Deborah Kaye, et al. "Patient- and provider-level predictors of mortality among patients with metastatic renal cell carcinoma receiving oral anticancer agents." Journal of Clinical Oncology 39, no. 28_suppl (October 1, 2021): 116. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.116.
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116 Background: It is important to understand how emerging new therapies, such as oral anti-cancer agents (OAAs), diffuse across and can improve outcomes within real-world populations, which include age groups and racial groups not well-represented in clinical trials, such as people older than age 65 and Black patients. Our objectives were to examine whether disparities in mortality persist among patients with metastatic renal cell carcinoma (mRCC) receiving OAAs and whether these disparities may be partially explained by patient’s clinical characteristics or provider-level factors. Methods: We used linked state cancer registry data and multi-payer claims data to identify patients with mRCC who were diagnosed in 2004 through 2015 and had initiated an OAA and survived ≥ 90 days after initiating. Provider data were obtained from North Carolina Health Professions Data System and the National Plan & Provider Enumeration System. A patient’s modal provider was the provider most frequently on claims with a diagnosis code of RCC or metastatic cancer between 2 months prior to and 3 months following the index date. We estimated hazard ratios (HR) and corresponding 95% confidence limits (CL) using Cox proportional hazard models to evaluate which patient demographics, patient clinical characteristics, and provider-level factors were associated with 2-year all-cause mortality. Results: The cohort included 207 patients with mRCC. In unadjusted analyses, public insurance (Medicaid or Medicare), de novo metastatic diagnosis, frailty, polypharmacy, and a visit to a skilled nursing facility were associated with increased all-cause mortality. In multivariable models, clinical variables such as frailty (HR: 1.36, 95% CL: 1.11-1.67) and de novo metastatic diagnosis (HR: 2.63, 95%CL: 1.67-4.16) were associated with higher all-cause mortality. Additionally, Medicare-insured patients continued to have higher all-cause mortality compared to privately insured patients (HR: 2.35, 95% CL: 1.32-4.18). None of the provider-level covariates (i.e., specialization, experience, volume, or practice location) investigated were associated with all-cause mortality. Conclusions: Even when adjusting for age, frailty, and comorbidities, Medicare-insured patient had lower overall survival than privately-insured patients. Patient survival did not differ based on modal provider’s characteristics.
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Brown, L. L., T. Ng, H. Anksorus, A. Savage, and V. Mak. "International Collaboration as an interdisciplinary approach for the development of a Cultural Competency online module." International Journal of Pharmacy Practice 29, Supplement_1 (March 26, 2021): i13. http://dx.doi.org/10.1093/ijpp/riab016.016.
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Abstract Introduction Culture is a concept most people instinctively understand, but may struggle to fully articulate. Culture is not limited to ethnicity and religion, but encompasses age, gender, sexual orientation, occupation, socioeconomic status, ethnic origin or migrant experience, religious or spiritual belief, and dis/ability. Given the breadth and complexity of culture, healthcare professionals in particular are challenged to interact with an increasingly multicultural world and various cultural groups. There is a growing need for appropriate training models to enhance cultural awareness, and cultural competence, including in pharmacy schools. “Interdisciplinary” can be defined as “relating to more than one branch of knowledge” [1], and international collaboration allows the connection of knowledge of different cultures. Developing a teaching intervention internationally, across three continents allows wider exposure to different cultures and can help students appreciate what culture may mean in different countries and how different ways of living are accepted and/or perceived in different societies. Aim To design and disseminate an online cultural communication module for use by pharmacy students across three countries and continents Methods A team from the Schools of Pharmacy at University College London (UCL), UK; Monash University, Australia and University of North Carolina (UNC), USA worked collaboratively to build an online module to help pharmacy students understand the importance of cultural awareness when communicating with patients. The Schools identified a range of cultural groups and scenarios in which pharmacist led communications could occur. Each School designed and filmed three scenarios, with two versions: one relatively good demonstration of communication and one poor. A range of actors, patients and pharmacists from different cultural groups (e.g. ethnic background, disability, LGBTQi, gender etc.) were involved in the design and filming. The module required students to reflect on the roleplays and provided feedback in the form of summary key points for each topic area. This module was embedded into the existing curricula for all Year 1 (Monash and UCL) and Year 2 (UNC) students in 2019. Students were informed as part of their regular course communication. A Likert style evaluation survey, including free text responses about the module was included, Questions were adapted from previous teaching evaluations. This data was recorded via each School’s Learning Management System. Descriptive statistics and a basic thematic analysis were conducted. Results Across the three Schools, a total of 525 students were offered the online module and 208 completed it. At UNC, 72.2% of students who completed would recommend the module to others, at UCL 83% and Monash 88%. Students’ feedback fell under three themes as seen in Table 1. Conclusion The innovation and strength of this learning intervention comes from the international collaboration. The online module allows students to identify and be culturally aware of a diverse group of people across three continents, allowing a unique and rich experience for all students through this collaboration and developing them not only as culturally competent healthcare professionals but also global citizens. References 1. Oxford Dictionaries, Oxford University Press, Definition of Interdisciplinary in English, Oxford, 2020. [Accessed 11th October 2020]. Available from: https://premium-oxforddictionaries-com.libproxy.ucl.ac.uk/definition/english/interdisciplinary
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Lane, Leigh Blackmon, Scott Hoffeld, and David Griffin. "Environmental Justice Evaluation: Wilmington Bypass, Wilmington, North Carolina." Transportation Research Record: Journal of the Transportation Research Board 1626, no. 1 (January 1998): 131–39. http://dx.doi.org/10.3141/1626-16.
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Among the common mandates of agency guidelines implementing Executive Order 12898, Federal Actions to Address Environmental Justice in Minority Populations and Low-Income Populations, is the determination of whether the subject action or project will cause disproportionately high and adverse human health or environmental effects on minority or low-income populations. This determination is often troublesome because it requires the analyst to know or define disproportionate impacts. A method is provided for defining disproportionate within the context of an environmental justice evaluation that was conducted for the Wilmington Bypass environmental impact statement. In response to strong local opposition to one of the alignment alternatives of the Wilmington Bypass and to address the perception that this community’s residents were not involved in the planning process, the Wilmington Bypass public involvement program was augmented to include a citizens’ informational workshop, project development meetings, and community liaison meetings. A brief history is provided of the Wilmington Bypass project, highlighting the public involvement surrounding the environmental justice evaluation. Discussions of the scoping process and delineation of the study area are followed by discussions of the reference population development for the minority and low-income populations. Particular emphasis is given to the use of available census demographic and socioeconomic data and graphical display of these data with the use of a geographic information system. Impact evaluations and mitigative responses for issues determined relevant for the environmental justice analysis conclude the discussion. Conclusions and recommendations for further study are provided.
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Austin, Anna, Harry Herrick, and Scott Proescholdbell. "0018 Adverse childhood experiences, sexual orientation, and adult health: an analysis of north carolina, washington, and wisconsin behavioural risk factor surveillance system data." Injury Prevention 21, Suppl 1 (April 2015): A6.3—A7. http://dx.doi.org/10.1136/injuryprev-2015-041602.16.
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Cassell, Cynthia H., Robert E. Meyer, and Anita M. Farel. "Predictors of Referral to the North Carolina Child Service Coordination Program among Infants with Orofacial Clefts." Cleft Palate-Craniofacial Journal 44, no. 1 (January 2007): 45–51. http://dx.doi.org/10.1597/05-198.
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Objective: North Carolina has several programs that identify high-risk women and children for needed services, including the Child Service Coordination Program (CSCP). This study determines CSCP referral rates among infants with orofacial clefts (OFCs) and predictors of CSCP referral. We hypothesized receiving Medicaid and maternity care coordination (MCC) services increases the likelihood of CSCP referral. Design and Setting: For births between 1999 and 2002, data were matched from North Carolina Vital Statistics, Health Services Information System (MCC and CSCP data), and North Carolina Birth Defects Monitoring Program. Multivariate analysis was used to determine crude and adjusted odds ratios for sociodemographic variables to predict CSCP referral. Participants: A total of 644 mothers of live-born infants with OFCs in North Carolina were identified. Results: About 45% of infants with OFCs were referred to the CSCP. Infants of mothers who were at least 30 years of age and mothers who had more than a high school education were significantly less likely to be referred to the CSCP. Compared with infants with OFCs whose mothers did not receive Medicaid, mothers who received Medicaid were 1.9 times more likely to be referred to the CSCP, and mothers who received Medicaid and MCC services were 2.3 times more likely. Conclusions: Receipt of Medicaid and MCC services and receipt of Medicaid alone were positively associated with CSCP referral. Future studies should examine the effects of the duration of MCC services and factors related to the timeliness of CSCP referral.
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Borst, Alexandra, Ibrahim Saber, Elizabeth Thames, Nimia Reyes, Michele Beckman, and Thomas L. Ortel. "Incidence of Pediatric VTE in Durham County, North Carolina." Blood 126, no. 23 (December 3, 2015): 5562. http://dx.doi.org/10.1182/blood.v126.23.5562.5562.
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Abstract Introduction There is no national surveillance system for venous thromboembolism (VTE) despite the associated morbidity, mortality and economic burden on the health care system. Estimates of the incidence of VTE in the U.S. range from 1-2 cases per 1,000 people, or approximately 300,000-600,000 cases per year. The estimated incidence in children is lower, ranging from 1-10 per 100,000, with the period of greatest risk for VTE < 1 year and in the teenage years. It has been observed that most children with VTE have a serious underlying medical condition. The contribution of inherited thrombophilia to VTE in children remains not well established. Methods All patients with VTE in Durham County, North Carolina (NC), were identified as part of a VTE Surveillance Project supported by the Centers for Disease Control and Prevention from April 2012 through March 2014. Surveillance included an information technology-based electronic medical record review of diagnosis and specific treatment codes combined with manual review of radiographic imaging and autopsy reports. De-identified data were collected from the three hospitals in the county (Duke, Duke Regional, and the Durham VAMC) and entered into a REDCap database for analysis. Results The estimated population of Durham County during the study period was ~268,000, and ~69,000 of these individuals were < 20 years of age (25.7%). There were a total of 726 new cases of VTE in the county during the study period, for an estimated overall annual incidence of 0.135% (1.35 cases per 1000 per year). Of the total cohort, 19 individuals were less than 25 years of age (Figure 1), but only 8 patients were younger than 20 years, for an estimated annual incidence of VTE in the pediatric subset of 0.006% (6 cases per 100,000 per year). All pediatric VTE cases were identified at Duke University Medical Center. Table 1 lists characteristics of the pediatric population identified. The majority of patients were in their teenage years (75%) and there were no infants. One patient had a prior history of VTE and was taking warfarin at the time of diagnosis. None of the patients received primary pharmacologic thromboprophylaxis. One patient with intracranial hemorrhage did not receive any anticoagulant therapy after diagnosis of a deep vein thrombosis (DVT). One patient was treated with argatroban because of a history of heparin-induced thrombocytopenia, and the remainder were treated with enoxaparin or heparin. None were treated with fibrinolytic therapy or implantation of an IVC filter. Three patients underwent a thrombophilia evaluation, and one was heterozygous for the prothrombin gene mutation. Table 1. Pediatric Patient Characteristics Age (yrs) Sex Race/Ethnicity VTE Event Diagnostic Imaging Prothrombotic Risk Factors Hemorrhagic Risk Factors 4 M White DVT MRI Hemoglobinopathy, CVC 5 M Hispanic DVT US CVC ICH, DIC 17 F White DVT; PE MRI;VQ Scan OCP, Prothrombin gene mutation 18 F White DVT US Immobility ICH 18 M African American DVT US CVC; relative immobility, trauma 19 M African American PE CT CrohnÕs disease, smoking 19 M African American DVT US Prior VTE; ?Protein S deficiency, obesity 19 F African American PE CT Contraceptive patch PE = pulmonary embolus, US = ultrasound, CT = computed tomography scan, VQ = ventilation/perfusion scan, MRI = magnetic resonance imaging, CVC = central venous catheter, OCP = oral contraceptive pill, ICH = intracranial hemorrhage, DIC = disseminated intravascular coagulation Discussion Although 25.7% of individuals living within Durham County, NC are < 20 years of age, this age group represents only ~1.1% of the total number of individuals identified with VTE. The incidence of pediatric VTE was approximately 6 per 100,000 per year, consistent with prior reports. VTE was more common in African Americans in the pediatric patients, which we have observed in all age groups in this surveillance study. Most patients were teenagers, and one or more acquired prothrombotic risk factors were present in all. We did not identify any infants (age < 1 year) in this study, likely reflecting the small sample size and geographic restriction of the study. The type of VTE events observed and initial treatment strategies were similar to adult patients studied. A more accurate assessment of pediatric VTE within a tertiary care academic medical center will need to capture patients from a broader geographic distribution to represent the referral patterns for these complex patients. Disclosures Ortel: Instrumentation Laboratory: Consultancy; Instrumentation Laboratory: Research Funding; Eisai: Research Funding; Daiichi Sankyo: Consultancy.
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Arcury, Thomas A., Grisel Trejo, DaKysha Moore, Timothy D. Howard, Sara A. Quandt, Edward H. Ip, and Joanne C. Sandberg. "“It’s Worse to Breathe It Than to Smoke It”: Secondhand Smoke Beliefs in a Group of Mexican and Central American Immigrants in the United States." International Journal of Environmental Research and Public Health 17, no. 22 (November 20, 2020): 8630. http://dx.doi.org/10.3390/ijerph17228630.
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This analysis describes beliefs about secondhand smoke and its health effects held by Mexican and Central American immigrants in North Carolina. Data from 60 semistructured, in-depth interviews were subjected to saliency analysis. Participant discussions of secondhand smoke centered on four domains: (1) familiarity and definition of secondhand smoke, (2) potency of secondhand smoke, (3) general health effects of secondhand smoke, and (4) child health effects of secondhand smoke. Secondhand smoke was generally believed to be more harmful than primary smoke. Mechanisms for the potency and health effects of secondhand smoke involved the smell of secondhand smoke, secondhand smoke being an infection and affecting the immune system, and personal strength being protective of secondhand smoke. Understanding these health beliefs informs a framework for further health education and intervention to reduce smoking and secondhand smoke exposure in this vulnerable population.
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Smokowski, Paul R., Roderick A. Rose, Caroline B. R. Evans, Katie L. Cotter, Meredith Bower, and Martica Bacallao. "Familial influences on internalizing symptomatology in Latino adolescents: An ecological analysis of parent mental health and acculturation dynamics." Development and Psychopathology 26, no. 4pt2 (November 2014): 1191–207. http://dx.doi.org/10.1017/s0954579414000960.
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AbstractThe aim of this study was to examine if family system dynamics (e.g., parent mental health, marriage quality, conflict, and cohesion) that have often been overlooked when studying Latino families play a more important role in predicting adolescent internalizing symptoms than acculturation processes. Data comes from the Latino Acculturation and Health Project, a longitudinal investigation of acculturation in Latino families in North Carolina and Arizona (Smokowski & Bacallao, 2006, 2010). Researchers conducted in-depth, community-based interviews with 258 Latino adolescents and 258 of their parents in metropolitan, small-town, and rural areas. Interviews were conducted at four time points at intervals of approximately 6 months. Parent and adolescent ratings of the adolescent's internalizing symptoms were used as the dependent variable in a longitudinal hierarchical linear model with a rater effects structure. Results showed that parent–adolescent conflict and parent mental health (fear/avoidance of social situations and humiliation sensitivity) were significant predictors of adolescent internalizing symptoms. Acculturation scales were not significant predictors; however, internalizing symptoms decreased with time spent in the United States. Females and adolescents from lower socioeconomic status families reported more internalizing symptoms, while participants who had been in the United States longer reported fewer internalizing symptoms. Implications were discussed.
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Mayfield, Carlene A., Margaret E. Gigler, Leslie Snapper, Jainmary Jose, Jackie Tynan, Victoria C. Scott, and Michael Dulin. "Using cloud-based, open-source technology to evaluate, improve, and rapidly disseminate community-based intervention data." Journal of the American Medical Informatics Association 27, no. 11 (September 17, 2020): 1741–46. http://dx.doi.org/10.1093/jamia/ocaa181.
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Abstract Building Uplifted Families (BUF) is a cross-sector community initiative to improve health and economic disparities in Charlotte, North Carolina. A formative evaluation strategy was used to support iterative process improvement and collaborative engagement of cross-sector partners. To address challenges with electronic data collection through REDCap Cloud, we developed the BUF Rapid Dissemination (BUF-RD) model, a multistage data governance system supplemented by open-source technologies, such as: Stage 1) data collection; Stage 2) data integration and analysis; and Stage 3) dissemination. In Stage 3, results were disseminated through an interactive dashboard developed in RStudio using RShiny and Shiny Server solutions. The BUF-RD model was successfully deployed in a 6-month beta test to reduce the time lapse between data collection and dissemination from 3 months to 2 weeks. Having up-to-date preliminary results led to improved BUF implementation, enhanced stakeholder engagement, and greater responsiveness and alignment of program resources to specific participant needs.
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Khoury, Audrey L., Eric G. Jernigan, Muntasir H. Chowdhury, Laura R. Loehr, and Jennifer S. Nelson. "Feasibility of a healthcare system-based tetralogy of Fallot patient registry." Cardiology in the Young 28, no. 2 (August 29, 2017): 269–75. http://dx.doi.org/10.1017/s1047951117001810.
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AbstractBackgroundPatient-reported outcomes and epidemiological studies in adults with tetralogy of Fallot are lacking. Recruitment and longitudinal follow-up investigation across institutions is particularly challenging. Objectives of this study were to assess the feasibility of recruiting adult patients with tetralogy of Fallot for a patient-reported outcomes study, describe challenges for recruitment, and create an interactive, online tetralogy of Fallot registry.MethodsAdult patients living with tetralogy of Fallot, aged 18–58 years, at the University of North Carolina were identified using diagnosis code query. A survey was designed to collect demographics, symptoms, history, and birth mother information. Recruitment was attempted by phone (Part I, n=20) or by email (Part II, n=20). Data analysis included thematic grouping of recruitment challenges and descriptive statistics. Feasibility threshold was 75% for recruitment and for data fields completed per patient.ResultsIn Part I, 60% (12/20) were successfully contacted and eight (40%) were enrolled. Demographics and birth mother information were obtained for all enrolled patients. In Part II, 70% (14/20) were successfully contacted; 30% (6/20) enrolled and completed all data fields linked to REDCap database; the median time for survey completion was 8 minutes. Half of the patients had cardiac operations/procedures performed at more than one hospital. Automatic electronic data entry from the online survey was uncomplicated.ConclusionsAlthough recruitment (54%) fell below our feasibility threshold, enrolled individuals were willing to complete phone or online surveys. Incorrect contact information, privacy concerns, and patient-reported time constraints were challenges for recruitment. Creating an online survey and linked database is technically feasible and efficient for patient-reported outcomes research.
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Tanabe, Paula, Audrey L. Blewer, Emily Bonnabeau, Hayden B. Bosworth, Denise H. Clayton, Nancy Crego, Marian F. Earls, et al. "Dissemination of Evidence-Based Recommendations for Sickle Cell Disease to Primary Care and Emergency Department Providers in North Carolina: A Cost Benefit Analysis." Journal of Health Economics and Outcomes Research 8, no. 1 (April 1, 2021): 18–28. http://dx.doi.org/10.36469/jheor.2021.21535.
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Background: Sickle cell disease (SCD) is a genetic condition affecting primarily individuals of African descent, who happen to be disproportionately impacted by poverty and who lack access to health care. Individuals with SCD are at high likelihood of high acute care utilization and chronic pain episodes. The multiple complications seen in SCD contribute to significant morbidity and premature mortality, as well as substantial costs to the healthcare system. Objectives: SCD is a complex chronic disease resulting in the need for primary, specialty and emergency care. Many providers do not feel prepared to care for individuals with SCD, despite the existence of evidence-based guidelines. We report the development of a SCD toolbox and the dissemination process to primary care and emergency department (ED) providers in North Carolina (NC). We report the effect of this dissemination on health-care utilization, cost of care, and overall cost-benefit. Methods: The SCD toolbox was adapted from the National Heart, Lung, and Blood Institute recommendations. Toolbox training was provided to quality improvement specialists who then disseminated the toolbox to primary care providers (PCPs) affiliated with the only NC managed care coordination system and ED providers. Tools were made available in paper, online, and in app formats to participating managed care network practices (n=1800). Medicaid claims data were analyzed for total costs and benefits of the toolbox dissemination for a 24-month pre- and 18-month post-intervention period. Results: There was no statistically significant shift in the number of outpatient specialty visits, ED visits or hospitalizations. There was a small decrease in the number of PCP visits in the post-implementation period. The dissemination resulted in a net cost-savings of $361 414 ($14.03 per-enrollee per-month on average). However, the estimated financial benefit associated with the dissemination of the SCD toolbox was not statistically significant. Conclusions: Although we did not find the expected shift to increased PCP visits and decreased ED visits and hospitalizations, there were many lessons learned.
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Martinez-Perez, Celia, Rodrigo San-Cristobal, Pilar Guallar-Castillon, Miguel Ángel Martínez-González, Jordi Salas-Salvadó, Dolores Corella, Olga Castañer, et al. "Use of Different Food Classification Systems to Assess the Association between Ultra-Processed Food Consumption and Cardiometabolic Health in an Elderly Population with Metabolic Syndrome (PREDIMED-Plus Cohort)." Nutrients 13, no. 7 (July 20, 2021): 2471. http://dx.doi.org/10.3390/nu13072471.
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The association between ultra-processed food (UPF) and risk of cardiometabolic disorders is an ongoing concern. Different food processing-based classification systems have originated discrepancies in the conclusions among studies. To test whether the association between UPF consumption and cardiometabolic markers changes with the classification system, we used baseline data from 5636 participants (48.5% female and 51.5% male, mean age 65.1 ± 4.9) of the PREDIMED-Plus (“PREvention with MEDiterranean DIet”) trial. Subjects presented with overweight or obesity and met at least three metabolic syndrome (MetS) criteria. Food consumption was classified using a 143-item food frequency questionnaire according to four food processing-based classifications: NOVA, International Agency for Research on Cancer (IARC), International Food Information Council (IFIC) and University of North Carolina (UNC). Mean changes in nutritional and cardiometabolic markers were assessed according to quintiles of UPF consumption for each system. The association between UPF consumption and cardiometabolic markers was assessed using linear regression analysis. The concordance of the different classifications was assessed with intra-class correlation coefficients (ICC3, overall = 0.51). The highest UPF consumption was obtained with the IARC classification (45.9%) and the lowest with NOVA (7.9%). Subjects with high UPF consumption showed a poor dietary profile. We detected a direct association between UPF consumption and BMI (p = 0.001) when using the NOVA system, and with systolic (p = 0.018) and diastolic (p = 0.042) blood pressure when using the UNC system. Food classification methodologies markedly influenced the association between UPF consumption and cardiometabolic risk markers.
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Xu, Paiheng, Mark Dredze, and David A. Broniatowski. "The Twitter Social Mobility Index: Measuring Social Distancing Practices With Geolocated Tweets." Journal of Medical Internet Research 22, no. 12 (December 3, 2020): e21499. http://dx.doi.org/10.2196/21499.
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Background Social distancing is an important component of the response to the COVID-19 pandemic. Minimizing social interactions and travel reduces the rate at which the infection spreads and “flattens the curve” so that the medical system is better equipped to treat infected individuals. However, it remains unclear how the public will respond to these policies as the pandemic continues. Objective The aim of this study is to present the Twitter Social Mobility Index, a measure of social distancing and travel derived from Twitter data. We used public geolocated Twitter data to measure how much users travel in a given week. Methods We collected 469,669,925 tweets geotagged in the United States from January 1, 2019, to April 27, 2020. We analyzed the aggregated mobility variance of a total of 3,768,959 Twitter users at the city and state level from the start of the COVID-19 pandemic. Results We found a large reduction (61.83%) in travel in the United States after the implementation of social distancing policies. However, the variance by state was high, ranging from 38.54% to 76.80%. The eight states that had not issued statewide social distancing orders as of the start of April ranked poorly in terms of travel reduction: Arkansas (45), Iowa (37), Nebraska (35), North Dakota (22), South Carolina (38), South Dakota (46), Oklahoma (50), Utah (14), and Wyoming (53). We are presenting our findings on the internet and will continue to update our analysis during the pandemic. Conclusions We observed larger travel reductions in states that were early adopters of social distancing policies and smaller changes in states without such policies. The results were also consistent with those based on other mobility data to a certain extent. Therefore, geolocated tweets are an effective way to track social distancing practices using a public resource, and this tracking may be useful as part of ongoing pandemic response planning.
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Weng, Yangqin, Mingzhi Li, and Check-Teck Foo. "Education inside China: a longitudinal (1989-2011) analysis." Chinese Management Studies 10, no. 2 (June 6, 2016): 217–41. http://dx.doi.org/10.1108/cms-02-2016-0030.
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Purpose This paper aims to analyze the rates of returns on education in China and in the process raises issues relevant to the management of China’s system of education. In the ongoing great transformation period of China, the rising rates of returns on education may have been indicators reflecting China’s social progressiveness. However, very little research efforts have been devoted to the study of the impacts of such factors as geographical regions and genders, etc. The authors hope to fill these gaps in the literature. Design/methodology/approach The China Health and Nutrition Survey (CHNS) database is used for this study (University of North Carolina). The longitudinal nature of the data sets covering 1989, 1991, 1993, 1997, 2000, 2004, 2006, 2009 and 2011 provides a good basis for comparative analyses. The theory is grounded upon the Mincer equations through which econometric estimates are then made. Findings Disparities in returns on education are found between genders and across geographical regions. The regression results show that the women’s returns on education are consistently higher than those of men. However, the scales of such gender differences differ between the rural and urban areas: smaller for rural area and larger, more significantly so for urban. Additionally, we have found that the rates of returns on education in China have risen significantly over these years, and these increases have been largely due to the effects of institutional reforms. The urban-rural gap in their degrees of market orientation has contributed to the differences in their rates of returns on education. The analyses also suggest that foreign direct investment inflows, international trade and the increasing competitiveness from private enterprises render human capital more valuable to urban businesses. In case of the rural areas, a lack of incentive system tends to have contributed to the lower rates of returns on education. Originality/value The authors have presented evidence on the trends in the rates of returns on education during China’s critical transition period. Analyses of the possible reasons behind the differential rates of returns are provided. These findings are helpful for the government to shape their policies towards education. For instance, the government should give more emphasis to vocational schooling due to their significantly higher rates of returns.
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Hansen, William, Ned Kalapasev, Amy Gillespie, Mary Singler, and Marsha Ball. "Development of a Pedestrian Walkability Database of Northern Kentucky Using Geographic Information Systems (GIS)." Journal of Physical Activity and Health 6, no. 3 (May 2009): 374–85. http://dx.doi.org/10.1123/jpah.6.3.374.
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Background:Rising obesity rates in the United States has spurred efforts by health advocates to encourage more active lifestyles including walking. Ensuring the availability, quality, and safety of pedestrian walkways has become an important issue for government at all levels.Methods:Pedestrian paths in Campbell County Kentucky were evaluated using a ranking criteria developed by the Walking and Bicycling Suitability Assessment (WABSA) project at the University of North Carolina School of Public Health. A pedestrian path Geographic Information System (GIS) data-layer was created, and mobile GIS units were used to assess the sidewalk segments using the ranking. Data from sidewalk surveys were compared with Census 2000 block group information on age of housing, population density, and household transportation characteristics to examine the correlation between these factors and sidewalk presence and quality. The analysis explored the use of census data to predict walkability factors and looked for trends in quality and availability of pedestrian paths over time.Results:Results showed higher overall scores for older urban areas adjacent to the Ohio River and Cincinnati. Housing built in the 1970s and 1980s showed the lowest scores, while more recent housing showed improvement over earlier decades. Age of housing was determined to be a useful predictor, while economic and population density attributes showed no correlation with walkability factors.Conclusion:Census housing age data are the most useful predictor of walkability demonstrating clear trends over time. The study shows improvements in walkways availability over the past few decades; however, infrastructure improvements are needed to provide more extensive pedestrian walkways and linkages between existing walkways in Campbell County.
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Zafar, Y., A. P. Abernethy, D. H. Abbott, J. E. Herndon, K. Rowe, J. Kolimaga, L. Conner, M. Patwardhan, S. Grambow, and D. Provenzale. "Comorbidity, age and stage at diagnosis in colorectal cancer (CRC)." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 6554. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.6554.
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6554 Background: Stage at diagnosis is a crucial predictor of outcome in CRC. The purpose of this study is to determine if comorbidity and age affect the stage at which CRC is diagnosed. Identifying variables that influence stage might improve outcomes in CRC. Due to frequent contact with the health care system, we hypothesize that patients with greater comorbidity and older age are more likely to be diagnosed with early-stage disease. Methods: We present data from two distinct patient populations: using the Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) database, we identified CRC patients treated at 15 Veterans Administration (VA) hospitals from 2003-present. We also identified CRC patients treated from 2003-present at 10 non-VA, fee-for-service (FFS) practices in North and South Carolina. Data were abstracted by retrospective chart review. Comorbidity was calculated by the Charlson comorbidity index (CCI) with high comorbidity defined as CCI =3. Older age was defined as age =70 years. Data were analyzed using logistic regression where the odds of late stage at diagnosis were modeled as influenced by older age, high CCI, and race. The analysis included estimation of adjusted and unadjusted odds ratios. Results: 347 VA and 282 FFS patients were included. 98% VA vs 50% FFS were male; 43% VA vs 27% FFS were aged =70; 56% VA vs 70% FFS were white; 26% VA vs 44% FFS presented with metastatic CRC; and 21% VA vs 6% FFS had a CCI =3. In both patient populations, regression analysis showed that older age, high CCI and white race were not significant predictors of stage at diagnosis. VA 95% confidence intervals (CI's) were 0.52–1.41 (age =70), 0.50–1.75 (CCI =3), and 0.42–1.11 (white race). FFS 95% CI's were 0.52–1.53 (age =70), 0.36–2.78 (CCI =3), and 0.74–2.11 (white race). Broader 95% CI's in the FFS analysis were due to smaller sample size. Conclusions: In CRC patients, age and comorbidity were not related to stage at diagnosis. The findings are similar whether the patients were treated in a fee-for-service or VA health system. While older age and greater illness might provide more contact with the health care system, this exposure did not result in earlier diagnosis of CRC. Future studies will examine the impact of comorbidity on CRC treatment and survival. No significant financial relationships to disclose.
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Shade, Starley B., Elliot Marseille, Valerie Kirby, Deepalika Chakravarty, Wayne T. Steward, Kimberly K. Koester, Adan Cajina, and Janet J. Myers. "Health information technology interventions and engagement in HIV care and achievement of viral suppression in publicly funded settings in the US: A cost-effectiveness analysis." PLOS Medicine 18, no. 4 (April 7, 2021): e1003389. http://dx.doi.org/10.1371/journal.pmed.1003389.
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Background The US National HIV/AIDS Strategy (NHAS) emphasizes the use of technology to facilitate coordination of comprehensive care for people with HIV. We examined cost-effectiveness from the health system perspective of 6 health information technology (HIT) interventions implemented during 2008 to 2012 in a Ryan White HIV/AIDS Program (RWHAP) Special Projects of National Significance (SPNS) Program demonstration project. Methods/findings HIT interventions were implemented at 6 sites: Bronx, New York; Durham, North Carolina; Long Beach, California; New Orleans, Louisiana; New York, New York (2 sites); and Paterson, New Jersey. These interventions included: (1) use of HIV surveillance data to identify out-of-care individuals; (2) extension of access to electronic health records (EHRs) to support service providers; (3) use of electronic laboratory ordering and prescribing; and (4) development of a patient portal. We employed standard microcosting techniques to estimate costs (in 2018 US dollars) associated with intervention implementation. Data from a sample of electronic patient records from each demonstration site were analyzed to compare prescription of antiretroviral therapy (ART), CD4 cell counts, and suppression of viral load, before and after implementation of interventions. Markov models were used to estimate additional healthcare costs and quality-adjusted life-years saved as a result of each intervention. Overall, demonstration site interventions cost $3,913,313 (range = $287,682 to $998,201) among 3,110 individuals (range = 258 to 1,181) over 3 years. Changes in the proportion of patients prescribed ART ranged from a decrease from 87.0% to 72.7% at Site 4 to an increase from 74.6% to 94.2% at Site 6; changes in the proportion of patients with 0 to 200 CD4 cells/mm3 ranged from a decrease from 20.2% to 11.0% in Site 6 to an increase from 16.7% to 30.2% in Site 2; and changes in the proportion of patients with undetectable viral load ranged from a decrease from 84.6% to 46.0% in Site 1 to an increase from 67.0% to 69.9% in Site 5. Four of the 6 interventions—including use of HIV surveillance data to identify out-of-care individuals, use of electronic laboratory ordering and prescribing, and development of a patient portal—were not only cost-effective but also cost saving ($6.87 to $14.91 saved per dollar invested). In contrast, the 2 interventions that extended access to EHRs to support service providers were not effective and, therefore, not cost-effective. Most interventions remained either cost-saving or not cost-effective under all sensitivity analysis scenarios. The intervention that used HIV surveillance data to identify out-of-care individuals was no longer cost-saving when the effect of HIV on an individual’s health status was reduced and when the natural progression of HIV was increased. The results of this study are limited in that we did not have contemporaneous controls for each intervention; thus, we are only able to assess sites against themselves at baseline and not against standard of care during the same time period. Conclusions These results provide additional support for the use of HIT as a tool to enhance rapid and effective treatment of HIV to achieve sustained viral suppression. HIT has the potential to increase utilization of services, improve health outcomes, and reduce subsequent transmission of HIV.
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Eswaran, Harish, Jamie Jarmul, Amy Shaheen, David Meaux, Tristan Long, Derek Saccoccio, and Stephan Moll. "Incidence of Vascular Thromboembolic Events in Outpatients with Mild COVID-19." Blood 136, Supplement 1 (November 5, 2020): 31–32. http://dx.doi.org/10.1182/blood-2020-140063.
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Introduction Hypercoagulability is a hallmark of COVID-19, the disease caused by the severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2).1 While studies have investigated vascular thromboembolic events (VaTE) in critically ill and hospitalized patients with COVID-19, less is known about thrombotic complications in patients with mild symptoms.2 Our current institutional management protocol recommends prophylactic anticoagulation for COVID-19 patients admitted to the hospital but not for outpatients with less severe disease. We evaluated the incidence of VaTE in outpatients diagnosed with COVID-19 at our institution in order to assess the potential need for thromboprophylaxis in outpatient COVID-19 management. Methods We conducted a retrospective analysis of electronic medical record data of outpatients in the University of North Carolina Health System who tested positive for Sars-CoV-2 between March 15 and June 20, 2020. Patients were diagnosed at one of 17 ambulatory respiratory diagnostic centers (n=706), or diagnosed and subsequently discharged from one of 11 emergency departments (n=1967) in the UNC system. Diagnosis was made using reverse transcriptase polymerase chain reaction testing of nasopharyngeal or oropharyngeal swab samples. The study outcome was the diagnosis of a vascular thromboembolic event within 30 days of COVID-19 diagnosis. This included deep vein thrombosis, pulmonary embolism, superficial thrombophlebitis, myocardial infarction, ischemic stroke, and systemic arterial thromboembolism. VaTE was defined based on documentation of an associated ICD-10 code in the patient's electronic medical record within the specified time frame. Outcomes data were reported as incidence rates for the entire study population. Results 2673 outpatients were diagnosed with COVID-19 in the study period. The mean age for this cohort was 37.9 ± 17.3 years and 54% were female. 20 unique individuals (0.7%) experienced a VaTE within 30 days of diagnosis. Of these, 3 (15%) experienced venous thromboembolic events, 16 (80%) experienced arterial events, and 1 patient experienced both. Mean time to VaTE was 12.8 ± 9.3 days. Within 30 days of diagnosis, 188 of these patients (7%) had an emergency department visit or experienced hospital observation or inpatient admission. Conclusions We found that the incidence of VaTE in outpatients with mild COVID-19 is low. Limitations of this study include that patients were not routinely screened for VaTE and may have sought treatment for thrombotic complications outside the hospital system. This may have led to an underestimate of the true incidence; however, the findings are in line with data showing that non-hospitalized COVID-19 patients tend to be younger and have fewer medical comorbidities than hospitalized patients.3 This argues against the routine use of thromboprophylaxis in outpatients with COVID-19. References 1. Hippensteel JA, Burnham EL, Jolley SE. Prevalence of venous thromboembolism in critically ill patients with COVID-19. British Journal of Haematology. 2020; 190(3):e134-e137. 2. Emert R, Shah P, Zampella JG. COVID-19 and hypercoagulability in the outpatient setting. Thrombosis Research. 2020; 192:122-123. 3. Killerby ME, Link-Gelles R, Haight SC, et al. Characteristics associated with hospitalization among patients with COVID-19 - metropolitan Atlanta, Georgia, March-April 2020. Morbidity and Mortality Weekly Report. 2020; 69(25):790-794. Disclosures No relevant conflicts of interest to declare.
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Singh, Rahul, Ryan Jordan, and Charin Hanlon. "Economic Impact of Sickle Cell Hospitalization." Blood 124, no. 21 (December 6, 2014): 5971. http://dx.doi.org/10.1182/blood.v124.21.5971.5971.
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Abstract Introduction: Sickle Cell Disease (SCD), which afflicts 100,000 Americans, is the most common inherited blood disorder in the US. In 2004, there were about 113,000 hospitalizations for sickle cell related illnesses in the United States, 75% occurring in adults. Estimated annual cost of hospitalization that year was $488 million. Many large academic health care centers have organized sickle management clinics, a service often not available to community hospitals. We describe the economic impact of sickle cell inpatient management in a large community hospital. Methods: With IRB approval, a retrospective study of the cost of sickle cell crisis readmissions at New Hanover Regional Medical Center in Wilmington, NC was conducted, a 628 bed community hospital in Southeast North Carolina. Individuals identified were patients who had a diagnosis of sickle cell disease and had at least one disease related inpatient admission during a five year study time frame. Data collected pertained to patient demographics, economic impact as well as admission characteristics. Summary statistics were calculated and reported in means, standard deviations, counts and frequencies. The data was analyzed using SAS 9.1. Results: Within the study time frame, 88 patients, including 433 admissions were analyzed. Only 37 patients (168 admissions) had admissions related to their sickle cell disease. Patients were shown to be 97.3% African American, 56.8% female, 40.5% having Medicaid, and 54.1% with Medicare. Seventeen patients (45.9%) accounted for 131 readmissions (78.0% of total admissions). On average, each admission lasted 5.1 days [SD 3.7] and cost per (patient or per admission) patient was $7,637.95 [SD 5334.26]. In five years, patients spent 863 days in the hospital with a total cost of $1,283,176.83. Discussion: As healthcare costs continue to be scrutinized, a more conscious effort will need to be placed on delivering high quality cost-effective care to our sickle cell population. From this analysis, there is a clear economic burden of sickle cell related hospitalizations to community hospitals. It is also clear that there is a small subset of patients who consume a large percentage of the resources. This may lend itself well to focused collaborative care management services of these high consumers of healthcare resources. The inpatient management of sickle cell vaso-occlusive crisis is well known, but the goal of treatment extends beyond that of just inpatient management. Patients with SCD need effective management in the outpatient setting in hopes to prevent readmissions, reduce hospital length of stays, and ultimately decrease the economic burden to our healthcare system. Given the significant economic burden to the community hospital, we plan to initiate a focused ambulatory quality improvement project. We plan to track the economic cost of providing intensive outpatient management, balanced against this historical cost information. We will systematically study the ability of a community hospital to impact the natural history of this devastating disease. Disclosures No relevant conflicts of interest to declare.
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Malpica Castillo, Luis E., Shannon Palmer, Anqi Zhu, Allison Deal, Sheh-Li Chen, and Stephan Moll. "Adherence to Infectious Disease Screening and Immunization Guidelines When Treating Non-Malignant Immune-Mediated Hematologic Disorders." Blood 134, Supplement_1 (November 13, 2019): 792. http://dx.doi.org/10.1182/blood-2019-121340.
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Background : The use of immunosuppressive therapies in the management of non-malignant immune-mediated hematologic disorders (NMIHD) leads to an increased risk of infections. Preventive strategies, such as immunization and infectious disease (ID) screening, reduce the burden of infectious complications. However, lack of compliance to available guidelines among healthcare providers (HCP) represent a major concern. The present study was performed to assess adherence by HCP to national guidelines and recommendations for the prevention of infectious complications in patients (pts) treated for a NMIHD with the goal to identify areas where interventions can be implemented to improve awareness. Methods : We retrospectively analyzed pts diagnosed with AIHA, acquired coagulation factor deficiency (ACFD), TTP, ITP, aHUS, PNH, and antiphospholipid syndrome (APS) between January 2016 and July 2018 at an academic medical center (University of North Carolina). Pts had to have received either rituximab (RTX), eculizumab, or splenectomy. Adherence to existing strategies was assessed based on available recommendations from recognized national entities (e.g. CDC, ACIP), and clinical societies (e.g. ASH) (summarized in Table 1). Immunizations considered for analysis included: pneumococcal, meningococcal and Haemophilus influenzae vaccines ('triple vaccine' if received all together). We considered 'adherence to an immunization recommendation' when, depending on the diagnosis and treatment employed, pts received all recommended vaccines at least 2 weeks prior to therapy or 4 weeks if splenectomy. Adherence to ID screening in pts receiving RTX therapy was defined as pts screened for both hepatitis B surface antigen and total core antibodies. Influenza virus and herpes zoster (HZ) immunization rates were also analyzed. Results : 269 pts from six UNC-affiliated hospitals were included. Pts clinical characteristics are summarized in Table 2. Overall, only 6% of all evaluable pts were appropriately immunized as recommended by national guidelines (5%, 8%, and 8%, for RTX, eculizumab, and splenectomy, respectively) (Table 3). Immunization rates are summarized in Figure 1. In the eculizumab group, although 92% of HCP recommended and prescribed meningococcal immunization, only 38% (n=5/13) received both vaccines (54% either, 8% none). Likewise, although 89% (n=47/53) of pts undergoing splenectomy had received a 'triple vaccine', only 11% of pts received guideline recommended vaccines (both pneumococcal and meningococcal vaccines) and only 8% were appropriately vaccinated by receiving all indicated vaccines at least 4 weeks prior to their scheduled surgery. 68% of pts treated with RTX were appropriately screened for hepatitis B, with lower rates found in young women (screening rate: 77% age >50 vs. 58% ≤50 years, p<0.01; 83% male vs. 58% female, p<0.01) diagnosed with TTP or APS (ITP 74%, AIHA 79%, ACFD 77% vs. TTP 46%, APS 55%, p=0.01). Lastly, 36% of pts received annual influenza virus vaccine, and 11% of eligible pts the HZ vaccine. Conclusion : To the best of our knowledge, there have been no studies conducted in the U.S. assessing adherence to infectious prevention guidelines among different NMIHD. We found that in pts with NMIHD undergoing immunotherapy or splenectomy, many pts received either incomplete recommended immunizations or the immunization was administered too close in proximity to the immunosuppressive therapy or splenectomy, both resulting in impaired immunologic response to vaccines. In addition, only two thirds of pts receiving RTX had pretreatment screening for hepatitis B infection at odds with national recommendations of 100%. Lastly, low immunization rates against influenza virus and HZ were found. Based on these results, we created infographics (supplemental figure), an "easy-to-use" pocket brochure summarizing recommendations (Table 1), and we are building immunization reminders when electronically prescribing immunotherapy, with the aim of improving HCP awareness in our health care system. Although we are unsure about other institution's compliance rate, we suspect that non-compliance to immunization is a systemic problem across the U.S. We will disseminate this data hoping to replicate this study at other academic institutions. There is an urgent need for the development of strategies to improve HCP awareness and adherence to infectious prevention guidelines! Disclosures No relevant conflicts of interest to declare.
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Bishop-Freeman, Sandra C., Laura W. Friederich, Marc S. Feaster, and Jason S. Hudson. "Buprenorphine-Related Deaths in North Carolina from 2010 to 2018." Journal of Analytical Toxicology, July 7, 2021. http://dx.doi.org/10.1093/jat/bkab073.
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Abstract Buprenorphine (BUP) is a commonly prescribed medication for the treatment of opioid use disorder (OUD). As prescriptions increase in North Carolina, BUP is more frequently encountered statewide in routine postmortem casework. Between 2010 and 2018, there were 131 select cases investigated by the Office of the Chief Medical Examiner where BUP was detected in peripheral blood and considered a primary cause of death (COD), with no other opioids present and no other non-opioid substances found in the lethal range. The decedents ranged in age from 14 to 64 years, with 67% male. The mean/median peripheral blood concentrations were 4.1/2.1 ng/mL for BUP and 7.8/3.4 ng/mL for its metabolite, norbuprenorphine. These postmortem blood concentrations overlap antemortem therapeutic concentrations in plasma reported in the literature for opioid-dependent subjects receiving sublingual maintenance therapy. The pathologist considered scene findings, prescription history, autopsy findings, toxicological analysis and decedent behavior prior to death to conclude a drug-related COD. Many of the deaths were complicated by the presence of other central nervous system depressants along with contributory underlying cardiovascular and respiratory disease. The three most prevalent additive substances were alprazolam, ethanol and gabapentin, found in 67, 36 and 32 cases out of 131, respectively. Interpreting BUP involvement in a death is complex, and instances may be underestimated in epidemiological data because of the lack of a defined toxic or lethal range in postmortem blood along with its good safety profile. As expansion of access to OUD treatment becomes a priority, awareness of the challenges of postmortem interpretation is needed as increased use and diversion of BUP are inevitable.
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Pavolini, E. "Italy: nationalist anti-migrant policies and emigration of Italian health professions." European Journal of Public Health 29, Supplement_4 (November 1, 2019). http://dx.doi.org/10.1093/eurpub/ckz185.566.
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Abstract Background Traditionally Italy has been characterised by a limited investment in healthcare personnel, apart from physicians. The outcome has been a low health worker to population density; especially nurses and long-term care personnel face shortages. The outcome has been, at least until 2010 an increasing presence of migrant care workers. However, the situation has changed for several reasons. On one hand, since austerity policies have been implemented, the whole healthcare system has registered a freeze in new healthcare personnel hiring. One the other hand, in more recent years policies have started to be implemented, especially by the latest government (where one of the two governing parties is a radical right one) to make it more difficult for migrants to access the country. Methods The study draws on an analysis of administrative data and previous researches in the field, matched by qualitative interviews with key informants at the national level. Results Shortage of skilled workers in the health sector is likely to increase in future. It is becoming more difficult for foreigners to get access to work in this sector, while Italian healthcare workers are leaving the country. In recent years there has been a strong increase in healthcare professionals’ emigration toward North America and other EU countries. Conclusions Italy needs both a new effective strategy of health workforce governance and a more migrant-friendly policy to manage incoming and outgoing flows of health professionals.
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Gwaltney, Angela You. "Effect of Psychotropic Medication on Foster Care Experience and Outcomes: A Causal Analysis using Administrative Data." International Journal of Population Data Science 3, no. 5 (October 12, 2018). http://dx.doi.org/10.23889/ijpds.v3i5.1082.
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Children in foster care experienced abuse, neglect, or dependency, and for the safety and well-being of the child, must be taken out of their biological home. Not surprisingly, children in foster care have higher rates of serious emotional and behavioral problems. Although pharmacological treatments can be an important component of the treatment plan, there seems to be a higher rate of use than would be expected. An estimated 13-25% of foster children are prescribed mind- and mood-altering medication vs. 4% in the general population.
Children in foster care are considered a vulnerable population and research involving these children justifiably requires additional measures to ensure their protection. As a result, studies on the use of psychotropic medication among youth in foster care have relied primarily on secondary data‚ typically administrative data. This study used linked administrative datasets to rigorously examine the effect of psychotropic medication on foster care experiences and outcomes among children who entered foster care in North Carolina between March 2006 and June 2012. The dataset was constructed by linking the North Carolina’s child welfare administrative records (also known as the Services Information System [SIS]) with the Medicaid claims database (also known as the Eligibility Information System [EIS]) for medical and mental health services received by the foster youth. Inverse probability of treatment weighting was calculated and applied to mimic a randomized study. Results revealed that children on medication stayed in care longer, less likely to experience placement disruption, and more likely to exit to adoption.
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Small, Cristine W., Susan D. Freeman, Dawn K. Becker, Katie A. McGrath, and Alexandria B. Gullette. "Abstract 2734: Thrombolytics, Treatment, Transfer, and Triage: Improving Access to Stroke Care in Eastern North Carolina." Stroke 43, suppl_1 (February 2012). http://dx.doi.org/10.1161/str.43.suppl_1.a2734.
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Background: We are a Certified Primary Stroke Center (PSC) at a regional health system serving 29 counties in eastern North Carolina. High poverty rates, socioeconomic, and demographics factors, create challenges for access to care in the heart of the stroke buckle. Purpose: This endeavor promotes best practice for acute stroke care and optimizes outcomes for patients. The PSC serves as the hub, offering supportive resources to community hospitals with an immediate feedback loop that fosters a seamless transfer process through a drip and ship model. As a result of outreach efforts in the region, an increased number of patients will receive thrombolytic therapy. Implementation of this model creates a community network that is well prepared to become a true stroke system of care. Methods: Development of a comprehensive transfer protocol that includes an algorithmic decision tree and continuous quality feedback loop Ongoing data analysis and sharing Key stakeholder collaboration 24/7 resource availability Immediate feedback loop to include phone calls Results: Regional transfers to our facility after t-PA, increased steadily each year from six in 2006 to 52 in 2010, illustrating a significant increase in t-PA utilization. Clinical outcomes were tracked throughout the hospital course to identify stroke severity and disposition. This resulted in a comprehensive analysis of all regional transfers post t-PA, prompting evaluation of t-PA utilization based on phone consults and the feasibility of triage for admission to an ICU or IU based on 18 months of clinical data. Last NIHSS < 12, favorable outcomes 71% of regional transfers had a last NIHSS < 12, 61% were discharged home, 34% Rehab, 5% SNF Regional and PSC average NIHSS comparison: Regional first NIHSS was13, last NIHSS - 9.9; PSC first NIHSS -11.5, last NIHSS 5.2 Conclusions: An increased number of patients are receiving thrombolytic therapy in our community hospitals as a result of outreach efforts in the region. Regional partnerships continue to grow. With growth comes an increased responsibility to explore every aspect of acute stroke treatment that may impact overall clinical outcomes. While the clinical efficacy of t-PA for stroke has been proven in numerous clinical trials, we are obligated as a PSC to take stroke care to the next level and continuously evaluate opportunities for improvement that will guide us to maximize EVERY patient’s outcome.
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Raynak, John, Michael Cowherd, Hannan Yang, Clay Sherrill, and Joseph Rossi. "Abstract 15095: CSHA Frailty Scale as a Predictor of Hospital Readmission After PCI." Circulation 142, Suppl_3 (November 17, 2020). http://dx.doi.org/10.1161/circ.142.suppl_3.15095.
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Introduction: The Canadian Study on Health and Aging (CSHA) Frailty Scale was included in the National Cardiovascular Data Registry’s (NCDR) CathPCI registry beginning April 2018. The value of this frailty assessment as an independent predictor of hospital readmission is unknown. Methods: A retrospective analysis was performed of patients who underwent PCI within the University of North Carolina Medical System between 04/2018 and 12/2018. Outcome data was obtained from our electronic medical record data repository and procedural data from the institutional CathPCI registry. The primary outcome was repeat hospital admission within 1 year of PCI. Significant covariates (p<0.05) in the univariate analyses were considered for inclusion in the multivariate model. Multivariate logistic regression was then performed to determine if CSHA Frailty Scale was an independent predictor of hospital readmission. Results: 1,592 subjects were identified with 367 readmission events. Patients in the readmission cohort were older, had a higher frailty score, and had more comorbidities. Table 1 summarizes the comorbidities included in the logistic regression. CSHA Frailty Scale did not meet significance requirements (P<.05) to be independently associated with readmission. Covariates that were significant independent predictors of readmission included age (OR 1.024, 95% CI 1.012-1.036); cerebrovascular disease (OR 1.688, 95% CI 1.234-2.308); dialysis (OR 2.983, 95% CI, 1.583-5.622); and CHF (OR 2.465, 95% CI, 1.851-3.282). Conclusions: The CSHA Frailty Scale was not independently associated with readmission in the setting of PCI in our health system. This particular assessment of frailty may not provide added value over traditional comorbidities in this patient population.
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Le, Patrick, Michelle Nguyen, Thoai Vu, Diem-Phuong Dao, Daniel Olson, and Alice Yang Zhang. "Anxiety and Depression in Patients With Retinitis Pigmentosa." Journal of VitreoRetinal Diseases, August 18, 2020, 247412642093645. http://dx.doi.org/10.1177/2474126420936455.
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Purpose: Retinitis pigmentosa (RP) is a chronic progressive disease with no curative treatments. Understanding the variables involved with improving patients’ quality of life is important in managing this population. The literature investigating the relationship of anxiety and depression with RP relies on the analysis of smaller subset populations of patients with RP, and no study has quantified the effect size of the potential association. This study aims to elucidate and quantify the association between RP, anxiety, and depression. Methods: A retrospective case-control study was conducted of 6 093 833 medical records within the University of North Carolina Hospital and outpatient clinic system from July 1, 2004, to August 30, 2019. Patients with a diagnosis of RP, anxiety, and depression were identified within the Carolina Data Warehouse for Health by International Classification of Diseases, Ninth and Tenth Revision codes. Results: From the base population of 6 093 833 patients' medical records, 690 patients were diagnosed with RP, 253 065 with anxiety, and 232 541 with depression. Patients with RP have an odds ratio, adjusted for sex and age, of 4.915 (95% CI, 4.035-5.987) for having comorbid anxiety, 5.609 (95% CI, 4.622-6.807) for comorbid depression, and 4.130 (95% CI, 3.187-5.353) for comorbid anxiety and depression. Conclusions: Patients with RP have a higher prevalence of anxiety and depression, with increased odds of approximately 5 to 6 times for also carrying a diagnosis of anxiety or depression and about 4 times for carrying diagnoses of anxiety and depression compared with the general population.
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Efird, Caroline R. "‘DIFFERENT THAN A REGULAR WHITE’." Du Bois Review: Social Science Research on Race, September 9, 2021, 1–22. http://dx.doi.org/10.1017/s1742058x21000333.
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Abstract Qualitative research can clarify how the racialized social system of Whiteness influences White Americans’ health beliefs in ways that are not easily captured through survey data. This secondary analysis draws upon oral history interviews (n=24) conducted in 2019 with Whites in a rural region of Appalachian western North Carolina. Interviewees discussed personal life history, community culture, health beliefs, and experiences with healthcare systems and services. Thematic analysis conveyed two distinct orientations toward health and healthcare: (1) bootstraps perspective, and (2) structural perspective. Whiteness did not uniformly shape interviewees’ perceptions of health and healthcare, rather, individual experiences throughout their life course and the racialized social system contributed to these Appalachian residents’ assessments of who is responsible for health and healthcare. Dissatisfaction with the Affordable Care Act was salient among interviewees whose life stories reflected meritocratic ideals, regardless of education level, age, or gender identity. They apprised strong work ethic as a core community value, assuming that personal contributions to the social system match the rewards that one receives in return for individual effort. Conversely, interviewees who were primarily socialized outside of rural Appalachia acknowledged some macro-level social determinants of health and expressed support for universal healthcare models. Findings suggest that there is not one uniform type of “rural White” within this region of Appalachia. Interventions designed to increase support for health equity promoting policies and programs should consider how regional and place-based factors shape White Americans’ sense of identity and subsequent health beliefs, attitudes, and voting behaviors. In this Appalachian region, some White residents’ general mistrust of outsiders indicates that efforts to garner more political will for health-promoting social programs should be presented by local, trusted residents who exhibit a structural perspective of health and healthcare.
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Constantine, S. Tyler, David Callaway, Jeremy N. Driscoll, and Stephanie Murphy. "Implementation of Drive-Through Testing for COVID-19 With Community Paramedics." Disaster Medicine and Public Health Preparedness, February 16, 2021, 1–7. http://dx.doi.org/10.1017/dmp.2021.46.
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Abstract Objective: In this manuscript, we discuss the implementation and deployment of mobile integrated health and community paramedicine (MIH/CP) testing sites to provide screening, testing, and community outreach during the first months of the 2019 coronavirus disease (COVID-19) pandemic in the metropolitan region of Charlotte, North Carolina. This program addresses the need for an agile testing strategy during the current pandemic. We disclose the number of patients evaluated as “persons under investigation” and the proportion with positive severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) results from these sites. We describe how the programs were applied to patient care and include considerations on how additional staffing, scalability, and flexibility of these services may be applied to future patient and health care crises. Methods: This is a descriptive report of the implementation of MIH/CP test sites in our health care system’s early response to the COVID-19 pandemic in March 2020. Retrospective data on the number of patients and their associated demographics are reported here as raw data. No statistical analysis was performed. Results: Between March 15, 2020, and April 15, 2020, our 6 MIH/CP test sites evaluated 4342 patients. Of these, 401 patients (9.2%) had positive test results, 62.8% of whom were women. The estimated duration of each patient encounter under investigation was 3 to 5 minutes. The paramedics were able to perform a brief history, specific physical examination, and screening for signs of hypoxemic respiratory failure. There were no cases of accidental exposure or failure of personal protective equipment for the MIH/CP paramedics. Conclusions: In our health care system, we pivoted the traditional MIH/CP model to rapidly initiate remote drive-through testing for COVID-19 in pre-screened individuals. This model allowed us to test patients with suspected COVID-19 patients away from traditional health care sites and mitigate exposure to health care workers and other patients.
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Hannah, Anya Ojiugo, Nwachuku Edna Ogechi, A. Waribo Hellen, and Bartimaeus Ebirien-Agana Samuel. "Inflammatory Markers in Workers Occupationally Exposed to Petrol and Petroleum Products." International Blood Research & Reviews, September 13, 2021, 44–52. http://dx.doi.org/10.9734/ibrr/2021/v12i430159.
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Place and Duration of Study: Sample: Abia State University Teaching Hospital, Aba, Abia State and Laboratory Department, JAROS Inspection Services Limited, Port Harcourt, Rivers State, between April 2018 and June 2018.
Methodology: A total of 204 samples comprising of 123 auto-mechanics and 81 non -auto-mechanics were assayed. Detailed information of the bio-data of the subjects including age, gender, medical history, health information and lifestyle were obtained from each participant. Blood samples were collected from for the analysis of inflammation markers, IL-6, TNF-α and CRP were determined using standard methods and techniques. The effect of age and duration of exposure on the inflammation parameters were considered. Statistical Analysis System (SAS), STAT 15.1, developed by SAS Institute, North Carolina State University, USA was used for statistical analysis. Data were presented as Mean ± SEM, comparison of means of groups that are more than two was done using Analysis of Variance (ANOVA), and the Tukey test of multiple comparison was used to test for variance within and across groups.
Results: There was significant increase in the means of IL-6, TNF-α and CRP in the exposed subjects (p <0.05) compared with the control subjects There was no significant difference (p >0.05) in the means of IL-6, TNF-α and C-reactive protein (CRP) between the age groups of the exposed and the control subjects. Similarly, there was no significant difference between the groups, based on duration of exposure. This suggests that the toxic effect does not depend on the age or duration of exposure but on other factors for the automechanics in Aba.
Conclusion: This study shows that the exposure of automechanics may significantly increase the serum IL-6 TNF-α and Hs-CRP levels. Increase in the serum levels of the inflammation markers is predictive of the danger of future pathology in automechanics compared with non automechanics in Aba metropolis. Age and duration did not influence significant variation in the automechanics.
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Erdogdu, Pinar, Stella Tsai, and Teresa Hamby. "HAI Surveillance Enhancement within EpiCenter by Utilization of Triage Notes." Online Journal of Public Health Informatics 9, no. 1 (May 2, 2017). http://dx.doi.org/10.5210/ojphi.v9i1.7618.
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ObjectiveEvaluate the usage of triage note data from EpiCenter, a syndromicsurveillance system utilized by New Jersey Department of Health(NJDOH), to enhance Healthcare-Associated Infections (HAIs)surveillance for infections following a surgical procedure.IntroductionIn New Jersey, Health Monitoring Systems Inc.’s (HMS) EpiCentercollects chief complaint data for syndromic surveillance from 79 of80 emergency departments (ED). Using keyword algorithms, thesevisits are classified into syndrome categories for monitoring unusualhealth events.HAIs are infections that patients acquire while they are receivingtreatment for a health condition in a health care setting. Followingthe 2014 Ebola outbreak in West Africa, the New Jersey Departmentof Health (NJDOH) Communicable Disease Service (CDS) startedrecruiting EDs to include triage note data in addition to chiefcomplaint data to enhance surveillance capability for Ebola and otherHAIs. Research by the University of North Carolina suggests triagenote data improve the ability to detect illness of interest by fivefold1.Currently, there are three NJ EDs with triage note data in EpiCenteralong with ICD 10 codes which can be used for comparison.This pilot study will assess whether infections following a surgicalprocedure can be captured in triage note data along with ICD codes.Also, this evaluation will determine if triage note data can be usedto create HAI custom classifications for syndromic surveillance.These classifications can potentially be used by surveillanceand/or preparedness personnel and local health departments, as wellas hospitals, to better prepare for detecting and preventing HAIs thatare a significant cause of morbidity and mortality in the U.S.2MethodsThree NJ facilities with triage notes information sending toEpiCenter were included in this study. ED visits occurred from10/23/2015 to 10/29/2015 and from 2/2/2016 to 2/10/2016 in thesefacilities with available ICD 10 codes information in EpiCenter wereevaluated.This analysis focused on sepsis and post-surgery infections relatedICD 10 codes: A400, A401, A402, A403, A408, A409, A410, A411,A412, A414, A4150, A4151, A4152, A4158, A418, A419, R571,R578, R579, T811, T81.43. The keywords tested in triage notesare abdominal pain, redness, fev, fver, pyrexia, temp, elev temp,elevated temp, temp elev, hi temp, high temp, temp hi, temp10, temp10, feeling hot, feels hot, feel hot, fuo, febr, cloudy fluid, cfluid,drainage, abscess, wound, tenderness, swelling, erythema, red, pain,post surgery, fever.The sensitivity, specificity and positive predictive value (PPV)of selected keywords applied in the triage notes were evaluated bycomparing to patient’s ICD 10 codes.ResultsThere were 2757 ED visits with triage notes and ICD 10 codes from10/23/2015 to 10/29/2015 and from 2/2/2016 to 2/10/2016. Duringthese time frames, one ED visit matched with both selected keywordsand ICD codes, five matched with ICD 10 codes only, 59 matchedwith keywords only, and 2692 did not match with either keywordsor ICD 10 codes. In Table 1, it indicates that selected keywordshave a high specificity (97.9 %) but with a relatively low sensitivity(16.7 %) and PPV (1.7%).ConclusionsSelected keywords and ICD 10 codes from facilities sending triagenotes were used to evaluate the surveillance system on identifyinginfections following a surgical procedure through analysis of EDtriage note field. We also reviewed all NJ ED data during the samestudy period for other facilities not sending triage notes. It indicatedthat several key ICD codes, e.g. ICD code T81.4, infections followinga surgical procedure, have been included in many facilities. Thisanalysis will be repeated as more EDs participate in EpiCenterwith triage notes and other data fields to refine the keywords and toimprove the sensitivity and PPV.Table 1: Sensitivity, specificity and PPV calculations of selected keywordsapplied in triage notes based on the ICD 10 codes related to infectionsfollowing a surgical procedure.
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Johnson, Rayetta. "Abstract 2197: Telestroke: Optimizing Access to Emergency Interventions in Acute Stroke Care." Stroke 43, suppl_1 (February 2012). http://dx.doi.org/10.1161/str.43.suppl_1.a2197.
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Background and Issues: The burden of stroke in North Carolina is one of the highest in the nation (approximately 28,000 stroke hospitalizations from 2003-2007). The number and high costs of stroke have made it incumbent to improve the numbers of patients receiving effective treatment. There are two major barriers for treatment of acute stroke: time and access. The utilization of telestroke in community hospitals aids in decreasing these barriers by providing immediate access to a stroke neurologist. In order for telestroke to be successful, awareness and education regarding acute stroke care must be provided for health care providers as well as the communities. Thus, the development of a telestroke system requires nursing and medical expertise. The Primary Stroke Center Team at Wake Forest Baptist Medical Center in Winston-Salem, N.C. implemented a telestroke network system (Intouch's Health's RP-7 Robotic system) in January of 2010 to provide 24/7 access to the medical center's acute stroke experts and the latest advancements in stroke interventions. There are eight hospitals in the network at the present time. Methods: Our team identified that many of the network hospital's staff are not experienced in taking care of a stroke patient and that a “roadmap” is useful to guide them in these steps.The stroke nurse specialist developed a quality improvement plan for the network hospitals which included: an evidence-based algorithm for patient care; stroke education, in particular, neurological assessment and tPA administration classes for the ED staff; quarterly meetings to provide outcome and feedback data with each network hospital; stroke awareness events for the community. Mock telestroke consults were also performed prior to “going live” with telestroke for each of the network hospitals. Of utmost importance is the early involvement and education of the EMS system in the respective county of the network hospital. The buy-in of EMS was found to be a key component in the success of the network. Finally, attention to customized quality improvement efforts for each of the facilities are required to accomplish integration into the telestroke network. Results: The data has been analyzed, and thus far, a 24% rate of tPA administration has been seen with our network hospitals (an increase from the 3.6% national average). Comparisons between each of the eight network hospitals' rates of administration of tPA prior to and after joining the network show a trend of increase (10%-40%). The effectiveness of the algorithm has also been explored by analysis of feedback and initial results have shown a positive impact. Conclusion: A combination of improving access to stroke neurologists in conjunction with a focus on improving the level of care via evidenced based stroke care teaching and implementation of algorithms at a network hospital is required for implementing and building a successful telestroke network.
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Cardoso, Andreia Tairine Gonçalves, Elsa Patrícia Alves Spínola Correia, Dionísio Eduardo Gonçalves Fernandes, João Pedro Justino de Oliveira Limírio, and Maria Cristina Rosifini Alves Rezende. "Experiência de educação em saúde bucal em escola de educação infantil na República de Cabo Verde, África." ARCHIVES OF HEALTH INVESTIGATION 8, no. 5 (August 8, 2019). http://dx.doi.org/10.21270/archi.v8i5.4752.
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Dados do Observatório de Saúde Africana (African Health Observatory), ligado à Organização Mundial de Saúde (World Health Organization) apontam elevada prevalência da cárie dentária, principalmente entre a população escolar de Cabo Verde, elencando a necessidade da priorização da promoção da saúde bucal e da prevenção das doenças bucais pela integração da saúde oral em outros programas tais como a formação de professores, educadores de infância e outros programas de responsabilidade na promoção de saúde. A literatura aponta que a educação em saúde bucal mostra alta eficiência na diminuição do risco à cárie dentária, de alta evolução em crianças na faixa de 0 a 6 anos de idade, e que a escola de educação infantil se mostra como local privilegiado para o desenvolvimento de programas de educação e prevenção em saúde bucal, uma vez que reúne crianças com e sem acesso aos cuidados odontológicos privados. Com base nessa perspectiva o objetivo deste trabalho foi descrever a experiência de educação em saúde bucal em escola privada de educação infantil em Cabo Verde, África.Descritores: Educação Infantil; Educação em Saúde; Saúde Bucal.ReferênciasMinistério da Saúde. Plano Multisectorial de Prevenção e Controlo de Doenças Não Transmissíveis de Cabo-Verde. Cidade da Praia, Junho de 2014 , Cabo Verde. Disponível em: https://www.iccp-portal.org/system/files/plans/CPV_B3_PMPCDNT_VFINAL_02.07.2014.pdfAcesso em:Country Meters. Disponível em: https://countrymeters.info/pt/Cape_Verde. Acesso em 03 de janeiro de 2019.Who-Afro. African Health Observatory. Data & statistics health situation analysis african health monitor atlas publications. Disponível em: http://www.aho.afro.who.int/profiles_information/index.php/Cape_Verde:Oral_health_and_noma/pt. Acesso em 03 de janeiro de 2019.Garbin C, Garbin A, Dos Santos K, Lima D. Oral health education in schools: promoting health agents. Int J Dent Hyg. 2009;7(3):212-16.Rozier RG, Sutton BK, Bawden JW, Haupt K, Slade GD, King RS. Prevention of early childhood caries in North Carolina medical practices: implications for research and practice. J Dent Educ. 2003; 67(8):876-85.Loupe MJ, Frazier PJ. Knowledge and attitudes of schoolteachers toward oral health programs and preventive dentistry. J Am Dent Assoc. 1983;107(2):229-34.Paiva SM, Gonçalves DHA, Péret LRCA. Promoção de saúde bucal: programa implantado em escolares da região leste de Belo Horizonte. Rev Saúde em Debate. 1992;37:36-9.Santos PA, Rodrigues JÁ, Garcia PPNS. Avaliação do conhecimento dos professores do ensino fundamental de escolas particulares sobre saúde bucal. Rev Odontol UNESP. 2002; 31(2):205-14.Wyne AH, Al-Ghorabi BM, Al-Asiri YA, Khan NB. Caries prevalence in Saudi primary schoolchildren of Riyadh and their teachers’ oral health knowledge, attitude and practices. Saudi Med J. 2002;23(1):77-81.Ferreira JMS, Massoni ACLT, Forte FDS, Sampaio FC. The knowledge of oral health of undergraduate students of Pedagogy. Interface (Botucatu). 2005;9(17):381-88.Garbin CAS, Garbin AJI, Santos KT, Hidalgo LRC, Moimaz SAS. Conhecimento sobre saúde bucal por concluintes de pedagogia. Trab Educ Saúde. 2012;10(3):453-62.Miller FY, Lautar CJ, Meyer JM, Summers DG. Achieving autonomy in dental hygiene practice through a school-based oral health program. J Den Hyg. 2006;80(1):28-8.