Literatura académica sobre el tema "North Carolina Health Professions Data and Analysis System"

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.

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.

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

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.

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.

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.

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.

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.