North Carolina Medical Journal最新文献

Local governments have been given direct control over a substantial amount of opioid settlement funding. While state-level data sources are valuable inputs, city and county leaders should consider local data sources when making decisions to ensure timely responses to emerging threats, as is exemplified by the rise of xylazine.

With this issue, the North Carolina Medical Journal ceases to publish in print and will appear exclusively online. The NCMJ will reach back almost 175 years to our founding in 1849 and will once again focus on peer-reviewed original research. Dr. Ronny Bell assumes to role of Editor-in-Chief.

School-based oral health programs are an effective approach to population-based care and a stalwart of public health, especially in rural and underserved communities. Lessons learned during the COVID-19 pandemic have informed contemporary strategies and policies to ensure integration into the delicate dental safety net in the Carolinas.

Work remains in North Carolina to effectively increase access to oral health care and address the maldistribution of the dental workforce. This study provides updated data on the oral health workforce (from 2000 to 2022) in response to the recommendations outlined in the North Carolina Institute of Medicine Oral Health Transformation Task Force report.

This perspective piece focuses on the impact that cultural influences have on oral health and underscores the need for culturally attuned care. It explores how integrating cultural elements into patient care can enhance health outcomes and offers a spectrum of recommendations for incorporating culturally attuned practices at various levels.

Background: This study surveyed family medicine residents in North Carolina regarding the state of nutrition education in their residency training. In addition, the survey explored comfort levels with, and attitudes about, discussing nutrition with patients.

Methods: We administered an online questionnaire to family medicine residents in North Carolina (n = 384) asking about their history of nutrition training and their current attitudes about nutrition. The 24-item survey included both Yes and No and Likert-scale responses.

Results: All but one resident had received formal or informal nutrition training during their medical education. Residents overwhelmingly considered nutrition to be an important component of health care, although a majority felt physicians are inadequately trained in nutrition. Feeling comfortable discussing nutrition with patients regarding specific health conditions varied from 45% (gastrointestinal concerns) to 94% (cardiovascular disease) or 95% (diabetes) among residents.

Limitations: The volunteer sampling method used in the study may limit generalizability of the study findings to a broader population of family medicine residents. In addition, precisely defining "formal" and "informal" nutrition training on the survey questionnaire would help to clarify the role of nutrition education in shaping resident attitudes and practices.

Conclusion: This study shows that family medicine residents recognize the importance of nutrition education but do not feel adequately trained to provide it to patients. Given the abundance of evidence linking nutrition and health as well as an apparent interest among family medicine residents in nutrition education, this study supports the integration of nutrition training in medical education. Suggestions for how to accomplish this objective are provided.

North Carolina, like much of the country, has seen a sig-nificant increase in substance use disorders and overdose deaths. This issue of the journal outlines how our state is managing funds from opioid settlements through collabora-tive partnerships among policymakers, public health, health care providers, and communities.

Effective oral health-related policymaking and program implementation rely on comprehensive, accurate, and timely data. This commentary will address the lack of data available and the need for a robust data dashboard, in addition to the importance of community water fluoridation.

Background: Academic health centers (AHCs) have traditionally focused on 3 core missions: patient care, research, and education. The current changing health care environment requires AHCs to broaden their focus to improve the health of their communities. This study reports the opportunities and challenges for the 5 North Carolina AHCs addressing social determinants of health (SDOH).

Methods: We used a mixed methods design. We analyzed financial data from systemwide community benefits reports and the Form 990 Schedule H of the primary medical centers (when available) from the 5 AHCs, and we conducted 4 key informant (KI) interviews at each of the 5 AHCs for a total of 20 interviews.

Results: Overall, AHCs spend a very small percentage of their total spending on community improvement services and community benefit operations. By far, the largest amount spent on community benefit is for treating patients eligible for charity care. Food insecurity and access to health care were the most addressed SDOH. Housing was viewed as a crisis that needed to be addressed at statewide and national levels.

Limitations: Community benefits reports from North Carolina AHCs lack important details. Key informant interviews provide far more recent information on the quantity and breadth of initiatives than the latest community benefits reports that were all completed pre-pandemic. We only interviewed 4 stakeholders from each AHC in North Carolina.

Conclusion: A new strategic vision must incorporate social accountability into the AHCs' core missions to remove barriers and institute and sustain change, but the AHCs face a steep challenge to incorporate social accountability at a core mission level.

North Carolina has adopted managed care for administration of its Medicaid program for management of medical benefits. The North Carolina Medicaid dental program, however, continues to be administered through a traditional fee-for-service model. This article addresses what a managed care model for Medicaid dental could look like in North Carolina.