North Carolina Medical Journal最新文献

Background: Occupational exposure to toxic substances has been associated with cancer. Including industry and occupation (I/O) in cancer surveillance can help identify potential links between occupational exposures and cancers using data already collected to monitor statewide cancer trends. I/O reporting is required in cancer registries and recently in death records. In this study, we examined the completeness of I/O information in North Carolina cancer and death certificate data.

Methods: The North Carolina Central Cancer Registry (NC CCR) is the sole repository of North Carolina cancer incidence data. NC CCR (2020-2021) and death certificate data (2020-2022) were analyzed for completeness of I/O. NC CCR incidence records for 1995-2021 diagnoses were linked to North Carolina death files (2020-2022).

Results: NC CCR data had I/O in 17% to 51% of the cases, depending on cancer type. I/O was included in 41% of 2020 death certificates and increased to a 99.9% inclusion in 2021 and 2022 death certificates. In 2020, 20,018 (18%) of 109,677 total deaths matched with a cancer record during NC CCR data linkage. In 2021, 20,225 (16%) of 119,237 total deaths matched with a cancer record, and in 2022, 20,367 (17%) of 116,406 total deaths matched to a cancer record.

Limitations: Data presented here only examine the completeness of 10 cancer types that the NC CCR regularly analyzes using the most recent data available (2021).

Conclusion: Health care providers should routinely record I/O using the standards explained in the training for providers on I/O data collection, provided by the North Carolina Department of Health and Human Services, and should increase their frequency of reporting I/O to NC CCR. Death certificate data may provide I/O data for individuals whose information is missing from cancer registry data.

Background: Every county in North Carolina must include a board of health (BOH) with specific prescribed duties and powers. It is unclear how BOHs in North Carolina are currently exercising their governance ability. In 2012, the North Carolina General Assembly provided coun-ties with additional flexibility to select among different configurations for their local health department (LHD). The impact of this flexibility on the governance and service delivery of LHDs is yet to be explored.

Methods: We conducted semi-structured interviews with LHD directors and BOH members to assess the strengths and weaknesses of BOHs within different local public health configurations across North Carolina. We employed conventional content analysis to derive themes from the interview transcripts.

Results: BOHs were largely described as an underutilized institution, with few BOHs noted to be active beyond satisfying their required legal duties. Strong BOHs were noted to fulfill three identities on behalf of the LHD: an advocate, a bridge, and an advisor. The majority of interviewees desired to work in a standalone county health department (as opposed to a consolidated human services agency) with an appointed (versus elected) board of health. This configuration was preferred because, according to participants, it is more likely to enable a structural focus on public health initiatives.

Limitations: Our sample frame did not control for the length of time an interviewee had been in the office nor the professional background of each BOH member.

Conclusions: Wide variations exist in the exercise of BOHs across the state, partially due to how different LHD configurations structurally focus resources and attention on public health.

This article examines the evolving role of local health departments in North Carolina's opioid crisis response. Highlighting strategies like community mobilization, data prioritization, and regional partnerships, it illustrates the impact of opioid settlement funds in empowering local health departments to manage behavioral health systems and implement effective opioid abatement interventions.

The recently created North Carolina Center on the Workforce for Health can help to ensure an adequate oral health workforce to appropriately meet the dental care needs of all our state's residents.

Teledentistry is a valuable technology tool that supports dental professionals in improving access to oral health care. Technological infrastructure, workforce availability, staff readiness, reimbursement, and patient population served must all be considered when implementing teledentistry.

Background: In this study, we aimed to examine postpartum health care utilization and identify gaps in care among a postpartum Medicaid population of patients diagnosed with opioid use disorder (OUD) during pregnancy.

Methods: We queried North Carolina Medicaid medical and pharmacy claims to identify individuals with a live delivery and evidence of OUD during pregnancy from 2015 to 2019. We examined any evidence of postpartum health care utilization and evidence of medications for OUD (MOUD) during postpartum. We also determined the impact that 4 factors may have had on these outcomes: type of Medicaid coverage (Medicaid for Pregnant Women as compared to other types of Medicaid coverage), rurality, race, and the prenatal use of MOUD. Descriptive statistics, Kaplan-Meier curves with log-rank tests, and negative binomial regression were used.

Results: Of the 6,186 individuals in the study, 84.5% were White, 29.6% lived in rural areas, and 35.0% had MPW coverage. Of the sample, 77.4% sought health care services during the postpartum period. In the multiple negative binomial regression model, individuals who were MPW beneficiaries, non-White, lived in rural areas, and had no evidence of prenatal MOUD all had significantly lower rates of postpartum health care utilization. Of the sample, 53.6% had evidence of MOUD utilization during the postpartum period. We found that patients with MPW continued MOUD at much lower rates compared to patients with other forms of Medicaid (86% versus 93% at 60 days; 57% versus 78% at 180 days, respectively).

Limitations: Limitations to this analysis are inherent to administrative claims data, such as misclassification of outcomes and covariates, as well as loss to follow-up.

Conclusions: Significant gaps in health care use remain across type of Medicaid coverage, race, geographic setting, and prenatal care access.

How did we let the mouth get separated from the rest of the body? And more importantly, how do we put oral health back into overall health? This issue of the NCMJ highlights recent efforts to develop strategies to create an accessible, sustainable, and equitable care delivery system in North Carolina.

This article explores the transformative impact of peer support specialists in creating communities where recovery is not only possible but probable. It focuses on the innovative approach of Wilkes Recovery Revolution, Inc. in addressing substance use disorders and the critical integration of harm reduction services to enhance current recovery efforts.

Untreated behavioral health conditions among the perinatal population are associated with high mortality and morbidity. We examined trends of behavioral health conditions and treatment received by perinatal Medicaid beneficiaries and described the characteristics of providers treat-ing these beneficiaries from 2017 to 2022. Results indicated that 24.4% of beneficiaries had a behav-ioral health diagnosis, 13.8% received a psycho-tropic prescription, and 7.1% received a behavioral health service.