North Carolina Medical Journal最新文献

英文中文

Going Beyond “Thank You for Your Service” 超越“谢谢你的服务”

Q2 Medicine

North Carolina Medical Journal

Pub Date : 2023-11-06 DOI: 10.18043/001c.89170

Peter J. Morris

引用次数: 0

Doing Your Part for National Security: Providing Quality Care to Our Military and Veterans 为国家安全尽自己的一份力量:为我们的军队和退伍军人提供高质量的护理

Q2 Medicine

North Carolina Medical Journal

Pub Date : 2023-11-06 DOI: 10.18043/001c.89172

Margaret Chamberlain Wilmoth

Civilian health professionals can play a significant role in our national security as it relates to medical readiness of the military. Members of the Reserve Component and many Veterans receive their health care in the civilian sector, thus all North Carolina health professionals need to understand the unique issues affecting this population. This issue highlights current challenges facing our military, their families, and our Veterans, and authors offer suggestions for providing quality care to this population.

平民卫生专业人员可以在我们的国家安全中发挥重要作用，因为它关系到军队的医疗准备。预备役人员和许多退伍军人在民用部门接受医疗保健，因此所有北卡罗来纳州的卫生专业人员都需要了解影响这一人口的独特问题。这个问题突出了我们的军队，他们的家庭和我们的退伍军人面临的当前挑战，作者提出了为这一人群提供优质护理的建议。

引用次数: 0

Telehealth Use and Access to Neurology Outpatient Clinical Services for Children: An Observational Cohort Study 远程医疗的使用和获得儿童神经病学门诊临床服务:一项观察性队列研究

Q2 Medicine

North Carolina Medical Journal

Pub Date : 2023-09-21 DOI: 10.18043/001c.88057

Savithri Nageswaran, Annette Grefe, Shyh-Huei Chen, Eric Kirkendall, Edward H. Ip

Background Access to neurology services is important for children’s well-being. We sought to evaluate the effects of telehealth on pediatric neurology appointment outcomes for children. Methods Using electronic health record (EHR) data, information about children with pediatric neurology appointments in a tertiary care children’s hospital in North Carolina was collected. Appointment outcomes (completion, cancellation, and no-show rates) were calculated for children who had a neurology appointment scheduled both in the pre-pandemic (March 10, 2019, to March 9, 2020) and pandemic (March 10, 2020, to March 9, 2021) periods. “Telehealth user” was a child who had at least one telehealth appointment scheduled between March 10, 2020, and March 9, 2021. In bivariate and multivariate analyses, we compared appointment outcomes for telehealth users and non-users. Limitations EHR data were limited to a single institution and could have missed children’s clinical encounters elsewhere. Since this study used secondary data that were not collected for research purposes, it is possible that there were unmeasured confounders. Because of the observational nature of the study, the association between telehealth use and appointment outcomes does not indicate causation. Results A total of 2110 children had 11,194 pediatric neurology appointments scheduled. Telehealth users compared with non-users were more likely to be White, non-Hispanic, have private insurance, and live farther from the children’s hospital. There was a statistically significant decrease in completion (66% versus 57%) and increase in cancellation (27% versus 33%) and no-show (7% versus 10%) rates in the pandemic when compared to the pre-pandemic period. In the pre-pandemic period, telehealth user and non-user groups had similar cancellation and no-show rates. In the pandemic period, there was a statistically significant decrease in cancellation and no-show rates in the telehealth user group when compared to the non-user group. Conclusions Pediatric neurology outpatient clinic visits decreased substantially during the pandemic. Telehealth mitigated these problems. Children belonging to a minority race/ethnicity are less likely to use telehealth, increasing their risk of poor access to neurology services.

获得神经病学服务对儿童的健康至关重要。我们试图评估远程医疗对儿童儿科神经内科预约结果的影响。方法利用电子健康记录(EHR)数据，收集北卡罗莱纳州某三级儿童医院小儿神经内科就诊患儿的信息。计算了在大流行前(2019年3月10日至2020年3月9日)和大流行期间(2020年3月10日至2021年3月9日)安排了神经病学预约的儿童的预约结果(完成、取消和缺席率)。"远程保健用户"是在2020年3月10日至2021年3月9日期间至少预约过一次远程保健的儿童。在双变量和多变量分析中，我们比较了远程医疗用户和非用户的预约结果。局限性EHR数据仅限于单一机构，可能会遗漏其他地方的儿童临床接触。由于本研究使用的二手数据不是为研究目的收集的，因此可能存在未测量的混杂因素。由于该研究的观察性质，远程医疗使用和预约结果之间的关联并不表明因果关系。结果共2110名儿童进行了11194次儿科神经病学预约。与非远程医疗用户相比，远程医疗用户更有可能是白人、非西班牙裔、拥有私人保险、住得离儿童医院更远。与大流行前相比，本次大流行期间完成率(66%对57%)显著下降，取消率(27%对33%)和缺席率(7%对10%)显著上升。在大流行前，远程保健用户和非用户群体的取消和未赴诊率相似。在大流行期间，与非远程保健用户组相比，远程保健用户组的取消和未到诊率在统计上显著下降。结论:大流行期间儿科神经病学门诊就诊人数大幅减少。远程医疗缓解了这些问题。属于少数族裔/族裔的儿童不太可能使用远程保健，从而增加了他们难以获得神经病学服务的风险。

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引用次数: 0

Disparities in Food Security and Glycemic Control Among People with Type 2 Diabetes During the COVID-19 Pandemic COVID-19大流行期间2型糖尿病患者的粮食安全和血糖控制差异

Q2 Medicine

North Carolina Medical Journal

Pub Date : 2023-09-21 DOI: 10.18043/001c.88084

Thanh Tran, Angelica Cristello Sarteau, Cy Fogleman, Laura Anne Young, Elizabeth Mayer-Davis

Background Little is known about the differing impacts of food insecurity on HbA1c by race in type 2 diabetes (T2D). Predictions around increased food insecurity from COVID-19 exacerbating racial disparities led us to estimate its prevalence and associations with HbA1c by race during the COVID-19 pandemic. Methods Data came from medical records and surveys among a clinic-based sample of T2D patients. Linear regression models estimated associations between food insecurity and HbA1c and between change in food insecurity and change in HbA1c. Likelihood ratio tests and examination of stratum-specific estimates assessed effect modification by race. Results Our sample was 59% White, 59% female, and mean age was 60.8 ± 12.6. During the pandemic, food insecurity prevalence and HbA1c were significantly (p < .05) higher among non-Whites (39%, 8.4% ± 2.1) compared to Whites (15%, 7.8% ±1.6). HbA1c among those who were very food insecure was 1.00% (95% CI: 0.222, 1.762, p = .01) higher than those who were food secure. Those with increased food insecurity had a 0.58% (95% CI: 0.024, 1.128, p = .04) higher HbA1c increase than among those experiencing no change. No effect modification was detected. Limitations Convenience sampling in an endocrinology clinic, recall bias, and inadequate power may underlie null effect modification results. Conclusion Although effect modification was not detected, racial disparities in HbA1c and food insecurity warrant further investigation. These disparities, combined with the significant impact of food insecurity on HbA1c, suggest that prioritization of resources to high-risk populations should be considered early during public emergencies to minimize short- and long-term health consequences.

对于不同种族的2型糖尿病(T2D)患者，食物不安全对HbA1c的不同影响知之甚少。关于COVID-19加剧粮食不安全的预测加剧了种族差异，这使我们在COVID-19大流行期间按种族估计其患病率及其与HbA1c的关联。方法数据来源于临床T2D患者的医疗记录和调查。线性回归模型估计了粮食不安全与糖化血红蛋白之间的关系，以及粮食不安全变化与糖化血红蛋白变化之间的关系。似然比检验和层特异性估计的检验评估了不同种族的效果改变。结果本组患者白人59%，女性59%，平均年龄60.8±12.6岁。大流行期间，粮食不安全患病率和糖化血红蛋白显著(p <.05)非白人(39%，8.4%±2.1)高于白人(15%，7.8%±1.6)。食物非常不安全组的糖化血红蛋白比食物安全组高1.00% (95% CI: 0.222, 1.762, p = 0.01)。那些食物不安全状况增加的人的糖化血红蛋白比没有变化的人高0.58% (95% CI: 0.024, 1.128, p = 0.04)。未检测到任何效果修饰。在内分泌门诊方便取样、回忆偏倚和功率不足可能是无效修正结果的基础。结论虽然没有发现效应修饰，但在HbA1c和食品不安全方面的种族差异值得进一步调查。这些差异，再加上粮食不安全对糖化血红蛋白的重大影响，表明在突发公共事件期间应及早考虑将资源优先用于高危人群，以尽量减少短期和长期的健康后果。

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引用次数: 0

COVID-19 Perceptions Among North Carolina Native Americans: Using a Qualitative Approach 北卡罗来纳州印第安人对COVID-19的看法:使用定性方法

Q2 Medicine

North Carolina Medical Journal

Pub Date : 2023-09-21 DOI: 10.18043/001c.88060

Xinyan Shi, SiAhn Mehng, Alice Kay Locklear, Zhixin (Richard) Kang, Tracie Locklear, Mary Beth Locklear, Mary Ann Jacobs, Tammy Maynor, Guanlin Gao, Deepak Kumar

Background COVID-19 has amplified the health and economic disparities in Native American communities. However, there are limited data from Native American populations. This study is the first phase of the Building Resilience And Vital Equity (BRAVE) project, the scope of which is to understand Indigenous perceptions, attitudes, and behaviors about COVID-19 and design and implement culturally sensitive interventions to increase testing and vaccinations among Native American communities. Method We recruited 26 Native Americans and conducted open-ended, semi-structured interviews to explore participants’ perceptions of COVID-19 and related themes, such as needed support, informational sources, trust, communication, and protection of elders. Results The results show that wearing a mask, hand sanitizing, and social distancing had very high support while perceptions of testing and vaccination decisions were mixed. Additionally, two themes stand out: the lack of reliable information resources to learn about COVID-19 and the lack of trust in the government. Limitation This study included a small sample size, which makes it difficult to include participants from diverse demographic backgrounds. Lack of familiarity with the online meeting format and the limited internet access in some indigenous communities may have prevented some people from participating. Conclusion The findings confirmed the need to improve existing public health information infrastructure and helped explain the intensified impact of COVID-19 on the Indigenous marginalized community. The findings help identify the key factors that affect Native Americans’ testing and vaccination decisions and provide guidance on the designs of community intervention programs.

COVID-19扩大了美洲原住民社区的健康和经济差距。然而，来自美洲原住民的数据有限。本研究是“建设韧性和重要公平”(BRAVE)项目的第一阶段，其范围是了解土著对COVID-19的看法、态度和行为，并设计和实施具有文化敏感性的干预措施，以增加美洲土著社区的检测和疫苗接种。方法招募26名印第安人，采用开放式半结构化访谈，探讨参与者对COVID-19及其相关主题的看法，如所需支持、信息来源、信任、沟通和对老年人的保护。结果显示，戴口罩、洗手和保持社交距离得到了很高的支持，而对检测和疫苗接种决策的看法则参差不齐。此外，还有两个突出的主题:缺乏可靠的信息资源来了解COVID-19和对政府缺乏信任。本研究样本量小，难以纳入不同人口背景的参与者。由于对在线会议形式不熟悉，加之一些土著社区的互联网接入有限，可能使一些人无法参加会议。结论研究结果证实了改善现有公共卫生信息基础设施的必要性，并有助于解释COVID-19对土著边缘化社区的影响加剧。这些发现有助于确定影响美洲原住民检测和疫苗接种决策的关键因素，并为社区干预计划的设计提供指导。

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引用次数: 0

Reducing the Risks of Nuclear War: The Role of Health Professionals 减少核战争的风险:卫生专业人员的作用

Q2 Medicine

North Carolina Medical Journal

Pub Date : 2023-09-01 DOI: 10.18043/001c.87533

Kamran Abbasi, Parveen Ali, Virginia Barbour, Kirsten Bibbins-Domingo, Marcel G. M. Olde Rikkert, Richard Horton, Robert Mash, Arun Mitra, Carlos Monteiro, Elena N. Naumova, Eric J. Rubin, Tilman Ruff, Peush Sahni, James Tumwine, Paul Yonga, Chris Zielinski

引用次数: 0

The 2017 North Carolina STOP Act is Associated With an Accelerated Decrease in Opioid Dispensing: A Statewide Analysis, 2013-2019. 2017年《北卡罗来纳州停止法案》与阿片类药物配药加速减少有关：2013-2019年全州分析

Q2 Medicine

North Carolina Medical Journal

Pub Date : 2023-07-01 DOI: 10.18043/001c.84335

Chris Gillette, Amber K Brooks, Gayle B Bodner, Courtney J Perry

Background: This study aimed to: 1) quantify the dispensing and days' supply of opioid prescriptions prior to and after the NC STOP Act went into effect among Medicare Part D beneficiaries; 2) evaluate how the STOP Act impacted physician assistant and nurse practitioner opioid prescribing; and 3) evaluate whether the NC STOP Act is associated with reductions in opioid prescriptions' days' supply among Medicare Part D beneficiaries.

Methods: This was a secondary analysis of Medicare Part D Public Use Files for 2013-2019. Only North Carolina providers and select Schedule II (CII) and III (CIII) drugs and tramadol (CV) were included in the analysis. Multivariable Poisson regression models were used to analyze the data.

Results: In 2013, there were population-adjusted 180,565.2/100,000 claims for the included CII and CIII opioids, which decreased to 79,329.12/100,000 claims in 2019. Each of the multivariable Poisson regression models indicates a reduction in per-provider populationadjusted claims and days' supply after the NC STOP Act went into effect for both selected CII and CIII medications and for tramadol. The results also indicate that the number of prescriptions for CII, CIII, and tramadol decreased over time.

Limitations: Due to the nature of the observational study design, we cannot conclude that the 2017 legislation had an effect on populationadjusted claims for certain CII and CIII opioids.

Conclusions: Since 2013 there has been a decreasing trend in certain CII and CIII opioids dispensations in Medicare beneficiaries, and the trend accelerated after the STOP Act went into effect.

本研究旨在：1）量化《NC STOP法案》生效前后医疗保险D部分受益人的阿片类药物处方的配药和供应天数；2）评估《停止法案》对医生助理和执业护士阿片类药物处方的影响；以及3）评估《NC STOP法案》是否与医疗保险D部分受益人阿片类药物处方“天数”供应的减少有关。这是对2013-2019年医疗保险D部分公共使用文件的二次分析。只有北卡罗来纳州的供应商和选定的附表II（CII）和III（CIII）药物以及曲马多（CV）被纳入分析。采用多变量泊松回归模型对数据进行分析。2013年，经人口调整的包括CII和CIII阿片类药物的索赔数量为1805652/100000，2019年降至79329.12/100000。每一个多变量泊松回归模型都表明，在选定的CII和CIII药物以及曲马多的NC STOP法案生效后，每个提供者经人群调整的索赔和天数减少。结果还表明，CII、CIII和曲马多的处方数量随着时间的推移而减少。由于观察性研究设计的性质，我们不能得出2017年立法对某些CII和CIII阿片类药物的人群调整索赔产生影响的结论。自2013年以来，联邦医疗保险受益人的某些CII和CIII阿片类药物处方呈下降趋势，《停止法案》生效后，这一趋势加速。

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引用次数: 0

Firearm Safety Counseling in Pediatric Primary Care. 儿童初级保健中的枪支安全咨询

Q2 Medicine

North Carolina Medical Journal

Pub Date : 2023-07-01 DOI: 10.18043/001c.81268

Kitty O'Hare, Brian Eichner, John Moses

Injury from firearms is the leading cause of death among children and adolescents in the United States. Prevention requires a multi-pronged approach involving clinicians and policy. One evidence-based method to improve firearm safety is counseling with lock provision. Through sharing our experiences, we aim to inspire more health care practices to adopt firearm safety prevention strategies.

枪支伤害是美国儿童和青少年死亡的主要原因。预防需要临床医生和政策多管齐下的方法。改善枪支安全的一种循证方法是提供锁咨询。通过分享我们的经验，我们旨在激励更多的医疗保健实践采用枪支安全预防策略。

引用次数: 0

Confronting the Infant Formula Shortage: Successes and Lessons Learned for Future Public Health Crises. 应对婴儿配方奶粉短缺：未来公共卫生危机的成功与教训

Q2 Medicine

North Carolina Medical Journal

Pub Date : 2023-07-01 DOI: 10.18043/001c.87528

Charlene Wong, Mary Anne Burghardt, Sara Lang, Kim Lovenduski, Kody Kinsley

引用次数: 0

Transforming Child Health and Family Well-being. 转变儿童健康和家庭幸福

Q2 Medicine

North Carolina Medical Journal

Pub Date : 2023-07-01 DOI: 10.18043/001c.87510

Charlene Wong, Kenya McNeal-Trice

Challenges to child health that pre-dated COVID-19, such as rising rates of child mental health issues, instability in the early care and education system, and food insecurity, accelerated during the pandemic. The health and well-being of children and families have been uniquely and disproportionately impacted. Children are paying the price as our strained child behavioral health, child welfare, and early care and education systems reach breaking points. The solutions that children and families need to recover stronger will require a whole-child and whole-family approach to health that addresses their physical, behavioral, and social needs. The articles in this edition of the NCMJ describe the scope of the challenges facing children and families in North Carolina and approaches to improving their health and well-being in priority areas including behavioral health, child welfare, early care and education, and nutrition.

在2019冠状病毒病之前就存在的儿童健康挑战，如儿童心理健康问题发生率上升、早期护理和教育系统不稳定以及粮食不安全，在大流行期间加剧了。儿童和家庭的健康和福祉受到了独特和不成比例的影响。孩子们正在付出代价，因为我们紧张的儿童行为健康、儿童福利、早期护理和教育系统达到了临界点。儿童和家庭需要的解决办法是更强地恢复，这将需要一个全儿童和全家庭的健康方法，解决他们的身体、行为和社会需求。本期NCMJ的文章描述了北卡罗来纳州儿童和家庭面临的挑战范围，以及在行为健康、儿童福利、早期护理和教育以及营养等优先领域改善他们健康和福祉的方法。

引用次数: 0

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