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North Carolina Medical Journal, Volume 82, pp 309-310; https://doi.org/10.18043/ncm.82.5.309

Abstract:
As Dr. Sarah Taylor Morrow reaches her 100th year, her impact on health care in North Carolina and across the United States continues to be celebrated by those who worked with her and those who were inspired by her example.
, Nancy Crego, Christian Douglas, Gary Rains, Emily Bonnabeau, Terri DeMartino, Nirmish Shah, Paula Tanabe
North Carolina Medical Journal, Volume 82, pp 312-320; https://doi.org/10.18043/ncm.82.5.312

Abstract:
BACKGROUND Sickle cell disease (SCD) is a complex disease associated with many complications and a shortened lifespan. In 2016, the National Heart, Lung and Blood Institute funded 8 centers in the United States to form the Sickle Cell Disease Implementation Consortium, with the goal of improving SCD care. The aim of our study was to describe SCD self-efficacy, pain interference, and barriers to care from the perspective of persons with SCD in the North Carolina center. METHODS Persons with SCD, aged 15 and older were recruited from a large SCD center in North Carolina. Surveys, focus groups, and interviews were completed. RESULTS Fifty-one people completed a survey, and 14 people completed an interview or focus group. Barriers identified in the survey included self-care barriers, misconceptions related to hydroxyurea (an oral medication that reduces rates of pain crisis), limited provider knowledge, and stigma. Concerning self-efficacy, participants reported that they were able to manage their pain symptoms most of the time. Pain interfered most with the ability to participate in social and day-to-day activities. Common themes from the focus groups and interviews included misconceptions about hydroxyurea, pain, provider knowledge, stigma, co-management, transportation, and insurance. Recommendations to improve care included the use of case managers, utilization of treatment guidelines, individualized pain protocols, and effective co-management by providers. LIMITATIONS Participants were recruited from 1 SCD center and may not be representative of the entire SCD population in North Carolina. CONCLUSIONS Participants described many perceived barriers to care, and their responses suggest a need for improvements in patient hydroxyurea education, provider knowledge, and care coordination.
Tina D. Tailor, Norma E. Farrow, Junheng Gao, Kingshuk R. Choudhury,
North Carolina Medical Journal, Volume 82, pp 321-326; https://doi.org/10.18043/ncm.82.5.321

Abstract:
BACKGROUND Low-dose chest CT (LDCT) is the only effective screening test for lung cancer. Annual lung cancer screening (LCS) is recommended by the US Preventive Services Task Force (USPSTF) for individuals at high risk for primary lung neoplasm. METHODS We retrospectively identified patients receiving LCS from January 2016 through March 2018 whose residential addresses were within our health center’s county. We estimated driving distance from the patient’s address to our health center and obtained sociodemographic characteristics from the electronic health record (EHR). The census-tract-level LCS-eligible population size was estimated, and their population characteristics determined via US Census Bureau, Centers for Disease Control and Prevention (CDC), and Behavioral Risk Factor Surveillance System (BRFSS) data. The Cochran-Mantel-Haenszel test was used to determine differences amongst the LCS-eligible and LCS-enrolled populations. Multivariable regression was used to determine the effects of sociodemographic characteristics on LCS eligibility. RESULTS There was modest correlation between census-tract-level LCS-eligible population size and LCS enrollment (r = 0.68, P< .001). 5.9% (364/6185) of the estimated LCS-eligible population in our county received LCS, with census-tract LCS rates ranging from 1.5% to 12.5%. Nonwhite race status (Hispanic and African American) was associated with decreased likelihood of LCS enrollment compared to White race (OR = 95% CI, 0.765 [0.61, 0.95] and 0.031 [0.008, 0.124], respectively). Older age, Medicaid, and uninsured statuses were positively correlated with LCS eligibility (P ≤ .01). LIMITATIONS This analysis comprises a single county. Other LCS facilities within our health system in neighboring counties, as well as individuals receiving LCS outside of our health system, are not captured. CONCLUSIONS The uptake of LCS remains low, with disproportionately lower screening rates amongst Hispanic and African American populations. Medicaid and uninsured patients in our community are also more likely to be LCS-eligible. These populations may be targets for interventions aimed at increasing LCS awareness and uptake.
Peter J. Morris
North Carolina Medical Journal, Volume 82, pp 328-328; https://doi.org/10.18043/ncm.82.5.328

Abstract:
It wasn’t so long ago we sang the praises of unsung heroes, our frontline and essential workers, as they fought a battle against an unseen enemy. That enemy has already killed more Americans than both World Wars combined, plus the Korean and Vietnam conflicts, and the Iranian and Afghan wars.
, Susan R. Mims, David Ellis, Teresa M. Herbert, Stacie Turpin Saunders, Nelle Gregory, Lucretia Stargell, Adrienne Ammerman, Marty L. Stamey, Richard Bunio, et al.
North Carolina Medical Journal, Volume 82, pp 259-265; https://doi.org/10.18043/ncm.82.4.259

, Katherine Peticolas, Erika M. Redding, Amy Ising, Anna E. Waller
North Carolina Medical Journal, Volume 82, pp 237-243; https://doi.org/10.18043/ncm.82.4.237

Abstract:
BACKGROUND Over the last several years, pedestrian fatalities have increased in North Carolina; however, fatalities represent a small proportion of the total number of nonfatally injured pedestrians. Therefore, we linked statewide motor vehicle crash (MVC) and emergency department (ED) visit data to better understand the circumstances and characteristics of pedestrians treated in North Carolina emergency departments (EDs) for injuries related to crashes. METHODS We linked information for pedestrians and bicyclists from 2017 North Carolina police-reported MVCs to population-based ED visit data using hierarchical deterministic methods. RESULTS We linked 45% of pedestrian crash records to ED visit records (N = 1383 incident ED visits). The rate of pedestrians treated in North Carolina EDs for their injuries was 13.6 ED visits per 100,000 person years. For pedestrian injuries treated in North Carolina EDs, rates (per 100,000 person years in parentheses) were higher among men (15.5) and Black pedestrians (22.7) than women (10.6) and White pedestrians (8.2). Sociodemographic characteristics associated with serious injuries included age, sex, race/ethnicity, and expected source of payment for the ED visit. Crash characteristics associated with serious injuries included posted speed limit, ambient light, number of lanes, and striking vehicle type. LIMITATIONS The study involved the use of secondary data, not collected specifically for pedestrian injury surveillance. CONCLUSIONS Pedestrian injuries and fatalities place a considerable burden on the population of North Carolina, especially among persons of color and older adults. Injury prevention programs are actively addressing this problem, but more needs to be done.
, Gabriela M. Maradiaga Panayotti, Leonor Corsino, Irene C. Felsman, Rosa M. Gonzalez-Guarda, Gabriela A. Nagy, Alejandro Peña
North Carolina Medical Journal, Volume 82, pp 278-281; https://doi.org/10.18043/ncm.82.4.278

Peter J. Morris
North Carolina Medical Journal, Volume 82, pp 244-244; https://doi.org/10.18043/ncm.82.4.244

Abstract:
Public health was invented from the scourges of endemic, epidemic, and pandemic infectious diseases years before the world knew of microbes. Our “clinical” thoughts ran more to superstitions and myths, temperaments and humors, and miasmas and mists. Then as now physicians and scientists were mocked for their theories even when they were dead-on right with their recommended practices. Science caught up to explain why they were right.
Michael E. DeWitt, Christopher Scheib, Morgan Jones, Pamela Cowin
North Carolina Medical Journal, Volume 82, pp 284-286; https://doi.org/10.18043/ncm.82.4.284

, C. Hendricks Brown, Paul Lanier, Adam Zolotor, Leah Frerichs, Kristen Hassmiller Lich
North Carolina Medical Journal, Volume 82, pp 229-238; https://doi.org/10.18043/ncm.82.4.229

Abstract:
BACKGROUND Decision makers face challenges in estimating local risk for child maltreatment and how best to prioritize which factors to intervene upon. METHODS Using US Census and survey data for all US counties (N = 3141), we derived US county profiles characterized by the severity of child maltreatment risk factors observed at the county level, such as parental health, health care access, and economic distress. We estimated how five child maltreatment outcomes would vary across the profiles for North Carolina counties (n = 100): total maltreatment reports (including unsubstantiated and substantiated), substantiated neglect, substantiated abuse, whether services were received, and reported child’s race/ethnicity. RESULTS We derived three profiles of county-level child maltreatment risk: high, moderate, and low risk, denoting that predicted risk factors means within profiles were all high, moderate, or low levels compared to counties in other profiles. One risk factor did not follow this pattern: the drug overdose death rate. It was highest in the moderate-risk profile instead of the high-risk profile, as would have been consistent with other factor levels. Moderate-risk counties had the highest predicted rate of child maltreatment reports, with over 20 more reports per 10,000 residents compared to low-risk counties (95% CI, 1.38, 38.86). LIMITATIONS We included only factors for which aggregate, county-level estimates were available, thus limiting inclusion of all relevant factors. CONCLUSIONS Results suggest the need for increased family-based services and interventions that reduce risk factors such as economic distress and drug overdose deaths. We discuss the implications for tailoring county efforts to prevent child maltreatment.
Roy Stein, Kate Roberts, Loftin Wilson, Fred Wells Brason, Sabra Murrow, Brenda Pearson,
North Carolina Medical Journal, Volume 82, pp 302-303; https://doi.org/10.18043/ncm.82.4.302

Peter J. Morris
North Carolina Medical Journal, Volume 82, pp 172-172; https://doi.org/10.18043/ncm.82.3.172

Abstract:
At the turn of this century, historians and scholars looked back to celebrate the public health accomplishments of the previous 100 years. In this issue of the journal, we bridge two centuries to look at 50 years of public health achievement, threat, and opportunity in our own state of North Carolina.
Aditya Santoki,
North Carolina Medical Journal, Volume 82, pp 164-170; https://doi.org/10.18043/ncm.82.3.164

Abstract:
BACKGROUND As antivaccination movements increase in the United States, underlying structural barriers to vaccination are often ignored. This study examines barriers to vaccination in an adult population to uncover factors leading to vaccination rates in underserved populations. METHODS This study was approved by the Duke University Campus Institutional Review Board. Fifty-four patients at the Adult Immunizations Clinic of the Durham County Department of Public Health were interviewed throughout June and July 2019. Subjects were enrolled on a voluntary basis followed by oral consent. Eligible subjects included English-speaking adults receiving vaccines aged 19 or older. Anonymous and confidential interviews were conducted verbally. RESULTS This study found that a large proportion of study participants were referred by their provider to receive vaccines at the health department. It was also found that having a provider appeared to lead to a decrease in vaccine hesitancy. Enhanced patient understanding of vaccines was not necessarily contributing to the apparent decrease in vaccine hesitancy. Patients who understood the importance of public health had the same rate of vaccine hesitancy as those who had no reason for receiving vaccines. LIMITATIONS External validity is limited due to small sample size. CONCLUSIONS Health care providers may play an essential role in reducing vaccine hesitancy. However, increases in vaccine uptake due to provider-level interventions may not necessarily be due to an enhanced understanding of vaccines or their importance to public health.
, Ishaq Winters, Rayan Kaakati, Andrew Lee, Arun Augustine, Nathan Thielman
North Carolina Medical Journal, Volume 82, pp 157-163; https://doi.org/10.18043/ncm.82.3.157

Abstract:
BACKGROUND This study explored the health needs, trends of health care utilization, and barriers to care of a diverse population of refugee children resettled in Durham County, North Carolina. METHODS Researchers conducted a retrospective chart review of 327 pediatric (aged 0-21 years) refugee patients who received care at Lincoln Community Health Center from 2016 to 2018. RESULTS Results describe a low prevalence of infectious diseases, such as human immunodeficiency virus (0%), hepatitis B (2%), and tuberculosis (5%), but a high prevalence of nutritional problems, such as growth stunting (17%), overweight (21%), Vitamin D insufficiency (79% of the 39 tested), and anemia (13%). Subspecialty care was frequently utilized, despite prolonged appointment delays and frequent missed visits. LIMITATIONS Limitations of the study included a small sample size that only considered refugees in one geographic area and one primary care clinic, as well as variability in physician documentation. CONCLUSIONS These findings highlight the need for tailored programs and processes, such as dedicated case management and improved screening practices, in order to facilitate integrated care and promote wellness among this vulnerable group of young refugees.
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