Body Mass Index and Uterine Fibroid Development: A Prospective Study.

Objective: Fibroids are hormonally dependent uterine tumors. The literature on adiposity and fibroid prevalence is inconsistent. Previous work usually combined all those with a body mass index (BMI) ≥30 kg/m2 into a single category and relied on clinically diagnosed fibroids, which misclassifies the many women with undiagnosed fibroids.

Dental Care During the COVID-19 Pandemic: Patient Perceptions of Barriers to Dental Care, COVID-19 Safety Precautions, and Administration of the COVID-19 Vaccine at the Dental Office.

Background: The Mountain Area Health Education Center (MAHEC) Dental Health Center sought to learn how COVID-19 affected dental care attainment and patient perceptions of appropriate safety measures, as well as their acceptance of the dental office as a site for COVID-19 vaccinations.

Methods: A cross-sectional online survey of dental patients was performed to inquire about barriers to care, safety precautions, including COVID-19 testing, and the acceptability of vaccination for COVID-19 in the dental office. All adult patients of the MAHEC Dental Health Center with an email address on file and a clinic visit in the past year were randomized for inclusion.

Descriptive Assessment of Race, Ethnicity, Comorbidities, and SARS-CoV-2 Infection- Fatality in North Carolina.

Background: SARS-CoV-2 infection has caused variable clinical outcomes including hospitalization and death. We analyzed state-level data from the North Carolina COVID-19 Surveillance System (NC COVID) to describe demographics of those infected with SARS-CoV-2 and to describe factors associated with infection-fatality in North Carolina.

Methods: This was a retrospective cohort study using surveillance data on positive SARS-CoV-2-infected individuals (N = 214,179) identified between March 1, 2020, and September 30, 2020.

Association of prenatal stress with distance to delivery for pregnant women in Western North Carolina.

Purpose: Rural areas throughout the US continue to see closures of maternity wards and decreasing access to prenatal and intrapartum care. Studies examining closure's impacts have demonstrated both positive and negative effects on maternal and neonatal outcomes of mortality and morbidity. Our study aims to build on growing evidence from Canada and Scandinavia that suggests increased travel time to give birth is associated with increased emotional and financial stress for rural pregnant women.

Vitamin D and uterine fibroid growth, incidence, and loss: a prospective ultrasound study.

Objective: Fibroid treatments that have few side-effects and can preserve fertility are a clinical priority. We studied the association between serum vitamin D and uterine fibroid growth, incidence, and loss.

Design: A prospective community cohort study (enrollment 2010-2012) with 4 study visits over 5 years to conduct standardized ultrasounds, measure 25-hydroxyvitamin D (25(OH)D), and update covariates.

Rural-urban outcome differences associated with COVID-19 hospitalizations in North Carolina.

People living in rural regions in the United States face more health challenges than their non-rural counterparts which could put them at additional risks during the COVID-19 pandemic. Few studies have examined if rurality is associated with additional mortality risk among those hospitalized for COVID-19. We studied a retrospective cohort of 3,991 people hospitalized with SARS-CoV-2 infections discharged between March 1 and September 30, 2020 in one of 17 hospitals in North Carolina that collaborate as a clinical data research network.

Primary Care Practices in Western North Carolina: Adaptation to the COVID-19 Pandemic and Ongoing Challenges.

Introduction: The COVID-19 pandemic has created unique challenges for primary care practices while also highlighting their importance in the pandemic response. To understand primary care practice needs, a survey was conducted of practices in Western North Carolina.

Methods: Phase 2 of a primary care needs assessment was administered to 63 practices in Western North Carolina over the course of six weeks, from July 23 to August 31, 2021.

An Evaluation of Twice-Daily Dosing of Caffeine for Apnea of Prematurity.

Objective: Preterm infants often require caffeine for the treatment of apnea. While the maintenance dose of caffeine citrate is usually administered once daily per FDA labeling, many providers administer the maintenance dose in two divided doses. This study evaluated the effectiveness of a twice daily dosing regimen of caffeine for apnea of prematurity.

Exploration of the Effects of Rural Obstetric Unit Closures on Birth Outcomes in North Carolina.

Purpose: Closures of rural labor and delivery (L/D) units have prompted national and state-based efforts to assess the impact on birth outcomes. This study explores local effects of L/D closures in rural areas of North Carolina (NC).

Methods: This is a retrospective cohort study of birth outcomes of 4,065 women in 5 rural areas of NC with L/D unit closures between 2013 and 2017.

Exploratory Analysis of Impact of Gabapentin on Incidence of Postoperative Nausea and Vomiting in Patients Undergoing Knee and Hip Arthroplasty With Neuraxial Anesthesia.

The incidence of postoperative nausea and vomiting (PONV) is unknown in neuraxial anesthesia for orthopedic surgery. The effect on PONV of adding gabapentin to an evidence-based antiemetic regimen as part of an opioid-sparing analgesic protocol is also unknown in this population. A retrospective analysis of all adults undergoing hip and knee arthroplasty and receiving neuraxial anesthesia in 2017 was conducted.

Early Comfort Care Following Operative Intervention for Traumatic Injury.

Background: Several studies have described the population of adult trauma patients who undergo withdrawal of life-sustaining treatments (WLST); however, no study has looked specifically at trauma patients who undergo WLST following surgery.

Methods: This was a retrospective chart review of all trauma patients who underwent surgery at our trauma center between January 1 and December 31, 2017. Demographics were collected along with injury patterns and advance directives.

Exploration of the STOP Act and Opioid Deaths in North Carolina, 2010-2018.

To examine the impact of North Carolina's 2017 Strengthening Opioid Misuse Prevention (STOP) Act on opioid overdose deaths. We used quarterly data from the North Carolina Opioid Dashboard to conduct an interrupted time series analysis ranging from 2010 to 2018. Results were stratified by heroin-fentanyl deaths and other opioid deaths.

COVID-19 Needs Assessment and Support for Primary Care Practices in Western North Carolina.

Background: It is critical to ensure that Primary Care Providers (PCPs) have adequate personal protective equipment (PPE), supplies, training, staffing, and contingency planning during pandemics, particularly in rural areas. In March 2020, during the onset of the COVID-19 pandemic, the Mountain Area Health Education Center (MAHEC), in collaboration with the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill, rapidly created and conducted a needs assessment of PCPs in western North Carolina (WNC).

Balloon-assisted remote external iliac artery endarterectomy: A safe and durable technique for the treatment of iliac artery occlusive disease.

Background: Historically, the treatment of iliac artery occlusive disease required a surgical bypass usually consisting of an aortobifemoral bypass or an iliofemoral bypass. With the advent of balloon angioplasty and stenting, these procedures are frequently replaced with endovascular options. However, the treatment of diffuse occlusive disease of the external iliac artery (EIA) using balloon angioplasty and/or stenting does not carry a favorable long-term patency rate.

Implementing pharmacogenetic testing in rural primary care practices: a pilot feasibility study.

Assess feasibility and perspectives of pharmacogenetic testing/PGx in rural, primary care physician (PCP) practices when PCPs are trained to interpret/apply results and testing costs are covered. Participants included PCPs who agreed to training, surveys and interviews and eligible patients who agreed to surveys and testing. 51 patients from three practices participated.

Patient Engagement in Type 2 Diabetes: A Collaborative Community Health Initiative.

Purpose The purpose of this study was to describe the effects of an innovative rural community-based, diabetes self-management education and support (DSMES) program on patient behaviors and outcomes. Methods A 12-month pre-post study design with physiological data collection at program initiation, 16 weeks, and 6 and 12 months postenrollment was used for program assessment. The program consisted of an American Diabetes Association-accredited curriculum provided by the hospital and interfaced with a YMCA curriculum promoting lifestyle change.

The Clinical Functional Impairment Scale Development.

Objective: The purpose of the project was to review content validity and assess the span of responses for the newly developed Clinical Functional Impairment Scale (CFIS).

Methods: A cross-sectional, content validity process using focus groups of developmental, behavioral pediatric clinicians was conducted. After qualitative analysis of the focus group data, adjustments were made in the CFIS based on the recommendations of the content experts.

Pharmacist-Provided Medication Management in Interdisciplinary Transitions in a Community Hospital (PMIT).

Background: Medication management during transitions of care (TOC) impacts clinical outcomes. Published literature on TOC implementation is increasing, but data remains limited regarding the optimal role for the inpatient pharmacist, particularly in the community health setting.

Objective: To evaluate the impact of a dedicated inpatient TOC pharmacist on re-presentations following discharge.

Intra-Arterial Therapy for Acute Stroke and the Effect of Technological Advances on Recanalization: Findings in a Community Hospital.

Background: Recent randomized controlled studies have shown improvement in recanalization outcomes when physicians use the latest intra-arterial therapy devices in patients with acute, large-vessel, intracranial occlusions. The goal of this study was to explore how new procedures affected degree of and time to recanalization at a single center over the past 12 years as technology has improved.

Methods: Patients were included in the study if they had a large or medium intracranial vessel occlusion and had undergone intra-arterial therapy for acute stroke during the period 2002-2013.

Outcomes associated with postoperative delirium after cardiac surgery.

Background: Delirium after surgery is a common condition that leads to poor outcomes. Few studies have examined the effect of postoperative delirium on outcomes after cardiac surgery.

Objectives: To assess the relationship between delirium after cardiac surgery and the following outcomes: length of stay after surgery, prevalence of falls, discharge to a nursing facility, discharge to home with home health services, and use of inpatient physical therapy.

The association of health literacy with time in therapeutic range for patients on warfarin therapy.

Patients on warfarin therapy need to achieve and maintain anticoagulation control in order to experience the benefits of treatment while minimizing bleeding risk. Low health literacy skills may hinder patients' ability to use and adhere to warfarin in a safe and effective manner. The authors conducted this study to evaluate the relationship between health literacy and anticoagulation control among patients on chronic warfarin therapy.

Incidence and progression of cervical lesions in women with HIV: a systematic global review.

Global data on cervical lesion incidence and progression in HIV-positive women are essential for understanding the natural history of cervical neoplasia and informing screening policy. A systematic review was performed summarizing the incidence and progression of cervical lesions in HIV-positive women. Of 5882 HIV-positive women from 15 studies, incidence ranged from 4.

High-grade endometrial cancer: revisiting the impact of tumor size and location on outcomes.

Objective: Research on tumor size (TS) and intracavitary tumor location in endometrial cancer has focused primarily on low-grade tumors. Data in patients with high-grade histology are limited. Our goal is to determine if TS or lower uterine segment (LUS) involvement, is associated with nodal disease and recurrence in women with high-grade endometrial cancer.