Associations Between Social Vulnerability and Providing Evidence-Based Diabetes Prevention and Management Activities in South Carolina, 2019.

We assessed associations between social vulnerability (ie, external stressors negatively affecting communities) and the provision of evidence-based diabetes prevention and management activities (eg, National Diabetes Prevention Program) in South Carolina counties with high burdens of diabetes and heart disease. These associations were examined by using relative risk estimation by Poisson regression with robust error variance. Results suggest that social vulnerability may have differential effects on the provision of evidence-based diabetes prevention and management activities in South Carolina. Findings support calls to identify upstream social factors contributing to adverse health outcomes and provide several potential points for intervention.

Assessment of Chronic Disease Management Strategies Among Health Care Practices in Medically Underserved South Carolina Counties.

Diabetes and heart disease are among the leading causes of death and disability in the United States, and these conditions are especially prevalent in the South. South Carolina's persistent racial and socioeconomic disparities in chronic disease outcomes are well-documented, yet little is known about how health care practices in medically underserved areas are addressing these challenges. Data were collected through a cross-sectional survey as part of two complementary 5-year cooperative agreements between the Centers for Disease Control and Prevention and the Division of Diabetes and Heart Disease Management (the Division) at the South Carolina Department of Health and Environmental Control. The Division fielded a survey to (a) assist in determining which Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) were best poised to implement specific strategies as part of these cooperative agreements and (b) provide data to establish the baseline for performance measures. FQHCs and RHCs in the top 25% of counties with the highest diabetes and heart disease burden were surveyed about eight domains: staffing/services, electronic health records, team-based care policies, lifestyle change programs, medication therapy management, telehealth, quality improvement collaboratives, and patient demographics. Data representing 71 practices revealed contrasts between RHCs and FQHCs and opportunities for improvement. For example, while most practices reported they were not implementing evidence-based lifestyle change programs (e.g., the National Diabetes Prevention Program), most RHCs and FQHCs expressed interest in starting such programs. Findings are being used to guide efforts to improve diabetes and heart disease prevention and management in South Carolina.

An Analysis of the Social Determinants of Health in South Carolina's I-95 Corridor.

BACKGROUND: One in four South Carolinians lives in a county along a nearly 200-mile stretch of Interstate 95 (I-95). Stretching from North Carolina to Georgia, this region is among the most rural, economically depressed, and racially/ethnically diverse in the state. Research is needed to identify social factors contributing to adverse health outcomes along the I-95 corridor, guide interventions, and establish a baseline for measuring progress. This study assessed social determinants of health in counties in South Carolina's I-95 corridor relative to the rest of the state. METHOD: Data for South Carolina's 46 counties were extracted from the Centers for Disease Control and Prevention Minority Health Social Vulnerability Index (SVI), which grouped 34 census variables into six themes: socioeconomic status, household composition and disability, minority status and language, housing type and transportation, health care infrastructure, and medical vulnerability. Each theme was ranked from 0 (least vulnerable) to 1 (most vulnerable). Measures between regions were compared using the Wilcoxon-Mann-Whitney test. RESULTS: Compared with counties outside the I-95 corridor (n = 29), counties in the corridor (n = 17) scored higher on socioeconomic status vulnerability (.67 and .82, respectively) and medical vulnerability (.65 and .79, respectively). No statistically significant differences were found across other themes. CONCLUSION: Identifying social determinants of health in South Carolina's I-95 corridor is a crucial first step toward alleviating health disparities in this region. Interventions and policies should be developed in collaboration with local stakeholders to address distal social factors that create and reinforce health disparities.

Expanding Opportunities for Data Dissemination Through Collaborative Writing Teams in Public Health Practice Settings.

Government health departments at all levels make meaningful contributions to advancing the public health of communities, yet state health departments lack the time and infrastructure to share their findings with the broader scientific community. To address this gap in data dissemination, the South Carolina Department of Health and Environmental Control developed a "collaborative writing team" (CWT) pilot. As part of this pilot program, teams of staff members leveraged existing data to advance the public health knowledge base, with an emphasis on public health practice. The six steps of the CWT included (1) identify team members' skills/strengths, (2) discuss available data, (3) determine opportunities to share data, (4) divide responsibilities based on team members' strengths, (5) write and submit product, and (6) debrief. Between December 2019 and November 2020, the team had six abstracts accepted to two national conferences, one abstract accepted to a state public health conference, and one editorial published in a peer-reviewed journal. Feedback from participants indicated that self-efficacy in areas including writing, project facilitation, and analysis had increased among team. CWTs are a framework for people working within public health practice settings to disseminate findings.

Vaginal versus cesarean delivery for breech presentation in California: a population-based study.

OBJECTIVE: To examine the population-based pregnancy outcomes associated with vaginal breech delivery. METHODS: A retrospective, population-based cohort study of all term (greater than 37 weeks' gestation), normal birth weight (2.5-3.8 kg), nonanomalous newborns in California, from January 1, 1991 to December 31, 1999 was performed. Neonatal mortality and major neonatal morbidity were compared by route of delivery for cephalic (3,271,092) and breech (100,730) presentations. RESULTS: More than 3.2 million singleton term newborns were identified during the study period, with 100,667 (3%) in breech presentation at the time of delivery. Of these, 4952 women (4.9%) had vaginal breech delivery, whereas 60,418 women delivered by cesarean without labor, and 35,297 women underwent cesarean in labor. Breech vaginal delivery in nulliparous women was associated with increased neonatal mortality (odds ratio [OR] 9.2, 95% confidence interval [CI] 3.3, 25.6) and morbidity (asphyxia: OR 5.7, 95% CI 4.5, 7.3; brachial plexus injury: OR 33.9, 95% CI 15.2, 76.1; and birth trauma: OR 5.8, 95% CI 4.7, 7.1) compared with breech delivery by prelabor cesarean in nulliparous women. In breech-presenting women with one prior vaginal delivery, neonatal mortality was not different between groups, but morbidities (asphyxia: OR 3.9, 95% CI 3.0, 5.1; brachial plexus injury: OR 22.4, 95% CI 9.9, 50.5; and birth trauma: OR 4.2, 95% CI 3.4, 5.3) remained increased for vaginal compared with cesarean delivery. CONCLUSION: The "normal" term breech fetus, when delivered vaginally, had significantly increased neonatal mortality (in nulliparous women) and morbidity (all breech deliveries), when compared with the breech fetus delivered by cesarean, which suggests that these patients might best be delivered by cesarean to avoid these adverse outcomes.