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PubMed1976

Comparison of hospital admissions for cerebrovascular disease in Michigan and North Carolina.

Hospital admission rates and death rates for cerebrovascular disease differ markedly between states. Hospital admission data were analyzed: (a) to ascertain why death rates from this disease group are lower in Michigan than in North Carolina and (b) to clarify whether hospital care in either state has inadequacies that can be corrected quickly. Among both whites and blacks of the same age, case-fatality ratios were higher in North Carolina than in Michigan. Subarachnoid and cerebral hemorrhages were diagnosed more often in the southern state. For both areas, the records showed a marked underreporting of hypertension and diabetes mellitus as secondary conditions in the hospital admissions; elevated blood pressures were about equally common in each state but were treated more vigorously in Michigan. Secondary diagnoses of respiratory disease and use of anti-infective agents were reported more frequently in North Carolina. In contrast, diabetes mellitus was more prevalent in Michigan admissions. Some reasons for these findings are advanced, particularly as they relate to diagnostic and treatment patterns. Finally, the need for more detailed research is emphasized to create guidelines for better hospital care of cerebrovascular disease.

Aged↗

PubMed2005

Incidence rates and trends for oral and pharyngeal cancer in North Carolina: 1990-1999.

This study describes the incidence of oral and pharyngeal cancer (OPC) in North Carolina (NC) from 1990 to 1999. OPC cases 1990-1999 from the NC Central Cancer Registry were included. Variables included date of diagnosis, county of residence, anatomical site, histology, age at diagnosis, sex, race, stage at diagnosis, grade, tumor behavior, and laterality. The overall average annual rate of OPC was 10.6 cases per 100,000 population. OPC incidence was highest for African-American males and for eastern NC; there was no significant trend in the overall annual incidence rate. Squamous cell carcinoma of the lip increased for white females and other oral cancers decreased among all females. With a few specific exceptions, NCCCR rates were similar to SEER rates. North Carolina continues to have substantial OPC incidence and substantial racial disparities persist.

Adult↗

PubMed1995

Isolation of potosi virus from Aedes albopictus in North Carolina.

A total of 4,169 adult mosquitoes were aspirated from 3 tire disposal sites in North Carolina for virus assays. Aedes albopictus was the dominant species, with a relative abundance of approximately 99%. Potosi virus was isolated from one pool of 68 female Ae. albopictus. Priorities for future Potosi virus research and the implications of the North Carolina isolate are discussed.

Aedes↗

PubMed1997

Tick-raccoon associations and the potential for Lyme disease spirochete transmission in the coastal plain of North Carolina.

Raccoons (Procyon lotor) were live-trapped and examined for ticks from July 1990 to July 1993 in the coastal plain of North Carolina on Marine Corps Base, Camp Lejeune, North Carolina (USA). Five species of ixodid ticks were found on 351 (78%) of 449 raccoons. Amblyomma americanum was the most abundant tick found on raccoons. Dermacentor variabilis, Ixodes texanus, and Ixodes scapularis were frequently collected, while Ixodes cookei were rarely collected from raccoons. Tick burdens were not affected by the age, sex, or trap location of captured raccoons. Ticks parasitizing raccoons had varying seasonal patterns of abundance. Amblyomma americanum were generally collected from raccoons year around, but infestation intensities were greatest in summer from June to September. Dermacentor variabilis adults were most abundant in mid-summer while peak numbers of larvae were collected in the fall. Infestation intensities of Ixodes texanus larvae were greatest in fall and winter months while nymphs were most abundant in winter and spring. No males were collected from raccoons, but females were most frequently collected in the spring and declined in abundance in the summer with no specimens collected in the fall or winter. Numbers of 1. scapularis adults appeared to reach peak numbers in the fall while larvae and nymphs were most abundant on raccoons in winter. Spirochetes, Borrelia burgdorferi, were identified in a small percentage (0.2%) of host-seeking A. americanum nymphs and adults, and I. scapularis adults by immunofluorescent antibody assays. Similarly, a small percentage (1.9%) of host-associated A. americanum, D. variabilis, I. texanus and I. cookei contained B. burgdorferi. Borrelia burgdorferi spirochetes were cultured from the blood of 23 (26%) of 87 raccoons.

Animals↗

PubMed1993

Decline in stroke mortality in North Carolina. Description, predictions, and a possible underlying cause.

Data from the National Center for Health Statistics were used to describe the decline in age-adjusted stroke mortality rates from 1962 to 1987 for North Carolina and for six regions of the state. For the state as a whole, stroke mortality decreased from 0.0050 to 0.0018 (64% decrease) for white males, 0.0039 to 0.0016 (59% decrease) for white females, 0.0072 to 0.0030 (58% decrease) for black males, and 0.0064 to 0.0025 (61% decrease) for black females. Under the hypothesis that the rate of decline in stroke mortality will slow and approach a "floor," a four-parameter logistic model was fit to the data. This model suggests that most of the decline in North Carolina stroke rates had occurred by 1987 and that the rates are now approaching the floor. For example, the estimated 1987 white male stroke mortality rate was 0.00190 and the floor 0.00176, suggesting only a 7% decline in the future. Similar percentage differences between 1987 levels and the floor were estimated for the three other race-gender groups. This analysis also suggested that while the absolute disparity by sex and race decreased between 1962 and 1987, the ratio of black to white mortality rates and the ratio of male to female mortality rates remained relatively constant. Estimates of 1-year case-fatality rates from two surveys of hospitalized stroke patients in a high-mortality five-county region of North Carolina decreased from 51% in 1970 to 38% in 1980. This decrease in stroke fatality rate is sufficient to account for 64% of the decrease in mortality estimated for this region over the same period.

Black People↗

PubMed1995

Potential for respirable quartz exposure from North Carolina farm soils.

Sandy-loam soils from six active farms in the coastal plains of North Carolina (USA) were analyzed for aerodynamic equivalent diameter and quartz content and compared with results to similar analyses of clay soils of the Piedmont and sandy soils from the sand hills of North Carolina to see whether respirable quartz content varies with soil type. The respirable fraction of sandy loam-soils averaged 0.04 (SD 0.02) versus 0.13 (SD 0.03) for clay soils and 0.04 (SD 0.03) for sandy soils. Quartz content in the 4.25 mu m fraction of sandy-loam soils averaged 15.2 (SD 4.1) % versus 2.2 (SD 0.8) % in clay soils and 29.0 (SD 11.1) % in sandy soils. The mass of respirable quartz in sandy-loam soils averaged 0.7 (SD 0.4)% versus 0.3 (SD 0.1)% in clay soils and 1.0 (SD 0.4) % in sandy soils. These results suggest that, during dusty farm activities, there is a potential for greater respirable quartz exposures associated with work with sandy or sandy-loam soils than from work with clay soils.

Agriculture↗

PubMedDate not supplied

Lethal domestic violence in eastern North Carolina.

Strategies for preventing domestic violence can be tailored to a particular geographic or socioeconomic area if the patterns of domestic violence in the area are known. National statistics, although widely available, may not be applicable to a specific region. We reviewed homicide deaths in Eastern North Carolina between 1978 and 1999 to identify patterns in this rural area. Approximately 20% of the homicide deaths in eastern North Carolina are caused by intimate partners. Women accounted for 53% of the victims in 1976, similar to national figures but not rising to 72% as seen nationally in 1998. Latinos are an increasing presence in the area, but had only one recorded episode of lethal violence against an intimate partner. Gunshots accounted for most of the deaths (59% in men, 72% in women). Knowledge of such patterns can assist in selecting prevention strategies for this particular area. Over the last 25 years increasing attention has been devoted to domestic violence (DV), initially defined as abuse committed against a spouse, former spouse, fiancée, boy- or girlfriend, or cohabitant. As time has passed, the definition has been broadened to include other family members--elders, children, and siblings. The Centers for Disease Control and Prevention (CDC) now uses the term "intimate partner violence" for intentional emotional or physical abuse inflicted by a spouse, ex-spouse, a present or former boy- or girlfriend, or date. For the purposes of this paper, we consider DV interchangeable with intimate partner violence. There has been a national concern that abusive events are under-reported. The National Crime Victimization Survey, an anonymous household survey, indicated nearly 1 million incidents of non-lethal intimate partner violence per year between 1992 and 1996. The number decreased from 1.1 million in 1993 to 840,000 in 1996. Attempts to validate such data for a given geographic area often require subjects to violate anonymity--this may account for lower reports of violence. A recent national report from the Justice Department found a decline in both lethal and non-lethal DV. The number of men murdered by wives or girlfriends "plunged 60% from 1976 through 1998". FBI data on homicides showed that "intimate partners committed fewer murders each year during 1996, 1997, and 1998 than in any other year since 1976". Nationally, intimate partners caused 3000 deaths in 1976, 1590 (53%) in women; in 1998, they caused 1830 deaths, 1320 (73%) in women. But fatal cases of DV are only the tip of the iceberg, and may pertain only to a particular geographic area. We undertook the present study to assess the prevalence of lethal domestic violence in the 29 counties of eastern North Carolina (ENC) that make up the catchment area for the University Health Systems of Eastern Carolina (UHSEC). UHSEC includes the Brody School of Medicine at East Carolina University (BSM-ECU; previously known as East Carolina University-SOM) and Pitt County Memorial Hospital.

Cause of Death↗

PubMed1999

Impact of North Carolina's universal vaccine purchase program by children's insurance status.

OBJECTIVE: To examine the impact of a new universal purchase vaccine program on immunization rates of children with different types of insurance. DESIGN: Ecologic study using parent telephone interviews, medical chart abstraction in sites of outpatient care, and insurance verification with Medicaid and private insurers. SETTING: State of North Carolina. PARTICIPANTS: Of a random birth certificate sample of 4385 children born in North Carolina during 1994 and 1995, 507 were excluded. A total of 2767 children had completed parent interviews; 95% of those had medical chart abstraction and insurance data. MAIN OUTCOME MEASURES: Immunization rates at each month during the first 2 years of age, site of delivery for immunizations and well-child visits, and insurance status. RESULTS: In month-by-month comparisons, children born in 1995 had immunization rates 4% to 10% higher than their 1994 counterparts. By 24 months of age, 84% of the 1995 cohort had completed the primary immunization series, compared with 79% of the 1994 cohort (P<.001). In all insurance subgroups, 1995 immunization rates were higher than 1994 rates. The largest increases occurred among privately insured children with no well-child coverage, children who had periods of being uninsured, and children enrolled in Medicaid exclusively or with private insurance. More children in the 1995 cohort received immunizations in the private sector. CONCLUSIONS: Implementation of North Carolina's universal purchase program was associated with improved immunization rates, especially for children with inadequate insurance for well-child care. However, insurance status still influences the ability of children to receive immunizations on schedule.

Adolescent↗

PubMed2006

The use of free resources in a subscription-based digital library: a case study of the North Carolina AHEC Digital Library.

BACKGROUND: The North Carolina (NC) Area Health Education Center's (AHEC) Digital Library (ADL) is a web portal designed to meet the information needs of health professionals across the state by pulling together a set of resources from numerous different sources and linking a pool of users to only the resources for which they have eligibility. Although the ADL was designed with the primary purpose of linking health care professionals to a set of licensed resources, the ADL also contains a significant number of links to free resources. These resources are available to any ADL member logging into their ADL account and to guest visitors to the ADL. While there are regular assessments of the subscription resources in the ADL as to utility and frequency of use, up until this point there has been no systematic analysis of the use of the overall set of free resources. It was decided to undertake an examination of the usage of ADL free resources over a 6-month period to analyze the utility of these resources to both ADL members and guests. METHODS: Each time a resource is accessed through the ADL, it is logged in a table. This study used a SQL query to pull every free resource accessed between November 1, 2005 and April 30, 2006. An additional query also pulled the user information for each free resource accessed. Once the queries of the database were complete, the results were imported into an Excel spreadsheet and analyzed using basic descriptive statistics. RESULTS: The vast majority of resource use through the ADL is to licensed resources. There are 2056 free resource URLs in the ADL, to which 1351 were linked out, meaning there was at least one link out to 65% of the free resources. The single most popular free resource was PubMed with 4803 link outs or nearly 20% of the total link outs to free resources. The breakdown of free resource use by different use groups indicates that the highest percentage of use of free resources was by guests followed by institutional affiliates and AHEC Faculty/Staff. The next 3 highest user groups accessing free resources are: paid members, preceptors, and residents. CONCLUSION: The only free resource capturing a significant number of link outs is the free link to PubMed. This reflects the importance placed on traditional medical literature searching by the ADL clinical user base. Institutional affiliates access free resources through the ADL with the second highest frequency of all the user groups. Finally, in analyzing use of free resources, it is important to note the overall limitations of this survey. While link outs are excellent indicators of frequency of use they do not provide any information about the ultimate usefulness of the resource being accessed. Further studies would need to examine not only the quantitative use of resources, but also their qualitative importance to the user.

Journal Article↗

PubMed1998

A North Carolina macular dystrophy phenotype in a Belizean family maps to the MCDR1 locus.

PURPOSE: To describe the clinical findings of an autosomal dominant macular dystrophy in a family of Mayan Indian ancestry in Belize, Central America, and to determine its molecular genetic relationship with the original North Carolinian family. METHODS: We performed comprehensive ophthalmic examinations on 56 members of a single family living in Chicago, Illinois, and Belize, Central America. Fundus photography and fluorescein angiography were performed on 17 affected subjects and six affected family members were serially examined over a 12-year period. Blood was collected from 26 individuals, and DNA was extracted for genotyping. Two-point linkage, multipoint linkage, and haplotype analysis was performed. RESULTS: In 17 affected individuals, the clinical features were consistent with the diagnosis of North Carolina macular dystrophy. Multipoint linkage analysis generated a peak lod score of 5.6 in the MCDR1 region. The haplotype associated with the disease was, however, different from that of the original North Carolinian family. CONCLUSIONS: This family has an autosomal dominant macular dystrophy that is clinically indistinguishable from North Carolina macular dystrophy (MCDR1). Our findings indicate that the mutated gene in this Belizean family maps precisely to the same region as that of the North Carolina macular dystrophy (MCDR1) locus. This study provides evidence that MCDR1 occurs in various ethnic groups and that there is no evidence of genetic heterogeneity.

Adolescent↗

PubMed2004

Canadian-trained nurses in North Carolina.

Little is known about nurses who leave Canada to work in the US. The main purpose of this study is to gain some insight into the emigration component of nursing supply and demand by comparing characteristics of nurses who left Canada to nurses who stayed. Specifically, Canadian-trained RNs who work in the state of North Carolina are compared to RNs who work in Canada. Results show that there are 40% more Canadian-trained RNs in North Carolina than there are in Prince Edward Island. A higher percentage of Canadian-trained RNs in North Carolina are male, under 40 years of age, have baccalaureate training and graduated less than 10 years ago. Canadian-trained nurses in both countries have very low rates of unemployment. The loss of Canadian-trained RNs to the US is a significant problem, and there is an urgent need to obtain a better understanding of why nurses leave the country.

Adult↗

PubMed1992

Primary amebic meningoencephalitis--North Carolina, 1991.

During September 1991, two children in North Carolina died from primary amebic meningoencephalitis (PAM), a rare and often fatal illness resulting from infection with Naegleria fowleri. This report summarizes clinical and epidemiologic information about these two cases and characterizes N. fowleri infection.

Amebiasis↗

PubMed2005

North Carolina Center for Nursing health policy fellowship: a strategy for developing nursing leaders for the future.

In the midst of ongoing concern about succession planning to develop the next generation of nursing leaders, the profession cannot afford to overlook succession planning in regard to the next generation of nurse leaders in health policy. This article describes a project of the North Carolina Center for Nursing that provides a fellowship in state-level health policy for North Carolina nurses who have completed a graduate level health policy course. Policy fellows are exposed to health policy analysis through the public policy arena, regulatory and administrative arenas, and organizational and institutional arenas. As part of this journey, all major state stakeholders in health policy are involved in the mentoring process. The North Carolina Center for Nursing Health Policy Fellowship is described here as a potential model related to policy initiatives in other states.

Academies and Institutes↗

PubMed2000

Has the mammography quality standards act affected the mammography quality in North Carolina?

OBJECTIVE: The United States Food and Drug Administration implemented federal regulations governing mammography under the Mammography Quality Standards Act (MQSA) of 1992. During 1995, its first year in implementation, we examined the impact of the MQSA on the quality of mammography in North Carolina. MATERIALS AND METHODS: All mammography facilities were inspected during 1993-1994, and again in 1995. Both inspections evaluated mean glandular radiation dose, phantom image evaluation, darkroom fog, and developer temperature. Two mammography health specialists employed by the North Carolina Division of Radiation Protection performed all inspections and collected and codified data. RESULTS: The percentage of facilities that met quality standards increased from the first inspection to the second inspection. Phantom scores passing rate was 31.6% versus 78.2%; darkroom fog passing rate was 74.3% versus 88.5%; and temperature difference passing rate was 62.4% versus 86.9%. CONCLUSION: In 1995, the first year that the MQSA was in effect, there was a significant improvement in the quality of mammography in North Carolina. This improvement probably resulted from facilities' compliance with federal regulations.

Mammography↗

PubMed2004

Preterm delivery rates in North Carolina: are they really declining among non-Hispanic African Americans?

The preterm delivery rate in North Carolina is consistently higher than the national average. However, recent reports suggest that singleton preterm delivery rates for non-Hispanic Whites are increasing while those for non-Hispanic African Americans are decreasing. To study this pattern further, the authors examined data on singleton non-Hispanic White and non-Hispanic African-American births in 1989 and 1999 by using North Carolina vital statistics data. They found that the frequency of preterm delivery rose 1.1% (8.5% to 9.6%) among non-Hispanic Whites but declined 1.4% (17.9% to 16.5%) among non-Hispanic African Americans over the same time period. For both subgroups, a bimodal distribution of birth weights was apparent among preterm births at 28-31 weeks of gestation. The second peak with its cluster of normal-weight infants was more prominent among non-Hispanic African Americans in 1989 than in 1999. To reduce the potential for bias due to misclassification of infant gestational age, frequencies of preterm delivery of infants who weighed less than 2,500 g were calculated. Unlike the original analysis, this calculation showed that preterm delivery increased for both subgroups. A number of non-Hispanic African-American births classified as preterm were apparently term births mistakenly assigned short gestational ages. Such misclassification was more frequent in 1989 than in 1999, inflating 1989 preterm delivery rates.

Adult↗

PubMed1999

Analysis of tractor-related deaths in North Carolina from 1979 to 1988.

This descriptive study examined 342 fatalities involving tractors and attachments that occurred during a 10-year period in North Carolina from 1979 to 1988. Reports of the North Carolina Office of the Chief Medical Examiner and medical examiner's certificates of death were reviewed using the public health model of causation. Data were collected on characteristics of thefatally injured (host), including age, occupation, blood alcohol concentration and length of survival; characteristics of the injury event (environment), including type of accident, weather conditions and terrain; and characteristics of the agent, including both the tractor and attachments, if any, in place at the time of injury. Ninety-eight percent of the victims were male. Victims ages 65 and older accounted for 38 percent of fatal injuries, and 11 percent were 18 years of age or younger. Only slightly more than one-half of the victims (54 percent) were full- or part-time farmers. Forty-four percent of the deaths were to nonfarmers who were not in the act of farming. Nineteen percent of tested victims had a detectable blood alcohol level. Almost three-fourths of the victims died in the first hour after injury and 87 percent within the first 24 hours. In the majority of accidents, the tractor operator was a victim of a rollover or runover. This study provided detailed characterization of the fatally injured and, to the extent possible, the tractor involved and the injury event itself. However, additional methods of data collection are needed to provide further characterization of the injury event and the injury agent to design and support prevention programs for tractor users.

Accidents, Occupational↗

PubMed1977

Acute ethanol poisoning: a two-year study of deaths in North Carolina.

A 24-month study of fatalities in North Carolina with high blood ethanol levels (300 mg/100 ml or over) revealed 502 cases with either acute alcoholism or the effects of this range of blood ethanol concentration having caused or contributed to death. This investigation reassessed the criteria for ethanol poisoning, including its cause and manner of death, and revealed recurrent patterns common to this syndrome. This inquiry also contrasted the frequency of ethanol poisoning in different areas of the country.

Acute Disease↗

PubMed1993

The quality of the new birth certificate data: a validation study in North Carolina.

A random sample of 395 December 1989 North Carolina birth certificates and the corresponding maternal hospital medical records were examined to validate selected items. Reporting was very accurate for birth-weight, Apgar score, and method of delivery; fair to good for tobacco use, prenatal care, weight gain during pregnancy, obstetrical procedures, and events of labor and delivery; and poor for medical history and alcohol use. This study suggests that many of the new birth certificate items will support valid aggregate analyses for maternal and child health research and evaluation.

Birth Certificates↗