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PubMed2006

A comparison of blue crab and bivalve delta15N tissue enrichment in two North Carolina estuaries.

Stable isotope analyses (delta(15)N) were used to examine invertebrate tissue enrichment in two North Carolina estuaries with differing amounts of nutrient loading. Bivalves collected from a nutrient sensitive estuary yielded a significant difference in mean nitrogen isotopic composition of tissue (10.4 per thousand+/-0.82; N=66) compared to bivalves collected from a less nutrient sensitive estuary (6.4 per thousand+/-0.63; N=45). Similarly, blue crabs from nutrient sensitive sites had a nitrogen isotopic composition of 11.4 per thousand (+/-1.3, N=77), which was significantly different (P<0.001) than the tissue of less nutrient sensitive blue crabs (9.6 per thousand+/-0.6; N=77). The results showed that an inverse relationship exists between invertebrate tissue enrichment and indicators of water quality across estuarine sites. This study suggests that a relationship may exist between nutrient sources and subsequent energy transfer to estuarine consumers in two North Carolina estuaries.

Animals↗
PubMed2004

The North Carolina Youth Empowerment Study (NCYES): a participatory research study examining the impact of youth empowerment for tobacco use prevention.

This article describes the North Carolina Youth Empowerment Study (NC YES), a 3-year participatory evaluation of youth programs addressing tobacco use prevention. The study goals of NC YES were to (1) convene an advisory board comprised of lay youths and adults in a participatory research process, (2) document the characteristics of youth programs for tobacco use prevention and control in North Carolina, and (3) track the role of youth involvement in initiating and implementing 100% tobacco-free policies in local school districts. The NC YES Statewide Advisory Board helped guide the evaluation process, reviewed study protocols and data collection instruments, and helped interpret preliminary findings. Both quantitative and qualitative methods(e.g., telephone interviews and written questionnaires) were used to gather data from youth and adult leaders to achieve these aims. Lessons learned about the process of conducting participatory evaluation approaches and summary findings about the role of youths in policy advocacy efforts are presented.

Adolescent↗
PubMed1995

The status of local smoking regulations in North Carolina following a state preemption bill.

OBJECTIVE: To determine the number and protectiveness of local smoking regulations adopted before the implementation of a preemptive statewide smoking control bill. METHOD: Review of local smoking control regulations from all 100 counties and 85 municipalities with populations greater than 5000 in North Carolina. MAIN OUTCOME MEASURES: Adoption of local smoking control regulations before and during the 3-month delay in enactment of the preemptive bill. Protectiveness of regulations was based on restrictions on smoking and requirements for separate ventilation systems at private work sites: none (smoking unrestricted); minimal (smoking restricted to designated areas); partial (smoking restricted to designated areas served by separate ventilation systems); and complete (smoking prohibited). Because some regulations would be phased in gradually over the next 5 years, we evaluated the requirements that will be in effect by January 1, 2000. RESULTS: Between July 15 and October 15, 1993, the number of local smoking regulations in North Carolina increased from 16 to 105. By the year 2000, 59% of private employees still will not be guaranteed any protection from work site environmental tobacco smoke; 19% will have minimal protection, 22% will have partial protection, and none will have complete protection. CONCLUSIONS: The 3-month delay in preemption created an unnatural time frame for communities to organize, debate, and adopt smoking restrictions. Despite the adoption of 89 new regulations, no private employees will be guaranteed complete protection from work site environmental tobacco smoke by the year 2000; new regulations can no longer be adopted. HB 957 has been a setback for public health in North Carolina.

Humans↗
PubMed2002

Hospitalizations and outcomes for diabetic gastroparesis in North Carolina.

BACKGROUND: Population-based data to assess the extent of gastroparesis in the diabetic population are scarce. We examined the demographic and clinical characteristics associated with hospital admissions for diabetic gastroparesis in North Carolina. METHODS: Data from the 1998 North Carolina Hospital Discharge database were abstracted from records in which gastroparesis and diabetes mellitus were listed as simultaneous diagnoses. RESULTS: There were 1476 discharges meeting our criteria, with total charges of $11,378,446 over 7850 total hospital days. Most patients were female (65.8%), > or = 45 years of age (54.5%), and had Medicare as the primary payer (52.1%). While most of these patients were admitted under emergency or urgent circumstances, the vast majority had routine discharges. CONCLUSION: Despite some limitations, these data indicate that diabetic gastroparesis is not uncommon, but can be treated effectively.

Diabetes Complications↗
PubMed2002

Sexual assault among North Carolina women: prevalence and health risk factors.

STUDY OBJECTIVE: Sexual assault is traumatic at the time it occurs, but it also may have longlasting negative effects on physical health. Much of the research linking specific health problems to sexual assault victimization has used samples from special populations. The goals of this study are to estimate the prevalence of sexual assault in a representative sample of women in North Carolina and examine sexual assault in relation to specific health risk factors for leading causes of morbidity and mortality in women. DESIGN: The North Carolina Behavioral Risk Factor Surveillance System (BRFSS) is a household telephone survey of non-institutionalised adults, 18 years of age and older, conducted by random digit dialling. SETTING: This investigation focuses on the study participants in the 1997 survey. PARTICIPANTS: The sample includes 2109 women who responded to the sexual assault questions in the 1997 North Carolina BRFSS interview. MAIN RESULTS: The lifetime prevalence of sexual assault was 19% (95% CI 17% to 20%), of which 73% of victims experienced or were threatened with forced sexual intercourse. Sexual assault victims, particularly victims of forced intercourse or the threat thereof, were more likely to perceive their general health as being fair or poor (OR=2.3, 95% CI 1.5 to 3.4) and were more likely to have suffered poor physical and mental health in the past month (poor physical health, OR=2.1, 95% CI 1.6 to 2.8; poor mental health, OR= 2.6, 95% CI 1.9 to 3.5). After controlling for sociodemographic factors and health care coverage, victims of forced intercourse or the threat thereof were more likely to smoke cigarettes (OR=2.0, 95% CI 1.4 to 2.8), to have hypertension (OR=1.5, 95% CI 1.1 to 2.2), to have high cholesterol (OR=1.7, 95% CI 1.2 to 2.5), and to be obese (OR=1.7, 95% CI 1.3 to 2.4). CONCLUSIONS: This study shows associations between sexual victimization and health risk factors in a non-clinical statewide population of women. Future research should determine whether clinically screening for and identifying a history of sexual victimization among women seen in a variety of health care settings leads to the initiation of effective interventions that help women successfully cope with these violent experiences. There is also a need for further research to investigate the temporal sequence of assaults and subsequent health outcomes by assessing physical health status before and after victimization.

Adult↗
PubMed1994

Factors responsible for immunizations referrals to health departments in North Carolina.

BACKGROUND: Despite the existence of Medicaid and other programs designed to eliminate cost as a barrier to immunization in physicians' offices, referrals to local health departments for immunizations are common. Many children leave their physicians' offices without receiving needed immunizations. PURPOSE: To determine: 1) the frequency and determinants of immunization referrals to health departments in North Carolina, and 2) the factors associated with private physicians' decisions to immunize Medicaid children in their offices and participate in the state-funded vaccine replacement program. METHODS: The 2537 pediatricians and family physicians licensed in North Carolina were surveyed by mail using a 23-item, self-administered questionnaire. RESULTS: Seventy-two percent of physicians responded; 93% referred at least some children to local health departments for immunizations. Concern regarding parents' ability to pay for immunizations was the most important reason for referral for 93% of respondents. Forty percent referred all or some of their Medicaid patients; excessive paperwork, inadequate reimbursement, and parental preferences were the most common reasons. Only 33% of physicians had participated in the state's vaccine replacement program. Family physicians, and physicians in solo or two-physician practices in rural counties, and in practices caring for a small number of children on Medicaid were most likely to refer children covered by Medicaid and not participate in the state's existing vaccine replacement program. CONCLUSIONS: Medicaid and North Carolina's vaccine replacement program are not preventing large numbers of immunization referrals to health departments. Future programs designed to increase the proportion of children immunized in physicians' offices will not succeed if more effective incentives for physician participation are not developed.

Child↗
PubMed1999

Multiple deliveries in North Carolina: effects on birth outcomes.

OBJECTIVES: The purpose of this study is to examine the trends in multiple deliveries in North Carolina and assess their effect on the rates of low birth weight, fetal mortality, and infant mortality. METHODS: Using North Carolina vital statistics files, trends in multiple births, categorized by race, maternal age, and birth weight, were examined for the period 1980-1997. A partitioning method was used to estimate the contribution of maternal age distribution and age-specific multiple birth rates to the overall increase in multiple births, and the contribution of the changing multiple birth rate to observed trends in low birth weight and fetal and infant mortality. RESULTS: Between 1980 and 1997, the state's multiple birth rate increased by 40%. Most of the increase was due to a rise in the age-specific multiple birth rates, rather than a shift in the maternal age distribution. The increase in the multiple birth rate accounted for a substantial proportion of the increase in low birth weight among Whites and Blacks. The rise in multiple births also hindered further declines in fetal and infant mortality during this time. CONCLUSIONS: Multiple births are an increasingly important contributor to perinatal outcomes, and warrant greater consideration in research aimed at evaluating trends in low birth weight and infant mortality.

Adult↗
PubMed2004

Mental health issues among female clients of domestic violence programs in North Carolina.

OBJECTIVE: This study estimated the prevalence of mental health problems among clients of domestic violence programs in North Carolina, determined whether domestic violence program staff members routinely screen clients for mental health problems, described how domestic violence programs respond to clients who have mental health problems, and ascertained whether domestic violence program staff members and volunteers have been trained in mental health-related issues. METHODS: A survey was mailed to all known domestic violence programs in North Carolina. RESULTS: A total of 71 of the 84 known programs responded to the survey (85 percent response rate). A majority of programs estimated that at least 25 percent of their clients had mental health problems (61 percent) and stated that they routinely asked their clients about mental health issues (72 percent). More than half the programs (54 percent) reported that less than 25 percent of their staff members and volunteers had formal training on mental health issues. An even smaller percentage of programs (23 percent) reported that they had a memorandum of agreement with a local mental health center. CONCLUSIONS: The substantial percentage of domestic violence clients with concurrent mental health needs and the limited mental health services that are currently available have important implications for domestic violence and mental health service delivery.

Adult↗
PubMed1996

Variation in recommendations for breast and cervical cancer screening among primary care physicians in North Carolina, 1991.

Physicians play an important role in recommending and doing cancer screening for their patients. In 1991, the North Carolina Department of Environment, Health and Natural Resources and the Centers for Disease Control and Prevention conducted a survey to determine the counseling and referral practices of primary care physicians practicing in North Carolina. Physicians were asked to report the percentage of patients in various age groups that they recommended receive a clinical breast examination, referral for mammography screening, or a Pap test and at what intervals they recommended each study. They were also asked their perceived barriers to cervical cancer screening. Obstetrician-gynecologists recommended annual Pap smear screening more frequently than did physicians in other specialties for patients of all ages. For mammography, variation existed for recommended screening intervals for all specialties by patient age (35 to 39 years, 40 to 49 years, 50 to 64 years, and over age 65). Recommendations for mammography also differed significantly according to physicians' age and sex. The medical community and the public need a consistent and clear message to promote effective screening maneuvers.

Adult↗
PubMed1987

A review of nasal cancer in furniture manufacturing and woodworking in North Carolina, the United States, and other countries.

Nasal adenocarcinoma in the High Wycombe furniture industry of England during 1956-1965 had an annual incidence of 500 to 1,000 times greater than that of the general population. Excesses of nasal cancer have also been described in France, Australia, Denmark, Finland, Italy, and Holland. Interestingly, one limited study in Canada revealed no excess, whereas a more recent one showed a slight excess. In contrast to the strikingly large excesses of nasal adenocarcinoma in other countries, there has never been any evidence of similarly large excesses in the US woodworking and furniture industry. Modern manufacturing conditions may not present the same degree of risk of developing nasal cancer as was present in the English furniture manufacturing industry. The incidence of nasal cancer associated with furniture manufacturing in the United States is examined in considerable detail in North Carolina, the leading furniture manufacturing state. Furniture manufacturing in the state began around 1890 and has grown steadily since. Utilizing statistics available from the North Carolina Department of Vital Statistics, the absolute mortality of nasal cancer in North Carolina was calculated from 1964 to 1977. The average mortality was approximately 3.5 times greater in the furniture manufacturing industry than in the general population.(ABSTRACT TRUNCATED AT 250 WORDS)

Facility Design and Construction↗
PubMed1996

Patient, hospital, and surgeon factors associated with breast conservation surgery. A statewide analysis in North Carolina.

OBJECTIVE: The objective of this study was to determine the trend of breast conservation surgery (BCS) in North Carolina over a 6-year period and to identify patient, hospital, and surgeon factors associated with the use of BCS. SUMMARY BACKGROUND DATA: Despite evidence that BCS is an appropriate method of treatment for early stage breast cancer, surgeons in the United States have been slow to adopt this treatment method. METHODS: Cases of primary breast cancer surgery in all 157 hospitals in the state from 1988 to 1993, inclusive (N = 20,760), were obtained from the State Medical Database Commission, Area Resource File, American Hospital Association and State Board of Medical Examiner's Databases. Multiple logistic regression was used to generate odds ratios (ORs) and 95% confidence intervals (CIs) to determine factors associated with BCS. RESULTS: The rate of BCS doubled from 7.3% in 1988 to 14.3% in 1993, with an overall rate of 10.2% (2117/ 20.760). Multiple logistic regression identified the following factors associated with BCS: patient age younger than 50 years of age (OR = 1.7, 95% CI = 1.4, 2.1), patient age 50 to 69 years of age (OR = 1.2, 95% CI = 1.1, 1.4), private insurance (OR = 1.2, 95% CI = 1.0, 1.4), hospital bed size 401+(OR = 2.0, 95% CI = 1.6, 2.5), bed size 101 to 400 (OR = 1.7, 95% CI = 1.3, 2.1), and surgeon graduation from medical school since 1981 (OR = 1.6, 95% CI = 1.2, 2.0). CONCLUSIONS: Rates of BCS in North Carolina are low. Least likely to have BCS were women older than 70 years of age, without private insurance, treated at small hospitals by older surgeons. To increase the use of BCS, widespread education of surgeons, other health care providers, policy makers, and the general public is warranted.

Age Factors↗
PubMed1982

A comparison of height, weight, and triceps skinfold thickness of children ages 5-12 in Michigan (1978), Forsyth County North Carolina (1978), and HANES I (1971-1974).

Height, weight, and triceps skinfold measurements were made on 1,668 Forsyth County, North Carolina students ages 5-12 during 1978. These data were compared to a representative sample of Michigan children taken during the same year and to their United States counterparts in HANES I (1971-74). The North Carolina children more closely resembled their US counterparts than did the Michigan group, casting doubt on the secular trend toward heavier children suggested by the Michigan researchers. (Am J Public Health 1982; 72:730-733.)

Black or African American↗
PubMed1996

Imported malaria in Montagnard refugees settling in North Carolina: implications for prevention and control.

In the winter of 1992, some 402 Southeast Asian refugees were resettled in North Carolina. They received very limited medical screening before immigration and many arrived in the United States with significant health problems, including several tropical infectious diseases. These refugees had lived for many years in remote areas along the Vietnam-Cambodia border, where there is intense transmission of malaria, including Plasmodium falciparum resistant to most antimalarial drugs available in the United States. Of 322 refugees screened after arrival in North Carolina, 187 (58%) were infected: 33% with P. falciparum, 23.5% with P. vivax, 23.5% with P. malariae, and 2.1% with P. ovale. Most infected persons were asymptomatic and infections with multiple species were common. Because of the documented high infection prevalence and the probable presence of many subpatent infections, all nonpregnant refugees were treated with halofantrine; those with P. vivax or P. ovale infections were given primaquine as well. This group accounted for the largest cluster of malaria cases reported in the United States in the last 50 years. Their rapid relocation, with minimal medical screening prior to arrival, resulted in a significant burden to the refugees and to the health-care system. Coordination between immigration agencies, the public health community, and medical workers in communities where the refugees are settled is critical for U.S.-based management of imported tropical diseases.

Adolescent↗
PubMed2004

HIV transmission among black college student and non-student men who have sex with men--North Carolina, 2003.

In the United States, young black men who have sex with men (MSM) and reside in urban settings have high rates of infection with human immunodeficiency virus (HIV), with incidence and prevalence as high as 14% and 32%, respectively. Few epidemiologic and behavioral studies have been conducted in this population, and even fewer data are available for black MSM from non-urban areas of the southern United States. In November 2002, the North Carolina Department of Health (NCDOH) identified two cases of acute HIV infection among non-Hispanic black male college students. A retrospective review of all men aged 18-30 years with HIV diagnosed during January 2000-May 2003 indicated an increase in HIV case reports in male college students, from two cases in 2000 to 56 during January 2001-May 2003. Of these 56, a total of 49 (88%) were black, and nearly all were MSM, including some men who had sex with both men and women. In August 2003, NCDOH invited CDC to assist with an epidemiologic investigation of young HIV-positive black MSM in North Carolina. This report summarizes the results of that investigation, which indicated that black MSM college students and non-students in North Carolina had high rates of HIV risk behaviors, underscoring the need for enhanced HIV-prevention programs in these populations.

Adult↗
PubMedDate not supplied

External collaboration and performance: North Carolina local public health departments, 1996.

OBJECTIVES: This study examined the extent to which local public health departments in North Carolina collaborated with other groups and organizations, the health problems on which they worked together, and the effect of external collaboration on health departments' performance on core public health functions. METHODS: The author mailed a questionnaire asking about interactions with city and county government agencies, boards of health, schools, nonprofits, physicians/private clinics, community health centers/migrant clinics, community members, citizens' groups, state and federal agencies, and universities to all of the directors of local public health departments in North Carolina. Sixty-four directors returned the questionnaire, for a response rate of 74.4%. RESULTS: Local public health departments most frequently interacted with boards of health, state agencies, community members, schools, city and county government agencies, and nonprofit agencies. Large majorities reported productive relationships with boards of health, state agencies, city and county government agencies, schools, nonprofit agencies, and hospitals. Greater frequency of interaction with several types of partners was associated with better performance. CONCLUSIONS: While questions exist about whether performance on core functions improves the community's health status, the results suggest that it is important for local public health departments to continue to build relationships with other organizations in the community.

Community-Institutional Relations↗
PubMedDate not supplied

Pharmacy-perceived barriers to cancer pain control: results of the North Carolina Cancer Pain Initiative Pharmacist Survey.

OBJECTIVE: To assess pharmacists' knowledge, attitudes, and beliefs regarding the use of narcotics in cancer pain management, identify pharmacist counseling activities for cancer pain patients, assess pharmacy-related barriers to cancer pain management, and evaluate the availability of narcotic analgesics. METHODS: Mailing of a six-page survey. SETTING: Five hundred randomly selected pharmacists registered in North Carolina. PARTICIPANTS: Of 500 pharmacists surveyed, 141 surveys were completed and returned for a response rate of 28.2 percent. RESULTS: Pharmacists surveyed were knowledgeable regarding the problem of undertreatment of cancer pain. More than 80 percent of respondents replied that most cancer patients experience pain at some time during their illness. Eighty-five percent of respondents agreed that the nurse must believe the patient's report of pain and that the patient is the best judge of the intensity of the pain. Conservative physician prescribing patterns and conservative administration patterns of nurses were identified as perceived barriers to adequate pain management by 51 and 44 percent of respondents, respectively. Less than 30 percent of respondents frequently counseled cancer pain patients and were unable to identify patients who have cancer pain as a major medical illness. Hospital pharmacists recommended adjunctive therapy more often than did community pharmacists (p = 0.013). Interventions in pain management regimens were more often conducted by hospital pharmacists than by community pharmacists (p = 0.049). Differences in availability of narcotics was noted among practice sites for some more potent narcotics. Of the pharmacists surveyed, only 43 percent had attended a continuing education program on cancer pain management. Ninety-six percent of respondents were interested in attending a continuing education program in the future. CONCLUSIONS: Pharmacists in North Carolina are aware that the undertreatment of cancer pain is a serious medical problem. Unfortunately, pharmacists appear to be unable to identify patients with cancer pain as a major medical problem; therefore, counseling activity is limited. Addiction is still perceived as a barrier by some pharmacists. Through organizations such as the North Carolina Pain Initiative, these problems can be addressed.

Community Pharmacy Services↗
PubMed1995

Health insurance access to young adult survivors of childhood cancer in North Carolina.

Historically, there has been evidence to support the hypothesis that survivors of childhood cancer have been discriminated against in the private health insurance market in some areas of the United States. Results of previous studies have been inconsistent and have generally focused on a limited number of outcome variables. A retrospective cohort study of young adult survivors of childhood cancer and their siblings was performed to determine the risk of health insurance access problems of childhood cancer survivors in North Carolina. Mailed questionnaires were completed by 182 cancer survivors from three institutions who were diagnosed between 1976 and 1988, and by 101 of their siblings for a response of 62.1%. Using logistic regression in SAS, cancer survivors were found to be more likely to be denied health insurance than their siblings, with an adjusted odds ratio of 15.1. Childhood cancer survivors also had health insurance policies that excluded care for pre-existing medical conditions more often than their siblings (OR = 5.5). In addition, cancer survivors reported problems obtaining health insurance coverage more frequently than their siblings with an adjusted odds ratio of 22.8. In general, survivors of childhood cancer who were diagnosed in North Carolina have had decreased access to health insurance coverage when compared to their siblings of similar age. North Carolina health insurance regulations permit health insurance firms to discriminate against cancer survivors because of their history of illness, often decreasing their access to needed follow-up care.

Adult↗
PubMed1993

Analysis of 222Rn concentration in North Carolina household water supplies derived from private wells.

The objectives of this study were to characterize the concentrations of 222Rn in North Carolina household groundwater supplies and to investigate the relationship between indoor air and groundwater 222Rn concentrations. Measurements of 222Rn in groundwater supplies were performed in 400 North Carolina homes in which a state/Environmental Protection Agency survey had made measurements of indoor airborne 222Rn. The arithmetic mean 222Rn concentration measured in groundwater supplies statewide was 67 Bq L-1 (1,800 pCi L-1), and the geometric mean was 24 Bq L-1 (660 pCi L-1). Sixty-seven percent of the state's homes with wells had 222Rn water concentrations in excess of the Environmental Protection Agency's proposed limit for public drinking water supplies of 11 Bq L-1 (300 pCi L-1). The percentage of homes with water concentrations in excess of the proposed limit was 30% in the eastern region of the state, 75% in the central region, and 83% in the western region. No significant correlation was observed between measurements of indoor air and water 222Rn concentrations in these homes.

Air Pollution, Indoor↗