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PubMed1989

Medical-examiner-reported fatal occupational injuries, North Carolina, 1978-1984.

Fatal occupational injuries are a major public health problem in the U.S. Utilizing a medical examiner database from North Carolina, 1,233 fatal work-related injuries were identified in a 7-year time period. Twelve percent of these deaths were in out-of-state residents. For men, highest risk industries were forestry/fishery, agriculture, trade, and transportation/public utilities/communications. Only 4% of deaths occurred in women. The most common manner of death in women was homicide. Highest-risk industries for women were agriculture, trade, and transportation/public utilities/communications. Of 902 decedents tested, alcohol was found in 11%, and 7% had levels at or above 100 mg%. Because of its completeness, the North Carolina Medical Examiner System is a useful tool to use in the surveillance of fatal occupational injuries.

Accidents, Occupational↗
PubMed2001

North Carolina macular dystrophy: clinicopathologic correlation.

PURPOSE: To describe the clinical and histopathologic findings in a 72-year-old woman with North Carolina macular dystrophy. METHODS: Clinical examination was performed by slit-lamp biomicroscopy, indirect ophthalmoscopy, color fundus photography, and focal electroretinography. Histopathologic examination of the enucleated left eye consisted of light microscopy. RESULTS: Light microscopy demonstrated a discrete macular lesion characterized by focal absence of photoreceptor cells and retinal pigment epithelium. Bruch's membrane was attenuated in the center of the lesion and associated with marked atrophy of the choriocapillaris. Adjacent to the central lesion, some lipofuscin was identified in the retinal pigment epithelium. CONCLUSIONS: North Carolina macular dystrophy has both clinical and microscopic appearances of a well-demarcated retinal and pigment epithelial lesion confined to the macula. This is consistent with the clinical impression that it is a focal macular dystrophy.

Aged↗
PubMed1996

The impact of laparoscopic cholecystectomy on the management and outcome of biliary tract disease in North Carolina: a statewide, population-based, time-series analysis.

BACKGROUND: Laparoscopic cholecystectomy (LC) has had a major impact on the treatment of patients with biliary tract disease, but the magnitude and the details of its effects on biliary surgery remain incompletely described. The purpose of this study was to perform a statewide, population-based, time-series analysis of the effects of LC on biliary surgery. STUDY DESIGN: Patient data were obtained from the statewide hospital discharge database that collects data from all 157 hospitals in the state of North Carolina. All patients with hospital admissions for biliary tract disease from 1988 through 1993 were selected for analysis. RESULTS: The use of open cholecystectomy (OC) dropped from 100 percent of all cholecystectomies in 1988 to 32.3 percent in 1993, while LC increased from eight cases in 1988 to over 7,800 per year in 1993. The increase in the rate of LC was not associated with an increase in the overall rate of cholecystectomy. Bile duct (BD) repairs increased from 13 in 1988 to a high of 36 in 1992. There was a strong, statistically significant correlation between the rate of LCs and the rate of BD repairs (R = 0.89, p = 0.0001). Hospital charges and component charges were lower for patients having elective LC compared to those having elective OC (p = 0.001). This remained true after stratification by age and type of gallbladder disease. Hospital stays were shorter for patients having LC than for those having OC (p = 0.001 for all). Surgeons in smaller hospitals were slower at adopting LC. Younger and board certified surgeons adopted LC more rapidly than older and non-board certified surgeons. CONCLUSIONS: In North Carolina, LCs progressed from nonexistent to the dominant approach for managing patients with cholelithiasis in a matter of a few years. Associated with this change were shorter hospitalizations and lower charges. Contrary to other published reports, North Carolina did not experience an increase in the overall rate of cholecystectomy with the adoption of LC. There was a highly correlated increase in the rate of bile duct repairs in the first years of the study.

Adolescent↗
PubMedDate not supplied

Out-of-hospital deaths due to asthma in North Carolina, 1980-1988.

Because deaths that occur outside hospitals have not been well-described, we studied out-of-hospital deaths from asthma in North Carolina from 1980 through 1988. We investigated out-of-hospital deaths from asthma using information from the North Carolina Office of the Chief Medical Examiner. We excluded deaths for which a hospital was listed as the place where the death occurred. For the nine years studied, the Office of the Chief Medical Examiner recorded 89 of 158 investigated deaths from asthma as having occurred out of hospital. Of the 89 deaths, 73% occurred in the decedent's home. The rates of out-of-hospital deaths from asthma increased as the age of the decedents increased, were higher in rural countries than they were in urban counties, and were over three times higher for blacks and American Indians than they were for whites. Racial minorities may warrant special attention in any attempt to prevent out-of-hospital deaths due to asthma.

Adolescent↗
PubMed1998

Racial differences in survival of oral and pharyngeal cancer patients in North Carolina.

OBJECTIVE: This study seeks to determine whether lower survival of black versus white oral and pharyngeal cancer patients is due to, or differs by, stage at diagnosis. METHODS: Subjects identified through the North Carolina Central Cancer Registry included all black and white North Carolina residents diagnosed from 1987 to 1990 with malignant squamous cell carcinoma of the oral cavity or pharynx. Proportional hazards regression models were used to calculate hazard ratios for all-cause mortality during the first 18 months after diagnosis, adjusting for age, reported histologic grade, site, and several time-dependent interactions. RESULTS: Within the first two months after diagnosis, the black/white hazard ratio for mortality among those with localized disease was 11.8 (95% CI = 3.7, 37.5), compared to 6.4 (95% CI = 2.6, 15.8) for those with advanced disease. During months 3 to 18 after diagnosis, black/white hazard ratios were 2.07 (95% CI = 1.03, 4.18) among those with localized disease and 1.12 (95% CI = 0.85, 1.47) for those with advanced disease. CONCLUSIONS: In the first 18 months after diagnosis, blacks with oral and pharyngeal cancer have higher all-cause mortality than whites diagnosed at the same stage of disease. Racial differences are greater among those with localized disease than for those with more advanced conditions.

Adolescent↗
PubMed1995

Differences between racial groups in the impact of oral disorders among older adults in North Carolina.

OBJECTIVES: This study investigated variations in impact of oral disorders between older black adults and older white adults living in North Carolina. METHODS: Using the Oral Health Impact Profile (OHIP) questionnaire, 440 participants aged 70 and older provided data on their perceptions of the impact of oral disease on aspects of their lives during the previous 12 months. RESULTS: For 22 of the 49 items queried in the OHIP questionnaire, older blacks reported more frequent impact than older whites (P < .05). For none of the OHIP items did whites report more frequent impact. The impacts reported were diverse and included items reflecting pain, physical disability, psychological disability, and social disability. When the number of items occurring fairly often or very often were summed for dentate participants, blacks reported more items than did whites (3.7 vs 1.1, P < .0001). This difference decreased to 2.7 vs 2.0 (P < .346) after controlling statistically for greater mean periodontal pocket depth, more unreplaced missing teeth, and more episodic dental visits among blacks. CONCLUSIONS: Older dentate blacks reported more impact from oral problems than older dentate whites. The differences in reported impact likely are linked to differences in oral status and dental visit history between these two racial groups in North Carolina.

Black or African American↗
PubMedDate not supplied

Five-year changes in North Carolina outpatient cardiac rehabilitation.

PURPOSE: The purpose of this study was to describe cardiac rehabilitation programming, barriers to participation, and reasons for dropout in North Carolina from a program director's perspective and to compare those results with those of a similar statewide survey conducted 5 years earlier. METHODS: In 1999 and 2004, a survey was mailed to all North Carolina program directors of outpatient cardiac rehabilitation programs. The response rate was 85% (61/72) in 1999 and 79% (61/77) in 2004. RESULTS: More than 85% of North Carolinians older than 40 years lived within a 15-mile buffer of an outpatient cardiac rehabilitation program in 2004. Most programs were staffed with personnel trained in nursing, exercise physiology, and nutrition in 1999 and 2004. Women and African Americans remained disproportionately underrepresented as participants in the program for both years. In 2004, approximately one third of cardiac rehabilitation programs reported having a referral to rehabilitation on the hospital discharge plan for myocardial infarction and coronary artery bypass surgery. In 1999 and 2004, the most frequently reported barrier to participation remained financial, followed by lack of interest or motivation and workplace conflicts. Work conflicts, lack of interest, and comorbidities were the most frequently reported reasons for dropping out from cardiac rehabilitation programs in both 1999 and 2004. CONCLUSIONS: Increasing participation in cardiac rehabilitation programs by addressing barriers at multiple levels may facilitate greater patient participation. This statewide survey could be used in other states as a surveillance tool, to track changes in rehabilitation over time from a program director's perspective.

Ambulatory Care Facilities↗
PubMed1983

Susceptibility of northern fowl mites in North Carolina to five acaricides.

The susceptibilities (dosage-response regression curves) of northern fowl mites collected from six poultry farms in North Carolina were determined for five acaricides by exposure of the mites for 24 hr to acaricide residues inside glass pipettes. The residue concentrations were expressed as parts per million on a weight-volume basis of the acaricide-acetone solution in which the pipettes were immersed prior to testing. All of the acaricides, except malathion, were highly toxic to the northern fowl mites. The mean LD50 values (ppm) were: permethrin, .53; tetrachlorvinphos, 4.06; carbaryl, 4.11; and coumaphos, 5.04. For malathion, the mean LD50 for mites from three caged layer flocks was 119.35 ppm while concentrations as high as 500 ppm gave only low mortalities (20% or less) of mites from the other flocks and LD50 values could not be calculated. These data show that northern fowl mites are highly resistant to malathion in North Carolina, as has been reported elsewhere, but there is no evidence of resistance to the other acaricides tested. The effect of temperature on the toxicity to northern fowl mites of the newest acaricide, permethrin, was determined. Permethrin was significantly more toxic at 20 C than at 25, 30, or 35 C.

Animals↗
PubMed1999

What's driving an epidemic? The spread of syphilis along an interstate highway in rural North Carolina.

OBJECTIVES: The purpose of this study was to determine whether county syphilis rates were increased along Interstate Highway 95 (I-95) in North Carolina during a recent epidemic. METHODS: Ecological data on syphilis cases demographic data, highway data, and drug activity data were used to conduct a cross-sectional and longitudinal study of North Carolina countries from 1985 to 1994. Crude and adjusted incidence rate ratios (IRRs) were determined by means of standard and longitudinal Poisson regression models adjusted for sociodemographic factors and drug use. RESULTS: Ten-year syphilis rates in I-95 counties greatly exceeded rates in non-I-95 counties (38 vs 16 cases per 100,000 persons) and remained higher after adjustment for race, age, sex, poverty, large cities, and drug activity (adjusted IRR = 2.05, 95% confidence interval [CI] = 1.84, 2.28). Syphilis rates were stable until 1989, when rates increased sharply in I-95 counties but remained stable in non-I-95 counties. Increased drug activity in I-95 counties preceded the rise in syphilis cases. CONCLUSIONS: A better understanding of the relationship between high-ways and the spread of sexually transmitted diseases may guide future prevention interventions.

Adult↗
PubMed2001

Prevention practices of family medicine clerkship preceptors in North Carolina.

PURPOSE: Before implementing a new prevention curriculum, the authors assessed the prevention practices and attitudes of community family physicians in North Carolina who precepted third-year family medicine clerkship students. METHOD: An 18-item questionnaire was mailed to 165 preceptors during the 1995-96 academic year. The questionnaire explored the preceptors' levels of preparation to counsel patients, the types of prevention services they offered, and their levels of success in modifying patients' behaviors. The survey was re-sent to non-respondents. RESULTS: The response rate was 70% (n = 112); of these 75% were men and 55% had graduated after 1987. Over 60% of the preceptors "almost always" offered services in smoking cessation, exercise, diet and nutrition, and age-specific services (range 62-86%). Over 50% felt "very prepared" to counsel patients regarding smoking cessation, sexually transmitted diseases, depression, exercise, alcohol use, and age-specific services (range 53-74%). However, the preceptors in this study felt pessimistic about their success in getting patients to change their behaviors. Preceptors who had graduated more recently offered more preventive services for smoking cessation, alcohol use, and illicit drugs than did earlier graduates. DISCUSSION: Although North Carolina preceptors were pessimistic about their success in changing patients' behaviors regarding prevention, they were confident about their knowledge and skills to provide these services. This information was used to modify a prevention curriculum for third-year medical students.

Attitude of Health Personnel↗
PubMed1980

Offender-victim relationships in criminal homicide followed by offender's suicide, North Carolina, 1972-1977.

An analysis of 90 cases of criminal homicide followed by suicide in North Carolina, 1972 to 1977. Homicidal victim-offender relationships were investigated in regard to age, sex, race and whether victim and offender were member of the same family, friends, acquaintances, or strangers. These results were compared with victim-offender relationships in 994 criminal homicide cases in North Carolina in which offenders did not commit suicide. Married white males over 30 years were much more involved in homicide-suicide than they were in homicide alone. In these homicide-suicide cases, the victim was usually the spouse. Except for marital status, characteristics of homicide offenders who killed themselves resembled those of suicide-only individuals much more than those of homicide-only offenders. In the homicide-suicide cases, the killing of someone in close relationship to the offender, often a wife, appeared to be part of the evolving process of suicide. This clearly has implications for intervention into marital strife and also for immediate treatment of homicide offenders who kill spouses and other family members.

Adolescent↗
PubMed1995

Health services access and use among older adults in North Carolina: urban vs rural residents.

OBJECTIVES: This study compared health service use and satisfaction with health care among older adults living in urban vs rural counties in North Carolina. METHODS: A stratified random sample of 4162 residents of one urban and four rural counties of North Carolina was surveyed to determine urban/rural variation in inpatient and outpatient health service use, continuity of care and satisfaction with care, and barriers (transportation, cost) to care. RESULTS: Inpatient and outpatient service use did not vary by residence in controlled analyses. Continuity of care was more frequent in rural counties. Transportation was not perceived as a barrier to health care more frequently in rural than in urban counties, but cost was a greater barrier to care among rural elderly people. CONCLUSIONS: In this sample, older persons living in rural counties within reasonable driving distance of urban counties with major medical centers used health services as frequently and were as satisfied with their health care as persons in urban counties. Cost of care, however, was a significant and persistent barrier among rural elderly people, despite Medicare coverage.

Age Factors↗
PubMed1998

North Carolina mosquito records. I. Uncommon Aedes and Anopheles (Diptera: Culicidae).

New distribution records are provided for 10 mosquito species that are rare or uncommon in North Carolina: Aedes aegypti, Ae. cinereus, Ae. dupreei, Ae. fulvus pallens, Ae. hendersoni, Ae. mitchellae, Ae. thibaulti, Ae. tormentor, Ae. trivittatus, and Anopheles atropos. Biological notes are provided for habitats, behavior, and, in some cases, color patterns. Comments are also made about 6 additional species that are rare or uncommon in North Carolina.

Aedes↗
PubMed1980

Clinical experience of medical students in North Carolina family medicine preceptorships.

The clinical experience of 29 medical students from 14 medical schools, while they were taking elective preceptorships with 15 North Carolina family physicians, is compared with clinical experience in a university medical center in the same state and in practices from the neighboring state of Virginia. A total of 6,641 problem contacts, averaging 229 per student, were reported over a three-year period. Certain problems were recorded with higher frequency in the preceptorships than in the medical center, for example, acute infections, lacerations, prenatal care, obesity, and hypertension. These findings support the importance of preceptorships in supplementing the clinical experience of university medical centers, and the close similarity of these North Carolina data to those from Virginia suggests the usefulness of this type of information for planning medical school and residency curricula.

Adolescent↗
PubMed1996

Firearm-related hunting fatalities in North Carolina: impact of the 'Hunter Orange' Law.

In the decade spanning 1983 through 1992, 68 people were killed by firearms while hunting in North Carolina (average of 1.66 fatalities/100,000 licenses issued). Of these, 58 deaths involved two parties, a shooter and a victim. In 22% of the incidents the victims were mistaken for game. During the 1987-1988 hunting season a "Hunter Orange" law was initially enforced. This law requires sportsmen to wear an article of bright orange clothing while hunting. After enactment of this law, a reduction in the incidence of hunters being killed because they were "mistaken for game" has proven statistically significant. The present study documents that legally mandating bright orange clothing has resulted in fewer firearms-related fatalities due to the victim's being mistaken for game while hunting. The North Carolina experience implies that governmental intervention can influence the incidence of accidental deaths during recreational hunting.

Clothing↗
PubMed1997

Prevalence and predictors of tobacco use among Lumbee Indian women in Robeson County, North Carolina.

Tobacco use among some Native American tribes is high compared to the overall US population. Little is known, however, about tobacco use among Native Americans in North Carolina, a state with strong economic ties to tobacco. To assess the epidemiology of tobacco use in this population, data from the North Carolina Native American Cervical Cancer Project was reviewed. Nine hundred eighty-two Lumbee Indian women in Robeson County provided general demographic information as well as information on cancer risk knowledge, attitudes and behaviors during the 5-year study. Women were selected from the community using a random sample of 5200 persons from the tribal roll of approximately 40,000 persons. 20.6% of women were current smokeless tobacco users, while 23.7% were current smokers. Demographic and social support predictors were unique for the different types of tobacco use. Cigarette smoking was associated with younger age, higher education, excellent or good self-reported health, having a recent physical exam, separated or divorced marital status, low church participation, and alcohol consumption. Conversely, use of smokeless tobacco was associated with older age, lower education level, fair or poor self-reported health, widowed marital status, and having a high number of friends. These data show a high prevalence of smokeless tobacco use among women in this population, and a contrast in the predictors of tobacco use by source. Intervention programs for tobacco use cessation should be sensitive to these differences.

Adult↗
PubMed2005

Outbreaks of Escherichia coli O157:H7 associated with petting zoos--North Carolina, Florida, and Arizona, 2004 and 2005.

During 2004-2005, three outbreaks of Escherichia coli O157:H7 infections occurred among agricultural fair, festival, and petting zoo visitors in North Carolina, Florida, and Arizona. One hundred eight cases, including 15 cases of hemolytic uremic syndrome (HUS), were reported in the North Carolina outbreak; 63 cases, including seven HUS cases, were reported in the Florida outbreak; and two cases were reported in Arizona. No fatalities occurred. Illnesses primarily affected children who visited petting zoos at these events. This report summarizes findings from these outbreak investigations, which indicated the need for adequate control measures to reduce zoonotic transmission of E. coli O157:H7.

Adolescent↗
PubMed1997

Fatal Occupational Injuries in the Forestry and Logging Industry in North Carolina, 1977-1991.

Fatal occupational injuries in the forestry and logging industry and occupation in the state of North Carolina from January 1, 1977, to December 31, 1991, were analyzed. Data were obtained through the North Carolina medical examiners system. The analysis was performed for the whole state as well as for the four forestry regions into which the state is divided. A total of 125 deaths happened over the study period. All were men, and the majority (60%) were white, with a mean age of 43 years. The crude fatality rate for the overall study period was 2.2 deaths per 1,000 person-years, with age-specific rates increasing with age. The Piedmont region had the highest proportion of cases (31.2%), while the Mountain region accounted for the highest overall rate (22.7 per 1,000 person-years). For all the forestry regions, the leading means of injury was found to be falling objects.

Journal Article↗