Perinatal mortality in North Carolina: a report for the Committee on Maternal Health Medical Society of the State of North Carolina.
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Humans↗
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Statement to the physicians of North Carolina from the Committee on Drug Abuse and Pharmacy of the North Carolina Medical Society.
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Drug Therapy↗
Effectiveness of health education to increase screening for cervical cancer among eastern-band Cherokee Indian women in North Carolina.
BACKGROUND: The North Carolina Native American Cervical Cancer Prevention Project was a 5-year, National Cancer Institute-funded trial of health education designed to increase screening for cervical cancer among Native-American women in North Carolina. PURPOSE: This study was conducted to evaluate the effectiveness of this education program in the Eastern-Band Cherokee target population. METHODS: Cherokee tribal lands were mapped and all households (N = 2223) were listed to ensure maximum coverage of the eligible population (women, aged 18 years and older, who were enrolled tribal members). Eligible women were identified by the use of a brief questionnaire administered to an adult member of the household. Of the 1279 households with eligible women, 1020 (79.8%) agreed to participate. The intervention was an individualized health education program delivered by female Cherokee lay health educators. The participants were randomly assigned to receive or not to receive the intervention (i.e., to program and control groups, respectively) by use of the Solomon Four-Group design. Data were collected in face-to-face interviews conducted in the participant's home. Of the 996 women who were ultimately enrolled, 540 were randomly assigned to receive a pretest (preintervention) interview that involved administration of a 96-item questionnaire designed to collect data on knowledge, intentions, and behaviors related to cervical cancer; of these 540 women, 263 were randomly assigned to receive the education program. The remaining 456 women did not receive the pretest, but 218 were randomly assigned to receive the education program. Six months after receiving the education program, the women in all four groups were administered a post-test that was identical to the pretest. Logistic regression was used to assess the effects of the pretest and the educational program. All P values resulted from two-sided statistical tests. RESULTS: Eight hundred and fifteen (81.8%) of the 996 participants completed the post-test interview. The remaining 181 women who were lost to follow-up were evenly distributed among the four study groups. At the post-test, 282 (73.2%) of the 385 women who received the education program reported having had a Pap smear following the intervention, compared with 275 (64%) of the 430 control subjects. Women who received the education program were more likely to answer all knowledge items correctly on the post-test (odds ratio [OR] = 2.18, 95% confidence interval [CI] = 1.08-4.39) and to report having obtained a Pap smear in the past year (OR = 2.06, 95% CI = 1.14-3.72) than women in the control groups. CONCLUSION: Women who received the education program exhibited a greater knowledge about cervical cancer prevention and were more likely to have reported having had a Pap smear within the past year than women who did not receive the program.
Adult↗
Understanding the public health impacts of farm vehicle public road crashes in North Carolina.
Discussions with groups of North Carolina farmers identified farm vehicle public road safety as their primary occupational health and safety concern. Findings of a mail survey of North Carolina growers participating in a North Carolina Department of Labor migrant housing inspection program indicated that over 97% of them felt less safe on North Carolina public roads now (1999) than five years prior (1995), and over 79% currently (1999) felt unsafe transporting farm vehicles on North Carolina public roads. Using both primary and secondary data, we explore the context of farm vehicle public road crashes, identify contributing individual and environmental risk factors, and estimate the public health cost. Recommendations and suggestions for future farm vehicle public road safety research and interventions are proposed.
Accidents, Occupational↗
Standardized hypnosis treatment for irritable bowel syndrome: the North Carolina protocol.
The North Carolina protocol is a seven-session hypnosis-treatment approach for irritable bowel syndrome that is unique in that the entire course of treatment is designed for verbatim delivery. The protocol has been tested in two published research studies and found to benefit more than 80% of patients. This article describes the development, content, and testing of the protocol, and how it is used in clinical practice.
Adaptation, Psychological↗
Policy implications of the epidemiology of dental diseases for the prevention and control of periodontal disease: the North Carolina studies.
The North Carolina Dental Manpower Study indicated that periodontal disease was widespread and little was being done to control the disease. We have continued to address issues identified by the Dental Manpower Study in order to better understand the high prevalence of periodontal disease. Drawing from the theoretical basis of behavioral science and the clinical and epidemiological knowledge of periodontal disease, we have planned a strategy for testing the feasibility for controlling periodontal disease through dental health services. Only when attention to periodontal disease pervades the thinking and behavior of all segments of the dental care system--professional education, professional certification and regulation, financing mechanisms, consumers, and dental research--will factors be totally conducive to controlling this problem.
Adolescent↗
The tandem mass spectrometry newborn screening experience in North Carolina: 1997-2005.
North Carolina (NC) was the first US state to initiate universal tandem mass spectrometry (MS/MS) newborn screening. This began as a statewide pilot project in 1997 to determine the incidence and feasibility of screening for fatty acid oxidation, organic acid and selected amino acid disorders. The MS/MS analyses were done by a commercial laboratory and all follow-up and confirmatory testing was performed through the NC Newborn Screening (NBS) Program. In April 1999, the NC NBS Laboratory began the MS/MS analyses in-house. Between 28 July 1997 and 28 July 2005, 944,078 infants were screened and 219 diagnoses were confirmed on newborns with elevated screening results, for an overall incidence of 1:4,300. Ninety-nine infants were identified with fatty acid oxidation disorders, 58 with organic acidaemias and 62 with aminoacidopathies. Medium-chain acyl-CoA dehydrogenase deficiency, 3-methylcrotonyl-CoA carboxylase deficiency and disorders of phenylalanine metabolism were the most common disorders detected. Identification of affected infants has allowed retrospective testing of other family members, resulting in an additional 16 diagnoses. Seven neonates died from complications of their metabolic disorders/prematurity despite timely MS/MS screening. In addition, there were six infants who were not identified by elevated NBS results but who presented with symptoms later in infancy. The NC MS/MS NBS Program uses a two-tier system, categorizing results as either 'borderline' or 'diagnostic' elevated, for both the cutoffs and follow-up protocol. Infants with an initial borderline result had only a repeat screen. Infants with a diagnostic or two borderline results were referred for confirmatory testing. The positive predictive value of the NC MS/MS NBS for those infants requiring confirmatory testing was 53% for 2003 and 2004. The success of the NC MS/MS NBS Program in identifying infants with metabolic disorders was dependent on a comprehensive follow-up protocol integrating the public health laboratory and the academic metabolic centres.
Blood Specimen Collection↗
The establishment of a population-based Cancer Registry for North Carolina.
In 1984 the North Carolina Medical Society's House of Delegates adopted Report S, which called for the North Carolina Legislature to fund a statewide cancer incident reporting system. The Cancer Committee continues to be advisory to the Division of Adult Health. A subcommittee of the Cancer Committee advises the Central Cancer Registry.
Forecasting↗
The report of the Task Force on the North Carolina Nursing Workforce--May 2004.
North Carolina is indeed fortunate to have avoided many of the extreme shortages of nurses reported in other states. Yet, even as this was noted, there were important developments on the horizon which had the potential to cause such shortages even here. The fact that there are so many pathways into this field and throughout an individual nurse's career made it necessary to organize our deliberations in a way that enabled the Task Force to deal with the special (often unique) situations faced by one form of nursing education, or one avenue of nursing practice. The Task Force then had to synthesize these findings and recommendations in a format that offered a potential framework for future policy decisions affecting the profession of nursing as a whole. It is a tribute to both the process and the participants that the way these discussions unfolded may have identified ways in which seemingly disjointed elements of North Carolina nursing might begin to see opportunities for collaboration, coordination, and ultimately greater levels of accomplishment in relation to the broad goals of this effort as a whole. In this report, as one would expect, there are identifiable needs: for additional financial support for nursing education (through support to our public and private institutions and their faculties offering different types of nursing credentials, as well as for the scholarship support of those who choose to enter this field), for programs and initiatives to enable recent nursing school graduates to enter nursing better prepared to render the professional services for which they were employed, and for concrete improvements in the nursing work environments. The fact that nursing, especially nursing at the bedside in hospitals and in long-term care, requires increasingly sophisticated technical skills and continues to demand intellectual, physical and emotional energy beyond what would be required in many other professions and occupations, the recruitment and retention of well-prepared and motivated nurses remains a challenge now and in the future. But, as these discussions and the interactions with Task Force members have demonstrated over and over again, nursing is both a dynamic and exciting field of professional practice. And North Carolina is considered by most to be one of the very best states within which to be a nurse. It is hoped that all the 47 recommendations offered in this report, only 16 of which are specified here, will serve as a template for a deliberate policy agenda through which the nursing workforce for North Carolina can continue to be the vibrant example of the highest standards of practice for which its reputation has been well-earned.
Advisory Committees↗
The sexual behavior of married Mexican immigrant men in North Carolina.
In the southern United States, North Carolina has attracted an unprecedented influx of Hispanic immigrants in the 1990s. Detailed data on the sexual behavior of these recent immigrants are lacking. This exploratory study used two methods, a survey and qualitative interviews. For both methods, participants were recruited using convenience sampling. All study participants were first-generation Mexican immigrants who had lived in North Carolina for at least six consecutive months. The survey, administered face-to-face, explored the sexual attitudes and behavior of 43 married Mexican men living in North Carolina. The qualitative interviews, conducted with men (n = 20) and women (n = 19), explored immigrants' perceptions of extramarital sex and sexually transmitted diseases (STDs). The study's results suggest that the sexual behavior of 'unaccompanied' married Mexican immigrant men, living alone in North Carolina, differs, at least in degree if not in kind, from that of 'accompanied' married men, residing in the state with their wives. Unaccompanied men who participated in the survey reported more lifetime sexual partners, more partners in the previous year, more extramarital partners and more contact with prostitutes than accompanied survey respondents. The qualitative interviews suggest that unaccompanied men's peculiar status as 'single' men in North Carolina may provide them with both motive and opportunity to have extramarital sexual relationships and that few married Mexican men and women perceive STDs as relevant to their lives. Overall, the study supports the need for male- and couple-focused STD prevention interventions for Hispanic immigrants.
Adolescent↗
A review of available data on the health of the Latino population in North Carolina.
OBJECTIVE: To portray major health problems and conditions in the Latino population of North Carolina. STUDY DESIGN: Presentation of descriptive information from North Carolina data sets on Latino health issues, with whites and African Americans as comparison groups. DATA SOURCES/STUDY SETTING: Statewide data on the health of the Latino population are provided from the following data sets: North Carolina Behavioral Risk Factor Surveillance System (BRFSS), death certificates, North Carolina Office of the Chief Medical Examiner records, sexually transmitted disease reports, reported pregnancies, certificates of live birth, North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS), and North Carolina Birth Defects Monitoring Program (BDMP) cases. DATA COLLECTION METHODS: Review of existing data systems. PRINCIPAL FINDINGS: Latinos in North Carolina have high death rates from motor vehicle injuries and homicide. Latinos who die from unintentional injuries, homicide, and suicide are much more likely than whites or African Americans to have a high blood alcohol level. Latinos are less likely than other groups to have health insurance. Latinos have much higher pregnancy rates, both for teens and older women, and are more likely to begin prenatal care late or have no prenatal care. Rates of sexually transmitted disease are higher than those for whites but lower than those for African Americans. Latinos are more likely to initiate breastfeeding. Latinos have a higher rate of neural tube defects compared to the other groups, while being less likely to take folic acid every day before pregnancy. Despite lower family incomes, later entry into prenatal care, and higher rates of certain birth defects, Latinos had the lowest rates of low birth weight and infant mortality. Lower rates of smoking during pregnancy among Latinos may partially account for the better birth outcomes. CONCLUSIONS: Many of the health issues among Latinos in North Carolina are consistent with the fact that they are a very young, mainly recently-arrived, immigrant population with more males than females. RELEVANCE: These findings may provide a basis for designing more effective health improvement programs for the Latino population of North Carolina.
Adolescent↗
The North Carolina Area Health Education Center program: an overview.
North Carolina has been at the forefront of the planning, development, and operation of area health education centers (AHECs). These centers have dramatically improved health manpower education and training at all professional levels. In effect, the North Carolina Area Health Education Center Program is a major decentralization and coordination of medical, dental, pharmacy, and public health education and regionalization of nursing, allied health education, medical residency training, and continuing education. The program links each of the university health science centers in North Carolina to major community hospitals that form a regional network with other institutions. The University of North Carolina at Chapel Hill School of Pharmacy has a major role in the AHEC program. A full-time faculty is located in each AHEC. In addition to providing and coordinating clinically oriented pharmaceutical services and functioning as a resource in all matters relating to drugs, they are extensions of the school's faculty. The North Carolina AHEC Program approach offers pharmacy an excellent opportunity to maximize the pharmacist's contributions to society through education and practice.
Area Health Education Centers↗
Proximity to pulp and paper mills and wheezing symptoms among adolescents in North Carolina.
Using data from the North Carolina School Asthma Survey about the respiratory health of 64,432 adolescents attending public schools in North Carolina and data provided by school employees about the environmental health conditions of the school buildings, we assessed the prevalence of daytime wheezing during the past year among students estimated to be exposed to air pollutants arising from pulp and paper mills located near the schools. Of the schools the students attended, 14% (37/266) were located within 30 miles of one or more pulp and paper mills and odor from the mills was identified by survey respondents for 9 of the 266 schools. The prevalences of daytime wheezing in smokers and nonsmokers with household cigarette smoke exposure were elevated among students attending schools located within 30 miles of a pulp and paper mill, compared to the prevalence among students attending schools located beyond 30 miles (10 miles, prevalence ratio (PR): 1.21, 95% confidence interval (95% CI): 0.99, 1.43; 10-30 miles, PR: 1.06, 95% CI: 0.96, 1.16) and among students attending schools with noticeable odor from a pulp and paper mill (PR: 1.12, 95% CI: 0.93, 1.31). These results indicate a possible association between paper mill location and wheezing symptoms among adolescents and suggest that community-based exposure to pulp and paper mill emissions may have a greater impact on smokers and individuals exposed to cigarette smoke in the home than on nonsmokers without such household exposure.
Adolescent↗
Anesthesiologists in North Carolina: a survey reflecting emerging subspecialization.
This North Carolina case study addresses the migration of anesthesiologists into subspecialty, clinical areas of anesthesiology over a 4-year period (1984 to 1987). Three hundred fourteen members of the North Carolina Society of Anesthesiologists (NCSA) were surveyed using a one-page questionnaire. The response rate was 93.6%. The questionnaire elicited data to characterize the magnitude of change in anesthesiologist manpower, to assess emerging subspecialization, to describe the flux of anesthesiologists entering and leaving practice, and to detail evolving modes of practice. Results indicated a net increase in manpower averaging 8.8% per year in academic programs, whereas clinical community practitioners increased physician positions at a rate three times the former (27% increase per year). Of 184 anesthesiologists recruited to North Carolina over 4 years, 75 different residency programs were represented; 48% of new anesthesiologists were from southern educational programs and 44% entered practice with fellowships (i.e., postgraduate year 4 to 5). The principal fellowship was cardiac (33%). Subspecialty areas were represented in all 53 reporting clinical practices. The principal practice mode emerging was hospital-based, same day surgery (85%) followed by pediatric anesthesia (81%), perioperative pain management (68%), obstetric anesthesia (63%), and an anesthesia "clinic" (54%). Respondents expected additional practice options over the next 3 years with anesthesia for ambulatory diagnostic and therapeutic modalities projected to emerge at the fastest rate. In conclusion, anesthesiologists in North Carolina seem to be filling unmet needs in obstetric and cardiac anesthesia, critical care, ambulatory surgery, and pain therapy units. These observations may represent a vignette of the national scene.
Anesthesiology↗
Cardiovascular disease risk factor intervention in low-income women: the North Carolina WISEWOMAN project.
OBJECTIVES: The North Carolina WISEWOMAN project was initiated to evaluate the feasibility of expanding an existing cancer screening program to include a cardiovascular disease (CVD) screening and intervention program among low-income women. METHODS: Seventeen North Carolina county health departments were designated as minimum intervention (MI), and 14 as enhanced intervention (EI). The EI included three specially constructed counseling sessions spanning 6 months using a structured assessment and intervention program tailored to lower income women. RESULTS: Of the 2,148 women screened, 40% had elevated total cholesterol (> or = 240 mg/dL), 39% had low high-density lipoprotein cholesterol (HDL-C) levels (< 45 mg/dL), and 63% were hypertensive (systolic blood pressure 140 and/or diastolic blood pressure > or = 90 mm Hg or on hypertensive medication). The majority of women (86%) had at least one of these three risk factors. Seventy-six percent were either overweight or obese. After 6 months of follow-up in the EI health departments, changes in total cholesterol levels, HDL-C levels, diastolic blood pressure, and BMI were observed (-5.8 mg/dL, -0.9 mg/dL, -1.7 mm Hg, and -0.3 kg/m(2), respectively), but were not significantly different from MI health departments. A dietary score that summarized fat and cholesterol intake improved by 2.1 units in the EI group, compared with essentially no change in the MI group. CONCLUSIONS: Expanding existing cancer screening programs to include CVD intervention was feasible and may be an effective means for promoting healthful dietary practices among low-income women.
Blood Pressure↗
Racial and ethnic disparities in childhood immunization coverage in North Carolina.
BACKGROUND/OBJECTIVES: In 2000 the North Carolina Immunization Branch established the Disparities Core Team to address the issue of disparities in immunization coverage in the state. Since no existing research identified disparities in childhood immunization, the Disparities Core Team undertook a kindergarten survey to determine the existence of disparities. Childhood immunization coverage levels were measured retrospectively by race and ethnicity in North Carolina. Completion of the 4-3-1 series (4 DTaP, 3 Polio and 1 MMR) by 24 months was considered up-to-date. METHODS: Immunization, demographic, and healthcare information was collected from school records in the fall of 2001 for a sample of kindergarten students. FINDINGS: Disparities were found on both state and regional levels. Disparities within regions varied. CONCLUSIONS: White children were more likely to be up-to-date by 24 months of age than African American children (OR = 1.60, 95% CI 1.26-2.03), Latino children (OR = 2.24, 95% CI 1.61-3.11), and Asian children (OR = 1.88, 95% CI 1.03-3.4). Discovery of the cause of racial and ethnic disparities requires further study. Implications for interventions to eliminate disparities are discussed.
Black or African American↗
Pediatric dentists' participation in the North Carolina Medicaid program.
Data on Medicaid participation by dentists in North Carolina were obtained from the North Carolina Division of Medical Assistance and through a survey of pediatric dentists. As a group, pediatric dentists were the most active participants in the North Carolina Medicaid program during the 1990-91 state fiscal year and provided a disproportionate share of treatment for Medicaid-eligible children. Seventy-five per cent of the pediatric dentists limit their Medicaid participation. Top reasons given for limiting access for new Medicaid patients included low reimbursement rates, broken or canceled appointments, and need for prior authorization of Medicaid treatment plans. This paper explores several critical issues regarding access to dental care for children served by the Medicaid program in North Carolina.
Chi-Square Distribution↗
The University of North Carolina Arthritis Center.
The University of North Carolina Arthritis Center combines the broadly-based research agenda of the Thurston Arthritis Research Center with comprehensive interdisciplinary clinical programs in rheumatology, orthopaedics, and pediatric rheumatology. In keeping with the University's long tradition of service to the people of North Carolina, a primary aim of the Center is to provide the citizens of this state with the best available arthritis care and prevention strategies. The approach here is twofold. New knowledge is created by laboratory investigation of basic disease mechanisms, by clinical studies of new therapies, by social and behavioral research to better understand how patients and their families cope and adjust to chronic arthritis, and by health services research that examines arthritis from a societal perspective. This information, together with advances in rheumatology and related fields from Duke and other institutions, is then applied to optimum clinical and educational services for North Carolina patients and their physicians.
Academic Medical Centers↗