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PubMed1988

Day care center illness: policy and practice in North Carolina.

We surveyed 62 North Carolina day care centers (DCCs) to determine their policies for excluding children. We found that the addition of a temperature of 100-101 degrees F to each of eight symptoms was associated with an increase in the percentage of DCCs choosing "immediate pick-up." Non-profit centers were more likely to send children home (70 per cent) than for-profit centers (48 per cent). Centers with and without written illness policies did not differ in their management of sick children.

Adult↗

PubMed1995

Survey of the practice of electroconvulsive therapy in North Carolina.

A survey of North Carolina hospitals was conducted to determine the distribution and characteristics of facilities that offer electroconvulsive therapy (ECT). Parameters examined in the survey included bed size, geographic location, and average volume of ECT treatments. Facilities that offer ECT make up only 14% of total hospitals surveyed. The majority of hospitals with ECT services are located in moderate to large urban areas. Specific areas of practice were surveyed for each facility, including type of ECT device, location of treatments/recovery, methods for monitoring ictal motor seizure, time required to perform treatments, staffing, and potential areas of ECT nursing education. Standard practices at facilities were found to be generally in compliance with American Psychiatric Association recommendations; differences in practices were identified. Potential nursing education topics related to ECT were ranked to determine those most useful to individual nursing staffs.

Electroconvulsive Therapy↗

PubMedDate not supplied

Efficacy of mandatory seat-belt use legislation. The North Carolina experience from 1983 through 1987.

The North Carolina General Assembly approved a law effective in October 1985 that mandated seat-belt use by front-seat occupants of passenger vehicles. In January 1987, a $25 fine for infractions of this law went into effect. This study examined numbers of car occupants with severe and fatal injuries in crashes in North Carolina, controlling for the amount of vehicle damage as a measure of crash severity. After the law, significant decreasing trends were seen in the percentages of front-seat occupants who had severe or fatal injuries in crashes, although the involvement of alcohol in crashes was still associated with an increased risk of such injury. Projections indicate that a reduction of approximately 1100 severe or fatal injuries per year can be attributed to the seat-belt law in North Carolina. This study supports the hypothesis that the societal burden of crash-associated injury can be reduced by mandating seat-belt use.

Accidents, Traffic↗

PubMed2003

Bariatric surgeries in north Carolina, 1990 to 2001: a gender comparison.

OBJECTIVE: The purpose of this research was to determine the number of bariatric procedures in obese men and women in a well-defined population and to examine gender differences among bariatric patients. RESEARCH METHODS AND PROCEDURES: Data on bariatric patients were taken from the North Carolina Hospital Discharge Database, which contains information on all nonfederal hospital discharges in North Carolina from 1990 to 2001. Using North Carolina Hospital Discharge Data, Census North Carolina resident estimates, and North Carolina obesity prevalence estimates, we constructed annual rates for bariatric procedures for the obese male and female population in North Carolina. RESULTS: Overall, 2197 bariatric procedures were performed between 1990 and 2001. The annual rate of bariatric procedures in obese women increased rapidly, particularly between 1998 and 2001, whereas the increase for men was considerably less than that for women. Controlling for age and year of procedure, the odds ratio for obese female North Carolina residents of having a bariatric procedure was 4.96 (95% confidence interval: 4.39, 5.59) and of having a Roux-en-Y procedure was 5.57 (95% confidence interval: 4.67, 6.64) compared with obese male North Carolina residents. Controlling for age, comorbidity burden, payment source, and year of procedure, obese male North Carolina residents had a significantly greater (22%) amount of inpatient days than obese female North Carolina residents. DISCUSSION: After controlling for population rates of obesity and year of procedure, women are more likely than men to undergo bariatric surgery, suggesting that gender-related factors may influence use. More research is needed to determine the causes for this large gender disparity.

Adult↗

PubMed2002

Risk-based analysis of environmental monitoring data: application to heavy metals in North Carolina surface waters.

The state of North Carolina's Department of Environment and Natural Resources (NCDENR) conducts routine water quality monitoring throughout the state to assess the health of aquatic systems. The current study reports the results of a retrospective (1990-2000) ecological risk assessment of six heavy metals (arsenic, cadmium, copper, lead, mercury, and zinc) in 17 North Carolina basins that was conducted to estimate the risk of heavy metal toxicity to freshwater organisms and assess the sufficiency of NCDENR's monitoring data to identify water-quality-related ecological threats. Acute and chronic ecotoxicological thresholds (ETs) were calculated for each metal based upon the 10th percentile of species sensitivity distributions and were normalized for water hardness. Statewide probabilities (expressed as percentages) of a random sample exceeding acute or chronic ETs among the six metals ranged from 0.01% to 12.19% and 0.76% to 21.21%, respectively, with copper having the highest and arsenic and mercury the lowest risk. Basin-specific probabilities varied significantly depending upon water hardness and presumably watershed development. Although the majority of specific sites where data were collected were at low risk for metal toxicity, some specific sites had a high probability of toxic events associated with one or more metals. Analytical detection limits for metals were frequently higher than estimated chronic ET, limiting the ability to assess the risk of chronic toxicity in soft-water basins. Results suggest risk-based criteria may be useful for assessing and validating the sufficiency of monitoring programs and prioritizing management goals.

Animals↗

PubMed1990

Evaluating the North Carolina safety belt wearing law.

The North Carolina Seat Belt Law required an evaluation of the effectiveness of the act with a report of the findings to the Legislature three years after the law went into effect. This paper addresses changes in statewide belt usage and in occupant injury associated with that law. Observational data collected bimonthly from a probability sample of 72 sites stratified by geographic region, rural/urban location, road type, and time of day show that belt use rose from a baseline rate of 25% to a warning ticket phase rate of 45%. Belt use then reached 78% upon enforcement and is now nearly 64%. Time series analysis showed that statistically significant reductions in percentages of moderate and serious injuries occurred at the beginning of both the warning ticket and the enforcement phases. Forecasts of injuries and deaths were also developed from the time series models and were compared with observed totals. Warning tickets brought about a modest 5.4% reduction in serious injuries; fatalities among occupants covered by the law showed no change. In contrast, the subsequent enforcement phase saw a reduction of 11.6% in fatalities and 14.6% in serious or worse injuries. This represents an estimated annual savings of 131 lives and over 2,300 serious injuries in North Carolina during the 18 months following onset of enforcement.

Accidents, Traffic↗

PubMed2006

Racial and ethnic disparities in pediatric tuberculosis in North Carolina.

OBJECTIVES: To investigate an increase in active pediatric tuberculosis (TB) cases in North Carolina from 9 cases in 2001 to 32 cases in 2002, and to pilot test a screening tool for detection of latent TB infection in children. DESIGN: Retrospective cohort and cross-sectional study. SETTING: State of North Carolina and a county public health department pediatric clinic. PARTICIPANTS: Children younger than 15 years with TB in North Carolina from January 1, 1994, to December 31, 2002, and children younger than 21 years initially seen in a primary care public health department pediatric clinic from July 16, 2004, to December 8, 2004. INTERVENTIONS: We reviewed medical records for 180 children (<15 years) with active TB reported in North Carolina. We subsequently initiated a screening project at a county public health department pediatric clinic. MAIN OUTCOME MEASURES: Incidence of TB and prevalence of latent TB infection. RESULTS: One hundred eighty pediatric TB cases were reported from 1994 to 2002. Compared with 0.2 case per 100 000 non-Hispanic white children, the incidence rates were 3.0 cases per 100 000 non-Hispanic black children (P = .003) and 4.5 cases per 100 000 Hispanic children (P = .01); 88.3% of pediatric patients with TB were nonwhite. The screening project detected 2 cases of latent TB infection among 864 US-born children of foreign-born parents. CONCLUSIONS: The burden of pediatric TB is almost entirely borne by black and Hispanic children in North Carolina. Tuberculin skin testing of US-born children of foreign-born parents is of low yield; more efficient screening strategies are necessary.

Adolescent↗

PubMed2007

Predictors of referral to the North Carolina Child Service Coordination Program among infants with orofacial clefts.

OBJECTIVE: North Carolina has several programs that identify high-risk women and children for needed services, including the Child Service Coordination Program (CSCP). This study determines CSCP referral rates among infants with orofacial clefts (OFCs) and predictors of CSCP referral. We hypothesized receiving Medicaid and maternity care coordination (MCC) services increases the likelihood of CSCP referral. DESIGN AND SETTING: For births between 1999 and 2002, data were matched from North Carolina Vital Statistics, Health Services Information System (MCC and CSCP data), and North Carolina Birth Defects Monitoring Program. Multivariate analysis was used to determine crude and adjusted odds ratios for sociodemographic variables to predict CSCP referral. PARTICIPANTS: A total of 644 mothers of live-born infants with OFCs in North Carolina were identified. RESULTS: About 45% of infants with OFCs were referred to the CSCP. Infants of mothers who were at least 30 years of age and mothers who had more than a high school education were significantly less likely to be referred to the CSCP. Compared with infants with OFCs whose mothers did not receive Medicaid, mothers who received Medicaid were 1.9 times more likely to be referred to the CSCP, and mothers who received Medicaid and MCC services were 2.3 times more likely. CONCLUSIONS: Receipt of Medicaid and MCC services and receipt of Medicaid alone were positively associated with CSCP referral. Future studies should examine the effects of the duration of MCC services and factors related to the timeliness of CSCP referral.

Adult↗

PubMedDate not supplied

Racial disparities in birth outcomes increase with maternal age: recent data from North Carolina.

BACKGROUND: Racial disparities in birth outcomes persist in North Carolina and the United States. We examined patterns of birth outcomes and womens health measures in North Carolina by race and age to portray the largest disparities. We wanted to see if our data were consistent with the "weathering hypothesis," which holds that the health of African American women may begin to deteriorate in early adulthood, with negative effects on birth outcomes. METHODS: We conducted a descriptive analysis of 1999-2003 North Carolina live birth and infant death records and 2001-2003 Behavioral Risk Factor Surveillance System survey data. Birth outcome measures examined were low birth weight, very low birth weight, infant mortality neonatal mortality and postneonatal mortality. Womens health measures examined were obesity self-reported health status, high blood pressure, high cholesterol, current smoking, and smoking during pregnancy. Rates for whites and African Americans were compared for each of three age groups. RESULTS: Racial disparities in birth outcomes increase with increasing maternal age. African American teens often experience better birth outcomes than older African American women. Racial disparities in measures of womens health also increase with increasing age. CONCLUSIONS: Health problems among older African American women of reproductive age may contribute substantially to racial disparities in birth outcomes. Improving the health of older African American women may be an effective strategy to reduce the overall racial disparities in birth outcomes.

Adolescent↗

PubMed1990

Pertussis immunization in eight-month-old children in North Carolina.

Between 1984 and 1987 reported pertussis cases in North Carolina increased threefold. Pertussis immunization rates were examined for those years in three one-year cohorts drawn from a random selection of North Carolina birth records. The percentage of children immunized with three DTPs at eight months of age was 58.1, 58.6, and 56.7 for the three cohorts. Only 20.5 percent of 117 reported pertussis cases in children 9-36 months of age during the last 10 years were adequately immunized. The low pertussis immunization rate may have contributed to the recent increase in pertussis cases in North Carolina.

Child↗

PubMed1998

North Carolina macular dystrophy: clinical features, genealogy, and genetic linkage analysis.

PURPOSE: To study the North Carolina macular dystrophy phenotype (MCDR1) in multiple families of different ethnic backgrounds, to determine the genetic relationships of these families, and to determine the minimal candidate region of the MCDR1 gene. METHODS: Thirteen families with the North Carolina MCDR1 were ascertained. These families were of various ethnic and geographic origins, such as Caucasian, Mayan Indian, African American, French, British, German, and American. Extensive genealogical investigations were performed for all families. A total of 232 members of these families underwent comprehensive ophthalmic examinations, including blood collection for genotyping. Of these, 117 were found to be affected with the disorder. Genetic linkage simulation studies were performed using the computer program SIMLINK. Two-point linkage analysis, haplotype analysis, and multipoint linkage analyses were performed using the computer programs M-LINK, VITESSE, and FASTLINK. RESULTS: The clinical features were consistent with the diagnosis of North Carolina macular dystrophy in all families studied. Multipoint linkage analysis and haplotype analysis indicate that the MCDR1 gene is in the 1.1-centimorgan (cM) interval between the genetic markers D6D249 and D6S1671, with a maximum LOD score of 40.03. There was no evidence of genetic heterogeneity. Families 765, 768, 772, 1193, and 1292 shared the same chromosomal haplotype in this region, suggesting they are the result of the same ancestral mutation. The remaining families each likely represent independent origins of the mutation in the MCDR1 gene. North Carolina macular dystrophy is present worldwide and does not emanate from a single founder from North Carolina.

Adolescent↗

PubMedDate not supplied

A profile of public health educators in North Carolina's local health departments.

The purpose of this study was to provide a profile of the public health education workforce in North Carolina. A survey was administered to all practicing health educators at local health departments (LHDs) in North Carolina. The study specifically attempted to answer four questions: (1) Who functions as health educators in LHDs in North Carolina? (2) What is the educational background and professional training of North Carolina LHD health educators? (3) What are the characteristics of health educators' positions in North Carolina? and (4) How do these characteristics of health educators (demographics and education) as well as their titles, job responsibilities, and supervisory relationships differ according to the size of the LHD? The study showed that most public health educators in North Carolina are white females; most do not have Certified Health Education Specialist certification; that younger health educators are more likely to have health education degrees; and that almost two thirds of public health educators have administrative responsibilities.

Adult↗

PubMed1997

North Carolina macular dystrophy phenotype in France maps to the MCDR1 locus.

PURPOSE: To determine if a family in France, which manifests an autosomal dominant macular dystrophy, has North Carolina macular dystrophy (MCDR1) and to determine its possible molecular genetic relationship with the original North Carolina family. METHODS: A family from Northern France with a macular dystrophy underwent comprehensive ophthalmic examinations and were ascertained for genetic studies. Blood collection and examinations were performed on 38 individuals. Fundus photographs with a hand held KOWA camera were obtained on affected subjects. DNA was extracted and genotyping performed using new microsatellite genetic markers, which have recently been found in the MCDR1 (North Carolina macular dystrophy) region. Standard two - point linkage and haplotype analysis was performed. RESULTS: Eleven individuals were found with the clinical manifestations of North Carolina macular dystrophy. Two - point linkage analysis generated a maximum peak LOD score of 4.5 with a recombination of 0% between D6S1717 and the macular dystrophy locus in the French family. The haplotype associated with the disease is, however, different from that of the original North Carolina family. CONCLUSIONS: These findings indicate that the macular dystrophy gene in this French family maps to the same region as that of North Carolina macular dystrophy (MCDR1) locus but that independent mutations are involved. The disease in the French family is clinically and genetically similar to North Carolina macular dystrophy. Therefore MCDR1 occurs in various ethnic groups, is present world-wide, and there remains no evidence of genetic heterogeneity for this clinically distinct form of macular degeneration.

Adolescent↗

PubMedDate not supplied

Granulocytic ehrlichiosis in dogs from North Carolina and Virginia.

Medical records of 3 dogs from North Carolina and 3 dogs from Virginia with ehrlichial morulae in circulating neutrophils were studied retrospectively. Two clinically distinct disease syndromes, including chronic, moderate to severe anemia (n = 3) and polyarthritis (n = 2) were associated with canine granulocytic ehrlichiosis (CGE) in these dogs. One dog was clinically healthy, and abnormalities were not detected during physical examination. Clinical signs were nonspecific and included fever, lethargy, anorexia, vomiting, and diarrhea. The most frequent laboratory abnormalities were normocytic normochromic nonregenerative anemia, moderate thrombocytopenia with large platelets, lymphopenia, and eosinopenia. Considerable variability was found in the serologic responses to Ehrlichia equi, Ehrlichia canis, and Ehrlichia chaffeensis antigens among the 5 dogs for which stored sera were available for indirect fluorescent antibody testing. Polymerase chain reaction amplification and sequencing of portions of the 16S rRNA gene from blood (collected in ethylenediaminetetraacetic acid) of 1 severely anemic dog (dog 3) and 1 polyarthritic dog (dog 4) resulted in DNA sequences nearly identical to the GenBank accessions for Ehrlichia ewingii. The DNA sequence from a 3rd dog (dog 5) was most similar to that of E. canis. Serologic or molecular results support the possibility of E. ewingii, E. equi, and E. canis coinfection or serologic cross-reactivity among canine granulocytic and monocytic Ehrlichia species in dogs from North Carolina and Virginia. Variability in response to tetracycline or doxycycline treatment was noted in these dogs, with more rapid resolution of signs in dogs with polyarthritis. We report the 1st cases of CGE in dogs from North Carolina and Virginia, including recognition of CGE in a healthy dog.

Animals↗

PubMed2003

Farmers' perceptions and concerns: the risks of driving farm vehicles on rural roadways in North Carolina.

This study focuses on farmers' perceptions of roadway safety and reviews specific and pertinent North Carolina rural road crash data to evaluate their perceptions and concerns. A survey was mailed to 1,357 prospective participants throughout North Carolina. Of these, 656 (48.3%) North Carolina farmers completed and returned the survey. The study revealed that while the majority of respondents took a number of specific safety measures to ensure their safety while driving their tractor on rural roads, most believed that driving their tractor on rural roads was more dangerous than it was five years ago. Few respondents believed that laws governing tractors on rural roads are well known by urban residents. While a majority of the respondents would support a law to mandate the use of a slow-moving vehicle (SMV) emblem on the back of slow-moving farm equipment, a majority also believed that a more effective way to mitigate potential crashes would be to ensure that all farm vehicles had blinking or flashing lights, that diamond-shaped caution signs depicting a tractor were posted on roadways with frequent tractor traffic, and that roadway shoulders were created or widened on roads with heavy farm traffic so that tractors could move off the roadway. Only 22% of respondents felt safe driving their tractor on rural roadways in North Carolina. Most respondents felt that the biggest problem with roadway safety was the lack of respect and increased speed of other drivers. Recent data indicate that in crashes involving farm vehicles, citations were issued to 34% of the non-farm vehicle operators and 24% to farm vehicle operators. For those driving non-farm vehicle who were deemed at fault, 66% were cited for failure to reduce speed. For those driving farm vehicles, the most frequent citation involved the lack of safe movement.

Accidents, Occupational↗

PubMed2002

The North Carolina Eden Coalition: facilitating environmental transformation.

The Eden Alternative, created by Harvard educated physician Dr. William Thomas, is a model for transforming skilled care facilities from institutions based on a medical model of care into human habitats that promote human growth. This change is accomplished through decentralizing the organizational structure of the facility to empower front-line care-delivery staff, and through introduction of plants, animals, gardening, and children into the daily lives of residents. Because the Eden Alternative is a trademarked name, only facilities recognized by the Eden Alternative registry are allowed to use the name. However, any facility may adopt the philosophies embodied by the Eden Alternative, and implement the principles for transforming their facility. In 1996, the North Carolina Division of Facility Services formed the North Carolina Eden Coalition (originally named the North Carolina Eden Alternative Coalition). This was the first organization of its kind in the country. The success of the Coalition has led it to become a model for implementation in other states. Currently, North Carolina leads the country in the number of registered Eden Alternative facilities, and has a large number of other facilities that have instituted some form of environmental enhancement. The Coalition functions as a consumer-driven advisory and educational body rather than a formal regulatory standard body, and endorses implementation of the principles and philosophies embodied in the Eden Alternative. The Coalition has proved to be a successful, cooperative effort among regulators, providers, advocates, and other experts to implement the philosophies of the Eden Alternative without regulatory basis. Because the Coalition was formed under the auspices of the Division of Facility Services and operates with its ongoing cooperation, it is in an excellent position to clarify and influence policies and regulatory issues concerning transformation of long-term care environments in North Carolina. This article explores the history, structure, function, mission, and goals of the North Carolina Eden Coalition. Examples of issues the Coalition has addressed in promoting environmental transformation in North Carolina's skilled care facilities are also included.

Aged↗

PubMed2002

Evaluation of the North Carolina "Baby Think It Over" project.

The North Carolina "Baby Think It Over" (BTIO) evaluation was conducted during spring semester 2000. Data were collected from participating teachers, students, and parents. Twenty-five teachers were selected randomly from different counties in North Carolina. Each randomly selected teacher coordinated the evaluation in conjunction with the intervention. Student surveys determined whether using the BTIO doll changed perceptions and attitudes toward teen parenting. Information also was collected on the veracity of each student's participation based on data provided from the computer in the baby. Surveys were sent home to the parents of participating students so information on communication, disruption of the household, and parenting perceptions could be obtained. Each teacher completed a survey that sought information on topics discussed throughout the intervention, hours of the program, and perceptions of program effectiveness. Parents and teachers were offered participation incentives. Overall, support existed for the BTIO intervention by parents and teachers. Most teachers and parents felt the program was effective at increasing communication about parenting and changing teens' attitudes in a desired direction. Most teachers reported that the intervention was not disruptive to their classes. However, results from student surveys did not reveal the same support. Student changes in attitudes and beliefs about parenting after the intervention were minimal.

Adolescent↗

PubMed2005

Adaptive management of flows in the lower Roanoke River, North Carolina, USA.

The lower Roanoke River in North Carolina, USA, has been regulated by a series of dams since the 1950s. This river and its floodplain have been identified by The Nature Conservancy, the US Fish and Wildlife Service, and the State of North Carolina as critical resources for the conservation of bottomland hardwoods and other riparian and in-stream biota and communities. Upstream dams are causing extended floods in the growing season for bottomland hardwood forests, threatening their survival. A coalition of stakeholders including public agencies and private organizations is cooperating with the dam managers to establish an active adaptive management program to reduce the negative impacts of flow regulation, especially extended growing season inundation, on these conservation targets. We introduce the lower Roanoke River, describe the regulatory context for negotiating towards an active adaptive management program, present our conservation objective for bottomland hardwoods, and describe investigations in which we successfully employed a series of models to develop testable management hypotheses. We propose adaptive management strategies that we believe will enable the bottomland hardwoods to regenerate and support their associated biota and that are reasonable, flexible, and economically sustainable.

Conservation of Natural Resources↗