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PubMedDate not supplied

Medical homes for children with special healthcare needs in North Carolina.

BACKGROUND: The American Academy of Pediatrics defines a medical home as medical care for children that is accessible, continuous, comprehensive, family-centered, coordinated, and compassionate. North Carolina uses the medical home concept as a model for providing high quality care to children with special healthcare needs (CSHCN). However, until recently, information on medical homes for CSHCN in North Carolina has not been available. METHODS: Using North Carolina data from the National Survey of Children with Special Health Care Needs (2000-2002), we describe the characteristics of children having a special healthcare need. We conducted bivariate analysis of socio-demographic factors with medical home and its five components (family-centered care, effective care coordination, personal doctor or nurse, usual source of care, and referrals for specialty care) and multivariate analysis to identify the predictors of having a medical home. RESULTS: Fifty-six percent of CSHCN in North Carolina have a medical home. White CSHCN are 1.7 times more likely to have a medical home compared to non-white CSHCN. CSHCN with no functional limitations are 1.6 times more likely to have a medical home compared to children with some or severe limitations of their functional status. CONCLUSIONS: Current, population-based information about CSHCN and their families is essential for assessing needs and evaluating pediatric initiatives at the state level. Disparities among CSHCN due to race and functional status should be considered in organizing services for CSHCN in North Carolina.

Child↗
PubMed2003

North Carolina Association challenges the state Medicaid agency and wins!

After Judge Beecher Gray ordered parties to attempt to settle before re-appearing on September 29, AHHC Executive Vice-President Tim Rogers and staff met with DMA officials as well as members of the General Assembly and Governor's office. Using a comprehensive approach, AHHC launched an immediate political and press campaign to help convince DMA in addition to its legal actions. Articles and testimony from affected PDN patients and their parents began appearing in North Carolina newspapers, and ultimately the state was persuaded to settle this issue out of court. At press time, DMA has finally instructed the state Attorney General to proceed with legal settlement papers that will in essence support all the issues AHHC was fighting for. North Carolina will maintain the current (higher) PDN reimbursement rate; will NOT recoup any funds from providers: and will file a state plan amendment and repay CMS the federal share. Due to AHHC's action, North Carolina providers have been spared nearly $4 million in recoupments and potential agency closure and shut-down of the PDN program ... which serves only 380 North Carolina residents. After nearly two years of having to react and advocate for its members, the North Carolina association can now rejoice in the fact that "you can fight city hall..." and win! Rogers reports "the North Carolina association has entered into a new era of stature and respect and advocacy on behalf of its record 570 agency members. This was truly a team effort and stands as a great legacy for AHHC." AHHC now enjoys a much improved, collaborative relationship with the North Carolina Department of Health and Human Services and DMA. AHHC has entered into a whole new era of cooperation and dialogue with the new Medicaid administration in North Carolina. DMA has been tremendously supportive and has expressed renewed interest in learning more about the state's growing home care and hospice industry. AHHC has a staff of five and a contract staff of three. Rogers rejoined the AHHC staff in 2001 after seven years in private home health and hospice employment. He states, "It was my dream to ultimately rejoin AHHC as its EVP and staff, like long-time AHHC regulatory expert Sherry Thomas. That dream materialized in 2001, and I must say--it's so good to be back HOME. "The last two years have been memorable for our great association, its staff, and its board of directors. But two special people who helped maintained our very existence during these lawsuits were attorney Renée Montgomery and Judge Jack L. Cozort. I always knew that Renee and Jack were among the state's health care legal experts, but never did I dream that they would envelop such passion, devotion, and vigor during this process." At the 2003 AHHC Annual Meeting, AHHC formally recognized Montgomery, Cozort, and Thomas as its "Home Care and Hospice Heroes."

Home Care Services↗
PubMed1994

Hypothermia-related deaths--North Carolina, November 1993-March 1994.

For 1979-1991, North Carolina (1990 population: 6,628,637) ranked second in number and ninth in rate of deaths associated with hypothermia (clinically defined as an unintentional lowering of the body temperature to < or = 95 F [< or = 35 C])). From November 1993 through March 1994, a total of 28 deaths attributed to hypothermia were reported to the Office of the Chief Medical Examiner in North Carolina. This report summarizes information about those deaths and describes specific findings for four deaths that reflect circumstances commonly associated with hypothermia.

Adult↗
PubMedDate not supplied

Discrepancies between published data on racial classification and self-reported race: evidence from the 2002 North Carolina live birth records.

OBJECTIVES: We compared data on race as reported by the mother on North Carolina birth certificates with data on race in officially reported statistics. We also determined to what extent differences in the classification of race affect measures of racial disparity in maternal and child health indicators. METHODS: We examined how data on race are collected, coded, and tabulated in North Carolina via live birth certificates, death certificates, the Behavioral Risk Factor Surveillance System (BRFSS) telephone survey, and the Central Cancer Registry case records. We showed how the data on race collected through North Carolina birth and death certificates are translated into 10 fixed racial categories designated by the National Center for Health Statistics (NCHS) for use in official vital statistics. We compared race as reported by the mother on birth certificates to racial tabulations used in the official published birth statistics. We also examined to what extent differences in the determination of race affect measures of racial disparity in maternal and child health indicators. RESULTS: Out of nearly 118,000 live births in North Carolina in 2002, mothers reported more than 600 different versions of race on birth certificates. These entries were collapsed into the 10 standard racial categories outlined in federal coding rules. Approximately two-thirds of mothers of Hispanic ethnicity report their race with a label that can be categorized as "Other" race, but nearly all of these births are re-coded to "white" for the official birth statistics. Measures of racial disparity vary depending on whether self-reported or officially coded race is used. CONCLUSIONS: This study shows that, given the opportunity to report their own race, North Carolinians describe their race using a wide variety of terms and concepts. In contrast, health statistics are usually reported using a few standardized racial categories defined by federal policy. The NCHS rules for coding race should be reexamined. As the ethnic and racial diversity of the United States continues to increase, these rules will become increasingly antiquated.

Birth Certificates↗
PubMed2002

Water safety among Latino farmworkers in North Carolina.

Latinos constitute the vast majority of North Carolina's farmworker population. Drowning is a significant occupational health hazard in agriculture. Recent reports also suggest a disproportionate number of drowning victims in North Carolina are Latinos. Survey data are used to examine the levels of farmworker participation in aquatic activities and water safety behaviors. Over one-third of the farmworkers reported that they did not know how to swim. About one-quarter of the farmworkers reported participation in aquatic activities, with a greater percentage of those knowing how to swim participating in these activities. Recommendations to increase farmworker water safety include providing information through their employers and health outreach workers.

Journal Article↗
PubMed1998

North Carolina macular dystrophy (MCDR1) in Texas.

PURPOSE: To map the gene responsible for causing a macular degeneration in a Texan family that appears clinically similar to the North Carolina macular dystrophy (MCDR1) phenotype. METHODS: A single family in Texas had all the typical clinical features of the North Carolina macular dystrophy phenotype. Of 23 family members examined, 10 were affected. Blood was collected from all 23 members and fundus photographs were obtained on those affected. A detailed family history consisting of nine generations was obtained. Genotyping and likelihood analysis was performed using the closest linked MCDR1 markers. RESULTS: The genealogic data showed no relation with the original North Carolina macular dystrophy pedigree. The dinucleotide repeat marker D6S283 yielded the highest 2-point LOD score with a Zmax = 4.1 at theta = 0. The peak LOD score generated from multipoint analysis was 6.0. CONCLUSIONS: The linkage results indicate that the macular degeneration in this Texan family is due to a mutation in the same genomic region as that causing North Carolina macular dystrophy. Furthermore, haplotype analysis suggests that the original North Carolina family and the Texan family have the same mutation and a common founder.

Adult↗
PubMed1999

Mortality among North Carolina construction workers, 1988-1994.

This study evaluated proportionate mortality patterns among all male construction workers in North Carolina who resided and died in North Carolina during the period 1988-1994. Proportionate Mortality Ratios (PMRs) and Proportionate Cancer Mortality Ratios (PCMRs) compared the number of deaths among male construction workers with the number of deaths expected based on the gender, race, and cause-specific mortality experience of the entire North Carolina population by five-year age groups for the same years of study. PMRs based on United States death rates also were calculated. Among all male construction workers, significantly elevated mortality was observed for several causes possibly related to work including malignant neoplasms of buccal cavity (PMR = 143), pharynx (PMR = 134), and lung (PMR = 113), pneumoconiosis (PMR = 111), transportation accidents (PMR = 106), and accidental falls (PMR = 132). Elevated mortality also was observed for causes more related to lifestyle and non-occupational factors including alcoholism (PMR = 145), cirrhosis of the liver (PMR = 129), accidental poisoning (PMR = 136), and homicide (PMR = 141). Patterns of elevated mortality for Whites and Black men were similar and PCMR mortality patterns for Blacks and Whites combined were similar to PMRs. Construction workers were at significantly increased risk for deaths resulting from falls from ladders or scaffolds, falls from or out of buildings or structures, and electrocutions. Construction trades found to have statistically elevated cancer risks include laborers and roofers (buccal cavity), painters (pharynx), laborers (peritoneum), and carpenters, painters, brick masons, and operating engineers (lung). These data are consistent with other reports demonstrating excess mortality from asbestos-related diseases (pneumoconiosis, lung cancer, and mesothelioma) among construction workers. Dry-wall workers and laborers were found to have a statistically elevated risk of death as a result of respiratory tuberculosis.

Adolescent↗
PubMed2004

From gunstore to smoking gun: tracking guns that kill children in North Carolina.

PURPOSE: This study reviews the epidemiology of pediatric firearm deaths in North Carolina and estimates the time from the retail sale of guns to their involvement in pediatric firearm deaths. METHODS: The authors reviewed autopsy reports for all children 0 to 14 years of age that died of firearm-related injuries in North Carolina from January 1999 through December 2002. Data obtained included demographic information, firearm type, and manner of death. Data from the Bureau of Alcohol, Tobacco and Firearms, which traced guns involved in crimes and determined the time elapsed from purchase to their involvement in a crime (ie, time-to-crime were also reviewed). RESULTS: During the study period, 40 children died of firearm injuries. Mean age was 7.6 years. Handguns were responsible for the majority of deaths (59%) followed by shotguns (27%), rifles (10%), and undetermined cause (10%). Most deaths were homicides (67%) followed by unintentional death (18%), suicide (13%), and undetermined cause (2%). Most crime guns (76%) were purchased legally, and many (40%) had a time-to-crime of less than 3 years. CONCLUSIONS: Legally purchased firearms pose a significant threat to children in North Carolina. A more restrictive approach to the sale of handguns is a logical approach to reducing pediatric firearm-related deaths in the United States.

Adolescent↗
PubMedDate not supplied

Provision of pharmaceutical care services in North Carolina: a 1999 survey.

OBJECTIVE: To describe the extent of and factors associated with the provision of pharmaceutical care services (PCS) and value-added pharmaceutical services (PS) by pharmacists in North Carolina, the physical changes made in pharmacies to accommodate these services, the nature and extent of prior consent or collaborative practice arrangements between North Carolina pharmacists and prescribers, and the frequency of reimbursement for PCS. DESIGN: Descriptive study based on a mail survey. PARTICIPANTS: Pharmacist-managers at each of the 2,048 licensed pharmacy sites in North Carolina; a list of licensed pharmacies provided by the North Carolina Board of Pharmacy was used as the sampling frame. MAIN OUTCOME MEASURES: Pharmacists' reports of PCS and pharmacy demographics. RESULTS: Response rate was 40%. More than 30% of respondents provided PCS at their site, although only 20% met our more stringent definition of PCS (i.e., ensuring appropriate pharmacotherapy, ensuring patient understanding and adherence, and monitoring and reporting patient outcomes). Services were more frequently offered by university-affiliated (35%) or independent (32%) pharmacies. The median number of patients receiving PCS across all sites was 10 per week. Diabetes was the most common health problem for which PCS were offered. Three variables-weekly prescription volume (positive correlation); number of staff pharmacists with advanced training, specifically fellowship training; and medical clinic/health maintenance organization setting-were significant predictors of the numbers of patients provided PCS. Independent community pharmacies were most likely to have private counseling areas and to bill for and receive payment for PCS. CONCLUSION: In North Carolina, a substantial number of pharmacists provided PCS in 1999 or planned to do so in the near future. However, the number of patients receiving PCS was relatively low. Practice setting, pharmacist education level, and prescription volume were weakly predictive of the number of patients receiving PCS. Pharmacists commonly used prior consent arrangements with physicians in their practices, but primarily to facilitate generic substitution. Relatively few pharmacists billed for PS or PCS.

Community Pharmacy Services↗
PubMed1997

Lizards as hosts for immature Ixodes scapularis (Acari: Ixodidae) in North Carolina.

Previously archived museum specimens of lizards collected throughout North Carolina were examined for Ixodes scapularis (Say). Lizards (n = 1,349) collected in 80 of North Carolina's 100 counties were examined. Lizards with ticks were collected in 23 (29%) of the 80 counties from which lizards were examined. I. scapularis was detected on 8.7% (n = 117) of the lizards and was the sole species of tick obtained from lizards. Immature ticks were most frequently found on the southeastern five-lined skink, Eumeces inexpectatus, and the eastern glass lizard, Ophisaurus ventralis. Larvae were most frequently found on the six-lined racerunner, Cnemidophorus sexlineatus. One C. sexlineatus harbored 177 larvae and 2 nymphs. Nymphs were most frequently observed on E. inexpectatus. The majority of counties (chi 2, P < 0.01) where ticks were found on lizards were in the Coastal Plain.

Animals↗
PubMedDate not supplied

Prevalence and care of diabetes mellitus in the Medicare population of North Carolina. Baseline findings from the Medicare Healthcare Quality Improvement Program.

OBJECTIVE: To describe diabetes and its care in the Medicare population of North Carolina. STUDY DESIGN: Cross-sectional. DATA SOURCE/STUDY SETTING: Medicare claims for North Carolina residents 18 to 75 years of age were reviewed to characterize diabetes prevalence during the late 1990s and to evaluate adherence to diabetes clinical practice recommendations. PRINCIPAL FINDINGS: Almost 84,000 persons with diabetes and Medicare were identified. Diabetes prevalence was 15.0% overall, 22.9% among African Americans, and 12.9% among Caucasians. A "diabetes belt" of relatively high prevalence was noted in the eastern coastal plain. Glycated hemoglobin testing, lipid testing, and retinopathy screening were performed at about half the recommended rate. Diabetes care rates were lower for African Americans than for Caucasians. CONCLUSIONS: Diabetes is a common and under-treated condition in the Medicare population of North Carolina, especially among African Americans. RELEVANCE: There is much room for improvement in diabetes care within one of North Carolina's most vulnerable populations, the disabled and elderly enrolled in Medicare. Substantial public health opportunities exist in the identification and removal of barriers to diabetes care.

Adult↗
PubMed2002

The potential impact of flooding on confined animal feeding operations in eastern North Carolina.

Thousands of confined animal feeding operations (CAFOs) have been constructed in eastern North Carolina. The fecal waste pit and spray field waste management systems used by these operations are susceptible to flooding in this low-lying region. To investigate the potential that flood events can lead to environmental dispersion of animal wastes containing numerous biologic and chemical hazards, we compared the geographic coordinates of 2,287 CAFOs permitted by the North Carolina Division of Water Quality (DWQ) with estimates of flooding derived from digital satellite images of eastern North Carolina taken approximately 1 week after Hurricane Floyd dropped as much as 15-20 inches of rain in September 1999. Three cattle, one poultry, and 237 swine operations had geographic coordinates within the satellite-based flooded area. DWQ confirmed 46 operations with breached or flooded fecal waste pits in the same area. Only 20 of these 46 CAFOs were within the satellite-based estimate of the inundated area. CAFOs within the satellite-based flood area were located in 132 census block groups with a population of 171,498 persons in the 2000 census. African Americans were more likely than whites to live in areas with flooded CAFOs according to satellite estimates, but not according to DWQ reports. These areas have high poverty rates and dependence on wells for drinking water. Our analysis suggests that flood events have a significant potential to degrade environmental health because of dispersion of wastes from industrial animal operations in areas with vulnerable populations.

Adult↗
PubMedDate not supplied

Air medical transport utilization review in North Carolina.

OBJECTIVE: To perform a review of the collective experience of all hospital-based helicopter ambulances in the state of North Carolina for compliance with utilization review criteria. DESIGN: Flight records of the six members of the North Carolina Aeromedical Affiliation for the months of November and December 1989 were compared with utilization review criteria by an independent reviewer. A secondary review was performed by a staff member for each service. Scene responses and patients flown to a hospital other than the sponsor were evaluated. SETTING: All six hospital-based helicopter services in North Carolina. TYPE OF PARTICIPANTS: All available flight records for November and December 1989. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 756 transports, 747 flight records were available for review. Initial review demonstrated compliance with the criteria for 713 (95.4%) patients; secondary review showed compliance for 18 of 34 flights not meeting initial review, for an overall compliance rate of 97.9%. Compliance rates for scene responses and transports taken to a hospital other than the sponsoring facility were 96.6% and 94.1%, respectively. CONCLUSIONS: Review of all flights over a period of two-months by all six hospital-based helicopter services in North Carolina using utilization review criteria demonstrated a very high rate of compliance with the established criteria.

Aircraft↗
PubMed1996

Comparative seroreactivity to Bartonella henselae and Bartonella quintana among cats from Israel and North Carolina.

Bartonella henselae, the predominant cause of cat scratch disease, and Bartonella quintana, the cause of trench fever, are closely related Bartonella species that induce cross-reactivity when cat or human sera are tested using an indirect immunofluorescence antibody (IFA) test. Cats are the natural reservoir for B. henselae, whereas a mammalian reservoir host for B. quintana has not been identified. Serum samples from 114 cats from Israel and 114 cats from North Carolina were tested by IFA for seroreactivity to B. henselae and B. quintana antigens. Similar numbers of cats from Israel [45 (39.5%)] and from North Carolina [46(40.4%)] were seroreactive to both antigens, however, as compared to cats from North Carolina [8 (7%)], a significantly (P = 0.001) larger number of cats from Israel were seroreactive to B. quintana antigen only [23 (20.2%)]. In addition, mean antibody titers were lower to B. henselae than to B. quintana (P = 0.0001) in the cats from Israel, whereas similar mean titers to both antigens were identified in cats from North Carolina. Absorption of serum using whole B. henselae organisms resulted in a significantly greater (P = 0.0001) decrease in antibody titer to B. henselae between absorbed and non-absorbed sera, as compared to the decrease in antibody titer following absorption with whole B. quintana organisms. There was a similar decrease in antibody titer in sera from cats experimentally infected with B. henselae and in cats naturally exposed to Bartonella species from Israel and North Carolina. Our results indicate that absorption of serum will, in most instances, distinguish species-specific reactivity by IFA to B. henselae from cross-reactivity to B. quintana in cats experimentally infected with B. henselae. The data support the conclusion that B. henselae is the principal Bartonella species responsible for seroreactivity against B. henselae and B. quintana in naturally exposed cats from Israel or North Carolina. It also suggests that in Israel, cats are exposed to one or more antigenically different Bartonella species, sub-species or strains, that seroreact by IFA more intensely with B. quintana antigen.

Animals↗
PubMedDate not supplied

Protecting workers from secondhand smoke in North Carolina.

BACKGROUND: Exposure to job-related secondhand smoke represents a significant, but entirely preventable occupational health risk to non-smoking workers. This article examines trends in smoke-free workplace policies in North Carolina. We also examine whether workers comply with such policies. METHODS: Data from the Census Bureau's Current Population Survey were analyzed from 1992 through 2002. Trends for North Carolina workers are compared with workers nationally and trends are presented by age, race, gender, and type of worker. RESULTS: North Carolina ranks 35th in the proportion of its workforce reporting a smoke-free place of employment. The proportion of workers reporting such a policy doubled between 1992 and 2002. Females were more likely to reporta smoke-free work environment (72.0%, CI +/- 2.6) than males (61.2%, CI +/- 4.6%). Blue-collar (55.6%, CI +/- 5.5) and service workers (61.2%, CI +/- 8.4), especially males, were less likely to report a smoke-free worksite than white-collar workers (73.4%, CI +/- 2.6). Compliance with a smoke-free policy does not appear to be an issue, only 3.2% of workers statewide reported someone had violated their company's nonsmoking policy CONCLUSION: While some progress has been made in North Carolina to protect workers from secondhand smoke, significant disparities exist. Smoke-free policies can make a significant difference in reducing exposure to airborne toxins and their associated diseases, and these protective public health policies have not been shown to reduce business revenues. Much has been done to assure the health and safety of workers through public health policy However, opportunities to protect North Carolina workers from the health effects of secondhand smoke are limited by a preemptive state law.

Adolescent↗
PubMed2006

Availability of crop residues as sustainable feedstock for bioethanol production in North Carolina.

The amount of corn stover and wheat straw that can be sustainably collected in North Carolina was estimated to be 0.64 and 0.16 million dry t/yr, respectively. More than 80% of these crop residues are located in the coastal area. The bioethanol potential from corn stover and wheat straw was estimated to be about 238 million L (63 million gal/yr) in North Carolina. The future location of ethanol plant in North Carolina was estimated based on feedstock demand and collection radius. It is possible to have four ethanol plants with feedstock demand of 400, 450, 500, and 640 dry t/d. The collection radii for these four ethanol plants are 46, 60, 42, and 67 km (28, 37, 26, and 42 miles), respectively. The best location for a bioethanol plant includes four counties (Beaufort, Hyde, Tyrrell, and Washington) with feedstock demand of 500 t/d and collection radius about 26 mile.

Biomass↗
PubMed1997

Clinical and genetic evidence for autosomal dominant North Carolina macular dystrophy in a German family.

PURPOSE: To describe a German family with clinical and genetic evidence of autosomal dominant North Carolina macular dystrophy. METHODS: Twenty-six individuals from a five-generation family from northern Germany were investigated clinically. In addition, we performed genetic linkage analyses using polymorphic markers from proximal 6q. RESULTS: The affected family members showed clinical abnormalities consistent with North Carolina macular dystrophy including multiple drusen, choroidal neovascularization in one patient, and geographic atrophy in elderly patients. The DNA analyses demonstrated significant linkage to the North Carolina macular dystrophy locus on chromosome 6q14-q16.2. CONCLUSION: Our findings provide strong evidence of a German pedigree with an autosomal dominant macular dystrophy manifesting with clinical abnormalities consistent with North Carolina macular dystrophy.

Adolescent↗