Showing papers in "North Carolina medical journal in 2011"
TL;DR: The majority of conditions treated during outpatient ED visits are treatable in primary care clinics or even preventable, and some groups are at higher risk for inappropriate use of EDs.
Abstract: Background Patients often inappropriately seek emergency services for ambulatory care-sensitive conditions (ACSCs). The unnecessary use of emergency departments (EDs) is an expensive burden on hospitals and payers. Here, we identify factors influencing ED visits for ACSCs and analyze the costs of such visits for EDs and primary care clinics. Methods Age, race, sex, and insurance data from 2007 for 3 primary care safety net clinics and 4 EDs in Charlotte, North Carolina, were analyzed using the New York University (NYU) algorithm to identify ACSC diagnoses. Cost analyses used hospital charge data and net margins as surrogates for payer and hospital system costs. Results A total of 113,730 (59.4%) of 191,622 ED visits were for ACSCs. Factors that increased the number of ACSC-related visits included lack of insurance coverage; receipt of Medicaid insurance; age of less than 2 years; African American, Hispanic, or Native American race or ethnicity; and female sex. Charges in the EDs were 320%-728% higher than those in the primary care clinics, allowing for a potential savings of 69%-86% had ACSCs been treated in primary care clinics instead of in EDs. Limitations The NYU algorithm may have inherent weaknesses in the categorization of ACSC-related visits and the accuracy of cost assignment, especially for vulnerable patients, such as those with comorbidities or those aged less than 2 years. Conclusion The majority of conditions treated during outpatient ED visits are treatable in primary care clinics or even preventable. Some groups are at higher risk for inappropriate use of EDs. Solutions to this complex problem will require payers and hospital systems to design and invest in novel targeted interventions.
62 citations
TL;DR: A diverse program of telehealth and telepsychiatric service delivery is described and its advantages and disadvantages are discussed.
Abstract: Telehealth improves access to medical services, especially for people living in rural areas. In North Carolina, the advantages of telepsychiatry also go beyond improving access. This article describes a diverse program of telehealth and telepsychiatric service delivery and discusses its advantages and disadvantages.
36 citations
TL;DR: Farmers are at risk for pulmonary illnesses, including chronic bronchitis, organic dust toxic syndrome, farmer's lung diseases, allergic and nonallergic asthma, nasal irritation and polyps, and chemical pneumonitis.
Abstract: Depending on the type of farming practice, respiratory symptoms are common among agricultural workers. Farmers are at risk for pulmonary illnesses, including chronic bronchitis, organic dust toxic syndrome, farmer's lung diseases, allergic and nonallergic asthma, nasal irritation and polyps, and chemical pneumonitis.
24 citations
TL;DR: School nurses are effective in using case management to enhance the health and well-being of children with diabetes and for teens, case management improved quality of life, particularly the ability to communicate with health professionals.
Abstract: BACKGROUND Managing diabetes in children is complex. The aims of this descriptive study were to describe the care provided to children with diabetes by school nurses using case management, to identify differences in care on the basis of the workload of the nurse and the age of the child, to explore the role of the nurse in responding to emergencies, and to describe the relationship between case management and quality of life. METHODS School nurses completed an expanded health assessment. Individualized goals were established and interventions were provided on the basis of a protocol. Quantitative and qualitative data for children enrolled during the 2009-2010 academic year were analyzed. RESULTS Eighty-six children were enrolled. The most common goals were related to establishing a safe school environment. Interventions varied depending on the workload of the nurse and the age of the child. Nurses assigned to 1-2 schools provided more intervention days (mean, 40.3 days) than did nurses assigned to 3-4 schools (mean, 24.4 days) (P < .05), particularly in the area of direct care. A total of 25 students experienced an emergency at school that initiated a cascade of events involving the parent (in 100% of cases), the teacher (in 96%), management of hyperglycemia (in 100%), and/or management of hypoglycemia (in 96%). For teens, case management improved quality of life, particularly the ability to communicate with health professionals. LIMITATIONS The sample was small, and there was no comparison group. CONCLUSIONS School nurses are effective in using case management to enhance the health and well-being of children with diabetes. This study should be replicated with a larger sample, a comparison group, and the inclusion of clinical outcomes.
24 citations
TL;DR: This commentary describes the characteristics of North Carolina farmworkers, important hazards they face, and the status of regulatory protections, and presents a summary of policy needed to protect the health of farmworkers.
Abstract: Migrant and seasonal farmworkers are essential to North Carolina agriculture, yet they experience major health risks. This commentary describes the characteristics of North Carolina farmworkers, important hazards they face, and the status of regulatory protections. Finally, it presents a summary of policy needed to protect the health of farmworkers.
21 citations
TL;DR: When and where spatial techniques can most effectively be deployed to address environmental health issues, especially as they relate to environmental justice concerns are discussed.
Abstract: Recent advances in spatial statistics and geographic information systems provide innovative platforms for diagnosing environmental health problems and for developing interventions. This article discusses when and where spatial techniques can most effectively be deployed to address environmental health issues, especially as they relate to environmental justice concerns.
21 citations
TL;DR: It is indicated that Medicare insurance and female sex were associated with glycemic control in a cohort of family medicine patients with type 2 diabetes.
Abstract: BACKGROUND As new payment models are developed for chronic diseases such as diabetes, there is a need to understand which patient characteristics impact glycemic control. This study examines the relationship between patient variables and glycemic control, defined as a hemoglobin A1c (A1c) level of <7%, in a cohort of family medicine patients with type 2 diabetes. METHODS A total of 1,398 medical charts were selected using International Classification of Diseases, Ninth Revision, Clinical Modification codes for diabetes. To gather information not available through chart review, a survey was used to collect data on individual-level characteristics. Information included marital status, education level, income level, insurance status, activity level, receipt of diabetes education, living arrangement, employment status, and annual income. A cross-sectional design was used to obtain, via chart review, data about diabetes outcomes (ie, A1c level, blood pressure, and low-density lipoprotein cholesterol [LDL-C] level). RESULTS A mailed survey was completed by 669 patients (response rate, 47.9%). Almost half of patients in this sample achieved the goal A1c level, LDL-C level (ie, <100 mg/dL), and/or blood pressure (ie, <130/<80 mm Hg). Medicare insurance (odds ratio [OR], 2.16 [95% confidence interval {CI}, 1.18-3.96]) and female sex (OR, 1.61 [95% CI, 1.01-2.56]) were associated with glycemic control. Other variables, such as annual income, education level, and receipt of diabetes education, that were expected to impact glycemic control were not significantly associated with an A1c level of <7%. LIMITATIONS The survey response rate was <50%, the study was conducted at a single site, and the chart data were retrospective. CONCLUSIONS Our findings indicate that Medicare insurance and female sex were associated with glycemic control. Further evaluation is needed to identify determinants that lead to achievement of optimal glycemic control among individuals with type 2 diabetes.
21 citations
TL;DR: The national and regional prevalence of the most-common behavioral health problems experienced by Operation Enduring Freedom and Operation Iraqi Freedom veterans are presented and resources for best practices for treatment are offered.
Abstract: The Department of Defense and the Department of Veterans Affairs place a high priority on behavioral health assessment, treatment, and research. We present the national and regional prevalence of the most-common behavioral health problems experienced by Operation Enduring Freedom and Operation Iraqi Freedom veterans and offer resources for best practices for treatment.
18 citations
TL;DR: There are three general approaches to reducing injuries: designing for safety, providing positive reinforcement in prevention programs, and making safety a family affair.
Abstract: Agriculture is a dangerous profession with an aging population, combining age-related changes in physical and cognitive abilities with complex tasks performed under hazardous conditions. There are three general approaches to reducing injuries: designing for safety, providing positive reinforcement in prevention programs, and making safety a family affair. Language: en
18 citations
TL;DR: In this paper, the authors surveyed municipal staff in North Carolina to understand barriers to municipal walking and bicycling projects and policies, and found that common barriers to walking and biking projects were selected from a 14-item list.
Abstract: BACKGROUND: The Guide to Community Preventive Services recommends implementing community- and street-scale urban design, as well as land use policies and practices, to promote walking and bicycling. To better understand barriers to municipal walking and bicycling projects and policies, we surveyed municipal staff in North Carolina. METHODS: We surveyed all 121 municipalities with at least 5,000 persons, and 62% responded. We also surveyed 216 of 420 municipalities with less than 5,000 persons, and 50% responded. The municipal staff member most knowledgeable about walking and bicycling planning was asked to complete the survey. Responses were weighted to account for the sampling design, to reflect prevalence estimates for all North Carolina municipalities. RESULTS: Common barriers to walking and bicycling projects and policies were selected from a 14-item list. For walking, barriers included lack of funding (93% of responding municipalities), other infrastructure priorities (79%), automobile infrastructure priorities (66%), and staffing challenges (65%). For bicycling, barriers included lack of funding (94% of responding municipalities), other infrastructure priorities (79%), automobile infrastructure priorities (73%), issues were not high priorities for the municipality (68%), staffing challenges (68%), and insufficient support from residents (63%). Barriers generally were more prevalent among rural municipalities than among urban municipalities (9 of 14 barriers for walking and 5 of 14 for bicycling; P KW: SR2S Language: en
16 citations
TL;DR: An analysis of the medical costs of SHS in North Carolina that was based on a similar study conducted in Minnesota provides additional rationale for regulating smoking in all work sites and public places.
Abstract: BACKGROUND The health hazards of exposure to secondhand smoke (SHS) are well-defined. Less is known about the economic costs. We performed an analysis of the medical costs of SHS in North Carolina that was based on a similar study conducted in Minnesota. METHODS We used 2006 Blue Cross and Blue Shield of North Carolina claims data and national and state surveillance data to calculate the treated prevalence of medical conditions that have been found to be related to exposure to SHS, as established by a 2006 report from the US surgeon general. We used the population attributable risk for these conditions to calculate the number of individuals whose episodes of illness could be attributed to exposure to SHS. We adjusted these treatment costs for other types of insurance provided in the state, using Medical Expenditure Panel Survey data. RESULTS The total annual cost of treatment for conditions related to SHS exposure in North Carolina was estimated to be $293,304,430, in 2009 inflation-adjusted dollars. Sensitivity analysis showed a range of $208.2 million to $386.3 million. The majority of individuals affected were children, but the greatest costs were for cardiovascular conditions. CONCLUSION These cost data provide additional rationale for regulating smoking in all work sites and public places.
TL;DR: There is a need for a new research model that accommodates the complex nature of disease etiology and improves translation of research findings into clinical practice and public health policy.
Abstract: Morbidity and mortality associated with complex diseases are expected to increase as the population ages and the number of Americans living in poverty continues to expand. Therefore, improved translation of research findings into clinical practice and public health policy must become a priority. This commentary emphasizes the need for a new research model that accommodates the complex nature of disease etiology.
TL;DR: Records from the Division of Water Quality would be of limited use in epidemiologic studies of the health effects of land application of biosolids, but additional information is needed for health investigations.
Abstract: Background Exposure to potentially harmful agents because of waste disposal practices is receiving increased attention. Treated sewage sludge (TSS), or biosolid material, is the solid waste generated during domestic sewage treatment after it has undergone processes to reduce the number of pathogens and vector attractants. Application of TSS to land, which is the most common method for disposal, is promoted as a soil amendment and fertilizer. Few studies have examined the effects of land application on the health and quality of life of neighboring populations. We describe and summarize publicly available records that could be used to study the public health impact of practices associated with land application in North Carolina. Methods We abstracted public records from the North Carolina Department of Natural Resources Division of Water Quality, to determine the following activities associated with land application of TSS in 8 counties in central North Carolina: the process for obtaining permits, reported applications, violations, documented concerns of residents, and penalties assessed. Results The Division of Water Quality routinely collects records of permits and approvals for land application of TSS, amounts applied, and reported pollutant levels. Documentation was useful in summarizing land application practices, but lack of standardization in reporting was a concern. Research into the public health impacts of the land application program is hindered by inconsistency in documenting inspections and resident concerns. Limitations We were not able to validate state records with direct observation of land application of TSS. Conclusions Records from the Division of Water Quality would be of limited use in epidemiologic studies of the health effects of land application of biosolids. Information about locations, amounts, and dates of application are relevant to exposure potential, but additional information is needed for health investigations.
TL;DR: This commentary discusses one community-based DPP translational study, Healthy Living Partnerships to Prevent Diabetes, in detail, as well as the implications of D PP translational studies for public policy.
Abstract: Numerous studies have translated the Diabetes Prevention Program (DPP) for community-based settings, and the results are encouraging. This commentary discusses one community-based DPP translational study, Healthy Living Partnerships to Prevent Diabetes, in detail, as well as the implications of DPP translational studies for public policy.
TL;DR: Poor pregnancy outcomes in North Carolina follow a clear seasonal pattern based on timing of conception, with patterns most pronounced among non-Hispanic white women living in urban areas, which is suggestive of causative environmental factors.
Abstract: BACKGROUND Seasonal variation in poor pregnancy outcomes has not received the same level of research attention and rigor as has the well-established seasonal variation in births. METHODS In this analysis of data from the 2001-2005 North Carolina Detailed Birth Record, we use season of conception as a proxy for environmental or other risk factors. We model the continuous pregnancy outcome of birth weight percentile for gestational age by use of linear regression. We use logistic regression to model the binary pregnancy outcomes of low birth weight (< 2500 g), preterm birth (< 37 weeks), and small for gestational age (< 10th percentile of birth weight for gestational age). RESULTS We found significant seasonal patterns in poor pregnancy outcomes. Our results suggest that, in North Carolina, seasonal patterns are most pronounced among non-Hispanic white women living in urban areas. LIMITATIONS The present study is limited by the restricted set of maternal and pregnancy variables available in this data set. Richer data, potentially including psychosocial and activity measures of the women, would allow us to more ably discern what is driving the seasonal patterns we observed. The pronounced increased risk associated with a spring season of conception provides an important clue for determining the true causative factors. CONCLUSIONS Poor pregnancy outcomes in North Carolina follow a clear seasonal pattern based on timing of conception, with patterns most pronounced among non-Hispanic white women living in urban areas. These seasonal patterns are suggestive of causative environmental factors and certainly warrant additional research.
TL;DR: While nurses alone cannot transform health care, they do need a stronger voice in health care systems, and they need better educational preparation as members of the health care leadership team.
Abstract: Two of the 8 recommendations in the Institute of Medicine of the National Academies report on the future of nursing call for increased leadership by nurses. While nurses alone cannot transform health care, they do need a stronger voice in health care systems, and they need better educational preparation as members of the health care leadership team.
TL;DR: Remote digital retinal screening for diabetic retinopathy is feasible in primary care settings in both urban and rural areas of North Carolina, and it may prove to be an effective means of reaching more patients who require annual screening examinations.
Abstract: Background Diabetic retinopathy is the leading cause of preventable blindness in adults. Project I See in NC was begun to determine whether access to eye screening for Medicaid recipients and uninsured patients with diabetes in North Carolina could be improved. Methods We targeted Medicaid recipients and uninsured adults with diabetes for screening in 2 Community Care of North Carolina Networks. Screenings were performed in primary care settings throughout 6 counties in the Northwest Community Care Network and 6 counties in Access III of Community Care of the Lower Cape Fear. Patients were screened using a high-resolution digital retinal camera with images read at a centralized reading center at Wake Forest School of Medicine. Results A total of 1,688 patients were screened from October 2005 through September 2007. Nearly 15% (282) were found to have mild, nonproliferative-to-proliferative retinopathy, while the majority of patients had no evidence of diabetic retinopathy. Nearly 12% (196) required referral to an ophthalmologist, with 5% (86) requiring urgent referral for potentially sight-threatening retinopathy. Limitations We were not able to confirm which patients kept their ophthalmologic appointments; however, we are currently analyzing data from the Medicaid patients in our study who required ophthalmologic referral. Conclusions Remote digital retinal screening for diabetic retinopathy is feasible in primary care settings in both urban and rural areas of North Carolina, and it may prove to be an effective means of reaching more patients who require annual screening examinations.
TL;DR: The roles of APRNs, the IOM recommendations, and efforts by national and state stakeholders to remove legal barriers to APRN practice are reviewed.
Abstract: A recent report from the Institute of Medicine of the National Academies (IOM) calls for states to amend regulations on the practice of advanced practice registered nurses (APRNs). This article reviews the roles of APRNs, the IOM recommendations, and efforts by national and state stakeholders to remove legal barriers to APRN practice.
TL;DR: The proportion of spirometries meeting American Thoracic Society and European Respiratory Society quality criteria in children with asthma evaluated in North Carolina primary care pediatric clinics were described and predictors of spirometry that meets ATS/ERS quality criteria were characterized.
Abstract: BACKGROUND Pulmonary function testing (eg, spirometry) is recommended by the National Heart, Lung, and Blood Institute as part of basic asthma management. Previous research has shown that spirometry is feasible in primary care settings. OBJECTIVES In this retrospective study, we sought to describe the proportion of spirometries meeting American Thoracic Society (ATS) and European Respiratory Society (ERS) quality criteria in children with asthma evaluated in North Carolina primary care pediatric clinics and to characterize predictors of spirometry that meets ATS/ERS quality criteria. METHODS Medical records and spirometries from January 1, 2001, to August 1, 2009, were reviewed and analyzed from children enrolled in a larger asthma study that focused on communication between physicians, children, and caregivers. Children were eligible for the larger study if they were between the ages of 8 and 16 years and had received a previous diagnosis of persistent asthma. Children were enrolled from primary care pediatric practices. RESULTS Spirometry was not acceptable, on the basis of ATS/ERS criteria, in 75% of cases. Approximately 19% of spirometries used incorrect or outdated predictive sets. CONCLUSIONS More than three-quarters of spirometries in these primary care pediatric clinics were unacceptable. Changes or lack of changes in asthma management may be based on unacceptable spirometry. Additional education and training regarding accurate spirometry and interpretation are warranted.
TL;DR: The diabetes burden in North Carolina is reviewed and sets the stage for commentaries and sidebars in the accompanying policy forum.
Abstract: The diabetes epidemic is rapidly growing in North Carolina. In 1999, an estimated 366,000 residents were living with diagnosed diabetes. Ten years later, the prevalence of diagnosed cases had increased to approximately 659,000. Diabetes is the seventh leading cause of death in the state and decreases life expectancy by up to 15 years. If the epidemic remains unchecked in the state, annual health care costs are predicted to exceed $17 billion by 2025. Prevention of diabetes and diabetes-related complications through treatment and disease self-management is paramount in changing this deadly and costly course and demands continued innovation in health programs and services and new partnerships among health professionals. This article reviews the diabetes burden in North Carolina and sets the stage for commentaries and sidebars in the accompanying policy forum.
TL;DR: Information technology is nearly ubiquitous in health care settings, and nurses must be prepared not only to work around complex health information technology, but also to communicate with individuals who can address the underlying problems.
Abstract: Information technology is nearly ubiquitous in health care settings. Nurses need basic computer skills and information literacy to effectively practice nursing. In addition, nurses must be prepared not only to work around complex health information technology, but also to communicate with individuals who can address the underlying problems.
Journal Article•
TL;DR: In the absence of a comprehensive agricultural injury surveillance system, individual data sources can still provide a useful snapshot of the epidemiology of farm injuries in a population, although county-level data should be interpreted with caution.
Abstract: Incidents involving agricultural machinery are a frequent cause of injuries related to farming activities, although the availability of data with which to track such injuries on a population-based level is limited. Multisource surveillance methods—employing data collected through sources such as death certificates, emergency department records, migrant and community health providers, and hospital discharge data— provide a more complete tracking system than does single-source reporting; however, such systems can be costly to set up and maintain [1, 2]. In the absence of a comprehensive agricultural injury surveillance system, individual data sources can still provide a useful snapshot of the epidemiology of farm injuries in a population. The following is a description of inpatient hospitalizations related to agricultural machine injuries, obtained from the North Carolina Hospital Discharge Database. The North Carolina Hospital Discharge Database captures information on all inpatient hospitalizations in nonfederal hospitals in North Carolina. North Carolina residents who are admitted to hospitals outside the state are not included in the database. This may bias data for certain border counties, particularly those in the northeastern part of the state, so county-level data should be interpreted with caution. The database contains 1 field for reporting an E code diagnosis, which was added to the database in 1997. The E code is used to denote an external cause of injury code and is used as a supplemental code, with the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis code. We searched the database for the code E919.0 (“accidents caused by agricultural machines”) for the 5-year period 2006-2010. For this analysis, the data for calendar year 2010 were provisional. There were a total of 294 inpatient hospital discharges for injuries related to agricultural machines in North Carolina during 2006-2010. Patients were cared for at 61 different facilities throughout the state, with the largest numbers of patients being admitted to Pitt County Memorial Hospital, in Greenville (n = 37), and North Carolina Baptist Hospital, in Winston-Salem (n = 34). Fractures, including skull, neck/
TL;DR: Palliative care addresses symptoms of disease regardless of prognosis, helps patients clarify their goals of care, and is key in improving value in the health care system.
Abstract: Improving value in health care is of paramount importance, and doing so will require focus on both the costs and benefits of care. Palliative care addresses symptoms of disease regardless of prognosis, helps patients clarify their goals of care, and is key in improving value in the health care system.
TL;DR: The program and the role of its graduates are reviewed and policy recommendations for improving mental health care in North Carolina are made.
Abstract: UNC-Chapel Hill's Psych NP-NC program prepares clinically and culturally proficient nurse practitioners to provide psychiatric and mental health care in North Carolina areas that are medically underserved and have a greater number of health disparities. This article reviews the program and the role of its graduates and makes policy recommendations for improving mental health care in the state.
TL;DR: This commentary examines diabetes incidence, prevalence, disparities, morbidity, mortality, and costs in North Carolina and facilitates discussion about how the meaningful use of electronic health records can create new opportunities for collaboration between public health and clinical care professionals and organizations.
Abstract: Diabetes is a major public health problem in North Carolina, affecting all sociodemographic groups. This commentary examines diabetes incidence, prevalence, disparities, morbidity, mortality, and costs. It also facilitates discussion about how the meaningful use of electronic health records can create new opportunities for collaboration between public health and clinical care professionals and organizations.
TL;DR: North Carolina's American Indian population experiences a disproportionate diabetes burden, in terms of both a high prevalence of the disease and excess diabetes-related death and disability.
Abstract: North Carolina's American Indian population experiences a disproportionate diabetes burden, in terms of both a high prevalence of the disease and excess diabetes-related death and disability. Concerted efforts need to be made to provide culturally appropriate and easily accessible education, health care, and health-promoting resources in these vulnerable communities.
TL;DR: The Emergency Department Asthma Program was a quality-improvement initiative designed to better understand the population of patients who use the ED for asthma care in rural western North Carolina and to demonstrate whether EDs at small hospitals could improve asthma care and reduce subsequent asthma-related ED visits.
Abstract: BACKGROUND In North Carolina, nearly one-fourth of persons with asthma visit an emergency department (ED) or urgent care center at least once a year because of an exacerbation of asthma symptoms. The Emergency Department Asthma Program was a quality-improvement initiative designed to better understand the population of patients who use the ED for asthma care in rural western North Carolina and to demonstrate whether EDs at small hospitals could, by implementing National Asthma Education and Prevention Program treatment guidelines, improve asthma care and reduce subsequent asthma-related ED visits. METHODS Eight hospitals in western North Carolina participated in the project, which lasted from November 2003 through December 2007. The intervention consisted of a series of individual and structured continuing medical education events directed at ED physicians and staff. Additionally, patients presenting to EDs for asthma-related problems were selected to receive a short patient questionnaire, to determine their basic understanding of asthma and barriers to asthma care; to undergo asthma staging by the treating physician; to receive focused bedside asthma education by a respiratory therapist; and, finally, at the treating physician's discretion, to receive a free packet of asthma medications, including rescue therapy with a beta-agonist and corticosteroid therapy delivered via a metered-dose inhaler, before discharge. RESULTS During the 37-month project, a total of 1,739 patients presented to the participating EDs for 2,481 asthma-related episodes of care; at 11% of these visits, patients received the intervention, with nearly 100 ED physicians referring patients to the program. Most of the patients using the ED for asthma treatment were judged to have the mildest stages, and nearly half were uninsured or were covered by Medicaid. For only 20% of the visits was a primary care physician or practice identified. The patient intervention did not appear to lessen the rate of return visits for asthma-related symptoms at 30 and 60 days. LIMITATIONS Selection bias is likely, as patients enrolled in the study were more likely than patients in the target sample to be adults and insured. Because we did not measure ED staff attendance at educational sessions or their knowledge of and attitudes about asthma care before and after the educational program, we cannot draw conclusions about the effectiveness of the program to change their knowledge, attitudes, or behavior. CONCLUSIONS Many patients who use the ED for care appear to have mild, intermittent asthma and do not identify a regular source of primary care. Efforts to improve asthma care on a communitywide basis and to reduce preventable exacerbations should include care provided in EDs, as this may be the only source of asthma care for many asthma patients. The project demonstrated that regional, collaborative performance improvement efforts in EDs are possible but that many barriers exist to this approach.
TL;DR: Recommendations to improve existing farm injury surveillance, to guide prevention of injury and mortality rates among agricultural workers in North Carolina.
Abstract: Work-related injury data suggest that agricultural workers in North Carolina are experiencing high rates of injury and death compared with workers in other occupations. However, current occupational injury data sources are insufficient to calculate accurate injury and mortality rates. We propose recommendations to improve existing farm injury surveillance, to guide prevention.
TL;DR: Many variables should be taken into account to optimize efforts to prevent tobacco use, countermarket campaigns, and policy initiatives in North Carolina.
Abstract: BACKGROUND As North Carolina works to sustain recent reductions in smoking among adolescents, more knowledge is needed to design effective prevention programs. This study examined the variables associated with use and susceptibility to use of cigarettes use among North Carolina students in high school (ie, grades 9-12). METHODS Data were collected from the 2007 North Carolina Youth Tobacco Survey (NCYTS). The NCYTS is a biannual public school- and charter school-based survey of North Carolina students in grades 6-12. Seventy-four of 115 school districts from 3 distinct geographic regions of the state were selected for participation in the 2007 NCYTS. The survey was completed by 3,364 students (81.6%) at participating high schools, for an overall completion rate of 78.3% among all North Carolina high school students. Logistic regression models examined variables associated with current use of cigarettes, ever having used cigarettes (also referred to as "ever use"), and susceptibility to use of cigarettes. All analyses included sampling weights, which enabled results to be generalized to all high school students in North Carolina. RESULTS A total of 48.9% of students reported ever use, 19.0% were classified as current users, and 33.5% were classified as susceptible to use. Females, nonminorities, and older students had higher odds than males, minorities, and younger students, respectively, of being a current smoker. Minorities, however, had higher odds than nonminorities of ever smoking. Use of other forms of tobacco increased the odds of current use and ever use of cigarettes. Agreement with the statement that smoking makes one look cool or fit in increased the odds of being susceptible to smoking. Having a willingness to wear an item promoting a tobacco company and having close friends who smoked individually increased the odds of each of the 3 outcomes. LIMITATIONS Data are from a cross-sectional survey conducted every other year, in which students self-report use of, attitudes about, and perceptions about tobacco products. CONCLUSIONS Many variables should be taken into account to optimize efforts to prevent tobacco use, countermarket campaigns, and policy initiatives in North Carolina.
TL;DR: In this paper, the authors explored the use of health care services and the prevalence of coinfections among HIV-infected residents, and recorded community perspectives on HIVrelated issues.
Abstract: Background Durham County, North Carolina, faces high rates of human immunodeficiency virus (HIV) infection (with or without progression to AIDS) and sexually transmitted diseases (STDs). We explored the use of health care services and the prevalence of coinfections, among HIV-infected residents, and we recorded community perspectives on HIV-related issues. Methods We evaluated data on diagnostic codes, outpatient visits, and hospitalizations for individuals with HIV infection, STDs, and/or hepatitis B or C who visited Duke University Hospital System (DUHS). Viral loads for HIV-infected patients receiving care were estimated for 2009. We conducted geospatial mapping to determine disease trends and used focus groups and key informant interviews to identify barriers and solutions to improving testing and care. Results We identified substantial increases in HIV/STDs in the southern regions of the county. During the 5-year period, 1,291 adults with HIV infection, 4,245 with STDs, and 2,182 with hepatitis B or C were evaluated at DUHS. Among HIV-infected persons, 13.9% and 21.8% were coinfected with an STD or hepatitis B or C, respectively. In 2009, 65.7% of HIV-infected persons receiving care had undetectable viral loads. Barriers to testing included stigma, fear, and denial of risk, while treatment barriers included costs, transportation, and low medical literacy. Limitations Data for health care utilization and HIV load were available from different periods. Focus groups were conducted among a convenience sample, but they represented a diverse population. Conclusions Durham County has experienced an increase in the number of HIV-infected persons in the county, and coinfections with STDs and hepatitis B or C are common. Multiple barriers to testing/treatment exist in the community. Coordinated care models are needed to improve access to HIV care and to reduce testing and treatment barriers.