Access to dental care for young children in North Carolina: history and current status of workforce issues

The 2000 North Carolina IOM report contained 23 recommendations. To date 16 have been fully or partially implemented. This represents progress, but accomplishing full compliance remains a goal. Absent new training programs in our state, as current federal training grants phase-out, identifying financial support to continue training an adequate number of pediatric dentists for North Carolina will be a challenge.     

Research for North Carolina: The University Cancer Research Fund

In 2008 an estimated 40,000 North Carolinians will be diagnosed with cancer. This disease is the number one cause of death in our state and will claim more than 17,000 lives this year. North Carolina is swimming against a demographic tide of growth and aging that will bring 80,000 new cancer cases by 2050, despite continued improvements in cancer prevention, early detection, and treatment. By establishing the University Cancer Research Fund, North Carolina has taken a bold, nation-leading step forward toward improving the future health and well-being of its citizens. Research that creates new knowledge, turns that knowledge into advances in treatment, screening, and prevention, and then ensures delivery of those advances across the state-that research is the key that unlocks the doors to a new and better future. The Fund will make that research possible. As has often been the case, North Carolina was ahead of the national curve by creating the UCRF in July 2007. In November 2007, Texas passed a $3 billion bond referendum to provide $300 million annually to support cancer research over the next decade. In 2005, California passed a $3 billion bond referendum to support stem cell research. Perhaps noting the downturn in federal funding for biomedical research, other states are watching these states' investments to see if they improve their citizens' health and make researchers nationally competitive. We will rigorously evaluate the UCRF to show the nation that North Carolina has taken a bold and wise step. The North Carolina General Assembly and the people of North Carolina have presented the University of North Carolina at Chapel Hill, the UNC Lineberger Comprehensive Cancer Center, the North Carolina Cancer Hospital, and UNC Health Care with an astounding opportunity and responsibility. We embrace that opportunity and that responsibility and pledge ourselves to our shared vision of a better future for the citizens of North Carolina.     

The establishment of a population-based Cancer Registry for North Carolina

In 1984 the North Carolina Medical Society's House of Delegates adopted Report S, which called for the North Carolina Legislature to fund a statewide cancer incident reporting system. The Cancer Committee continues to be advisory to the Division of Adult Health. A subcommittee of the Cancer Committee advises the Central Cancer Registry.     

The role of the North Carolina Community College System in nursing education

Two-thirds of nurses educated in North Carolina receive an associate's degree in nursing (ADN). Community college graduates work in health care areas and geographic regions in which recruitment and retention of employees are difficult. To enhance educational preparation for its graduates, the North Carolina Community College System has redesigned the ADN curriculum and encouraged partnerships for seamless transition to more-advanced nursing degrees.     

Violence against women in North Carolina

Research shows that partner violence and sexual assault against women are significant statewide problems in North Carolina. This commentary provides an overview of the research on evidence-based interventions designed to prevent such violence, highlights current prevention efforts in North Carolina, and offers future directions.     

Economic impacts of Medicaid in North Carolina

OBJECTIVE: The purpose of this study is to provide estimates of the economic impacts of Medicaid program expenditures in North Carolina in state fiscal year (SFY) 2003. STUDY DESIGN: The study uses input-output analysis to estimate the economic impacts of Medicaid expenditures. DATA SOURCES/STUDY SETTING: The study uses North Carolina Medicaid program expenditure data for SFY 2003 as submitted by the North Carolina Division of Medical Assistance to the federal Centers for Medicare and Medicaid Services (CMS). Industry structure data from 2002 that are part of the IMPLAN input-output modeling software database are also used in the analysis. PRINCIPAL FINDINGS: In SFY 2003 $6.307 billion in Medicaid program expenditures occurred within the state of North Carolina-$3.941 billion federal dollars, $2.014 billion state dollars, and $351 million in local government funds. Each dollar of state and local government expenditures brought $1.67 in federal Medicaid cost-share to the state. The economic impacts within North Carolina of the 2003 Medicaid expenditures included the following: 182,000 jobs supported (including both full-time and some part-time jobs); $6.1 billion in labor income (wages, salaries, sole proprietorship/partnership profits); and $1.9 billion in capital income (rents, interest payments, corporate dividend payments). If the Medicaid program were shut down and the funds returned to taxpayers who saved/spent the funds according to typical consumer expenditure patterns, employment in North Carolina would fall by an estimated 67,400 jobs, and labor income would fall by $2.83 billion, due to the labor-intensive nature of Medicaid expenditures. LIMITATIONS: Medicaid expenditure and economic impact results do not capture the economic value of the improved health and well-being of Medicaid recipients. Furthermore, the results do not capture the savings to society from increased preventive care and reduced uncompensated care resulting from Medicaid. ConclusionS: State and local government expenditures do not fully capture the economic consequences of Medicaid in North Carolina. This study finds that Medicaid makes a large contribution to state and local economic activity by creating jobs, income, and profit in North Carolina. Any changes to the Medicaid program should be made with caution. RELEVANCE: The rising costs of health care and the appropriate role of government health insurance programs are the object of current policy debates. Informed discussion of these issues requires good information on the economic and health consequences of alternative policy choices. This is the first systematic study of the broader economic impacts of Medicaid expenditures in North Carolina.     

The state of diabetes in North Carolina

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.     

The University of North Carolina Arthritis Center.

The University of North Carolina Arthritis Center combines the broadly-based research agenda of the Thurston Arthritis Research Center with comprehensive interdisciplinary clinical programs in rheumatology, orthopaedics, and pediatric rheumatology. In keeping with the University's long tradition of service to the people of North Carolina, a primary aim of the Center is to provide the citizens of this state with the best available arthritis care and prevention strategies. The approach here is twofold. New knowledge is created by laboratory investigation of basic disease mechanisms, by clinical studies of new therapies, by social and behavioral research to better understand how patients and their families cope and adjust to chronic arthritis, and by health services research that examines arthritis from a societal perspective. This information, together with advances in rheumatology and related fields from Duke and other institutions, is then applied to optimum clinical and educational services for North Carolina patients and their physicians.     

Injury prevention: North Carolina's challenge and capacity to respond

North Carolina has worked to develop an infrastructure and identify priorities to reduce the high morbidity and mortality from injuries. Findings of the North Carolina Institute of Medicine (NCIOM) Task Force on Adolescent Health and the NCIOM Task Force on Prevention, combined with the North Carolina Division of Public Health strategic plan and the Injury and Violence Prevention State Advisory Council, have laid the path toward this goal.     

North Carolina's preparedness to respond to on-farm emergencies

North Carolina farm families, emergency services, and fire departments do not always have sufficient training to respond to on-farm emergencies. The main barrier to preparedness is lack of awareness of these needs. We recommend improved emergency response through collaborative education using AgriSafe of North Carolina and Certified Safe Farm North Carolina, two programs geared toward safety training.     

Collaborative accountability for care transitions: the community care of North Carolina transitions program

Community Care of North Carolina initiated efforts to improve care transitions for North Carolina Medicaid recipients in 2008. The transitions program is now statewide, serving more than 4,000 patients every month, virtually every North Carolina hospital, and more than 1,400 primary care practices. This commentary describes program components, early outcomes, and future challenges.     

Reducing North Carolina's health care costs through environmental disease prevention

At a time of unprecedented pressure on the North Carolina state budget, reducing environmental risks to health may provide opportunities for substantial savings in the proportion of the state budget (24%) that is allocated for medical assistance. Recently, the Research Triangle Environmental Health Collaborative held a summit to identify options for increasing attention to environmental impacts on health in the ongoing health care and budget debates. Summit participants included not only public health and environmental experts, but also individuals (such as transportation planners, developers, and industry representatives) whose decisions can have a significant impact on environmental quality. This article summarizes key recommendations from the summit, as well as commentaries in the policy forum of this issue that further elaborate on why environmental quality matters for public health in North Carolina. Key recommendations from the summit include requiring formal health impact assessments (similar to environmental impact assessments but with an emphasis on health) in state and local transportation and land use planning processes, quantifying the total disease burden attributable to environmental hazards in North Carolina, prioritizing environmental risks to health in North Carolina, providing state technical assistance for communities disproportionately affected by poor environmental quality, establishing a new database system to link existing environmental and public health data by geographic location, undertaking North Carolina case studies to test the hypothesis that improving environmental quality also reduces medical care costs, and developing "environment matters to your health" public awareness campaigns.     

Health and safety on North Carolina farms

Many rural areas in North Carolina do not receive the professional health care they deserve. North Carolina Farm Bureau recognized this unfilled need and implemented its Healthy Living for a Lifetime program in 2010. This initiative is one way to help improve the health of the state's 52,000 family farmers.     

The North Carolina Clean Smokestacks Act

The story of North Carolina's Clean Smokestacks Act is a story about the link between the environment and health. It is a story about the good things that can happen when a state looks at health care policy through the lens of environmental health. For North Carolina, those good things are cleaner air and better health, for people and the environment, from Clingman's Dome to Jockey's Ridge.     

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.     

North Carolina's behavioral health delivery system: a historical perspective

This commentary provides an overview of the mental health system in North Carolina. It suggests that the key to building a mental health system is settling on a strategy, implementing it, evaluating it, and funding it. More than a decade after reform was passed in North Carolina, this state still has not settled on a strategy.     

Preventing child maltreatment in North Carolina

Child-maltreatment prevention has become more robust in North Carolina since the North Carolina Institute of Medicine Task Force convened in 2005. The commitment by state governmental and nongovernmental leadership and funding agencies has been instrumental to this achievement. This commentary highlights several successful approaches used to prevent child maltreatment in the state, although there is much work to be done.     

Newborn screening in North Carolina: the evolution of policy and practice

Newborn screening policies in North Carolina are due to the efforts of skilled and knowledgeable state officials, clinicians, and scientists who are able to develop effective newborn screening procedures. A newborn screening that was developed in North Carolina is the first automated method for diagnosing phenylketonuria. This process was later adopted in many other states. The use of tandem mass spectrometry in newborn screening was also pioneered in North Carolina, and it is being used in an increasing number of states. Newborn screening is more than testing, however; follow-up and specialized care are essential. State-level policies should recognize the multiple links necessary to make newborn screening effective and efficient.     

Honoring their service: behavioral health services in North Carolina for military service members, veterans, and their families

The North Carolina Institute of Medicine Task Force on Behavioral Health Services for the Military and Their Families examined the adequacy of Medicaid- and state-funded services for mental health conditions, developmental disabilities (including traumatic brain injury), and substance abuse that are currently available in North Carolina to military service members, veterans, and their families. The task force determined that there are several gaps in services and made 13 recommendations related to federal, state, and local community resources. This article reviews the work of the task force and current efforts to improve services in North Carolina.     

Lethal domestic violence in eastern North Carolina

Strategies for preventing domestic violence can be tailored to a particular geographic or socioeconomic area if the patterns of domestic violence in the area are known. National statistics, although widely available, may not be applicable to a specific region. We reviewed homicide deaths in Eastern North Carolina between 1978 and 1999 to identify patterns in this rural area. Approximately 20% of the homicide deaths in eastern North Carolina are caused by intimate partners. Women accounted for 53% of the victims in 1976, similar to national figures but not rising to 72% as seen nationally in 1998. Latinos are an increasing presence in the area, but had only one recorded episode of lethal violence against an intimate partner. Gunshots accounted for most of the deaths (59% in men, 72% in women). Knowledge of such patterns can assist in selecting prevention strategies for this particular area. Over the last 25 years increasing attention has been devoted to domestic violence (DV), initially defined as abuse committed against a spouse, former spouse, fiancée, boy- or girlfriend, or cohabitant. As time has passed, the definition has been broadened to include other family members--elders, children, and siblings. The Centers for Disease Control and Prevention (CDC) now uses the term "intimate partner violence" for intentional emotional or physical abuse inflicted by a spouse, ex-spouse, a present or former boy- or girlfriend, or date. For the purposes of this paper, we consider DV interchangeable with intimate partner violence. There has been a national concern that abusive events are under-reported. The National Crime Victimization Survey, an anonymous household survey, indicated nearly 1 million incidents of non-lethal intimate partner violence per year between 1992 and 1996. The number decreased from 1.1 million in 1993 to 840,000 in 1996. Attempts to validate such data for a given geographic area often require subjects to violate anonymity--this may account for lower reports of violence. A recent national report from the Justice Department found a decline in both lethal and non-lethal DV. The number of men murdered by wives or girlfriends "plunged 60% from 1976 through 1998". FBI data on homicides showed that "intimate partners committed fewer murders each year during 1996, 1997, and 1998 than in any other year since 1976". Nationally, intimate partners caused 3000 deaths in 1976, 1590 (53%) in women; in 1998, they caused 1830 deaths, 1320 (73%) in women. But fatal cases of DV are only the tip of the iceberg, and may pertain only to a particular geographic area. We undertook the present study to assess the prevalence of lethal domestic violence in the 29 counties of eastern North Carolina (ENC) that make up the catchment area for the University Health Systems of Eastern Carolina (UHSEC). UHSEC includes the Brody School of Medicine at East Carolina University (BSM-ECU; previously known as East Carolina University-SOM) and Pitt County Memorial Hospital.