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Dispatch From the International AIDS Conference: Social Media, Isolation and Risky Behavior


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Lee Storrow, the head of the NC AIDS Action Network, is in Durban, South Africa for the 2016 International Conference on AIDS to present his own research. This week, NC Health News will be featuring some stories from Lee about the conference and where North Carolina fits into the global fight against HIV/AIDS.

By Lee Storrow

The poster presentation section at the International Conference on AIDS is overwhelming. The five sections line the perimeter of the second floor of the convention center, a space twice the size of Raleigh’s Halifax Mall. Hundreds of posters are on display each day.

You can read the details of the results on LaGrand’s abstract here.On Tuesday, I spoke with Dr. Sara LeGrand, Assistant Research Professor of Global Health at the Duke Global Health Institute. She was presenting her research on whether the use of social networking (Facebook, Instagram) and dating/hook-up sites (Grindr, Jack’d) in young black men who have sex with men (MSM) in North Carolina could predict whether these men felt socially isolated.

Apps such as Grindr and Instagram are here to stay. The question is how HIV prevention advocates can get their messages out to users.

Apps such as Grindr and Jack’d are here to stay. The question is how HIV prevention advocates can get their messages out to users. Image courtesy: Grindr

The study reveals that young black MSM are, indeed, using social networking accounts and using those accounts may reduce these men’s feelings of social isolation.

Across the survey of N.C. teens, participants reported an average of 7.35 hours of Internet use per day and the average number of social networking platforms – such as Facebook or Grindr –  that participants used was 3.62. The study found that the more social network sites used translated into decreased feelings of social isolation, as well as increased searching for sex partners online.

“I think the results of this study are especially important for young people in rural areas of North Carolina who often face greater stigma around their sexuality,” said Dr. LeGrand.

Dr. Mehri McKellar and Dr. Jessica Seidelman present their research on the willingness of primary care providers to prescribe PrEP at the International Conference on AIDS in Durban, South Africa.

Dozens of North Carolina researchers are at the 2016 International AIDS Conference in South Africa this week. Here, Drs. Mehri McKellar and Jessica Seidelman from Duke University present their research on the willingness of primary care providers to prescribe PrEP at the International Conference on AIDS in Durban, South Africa. Photo credit: Lee Storrow

There’s been a lot of chatter about the rise of dating and hook-up apps and their potentially negative role in changing the nature of gay sex. At the same time, gay men in rural parts of North Carolina have limited support systems and often live in homophobic environments. If Grindr can provide even a limited outlet to remind a closeted gay man that he is not alone, it might be beneficial.

Dating and hook-up apps aren’t going away any time soon. HIV prevention advocates need to think about how to harness those apps to disseminate positive prevention messages and build support systems for those most at risk.

A Traumatic Brain Injury Survivor’s Trail of Ups and Downs


Many sudden trips to emergency departments, long stays in myriad hospitals, and countless interactions with health-care and government professionals have marked the past four and a half years for the Irby family of Burlington.

Their goal was continuing rehabilitative treatment for son Zack, 27, who emerged from a January 2013 car wreck with traumatic brain injury. Parents Jeannie and Rick Irby have met with a mixture of helpful professionalism, red tape and seemingly contradictory regulations with all the stamina they can muster.

Zack retains the ability to talk and joke, follows pro and college sports and enjoys ‘90s pop music like “MMMBop” by Hanson.

Zack Irby, 27, was an active, busy young man before he had a horrific wreck in January 2013.

Zack Irby, 27, was an active, busy young man before he had a horrific wreck on I-85 in January 2013. Photo credit: Thomas Goldsmith

He’s a paraplegic who uses a wheelchair to get around but needs help with bathing, grooming, meds and eating.

But Mom Jeannie Irby said she knows, “Zack would be working on a walker, if he had just been rehabbed without letting his regressions happen.”

Click here for a detailed account of the Irbys’ journeyAn outline of Zack’s treatment history makes plain the ordeal a family can face in the wake of a severe brain injury.

Jan. 28, 2013: After Zack’s accident, he is taken by helicopter, in a coma, to Wake Forest Baptist Hospital, where he stays for 11 or 12 weeks, receiving treatment for injuries to his brain, a fractured left pelvis and other results of the accident.

While there, Zack develops pneumonia, then Clostridium difficile, a bug that causes diarrhea and more serious intestinal problems. He maintains a fever of 104.5 for two days before doctors treat the infection by flushing his colon every two hours with zygomycin, an antibiotic.

Late May-early June 2013: Zack is discharged to Carolinas Medical Center in Charlotte, where he receives intensive rehabilitation for 59 days, the amount covered by insurance. “He was making phenomenal progress,” Jeannie said. “By the time he left, he was sitting up straight, he was able to eat and drink thin liquids. He was standing in a standing frame for more than an hour. Then they sent him home with in-home therapy.”

Snapshot of Zack Irby as a boy with basketball superstar Michael Jordan.

Snapshot of Zack Irby as a boy with basketball superstar Michael Jordan. Photo courtesy Irby family.

June-July 2013: After going through evaluations, Zack starts treatment at Alamance Regional Hospital, where the family is told that he will only receive therapy in his wheelchair, a condition they turn down. During a rare family trip, to Myrtle Beach, Zach has to be admitted to an ICU at Grand Strand Medical Center. “He had a very severe respiratory pneumonia and shower of pulmonary embolisms due to being so sedentary and not receiving therapy,” Jeannie said. Readmitted to Wake Forest Baptist, Zack is in worse shape than he was immediately after his accident, doctors tell them.

August 2013: The family is elated when representatives of the Shepherd Center in Atlanta say Zack will be admitted to the private, not-for-profit hospital, which specializes in treatment, research and rehabilitation for people with brain and spinal cord injuries. Their hopes are soon crushed when the decision is reversed because Zack’s injury is not a new one.

September 2013: Zack is admitted to WakeMed in Raleigh, where, after an initial attempt to send him home, Blue Cross and Blue Shield of North Carolina agrees to pay for the hospital to treat both his medical problems and to provide rehab. Jeannie stays with a high school friend in Raleigh so she can be at her son’s side.

“They fought for him week after week. They had Zack up initiating walking. He was able to vocalize. His swallow was getting stronger,” Jeannie said. “Not only was the team at WakeMed motivated, but Zack was motivated.”

Dec. 2, 2013: After allowing three extra weeks of rehab, the insurance company declines to pay for more therapy and WakeMed discharges Zack, sending him home, 10 months after his initial injury.

Before his wreck, Zack Irby studied this Bible, held here by his mother. Zack underlined and starred crucial passages.

Before his wreck, Zack Irby studied this Bible, held here by his mother. Zack underlined and starred crucial passages. Photo credit: Thomas Goldsmith

“The first year ended up costing Blue Cross Blue Shield $4 million,” Rick Irby said. “If they had just rehabbed him, it probably would have cost less than a million.”

Zack is again accepted at the Shepherd Center, but in an outpatient treatment program. Jeannie and later Rick move to Atlanta and live in an apartment provided by the center. “We started doing outpatient therapy at the Shepherd Center, but they were not prepared, nor were they equipped, for someone at his level of care,” Jeannie said.

January 2014: The Irbys bring Zack home. They are out of money and ideas.

Zack continues to have medical problems and is admitted at Memorial Hospital at UNC-Chapel Hill, but does not receive rehab. He spends two weeks back at Wake Forest, but is sent home, to go through months of periodic hospitalizations for medical problems.

September 2014: After Zack has another stint at Alamance Regional Hospital, an exhausted Jeannie refuses to take him back home: “He stayed at Alamance Regional for probably about a month. They couldn’t find a nursing home, they couldn’t find any place to take him. He was having outbursts; he was also getting very frustrated.”

It’s around this time that Jeannie learns about Money Follows the Person, a federal program that allows patients to return home and receive services through a Medicaid waiver.

October 2014: Zack enters an Alamance County nursing home, but receives poor treatment, including being left in his own feces and urine. Meanwhile, the family remodels a former garage to suit Zack’s needs. A $13,000 ceiling lift-system to transport Zack to his bathroom with roll-in shower gets funded through state traumatic brain injury funds, but the family bears the rest of the $100,000 cost themselves.

April 2015: With the house revamped, Zack comes home. He is able to receive 50 hours a week of assistance from an in-home aide through a North Carolina Medicaid waiver program called Community Alternatives Program for Disabled Adults. Under the program, he receives 30 visits a year for rehab, or fewer than one per week.

Jeannie, Rick and daughter Meghan spend a lot of time with Zack. Older daughter Julie Anne spent many hours helping care for Zack, but she’s moved out.

Zack is present in conversations, though sometimes blurting out inappropriate language. The stint in a nursing home brought about more regression, Jeannie said.

“He was absolutely crazy by the time he came home, he was absolutely insane,” she said, while maintaining that Zack’s intellect and real self live on inside him.

“He’s locked in a body,” she said.

This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina.

North Carolinians React to Supreme Court Abortion Ruling


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By Rose Hoban

By a 5-3 margin, justices on the U.S. Supreme Court overruled a Texas law restricting the size and configuration of abortion clinics. The bill, known as HB2, has resulted in the closure of about half of Texas abortion clinics since it was passed and enacted in 2013, mandated that abortion providers have admitting privileges at nearby hospitals and that facilities providing the procedure come up to standards of ambulatory surgical centers.

NARAL/Pro-Choice North Carolina head Tara Romano spoke at a rally in front of Gov. Pat McCrory's mansion Monday afternoon. Photo credit: Rose Hoban

NARAL/Pro-Choice North Carolina head Tara Romano spoke at a rally in front of Gov. Pat McCrory’s mansion Monday afternoon. Photo credit: Rose Hoban

North Carolina lawmakers have not passed similar legislation, known as TRAP (for Targeted Regulation of Abortion Provider) laws. In her concurring opinion, Justice Ruth Bader Ginsburg stated that such laws, “do little or nothing for health, but rather strew impediments to abortion.”

“The idea behind a TRAP law is that it’s something you wouldn’t do for another procedure,” said NARAL /Pro-Choice North Carolina head Tara Romano. “There’s no legislation that says this is what we’re going to need when someone gets a colonoscopy.”

Pro-choice advocates point out, however, that some North Carolina proposals have been similar to those adopted by Texas.

In 2004, North Carolina’s abortion rate was 16.0 per 1,000 women of child-bearing age. In 2013 (the most recent year of data), the rate was 10.1.“[In 2013], the Senate started with a bill that was not substantially different from what Texas enacted; the standards that just got struck down,” said ACLU policy director Sarah Preston, referring to a 2013 measure that would have required that clinics meet ambulatory surgical clinic standards.

That bill was substantially changed, eventually requiring the Department of Health and Human Services to review and rework many of its regulations concerning abortion clinics. It also restricts sex-selective abortions and forbids publicy funded health plans from covering the procedure.

Sarah Preston from the ACLU of North Carolina speaks at a rally in front of Gov. Pat McCrory's mansion to mark the Supreme Court decision. Photo credit: Rose Hoban

Sarah Preston from the ACLU of North Carolina speaks at a rally in front of Gov. Pat McCrory’s mansion to mark the Supreme Court decision. Photo credit: Rose Hoban

What remained after that review was an increased regimen of abortion-clinic inspections with state funding for more DHHS inspectors.

Last year, the legislature passed a bill requiring women to wait 72 hours before they can obtain an abortion. In addition, the Women and Children’s Protection Act requires physicians performing abortions after 16 weeks gestation to send their notes and copies of ultrasounds to the Department of Health and Human Services for review.

An earlier regulatory act, the 2011 “A Woman’s Right to Know” Act, requires the “voluntary and informed consent” of a woman before an abortion can be performed. Specific conditions must be met for consent to be considered “voluntary and informed” under state law. Providers are required to orally inform patients of nearly a dozen points of information in the 24 hours before the procedure.

All those restrictions remain standing in North Carolina, and no laws will be repealed as a result of Monday’s decision.

“It would stop us from doing that same regulation, but it we don’t have anything like that in our law today,” said Rep. Paul Stam (R-Apex), who has championed bills limiting abortions at the General Assembly.

Stam said he had not yet read the ruling, but was dismissive.

“For some reason, whenever abortion is the subject of a Supreme Court case, they just put their finger in the air and make a new law,” he said. “The women of Texas will not be as safe as they were yesterday.”

Pro-choice advocates celebrated at a rally in front of the residence of Gov. Pat McCrory.

“The Supreme Court decision will help will politicians think twice about putting these [kinds of laws] through,” Romano said. “The Supreme Court said, ‘We recognize that these are needless laws.’

“You have to do more than say that they’re for the health and safety of a woman, you have to prove it.”

Ending Solitary for Juveniles, Prison Commissioner Cites Use of Evidence-Based Alternatives


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By Rose Hoban

Juveniles under the age of 18 who are incarcerated in North Carolina prisons will no longer be subjected to solitary confinement starting this fall, prison commissioner David Guice announced last week.

In a statement accompanying a 16-page policy document, Guice wrote that “it is of paramount importance that, while these youth are in our care, their unique needs are accurately identified and addressed in the most effective way possible.”

Foothills Correctional Institution in Morganton from the air. Photo courtesy Irakli Rakeman, flickr creative commons

Foothills Correctional Institution in Morganton from the air. Photo courtesy Irakli Rakeman, flickr creative commons

The policy, which will be fully in place by Sept. 1, will apply to about 70 juvenile offenders currently housed at the Foothills Correctional Institution in Morganton. Those juveniles are the last 16- and 17-year-olds being held in “restrictive housing,” where inmates are confined to a cell for 22 or 23 hours a day.

According to the advocacy group Disability Rights NC, being segregated in solitary confinement can cause deterioration in mental health, producing paranoia, post-traumatic stress disorder, self-harm, and thoughts of suicide.

Guice said that a few more months are needed to get enough staff and get them trained for the new housing regimen that will address inmates with behavioral issues in a different way. And his department is working to create a similar facility in Pasquotank County that will open in the near future.

Positive reinforcement

“Although 16- and 17-year-olds are adjudicated as adults, they should not be treated the same as adults in the prison system,” Guice told NC Health News in an interview last week.

The new regimen at Foothills consists of creating smaller housing “pods” where inmates are given positive reinforcements to engage in good behavior. The policy document describes an evidence-based approach that emphasizes “rational thinking, appropriate communication and behaviors.”

Key to the approach are incentives ranging from receiving books, extra movies, popcorn or nachos, to participation in field days and access to music.

Inmates who do display behavior problems, instead of being confined in solitary, will be placed in “modified housing,” with more intense supervision and tiered losses of privileges.

There’s also the opportunity for inmates to learn trade skills and an increased emphasis on addressing the mental-health needs of teen inmates.

“We’ve actually set up programs where even those who have the worst behavioral issues in the system, we’re now placing those people in programs that we believe are going to be successful,” he said.

Prison commissioner David Guice told mental health advocates Photo credit: Rose Hoban

Prison commissioner David Guice. Photo credit: Rose Hoban

North Carolina is one of only two states in the country — the other is New York — that still charges 16- and 17-year-olds as adults, even when their crimes are for minor offenses such as littering.

For years, advocates have been pushing for legislation to “raise the age” of incarceration in the prison system. A bill passed the House in 2014, but the legislation has stalled in the Senate.

A cost-benefit analysis performed by the Vera Institute of Justice in 2009 found that raising the age of adult incarceration would cost $70.9 million but provide $123.1 million in benefits and savings per year.

Until the legislature acts, the new policies will make for more age-appropriate incarceration, Guice said.

Remissioning

Guice also said his department is in the process of “remissioning” all of the state’s correctional facilities, and an effort that includes getting adults out of solitary confinement as well.

“About six months ago we had about 5,500 inmates who fell into that category, and today we have less than 2,500,” he said.

For advocates, the changes can’t happen fast enough, especially because other young people in the correction system are still subject to solitary confinement.

“Today, for example, 20 percent of 18-year-olds in NC prisons are in segregation as well as hundreds of adults who have mental illness,” Vicki Smith, head of Disability Rights NC, said in a statement. The organization has long pushed for raising the age, and for ending solitary for all inmates.

“Commissioner Guice has identified solutions, but his progress will be stifled without adequate funding from the General Assembly,” she said.

Guice said he’s doing what he can with what he’s got. He has gotten some funding from the legislature over the past few years, a result of the Justice Reinvestment Act, which was signed in 2011.

He stressed the fact that more than 90 percent of people who end up in prison will eventually return to the community, and this is what’s driving his reform efforts.

“It is truly my goal to insure that the person who comes to us… that we provide them with a pathway that’s going to give them an opportunity to leave us better off than they came,” said Guice, who pointed out this means addressing mental-health needs and housing and work for newly released inmates.

“I know what we need to do and it’s creating a pathway to address those underlying issues,” he said. “I believe that the system fails if we release someone and we do not provide a pathway that that individual can be successful.”

Patient Advocates Push for Limits on Step-Therapy Prescription Practices


Patients, doctors and family members affected by the prescription practice called “step therapy” brought personal stories to the General Assembly Thursday in support of a bill that would prohibit it in some cases and limit it in others.

Pills

Photo credit: Rose Hoban

The bill, House Bill 1048, defines step therapy as an approach “under which patients are required to try one or more prescription drugs before coverage is provided for a drug selected by the patient’s health care provider.” The practice has been widely adopted by insurance companies, in part in response to demand for specific new drugs targeted to consumers by advertising.

Thursday’s event, put on by the National Patient Advocate Foundation, was part of an advocacy day designed to bring legislators’ attention to the bill, which is being called “Reduce Barriers to Improve NC Health and Safety.’ The bill has passed the House, but not the Senate.

Proponents of step therapy describe the practice as a necessary cost-saving measure. At an earlier legislative hearing this year, Tom Friedman, North Carolina State Health Plan policy liaison, said step therapy saves the plan for state employees about $10 million in its $700 million annual prescription-drug budget.

Panelists — including two physicians, a patient advocate who has rheumatoid arthritis and a state lobbyist for the American Cancer Society Cancer Action Network — resisted assertions that efforts to limit step-therapy represent a “mandate” that would harm providers.

“I suggest that they disregard the label of ‘mandate,’ when it is a word that is thrown around haphazardly when we are talking about lives at stake,” said rheumatologist Dr. Gwenesta Melton.

Protracted conflict with insurance companies and third-party vendors over step-therapy prescriptions has taken a toll on Melton’s practice, she said: “They are upset because they think that we are going to run amok and put all these people on these expensive drugs.”

Before some patients are approved for the most efficacious drug for their conditions, they can spend months or years taking the less expensive drugs that make up the first steps of the process, Melton said.

On the other hand, many patients may come into their doctors asking for a new, expensive, medication they saw in an advertisement, when an older, generic drug can suffice.

The legislation, sponsored by Rep. David Lewis (R-Dunn), would require insurers to allow exemptions from step therapy in cases where doctors find that the drug required by the insurer is not in the patient’s best interest.

A section of the bill specifically endorsed by Duke physician Dr. Steven Prakken prohibits step therapy when a doctor has prescribed abuse-deterrent opioids. These relatively new painkillers are designed to lose their potency if altered for potential abuse by crushing or cooking them.

“That’s a deterrent to abuse,” Prakken said. “Since they are more expensive, you can’t use them first” under step-therapy protocols, he said.

The federal Food and Drug Administration recently urged pharmaceutical companies to develop generic equivalents of abuse-deterrent drugs, while noting that some questions persist about how effectively the medications actually keep people from misusing them.

“Abuse-deterrent properties make certain types of abuse, such as crushing a tablet in order to snort the contents or dissolving a capsule in order to inject its contents, more difficult or less rewarding,” a March FDA statement said.

“It does not mean the product is impossible to abuse or that these properties necessarily prevent addiction, overdose or death – notably, the FDA has not approved an opioid product with properties that are expected to deter abuse if the product is swallowed whole.”

Firefighters Petition for More Health Care


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For firefighters, occupational exposures can lead to many types of cancer, with health care costs that currently aren’t covered under workers’ compensation insurance.

By Minali Nigam

A budget measure passed by the North Carolina House of Representatives last month adds language that would extend workers’ compensation for firefighters to include coverage for cancers related to fire exposure. But the budget passed earlier this month by the state Senate budget doesn’t.

Capt. Mark Stafford, from the City of Conover FD, Chief Andy Webster from the Statesville FD and Depty Chief Derik Martin from the Hickory FD came to the legislature to ask for, among other things, a death benefit for firefighters who die of certain cancers during their working lives.

Capt. Mark Stafford, from the City of Conover FD, Chief Andy Webster from the Statesville FD and Depty Chief Derik Martin from the Hickory FD came to the legislature to ask for, among other things, a death benefit for firefighters who die of certain cancers during their working lives. Photo credit: Rose Hoban

Almost 200 firefighters from all around North Carolina came Wednesday to the General Assembly, where they discussed many issues with lawmakers, including pension and health-care compensation. Cancer was also part of those conversations.

“We see a whole array of emergencies that we respond to that deal with medical maladies and long-term disease states of that nature,” said Kevin Gordon, president of the North Carolina State Firemen’s Association.

“Our biggest concern would be making sure that the firefighters have necessary health care for themselves and their families.”

Compensating Cancer

Currently, under workers’ compensation, firefighters can get medical costs covered for health problems including lead poisoning, carbon monoxide poisoning, and asbestosis, a chronic respiratory disease.

But constant exposure to chemicals and smoke has been linked to additional long-term health effects, such as cancer. In the House budget, representatives extended occupational diseases covered under workers’ compensation for firefighters to include testicular, brain and rectal cancers; mesothelioma; and esophageal cancers, among others.

“But it was taken out of the Senate budget,” said Anthony Penland, a firefighter in Buncombe County. “We’re hoping that the Senate will put that back in when the budget is finalized.”

An active firefighter’s death as a result of one of these cancers would be considered a “line of duty death” under this new measure, said Penland, who serves on the North Carolina Firemen’s Association Board of Directors. Families of deceased firefighters would be able to receive a $50,000 death benefit in the form of $20,000 at the time of death and three annual payments of $10,000.

“We’re having more and more firefighters dying of cancer due to the types of materials that’s in the houses that’s burning now,” said Ryan Cole, a board director for the North Carolina Association of Fire Chiefs.

Some of these materials include asbestos found in pipes and flooring, along with combustion products from smoke that include carbon monoxide, benzene and cyanide.

Even with breathing equipment and protective gear, Cole said, today’s firefighters are actually at a greater risk for occupational diseases because of potential carcinogens found in burning houses.

“We’re starting to see more and more firefighters coming down with cancer,” he said. “And we feel like that’s going to be a growing trend that we’re going to have to address throughout our generation for firefighters.”

Researchers from the National Institute for Occupational Safety and Health found that the longer firefighters were exposed to fire and burning buildings, the more likely they were to die from lung cancer and leukemia. The study also found that firefighters had twice as many incidences of mesothelioma, a cancer resulting from asbestos exposure, as the rest of the U.S. population.

Right now, the family of a firefighter who dies can claim the benefit if the death was the result of a heart attack or stroke or injury within 24 hours of fighting a blaze.

Several senators involved in budget negotiations said they didn’t know enough about the firefighter death-benefit measure to have formed an opinion.

Mental Health

Fire chiefs (r to l, top row) Allen Wilson, Freddy Johnson Sr., TJ McLamb, John Grimes, and Chris Heath, sit in at the House hearing.

Fire chiefs (r to l, top row) Allen Wilson, Freddy Johnson Sr., TJ McLamb, John Grimes, and Chris Heath, sit in at the House hearing. Photo credit: Minali Nigam

Firefighters also watched a House session where representatives passed House Bill 451, which calls for a study on suicide prevention in minors, veterans, and emergency responders in North Carolina.

Cole said firefighters were hoping to be included as part of that study, especially to help those afflicted with post-traumatic stress disorder.

“Please allow me to also acknowledge the North Carolina Association of Firefighters, who reached out to me to be included in this piece of legislation,” Rep. Carla Cunningham (D-Charlotte) said from the floor of the chamber, motioning to the uniformed men and women sitting in the gallery above.

Cunningham had worked to add firefighters into the suicide study bill.

Passage of the measure was unanimous in the House. Now the study bill moves to the Senate.

New ASU Health Sciences Facility to Benefit Students, Region, Says Dean


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By Thomas Goldsmith

A new College of Health Sciences building for Appalachian State University in Boone will broaden students’ educational experience as well as the college’s reach into underserved Western North Carolina counties, the college dean said Monday.

When the 203,000-square-foot building breaks ground next week it will consolidate several fast-growing degree programs, Dean Fred Whitt said.

“We are trying to set up interprofessional delivery of services,” Whitt said. “We think we’ll be training the health-care leaders of tomorrow today.”

In anticipation of an increasingly team-oriented health-care environment, the new building will allow speech therapists, nurse practitioners, dieticians, physical therapists and other specialists to train side-by-side.

Gov. Pat McCrory’s office announced last week that contracts have been let for the facility, using $70 million in funding from the state’s Connect NC initiative. The Council of State approved $200 million June 7 in the first segment of the $2 billion bond program voters OK’ed in March.

Since 2008, the College of Health Sciences, with more than 3,300 students, has more than doubled its enrollment.

“We had just run out of room,” Whitt said.

nursing students listen to a heart

The new Health Sciences building at App State will provide room for several fast-growing degree programs, including a new masters program in nursing. Photo courtesy Appalachian State University

The new facility will offer “specialty laboratories, classrooms and support space centralizing several different health sciences degree programs under one roof,” according to a news release.

“New university facilities like the Health Sciences Building at Appalachian State will prepare students for high-demand medical careers to further enhance the health and quality of life in the region and state,” McCrory said in a statement.

The 16-county area around Boone has some of the state’s largest deficits in health-care professionals per 10,000 residents, Whitt said. Because professionals often remain in the area where they are educated, Western North Carolina should see ongoing benefit from the college’s growth.

“If you are trained in rural areas, you’ll want to go back and work in rural areas,” Whitt said. “When you get in the rural health area, it really means enhancing the quality of life in the region. In some counties up here, you may have only one physical therapist.”

In 2015, the college received funding for a Rural Health Care Services Outreach Program to provide services through partnerships with Wake Forest School of Medicine physician-assistant program and the High Country Council on Governments Area Agency on Aging.

How’s that arrangement working out?

“Awesome,” Whitt said. “They have a cohort of physician assistant students training here in our college.

“On the other hand, for our benefit, we are able to place some of our nursing students in clinical rotations in certain specialty areas at Wake Forest Baptist.”

Health-care jobs are represent one of the state’s strongest employment sectors, with about 400,000 people working as health-care practitioners, technicians or support employees, according to the commerce department’s Labor and Economic Analysis Division.

ASU offers undergraduate degrees in areas including athletic training, communication sciences and disorders, exercise science, health-care management, nursing, nutrition and recreation management, as well as masters programs in exercise science, nutrition, speech language pathology, social work and health administration.

A master’s program in nursing is slated to begin this fall.

This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina.

Backyard Chickens At Center of Salmonella Outbreak


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By Catherine Clabby

Within the really-local food movement, setting up a backyard chicken coop is a hot hobby.

And for good reason. No fresher source of eggs can be found. Whether down-coated chicks or speckle-backed hens, the birds are good company. Keeping the birds can teach children about biology, ecology and the effort involved in putting fresh food on the table.

USDA_ChickenPhoto

Even when chickens look healthy, it’s best to assume that they are infected with Salmonella and take steps to protect all living nearby. Source: U.S. Department of Agriculture.

But disease risk, particularly Salmonella infection, lurks in backyard coops too. And it’s back.

The Centers for Disease Control and Prevention has confirmed Salmonella cases in 35 states linked to exposures in backyard poultry flocks. North Carolina, with 26 known cases reported, ranks among the five states with most infections during this outbreak.

Long illness

Salmonella is not to be trifled with. At best, multiple strains of the bug produce significant diarrhea, fever, and cramping that can last four days to a week. Most people recover completely but a fraction develop reactive arthritis, an inflammation in the joints that can disappear, but roar back as a chronic condition.

“It’s not just: ‘I’m going to be better in a couple of days.’ It can lead to long-term issues,” said Ben Chapman, a NC State University food-safety specialist. “You can have quite a long illness.”

Children younger than five, whose immune systems are still developing, are most vulnerable to getting infected. Those children, elderly people, and anyone with an impaired immune system are most likely to get very sick or, on occasion, die from it.

A Salmonella infection can turn fatal if it moves from a person’s intestines into the bloodstream.

As of May 26, 2016, the Centers for Disease Control and Prevention counted 324 people infected by Salmonella strains, infections linked to live poultry in backyard flocks. Source: CDC

As of May 26, 2016, the Centers for Disease Control and Prevention counted 324 people infected by Salmonella strains, infections linked to live poultry in backyard flocks. Map credit: CDC

This trouble can start in chicken coops because Salmonella bacteria thrive in the intestines of healthy-looking poultry. When the birds poop, the pathogen escapes the chicken gut and enters spaces that poultry share with us.

People easily come into contact with infected feces on the ground where chickens peck, inside a flock’s coop or cages, in feed dishes and on the birds themselves. It’s not at all difficult for some of that material to travel on a person’s clothes or shoes.

Infection can strike when even trace amounts of feces get close to a person’s mouth. Given that young children are most likely to put their fingers and almost anything else into their mouths, they are most likely to encounter the bug.

Careful with those birds

The good news is that infection is preventable. CDC officials recommend that children five and younger not be allowed to touch chickens at all. Cuddling with or kissing the birds should be verboten for all. And anyone who touches a chicken or duck, or even has contact with their living quarters, must wash their hands well immediately.

The North Carolina Department of Agriculture and Consumer Services is advising people not to be deterred from keeping backyard flocks. Instead, in the latest edition of the Poultry Safety Newsletter, agency officials urge people keeping chickens to take all known steps to protect themselves.

“Poultry owners must remember that birds inherently have a degree of risk, and even though they feel like members of the family, birds should be kept out of human living areas,” said Sarah Mason, a veterinarian and director of the agency’s poultry-health program.

Mason stressed that there is no reliable way to test flocks for Salmonella because infected birds don’t shed the bacteria constantly. The best thing, she said, is to assume the infection is present.

Families living with young children or with elderly people at home can also discuss vaccinations with a veterinarian to see if a vaccine exists for the types of chickens they keep.

The CDC has linked Salmonella outbreaks to backyard poultry every year since at least 2012. Investigations linked this most recent outbreak to chicks and ducklings obtained from multiple sources, including feed stores, co-ops, hatcheries, and friends in multiple states.

CDC officials are asking mail-order hatcheries specifically to help stop these outbreaks, in part by tutoring customers about how to protect themselves.

Chapman, the N.C. State associate professor and creator of barflblog.com, sees great value in everything that children can learn when a family keeps chickens. But he also knows from experience with his two children, ages 5 and 7, that it’s tough to keep kids away from chickens, particularly the youngest ones. But it must be done.

“Baby chicks are cute to look at,” Chapman said.

PountryBoxPoultryBoxThe sight of a child suffering with Salmonella is not.

Senators Eyeing Solutions for Optometrist Shortage


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By Minali Nigam

The eyes have it in this year’s Senate budget, which calls for $2.1 million to fund adult eye exams.

“We have reinstated [that] coverage so that we can continue to find glaucoma and diabetes and other vision issues that exist in the Medicaid population for adults,” said Senate Health and Human Services appropriations co-chair Ralph Hise (R-Spruce Pine).

photo of the eye measurement device at an optometrist's office

Photo courtesy Andrew Fresh, flickr creative commons

Sen. Gladys Robinson (D-Greensboro) asked during a Senate appropriations meeting Wednesday whether the coverage would extend to treatment for people who are diagnosed after the routine eye exam.

Only the exams would be covered for adult eye issues, Hise conceded, adding that funding for follow-up services would be considered in the long run.

Even with the coverage, having all those eye exams performed could pose problems. According to 2014 health workforce data from UNC-Chapel Hill, twelve counties in North Carolina have few or no optometrists.

“Our ratio of optometrists to the population is low,” optometrist Dr. Hal Herring told legislators during a 2014 hearing.

That meeting brought lawmakers and optometrists together at the General Assembly to discuss provider practice, training, and the current state of optometry in North Carolina. Since Herring spoke at the legislature, there’s been little discussion about optometry training in North Carolina.

Until now.

The current Senate budget would also make moves to alleviate an optometrist shortage. Senators’ spending plan supports a study on creating a training school at Wingate University, in Union County.

“There are no schools for optometry in the state,” Sen. Tommy Tucker (R-Waxhaw) said during this week’s appropriations committee meeting. “Optometrists are aging out.”

The optometry program would be funded privately by Wingate, according to Tucker, but the state would put $900,000 towards establishing a free clinic so students could get experience while treating Medicaid patients.

Boy at phoropter; The phoropter is the most recognizable tool used by optometrists, used to determine a person's eyeglass prescription.

The phoropter is the most recognizable tool used by optometrists, used to determine a person’s eyeglass prescription.
Photo courtesy woodley wonderworks, flickr creative commons.

The plan encourages Wingate to assess the number of potential applicants and expenses for the program.

“No money has actually been appropriated; it’s just a study for the State to get the numbers,” Tucker said.

Herring told lawmakers in 2014 that national figures show roughly one optometrist per 7,000 persons. “In NC, it is closer to one optometrist for every 10,000 of the population,” he said.

Herring’s practice is in Robeson County, one of the shortage areas.

“If we had a school of optometry in North Carolina, we feel like that would be beneficial to our ratio of optometrists to population over the coming years,” he told lawmakers at the time.

Students from North Carolina who want to attend optometry training programs have to go out of state and pay out-of-state fees. Herring said that students who leave to be trained tend not to return to the state to establish their own practices.

How is North Carolina’s Medicaid Program Doing This Year?


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By Rose Hoban

As Gov. Pat McCrory introduced North Carolina’s Medicaid reform plan Wednesday, he praised this year’s “$300 million surplus in the Medicaid budget made possible by Republican-led reforms that have gotten the chronically troubled program back on track.”

When the budget numbers came in this spring, they showed the program was at least $313 million below it’s target budget.

And Republican leaders in the legislature have crowed over that number, most of which was returned to the state’s general fund this year.

However, it’s not clear that this year’s Medicaid surplus was a result of better management or legislative reforms, so much as better budgeting and some positive changes made possible by outside forces.

One of the biggest drivers for growth in the Medicaid program is enrollment. Last year, DHHS leaders projected that Medicaid enrollment would grow by 8.3 percent. That enrollment projection represented a higher growth rate than the level seen in most of the previous seven years. Even during the 2009 fiscal downturn, when many more people became eligible as people lost work, Medicaid grew by only 6.2 percent.

Blue lines show the predicted enrollment growth for Medicaid last year. The green lines show that actual growth was much lower.

Blue lines show the predicted enrollment growth for Medicaid last year. The green lines show that actual growth was much lower. Graph courtesy NC DHHS

[In 2014, enrollment growth for Medicaid alone was high at 9.2 percent, but that was in large part because kids in the state’s Health Choice program were moved into Medicaid as Health Choice was phased out. The total growth for the two programs overall was 6.6 percent.]

In a program as large as Medicaid, a small change makes a big difference. Last year’s actual growth in enrollment was only 3.3 percent. That seemingly small difference added up to more than $107 million in savings.

When asked about those over-estimates, Medicaid head Dave Richard said the forecast was a “reasonable projection.”

“We knew that we were conservative in that,” said Richard, citing uncertainty caused by an influx of Medicaid applicants into the system as a result of the Affordable Care Act, which added about 66,900 people in 2014, but only about half that amount in 2015.

“We didn’t know what it would be like,” he said.

All data courtesy NC DHHS.

All data courtesy NC DHHS.

The other big source of savings in last year’s Medicaid budget came from federal dollars paid into the program. More than $87 million of surplus arose from a more generous federal rate for matching the state dollars North Carolina puts into the program. In 2014, the federal government paid $1.93 for every dollar paid in by North Carolina. Last year that matching payment went up to $1.96 for every North Carolina dollar.

That change amounted to at least $100 million. And this year, that rate will tick up again, to more than $2.02 paid by the feds for every North Carolina dollar spent.

As DHHS officials told legislators in May, “over 60 percent of the reduction is due to lower than anticipated enrollment and a more favorable match.”

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