William Pully

“Bill is well deserving of this prestigious recognition for his leadership in helping create a statewide disease event tracking system and the Public Health and Hospital Collaborative,” NCMS EVP, CEO Robert W. Seligson said. “These advancements contribute greatly to the quality of care given our citizens and to the public health of our great state.” 

The Collaborative is a public-private partnership between the Division of Public Health, NCHA, the NC Institute for Public Health and the NC Center for Health Quality that has developed standards for community health assessments as required for non-profit hospitals by the federal health care reform law and the Public Health Exchange.

Pully, a Rocky Mount native began his career with NCHA as director of government relations. He became president of the association in 1999.

Speaking for the NCDA were David Ollila, MD, Professor of Surgery at UNC-Chapel Hill and Co-Director of the UNC Melanoma Program; and Craig Burkhart, MD, Assistant Professor of Pediatric Dermatology at UNC-Chapel Hill. Also providing supporting statements were Amy Whited on behalf of the NC Medical Society and Christine Weason for the American Cancer Society.

Some of the key points in the NCDA’s testimony included:

• The science is clear: there are no health benefits from tanning beds that cannot be obtained more safely and without the risk of skin cancer.
• There are safe alternatives to tanning beds that many tanning bed operators are already offering.
• UV radiation in tanning booths can be up to 15 times greater than the sun.
• Every visit to a tanning bed increases the odds of developing melanoma.
• Melanoma incidence is rising at alarming rates.
• Melanoma ranks second among all cancers in years of productive life lost.
• Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for adolescents and young adults 15-29 years old.
• Melanoma is increasing faster in females 15-29 years old than males in the same age group.
• Even minimal exposure to UV radiation from tanning beds before the age of 35 can increase the risk of developing melanoma by 75 percent.
  [IARC. International Journal of Cancer: 2006 March 1;120:1116-1122.]
• A person who has used tanning devices for more than 50 hours, 100 sessions, or 10 or more years is 2.5 to 3 times more likely to develop melanoma than a person who has never tanned indoors.
  [Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson KE, Warshaw EM.  Indoor tanning and risk of melanoma: a case-control study in a highly exposed population. Cancer Epidemiol Prev 2010;19:1557-68.]
• North Carolina laws currently protect children’s health by restricting their access to: 
        -Tobacco         -Alcohol         -OTC medications
• The estimated total direct cost associated with the treatment of melanoma in 2010 was $2.36 billion
• Protecting children from tanning beds will save lives and millions of dollars in avoidable health care costs

The indoor tanning industry was represented by a paid consultant, Mr. Lee Feldman, who asserted that the research on indoor tanning was of poor quality and that the science is inconclusive. 

Following deliberation, the committee voted to send a recommendation to the full Child Fatality Task Force that it should support an increase on the age limit for indoor tanning from 14 to 18 years of age. The Task Force is scheduled to take up this issue at the April 16 meeting.

Questions about the indoor tanning issue may be directed to Alan Skipper, Director of Speciality Society and Meeting Services, at askipper@ncmedsoc.org.

On Wednesday, February 1, 2012, CBS News reported that a new congressional report accused tanning salons of lying to customers just to get their business. Click here to view Probe: Tanning Salons Lure Teens with Lies, by Correspondent Nancy Cordes.

“The most important message we have right now is that people who are ill with vomiting or diarrhea should not work, go to school or attend daycare while they are having symptoms,” said State Epidemiologist Megan Davies, MD. “Everyone needs to wash their hands frequently and thoroughly with soap and water. This is the most effective way to protect yourself and others against norovirus since hand sanitizers alone are not as effective against this hardy virus.”

People with norovirus are contagious from the moment they begin feeling sick until at least three days after they recover. Dr. Davies says some people may be contagious for an even longer period. Dehydration can occur rapidly and may require medical treatment or hospitalization.

Noroviruses are easily transmitted by touching a contaminated surface as well as by direct contact or by eating food or drinking liquids that have been contaminated with the virus, according to a news release issued by the NC Department of Health and Human Services. Noroviruses are notoriously difficult to kill with normal cleaning and disinfecting procedures. Symptoms include nausea, vomiting, diarrhea and stomach cramping. Some people may have fever, chills, headache, muscle aches and a general sense of tiredness.

For more information on norovirus and precautions to minimize its spread, go to http://www.ncpublichealth.com/.

The leadership moves coincide with the Governor’s executive order encouraging agencies to consolidate and realign state government, to improve service and efficiency, according a DHHS news release.

“As we move to enact the Governor’s executive order, the focus shifts to a more integrated approach to improving the health of all North Carolinians,” outgoing DHHS Secretary Lanier Cansler said. He will be working in consultation with incoming Acting Secretary Al Delia to begin the formation of the new division.

Related articles:

State health official stepping down, 1-24-12, Winston-Salem Journal, by Richard Carver

Governor Names Delia Acting DHHS Secretary, Bulletin, 1-20-12

Special Report: DHHS Secretary Cansler Resigns, Doctor to Doctor Blog, 1-14-12

The World Health Organization (WHO) reports flu activity in the temperate regions of the northern hemisphere remains below seasonal thresholds, though notable increases in activity have been reported in some areas of Canada, Europe, northern Africa and the Middle East. The viruses detected throughout the northern hemisphere temperate zone have been predominately of the A(H3N2) type. Only very small numbers of A(H1N1) have been reported in recent weeks.

More information is available at www.flu.nc.gov and at http://www.cdc.gov/flu.

Click here to download the Help Your Patients flyer.

Click here to download the Quitline NRT Program flyer, which can also be used as a poster in your waiting room or examining room.

“While any improvement is encouraging, we still have a long way to go to improve the health of all North Carolinians,” Governor Beverly Perdue said.  “Now is not the time to cut critical funding to health care and prevention among the most vulnerable members of our communities.”

The report notes that North Carolina’s rising obesity rates are mirrored in increased diabetes rates, with an estimated 711,000 adults with diabetes in the state. The NC Division of Public Health is working in numerous communities to prevent obesity and type 2 diabetes by promoting healthy eating and physical activity.

The state was recognized for progress in reducing smoking rates among adults over the past decade; however, the report also points out more than 1.4 million adults still smoke in the state. North Carolina has 100 percent tobacco-free campus policies in all public schools, all hospitals, all prisons and half of its community colleges. A 2010 state survey found that 81 of 100 county governments and more than 200 municipal governments reported they had implemented 100 percent smoke free or tobacco free buildings.

“The passage of smoke-free bars and restaurants law was a tremendous milestone for public health in North Carolina,” State Health Director Jeffrey Engel, MD, said. “Not only has it improved the health of restaurant workers by not exposing them to secondhand smoke, but also is expected to save an estimated $4.7 million per year in avoidable medical care costs for hospitality workers.”

For more flu information and guidance visit:

North Carolina: http://www.flu.nc.gov

CDC: http://www.cdc.gov/flu

The Division of Medical Assistance (DMA), North Carolina’s Medicaid agency, entered a similar arrangement two years ago with Prodigy Diabetes Care. That contract expired November 14, 2011. DMA is working with both Roche and Prodigy on a transition plan that will extend into January 2012.

During the transition period, Roche will provide a glucose meter to the nearly 77,000 NC Medicaid and NC Health Choice members living with diabetes. As under the previous contract, other brands will be available on a prior-approval basis for specific medical circumstances. The meters are free. DMA will pay for disposable test strips, control solution, lancets and lancing devices. Insulin syringes, which Prodigy supplied under the expiring contract, are no longer a sole-source item.

The NCMS Foundation’s Community Practitioner Program (CPP) works closely with the Office of Rural Health and Community Care in helping to recruit physicians, physician assistants and nurse practictioners to medically underserved communities in North Carolina.

For more information about the Office of Rural Health and Community Care, visit: http://www.ncdhhs.gov/orhcc/.

Click here to learn more about the NCMS Foundation and its programs and services.

Guidelines for Health Insurance Exchanges created by Affordable Care Act

The new policies include support for using the open marketplace model for exchanges to increase competition and maximize patient choice, and the involvement of state medical associations in the legislative and regulatory processes concerning state health insurance exchanges.

Stop the Implementation of ICD-10

The House of Delegates voted to work vigorously to stop implementation of ICD-10 (The International Classification of Diseases and Related Health Problems, 10^th Revision), a new code set for medical diagnoses. ICD-10 has about 69,000 codes and will replace the 14,000 ICD-9 codes currently in use. AMA says the implementation of ICD-10 will create significant burdens on the practice of medicine with no benefit to individual patients’ care.

Virtual Medical IDs

New policy encourages the availability of portable medical identification alert systems for patients. Virtual medical identification systems allow emergency medical personnel to access a patient’s medical history and emergency contact phone numbers through a pin number that can be attached to clothing, a key, or stored in a wallet.

Combat National Drug Shortages

New AMA policy supports federal drug shortage legislation, such as HR 2245 and SB 296, that would require manufacturers to notify the FDA of any discontinuance, interruption, or adjustment to the manufacture of a drug that may result in a shortage. In the past few years, AMA reports that shortages of medically necessary drugs have worsened appreciably, with the number of FDA identified shortages tripling between 2005 and 2010.

For more on AMA House of Delegates Actions, visit:

http://www.ama-assn.org/ama/pub/news/news/2011-11-15-ama-adopts-new-policies.page, or

http://www.ama-assn.org/ama/pub/meeting/index.shtml.

The NC Division of Public Health report cites studies from numerous communities, states and countries that show similar declines in heart attack rates after enacting tobacco-free policies as well as a 2008 Institute of Medicine report concluding smoke-free laws are a proven way to decrease heart attack rates.

“The Institute of Medicine has evaluated the effects of indoor smoking bans world-wide, and data consistently show that smoke-free laws reduce heart attacks,” Dr. Engel said. “The Centers for Disease Control acknowledges that secondhand smoke exposure causes heart attacks; even a brief stay in a smoky area can trigger a heart attack in someone who is at risk, such as those with heart disease, a family history of heart disease, high blood pressure, or high cholesterol.”

Dr. Engel says the decline in heart attacks in the state in 2010 represents an estimated $3.3 to $4.8 million in health care cost savings. Secondhand smoke is a known trigger for other health conditions like asthma, stroke, and chest pain, and is a major risk factor for lung cancer, North Carolina’s leading cancer killer.

The heart attack study can be viewed at NC Report on Heart Attack Rate After Smoke-Free Law.

To date, FDA-commissioned officials have conducted more than 27,500 compliance checks. Retail inspections focus on age and ID verification, requirements for labeling and advertising of smokeless tobacco products, restrictions on the sale of single cigarettes, a ban on certain candy and fruit-flavored cigarettes, and prohibited self-service displays and vending machines.

North Carolina is among fifteen states that were awarded FDA Tobacco Retail Inspection Contracts in September 2011, allowing the state to assist the FDA with conducting compliance check inspections of tobacco retailers.

Click here to view current inspection results on the FDA website.

The results came after a carefully conducted case-control study involving the 27 individuals identified as having contacted E. coli after attending the Fair in October, and another 87 individuals who attended the fair but did not get sick.

State Epidemiologist Megan Davies, MD, said the illness is likely related to animal contact, though the investigation did not implicate any specific animal or breed in the outbreak.

“We know that E. coli O157 is often found in the intestines of ruminant animals, which include cows, goats and sheep,” Dr. Davies said. “These bacteria are shed in the animal’s feces, so if it is on the animal itself or surfaces around the animal that someone touches, the bacteria can be transmitted to that person.”

Health and Agriculture officials say they are working to identify additional protective measures for fairgoers in the future.

NAMCS data are used by public health policy makers, health services researchers, government agencies, medical schools, physician associations, epidemiologists, and the print and broadcast media to describe and understand the changes that occur in medical care requirements and practices. The data are disseminated in the form of NCHS reports, journal articles, and downloadable data files. Previously, the NAMCS has provided only national-level estimates. For the first time starting in 2012, NAMCS poses a unique opportunity to produce state-level data as well as national and census divisional estimates. Moreover, your particular state is one among 34 of which NCHS will be able to provide state level estimates. Below are a few highlights of the 2012 NAMCS survey:

• Survey data will now be collected using a computerized instrument; which will simplify data collection activities and reduce data entry errors and omissions, thus improving data quality. 
• Sample size has been increased nearly five-fold to allow NAMCS to provide estimates for the top 34 most populated states in the United States.
• Findings will allow physician offices and community health centers at the state level to baseline themselves against national estimates (including 9 Census divisions).

To learn more about NCHS, please visit the CDC website: http://www.cdc.gov/nchs/data/factsheets/factsheet_overview.htm.

If you would like more information about NAMCS, check out this link:  http://www.cdc.gov/nchs/ahcd/namcs_participant.htm.

See how NAMCS data is used (click titles):

NCHS 2010 DATA BRIEF: POPULATION AGING AND THE USE OF OFFICE-BASED PHYSICIAN SERVICES

SELECTED 2009 SUMMARY TABLES: PHYSICIAN AND PHYSICIAN PRACTICE CHARACTERISTICS

Questions? Feel free to call this toll free number: 1-800-392-2862.

Here is the latest list of counties and cases reported:

Wake               13

Sampson           6

Cleveland           1

Durham              2

Johnston             1

Lenoir                  1

Orange                2

Wilson                 2

Four of the confirmed cases involve children who have been hospitalized with hemolytic uremic syndrome (HUS). Health officials say the outbreak appears to be linked to people who attended the State Fair in mid-October.

On Monday, State Epidemiologist Megan Davies, MD, explained that investigators are using an exhaustive interview process to help pinpoint the source of the E. coli O157. This includes further interviews involving confirmed or suspected cases, and interviews with more than seventy randomly chosen people who attended the fair but did not become ill. By using a control group, officials hope to find some commonality that may provide additional clues as to the source, but Davies cautioned that it’s possible they may not learn what the specific exposure was.

The investigation is expected to be completed by early next week. DPH officials have been working closely with the Agriculture Department and local health departments. Updates on the investigation are being posted daily by 4:00 pm at: http://epi.publichealth.nc.gov/gcdc/ecoli.html.

State law requires that all suspected shiga toxin-producing E. coli infections and HUS cases be reported within 24 hours to the local health department or by contacting the epidemiologist on call at 919-733-3419. Suspected cases do not require laboratory confirmation to be reported.

As of 3:00pm Monday, here are the cases and counties reported:

                11                          Wake County

                  7                          Sampson County

                  2                          Wilson County

                   1 each                Cleveland, Durham, Johnston and Warren counties

Of the 24 cases reported, five remain hospitalized, with four of the patients children who are suffering from hemolytic uremic syndrome (HUS), a type of kidney disease associated with E. coli O157.

All nine of the confirmed cases attended the State Fair, according to State Epidemiologist Megan Davies, MD. No new cases were reported over the weekend, as the first incubation period (10 days) ends this week. Dr. Davies says officials typically wait two incubation periods before determining whether an E. Coli O157 outbreak has ended.

Officials are using an exhaustive interview process involving patients and a control group to help pinpoint the source of the outbreak. Dr. Davies said this includes further interviews with the confirmed and suspected cases, and interviews with more than seventy people who attended the fair but did not become ill. The process is designed to find some commonality to lead investigators to the source, but Dr. Davis cautioned that it’s possible they will not learn what the specific exposure was.

People in the control group were selected randomly from about 2,000 fairgoers who had provided emails when purchasing tickets. State Health Director Jeffrey Engel, MD, said media reports had helped the investigation by making people aware of the outbreak and making it easier for investigators to obtain information.

Dr. Davies say she expected the investigation to be completed by early next week. Working closely with the Division of Public Health are officials from the state Agriculture Department and local health departments.

Updates on the investigation are being posted daily by 4:00 pm at http://epi.publichealth.nc.gov/gcdc/ecoli.html.

State law requires that all suspected shiga toxin-producing E. coli infections and HUS cases be reported within 24 hours to the local health department. Physicians may call their local health department or the epidemiologist on call at 919-733-3419 to report suspected cases, which do not require laboratory confirmation to be reported.

State health officials reported today that they were investigating 26 cases of E. coli, with 10 confirmed cases and 16 cases still being evaluated. Of the 26 cases under investigation, 13 are adults (18 years old or older) and 13 are children (under 18).    Five people remain hospitalized: four children and one adult.  Current patient interview information shows that 23 of the 26 persons involved in the investigation report having attended the State Fair, and cases have been reported from Durham, Wake, Johnston, Franklin, Cleveland, Orange, Wilson and Sampson counties.

Updated information on case numbers in the investigation will be posted daily by 4 p.m., beginning on Friday 10/28, at http://epi.publichealth.nc.gov/gcdc/ecoli.html

Dr. Davies issued the memo to make physicians and other providers aware of the outbreak and to encourage reporting of suspected E. coli O157 infections among patients seen in their practices. The memo also cites recent literature on nephroprotection to prevent hemolytic uremic syndrome in susceptible individuals (Ake JA et al. Relative Nephroprotection During Escherichia coli O157:H7 Infections: Association with Intravenous Volume Expansion. Pediatrics. 2006;115:e673-680).

Read the memo here.

The memo covers clinical, laboratory and public health issues and reminds providers that early recognition and IV hydration may help prevent renal failure. By law, all suspected shiga toxin-producing E. coli infections and HUS cases must be reported within 24 hours to the local health department. Dr. Davies reminds providers that they should report suspected cases and not wait for laboratory confirmation.

To report suspected cases, contact your local health department or contact the epidemiologist on call at 919-733-3419.

Physicians and practices can go find more information about flu activity in North Carolina at: http://www.flu.nc.gov/flu/.

As the 2011-2012 flu season gets underway, the Hanover-Pender County Medical Society (NHPCMS) is urging area health care professionals to be immunized against influenza. The call comes in a letter that was drafted after Paul Kamitsuka, MD, an infectious disease physician, expressed concerns about the lack of influenza immunization among staff in long-term care centers in the area. The letter was jointly signed by NHPCMS President Philip M. Brown, Jr., MD, and New Hanover County Health Department Director David E. Rice, MPH, MA. It was sent to area health care professionals, agencies, schools and others with direct person-to-person contact with a patient, student or client. Read the letter here.