Whitney Palmer

Healthcare. Politics. Family.

Treatment and prevention in the ‘buckle’ of the stroke belt

Published in the Spring 2011 Carolina Public Health Magazine

By Whitney L.J. Howell

During the last 20 years, North Carolina has edged toward the top of an ignominious list. The state currently has the sixth highest incidence of stroke mortality in the nation. There’s no time to waste in turning this trend around.

Annually, 27,000 North Carolinians suffer strokes; one dies every two hours. These statistics led researchers to label certain North Carolina counties as part of the “buckle” of the Stroke Belt, which runs through the southeastern United States. Stroke risk in the region is two to three times greater than the national average.

Recognizing stroke risks and symptoms and providing appropriate and timely treatment are critical to preventing stroke and lessening its long-term impacts. For more than a decade, UNC Gillings School of Global Public Health researchers have dedicated themselves to reducing the impact of the nation’s third highest killer. They identify “best practices” in stroke treatment and prevention, help hospitals implement quality of care improvement programs, and train medical personnel to recognize and respond quickly to stroke symptoms.

“We want to improve patients’ care – wherever they may be – should they have a stroke in North Carolina,” says Wayne Rosamond, PhD, epidemiology professor and principal investigator for the North Carolina Stroke Care Collaborative (NCSCC).

The NCSCC works with 56 of the state’s 102 hospitals, from Henderson County’s Park Ridge Health in the west to Carteret County General Hospital in the east. Participating hospitals range from the 25-bed Transylvania Medical Center to Pitt County Memorial (745 beds, affiliated with East Carolina University’s Brody School of Medicine), Duke University Medical Center (989 beds) and Greensboro-based Moses Cone Health System (529 beds).

With Centers for Disease Control and Prevention funding, the collaborative created an interactive database so that a hospital’s stroke care performance can be monitored and compared to similar facilities. Each month, NCSCC hosts webinars for stroke experts to address specific quality improvement topics, and they assist hospitals in giving emergency medical technicians and caregivers advanced education in both identifying and reacting appropriately to a stroke.

NCSCC annually awards up to 12 grants to fund initiatives that meet individual hospital needs. For example, for 2009–2010, Catawba Valley Medical Center received $15,000 for a stroke nurse coordinator. NCSCC also collaborates with the Registry of the Canadian Stroke Network. In February, the NCSCC joined with UNC’s Department of Emergency Medicine to participate in a seminar, presented at the International Stroke Conference 2011, about integrating a stroke registry into EMS data sources.

However, ensuring that patients receive appropriate services is only part of the stroke-prevention equation, says June Stevens, PhD, nutrition and epidemiology professor and nutrition department chair. Health care providers also should focus on helping individuals tackle obesity – a substantial, preventable stroke risk factor.

“Obesity increases the risk of stroke, because it raises the likelihood of high blood pressure,” Stevens says. “In fact, we’ve found that if you have a significant weight gain over an extended period of time, your risk is substantially higher than if you maintain your weight.”

In a soon-to-be published study of 15,000 people from North Carolina, Mississippi and Minnesota, Stevens and her colleagues found that a 10- to 30-percent weight gain between age 25 and middle age resulted in a 29 percent increase in stroke risk. Individuals who gained more than 30 percent of their body weight had a 64 percent higher risk. These results were compared to individuals who maintained their weight within 3 percent of the initial measurement.

“People already know obesity isn’t healthy,” Stevens says. “They also need to know about evidence that shows they’re at high risk for stroke – so they can do something about it.”

To read the story online: http://www.sph.unc.edu/images/stories/news/cph_2011_spring/documents/howell_stroke.pdf


June 2, 2011 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , | Leave a comment

Swa Koteka ‘It is possible’ to prevent HIV

Published in the Spring 2011 Carolina Public Health Magazine

By Whitney L.J. Howell

Even without engaging in risky behaviors, young girls and women who live in South Africa have a 1-in-3 chance of contracting HIV.

Audrey Pettifor, PhD, assistant professor of epidemiology at UNC Gillings School of Global Public Health, launched a study in March 2011 to examine the factor known to have the greatest impact on reducing HIV infection risk – education. Pettifor partners with University of the Witwatersrand researchers  Catherine MacPhail, PhD, and Kathleen Kahn, MD, PhD.

Audrey Pettifor, Ph.D., assistant professor of epidemiology at the UNC-Chapel Hill Gillings School of Global Public Health

“We know young girls who finish high school are four times less likely to become infected with HIV than those who don’t complete school,” Pettifor says. “Condom use and number of partners simply don’t explain the high levels of HIV infection we observe in young South African women.”

To keep girls in school, Pettifor and her team will randomize 2,900 young women and their  parents/guardians to receive a monthly cash transfer, based on whether they attend school 80 percent of the time over the next three years. Then, they will determine whether girls receiving the cash  transfers are less likely than girls in the control group to become infected with HIV.

The study, funded by the National Institute of Mental Health and the National Institutes of Health’s (NIH) HIV Prevention Trials Network, also will measure HSV-2 (genital herpes), sexual behavior, mental health, school outcomes, socio-economic status and other key social factors. It is referred to locally as Swa Koteka, which means “it is possible” in the native language, Shangaan.

Educating girls is only half the battle, however, Pettifor says. Cultural norms that impinge upon a woman’s right to resist sex or insist on condom use also have to change if young women’s HIV risk is to be decreased. Therefore, half of the young women’s villages also will be randomized to receive an intervention focused on changing negative gender norms and HIV risk among men ages 18 to 35. The team partners with a local nongovernmental organization, Sonke Gender Justice, which aims to challenge and reshape negative gender norms in South Africa.

Pettifor also directs two NIH-funded pilot projects in Lilongwe, Malawi, to help those with acute HIV infection (AHI) lessen the likelihood of transmission. AHI is a highly infectious phase of the disease.

One of Pettifor’s projects, co-led with Amy Corneli, PhD, of FHI,* will compare the effect of four intensive counseling sessions in the first two weeks after AHI diagnosis to standard counseling in reducing transmission risk to partners.

In the second project, co-led with Bill Miller, MD, PhD, UNC associate professor of epidemiology and medicine, Pettifor’s team will compare effects of three interventions – antiretroviral treatment for the first 12 weeks after infection, in combination with intensive alone and standard counseling.

“This is a behavior change intervention through which we’re asking people to change behavior for a defined and short period of time,” Pettifor says. “If we get them through this really risky time, then we can talk about a longer-range risk reduction plan.”

To read the story online: http://www.sph.unc.edu/images/stories/news/cph_2011_spring/documents/howell_HIV.pdf


June 2, 2011 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment


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