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PubMed2005

The impact of an innovative reform to the South Carolina dental medicaid system.

OBJECTIVE: To evaluate the effectiveness of an innovative reform in 2000 to the Dental Medicaid program in South Carolina. DATA SOURCES/STUDY SETTING: South Carolina Medicaid enrollment data and dental services utilization data from 1998, 1999, and 2000. STUDY DESIGN: The study was observational and retrospective in nature. Quarterly data were used in general linear regression models to examine time trends in the percent of Medicaid enrollees ages 21 and younger who received dental services. Trends in the total number of dental procedures provided per Medicaid enrollee were also analyzed, with sub-analyses performed on the four most frequent categories of procedures. DATA COLLECTION/EXTRACTION METHODS: Data were provided by the state's Quality Improvement Organization. PRINCIPAL FINDINGS: From 1998 to 1999, there was a downward trend in the number and percent of Medicaid enrollees ages 21 and younger receiving dental services and in the total number of services provided. This trend was dramatically reversed in 2000. CONCLUSIONS: The January 2000 dental Medicaid reform in South Carolina had marked impact on Medicaid enrollees' access to dental services.

Adolescent↗

PubMed2003

Laboratory survey of antibiotic nonsusceptibility among Streptococcus pneumoniae isolates in South Carolina, 1998 versus 2000.

BACKGROUND: In 1998, the South Carolina Department of Health and Environmental Control surveyed clinical microbiology laboratories statewide to determine the prevalence of antibiotic nonsusceptibility among isolates of Streptococcus pneumoniae. A follow-up study was conducted in 2001. METHODS: A cross-sectional study was conducted to estimate the prevalence of penicillin nonsusceptibility (PCN-N), extended-spectrum cephalosporin nonsusceptibility (ESC-N), and levofloxacin nonsusceptibility (LEV-N) in South Carolina. A standardized questionnaire was mailed to 89 laboratories. RESULTS: The prevalence of penicillin intermediate resistance increased from 1998 (17.6%) to 2000 (20.9%, chi2 P = 0.008). Furthermore, the prevalence of PCN-N increased from 1998 (34.5%) to 2000 (38.4%, chi2 P = 0.01). The prevalence of ECN-N decreased from 1998 (19.1%) to 2000 (17.7%), but the difference was not significant (chi2 P = 0.25). CONCLUSION: The laboratory survey was a low-cost method of estimating the change in prevalence of antibiotic nonsusceptibility, and it emphasizes regional surveillance because the prevalence of antibiotic nonsusceptibility varied geographically.

Cross-Sectional Studies↗

PubMed2003

When life is on the line: orthopaedic trauma care in South Carolina.

There are approximately 300 orthopaedic surgeons in South Carolina, a state with a population of approximately four million. There is one orthopaedic surgeon per approximately 13,000 people, which should be adequate to meet the demand for orthopaedic care. The problem is not the quantity of orthopaedic surgeons. The problem is staffing our trauma centers with orthopaedic surgeons who are enthusiastic, have an interest in trauma care, and maintain high levels of CME and technical expertise. They need to be supported with appropriate medical liability reform, such as has been adopted in other states, and methods should be put into place to compensate surgeons for expensive, time consuming, and potentially risky procedures performed on uninsured and under insured patients. The number of patients with extremity trauma in South Carolina increased 25.6 percent during a five-year time period and is expected to continue to increase. It is estimated that 40 percent of all surgical charges generated for orthopaedic surgeons staffing trauma centers are for self-pay patients. Given the higher liability cost and lower reimbursement from other payer sources for elective procedures, it will soon become impossible for orthopaedic surgeons to continue to provide services at trauma centers without support from hospitals or government agencies.

Ambulatory Care↗

PubMedDate not supplied

Initial results from a multi-institutional collaboration to monitor harmful algal blooms in South Carolina.

The rapid rate of development in the South Carolina (SC) coastal zone has heightened public concern for the condition of the state's estuaries, and alerted scientists to the potential that novel and adverse effects on estuarine ecosystems may result. Although well-developed databases from long-term monitoring programs exist for many variables valuable in predicting and following system responses, information on phytoplankton distributions in SC estuaries has lagged. Knowledge of the dynamical relationship between environmental (e.g., nutrient quantity and quality) and biological (e.g., grazing) regulation, and phytoplankton biomass and composition is critical to understanding estuarine susceptibility to eutrophication or harmful algal blooms (HABs). Recently, SC scientists from federal, state, and academic institutions established a collaborative monitoring program to assess HAB distribution and ecology statewide. The South Carolina Harmful Algal Bloom Program includes: a) intensive temporal monitoring at areas of known HAB occurrence or those exhibiting symptoms potentially related to HABs (e.g., prevalent fish lesions), b) extensive spatial monitoring in coordination with existing statewide efforts, c) a citizen volunteer monitoring network, d) nutrient response bioassays, and e) laboratory-based physiological experiments on HAB isolates. By combining "trip-wire" surveillance and rapid response systems, routine monitoring of environmental parameters and HAB distribution, and process-oriented studies examining the physiological functioning of HAB species, an enhanced understanding of the impact and environmental control of HABs in SC estuaries will be achieved. The application of this approach to studies on the distribution and physiological ecology of a new widespread SC red tide, and to the discovery of several potentially toxic blooms (including Pfiesteria) in SC holding ponds, are described.

Biomass↗

PubMed1999

Providing worksite health promotion through university-community partnerships. The South Carolina DOT project.

The occupational health nurse for the South Carolina Department of Transportation (SCDOT) collaborated with the Schools of Nursing within the state universities of South Carolina to coordinate individual health screenings for the employees of SCDOT. Personal Wellness Profiles (PWP) by Wellsource, Inc., were used to perform the health screenings and included family and personal histories, and assessment of blood pressure, vision, height, weight, total and high density lipoprotein cholesterol, and blood glucose levels. In addition, hepatitis and tetanus/diphtheria immunizations and influenza vaccines were provided. Each of the 48 county sites was visited twice during the semester by nursing faculty and nursing and public health students. The first visit was to collect assessment data for screening and provide immunizations. The second visit was to provide individualized analyzed data and health counseling. Of the 5,118 SCDOT employees, 3,141 were screened the first year and 2,315 were screened the second year. Of the original 3,141, only 1,549 elected to participate in the rescreening. Although the average population age was 41, 78.3% were rated at high coronary risk because of high blood pressure, high cholesterol and blood sugar levels, excessive weight and stress levels, and sedentary lifestyles.

Adult↗

PubMed1995

Death in Charleston, South Carolina. A retrospective.

Over the past 324 years, Charleston, South Carolina, has triumphed over rampant infectious disease only to be overcome by more modern plagues: heart disease, neoplasia, homicide, and suicide. Examination of death records of the state of South Carolina, Charleston City, and Charleston County provides us with a glimpse of the medical challenges of our recent past; it also reminds us of the scourges that still ravage underdeveloped countries. The 18th- and 19th-century South Carolinians were besieged by tuberculosis, diarrhea, and a myriad of fevers. These diseases, though prevalent in other parts of the world, result in limited mortality in the 20th-century United States. A review of the historic trends in mortality in Charleston is presented; current significant causes of death, with emphasis on recent trends in homicide, are also discussed.

Cause of Death↗

PubMed2005

Maternal prepregnant body mass index and weight gain related to low birth weight in South Carolina.

OBJECTIVES: The primary purpose of this study was to describe the proportion of low birth weight that could be potentially prevented by programs focusing on maternal prepregnant body mass index (BMI) and/or weight gain during pregnancy. METHODS: In this historic cohort design, study data consisted of birth certificates linked to the Pregnancy Risk Assessment Monitoring System for South Carolina resident women delivering in South Carolina during 1998 and 1999. Statistical analysis was conducted with the use of chi2, population-attributable risk, and logistic regression. The analysis was performed using SUDAAN to accommodate the analysis weight and extrapolate the sample data to the South Carolina state population. RESULTS: Eight percent of the very low birth weight (VLBW) rate in South Carolina can be attributed to inadequate weight gain in pregnancy. Approximately 19% of the state's VLBW rate can be attributed to either underweight or overweight BMI at conception. Women with less than adequate weight gain were 1.4 times more likely to deliver a VLBW baby and 1.9 times more likely to deliver a moderately low birth weight baby as compared with women with adequate weight gain. CONCLUSIONS: Appropriate maternal BMI at conception followed by adequate weight gain during pregnancy may have a substantial influence on reducing the number of low birth weight deliveries.

Body Mass Index↗

PubMed1979

Effects of organochlorine residues on eggshell thickness, reproduction, and population status of brown pelicans (Pelecanus occidentalis) in South Carolina and Florida, 1969--76.

Shells of brown pelican (Pelecanus occidentalis) eggs collected in South Carolina from 1969 through 1975 and in Florida during 1969, 1970, and 1974 were significantly thinner (P greater than 0.05) than eggshells collected before 1947. Thickness of South Carolina eggshells increased in 1975, and mean thickness of eggshells collected in Florida during 1974 was greater than that of eggshells collected during 1969 and 1970, primarily in Gulf Coast colonies. Residues of 13 organochlorines were found in eggs and tissues of pelicans found dead during 1974 and 1975, although residues in brains of these specimens were not high enough to cause death. Residues of organochlorines, except PCBs, declined through 1975. PCBs increased in eggs from Atlantic Coast colonies. Reproductive success and population status of brown pelicans in South Carolina have improved markedly since authors began their studies in 1969. Good reproductive success was reported in 3 of 5 years from 1973 through 1977.

Animals↗

PubMed2001

A community health promotion partnership model: the South Carolina health connection.

Over a five year period, the South Carolina Health Connection Project has evolved to multi-site, multi-organization community-base collaborative initiative. From this project over $60,000.00 in funds have been secured. However, when costing the human resources and many other in-kind contributions involved in the SCHC Projects activities, the Project can modestly be valued at nearly $200,000.00. The efforts of a few have been shared with others, who also shared the resources with others, and the health promotion empowerment cycle continues. We believe the South Carolina Health Connection is an exemplary of a Community Health Promotion Partnership Model. We hope you will agree!

Adolescent↗

PubMed2003

Comfort always. The Rainey Hospice House: South Carolina's first inpatient hospice.

The Rainey Hospice House, South Carolina's first stand-alone inpatient facility opened in September 1998. During the year 2000, 220 inpatients were served in the house. Patients ranged in age from 23 to 107 years old (average age 73). Cancer was the most common hospice diagnosis, followed by congestive heart failure, cardiovascular disease and cerebrovascular disease, dementia, cirrhosis, renal failure, and COPD. Thirty-three percent of patients were in the program less than ten days. Over 98 percent of deaths under hospice care were described as peaceful. During 2000, our outpatients and our inpatients were similar in age, insurance coverage, diagnoses, and time in the program. Inpatient hospice is highly valued by families and patients alike. It is especially useful for the following patients: those with uncontrolled symptoms, those with exhausted care givers, those with no caregivers, those who require total care, and those very close to death. The symptoms most likely to precipitate inpatient admission include pain, nausea, confusion, and agitation. Given the graying of South Carolina's population and the increase in outpatient hospice care, more areas of the state will need inpatient facilities in the future.

Adult↗

PubMed1999

Risk factors for neonatal death in twin gestations in the state of South Carolina.

OBJECTIVE: The aim of the study was to describe risk factors for neonatal death among twins born in South Carolina. STUDY DESIGN: South Carolina publicly accessible live birth and infant death cohort files for live-born twins >500 g were reviewed for the years 1988 through 1993. Infants with lethal anomalies were deleted from the cohort before analysis. Risk factors for neonatal death were determined for the entire cohort and for the birth weight categories of 500 to 999 g, 1000 to 1499 g, 1500 to 2499 g, and >/=2500 g. Statistical comparisons were performed with the Mantel-Haenszel chi2 test and multivariate logistic regression. RESULTS: Of 7833 live-born twins, 263 (3.4%) died during the neonatal period. The mean birth weight was 2357 +/- 650 g (range 500-5358 g) at a mean gestational age of 35.7 +/- 3.5 weeks. Overall neonatal mortality rates were significantly increased (P <.001) for twins whose mothers were nonwhite (4.2 vs 2.8%), were <20 years old (6.0 vs 3.2%), or received no prenatal care (14.7 vs 3.1%). After we controlled for population characteristics with multivariate techniques, analysis revealed birth weight <2500 g and residence in the most populous urban areas to be associated with increased neonatal mortality rates. After stratification into birth weight categories, race was no longer a significant variable; in fact, nonwhite twins had a survival advantage at birth weights <1500 g, but this was not significant. Maternal age <20 years was associated with a higher neonatal mortality rate for infants with birth weights between 1500 and 2499 g. Absence of prenatal care significantly increased the neonatal mortality rate for twins >/=1500 g but not for those who were smaller. For infants weighing 500 to 999 g neonatal mortality rates were significantly lower at hospitals with >/=2000 deliveries/y than at hospitals with lower delivery volumes (P =.005). CONCLUSIONS: Although the overall neonatal mortality rate for twins continues to improve, increased rates are still seen among blacks, teenagers, and women who receive no prenatal care. Twins between 500 and 999 g have significantly reduced neonatal mortality rates when delivered at hospitals with a high obstetric volume.

Adult↗

PubMed1992

Blindness in South Carolina.

In less than 40 years the number of people aged 55 and older will constitute almost a third of the United States population. With the median age in South Carolina increasing, the incidence of visual impairment and blindness will rise. Most of the leading causes of blindness in South Carolina are age related. Most of these causes can be prevented or treated resulting in the preservation of functional vision. By increasing public awareness of blindness prevention opportunities, a significant reduction in blindness in South Carolina can be attained. By eliciting the help of all health professions in South Carolina the incidence of visual impairment/blindness can be reduced.

Blindness↗

PubMed1999

The fleas (Siphonaptera) of South Carolina with an assessment of their vectorial importance.

We document 25 species of fleas from South Carolina including new state records for two species, the ctenophthalmids Epitedia cavernicola and Rhadinopsylla orama. Host and other collection data, by county, are provided, including many new records amassed from 1992-1998 and some older records gleaned from the Clemson University Arthropod Collection. One flea species, the rhopalopsyllid Polygenis gwyni, is especially common and widespread in South Carolina, particularly on the cotton rat (Sigmodon hispidus) in coastal plain habitats. The largest number of flea species (8) from a single host species was recorded from the cotton mouse, Peromyscus gossypinus. Several flea species of potential medical or veterinary importance were recorded, some of which are potential vectors of pathogens, such as the agents of murine typhus, murine typhus-like disease, sylvatic epidemic typhus, cat scratch disease, and rodent bartonellosis. A host-flea list for South Carolina is included.

Animals↗

PubMed2000

Drug-susceptible tuberculosis outbreak in a state correctional facility housing HIV-infected inmates--South Carolina, 1999-2000.

During 1999-2000, South Carolina's Department of Corrections (SCDC), Department of Health and Environmental Control (DHEC), and CDC investigated an outbreak of drug-susceptible tuberculosis (TB) that occurred in a state correctional facility housing human immunodeficiency virus (HIV)-infected inmates. All culture-confirmed case-patients have been linked by IS6110-based DNA fingerprinting of Mycobacterium tuberculosis isolates. This report describes the outbreak investigation and illustrates the need for increased vigilance for TB in settings in which HIV-infected persons congregate.

AIDS-Related Opportunistic Infections↗

PubMed1982

Frequency of bluetongue and bovine parvovirus infection in cattle in South Carolina dairy herds.

A survey of South Carolina diary cattle in 12 commercial herds was conducted, using serologic testing to determine the frequency and impact on reproduction of bluetongue (BT) and bovine parvovirus (BFV) infections. Results of the study of serum antibodies titers and dairy cattle health records indicated that the majority of the cattle surveyed was adequately protected against the major reproductive tract diseases through vaccination programs. The frequency of reproductive dysfunction was common in vaccinated herds, however. Six of the 12 herds in the survey had cattle which were BT serotest reactors, although total numbers of these reactor cattle were relatively small. Further, reproductive performance of reactor cows indicated that BT was of little consequence and was not associated with reproductive problems. All herds contained BPV serotest reactors and the latter comprised 59.7% of the total number of cows surveyed. The BPV seroreactor cows were commonly associated with the group of reproductive problem cows which experienced higher rates of embryonic mortality and more services per conception than did nonreactor cattle. The results of the survey emphasize the need for continued investigation and efforts to control BT, and especially BPV infection, in dairy cattle.

Abortion, Septic↗

PubMed1994

Rurality and tuberculosis incidence trends in North and South Carolina, 1980 to 1992.

U.S. tuberculosis incidence rates increased steadily from 1985 through the end of 1992. Many factors have been implicated as contributors to the reversal in the historic decline of tuberculosis: the HIV epidemic, poverty and homelessness, immigration from less developed countries, and a deteriorating public health infrastructure. The purposes of this study were to demonstrate the extent of geographic variation in tuberculosis incidence rate trends in North and South Carolina and to quantify the association between aggregate-level characteristics of state economic areas and incidence rate trends. Data were obtained from the U.S. 1980 and 1990 decennial census and from the North and South Carolina health departments. In North Carolina, tuberculosis trends declined rapidly in the early 1980s, but declined much less rapidly from 1986 to 1992. In South Carolina, tuberculosis trends were nearly static during the early 1980s, but declined rapidly from 1986 to 1992. Rural and high-poverty state economic areas in South Carolina experienced especially favorable changes in tuberculosis incidence trends. South Carolina has a unique tuberculosis control program that makes widespread use of enablers, incentives, and directly observed therapy. This study demonstrates the distinct tuberculosis incidence trends that existed in two contiguous states and suggests that approaches to tuberculosis control that improve access to care may be effective in improving tuberculosis incidence trends, particularly in poor and rural areas. Strengthening tuberculosis programs may be an important strategy for controlling the current resurgence of tuberculosis in the United States.

Cohort Studies↗

PubMed2005

A century of cardiology as reported in The Journal of the South Carolina Medical Association.

Through the years, numerous articles and symposium issues in The Journal have provided South Carolina physicians with up-to-date information on strategies and technologies for diagnosis and management of heart diseases. The Journal has also featured articles on the epidemiology and prevention of heart disease, and on two occasions published the proceedings of national workshops on heart disease. During this interval heart disease crested as the most frequent cause of death in South Carolina and indeed in the United States. However, in the last three years, due to reduced cigarette consumption and other preventive and therapeutic advances, heart disease mortality has declined faster than cancer related deaths. As a result, since 2002, malignancies now kill more Americans than does heart disease. This victory, of sorts, creates an optimistic beginning of the second century of The Journal of the South Carolina Medical Association.

Cardiology↗

PubMed1995

Use of occupational therapists in mental health settings in South Carolina.

OBJECTIVES: Severe workforce shortages in occupational therapy require an examination of viable practice areas for occupational therapists. The mental health practice area has experienced greater shortages than have other areas of occupational therapy; in South Carolina, only 2% of occupational therapists work in mental health. This study was undertaken to examine the use of occupational therapists in mental health settings in South Carolina. METHOD: A survey was sent to administrators at 52 South Carolina mental health facilities to collect information on the use of occupational therapists, the associated economic issues, and the perception of the roles of occupational therapists. RESULTS: Among the 34 respondents, 39% hired occupational therapists on a part-time or contractual basis, and 17% had full-time occupational therapist positions; 33% hired certified occupational therapy assistants on a part-time or contractual basis, and 11% had full-time certified occupational therapy assistant positions. Occupational therapy positions decreased over a 5-year period, and respondents cited the cost of salaries and problematic recruitment as two of the major contributing factors. The need for occupational therapy services was ranked as the number one factor both for increased and decreased use of occupational therapists. Personnel factors were highly ranked for facilities with decreased use whereas patient-related factors were highly ranked for facilities with increased use. CONCLUSION: The findings highlight factors that may contribute to recent trends of fewer occupational therapists in South Carolina choosing mental health as a primary practice area.

Community Mental Health Centers↗