Health Report Card Released for NC Children

The health of North Carolina children is improving is several key areas, but in other aspects the Tar Heel state is lagging, according to a new study.

The 20th Annual Child Health Report Card was released Monday morning by the child advocacy group NC Child.

The report card found the number of uninsured children has decreased across the state, while the overall dental health improved. Also, the number of high school students graduating on time was up nearly eleven percent for the 2012-2013 academic year, when compared with 2008-2009. Another positive note was the finding the teen pregnancy rate was also down in North Carolina.

Overall health of children at birth was also improved and child fatalities, in general, were down.

There were negatives in the report. It found the percentage of children under age 18 living in poverty was up, and that 36 percent of children age 10-17 were overweight.

Teen cigarette use was down to 13.5 percent; meanwhile the number of teens using “Emerging Tobacco Products,” including e-cigarettes, was listed at 22.4 percent.

The number of high school students who said they had used marijuana in the last 30 days was 23 percent, that’s up from just under 20 percent in 2011. Meanwhile, reported alcohol, cocaine, and prescription pill use was down across the same age group.

NC Scores Low on Public Health Report Card

According to the NC Prevention report card, North Carolina residents are struggling to meet public health goals for tobacco use, nutrition, obesity and physical activity.

Rachel Zuker is the research and evaluation coordinator for the Chapel Hill-based nonprofit Prevention Partners. She says the state’s grades are not looking good.

“Right now, we’re not doing great,” says Zuker. “We have a C in tobacco, a D in physical activity and Fs in both nutrition and obesity, so there’s definitely work to be done.”

The report measures state progress on national public health goals set for 2020.

Tobacco use continues to be the leading cause of preventable death in the US, and here in North Carolina, residents are smoking at a higher rate than elsewhere.

Zuker says this year North Carolina earned a C for tobacco use, down from a B grade last year.

“In tobacco policies, other states have continued to make progress, whereas we’ve kind of stayed the same, so I think we’re seeing ourselves slide a little bit in tobacco, which is too bad, because previously we’d been at a B and we were seeing that as a great area,” says Zucker.

The report points to policy changes at the state and local levels that could lower tobacco use, including designating more smoke-free places and increasing funding for cessation support services.

When it comes to nutrition and obesity, the report suggests economic challenges are hitting families hard. Seventeen percent of North Carolina households face hunger. At the same time, two out of every three adults and slightly more than a quarter of  high school students are overweight or obese, and the problem is more significant for those with lower levels of education and income.

Zuker says obesity and poor diet go hand in hand, as it costs more to eat well.

“You can be malnourished and obese. There’s a difference between malnourishment and obesity.”

Compounding the problem, the majority of North Carolina’s adults are not getting the recommended weekly minimum amount of physical activity.

Zuker says when it comes to changing the state’s health grade, workplace programs can have a big impact.

“People spend so much of their daily lives at work, and so if we see workplaces passing policies to promote cheaper, healthy foods, time for physical activities or access to those facilities, helping employees to quit [smoking], we really see that as key.”

Prevention Partners is launching an initiative with some of North Carolina’s largest employers to try to change the workplace culture to support healthy lifestyles. Zuker says the plan, called Healthy Together North Carolina, could reach up to 20 percent of the state’s workforce.

You can read the full interactive report card here.

30 New Flu Deaths Reported Across State

We are entering the heart of flu season across the Tar Heel state, and this year’s virus is proving difficult to fight.

The most recent numbers from state health officials show a staggering increase in flu deaths. 30 new flu-related deaths were reported across North Carolina for the week ending January 3. That brings the total number of deaths related to influenza to 54, since early October. Last flu season saw 107 deaths in the state.

Earlier this week, officials with the Department of Health and Human Services Division of Public Heath gave an update on the severity of the flu this season. State Epidemiologist Dr. Megan Davies says they began to see widespread flu occurrences in mid-November, with a sharp increase in mid-December.

“Flu activity has been more intense this year, compared with recent seasons,” she says, “as measured by visits to emergency departments and doctor’s offices for flu-like illness.”

Davies says the main strain, to this point, has been H3N2, which is a strain of the virus that tends to cause more severe illness in the elderly.

“About two-thirds of the H3N2 that is circulating,” she says, “has not been well matched to the vaccine, unfortunately.”

Officials are still encouraging North Carolinians to get the flu shot because different strains of the virus may become prominent later in the season.

Other treatments are available, including anti-viral drugs. But not all patients will require these medications, according to Dr. Davies.

“The people who most need these medications are people who are at high risk for influenza complications,” she says. That group includes the elderly, young children, pregnant women, and people with medical conditions including asthma and heart disease.

Dr. Thomas Moore says the flu season typically has a standard length, regardless of when that season starts.

“In general, once they start, widespread flu activity lasts on the order of three months,” he says.

Moore adds that if children begin showing symptoms of the flu, keeping them home from school can help stop the spread of the virus.

“Children with fever should not be going to school,” he says. “And they should be kept home until they’ve been without fever for at least 24 hours, without taking Tylenol or ibuprofen.”

As we expect the flu to remain intense over the next several weeks, there are every-day steps to help lower your chance of contracting the virus: staying away from those who are sick, increased hand washing with soap and warm water, and staying home from school or work if you are showing symptoms.

Town of Chapel Hill Named among Healthiest Companies in Triangle

The Town of Chapel Hill has been named one of the 35 healthiest employers across the Triangle by the Triangle Business Journal.

Jason deBruyn, with TBJ, says he is very excited about a new program that has been launched by the Town of Chapel Hill.

“They do some pretty progressive stuff,” he says. “They have a free employee health clinic. That’s staffed with a nurse practitioner, a registered nurse, and a health coach that are all employed by UNC Health Care.”

deBruyn says that the clinic is open to all town employees – eliminating many of the excuses we use for not going to the doctor.

“By having this clinic on site, and by the Town of Chapel Hill saying that the employees can come during work and get checked out, people are a lot more likely to use it,” he says.

deBruyn says he expects the use of on-site clinics to increase in the area, especially in locations where multiple companies share an office park and can split the healthcare costs.

After a long tenure with their headquarters in Chapel Hill, Blue Cross Blue Shield of North Carolina has transitioned to a more central campus in Durham.

deBruyn says Blue Cross Blue Shield has been on the leading edge of providing a healthy workplace in recent years.

“They offer various incentives to encourage employees to lose as much weight as possible,” he says. “They’ll even group them into teams.”

deBruyn adds that BCBS was one of the first companies in the Triangle to begin offering this program. He says that breaking the participants up into teams can also build strong bonds among the employees.

Overall, the region has actually regressed below the national average in terms of the health workplaces, but deBruyn says a portion of that can be caused by the fact that companies have been working to stay ahead of the curve for so long.

He adds that having healthy employees can be very beneficial to the companies as well.

“There have been some really good studies,” he says, “that show that for every dollar invested in a wellness program – or in some kind of a health benefit outside of traditional health insurance – it returns as many as three, four, sometimes as much as five dollars in work productivity and in less lost time.”

Both the Town of Chapel Hill and Blue Cross Blue Shield of North Carolina have both been on the annual list in recent years. For 2014, BCBS checks in at number 7 in the region and the Town of Chapel Hill ranks 14th.

This Thursday, Join The “Great American Smoke-Out”

Are you a smoker who’s thinking about quitting? There’s no better day to start than Thursday.

That’s the day of the Great American Smoke-Out, a national event held every year by the American Cancer Society.

The Smoke-Out “encourages people who smoke or use tobacco to quit for 24 hours,” says Barbara Silver, the program manager for employee wellness at UNC Family Medicine and the Town of Chapel Hill. “And then if they’re successful, to quit for another 24 hours – and just do it one day at a time, as a prelude to being able to quit altogether.”

If you’re one of the 42 million Americans who smoke, and you’re looking to quit, UNC’s Nicotine Dependence Program is setting up booths around town on Thursday from 11 to 3 as part of the Great American Smoke-Out.

“We’ll have information tables at the (UNC) hospital outside of Starbucks (and) at UNC Family Medicine by the patient entrance,” Silver says. “And then CVS also has been partnering with us because they’re not selling tobacco anymore – (so) we’re going to have some pharmacy students helping us down there on Franklin Street.”

And if you can’t make it to the booths, there’s also a statewide quit line, 1-800-QUIT-NOW. You can call that number at any time – but if you call on Thursday, as part of the Great American Smoke-Out, you can receive even more support.

“If you call 1-800-QUIT-NOW, on Thursday, the Quit Line will give you eight weeks of free (nicotine) patches,” says Silver.

Silver says nicotine patches and other forms of medication can double your chances of quitting successfully.

It’s a hard road to quitting, and there may be stumbles along the way – but Silver says those stumbles are just “bumps on the road to progress.” And it is possible to quit – you just have to take it one day at a time.

Matt Englund of UNC Health Care has been smoke-free for a year.

“(I did it by) spreading out my cravings,” he says. “When you want a cigarette, you just take an extra 15 minutes and try to hold off – then try 30 minutes, then an hour, and eventually you train yourself to realize that you don’t – though you think you need it at that moment – you don’t need it at that moment…

“And work up to the moment when you can take a day. Take two days. Take a week. Do as much as you can – and keep trying until you’re successful.”

England and Silver joined Aaron Keck on WCHL this week.


The Great American Smoke-Out is held every year on the third Thursday in November. For more information, visit the American Cancer Society’s website, – and for more information on programs here in our area, visit the Nicotine Dependence Program’s page,

Of Minerals And Men

I recently read a report from the journal Nature noting that the concentration of mercury dissolved in the oceans has more than tripled since the beginning of the Industrial Revolution. A number of questions immediately came to mind, such as, “How did this happen?” and “How concerned should we be?” And thus a Common Science® column was born. However, in the process of writing about mercury, I got off on a bit of a tangent on the critical importance of metals in maintaining good health and in the functioning of biological processes. That tangent eventually grew into this week’s column, which will serve as a prelude to the column on mercury next week.

To understand why metals are biologically important, we first need to review some chemistry. You should remember from high school chemistry that molecules are formed when atoms share electrons as part of a chemical bond.(1) In order for a molecule to participate in a chemical reaction, at least one of its chemical bonds must first be broken. In order for a bond to break, two molecules have to smash into each other with enough energy to break the bond – known as the activation energy barrier.

If you want to encourage a chemical reaction to occur or to make it go faster, there are two strategies that can be employed to overcome the activation energy barrier. The simplest approach is to heat up the reactants. Hot reactants move around faster, and thus smash into one another with greater enthusiasm. The other approach is to use a catalyst. Catalysts help chemical reactions to occur by reducing the amount of energy required for them to occur. Catalysts can be particularly useful if you want to induce a chemical reaction to occur but, due to some constraints, cannot add heat.

In both industrial and biological processes, catalysts often include metal atoms. The reason for this stems from the electrical properties of metals which allow them to either accept or donate electrons. As an example, let’s consider what is perhaps the most famous industrial reaction of all (at least to geeks like me): the reaction of nitrogen (N2) with hydrogen (H2) to make ammonia (NH3), the key component of industrial fertilizers, via the Haber-Bosch Process.(2) Nitrogen molecules consist of two nitrogen atoms bound together with a triple bond, making it one of the most stable and therefore unreactive molecules in the entire universe. Without the use of a catalyst, nitrogen will not react with hydrogen even at extremely high temperatures. Haber and Bosch found that if nitrogen molecules were first allowed to absorb on (stick to) osmium metal, they could be converted to ammonia at a high, but not unreasonable, temperature. The reason this works is that when nitrogen absorbs on osmium, some of the electrons in the nitrogen-nitrogen triple bond are pulled towards the metal, which weakens the bonds between the two nitrogen atoms. Now that this bond has been weakened by the catalyst, the activation energy barrier required to induce nitrogen to react with hydrogen is much lower. The development of the Haber-Bosch process, which today provides the fertilizer to generate approximately half of the food calories produced on Earth, is often rated as the greatest scientific achievement of the 20th century.

Now that we have finished our primer on how metals can catalyze chemical reactions, let’s turn to how that applies to people. The functioning of the human body involves a staggering number of chemical reactions, including the digestion of food, the repair of wounds and injuries, and the formation of new blood cells. Since the temperature of the human body hovers around 98.6 ºF, the only practical way to encourage chemical reactions in the body to go faster is to use a catalyst (3). In order to make sure that all of these needed chemical reactions occur, your body produces over 55,000 different catalysts. Catalysts in biologic systems are called enzymes. Many of the enzymes that your body produces include one or more metal atoms, such as iron, magnesium, manganese, zinc, and selenium. The metal atoms in these enzymes function in an analogous way to the osmium in the Haber-Bosch process. The need for your body to produce metal-containing enzymes is a primary reason that you need to eat a diet that contains a wide range of minerals in sufficient quantities and in the proper ratios. If your diet becomes deficient in minerals, a number of rather bad things can happen to you, including nerve damage, kidney stones, anemia, muscle weakness, birth defects, and, in the extreme, death.

If you have made it this far, you now have an understanding of how a catalyst functions, why metals make good catalysts, and that many processes in the human body rely on metal-containing enzymes. That information alone would constitute a reasonably complete Common Science® column. But I have yet to share with you the basis of my fascination with this topic. So pour yourself another cup of coffee and let’s delve into evolutionary development and biology.

The evolution of our species has occurred over the last 500,000 years. During this time, our bodies have evolved to respond to an impressive array of challenges, including wild swings of climate, devastating plagues, changes in food sources, and competition with other hominid species. While these past challenges were certainly significant, even events like the onset and retreat of ice ages occurred slowly over the course of thousands of years, which gave our ancestors time to react both strategically and biologically. Successful human evolution over the millennia proceeded in equilibrium with the available metal-containing minerals in our diets, which allowed us to create just the right balance of enzymes and go on to become the dominant species on Earth.

Over the last two hundred years, with the advent of fossil fuel use, the growth of industrial agriculture, and the explosion of the human population, we have introduced environmental changes at a rate which is unprecedented in the history or our species. This includes some dramatic shifts in the mineral content of our diets. I have written several times about that fact that the mineral content in the U.S. food supply has fallen by around 30% since the 1940s. While it can be difficult to tease out all of the direct mechanisms, we know that these changes in the American diet over the past several decades have led to dramatic increases in tooth decay, heart disease and diabetes, processes which are all intertwined with the proper or improper functioning of metal-containing enzymes.

The dramatic rise in mercury concentration in the oceans represents a different sort of challenge to the human-metal interplay in our environment and diets. This time, rather than a developing deficiency, we are introducing an excess amount of a metal into our diets, a metal which, far from being essential for good human health, is poisonous to us. This is a development which deserves further exploration. But that will have to wait until next week.

Have a comment or question? Use the interface below or send me an email to Think that this column includes important points that others should consider? Send out a link on Facebook or Twitter. Want more Common Science? Follow me on Twitter on @Commonscience.

(1) I am aware that in many school districts (including, sadly, the Chapel Hill Carrboro City Schools) it is possible to receive a high school diploma without taking chemistry. This knowledge makes me sad, so I choose to repress it and continue to assume that all of you had chemistry in high school.

(2) If you want to know more about the Haber-Bosch process and its role in driving the human population explosion, please follow this link to Fun with Fritz and Carl.

(3) As you know, when the body is threatened by viruses and bacteria, it will respond by raising its temperature. This strategy is designed to make a number of disease-fighting chemical reactions go faster to defeat the intruder. However, if the body over-corrects and raises its temperature to 104 °F, it can start to cause collateral damage to other body systems by damaging beneficial enzymes. This is why fever of this magnitude requires intervention with medicine and/or physical cooling of the body. In a display of evolutionary solidarity, beneficial enzymes in plants also shut down at this temperature. Sadly, there is no aspirin for basil plants.

How To Help Family Members With Mental Illness

Do you have a close family member struggling with mental illness?

The National Alliance on Mental Illness (NAMI) is offering a 12-week series of free classes beginning this Thursday, for family members of people living with major depression, bipolar disorder, schizophrenia, schizoaffective disorder, panic disorder, OCD, or borderline personality disorder.

It’s called the “Family-to-Family Education Program,” co-taught by Dana Greenwood and Tana Hartman-Thorn.

Visit this link for information about the class.

Classes take place at the Seymour Center in Chapel Hill, from 6:00-8:30 p.m. on Thursdays beginning September 4.

Dana Greenwood and Tana Hartman-Thorn joined Aaron Keck on “Aaron in the Afternoon” earlier this week to discuss the class – and the importance of the issue.

For more information – or to register for the class – contact Dana Greenwood at 919-622-3795 or by email at

Parents Aging? Remember The “40-70 Rule”

As your parents grow older, it becomes more and more important to have those tough conversations about aging – but most American families put off those discussions, often until it’s too late.

That’s why senior caregiving experts are promoting the “40-70 Rule” – a new program that’s designed to help seniors and their children and caregivers through the process.

“40-70″ gets its name from a very simple rule: experts say the time to start talking with your parents about aging-related issues is when you’re getting close to 40 and your parents are getting close to 70. That will give you enough time to discuss tough issues calmly and thoughtfully, well in advance of any health crisis or other emergency.

Those issues may include living arrangements, finances, when and when not to drive, health care and end-of-life decisions – and even dating, when your parent is divorced or widowed.

Stephen Lair, of the Home Instead Senior Care branch in Chapel Hill, spoke with Aaron Keck last week on “Aaron in the Afternoon.”

Visit for more information about how to get started with the 40-70 program.

Click here for seven tips on how to communicate with your aging parents. (Key tips: start early, before a problem arises; put yourself in your parents’ shoes; try to find solutions that maximize your parents’ independence; and don’t be afraid to ask for help when you need it.)

And for a longer discussion of the “40-70″ plan, visit this link.

Another Chapel Hillian To Help Fight Ebola?

Another medical professional with ties to Chapel Hill may be heading to Africa to help in the fight against the Ebola virus.

Chapel Hill native Anna Freeman is a nurse with Doctors Without Borders, which says its mission is to serve areas where there is the greatest need.

Freeman was a nurse at UNC Hospitals before applying to work with DWB. She worked in post-surgical care of children with heart defects.

“One thing that I find very rewarding about nursing work—working as a bedside nurse—is working with somebody who finds themselves in a situation often out of their control that can be very difficult to deal with either physically or emotionally, or often both,” Freeman says.

Freeman says she felt drawn to areas known as conflict, post-conflict, and intermittent-conflict zones, or areas struggling with epidemic diseases. She says there was an urge to help those who couldn’t always help themselves.

“Very often, people who find themselves in these circumstances are civilians, are women and children who live in very poor areas,” Freeman says. “I find that very unjust that people don’t have access to health care as a result or have very poor health care. There’s a lot of suffering that goes along with that.”

She says working to help alleviate suffering is very rewarding and that she’s fascinated experiencing new things in places that, when you first arrive, you might not know what awaits you.

Freeman may be heading to Africa in the next few weeks to help in the fight against Ebola. This is the largest outbreak of the disease on record. As of Tuesday, the Centers for Disease Control reported the suspected and confirmed case count was nearing 1,900; the suspected number of deaths had just surpassed 1,000.

WCHL spoke with UNC physician William Fischer upon his return to the states from Africa where he treated people who had contracted Ebola. He said he left feeling like there was more he could do, and that he would certainly be willing to return.

Freeman’s comments were made on a recent edition of Who’s Talking with D.G. Martin, heard weekends on WCHL. Click here to listen (August 2, 2014 edition).

As The Epidemic Worsens, A UNC Doctor Details The Battle Against Ebola

In the three and a half weeks Dr. William Fischer spent in Gueckedou, Guinea, he encountered between thirty and fifty patients suffering from Ebola. Only seven survived.

“It’s hard. It’s really hard work. It’s really intense work,” says Fischer. “But I’m totally sold on this idea that we can improve mortality with even just basic mechanisms right now.”

Fischer is a pulmonary and critical care physician at UNC Hospitals. He traveled to Guinea in May with the World Health Organization to help battle the latest outbreak of Ebola.

The current outbreak is the largest and deadliest on record. More than 1,200 have been infected and at least 670 have died in the past four months.

Unlike past outbreaks, which were located in remote regions in Central Africa, this began in West Africa, starting in Guinea before spreading to Liberia, Sierra Leone and Nigeria.

“It’s so easy for infection and infected patients to cross international borders, but it’s much more difficult for resources to follow that path,” says Fischer. “Increasingly we’re becoming a much more interconnected world. People are much more mobile. This is a very nice reminder of that interconnectedness, as this population is incredibly mobile and that mobility is sustaining this epidemic.”

The Ebola virus produces a hemorrhagic fever that is spread by contact with bodily fluids. The mortality rate among those infected can reach as high as 90 percent. There’s currently no cure, no vaccine, and no specific treatment, but Fischer says aggressive rehydration can help victims fight off the virus.

“I initially was skeptical about what care we could provide, but in fact, what I saw was that we can have a dramatic effect on reducing Ebola-related mortality with aggressive critical care.”

Yet Fischer said in his three weeks treating patients only a handful recovered, and when they did, the doctors were often happier than the survivors.

“One of the most difficult things about Ebola is that it doesn’t just kill people- it wipes out their families,” says Fischer. “This gentleman we were able to get through, but he lost his mother-in-law, his mother, and his wife and their unborn child. So you can imagine the despair that permeated every inch of that room when he heard that his wife had passed shortly after delivering their child.”

One of the biggest challenges facing doctors battling this current outbreak is convincing communities and individuals to seek medical treatment at the first sign of infection.

Western medical resources flood into the region only when an outbreak occurs, forming an association between doctors and death that’s hard for residents in the affected areas to ignore.

“They don’t understand that their best chance for survival is to come to a treatment facility early and that their best chance at preventing transmission to their loved ones is to go to the treatment facility,” says Fischer. “There’s an incredible amount of distrust between the people and the healthcare providers because they see their loved ones go to these facilities and then 90 percent of them return in a body bag. Facing those statistics, I’d be skeptical of those treatment facilities.”

Fischer says medical personnel need to reach out to community leaders to help stem the spread of the virus and build trust.

“This is a challenge. This is a major, major challenge. But it’s also an opportunity. If we can empower local community leaders to spread the word about the benefits of presenting early to a treatment facility- the benefits being it increases your chance of survival and decreases the chance of transmission- then we can have patients present earlier. If we can reduce that mortality we’re going to improve the trust between the community and the healthcare providers.”

This latest outbreak began in March and continues unabated. Fischer notes that with a twenty-one day incubation period and an increasingly mobile populace, this disease is poised to spread.

“I don’t see this ending any time soon, unfortunately. I do think that we are going to have to dedicate and we should dedicate a tremendous amount of resources, both from a material perspective as well as from a human infrastructure perspective in order to stop this outbreak before it gets even worse.”

Just last week a seemingly healthy man boarded an airplane in Liberia, only to arrive in Lagos, Nigeria with symptoms of Ebola. He later died. Officials are still trying to track other passengers on that plane.

The disease takes a toll on healthcare workers too, as they are often in contact with the bodily fluids that spread Ebola. Top doctors in Liberia and Sierra Leone have succumbed to the disease, and two Americans, a doctor and an aid worker, are currently in quarantine suffering symptoms. This has prompted two North Carolina-based charities to call for an evacuation of all non-essential staff from Liberia.

Nonetheless, Fischer says he is eager to return to the region.

“I’d like to go back. I think, for me, leaving was just as difficult as going. It was the thought that I was leaving in the midst of the epidemic as opposed to the end of the epidemic. I feel a strong draw to go back. My hope would be that I could, through aggressive critical support, reduce the mortality and then improve community trust.”

You can read Dr Fischer’s dispatches from Guinea here.