Tick borne diseases are a very real problem in Chatham County. Rocky Mountain Spotted Fever, a well-known illness caused by ticks, is the second most commonly reported communicable disease in Chatham, second only to Chlamydia. It is more than twice as common here as it is with our neighbors in Randolph and Harnett Counties.

Dr. Meshnick reported on some national trends revolving around ticks. While Lyme disease caused by ticks is a problem especially in the North East of the US, North Carolina is considered the “buckle” of what is called the “tick belt.” In this area stretching west through Oklahoma, the greatest health concern is a group of diseases called Spotted Fever Group Rickettsia. Many of these tick-related illnesses are correlated with a major increase in the deer population. It was estimated in 2011 that there were 1 million deer in North Carolina– compare that to the 1950’s when deer were imported to the state for hunting!

www.cdc.gov/ticks

One of the studies Dr. Meshnick is involved in may make dealing with ticks significantly easier. He is currently working with the NC Division of Water Quality to count the number of tick bites its employees face each day. There is a control group, and a treatment group that is using a chemical called Permethrin. Permethrin is an insect repellent that is used on clothing to fend off ticks. It is invisible, odorless, and available commercially. Initial results show a protection rate of 98%!

The Chatham County Public Health Department has been using similar Insect Shield products for about a year. The Environmental Health and Animal Control Divisions began using permethrin-covered  socks with their staff who are often out and about in Chatham County. Many of these employees conduct inspections in un-landscaped areas as well as animals. The staff reported finding fewer ticks on themselves after being out. Soon, the Division will be sending additional outer wear to Insect Shield for treatment with the hope that their results will match those of Dr. Meshnick’s study.

Follow up: Do you have any other helpful tick-tricks?

The Chatham County Public Health Department would like to thank Molly VanDuser and Dr. Steve Meshnick for their time. We would also like to thank our forum participants and staff for attending. The EPI Response team looks forward to producing more events in the future.

After surveying community partners and Health Department Staff, the first topic voted on to discuss was Post Traumatic Stress Disorder (PTSD). The Department has seen a number of clients from different programs over the years that have suffered from PTSD and worked with organizations which specialize in its treatment. To lead the discussion on the topic, the EPI Team recruited Molly VanDuser, President of Peace of Mind, Inc. Ms. VanDuser is a licensed professional counselor, has more than thirty years’ experience, and recently was instrumental in the counseling of associates from the Lowes store in Sanford following last year’s tornado.

Ms. VanDuser defined PTSD as a natural reaction to unnatural events. The main criterion includes a person having these two characteristics: “The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others” [and] “The person’s response involved intense fear, helplessness, or horror” (VanDuser 2012).

A picture of the tornado destruction at the Lowes in Sanford, NC

A very important point made by VanDuser was that the onset of PTSD can occur anywhere from immediately following a traumatic incident to several or even many years later. Symptoms can be triggered by similar events, or the person being forced to remember the experience through sight, sound, or smell.
Below is a list why some PTSD victims may be hesitant or resistant to receiving the help they need:
* People expect to be able to handle a traumatic event on their own
* People may blame themselves
* Traumatic experience may be too painful to discuss
* Some people avoid the event all together
* PTSD can make people feel isolated, making it harder to seek help
* People don’t always make the connection between the traumatic event and the symptoms that follow
* People often have more than one anxiety disorder or may suffer from depression or substance abuse

Follow up question: Can you think of any other reasons people may be resistant to care for PTSD? Share a comment below!

To learn more about PTSD or our speaker Molly VanDuser, visit www.peaceofmind.org.

The Chatham County Public Health Department would like to thank Molly VanDuser and Dr. Steve Meshnick for their time. We would also like to thank our forum participants and staff for attending. The EPI Response team looks forward to producing more events in the future.

Grocery Shopping Basics:
-Make a list before going to the store. Base this off of items you already have at home. Stick to your list, impulse buying is expensive.
-Shop the perimeters of the store. The basic outline of most grocery stores has the staples on the perimeter (produce, dairy, bread and meat/poultry/fish) and the more processed goods on the inside aisles of the store.
-Don’t go shopping on an empty stomach. When you’re hungry, you will be more tempted to buy foods you could resist normally (usually sweets or ‘empty’ calorie foods).
-Develop a budget. Allot a specific amount of money to be used each month for groceries and stick with it. A few ideas to help save money include comparing the unit price and giving store brands a try.
-Look for coupons and specials. This is a great way to save money if they’re products that you normally use and enjoy. Be careful though – buying a new product just because you have a coupon is a quick way to increase, rather than decrease your bill.
-Buy produce that is in season. Frozen and canned can also be great options, just be sure to watch for added sodium.

Tips for the individual aisles:
Beverages:
• Choose water.
• Limit fruit juice. If you do choose juice, make sure the label says 100% juice
• Skip sugar-sweetened sodas and even sports drinks (unless you’re a competitive athlete).

Canned fruits and vegetables:
• Select canned fruit packed in water. If not available, look for fruit packed in its own juice.
• Choose low-sodium or no-salt-added canned vegetables; if not available, drain and rinse well to reduce sodium.

Bread:
• Check the ingredients—look for ‘whole’ grains as the first ingredient.
• Choose breads with at least 2 grams of fiber per slice.

Dairy:
• Choose skim or 1% milk.
• Choose low-fat cheese or use less regular cheese.
• Choose low-fat or fat-free yogurt with live, active cultures and fewer than 12-15 grams of sugar per 6 ounces.
• Limit flavored milks.

Fresh and frozen produce:
• Supersize it! More is better when it comes to fresh and frozen produce. You’ll also get more bang for your buck!
• Choose a variety of colors and buy local if available; it’s often the freshest.

Frozen meals:
• Aim for frozen meals that are 500 calories or fewer.
• 5 grams of saturated fat or less.
• 600 milligrams of sodium or less.
• 3 grams of fiber or more.
• Be sure to check your serving sizes; most pizzas have three or four servings in one package.
• Limit the number of frozen meals you eat each week.

Meats/protein:
• Choose lower-fat cuts of meat such as “loin” or “round.”
• Look for ground meat with the highest percent lean, such as 93/7.
• Go for white meat instead of dark meat chicken or turkey.
• Try fresh salmon – it’s high in healthy fats.
• Choose plain, fresh fish instead of frozen or breaded and make the switch to baked, broiled or grilled fish instead of fried.
• Avoid processed meats like hot dogs, bacon and sausages – they are loaded with sodium.
• Remember, a correct portion size of meat is the size of a deck of cards or a computer mouse.

Also, don’t forget your reusable grocery bags… they can normally hold more food than normal plastic bags, and save you trips from your car. Some grocery stores even give small discounts for using your own bags instead of theirs!

For more information on healthy grocery shopping, visit www.MyEatSmartMoveMore.com. Look for the Aisle by Aisle video series.

Have you visited Chatham Counties Animal Shelter lately? No? Well why not? It’s a great place to find your furry forever friend. We have cats, kittens, dogs and even puppies that are desperately looking for a home. The thing is if you don’t come to the shelter they can’t find you… Just because an animal ends up at the shelter doesn’t mean he or she isn’t a great pet. They may have simply wandered away from home and been unable to find their way back. Maybe their owner moved on and no one was left to take care of them. Some of them end up here because their owners didn’t believe in spaying and neutering their other animals and they are unwanted. Help save a life and make a difference right here in your community by adopting from the local animal shelter.

If you haven’t been out here in a while you will be pleasantly surprised to see a caring staff and updated facilities. We have added a fenced-in, landscaped play area that allows you to visit with the animal you are interested in adopting away from the other animals and other distractions.

Don’t forget the Chatham County animal control will be holding a Rabies Vaccination clinic in Pittsboro in the parking lot at Lowes on Saturday the 19th of May! Rabies shots will be $5 and no appointment is necessary. Don’t miss this chance to protect your pet and comply with state law! Don’t procrastinate—just vaccinate!!

Additionally, April is Sexual Assault Awareness Month.  The Chatham County Board of Commissioners has proclaimed April as Sexual Assault Awareness Month.

Throughout the month of April, there will be displays about Child Abuse Prevention and Sexual Assault Awareness at the public libraries and local businesses.  In addition, there will be articles in the Chatham News related to April activities, events, and information.

Stand Together: A Community Event for Child Abuse Prevention & Sexual Assault Awareness Month was held April 24, 2012 at 5:30pm, on the lawn at Chatham Market Place.  This event highlighted Chatham County’s response to child abuse and sexual assault.

Did you attend? What are your thoughts on the event?

For more information contact: www.preventchildabusenc.org and/or www.fvrc.org

After soliciting project ideas from the CCPHD staff, it was decided to focus on the Child Health Program for its quality improvement (QI) project during the 9-month training course. This QI project will be implemented by June 2012. Once the project was chosen, employees were selected to form the QI 101 Team. Ready… Set… Go!

As part of the QI 101 Training Course, the QI 101 Team participated in a Kaizen Event onsite at the Siler City Clinic last February. The word Kaizen stems from two words meaning “to take something apart” (kai), and “to put back in a better way” (zen). This was an intense 4-day interactive training with a facilitator from NC State University (provided by NC CPHQ) who guided the team through a series of exercises. The team reviewed the steps involved in a Well Child Check visit, looked at the data gathered so far, examined the changes that had been made up until that point in time, and determined where staff could make an impact on the time it takes to complete a Well Child Check visit and maintain quality customer service.

The QI team used the PSDA Cycle to implement changes. Each time a QI team makes a change to one part of a process, it has to be part of a Plan, the team plans a specific time to Do (test) the change, then it must Study the data from the test, and Act according to the change. Usually, it takes a few PDSA Cycles to make a process change. One of the major changes the clinic made in the WCC visit was to locate all the necessary equipment in one room, allowing the visit to take place in one location rather than asking the child and parent to move to three different rooms.  This enables the nurse to complete the examination and visit in one location. This one decision lessens frustration for patients and staff alike!

The QI 101 Team will attend a second Workshop (funded by NC CPHQ) to learn a few more QI tools, but mostly the team will learn how to keep quality improvement going within the Chatham County Public Health Department. According to the 2012-2016 Strategic Plan for CCPHD, each division will participate in a significant QI project over the course of the next four years. Our goal is to “Lead the Charge to a Healthier Chatham!”

What other changes can you think of to help the process of Well Child Checks?

Rabies is a viral disease of mammals – that means you and me, cats, dogs, horses, cows – and many species of wild animals found in Chatham County. In 2011, North Carolina reported 420 cases of rabies occurring in 10 different species.  Rabies is complex and frightening – many myths exist about the disease.

Do you know rabies fact from fiction?

FICTION: If an animal is behaving in an unusual way, it probably has rabies.
FACT: Unusual behavior may be an indication of rabies in some animals, but animals infected with rabies could also appear normal during the course of the infection. The best policy is to avoid direct contact with all wild or unknown animals, at all times.

FICTION: The only way I can get rabies is by being bitten by a rabid animal.   
FACT:  A bite is the most common way that rabies is transmitted between mammals. However, because rabies is carried in the saliva, any contact with the animal’s saliva (including during disposal of the body) puts you at risk for rabies infection.

FICTION: Every human bitten by a rabid animal will die.                         FACT:  Responding rapidly to a rabies exposure is critical. When treatment occurs in time, human bite victims will recover. If rabies is allowed to progress to the late stage, recovery is unlikely. There are only three documented cases of late stage rabies survival in the US.

We love our companion animals, and enjoy glimpses of wild animals in the outdoors. But remember to protect yourself and your loved ones, including your pets! AVOID CONTACT WITH WILD AND UNKNOWN ANIMALS!

Want to know more? Check out this fact sheet from the North Carolina Department of Agriculture: http://ncagr.gov/vet/FactSheets/rabies.htm

• Inspect restaurants and post a grade card at food service establishments so the consumer can see the level at which the restaurant protects its patrons from food borne illnesses–the  higher the grade, the better the protection
• Inspect licensed child care centers for sanitation and safety issues
• Permit for profit food vendors at events around the county to protect visitors from food borne illnesses
• Permit wells to verify the proper distance is maintained from sources of contamination to protect you, your family and neighbors from water borne illnesses
• Permit septic systems in suitable soils to prevent wastewater from contaminating surface water and/or groundwater
• Permit and inspect public swimming pools to help prevent the spread of water borne illnesses
• Conduct lead poisoning prevention outreach for parents of children between the ages of 6 months and 6 years living in homes built before 1978 to prevent lead poisoning
• Partnered with US Geological Survey to provide additional background information about geological formations around drinking water wells in the proposed hydro-fracking study area
• Conducted well camera inspections of private wells experiencing water quality issues
• Partnered with the Cooperative Extension Office to provide:
  • The Annual Septic Contractors Workshop
  • Subsurface Wastewater System Operator Workshop
  • The Septic Systems and Wells for Homeowners Workshop
  • ServSafe®-food safety course for restaurant operators
  • Conduct in-services about safe food handling for employees of food service establishments in English and Spanish
  • Conduct inspections of wastewater systems to verify proper functioning and provide additional information to extend the life of the system
  • Placed computer touch screen tick educational kiosks in local buildings

I am sure I have forgotten some of what we have accomplished over the last year, but if we can do more or if you have questions about any of these items please visit our website at www.chathamnc.org/environmentalhealth.

~Environmental Health Director

It should come as no surprise that tobacco and alcohol are the two most reportedly-abused drugs. But can you think of what others may be? Scarily enough, the ingredients for some of these drugs may be in your own home. Some of the other most reported drugs can be made with household items such as cold medicine, glue, paint, and gasoline. Parents should always keep track of potentially hazardous prescriptions, chemicals, and over the counter medications.

The Federal Government’s Interagency Coordinating Committee on the Prevention of Underage Drinking (ICCPUD) is supporting a series of Town Hall Meetings. The meetings will take place in communities across America.  Chatham Drug Free, Chatham County’s coalition to prevent underage alcohol and substance abuse will join in this national effort and host a Chatham Town Hall Meeting on April 30, 2012, from 9-11am at Central Carolina Community College, Pittsboro Campus in the Multipurpose Room.

Here is a list of resources available to Chatham County Residents:

www.quitlinenc.org
www.chathamdrugfree.org
www.theantidrug.com
www.governorsinstitute.org

Have you heard? North Carolina is following the lead of other states with major shortfalls in funding and implemented the Money Follows the Person (MFP) Program. This is Medicaid’s largest demonstration program to date. It was included in the President’s 2005 budget request as a major component of the President’s New Freedom Initiative to integrate people with disabilities into communities. After being in a nursing home for at least 90 days, qualified persons are given the freedom to choose where they live. Consideration of the patient’s safety is an important piece of the decision making process, i.e., can the person live safely in the community? Initially a pilot program in some counties in North Carolina, Medicaid realized a 25% – 35% savings by allowing people with nursing home level of care to move out of the nursing home and back into their communities.

The early evidence also suggests that the quality of life for MFP participants improves after their return to the community. A study was done by Mathematica Policy Research*, using a sample of 1,090 participants with similar baseline and follow-up surveys. The quality-of-life data from this study shows that 8 out of 10 MFP participants were satisfied with the way they lived their lives after one year of community living, up from the 6 of 10 participants pre-transition. Of all the areas assessed, satisfaction with living arrangements exhibited the largest increase, from 52% reporting satisfaction with their living arrangements before the transition to 94% post-transition. After one year, the level of community integration also improved by 14 percentage points. Below is a brief description of the program. Go to the NC DHHS Website to learn more.

The MFP Program is a new component of Chatham County Public Health’s Community Alternatives Program for Disabled Adults (CAP DA) Program which is a Medicaid Program. CAP’s main goal is to help people who need long term care stay in their own homes. CAP provides both medical and non-medical services to delay or prevent the need for admission to a long-term facility. Funding for the CAP Program is not unlimited, only a specific number of people may participate in the programs. The CAP Social Workers are now taking applications for the MFP Program. We are very excited about the benefits of the MFP program for qualifying Chatham residents with nursing home levels of care. Please call the Pittsboro (919-542-8220) or Siler City (919-742-5641) sites of Chatham County Public Health Department for more information related about the program. You may also find information on the Division of Medical Assistance Website (http://www.ncdhhs.gov/dma/).

*Mathematica Policy Research, a nonpartisan research firm, provides a full range of research and data collection services, including program evaluation and policy research, survey design and data collection, research assessment and interpretation, and program performance/data management, to improve public well-being. Its clients include federal and state governments, foundations, and private-sector and international organizations. The employee-owned company, with offices in Princeton, N.J., Ann Arbor, Mich., Cambridge, Mass., Chicago, Ill., Oakland, Calif., and Washington, D.C., has conducted some of the most important studies of health care, education, family support, employment, nutrition, and early childhood policies and programs.