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Data collected through ongoing, state-based, cross-sectional health surveys could be used to better understand the contribution of respiratory symptoms to impaired health among the US adult population.We used the 2015 Behavioral Risk Factor Surveillance System telephone health survey in four states (Kentucky, Florida, South Carolina, Texas) to describe the relationship between symptoms, associated factors such as tobacco smoking, and health impairments. Self-reported productive cough, shortness of breath (SOB), and dyspnea on exertion (DOE) were categorized as minimal, moderate, or severe. Data were analyzed using multiple logistic regression models with age as a covariate to assess relationships of symptoms with other factors.Among adults ≥ 18 years, respiratory impairment [current asthma, chronic obstructive pulmonary disease (COPD), or a current moderate or severe symptom] occurred in 39.1% of the population. More than half of adults reporting moderate or severe symptoms had not been diagnosed with asthma or COPD, particularly with DOE and productive cough. Subjects were at greater risk of moderate and severe SOB or productive cough with increasing age, prolonged smoking duration (≥ 20 years), being an ever-smoker, or if reporting COPD, current asthma, or any other comorbidity except cancer. Morbid obesity [body mass index (BMI) 35 kg/mIn the largest US survey in decades, we provide a current perspective of respiratory symptoms among adults of all ages. While known risk factors were apparent, low-risk persons also frequently reported symptoms and impairments.

To evaluate "high-risk" opioid dispensing to adolescents, including daily morphine milligram equivalents (MME) above recommended amounts, the percentage of extended-release opioid prescriptions dispensed to opioid-naïve adolescents, and concurrent use of opioids and benzodiazepines, and to evaluate changes in those rates over time.Retrospective cohort study of one state's prescription drug monitoring program data (2010-2017), evaluating adolescents 12-18 years old dispensed opioid analgesic prescriptions. Outcomes of interest were the quarterly frequencies of the high-risk measures. We utilized generalized linear regression to determine whether the rate of the outcomes changed over time.The quarterly percentage of adolescents ages 12-18 years old dispensed an opioid who received ≥90 daily MME declined from 4.1% in the first quarter (Q1) of 2010 to 3.4% in the final quarter (Q4) of 2017 (p 0.0001). The frequency of adolescents dispensed ≥50 daily MME changed little over time. In 2010, the percentage of adolescents receiving an extended-release opioid who were opioid naïve was 60.7%, declining to 50.6% by Q4 of 2017 (p 0.10 overall change 2010-2017). The percentage of adolescent opioid days overlapping with benzodiazepine days was 1.6% in Q1 of 2010, declining to 1.1% by Q4 of 2017 (p 0.001).Among persons 12-18 years old dispensed an opioid analgesic, receipt of ≥90 daily MME declined during the years 2010-2017, as did the percentage of adolescent opioid days that overlapped with benzodiazepines. More than half of the individuals who received extended-release opioid analgesics were identified as opioid naïve and, counter to guidelines, received products intended for opioid-tolerant individuals.

BACKGROUND: Whether emergency medical services (EMS) transport improves disability outcomes compared with other transport among acute ischemic stroke (AIS) patients is unknown. OBJECTIVE: To study severity-adjusted associations of hospital arrival mode (EMS vs. other transport) with in-hospital and discharge disability outcomes. DESIGN: Prospective observational study. PARTICIPANTS: AIS patients discharged April 2016 to October 2017 from a safety-net hospital in South Carolina. MAIN MEASURES: National Institutes of Health Stroke Scale (NIHSS) change at discharge (admission NIHSS score minus discharge NIHSS, continuous variable), 24-h NIHSS change (attaining high improvement, admission NIHSS minus 24-h NIHSS being 75th percentile or higher), door to neuroimaging (DTI) time, and IV alteplase receipt. NIHSS change was assessed within stroke severity groups, mild, moderate, and severe (admission NIHSS 0–5, 6–14, and ≥ 15, respectively). KEY RESULTS: Of 1168 patients, 838 were study-eligible (52% male, 52.4% Black, 72.2% EMS arrivals, 56.6% mild strokes). Severe and moderate stroke patients were more likely than mild stroke patients to use EMS (adjusted odds ratios, AOR [95% CI] 11.7 [5.0, 27.4] and 4.0 [2.6, 6.3], respectively). EMS arrival was associated with shorter DTI time (adjusted difference − 88.4 min) and higher likelihood of alteplase administration (AOR 5.3 [2.5, 11.4]), both key mediating variables in disability outcomes. High 24-h NIHSS improvement was more likely for EMS arrivals vs. other arrivals among moderate strokes (AOR 3.4 [1.1, 10.9]) and severe strokes (AOR > 999). EMS arrivals had substantially higher NIHSS improvement at discharge within the severe stroke group (adjusted NIHSS change at discharge, 5.9 points higher, p = 0.01). Alteplase recipients showed higher discharge NIHSS improvement than non-recipients (by 2.8 and 1.9 points among severe and moderate strokes, respectively; p = 0.01, 0.02). CONCLUSIONS: The findings offer evidence for including stroke education as a standard of care in the primary care management of patients with stroke-risk comorbidities/lifestyle in order to minimize post-stroke disability.

BACKGROUND AND OBJECTIVES: Despite published declines in opioid prescribing and dispensing to children in the past decade, in few studies have researchers evaluated all children in 1 state or examined changes in mean daily opioid dispensed. In this study, we evaluated changes in the rate of dispensed opioid analgesics and the mean daily opioid dispensed to persons 0 to 18 years old in 1 state over an 8-year period. METHODS: We identified opioid analgesics dispensed to children 0 to 18 years old between 2010 and 2017 using South Carolina prescription drug monitoring program data. We used generalized linear regression analyses to examine changes over time in the following: (1) rate of dispensed opioid prescriptions and (2) mean daily morphine milligram equivalents (MMEs) per prescription. RESULTS: From the first quarter of 2010 to the end of the fourth quarter of 2017, the quarterly rate of opioids dispensed decreased from 18.68 prescriptions per 1000 state residents to 12.03 per 1000 residents (P < .0001). The largest declines were among the oldest individuals, such as the 41.2% decline among 18-year-olds. From 2010 through 2017, the mean daily MME dispensed declined by 7.6%, from 40.7 MMEs per day in 2010 to 37.6 MMEs per day in 2017 (P < .0001), but the decrease was limited to children 0 to 9 years old. CONCLUSIONS: The rate of opioid analgesic prescriptions dispensed to children 0 to 18 years old in South Carolina declined by 35.6% over the years 2010–2017; however, the MME dispensed per day declined minimally, suggesting that more can be done to improve opioid prescribing and dispensing.

Objective Deaths due to opioids have continued to increase in South Carolina, with 816 opioid-involved overdose deaths reported in 2018, a 9% increase from the prior year. The objective of the current study is to examine longitudinal trends (quarter [Q] 1 2010 through Q4 2018) of opioid prescribing volume and high-risk opioid prescribing behaviors in South Carolina using comprehensive dispensing data available in the South Carolina Prescription Drug Monitoring Program (SC PDMP). Design Retrospective analyses of SC PDMP data were performed using general linear models to assess quarterly time trends and change in rate of each outcome Q1 2010 through Q4 2018. Participants Opioid analgesic prescription fills from SC state residents between Q1 2010 and Q4 2018. Main outcome measures High-risk prescribing behaviors included (1) opioid prescribing rate; (2) percentage of patients receiving opioids dispensed 90 or more average morphine milligram equivalents daily; (3) percentage of opioid prescribed days with overlapping opioid and benzodiazepine prescriptions; (4) rate per 100 000 residents of multiple provider episodes; and (5) percentage of patients prescribed extended release opioids who were opioid naive. Results A total of 33 027 461 opioid prescriptions were filled by SC state residents within the time period of Q1 2010 through Q4 2018. A 41% decrease in the quarterly prescribing rate of opioids occurred from Q1 2010 to Q4 2018. The decrease in overall opioid prescribing was mirrored by significant decreases in all 4 high-risk prescribing behaviors. Conclusion PDMPs may represent the most complete data regarding the dispensing of opioid prescriptions and as such be valuable tools to inform and monitor the supply of licit opioids. Our results indicate that public health policy, legislative action, and multiple clinical interventions aimed at reducing high rates of opioid prescribing across the health care ecosystem appear to be succeeding in the state of South Carolina.

OBJECTIVE To evaluate the effect of a 2016 South Carolina payor mandate to query the state prescription drug monitoring program (PDMP) before prescribing controlled substances on the rate of opioid prescribers in South Carolina. METHODS South Carolina PDMP datasets from 2010-2017 were evaluated using interrupted time series regression to compare changes in the rate of opioid prescribers before and after the 2016 mandate. The rate of opioid prescribers was defined as the number of prescribers who prescribed class II to IV opioids on any one prescription in each quarter divided by the total number of South Carolina prescribers who prescribed any one class II to IV medication. The rate of high-dose opioid prescribers was defined as the number of prescribers who prescribed ≥90-morphine milligram equivalent per day on any one prescription in each quarter divided by all of the prescribers who prescribed an opioid analgesic prescription. RESULTS The rates of South Carolina opioid prescribers decreased from 75% in 2010 to 60% in 2017, with no significant change in slope (P = 0.24) after the 2016 payor mandates. The rates of South Carolina high-dose opioid prescribers decreased from 40% in 2010 to 32% in 2017, with a significant decrease in slope (P < 0.001) after the payor mandate. CONCLUSIONS The slope of the South Carolina high-dose opioid prescriber rate significantly decreased after the 2016 South Carolina payor mandate, while the slope of the South Carolina opioid prescriber rate did not. The long-term outcomes related to the change in opioid prescriber rates are unknown and warrant further study.

Background Patients with acute ischemic stroke (AIS) who use emergency medical services (EMS) receive quicker reperfusion treatment which, in turn, mitigates post-stroke disability. However, nationally only 59% use EMS. We examined why AIS patients use or do not use EMS. Methods During 2016–2018, a convenience sample of AIS patients admitted to a primary stroke center in South Carolina were surveyed during hospitalization if they were medically fit, available for survey when contacted, and consented to participate. The survey was programed into EpiInfo with skip patterns to minimize survey burden and self-administered on a touchscreen computer. Survey questions covered symptom characteristics, knowledge of stroke and EMS importance, subjective reactions, role of bystanders and financial factors. Descriptive and multiple regression analyses were performed. Results Of 108 inpatients surveyed (out of 1179 AIS admissions), 49% were male, 44% African American, mean age 63.5 years, 59% mild strokes, 75 (69%) arrived by EMS, 33% were unaware of any stroke symptom prior to stroke, and 75% were unaware of the importance of EMS use for good outcome. Significant factors that influenced EMS use decisions (identified by regression analysis adjusting for stroke severity) were: prior familiarity with stroke (self or family/friend with stroke) adjusted odds ratio, 5.0 (95% confidence interval, 1.6, 15.1), perceiving symptoms as relevant for self and indicating possible stroke, 26.3 (7.6, 91.1), and bystander discouragement to call 911, 0.1 (0.01,0.7). Further, all 27 patients who knew the importance of EMS had used EMS. All patients whose physician office advised actions other than calling EMS at symptom onset, did not use EMS. Conclusion Systematic stroke education of patients with stroke-relevant comorbidities and life-style risk factors, and public health educational programs may increase EMS use and mitigate post-stroke disability.

Objective To assess and enumerate the trends in diabetes prevalence, morbidity and mortality rates in South Carolina (SC) within the past 2 decades. Materials and Methods We analyzed state-level data from vital records, Behavioral Risk Factor Surveillance System, Children׳s Health Assessment Survey and Administrative Claim Files. Results Over the past 20 years, there has been an average 2.5% annual increase in diabetes prevalence among adults in SC ( P 0.01). Although a typical reduction in mortality rate of 2.2% has been observed during the same period, the increased number of people living with diabetes (from 5.0% in 1995 to 12.0% in 2014) has brought more need for diabetes care, particularly for severe in-hospital cases and cases with crisis at the emergency department, totaling $404 million in annual costs. Conclusions SC has experienced an epidemic of diabetes. Coupled with declining trends in mortality and increased hospitalization and emergency department visits, the state is experiencing historical morbidity and complications due to diabetes. The shift in complexity of the disease onset and management has resulted in more individuals living with cardiovascular disease and other comorbidities. The cost of care for all South Carolinians with diabetes is estimated to exceed 2.8 billion dollars in 2014 and projected to be more than 4 billion dollars by 2020. If the diabetes prevalence trend of increasing rates continues over the next 20 years, the number of individuals living with diabetes and its complications would rise to 1.3 million in SC.

Rationale/Objective: The Behavioral Risk Factor Surveillance System (BRFSS) health survey has been used to describe the epidemiology of chronic obstructive pulmonary disease (COPD) in the US. Through addressing respiratory symptoms and tobacco use, it could also be used to characterize COPD risk. Methods: Four US states added questions to the 2015 BRFSS regarding productive cough, shortness of breath, dyspnea on exertion, and tobacco duration. We determined COPD risk categories: provider-diagnosed COPD as self-report, high-risk for COPD as &ge, 10 years tobacco smoking and at least one significant respiratory symptom, and low risk was neither diagnosed COPD nor high risk. Disease burden was defined by respiratory symptoms and health impairments. Data were analyzed using multiple logistic regression models with age as a covariate. Results: Among 35,722 adults &ge, 18 years, the overall prevalence of COPD and high-risk for COPD were 6.6% and 5.1%. Differences among COPD risk groups were evident based on gender, race, age, geography, tobacco use, health impairments, and respiratory symptoms. Risk for disease was seen early where 3.75% of 25&ndash, 34 years-old met high-risk criteria. Longer tobacco duration was associated with an increased prevalence of COPD, particularly &gt, 20 years. Seventy-nine percent of persons &ge, 45 years-old with frequent shortness of breath (SOB) reported having or being at risk of COPD, reflecting disease burden. Conclusion: These data, representing nearly 18% of US adults, indicates those at high risk for COPD share many, but not all of the characteristics of persons diagnosed with the disease and demonstrates the value of the BRFSS as a tool to define lung health at a population level.

This study aims to assess the relationship of body mass index (BMI) status with respiratory conditions, asthma, and chronic obstructive pulmonary disease (COPD) in a state population.Self-reported data from 11,868 adults aged ≥18 years in the 2012 South Carolina Behavioral Risk Factor Surveillance System telephone survey were analyzed using multivariable logistic regression that accounted for the complex sampling design and adjusted for sex, age, race/ethnicity, education, smoking status, physical inactivity, and cancer history.The distribution of BMI (kg/m(2)) was 1.5% for underweight (18.5), 32.3% for normal weight (18.5-24.9), 34.6% for overweight (25.0-29.9), 26.5% for obese (30.0-39.9), and 5.1% for morbidly obese (≥40.0). Among respondents, 10.0% had frequent productive cough, 4.3% had frequent shortness of breath (SOB), 7.3% strongly agreed that SOB affected physical activity, 8.4% had current asthma, and 7.4% had COPD. Adults at extremes of body weight were more likely to report having asthma or COPD, and to report respiratory conditions. Age-adjusted U-shaped relationships of BMI categories with current asthma and strongly agreeing that SOB affected physical activity, but not U-shaped relationship with COPD, persisted after controlling for the covariates (p 0.001). Morbidly obese but not underweight or obese respondents were significantly more likely to have frequent productive cough and frequent SOB than normal weight adults after adjustment.Our data confirm that both underweight and obesity are associated with current asthma and obesity with COPD. Increased emphasis on exercise and nutrition may improve respiratory conditions.

The purpose of this project was to determine the effectiveness of the Helping Administer to the Needs of the Student with Diabetes in Schools (H.A.N.D.S.sm) continuing education program in improving the level of experience and competence in performing services associated with diabetes care. This program is a live course for school nurses providing clinical information about diabetes management and their professional role in the care of students with diabetes. Pre- and post-surveys were administered via e-mail to assess their level of experience and competence in diabetes care. A total of 105 nurses completed both surveys and were included in the analysis. The changes between pre- and post-survey questions were assessed. The H.A.N.D.S. participants’ levels of experience and competence for each of the four categories of diabetes care improved significantly, and a greater number of nurses reported being able to perform the services independently and having the ability to teach others.

Aims and objectives: To help define lung health in US adults, we used the 2015 Behavioral Risk Factor Surveillance System telephone survey to assess respiratory symptoms and health characteristics. Methods: A 4 state (Florida, Kentucky, South Carolina, Texas) survey with >70 questions regarding frequency of productive cough, shortness of breath (SOB), SOB affecting physical activities as well as sociodemographics, chronic diseases, and health behaviors was done. Data were analyzed using several multiple logistic regression models with age as a covariate to assess relationships of respiratory symptoms with other factors. Results: Among 37,898 adults >35 yrs (51.3% never smokers, 60.5% female) 9.9%(8.2-10.7) had a productive cough most or every day, 4.7%(4.2-5.3) had SOB most or all the time, 17.9%(16.8-19.0) strongly agreed that SOB affected physical activities. After adjusting for age, sex, race, and education, respondents were at greater risk of frequent SOB with the following-current or former smoker, physician diagnosis of COPD, current asthma, coronary disease, depression, stroke, renal disease, and mental health impairment. Except for stroke and renal disease, these same measures were associated with a frequent productive cough. Being diagnosed with diabetes, having cancer, and higher education were associated with a lower risk of all 3 respiratory symptoms. The only gender difference was more cough in males. Conclusion: Our population-based data provides insight into relationships among frequent respiratory symptoms, chronic diseases, and sociodemographics.

Diabetes is a serious disease, which is often accompanied by complications, such as blindness, kidney failure, heart attacks, strokes and amputations. High blood pressure and abnormal cholesterol levels are frequent comorbidities. Diabetes has an immense impact on public health and medical care. In South Carolina (SC), medical costs rise with increased duration of the disease, and lifespan is shortened by 5 to 10 years in most patients. To describe the burden of diabetes in SC, we examined the public health surveillance systems available to estimate the prevalence, mortality and hospitalization rates and some disability statistics and hospital charges. Diabetes is the 7 leading cause of death in SC, directly or indirectly claiming more than 3,000 lives annually, and the 5 leading cause of death in blacks, claiming about 1,200 black lives each year. Minorities, predominantly blacks, experienced a substantially higher death rate and more years of potential life lost than whites. The racial disparity in mortality has widened over the past 10 years. People with diabetes are at increased risk for blindness, lower extremity amputation, kidney failure, nerve disease, hypertension, ischemic heart disease and stroke. Approximately 450,000 South Carolinians are affected by diabetes, many of whom were still undiagnosed in 2010. One of every 5 patients in a SC hospital has diabetes, and 1 in every 10 visits to a SC emergency room is diabetes related. The total charges for diabetes and diabetes-related hospitalizations and emergency room visits were more than $4.2 billion in 2010.

To assess relationships between obstructive lung diseases, respiratory symptoms, and comorbidities by gender.Data from 12 594 adult respondents to the 2012 South Carolina Behavioral Risk Factor Surveillance System telephone survey were used. Five categories of chronic obstructive airway disease (OAD) were defined: former asthma only, current asthma only, chronic obstructive pulmonary disease (COPD) only, asthma-COPD overlap syndrome (ACOS), and none. Associations of these categories with respiratory symptoms (frequent productive cough, shortness of breath, and impaired physical activities due to breathing problems), overall health, and comorbidities were assessed using multivariable logistic regression for men and women.Overall, 16.2% of men and 18.7% of women reported a physician diagnosis of COPD and/or asthma. Former asthma only was higher among men than women (4.9% vs. 3.2%, t-test p = 0.008). Current asthma only was more prevalent among women than men (7.2% vs. 4.7%, p0.001), as was ACOS (4.0% vs. 2.2%, p0.001). Having COPD only did not differ between women (4.3%) and men (4.4%). Adults with ACOS were most likely to report the 3 respiratory symptoms. COPD only and ACOS were associated with higher likelihoods of poor health and most comorbidities for men and women. Current asthma only was also associated with these outcomes among women, but not among men.In this large population-based sample, women were more likely than men to report ACOS and current asthma, but not COPD alone. Gender differences were evident between the OAD groups in sociodemographic characteristics, respiratory symptoms, and comorbidities, as well as overall health.

Telestroke centers can increase access to proper and timely diagnosis and treatment of stroke, especially for rural populations, thereby reducing disability and death. Census tract information was used to map primary stroke centers geographically and to identify areas that would benefit from additional access to medical care via telestroke centers (health care facilities that provide information on stroke care from a distance). Results indicate that in 2013, approximately half of the South Carolina population did not have access to a primary stroke center within a 30-minute drive of their home, and 30% did not have access within 60 minutes. Increasing access to prompt evaluation, diagnosis, and treatment of stroke and improving long-term quality of life requires the addition of telestroke centers in areas without primary stroke centers and examination of the effects of these centers on stroke incidence and mortality in South Carolina.

Background: Cincinnati Pre-hospital Stroke Scale (CPSS) and Los Angeles Pre-hospital Stroke Scale (LAPSS) are widely used by emergency medical services (EMS) to screen potential ischemic stroke patients. We performed a population based state-wide study to evaluate the accuracy of CPSS and LAPSS in identifying stroke cases and investigate their impact on ischemic stroke treatment. Methods: A statewide EMS database was created by linking South Carolina’s statewide Emergency Department (ED) and hospital discharge records for the calendar years 2010-2012. The EMS data were obtained from the Division of EMS and Trauma at Department of Health Environmental Control and linked to hospitalization records at Office of Research and Statistics. Results from the EMS use of CPSS and LAPSS were compared with hospital discharge diagnoses for stroke. For both scales, we calculated Sensitivity, Specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV). Additionally we evaluated the impact of identification of stroke during EMS transportation by CPSS/LAPSS on treatment of ischemic stroke with intravenous tissue plasminogen activator (IV-tPA). Results: Of all the EMS transported cases between January 2010 and December 2012, use of CPSS or LAPSS was recorded for 101,442 cases. Among the cases where the use of CPSS/LAPSS stroke scale was recorded, 6,757 cases had a diagnosis of ischemic stroke on hospital discharge records. CPSS demonstrated sensitivity of 59%, and specificity of 96%. Sensitivity and specificity for LAPSS were 26% and 84%, respectively. PPV and NPV for CPSS were 45% and 98%, and for LAPSS were 27% and 83%, respectively. Rates of IV-tPA administration were approximately five times higher for those correctly identified by CPSS (18.3% for true positive vs. 3.5% for false negative, P Conclusion: Early identification of potential stroke cases using CPSS/LAPSS can have a significant impact on treatment of ischemic stroke with IV-tPA. We report a modest accuracy of CPSS and LAPSS in correctly identifying stroke cases in the field, with CPSS leading to a better rate of IV-tPA use compared with LAPSS.

Background and Objective: South Carolina is located in the “buckle” of the stoke belt. Use of the emergency medical services (EMS), intravenous tissue plasminogen activator (IV t-PA) in acute stroke and its correlates, including outcomes have not been trended over time. To study the annual trends in the above acute stroke care parameters we linked the EMS database with the statewide hospital discharge records stored at South Carolina Department of Health and Environmental Control (SC DHEC). Methods: The ongoing statewide EMS database linkage with the hospital discharge records stored at SC DHEC, allow us to track EMS and acute stroke thrombolysis in real-time. Patients with a discharge diagnosis of ischemic stroke were included in the analysis. Patients transported via EMS were compared with patients not transported by EMS. Variables considered included patient demographics, stroke center status of the hospital, telemedicine usage and treatment with IV t-PA for the calendar years of 2010-2012. Results: In the calendar years of 2010-2012, 10,377; 10,532 and 10,900 hospitalized patients in SC were assigned a primary discharge diagnosis of ischemic stroke respectively. Of these, the number of patients transported by EMS that received IV t-PA (7.1%, 9.5% and 10.2%, in the years 2010-12; χ2 trend =15.3, p < 0.0001) shows a significant increasing linear trend over the number of patients that were not transported by EMS that received IV t-PA (2.5%, 3.6% and 3.7%, in the years 2010-12). Over the three years, patients that are treated with IV t-PA were more likely to be discharged home (39%, 42% and 49% in the years 2010-12 ) and less likely to be discharged to a healthcare institution or expire (61%, 58% and 51% in the years 2010-12; χ2 trend=9.3, p =0.002). Conclusion: Transportation by EMS increased the likelihood of receiving IV t-PA. Over three years, IV t-PA usage led to better outcome including increasing discharge to home, decreasing discharge to healthcare institution and death. The real-time data linkage methodology may allow us in future to test the impact of statewide interventions geared to promote the usage of EMS and IV t-PA.

Introduction We investigated the prevalence of chronic obstructive pulmonary disease (COPD) in various population subgroups in South Carolina and examined associations between COPD and 4 core measures of health-related quality of life (HRQOL). Methods Data from 12,851 participants of the 2011 South Carolina Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. COPD prevalence rates were age-adjusted to the 2000 standard US population. Logistic regression models were used to estimate adjusted odds ratios (AOR’s) and 95% confidence intervals (CIs). Results The overall age-adjusted prevalence of self-reported diagnosis of COPD among community-dwelling adults in South Carolina in 2011 was 7.1% (standard error [SE] ±0.3). Prevalence of self-reported diagnosis of COPD was highest among women (8.9%; SE, ±0.5), those aged 65 years or older (12.9%; SE, ±0.5), current smokers (15.9%; SE, ±0.7), and those with low levels of education and income. Compared with community-dwelling adults without COPD, those with COPD were more likely to report fair or poor general health status (AOR, 3.97; 95% CI, 3.13–5.03), 14 or more physically unhealthy days (AOR, 2.10, 95% CI, 1.57–2.81), 14 or more mentally unhealthy days (AOR, 1.72; 95% CI, 1.21–2.43), and 14 or more days of activity limitation (AOR, 2.22; 95% CI, 1.53–3.22) within the previous 30 days. Conclusion COPD is a highly prevalent disease in South Carolina, especially among older people and smokers, and it is associated with poor HRQOL. Future work aimed at reducing risk factors may decrease the disease prevalence, and increasing early detection and improving access to appropriate medical treatments can improve HRQOL for those living with COPD.

Background: Emergency medical services (EMS) transportation of a potential stroke patient may provide a means of reducing evaluation and treatment times and improve fibrinolytic treatment rates; yet, state-level data have not been linked to diagnosis at discharge and clinical outcomes. Objectives: To link the South Carolina (SC) statewide EMS database with hospital discharge diagnosis and evaluate the impact of EMS transportation in improving identification and treatment of acute stroke. Methods: A retrospective analysis was conducted of the statewide EMS database linked with statewide hospital discharge records stored at SC Department of Health and Environmental Control, for the calendar year 2010. Patients with a discharge diagnosis of stroke were included in the analysis. Patients transported via EMS were compared with patients not transported by EMS. Variables considered included patient demographics, transportation time, location/ type of destination hospital and treatment with intravenous tissue plasminogen activator (tPA). Results: In the year 2010, 18,962 hospitalized patients in SC were assigned a primary discharge diagnosis of stroke. Of these, 36% (6,824) were transported via EMS. The average time from 911 call to hospital arrival was 44.6 minutes. Time from 911 calls to EMS on scene was on average of 1.2 minutes longer for patients residing in rural areas than those in urban areas. About 48% of all stroke cases were treated in primary stroke centers (PSCs) and 4.3% of all ischemic cases received thrombolytic therapy. EMS identification of stroke signs and symptoms was associated with shorter transfer times and a higher transfer rate to a PSC than cases whose symptoms were not identified as stroke by EMS (50% vs. 43% for all strokes, P Conclusions: EMS identification of stroke signs and symptoms was associated with increased rate of transportation to PSCs and fibrinolytic treatment for ischemic stroke.

Background: South Carolina (SC) is located in the “buckle” of the stroke belt with one of the highest stroke death rates in the country. In 2010, SC had 66 acute care hospitals caring for strokes, nine of which were certified primary stroke centers (PSC). The rate of intravenous tissue plasminogen activator (IV-tPA) use and its correlates have not been investigated in the state. Objectives: To study the rate of IV-tPA use and its correlates using the statewide hospital discharge records stored at SC Department of Health and Environmental Control (DHEC), for the calendar year 2010. Methods: A retrospective analysis was conducted of the statewide hospital discharge records stored at SC DHEC, for the calendar year 2010. Patients with a discharge diagnosis of ischemic stroke were included in the analysis. Variables considered included patient demographics, insurance status, location/type of destination hospital, and treatment with IV-tPA. Results: In the calendar year 2010, 10,377 hospitalized patients in SC were assigned a primary discharge diagnosis of ischemic stroke. Of these, 4.2% (442) were treated with IV-tPA. Those who were treated with IV-tPA were younger (mean age ± standard deviation=66.7 ± 14.4, p=0.002) compared with those who did not receive IV-tPA (68.8±13.6). Patients treated at a PSC (49% of all ischemic stroke patients) were more likely to receive IV-tPA (Odds Ratio or OR 4.0, 95% CI 3.2-5.0).Patients treated in hospitals located in urban counties were more likely to receive IV-tPA compared to those treated in rural counties (OR 1.3, 95% CI 1.1-5.3). On multivariate logistic regression analysis, patients treated at a PSC (Adjusted OR 2.2, 95% CI 1.9-2.5) and those treated in urban counties (Adjusted OR 1.4, 95% CI 1.1-1.8) independently increased the likelihood of receiving IV-tPA. Gender, race and insurance status did not significantly change the likelihood of receiving IV-tPA. Conclusions: Younger stroke patients, treatment in a PSC and hospitals located in an urban county increased the likelihood of receiving IV-tPA. Increasing community awareness of PSCs, their location and designation may increase the rate of IV-tPA use.

To investigate opportunities for early human immunodeficiency virus (HIV) testing of women.A retrospective cohort study design linked case reports from HIV surveillance to several statewide health-care databases. Medical encounters occurring before the first positive HIV test (missed opportunities) were categorized by diagnosis/procedure codes to distinguish visits that were likely to have prompted an HIV test. Women were categorized as late testers (AIDS diagnosis12 months from first HIV test date), non-late testers (no AIDS diagnosis during study period or diagnosis of AIDS12 months of HIV diagnosis), of reproductive age (13-44 years old), and not of reproductive age (44 years old). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were used to estimate risk and its statistical significance.Of 3303 HIV-infected women diagnosed during the study period, 2408 (73%) had missed opportunity visits. Late testers (39%) were more likely to be black than white (aOR 1.48, 95% CI 1.12-1.95), be older (44 years old; aOR 7.85, 95% CI 4.49-13.7), and have10 missed opportunity visits (aOR 2.17, 95% CI 1.62-2.91). Fifty-four percent of women44 years old were also late testers. Women44 years old had lower median initial CD4 counts (p0.001). The top two procedures were the same for all groups of women but mammography was ranked fourth for women44 years old and Papanicolau smear was ranked fourth for late testers.Feasibility and acceptability of routine HIV testing in nontraditional health-care settings, such as mammography and Papanicolau screenings, should be explored to identify late testers and older (not of reproductive age) HIV-infected women.

Introduction Timely access to facilities that provide acute stroke care is necessary to reduce disabilities and death from stroke. We examined geographic and sociodemographic disparities in drive times to Joint Commission–certified primary stroke centers (JCPSCs) and other hospitals with stroke care quality improvement initiatives in North Carolina, South Carolina, and Georgia. Methods We defined boundaries for 30- and 60-minute drive-time areas to JCPSCs and other hospitals by using geographic information systems (GIS) mapping technology and calculated the proportions of the population living in these drive-time areas by sociodemographic characteristics. Age-adjusted county-level stroke death rates were overlaid onto the drive-time areas. Results Approximately 55% of the population lived within a 30-minute drive time to a JCPSC; 77% lived within a 60-minute drive time. Disparities in percentage of the population within 30-minute drive times were found by race/ethnicity, education, income, and urban/rural status; the disparity was largest between urban areas (70% lived within 30-minute drive time) and rural areas (26%). The rural coastal plains had the largest concentration of counties with high stroke death rates and the fewest JCPSCs. Conclusion Many areas in this tri-state region lack timely access to JCPSCs. Alternative strategies are needed to expand provision of quality acute stroke care in this region. GIS modeling is valuable for examining and strategically planning the distribution of hospitals providing acute stroke care.

Diabetes is the leading cause of amputation of the lower limbs. Yet, half of these amputations might be prevented through simple but effective foot care practices. This article describes the progress made in the reduction of lower extremity amputations in people with diabetes by the Racial and Ethnic Approaches to Community Health (REACH) Charleston and Georgetown Diabetes Coalition. The coalition's community action plan and interventions were based on an expanded Chronic Care Model that spawned changes in policies, health and education systems, and other community systems for people with diabetes and their support systems.

Yong Liu,1 Roy A Pleasants,2 Janet B Croft,1 Anne G Wheaton,1 Khosrow Heidari,3 Ann M Malarcher,4 Jill A Ohar,5 Monica Kraft,6 David M Mannino,7 Charlie Strange8 1Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, 2Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, 3Chronic Disease Epidemiology Office, Department of Health and Environmental Control, South Carolina, SC, 4Office of Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA, 5Section on Pulmonary, Critical Care, Allergy and Immunologic Disease, Wake Forest University, Winston Salem, NC, 6Department of Medicine, University of Arizona, Phoenix, AZ, 7Division of Pulmonary, Critical Care, and Sleep Medicine, Pulmonary Epidemiology Research Laboratory, University of Kentucky, Lexington, KY, 8Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA Background: The purpose of this study was to assess the relationship of smoking duration with respiratory symptoms and history of chronic obstructive pulmonary disease (COPD) in the South Carolina Behavioral Risk Factor Surveillance System survey in 2012.Methods: Data from 4,135 adults aged ≥45 years with a smoking history were analyzed using multivariable logistic regression that accounted for sex, age, race/ethnicity, education, and current smoking status, as well as the complex sampling design.Results: The distribution of smoking duration ranged from 19.2% (1–9 years) to 36.2% (≥30 years). Among 1,454 respondents who had smoked for ≥30 years, 58.3% were current smokers, 25.0% had frequent productive cough, 11.2% had frequent shortness of breath, 16.7% strongly agreed that shortness of breath affected physical activity, and 25.6% had been diagnosed with COPD. Prevalence of COPD and each respiratory symptom was lower among former smokers who quit ≥10 years earlier compared with current smokers. Smoking duration had a linear relationship with COPD (P

for SBP at 133cM). We also found several linkage regions within 1.2 LOD Score 1.9 (LOD 1.80 for SBP and LOD 1.56 for DBP near 95cM on chromosome 9; LOD 1.77 at 20cM and LOD 1.76 at 70cm for SBP, LOD 1.22 at 24cM and LOD 1.56 at 190cM for DBP on chromosome 2; LOD 1.56 at 147cM for DBP on chromosome 5). CONCLUSION: In conclusion, although evidence of linkage for blood pressure is weak, our finding provided additional evidence of linkage between BP and several genomic regions reported in other studies. Some regions harbor candidate genes. Some regions were the same linkage regions as diabetes or obesity linkage regions in our study.