04/07/2004
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New Hanover County Health Department
Revenue and Expenditure Summaries for February 2004
Cumulative: 66.67% Month 8 of 12
Revenues
Current Year Prior Year
Type of Budgeted Revenue Balance % Budgated Revenue Balance %
Revenue Amount Earned Remalnln Amount Earned Remalnln
Federal & Slale $ 1.980,625 $ 1,166,666 $ 791.937 $1.552,464 $ 604,562 $ 947,922 36,94%
CFees $ 570.161 $ 423,956 $ 146.205 $ 567,944 $ 342,665 $ 245,279 56.28%
Medicaid $ 1,044,080 $ 402,492 $ 641,588 $1,026,386 $ 554.874 $ 473,512 53.96%
Medicaid Max $ 273,333 $ $ $
EHFees $ 300.212 $ 134.770 $ 312,900 $ 182,866
Heafth Fees $ 113,850 $ 120,483 $ 117,850 $ 114,589
Other $ 2.394,203 $ 1,788,215 $1,751.264 $1,190.579
Expenditures
Budgeted
Amount
Current Year
Expended
Amount
Prior Year
Balance
Remalnin
%
Budgeted
Amount
Expended
Amount
Balance
Remalnln
%
Summary
Budgeted Actual %
FY 03-04 FY 03-04
Expenditures:
Salaries & Fringe $10,051,016 $6,015,559 59.85%
Operating Expenses $1,723,130 $899,137 52.18%
Capital Outlay $374,922 $97,125 25.91%
Total Expenditures $12,149,068 $7,011,821 57.71%
Revenue: $6,676,464 $4,058,604 60.79%
Net County $$ $5,472,604 $2,953,217 53.96%
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Revenue and Expenditure Summary
For the Month of February 2004
8
NHCHD BOARD OF HEALTH APPROVED GRANT APPLICATION STATUS FY 03-04
e
Date (BOH) Grant Requested Pending Received Denied
Safe Kids Coalition- Safe Kids Buckle Up
3/3/2004 Program- Child Safety Seat Grant $3,500 $3,500 .
2/412004 No activity to report for February 2004.
Cape Fear Memorial Foundation. Funds needed to
enhance health education in 4 areas other than
11712004 Diabetes (an enhancement to Diabetes Today Grant). $20,000 $18,500 $1,500
12/312003 No activity to report for October 2003.
Cape Fear Memorial Foundation. funds needed to
cover dental services for needy children as identified by
11/512003 School Heafth Nurses. $3,000 $3,000
Ne Medical Foundation - Through the Good
Shephard Ministries for nursing services to the
population frequenting the shelter. $25,000 $25,000
Duke University- To provide 10 hours of nursing
services for TS Outreach. $10,388 $10,700 -$312
NC Tobacco and Control Branch, DHHS-
Continuation of Tobacco Prevention Program. $100,000 $64,093 $35,907
10/1/2003 No activity to report for October 2003.
New Hanover County Safe Schools- Uniting for
Youth "U4Youth"(funding will be received over a
9/3/2003 3 year grant period) $49,000 $49,000
Safe Kids Coalition- Fire Prevention (please note
this grant was pulled- coalition not able to meet
deadline for request) $2,500 $2,500
8/6/2003 NC DHHS- OPH Preparedness and Response $82,350 $31,950 $50,400
Smart Start- Partnership for Children (Grant
7/312003 Increase for Part Time Nurse Position) $5,523 $5,523
Cape Fear Memorial Foundation - Diabetes
Today (two-year request; $42,740 annually)
(Received $25,00 year 1 and $20,000 year 2) $85,480 $45,000 $40,480
Duke University Nicholas School of the
Environment-Geographic Information Systems
Grant (Env Health) $10,000 $10,000
Safe Kids Coalition- Safe Kids Mobile Car Seat
Check up Van $50,000 $50,000
Safe Kids Coalition- Risk Watch Champion
6/412003 Team' $10.000 $12,500
Smart Start. Partnership for Children: Child
5/7/2003 Care Nursing Program (Preliminary Approval) $171,977 $172,500
Smart Start- Partnership for Children: Health
Check (Preliminary Approval) $41,035 $41,747
UNC-CH: Child Care Health Consultant $62,849 $64,495
Cape Fear Memorial Foundation (through
Partnership for Children): Navigator Program $178,707 $180,000
4/312003 No activity to report for April 2003,
3/5/2003 No activity to report for March 2003.
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As of 3/22/2004
* NOTE: Notification received since last report.
Date (BOH) Grant Requested Pendina Received Denied
2/512003 No activity to report for February 2003.
1/812003 NC DHHS- OPH Preparedness and Response $115,950 $33,600 $82,350
12/412002 No activity to report for December 2002.
NC Health and Wellness Trust Fund-Teen
Tobacco Use Prevention & Cessation Program
11/612002 ($100,000 per year for 3 years) $100,000 $100,000
Safe Kids Buckle Up Program-North Carolina
101212002 Safe Kids $5,000 $5,000
Developing Geographic Information Systems
(GIS) Capacity in Local Health Department in
Eastern North Carolina-Duke University
Nicholas School of the Environment and Earth
Sciences (NSEES) $18,000 $18,000
I No actIvity to report .or September 2002.
I No activity to report .or August 2002.
I No activity to report .or .uly 2002.
Totals $1,150,259 $49,000 $739,585 $368,348
NHCHD BOARD OF HEALTH APPROVED GRANT APPLICATION STATUS FY 03-04
4.26%
Pending Grants 1 5%
Funded Total Request 12 55%
Partially Funded 5 23%
Denied Total Request 4 18%
Numbers of Grants Applied For 22 100%
10
As of 3/22/2004
* NOTE. Notification received since last report.
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64.30%
32.02%
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NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda: Consent Meeting Date: 04/19/04
A enda:[2J
Department: Health Presenter: Cindy Hewett, Business
Mana er
Contact: Cind Hewett, Business Mana er, ext 6680
Subject: Additional Title X Funding for New Hanover County Health Department
Family Planninl! Program ($18,965)
Brief Summary: The Department of Health and Human Services, Division of Public
Health, Women's and Children's Health Section, Women's Health Service Fund has
announced they have additional funds available for local health departments to use to
support any Family Planning approved (Title X) expense. These funds must be expended
prior to the end of the current fiscal year. The amount approved at the State for New
Hanover County Health Denartment is $18,965.
Recommended Motion and Requested Actions: To approve additional funding and
associated budget amendment in the amount of$18,965 for use in the New Hanover
Count Health De artment Famil Plannin ro ram.
Funding Source: The Department of Health and Human Services, Division of Public
Health, Women's and Children's Health Section.
Will above action result in:
[]New Position Number ofPosition(s)
OPosition(s) Modification or change
[2JNo Change in Position(s)
I Explanation:
11
:;.. ..
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David E Rice
03/15/2004 07:59 AM
To: jmccumbee@nhc90v.com
ee: chewell@nhcgov.com@NHC. (bee: archive)
Subject: IlhdJ Year-end Family Planning Funds (Title X) - Urgent Information for
Health Directors
fyi
_ Forwarded by David E RicelNHC on 03/1512004 07:59 AM-
Q)
Joe Holliday
<Joe.Holliday@ncmail.
net>
Sent by:
ihd-admin@dehnet.net
To: local Health Directors <Ihd@dehnet.nel>
ee: Dennis Harrington <Dennis.Harrington@ncmall.net>. Joy Reed
<Joy.Reed@ncmail.net>. Kevin Ryan <Kevin.Ryan@ncmail.net>.
(bee: archive)
Subject: [lhd] Year-end Family Planning Funds (Title X) - Urgent Information for
Health Directors
03/121200404:38 PM
March 12, 2004
To: Local Health Directors
Attn: Family Planning Coordinators
From: Sydney Atkinson, Family Planning and Reproductive Health Unit Supervisor
eRe: Year-end Family Planning Funds (Title X)
We are pleased to announce that we have additional one-time Title X funds to allocate to county
and district health departments this fiscal year. We have a total of $1,128,427 to distribute
among all the counties. These funds may be used for any Family Planning (Title X) approved
expense, including higher than anticipated costs of contraceptives and cervical cancer screening
supplies, sterilizations and/or equipment that will be used to serve the family planning
population, or the pro-rata share of equipment to be used by multiple programs. Every effort
needs to be made to expend these funds prior to the end of the fiscal year, reporting the
expenditure in June or July. If you encounter any difficulty in doing so, please let us know.
We are still anticipating using our Women's Health Service Fund (WHSF) money for State
Fiscal Year 2005 as the matching state funds to support our Medicaid waiver for Family
Planning. Therefore, these new funds are to help your Family Planning Program end this year in
a good financial position.
e
The 10tal available to each Health Department or District is 150% of the amount of the WHSF
received this fiscal year (see attachment). For those counties who have not been receiving WHSF
monies, we have used their three year baseline averages and compared them to similar counties
to generate an amount for the year-end distribution. We realize that the fact you are receiving this
notice late in the fiscal year is a hardship and we regret that. However, please try to expend as
much of the money as possible before the end of the year.
We have discussed this plan with several members of the WCHS Liaison Committee and
12
",
incorporated their suggestions. New Budgetary Estimates are being prepared. A spreadsheet is
attached that shows the total amount each county will receive. Should you have questions about
these funds, please contact Sydney Atkinson at 919-715-3393 or sydnev.atkinson(a)ncmai1.net or
Tricia Parish tricia.oarish@ncmai1.netor919-715-3408.
Attachment
c: Joe Holliday
Kevin Ryan
Joy Reed
Dennis Harrington
Regional Nurse Consultants
Administrative Consultants
Tricia Parish
II
Activity5151 BudEstFY04wksht(3-12-2004
NOTICE. E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties by an authorized county official.
13
"
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... FP Yr-End funds
...
...
;.;.;: FunCllRCCIFRC
... 1511 601. fE
..' "REGULAR"
..
...
...
..
COUNTYIOISTRICT ... 'MOUNT
01 ALAMANCE .. 510,625.00
...
..
214 ALBEMARLE REG ... 661.064.00
02 ALEXANDER ..
... $11.351.00
04 ANSON ... $10,625.00
204 APPALACHIAN ..
.. 630.125.00
07 BEAUFORT ... 66.450.00
09 BLADEN ... 620,032.00
..
10 BRUNSWICK .. 110,625.00
11 BUNCOMBE ... 63,125.00
12 BURKE ... 66,715.00
..
13 CABARRUS ... 110.625.00
."
'4 CALDWELL ... 69,602.00
...
16 CARTERET ... $1 0,625.00
...
17 CASWEll ... $7,625.00
...
18 CATAWBA ... 510.625.00
19 CHATHAM ... 67,625.00
...
20 CHEROKEE ..' 67.625.00
..'
22 CLAY ... 56.31..00
..'
23 CLEVELAND .. $7.625.00
24 COLUMBUS ..
.. $10.625.00
...
25 CRAVEN .. '1,802.00
26 CUMBERLAND ..
.. $9,' 25.00
28 DARE ... 67,625.00
..
2S DAVIDSON ..' $43.925.00
..
30 DAVIE .. $6,875.00
31 DUPLIN ... 57,625.00
...
32 DURHAM ... $10,625.00
33 EDGECOMBE ..' 67,625.00
...
.. FORSYTH .. 67,625.00
..'
35 FRANKLIN ... $3,125.00
..
36 GASTON ... $7,625.00
...
38 GRAHAM .. 513,409.00
221 GRAN-VANCE ... 610,672.00
..
40 GREENE ... $6,287.00
...
., GUILFORD ..' $45,175.00
..
42 HALIFAX ..' $12,611.00
43 HARNETT .. S3,125.OO
44 HAYWOOD ..' 515.973.00
..
45 HENDERSON ..
.. $10,625.00
209 HERT.GATES ..' $21,125.00
..
47 HOKE .. 522,511.00
..
48 HYDE ... $3,524.00
...
49 IREDELl ... 610,475.00
...
FP Yr~End Funa
......CCIFRC
ll!1 601~ fE
"'REGUlAR-
..
COUNTYIOISTRICT .. .MOUNT
50 JACKSON .. $14,890.00
.. 67,625.00
51 JOHNSTON ...
52 JONES ... 62,609.00
..'
... 63,125.00
53 LEE ...
... 69,275.00
54 LENOIR ...
55 LINCOLN ... 63,876.00
56 MACON .. $10,625.00
57 MADISON ... 610,625.00
..
218 MAR.TYR-WASH .. 627,125.00
..
60 MECKLENBURG ... $46,559.00
....
62 MONTGOMERY ... 621,205.00
....
63 MOORE ... 610,625.00
....
54 NASH ... 63,125.00
....
65 NEW HANOVER ... 518,965.00
....
66 NORTHAMPTON .. $4,868.00
....
67 ONSLOW .... $10,625.00
68 ORANGE .... $9,125.00
..
69 PAMLlCD .... 68,487.00
-.. $10,625.00
71 PENDER ....
.... $12,404.00
73 PERSON ....
74 PITT .... 618,125.00
....
76 RANDOLPH .... $14,578.00
....
n RICHMOND .... $4,625.00
...
78 ROBESON 136,272.00
79 ROCKING HAM ... $13,555.00
80 ROWAN .... $29,654.00
...
216 R-P-M .... 53e,5oo.00
...
82 SAMPSON .... $10,625.00
...
83 SCOTLAND .... 627,287.00
...
84 STANLY .... 110,003.00
...
85 STOKES ... 62,375.00
...
86 SURRY ..' $7,625.00
..
87 SWAIN ... $e,358.00
..
205 TOE RIVER ... $31,625.00
..'
88 TRANSYLVANIA ... $13,621.00
90 UNION ... 67.625.00
...
... 613,025.00
113 WARREN ..
96 WAYNE ... $7,625.00
..'
97 WILKES .. $9,125.00
..
98 WilSON ... $10,625.00
..
99 Y ADKIN ... '15,440.00
14
.., FP Yr-End Fun~
...
...
;.;.; '_CClFRC
... ll!1 601. fE
,.. "REGULAR"
..,
...
...
ICOUNTYIDISTRICT I ...
.. AMOUNT
15
FP Yr-End Funds
._CClFRC
1511 601. fE
"REGULAR-
ICOUNTY/DISTfUCT I:.... -
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NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda:
Consent Meeting Date: 04/19/04
A enda: ~
Presenter: Cind Hewett, Business M r
De artment: Health
Contact:Cind Hewett, ext 6680
Subject: Additional Breast and Cervical Cancer Control Program (BCCCP) Funding
($8,000)
Brief Summary: The New Hanover County Health Department will receive an additional
$8,000 from the North Carolina Department of Health and Human Services, Division of
Public Health, BCCCP Section to be used this fiscal year to meet service needs in the
existing BCCCP program.
Recommended Motion and Requested Actions: To approve and accept the additional
BCCCP funding in the amount of$8,000 and associated budget amendment.
Funding Source: North Carolina Department of Health and Human Services, Division of
Public Health, Breast and Cervical Cancer Control Program.
Will above action result in:
DNew Position Number ofPosition(s)
Dposition(s) Modification or change
~No Chan e in Position(s
Explanation: New Hanover County Health Department submitted a request to the State
BCCCP Section asking for available funds to be reallocated to the NHCHD BCCCP
based on actual ro ram needs for the current fiscal ear.
I Attachments: Supporting documentation.
16
e .... Kim Roane
...... 0311512004 10:261Wl
To: Cindy HeweWNHC@NHC, Nancy RusslNHC@NHC, BettyJo
McCorkleINHC@NHC, Janet McCumbeeINHC@NHC
cc: (bee: archive)
Subjed: Request for BCCCP Funds
HOORAYI I just called Jim Higgins to follow up on the letter requesting additional BCCCP funds, and he
said he's processing paperwork to grant us an additional $8,000 in funds this year\ll He said the letter is
being held up while the State budget office handles the details, so he doesn't yet feel comfortable sending
an official response yet, but that is the additional amount he's awarded to usl
..__ Forwarded by Kim Roane/NHC on 03/15/2004 10:23 AM-
M6a Kim Roane
.,.. 03/0212004 03:04'PM
To: jim.higgins@ncmail.net
cc:
Subjed: Request for BCCCP Funds
Hello from New Hanover Countyl
Please read the following letter requesting additional BCCCP funds for the remainder of this current fiscal
year Due to the need to make decisions about pending appointments, we hope you will be able to render
a decision soon, and appreciate your consideration. Thank you, in advance, for any help you can offer to
send our wayl
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iii
BCCCP 04 funding request.d
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17
NEW HANOVER COUNTY
HEALTH DEPARTMENT
2029 SOUTH 17TH STREET
WILMINGTON, NC 28401-4946
TELEPHONE (910) 343-6500 FAX (910) 341-4146
March 2, 2004
Mr. Jim Higgins
N C Dept. Health & Human Services
Division of Public Health, BCCCP
1915 Mail Service Center
Raleigh, NC 27699-1915
Dear Jim:
e
New Hanover County Health Department has committed expenditures amounting to
100% of available BCCCP funding for services provided to eligible patients as of this
week, which is only 67% of the fiscal year. We recognize a significant need for
provision of BCCCP services in New Hanover County, but will not have sufficient
funding to ensure those services are rendered to eligible patients. If it will be possible
for you to reallocate BCCCP funds from county to county based on actual need, we
respectfully request an additional $8,000 to meet service needs through the remainder
of this fiscal year.
Appointments have already been scheduled for BCCCP-eligible patients over the next
few months, at a projected cost of $3,000. We continue to receive requests for
appointments, increasing our anticipated volume of patients to be seen this current
fiscal year. Conservatively, this is anticipated to add approximately $5,000 to the
overall cost of services to be provided through the remainder of this fiscal year. This
brings our total request to an additional $8,000 in BCCCP funds.
We're doing our best to provide needed services to eligible patients through New
Hanover County BCCCP and look forward to continuing this very necessary program.
Your consideration of this request for additional funds is much appreciated I
Best regards,
Kim Roane
Accountant
e
18
"Healthy People, Healthy Environment, Healthy Community"
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North Carolina Department of Health and Human Services
Division of Puhlic Health. Chronic Disease and Injury Section
Cancer Prevention and Control Branch, Breast and Cervical Cancer Control Program/WiseWolD8n
1915 Mail Service Center. Raleigh, North Carolina 27699-1915
Tel 919-715-0111 . Fax 919-715-3153
Michael F Easley, Governor
Carmen Hooker Odom,
Secretary
March 19,2004
Mr. David E. Rice
Health Director
New Hanover County Health Department
2029 South 17th Street
Wilmington, NC 28401
RE: Additional Funding for the Breast and Cervical Cancer Control Program (BCCCP)
e Dear Mr. Rice:
We are pleased to offer your BCCCP program additional funding due to its performance. This
$8,000 additional funding is a I-time event, and must be spent, like all state funds, by the end of
May 2004. These funds can be used to purchase supplies, attend the annual conference in May,
for outreach activities, almost anything related to the BCCCP program but equipment.
As soon as the budget estimate has been approved and processed, we will get it to you. Please
thank your staff for working so hard on the BCCCP program. It is programs like yours that are
leaders in Breast and Cervical Cancer screening in North Carolina.
If you have questions, 1 can be reached at (919) 715-0119.
srrlY, ~
f,)):ti~'MSlIA ~
Director, NC BCCCP
Operations Manager
Chronic Disease & Injury Section
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Location: 1330 SL Mary's Street. Raleigh. N.C. 27605 ~
Eri\plOye.--
An Equal Opportunity / Affirmative A.-.. 21
,
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NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda: Consent Meeting Date:
A enda:
Department: Health; Health Promotion Presenter: Geoff Zuckerman, Injury
Prevention Health Educator
Contact:Geoff Zuckerman, 343-6636; Elisabeth Constandy 343-6658 (Sr. Health
Educator
Sub'ect: Governors Hi hwa Safet Pro ram rant re uest for coalition vehicle
Brief Summary: Requesting grant money from Governors Highway Safety Program
(GHSP) to purchase coalition vehicle to enable us to take our injury prevention message
to more of New Hanover County and surronding areas. The amount we are applying for
is $16,000.
Recommended Motion and Requested Actions: Approve grant application for $16,000
and bud~et amendment if fundin~ is received.
e I Funding Source: Governer's Highway Safety Program
Will above action result in:
DNew Position Number of Position(s)
Dposition(s) Modification or change
~No Change in Position(s)
Explanation: The funds will be used to purchase Chevy Work Truck. Funds will be used
as follows:
2005 Chevy Silverado Work Truck w/ towing package
3% fee for new title
Insurance for 3 yrs
Tags
Truck box
Miscellaneous Expenses
$12,101.06
$650
$2550
$60
$399.94
$239
Total: $16,000
I Attachments: Draft of RFP
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22
. .
GHSP-05
v
e North Carolina Governor's Highway Safety Program
Highway Safety Equipment Project Request - Form GHSP-05
3. Address
5. Cit
7. Count
9. State
Inf()rmatlon..":.:,,,\i',,:,~,,: .,;,ir,,?::.',,';....:....
q< '.r~.~t~,j.~CH31;:~~ ".
4. .COniacf
.. 6. Phone'"
. '8iru
. 28401 11i Email
1. Agency
1. Prior Projects with GHSP (Include prior project numbers): nla
Years of Prior Funding:
l8Io 01 02 03 03+
2. Problem Identification (Include data): Unintentional injuries are the leading cause of death in children 1-14.
This is one of the most pressing problems in the United States, but more specifically in New Hanover County
(NHC). Year after year, NHC has been identified as the leading county in North Carolina for traffic crash
rate(2oo2 NC Traffic Crash Facts). Child Passenger Safety Technicians in the county are seeing and reporting
numerous amounts of misuse(90-95% ) and nonuse (50%-almost all are children 4-8yrs) of Child Safety Seats.
The combination of astronomical amount of motor vehicle collisions and a high percentage of child safety
seat misue and nonuse could prove to be deadly for children in New Hanover County. Motor vehicle crashes
_ and car seat misuse are not our only problems. According to the New Hanover County Injury Needs
., Assesment, 90% of bicyclists do not wear a helmet. Other alarming statistics include 39 deaths and another 63
hospitalizations from unintentional injuries in children age 0-14. (Data Book of Injury for North Carolina
published by NCDHHS-Division of Public Health).
In North Carolina the Latino population has increased by 400% from 1990-2000 (NC Latino Health,
2003). The report also stated that Latinos are more likely to die from alcohol-related motor vehicle
crashes, are less Iikey to use child restraints and are less likely to seek publicly-funded services. These
facts show that they are not getting the message and to get it to them, you need to physically take it to
them.
Eight of our neighboring counties (Pender, Onslow, Carteret, Sampson, Cumberland, Bladen, COlumbus,
and Brunswick) do not have an affiliation to SAFE KIDS. Thus, they do not have a sustained program on
Child Passenger Safety, Bicycle Safety or Pedestrian Safety.
To recap, unintentional injuries are the #1 cause of death; NHC is the #1 county for traffic crash rate; high
reports of child safety seat misue and non usage of bike helmets; Latino population exploding; and the
lack of SAFE KIDS outreach in the majority of the southeastern NC.
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3. Proposed Solution (List goals and objectives): Goal 1 By December 31, 2006, increase the number
of saves (children's lives saved) by child safety seats and selt belts by 5 in New Hanover County.
Objectives: 1 Train 60 new Child Safety Seat Technicians by December 31, 2006. 2. Train 480
new parents, at least 120 Latinos, in proper child safety seat use and installation by the end of
2006. 3. Conduct at least 52 child passenger safety events by December 31, 2006. 4. Conduct at
least 12 workshops to raise awareness and educate the public on Child Pasenger Safety by the end
of 2006. 5. Distribute low cosVno cost child safety seats to low income, high risk families.
Rev 10/02
23
.
Goal 2: To increase the number of people wearing bicycle helmets by 10% by 2010. -
Objectives: 1. Conduct at least two bicycle rodeos each year with a target of reaching at least ,.,
50 children at each. 2. Conduct at least four workshops on bicycle safety each year.
3. Distribute free helmets to low income, high risk families. 4. Secure more schools in the Basics
of Bicycling program.
Goal 3: To reduce the number of injuries and fatalities of Latino children (0-14) as a result of
traffic crashes by 5% by 2010.
Objectives: 1. Train and educate at least 5 Latino parents in proper child safety seat use and
installation each month. 2.Conduct at least five workshops on child passenger safety in Latino
Churches each year.
Goal 4. To increase the number of child passenger safety andlor bicycle safety events in the 8
surrounding counties by at least 1 in each county by 2010.
Objectives: 1.Train and educate at least 1 representative from each county in Child Passenger
Safetyl Bicycle Safety each year. 2. Assist in the planning and organizing of child passenger
safety and bicycle safety events in each couilty. 3. Introduce the Basics of Bicycling to their
school systems. 4.Distribute low cosVno cost child safety seats to Latino families.
Having the availability to have a vehicle to tow our CPS and Bike trailor will enable us to meet
those goals.This will also provide reliable transportation and relieve the burden and liability of
using personal vehicles.
4. Specific Equipment Needs (Itemize costs):
"2005 Chevy Silverado Work truck (Stat contract rate for 2004)
Towing Package
Suspension Upgrade
Tire upgrade
2% increase for 2005
3% fee for new title
Insurance (per year $850x 3 years)
Tags
Toolbox for bed
Miscellaneous Expenses
Total:
$11,312.00
$310.20
$89.30
$152.28
$237.28
$650.00
$2550.00
$60.00
$399.94
$239.00
$16,000.00
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5. Specific Special Equipment Needs (Itemize costs):
Equipment Costs
Special Equipment Costs
Total Project COsts
Bud et Information
Total Federal Funds
Amount % Amount
$16000 75 $12000
$
$16000
50
$
$12000
State/Local Funds
% Amount
25 $4000
50 $
$4000.
.$4000 matching funds has been set aside in SAFE KIDS balance sheet to be used to enhance ..
child passenger/bike safety programs. Our local dealership, Jeff Gordon Chevrolet has offered to -
donate a maintenance package for the truck,
24
Rev 10/02
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Crash Rankin '
Contract
Rev 10/02
For.GHSPUs~ Oill
, D FH 01H OCLDJM'D AR"; Date
',of y"."AfRCrashRankiri
DYes" " 0 No',""ORevisit'i!t 'LetierSent;;',F
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, "':,20
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25
.
NEW HANOVER COUNTY BOARD OF COMMISSIONERS
Request for Board Action
Agenda:~ Consent Meeting Date: 5/3/04
Agenda: ~
Department: Health Presenter: David Rice or designee
ContactJanet McCumbee
Subject: School Health Dental Grant Application - FY 04-05
Brief Summary' Need approval to submit a School Health Dental Grant to Cape Fear
Memorial Foundation (CFMF) for $15,000 for emergency dental care funds. This money
will be used to pay for dental care for students with no insurance/medicaid, and who are
financially eligible for free or reduced school lunch. The children are referred by school
nurses when they are experiencing pain from a decayed tooth. The child is referred to a
local dentist who has agreed to see such children and accept payment at Medicaid rate.
Recommended Motion and Requested Actions: To approve the School Health Dental
Grant application to CFMF for $15,000; to accept the funds if awarded and approve any
associated budget amendment for FY 04-05
e I Funding Source: Cape Fear Memorial Foundation
Will above action result in:
DNew Position Number of Position(s)
DPosition(s) Modification or change
~No Change in Position(s)
I Explanation: funds all for payment of dental care
I Attachments: Letter of intent to CFMF
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26
NEW HANOVER COUNTY
HEALTH DEPARTMENT
2029 SOUTH 17TH STREET
WILMINGTON, NC 28401-4946
TELEPHONE (910) 343-6500 FAX (910) 341-4146
April 8, 2004
Mr Garry Garris, President
Cape Fear Memorial Foundation
2508 Independence Blvd, Ste,200
Wilmington, NC 28412
Dear Mr, Garris:
e
The number of children experiencing acute dental problems requiring immediate attention has
increased dramatically, particularly in the Hispanic population, The $3,000 interim funding we
received in December 2003 from the Cape Fear Memorial Foundation has helped provide
emergency dental care to some children in our community, We have many, many more
children on a waiting list but no remaining funds available for their care. There remains a
significant need in this community for provision of pediatric dental services for children with no
dental insurance or Medicaid benefits.
We have in past years received a multi-year CHIP grant from New Hanover Regional Medical
Center and some minimal State funding to provide services. Those funding sources are no
longer available to provide pediatric dental care. To qualify for services, children must have no
Medicaid or third party dental insurance and must meet eligibility requirements for free or
reduced price lunches. We are currently working on obtaining funding to implement a dental
care van project in the community. Until that is a reality, we have no means to provide care to
the many children with unmet needs.
The New Hanover County Health Department requests permission to submit a grant application
for the Foundation's next funding cycle to provide emergency dental services to children in the
community We hope to better meet the growing needs of children with acute dental problems,
allowing them to focus on their own growth, development and educational needs without
suffering in constant pain. We respectfully request your consideration.
David E. Rice
Health Director
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1J~ mc~ RJ\I.
~et McCumbee
Director, Personal Health Services
27
"Healthy People, Healthy Environment, Healthy Community"
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Studies have shown for a long time that sugarless gum has had a
benefit of reducing the decay rate due to the increased salivary flow and
the removal of plaque from the surfaces of the teeth. However, recent
studies of xylitol have shown that not only has it reduced the occurrence,
but the bacteria that is responsible for the cavity formation is destroyed.
The handouts I am giving you are from myself and Dr. Skip Tyson, and they
will give you more information about the product.
Dr. Speck mentioned that this may be a good thing to incorporate into
the public health program for the expectant mothers for decay prevention,
since prevention is our key. I wanted to look into it further, and upon
research, not only do I think it is advantageous for the Health Department,
but I am ordering some for my office to give to my patients and educate
them on the product.
If we used it here at the Health Department, we could try to
incorporate it into the pre-delivery program and have the expectant mothers
begin chewing them when they first visit us.
The purchase of the xylitol is simple by going on-line and go;n~ to"their web site. Please t:onsider this for the health of our communitY and for
'!iw. aid to the unborn children.
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FAMILY GENTLE DENTAL CARE ')\-~
DR. DAN PETERSON
1415 SAGE STREET - GERING, NEBRASKA 69341
308-436-3491
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CHEWING GUM & XYLITOL GUM
Xylilol causes bacteria to lose the ability to adhere to the tooth,
stunting the cavity causing process!
Breath Rx GU,Ql
Cavity Killer
Mother chew.,gu.m affects
children dent.lI health
Trident White_ ChewingJium.
XylitoU).Jl-1I3J~$
Breath Rx Gum contains Xylitol
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, . "."<,,. BreathRx Halispheres Clean Mint chewing gum provides
a burst of mint flavor that continues to work throughout the day to keep
your mouth feeling fresh and clean. Halispheres increase saliva flow to
combat dry mouth, and clean the mouth with 2YTEX, a powerful odor
neutralizer, attacking bad breath where it starts. Halispheres are sugar-free,
and are sweetened with Xylit()lwhich is proven to inhibit the growth of
s.mutans, the primary organism found in tooth decay.
To order click here: Breatb Rx Xylitol e:um
http://www.dcntalgentlecare.comltriden.-advantage....gum.htm
3/24/2004
L
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Dr Skip Tison
No.4640
IF 12 f
45..... 0 7
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Up To Top
If Mom Chews Gum, Children Have Healthier Mouths
Be ccrtain to check the ingredients of your gum and make sure it
contains xylitol, an incredible cavity buster!
Researchers in Finland reported six-year results of a study that tested
whether mothers who chew gum sweetened with xylitol are less likely to
transmit cavity-causing bacteria to their children.
Xylitol is a natural sweetener found in plants, trees, fruits and vegetables.
Some sugar free gums use xylitol as a sweetener, it's these gums that will
hclp keep your kids cavity-free.
The study originally enrolled 195 pregnant women whose mouths had high
levels of StreptococCllS, known to be a major cause oftooth decay. The
women were divided into three groups:
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The xylitol group began chewing xylitol-sweetened gum three monlhs
after giving birth and continued for 21 months, until their children
were 2 years old. Xylitol is a natural sweetener.
The fluoride group received fluoride y.!!Illish ~atments_at 6, 12 and 18
months after giving birth.
The chlorhexidin~ group received a chlorhexidine varnish (an
antiseptic) at 6, 12 and 18 months after giving birth.
Six years after the women gave birth -- several years after the treatments
stoppcd -- their children were tested for the presence of the cavity-causing
bacteria. Children whose mothers chewed xylitol gum had significantly
lower levels of these bacteria in their mouths than did children in the other
two groups. S. mutans generally is p'~sed from mothers to children when
they are between 6 and 31 months old. Higher levels of bacteria in a child's
mouth increase the risk of tooth decay
Research published last year from the same study found that at 5 years of
age, the children whose mothers had chewed xylitol gum had 70 percent
less dental decay, compared with children whose mothers received the
varnish treatments.
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Xylitol has received a lot of attention in recent years as studies have shown
that chewing xylitol-sweetened gum can slow the buildup of plaque on
the teeth and inhibit the f()rmation of cavities. Other sweeteners don't
have thc same effect.
May-June issue of CArles Research. B~' Nancy Valleers InteUHea1th News Serviee
http://www.dcntalgenllecare.com/trident3dvantage....gtnn.htm
3/24/2004
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XylifQ{ ancl Denied Caries: An Overview for Qinicians Lynch H, Milgrom P March 2003 JoutCUJi of/h.
California Dental Association.
!lP-To Top
Xylitol News Updates
Recent studies Teport that subjects who chewed gum had fewer cavities than
non gum chewers. Xylitol in chewing gum caused the GREATEST
REDUCTION in cavities. The greatest reduction in cavities occun
when gum chewing is begun at least 1 year prior to the eruption of
permanent teeth. The antimicrobial effect ofxylitol on strep mutans.
Children chewing xylitol gum had a greater reduction in the numbeT of
SiTep mutans than those children who were not gum chewers. Maximum
effect of sugarless gum chewing Gecurs when it is chewed 3 time a day
directly after meals.
Oral Care Report Vol. 13 No. 2.2003
Up To Top
Use of xylitol chewing gum in daycare centers: a follow-up study in
Savonlinna, Finland.
The use of toothbrushes in daycare centers has been questioned because of
the possibility of infections spreading through unsupervised brushing.
Several field studies have demonstrated a caries-preventive effect ofxylitoI
chewing gum--a measuTe that could be a practical way of taking care of oral
hygiene during daycare hours without brushing. A community trial was
conducted in total of 921 children. Oral health status in the xylitol group
was a little bit better than in the control group. The use ofxylitol can
thercfore be recommended, especially ifthe personnel do not have the
possibility to supervise the brushing. Acta OOOntol Scand. 2003 Dec;61(6):367-
70. Kovari H. Piellih.ldrincn K, Alanen
Up I~LTop
Remineralization effects of xylitol on demineralized enamel. We
mOll'hologically determined the effects ofxylitol on the rernineralization of
artificially demineralized enamel. The samples were demineralized and then
immersed in a Temineralizing solution with or without 20% xylitol at 37
degrees C for 2 weeks. Samples immersed in a xylitol solution
demonstrated less mineralization in the outer 10 microm of the outermost
surface laycrs, but more mineralization in the middle and deep layerss. The
MIP evaluation indicated that remineralization was mOTe prominent in
layers at depths of 50-60 microm in the xylitol samples than in the non-
xylitol samples. These results indicate that xylitol can induce
hllp:/lwww.del1talgentlecarc.comltrident_advantage_gum.htm
3/24/2004
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remineralization of deeper layers of demineralized enamel by
facilitating Ca2+ movement and accessibility. Clinical Trial Randomlzed
Controlled Trial PMID: 14960009 [PubMcd - indexed faT MEDLINE]J Electron
Microsc (Tokyo), 2003;S2(S):471-6.Miake Y, Sacki Y. Tahh".lti M, Yanagisawa T
U.ILIQ Top
Xylitol and dental caries: an overview
Xylitol is a naturally occurring, low-calorie sugar substitute with
anticanogenic properties. Data from recent studies indicate that xylitol
can reduce the occurrence of dental caries in young children,
schoolcbiIdren, and mothers, and in children via their motbers. Xyhtol,
a sugar alcohol, is derived mainly from birch and other hardwood trees.
Short-tenn consumption of xylitol is asSociated with decreased
Streptococcus mutans levels in saliva and plaque. Aside from decreasing
dental caries, xylitol may also decrease the transmission of S. mutans
from mothers to children. Commercial xylitol-containing products may be
used to help control rampant decay in primary dentition. Studies of
schoolchildren in Belize and Estonia, along with data from the University
of Washington, indicate that xylitol gum, candy, ice pops, cookies,
puddings, etc., in combination with other dental therapies. are associated
with the arrest of carious lesions. PMID: 14700079 J Calif Dent Assoc. 2003
Mar;3I (3):205-9.Lynch H, Milgram P.
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In vitro testing ofxylitol as an anticariogenic agent.
A number of studies involving xylitol chewing gum have demonstrated that
xylitol is both noncariogenic and anticariogenic. The ability ofxylitol to
act as an anticariogcnic agent most likely is due to its ability to be
transported into caries-causing oral bacteria and inhibiting fennentation
either by depleting the cell of high-energy phosphate or by poisoning the
glycolytic system. In vitro tests were conducted to determine the
concentration ofxylitol required to inhibit the growth of three strains of oral
streptococcus (S. mutans, S. saliVarius, and S. sanguis). All three strains
were inhibited significantly at xylitol concentrations of 12.5% and higher;
however, only S. mutans was inhibited siguificantly at a xylitol
concentration of 1.56%, Gen Dent. 2002 Jul-Aug;SO(4):340_3. _Sahni PS,
Gillespie MJ, BOlto RW. Otsuka
Up To IflP
Maintaining Mutans Streptococci Snppression: With Xylitol Chewing
Gum One strategy for treating dental caries is to suppress oral mutans
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3/24/2004
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Dr Sk i p T 1 ~ I' n
No.4640
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streptococci, or MS, with chlorhexidine, or CHX, mouthrinse. Oral MS
levels, however, tend to quickly return to baseline values without
further intervention, In this clinical study, the authors evaluated the effect
of xylitol chewing gum on MS regrowth. Subjects rinsed with 0.12 percent
CHX gluconate mouthrinse twice daily for 14 days. Those in the test group
chewed a commercial xylitol gum three times daily for a minimum of five
minutes each time for three months. The placebo group subjects used a
commercial sorbitol gum, and the control group subjects did not chew gum.
After three months of gum chewing, the test group subjects had
significantly lower salivary than did the placebo or control group subjects.
Conclusions. Xylitol chewing gum appears to bave the ability to prolong
the effect of CHX therapy on oral MS. . [Maintaining Mutans Streptococci
Suppression: With Xylitol Chewing Gum Hi= ldebrandt G.H., Sparks B.S. JADA The
Journal of the American Dental Assoeiation, July 2000, vol. 131, no. 7,pp. 909-916]
Up To Top
How Xylitol-Containing Products Affect Cariogenic Bacteria
The authors examined the effect ofxylitol on levels of Streptococcus
mutans and S. sobrinus. In the first study, l87 children received xylitol
containing snacks in school for four weeks. The children's salivary S.
mutans levels remained stable before and after xylitol exposure. Bacteria
from five of these children grew with 10 percent or less xylitol at baseline,
while the bacteria from all seven children grew with l5 percent xylitol after
exposure to the xylitol containing snacks, suggesting that the S. mutans
increased in tolerance to xylitoJ during exposure. Overall, consumption of
xylitol-containing snacks and candy did not reduce S, mutans levels.
However, bacteria from five children and one adult became more xylitol
tolerant. [How Xylito~ntaining Products Affect Cariogenic Bacteria Robens
M.C., Riedy C.A., Coldwell S.E., Nagahama S., Judge K., Lam M., Kaakko T.,
Castillo J.L., Milgrom P. JADA The Joumal of the American Dental Association,
April 2002, vol. 133, no. 4,pp. 435-441 ]
UpJ:!L To-p
Cavity Killer
If you tend to get cavities, chew on this: Gum that is sweetened with xyIitol
can help prevent tooth decay
Study participants who chewed on gum with xylitol after meals had far
[ewer cavity-causing bacteria in their mouths five minutes afterward than
people who chewed gum sweetened with sorbitol or people who didn't chew
gum at all. Check the label on your favorite gum to see ifit contains the
cavity-fighting ingredient.
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3/24/2004
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RealAge as much as 6.4 years younger
Chewing gum can improve your memory! Read more abo\)t it.
UpTo Top
Trident White Gu,m WIth Recalent
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This IS a sugarless chewing gum with RecalentTM that is a MILK
DERIVED product ****
The advantages to chewing Trident White- are:
""" R ed\l(,.es Plaque through mechantcal action of chewing
... Helps prevent dry O1outh by promoting slIhvary flow to help remove
plaque
."l R eea Ident remmerali7l's anel strengthens teeth
... It is a soft gum whi~h lInOW, you to chew it with braces
.I.. ) ~% ff>:w"r ",,10m,s tha" SlHyar"el "'''01
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u ~,.;'v~ i4:-:='r-l~ii_i:=.j:--'::,; :--~~!"-:TA~Ng PHENYLALANINE.
**Trident For Kids* and Trident White* chewing gum products contain
RecaJdent*: any children, especially two and Imder, that are allergic to milk
protein, should AVOID these products. Recaldent is a milk-casein
derivative found in milk. Recaldent does not contain lactose and will not
affect people who are lactose intolerant. Other Trident* chewing gums do
not contain Recaldent.
Visit Trid.~!!twebsite or call1-800-TRI-0013.
http://www.dcntalgentlecare.comltrident_advantage_gum.htm
3124/2004
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Dr Sk i 0 T ~ I' II
No 4640
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Xylitol Information site.
~We have NO financial interest in this company
Denlalnotes Fall 2002 pg 1
UP To Top
Chewmg Gum !lffects Memory
Trident Gum Research
March 16,2004
Back Home Prevention Index Site Map Trident Gum R~searc.h
If you have any questions please e-mail me at: drgentlediln@ID:,
308-436-3491 Ottic
PLEASE NO rE. The infot'mCi(i{)n contained herein is inl9nd8# lor educationtlpurposss~. It ~ not intended and $hoWd not be COIIstrue<.1 ~
is not a 5vIJsMlIte for pefson:J1 hands Of) denliJVmedical anention. dfagt10sis or tTHlment. Persons rBquiring disgnosis, treatment. or with speClbc que.~!
dentallhcafrh care pt'Ovid~r for appropriate cam.
This sfte is prlvale/y and personally sponsored, funded and suppofted by Dr. Peterson. W9 have na outside funding.
Confidentiiillity of data including YOllr identity, IS fOS~ed by this Web $it8. W9 ulKlemke to honor or exC8tKJ the legal requUemBnts of me{licaV/'i(}a!t;
Nebraska.
Copyright e1998-2004 ~lVnily Gentle Dental Care, alf rir]hts reserved.
http://www.dcntalgcnllecare.comltrident_ advantage ~um_htm
3/24/2004
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rates: a 40-m0nth cohort study J Dent Res. 1995;74:1904-1913.
15. Makinen KK. Hujoel PP Bennett CA et al. Palyal chewing gums and caries
oate5 iii pnmary dentition: a 24-month cohort study. Caries Res. 1996;30:408-
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Xylitol.Org
Xylitol.Org has been created for you, the public, as an educational
tool. The many benefits of xylitol are largely unknown to the general
public, and it is our goal to enlighten you. Please peruse our site at
your convenience and take advantage of the wealth of knowledge
made available by our contributors.
What is Xylitol?
Pure xylitol is a white crystalline substance that looks and tastes like 5ugar
Oii food labels, xylitol is classified broadly as a carbohydrate and more
narrowly as a polyol. Because xylitol is only slowly absorbed and partially
utiiized, a reduced calorie claim is allowed: 2.4 calories per gram or 40%
le5s than other carbohydrates.
Xyiitol has been u5ed in food5 since the 1960's. It is a popular sweetener
for the diabetic diet in some countries. In the US., xylitol is approved as a
food additive in unlimited quantity for foods with special dietary purposes.
Over 25 years of testing in widely different conditions confirm that xylitol is
the best 5weetener for teeth, Xylitol use reduces tooth decay rates both in
high-ri5k groups (high caries prevalence, poor nutrition, and poor oral
hygiene) and in low risk groups (low caries incidence using all current
prevention recommendations). Sugarfree chewing gums and candies made
with xylitol as the principal sweetener have already received official
endor5ements from six national dental associations.
Why Use Xylitol?
~ Effective
Studie5 u5ing xylitol as either a sugar substitute or a small dietary addition
have demonstrated a dramatic reduction in new tooth decay, along with
arrest and even some rever5al of existing dental caries. Xylitol provides
additional protection that enhances all existing prevention methods. This
xylitol effect is long-lasting and pos5ibly permanent. Low decay rates
persist even years after the trials have been completed.
~ Natural
Xylitol is right here, inside, already Our bodies produce up to 15 grams of
xylitol from other food sources u5ing established energy pathways. Xylitol is
not a strange or artificial substance, but a normal part of everyday
metabolism.
Xylitol is widely distributed throughout nature in small amount5. Some of
the best sources are fruits, berries, mushrooms lettuce, hardwoods, and
corn cobs. One cup of raspberries contains less than one gram of xylitol.
Chewing i5 a natural process and chewing gums provide some exercise
lacking in a refined diet. If chewing is uncomfortable, xylitol mints or
candies can also stimulate saliva, the natural tooth protector
~Safe
In the amount5 needed to prevent tooth decay (less than 15 grams per
day), xylitol is safe for everyone.
~ Convenient
Xylitol can be conveniently delivered to your teeth via chewing gum,
tablets, or even candy You can implement your xylitol program anywhere,
anytime. It fits right in with the m05t frantic schedules. You don't need to
_l...~~~.... ,......... ".....r............1 rr",Hna tn l'Tl';lVO rnnm fnr Y\llitnl
Page I on
For more information,
questions or comments,
please contact our
organization.
Al! inquiries are welcome and
appreciated.
General Information:
$Elnd an Email
Free!
Click to Download Dr
Peldyak's eBook,
"Xylitol - Sweeten Your
Smile"
Learn more about the
benefits of Xylitol from
one of the experts!
Our site is organized
in the following
manner'
Home (XylitoI.Org) -
Home Page (You're
here now)
Dr's Corner - Read
advice and opinions of
leading doctors
regarding Xylitol and its
benefits and uses
FAQs (Frequently
asked questions) - The
most commonly a5ked
question5 regarding
Xylitol and its uses.
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tsut xylltOI tastes so gooa Ulc:llll Ul::!GUIIIl::!::i i:SUlUllldUl. \..IllllUICl1 IUVC ll: I'
Nagging is minimized.
How to use Xylitol
It is not necessary to replace all sweeteners to get the dental benefits of xylito!. Look for xylitol
sweetened products that encourage chewing or sucking to keep the xylitol in contact with your teeth.
The best items use xylitol as the principal sweetener
HOW MUCH?
Studies show that 4 to 12 grams of xylitol per day are very effective. It's easy to keep track of your
xylitol intake. The "all xylitol" mints and gums contain about one gram of xylitol in each piece. You
could begin with as little as one piece four times a day for a total of four grams. It is not necessary to
use more than 15 grams per day as higher intakes yield diminishing dental benefits.
HOW OFTEN?
If used only occasionally or even as often as once a day, xylitol may NOT be effective, regardless of
the amount. Use xylitol at least three, and preferably 5 times every day
TIMING
Use immediately after eating and clearing the mouth by swishing water, if possible. Between meals,
replace ordinary chewing gum, breath mints, or breath spray with comparable xylitol products.
e http://www.xylitol.org/main.htm
4/6/2004
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Xylitol CHOICE For iHerb
Search
"The Natural Pharn1acist
CO"Sl .1/1:"1< 1:D/T10\
Herbs & Supplements:
Xylitol
Principal Proposed Uses
, Cavities (Prevention)
Other Proposed Uses
, Ear Infections (Prevention); Periodontal Disease (Prevention)
Page Navigation
What Is Xylitol Used for Today?
What Is the Scientific Evidence for Xylitol?
Dosage
Safety Issues
References
A natural sugar found in plums, strawberries, and raspberries, xylitol is used as
a sweetener in some "sugarless" gums and candies. Not only does xylitol
replace sugars that can lead to tooth decay, it also appears to help prevent
cavities by inhibiting the growth of bacteria that cause cavities, such as
Streptococcus mutans.1 Xylitol also inhibits the growth of a related species,
Streptococcus pneumoniae, which is a cause of ear infections.2
Gums, toothpaste and candy containing high levels of xylitol are beginning to
become available in the United States.
What Is Xylitol Used for Today?
Many studies, including several under the auspices of the World Health
Organization, have evaluated xylitol gums, toothpastes and candies for
preventing dental cavities, with good results.3-9 In all of these studies, xylitol
users developed fewer cavities than those receiving either placebo or no
treatment.
Xylitol is thought to prevent cavities by inhibiting the growth of the
Streptococcus mutans bacteria. 10 Since a related bacteria, Streptococcus
pneumoniae, can cause ear infections, xylitol has been investigated as a
preventive treatment for middle ear infections, with some success. 11-13
In addition, preliminary evidence suggests that use of xylitol may offer some
protection against periodontal disease (gum disease).6
'alL_.... 1_ .&.L_ ...._~__...:.c_ r"..:....____ ~__ V._I:..._I....
Page 1 of5
Double-blind, placebo-controlled studies enrolling a total of almost 4,000
people, mostly children, have found that xylitol gum, candy, or toothpaste can
help prevent cavities.14-19
.
A double-blind, placebo-controlled study of 1,677 children compared a standard
fluoride toothpaste with a similar toothpaste that also contained 10% xylitol.21
Over the 3-year study period, children given the xylitol-enriched toothpaste
developed significantly fewer cavities than those in the fluoride-only group.
In another trial, a 4o-month, double-blind study of 1,277 children, researchers
studied gum products containing various concentrations of xylitol and/or
SOrbitol.2o Participants were divided into nine groups: xylitol gum in four different
concentrations, two forms of xylitoVsorbitol gum, sorbitol-only gum, sucrose
(ordinary sugar) gum, or no gum.
The gum with the highest xylitol concentration proved most effective at reducing
cavities. However, children in every one of the the xylitol and/or sorbitol gum
groups showed significant reductions in cavities as compared to the sugar gum
or no-gum groups.
Another series of studies suggests that children acquire cavity-causing bacteria
from their mothers; regular use of xylitol by a mother of a newbom child may
provide some protection to the child, as well. 26-28
Ear Infections
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One large double-blind, placebo-controlled trial of 857 children investigated how
well xylitol (in chewing gum, syrup, and lozenges) could prevent ear
infections.24 The gum was most effective, reducing the risk of developing ear
infections by a full 40%. Xylitol syrup was also effective, but less so. The
lozenges weren't effective; researchers speculated that children got tired of
sucking on the large candies and didn't get the proper dose of xylitol. (In
addition, the children were able to distinguish between the xylitol and placebo
lozenges by taste, making that portion of the study single-blind.)
Similarly positive results had been seen in an earlier double-blind study by the
same researchers, evaluating about 300 children.25
However, these studies were of short duration and did not test the long-term
effect of xylitol in young children and infants, who are most at risk of contracting
ear infections.
Dosage
In the studies described above, dosages for cavity prevention ranged from 4.3
to 10 g per day The doses were divided throughout the day, usually after
meals. For ear infections, children given xylitol-sweetened gum received 8.4 g
ofxylitol daily, also in divided doses. Those who took syrup received 10 g daily
Safety Issues
_. http://cornmunity.healthgate.comlGetContent.asp?siteid=iHerb&docid=/tnp/pgOOO935
4/6/2004
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Xylitol is believed to be safe, but doses higher than 30 g per day can cause
stomach discomfort and possibly diarrhea. In studies, children taking xylitol
syrup tended to have more such side effects than those using other forms of
xylitol, possibly because it reached the stomach in a more concentrated dose.
References
1 Hildebrandt GH, Sparks BS. Maintaining mutans streptococci suppression
with xylitol chewing gum. J Am Dent Assoc. 2000;131 :909-916.
2. Uhari M, Kontiokari T, Niemela. A novel use of xylitol sugar in preventing
acute otitis media. Pediatrics. 1998;102:879-884.
3. Gales MA, Nguyen T -M. Sorbitol compared with xylitol in prevention of dental
caries. Ann Pharrnacother 2000;34:98-100.
4. Makinen KK, Bennett CA, Hujoel PP, et al. Xylitol chewing gums and caries
rates: a 4o-month cohort study. J Dent Res. 1995;74:1904-1913.
5. Makinen KK, Hujoel PP, Bennett CA, et al. Polyol chewing gums and caries
rates in primary dentition: a 24-month cohort study Caries Res. 1996;30:408-
417
6. Makinen KK, Pemberton D, Makinen P-l, et al. Polyol-combinant saliva
stimulants and oral health in Veterans Affairs patients-an exploratory study
Spec Care Dent. 1996;16:104-115.
7 lsokangas P, Alanen P, Tiekso J, et al. Xylitol chewing gum in caries
prevention: a field study in children. J Am Dent Assoc. 1988;117:315-320.
8. Scully C, Greenman J, Porter S, et al. Anti-caries efficacy of xylitol and
sodium fluoride in dentifrices [abstract). Int Dent J. 1995;45:325.
9. Sintes Jl, Escalante C, Stewart B, et al. Enhanced anticaries efficacy of a
0.243% sodium fluoridel10% xylitoVsilica dentrifrice: 3-year clinical results. Am
J Dent. 1995;8:231-235.
10. Uhari M, Kontiokari T, Niemela. A novel use of xylitol sugar in preventing
acute otitis media. Pediatrics. 1998;102:879-884.
11 Kontiokari T, Uhari M, Koskela M. Antiadhesive effects of xylitol on
otopathogenic bacteria. J AntimicrobChemother 1998;41:563-565.
12. Uhari M, Kontiokari T, Koskela M, et al. Xylitol chewing gum in prevention of
acute otitis media: double blind randomised trial. BMJ. 1996;313:1180-1184.
13. Uhari M, Kontiokari T, Niemela. A novel use of xylilol sugar in preventing
acute otitis media. Pediatrics. 1998; 1 02:879-884
14. Gales MA, Nguyen T-M. Sorbitol compared with xylitol in prevention of
dental caries. Ann Pharrnacother 2000;34:98-100.
15. Makinen KK, Bennett CA, Hujoel PP, et al. Xylitol chewing gums and caries
http://cornmunity.healthgate.comlGetContent.asp?siteid=iHerb&docid=/tnp/pgOOO935
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rates: a 4O-month cohort study J Dent Res. 1995;74:1904-1913.
16. Makinen KK, Hujoel PP, Bennett CA, et al. Polyol chewing gums and caries
rates in primary dentition: a 24-month cohort study Caries Res. 1996;30:408-
417
17 Makinen KK, Pemberton D, Makinen P-l, et al. Polyol-combinant saliva
stimulants and oral health in Veterans Affairs patients-an exploratory study
Spec Care Dent. 1996;16:104-115.
18. lsokangas P, Alanen P, Tiekso J, et al. Xylitol chewing gum in caries
prevention: a field study in children. JAm Dent Assoc. 1988;117:315-320.
19. Sintes Jl, Escalante C, Stewart B, et al. Enhanced anticaries efficacy of a
0.243% sodium fluoride/10% xylitollsilica dentrifrice: 3-year clinical results. Am
J Dent. 1995;8:231-235.
20. Makinen KK, Bennett CA, Hujoel PP, et al. Xylitol chewing gums and caries
rates: a 4O-month cohort study J Dent Res. 1995,74:1904-1913.
21 Sintes Jl, Escalante C, Stewart B, et al. Enhanced anticaries efficacy of a
0.243% sodium fluoride/10% xylitollsilica dentrifrice: 3-year clinical results. Am
J Dent. 1995;8:231-235.
22. Makinen KK, Pemberton D, Makinen P-l, et al. Polyol-combinant saliva
stimulants and oral health in Veterans Affairs patients-an exploratory study
Spec Care Dent. 1996;16:104-115.
23. Alanen P, Isokangas P, Gutmann K. Xylitol candies in caries prevention:
results of a field study in Estonian children. Community Dent Oral Epidemio/.
2000;28:218-224.
24. Uhari M, Kontiokari T, Niemela. A novel use of xylitol sugar in preventing
acute otitis media. Pediatrics. 1998;102:879-884.
25. Uhari M, Kontiokari T, Koskela M, et al. Xylitol chewing gum in prevention of
acute otitis media: double blind randomised trial. BMJ. 1996;313:1180-1184.
26. Soderling E, lsokangas P, Pienihakkinen K, et al. Influence ot matemal
xylitol consumption on mother-d1i1d transmission ot mutans streptococci: 6-year
follow-up. Caries Res. 2001;35:173-1n
27 lsokangas P, Soder1ing E, Pienihakkinen K, et al. Occurrence ot dental
decay after matemal consumption ot xylitol chewing gum, a follow-up from 0 to
5 years ot age. J Dent Res. 2000;79(11):1885-1889.
28. Soderling E, lsokangas P, Peinihakkinen K, et al. Influence of matemal
xylitol consumption on acquisition of mutans streptococci by infants. J Dent
Res. 2000;79(3):882-887
last reviewed September 2003 by HealthGate CAM Medical Review Board
http://comrnunity.healthgate.comlGetContentasp?siteid=iHerb&docid=/tnpIpg000935
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New Hanover County Health
Department
Organizational Analysis Update
Apri I 2004
lliJ
!!!!!!i'I Recommendation 1
. Revised Organizational Chart
. Successful1y used workgroups to restructure
services and teams
. Reclassified positions
. Reduced number of supervisors
. Supervisors and team leaders attended UNCSPH
"Basic Supervision", "Myers-Briggs",
Bioterrorism. Epidemiology. and Incident
Command System training
- Recommendation 2
. Restructured the Management Team
. Reclassified Personal Health Services
Manager. Health Programs Administrator.
Human Services Agency Business Manager,
Animal Control Services Manager,
Environmental Health Services Manager,
and Administrative Support Coordinator
. Created Health Planner position
III
Recommendation 1:
Reduce the number of
administrative levels
between the Health Director
and the line staff.
.
Recommendation 2:
Strengthen the central
administrative staff of the
Health Director's Office
- Recommendation 2
. "The Team Handbook" training has been
initiated and Management Team functions
have been redefined.
. Management Team reviews Policy
Committee recommendations
. FY 2004-05 Budget process combined
several areas
1
. Recommendation 2
Board of Health Discussed Authority and
Operations issues: Policy Making Body. State
Statutes.Ordinances/Regulations; Budget; Grants
& Contracts; Management of Concern: Board to
Staff (Chairman) I Staff to Board (Health
Director)
Discontinued Board of Health assistance in
developing program budgets
Adopted Public Contact with Board of Health
policy
_J
~ Recommendation 3
Board of Health revised Stationery in October
2003
Centralized Newsletter Processing
Centralized Quarterly Report Processing
Management Team adopted "Universal" Business
Card for staff
Environmental Health Services relocation to
Market Place Annex
. Accreditation process - Pilot County
.
Recommendation 4:
Adopt a team-oriented
management style.
_J
~
Recommendation 3:
Promote an internal and
external image of the
NHCHD as a single
organizational unit.
llliJ
~ Recommendation 3
In addition to 2000 Strategic Planning. NHCBH
and NHCHD conducted a Strategic Planning
retreat in March 2003 and a Mission and Vision
retreat in August 2004
Communications Plan. Marketing Committee -
Health Promotion Team
Media Contacts are coordinated through the
Health Programs Administrator
New Health Department brochure developed
_J
I!l!!!!iP Recommendation 4
Reduced size of Management Team
The Management Team agreed to the following elements
of purpose on March 25, 2003: Policy and Procedures,
Leadership, Strategic Planning, Depanmem Priorities,
Emergency Response, Department Programs, Regulatory,
Budget - Resource Allocation - Staffing, Marketing, and
Community Support
Team Handbook Training - Management Team
Work groups established within and among divisions
Guidelines for Effective Meetings adopted by Management
Team on March 25. 2003
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Recommendation 5:
Improve strategic and
management planning
systems.
Recommendation 5
. One of six NC counties piloting the
accreditation process
. Quality Assurance process to begin; QA
Committee formed on March 23, 2004
. Health Director is a member of the NC
Department of Health and Human Services
- Public Health Task Force 2004
. Recommendation 6
. Personal Health Services Division Created in
December 2002. PHSD includes: Child Service
Coordination Team, Clinic Team, Community
Team, Maternal Health Team. School Health
Teams 1 & 2, Laboratory and Nutrition.
Support Services Division created in October
2003. SSD includes: Accounting, ACSIEHS
Support Services, Billing, Customer Care. Fiscal
Operations, Information Technology, Medical
Records, and Program Support
. Recommendation 5
Areas of strategic planning identified: Access to
health care; 2) preventive services and lifestyle-
related risks; 3) communication, education and
marketing (promotions); 4) facility utilization and
information technology; 5) water quality, storm
management and drainage; and air quality; 6)
emerging health risks
Board of Health adopted the Vision and Mission
Statements on September 3, 2003
.
Recommendation 6:
Provide for greater unity,
flexibility, ~nd coordination
of nursing and related
personal health service
programs.
Recommendation 6
. Centralized appointment and registration
system
. Progressing towards Open Access Clinic
. Jail Health contracted to Prison Health
Services in July 2003
. Created Interpreter and Floater positions
3
., Recommendation 7
Recommendation 7:
Centralize finance,
budgeting, and billing
systems
. Human Services Agency Business Manager
appointed.
. Support Services Division created
. Created Accountant position
. Billing system and billing staff centralized
. Grants/contracts procedures centralized
Recommendation 7
. Purchasing is being centralized in Fiscal
Operations Unit
. Established Central Supply Room
. Travel/training to be consolidated
. Several existing budgets were consolidated
for FY2004-05. This should allow for ease
in auditing and tracking revenues and
expenditures
Recommendation 8:
Strengthen information
systems management and
resources.
Recommendation 8
.""",
- -
. Added an Information Systems Support Specialist
. Information Systems Support Technician
requested
. Software and hardware applications in place
according to need
. Improved Equipment/Software Inventory database
. Purchased copier with scanning and email
. The Health Department has been selected to serve
as a pilot for the County Database Document
Management System
. HIPAA privacy in place; addressing security
Recommendation 9:
Centralize and strengthen
health education, training,
and communications
capabilities.
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~ Recommendation 9
. Relocated Health Promotion staff in January 2004
. Reclassified Heahh Education Supervisor
. Jnstallation of Video-conferencing equipment
. Adopted Media Communications Plan Policy
. Health Programs Administrator to coordinate
media contacts
. Recommendation 10
. Revised policies: Dress Code; Parking; Sick Leave
. Adopted policies: Flexible Workweek Schedule;
Fund Raising; Media Communications Plan;
Public Contact with Board of Health; Reduction in
Force
. Basic Supervision Workshops
. Supervisor and Employee training: Myers Briggs
_J
~ Recommendation 11
. Space Utilization Team
. Relocation of Community Health, Health
Promotion, Customer Care and Program Support
Staff to Z"floor
. Relocation of Care Coordination. IT,
S.ockroomlSupplies and Billing Staff to 2"" floor
. Relocation of Environmental Health Services to
Marketplace Annex
.
Recommendation 10:
Conduct a comprehensive
review of personnel (human
resources) policies and
procedures and develop a
written handbook of them that
is consistently interpreted and
applied consistently
throughout the organization.
.
Recommendation 11:
Review current space
allocation and use and
explore alternatives for
improvement given existing
funding and resources.
. Recommendation 11
. Spay-Neuter Facility being buiR
. Vector Control Building to be built
. New furniture for Auditorium
. Installation of Building Security System
. Major clean up of 17'h Street Facility; no
hallway clutter
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NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
Recommendationl
Su""estion Resnonse
Recommendation . 50% reduction of supervisors in Personal Health Services
1: Reduce the . 30% reduction of supervisors in Support Services.
number of . Team leader roles will be changing - no supervision but stronger
administrative leaders to help supervisors
levels between . Working with Human Resources: PHNII and PHN III roles
the Health enhanced; Zones II and III rewritten
Director and the . Restructured work units
line staff. . Reclassified Assistant Health Director position to Health Programs
Administrator
. Reclassified Public Health Division Manager positions to: Personal
Health Services Manager, Animal Control Services Manager, and
Environmental Health Services Manager
. Reclassified Business Officer position to Human Services Agency
Business Manager
. Reclassified Administrative Support Manager to Administrative
Support Coordinator
. Reclassified two Public Health Division Managers to Public Health
Nurse Supervisors
. Reclassified one Public Health Division Manager position to
Medical Lab Technologist
. Reclassified an Administrative Support Supervisor position to an
Information Systems Support Specialist
The Health . Organizational Chart revised
Department . 50% reduction of supervisors in Personal Health Services, Three
leadership needs supervisor positions reclassified down to line staff level after
to carefully review resignations/retirements, several other supervisors changed to PHN Zone II
its overall team leaders, roles redefined under different supervision
organizational . Personal Health Services Supervisors have larger groups to
structu re and supervise.
adopt a more . Team leader roles are changing - no staff supervision
flexible and less responsibility, but stronger team leaders to help supervisors
hierarchical . Working with Human Resources on PHN I, II, III roles; for team
system from the leaders, program coordinators, and enhanced role nurses
Health Director's . EHS completed the implementation of specialty work teams
Office through the . Reduced number of Supervisors and formed new divisions.
Divisions to the
line staff.
The Department . Done and continuing revisions regarding policies and procedure
should consider changes.
restructuring its . Restructured work units in Personal Health Services Division, 8
work units, teams of nursing programs, nutrition, and lab, with 8 supervisors reporting
developing clear to PH Division Manager
guiding policieS . Successfully used workgroups to restructure services and teams
and procedures . Team handbook Training for the Management Team
(see . Meyer's Briggs
Recommendation . Supervisors and team leaders attended UNCSPH "Basic
10\, and nrovidinn
1
basic leadership
training to all
existing and newly
appointed
supervisors.
With this in mind,
the roles and
responsibilities of
supervisors should
be examined to
determine which of
those cou Id be
more appropriately
and productively
performed in a
"team leader" role.
Recommendation
2: Strengthen
the central
administrative
staff of the Health
Director's Office
The NHCHD
should consider
establishing a
Health Director's
Staff that includes
four newly
configured
Associate Director
Positions:
Associate Director
of Population-
Based Personal
Health Services;
Associate Director
of Education,
Training, and
Development;
Associate Director
of Budnet and
NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
i
e
Supervision", "Myers-Briggs", Bioterrorism, Epidemiology & Incident
Command System training
. Still fine-tuning, but most is complete. Review of job descriptions
underway at present.
. Reclassified Administrative Support Supervisor to Information
Systems Support Specialist
. Dental Assistant position reclassified to Interpreter
. Management Team restructured
. Identified four areas, 1) Policy Making Body-State Statutes-
Ordinances/Regulations, 2) Budget, 3) Grants & Contracts, 4) Mgmt. Of
Concern: Board to Staff (Chairman)/Staff to Board (HDBOH operations:
. Organizational chart revised
. Reclassified Administrative Support Manager to Administrative
Support Coordinator
. Reclassification of Personal Health Services Manager, Health
Programs Administrator, Human Services Agency Business Manager,
Animal Control Services Manager and Environmental Health Services
Manager
e
. Unable to do as desired (or recommended)
. New Management Team: Administrative Support Coordinator,
Health Programs Administrator, Personal Health Services Manager, Human
Services Agency Business Manager, Animal Control Services Manager,
Environmental Health Services Manager, Dental Health Services Manager,
and Physician Epidemiologist.
. Health Planner position created with bioterrorism funding
. Reclassified Assistant Health Director position to Health Programs
Administrator
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NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
Finance; and
Associate Director
of Information and
Administrative
Services. Each
Division Director
should report to
one of these
Associate
Directors or to the
Health Director
Also, the
Associate
Directors should,
in some cases,
directly manage
operational units
that are not
assigned to a
specific division.
If the above . N/A
suggestion to form . Reduced size of Management Team
a Health Director's . Reclassified Assistant Health Director position to Health Programs
Staff or some Administrator
similar design is
not adopted, we
believe that the
respective roles of
Health Director
and Assistant
Director should be
carefully assessed
and realigned.
We strongly urge . In process. Team Handbook training has been initiated and
that the purpose Management Team functions have been redefined.
and role of the . Strategic planning process completed in March 2003
Management Organizational Vision & Mission Workshop conducted in August 2003
Team be redefined . Management Team reviews Policy Committee recommendations
as that of a
Department policy-
making and
leadership group.
Among the many . To be addressed
agenda ~ems for . FY 2004-05 Budget process combining the following areas:
the Management MCC/CSC/MOW/Navigator budgets into Care Coordination; Family
Team, we believe Planning! BCCCP/ TANF into Women's Preventive Health; Personal Heanh
that decisions GeneraV Neurology/CSHS into Commun~ Health and Risk
regarding service ReductionlHealth Education into Health Promotion
provision and
resource
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NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
allocation,
particularly as they
involve service
expansion or cuts
and stall
deployment,
currently made
within Divisions
should be routinely
reviewed and
placed in the
context of the
Department prior
to implementation.
We believe that . In process. Ongoing developments.
the Health . Organizational Analysis discussion with Board of Health
Director, in concert Reviewed the following Board of Health (Authority/Operations issues):
w~h the Board of - Policy Making Body - State Statutes -
Health, should Ordinances/Regulations
delineate a - Budget
demarcation of - Grants & Contracts
"policy" and - Management of Concern: Board to Stall (Chainnan) / Stall
"operational" to Board (Health Director)
decisions in order
to clearly identify
the appropriate
range of decision-
makino authoritv.
We believe that . Board of Health assistance in developing program budgets was
the practice of discontinued in November 2002
Board assistance . Presenting Board of Health with Budget Summary Infonnation only.
in developing Budget Workbook with complete line ~em detail is available for review as
program budgets requested.
should be
discontinued.
We suggest that . Public Contact with Board of Heaijh policy adopted by Board of
the Board of Health in September 2003
Health adopt a
specific policy that
refers any
concems brought
to individual Board
members to the
Executive Director
of the Health
Department for
follow-up and
resolution with a
"report" back to the
Board.
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Recommendation
3: Promote an
internal and
external image of
the NHCHD as a
single
organizational
unit.
Divisions must
take every
opportunity
themselves to
contribute to the
Department's
overall image and
substance, to learn
to see their
activities in the
context of the
Department as a
whole, and build
full staff
awareness and
appreciation of the
contributions of the
all departmental
un~s.
The crucial need
for the Health
Director to give
even more time to
external
representation
functions in the
face of increased
community
chanoe. reduced
NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
. Board of Heaijh approved the revised Stationery in October 2003
. Intemal NHCHD image:
- Annual & quarterly reports
. External NHCHD image:
. Health Programs Administrator coordinate media relations
. 3-4 Health Educators being trained to deal w/issues
. Promote motto logo: Organizational Vision & Mission efforts
. Staff unity: General staff meeting "Who Moved Cheese Party"-
positive comments
. Frequency of General Staff meetings changed from quarterly to
bimonthly
. Meetings with Adm. Support Services monthly
. Clinical staff needs have been addressed re: smocks/lab coats
. Centralized Newsletter Processing
. Centralized Quarterly Report Processing
. Centralized Courier Process to include EHS and ACS
. Creation of Floater Position
. Cross-training staff within units
. Staff Shirts
. Up-to-date Website
. Adoption of "Universal" Business Card for staff
. One of our more difficult challenges, but being implemented
through open clinics and combining support services.
. Health Programs Administrator to coordinate media relations
. Organizational Vision & Mission revisited
. Enhanced staff awareness with emphasis on communication via
email and meetings; new Personal Health Division and Support Services
Division meetings every other month opposite general staff meetings
. General staff meeting "Who Moved Cheese Party" - positive
comments
. Environmental Health Services relocation to Market Place Mall
expanded Health Dept presence in & service to community; further, it
aligned Health Dept EHS services with other NHC agencies that share a
similar customer base
. Accred~ation process has taken valuable time form implementing
this more fully.
. Health Director recently named to the NC Area Maritime Security
Executive Committee.
. Health Director promoted the NHC Preparedness and Response
Coalition. Recent changes in the President and CEO of NHHN and the
NHC Emergency Manager One of four counties selected to process the
Strategic National Stockpile Planning Committee.
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NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
budgets, and
disaster and bio-
terrorism threats
further supports
the need to
strengthen that
office.
This area was . In addition to 2000 Strategic Planning, NHCBH and NHCHD
given serious conducted a Strategic Planning retreat in March 2003 and a Mission and
attention following Vision retreat in August 2004.
the Department's . Communications Plan. Marketing Committee- HP Team
2000 Strategic
Planning effort.
The more
emphasis this is
given the better,
especially from the
Health Director
who is the
recognized
spokesperson for
public health in the
community.
However, these . Media Contacts are coordinated through the Health Programs
assignments must Administrator
be made carefully . Media training for approximately 20 employees is scheduled on
with the purpose April 16, 2004
and any special
interests or goals
fully explained to
the individual
assigned.
The Health . In process. Staff shirts to be ordered. Lab coats in place.
Department should Missionlvision exercise was completed to review needed changes.
also explore a . Annual & quarterly reports revised. on web site
variety of specific . New brochure
steps to improve . Updated Annual Report and quarterly newsletter format
staff and
community pride
and appreciation,
including:
publicizing the
Department name,
motto, and logo in
every possible
way.
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NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
Recommendation . Guidelines for Effective Meetings adopted by Management Team
4: Adopt a team- on March 25, 2003
oriented . Scheduled meetings:
management Reduction in size of Management Team
style. . Team Handbook Training
Manaaement Team Puroose: The Management Team agreed on March
25, 2003 to the following elements of purpose:
0 Policy and Procedures
0 Leadership
0 Strategic Planning
0 Department Priorities
0 Emergency Response
0 Determine Department Programs
0 Regulatory
0 Budget - Resource Allocation - Staffing
0 Marketing and Community Support
The Department . Differences between how those in management positions and
will benefit by higher see the organization and how line professional and administrative
taking every staff see the organization.
possible . Work groups established within and among divisions
opportunity to
close this gap of
perception.
The NHCHD . Guidelines for Effective Meetings adopted by Management Team
should develop a on March 25, 2003
model for
"effective
meetings" that
includes a "team
orientation" toward
substantive
discussion,
policymaking,
problem
identification and
resolution, priority
setting, and task
assignment and
follow-up.
The role and . Some work done, but not fully explored. People have been shifted
functions of to new jobs, but in process of review for job descriptions.
supervisory . PHN III team leader role has been redefined and reviewed by
responsibilities Human Resources; still transitioning staff
should be . EHS completed the implementation of specialty work teams
reviewed, the
"team leader" role
explored, and the
number of
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NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
supervisors
adjusted.
Recommendation . Reviewed mandated services
5: Improve . Strategic Planning Retreat on March 22, 2003
strategic and . Vision and Mission Workshop on August 19, 2003
management . Efforts initiated to Link budget process with strategic planning
planning . One of six NC counties piloting the accreditation process; Self-
systems. appraisal; S~e Visit Team on February 24-26, 2004
. Areas of strategic planning identified: Access to health care; 2)
preventive services and lifestyle-related risks; 3) communication, education
and marketing (promotions); 4) facility utilization and information
technology; 5) water quality, storm management and drainage; and air
quality; 6) emerging health risks
. Creation of Health Planner position
. Quality Assurance Committed being formed
The NHCHD . Mandated services have been identified
should revise its . Accred~ation process will involve new planning and new processes
strategic planning in future
update system to . Areas of strategic planning: 1) access to health care; 2) preventive
make it more goals services and lifestyle-related risks; 3) communication, education and
oriented and marketing (promotions); 4) facility utilization and information technology; 5)
understandable to water quality, storm management and drainage; and air quality; 6) emerging
Board of Health health risks
members and . Quality Assurance process to begin; QA Commillee being formed
Health Department
staff.
As one aspect of . Vision and Mission Workshop held on August 19, 2003
the strategic . Board of Health adopted the Vision and Mission Statements on
planning process, September 3, 2003
engage the entire
organization in
developing and
adopting a new,
concise mission
statement that will
have meaning to
external
stakeholders and
the public.
We think it will be . Vision and Mission Workshop held on August 19, 2003
useful if the . Board of Health adopted the Vision and Mission Statements on
NHCHD adds a September 3, 2003
"visioning
exercise" to its
strategic planning
process in which
the Deoartment
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NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
engages in
imagining what it
"wants to be" in
the future. Once
this vision for
direction is
determined, each
policy and
management
decision should be
assessed in terms
of whether it is
moving the
Department in that
direction.
We are convinced . To be addressed
that the NHCHD
would benefit by
building an
ongoing
Departmental
Management
Planning Process
that complements
the strategic
planning effort and
fits within the
county budget
cycle.
Decision-making . To be addressed
about ongoing
operations should
be linked to the
Department's
strategic priorities,
and decision-
making and
program
development
within individual
Divisions should
be conducted and
assessed in the
context of their
contribution to the
priority areas.
In further
consideration of . In process.
current tight . Health Director is a member of the NC Department of Health and
budgets, the Human Services - Public Health Task Force 2004
NHCHD should
9
NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
collaborate w~h . Public Health Infrastructure focus from the state level through the
other local NC Association of Local Heallh Directors
departments in
requesting that the
NC Department of
Health and Human
Services and its
Division of Public
Health reassess
the
appropriateness
and priority of the
"mandated
services."
The Department . Quality assurance process underway and developing.
should, through . One of six NC counties piloting the accred~ation process; Self-
the strategic appraisal completed; Site Vis~ Team on February 24-26, 2004.
planning process, Accreditation process has in~iated new planning processes
begin to
systematically
identify, measure,
and track
performance
measures of
Health Department
programs and
activities.
Recommendation . Centralized appointment system
6: Provide for . Workgroups formed
greater unity, . Time study data compiled
flexibility, and . Business Manager interviewed all Adm. Support Supervisors.
coordination of Administrative Support Staff and State Consullant, Penny Lewis assisted in
nursing and this effort
related personal . Hired Interpreter; contracts processed for other interpreters
health service . Consolidated nursing divisions: Child Service Coordination Team,
programs. Clinic Team, Community Team, Maternal Health Team, School Health
Teams 1 & 2, Laboratory and Nutrition.
. Reviewed clinic services: After August 2003, Well Baby Clinics
brought back to Health Department.
. Coordinate personal health: on-going
. Cross training in clinical and also in administrative support services
. Floater position - already effective in ACS, EH, Med. Rec.,
Switchboard, Nutr~ion
. School health staff worked on Clinic Team during time out of school
- worked well
. Clinical (clerical) staff have assisted in Nutrition
. Migrated contracts to Accountant pos~ion
. School health positions: 4 positions were requested to have school
nurse in each school
. Open Access Clinic: Site visit to Buncombe and Duplin counties.
Ooen clinic was out to test month of Julv (think this was meraina of 3 child
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NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
health clinics); still need coordination
. Centralized reception/registration:
. Personal heallh workgroups, Open clinic workgroups, Clinical work
groups
. Nutrition transferred to Personal Health Services in August 2003
. Combined Women's Heallh Care, Child Health, Communicable
Disease, Community Health and Laboratory in December 2002
. Jail Health contracted to Prison Health Services in July 2003
. Medical records process completed with jail health medical records.
. Workload distribution reviewed
. Creation of Support Services Division in October 2003
. Support Services Division includes: Accounting, ACS/EHS Support
Services, Billing, Customer Care. Fiscal Operations, Information
Technology, Medical Records, and Program Support
. Progressing towards Open Access Clinics
. Flu Clinic held in Auditorium for month of October
. Consolidated Child Health clinics (Well Baby, Health Check. and
Kindergarten Health Assessment)
. Extended Clinic Hours for Child Health Clinic
. Cross-training of Registration Staff
We suggest that . Personal Health Services Division Created in December 2002
the Health . Personal Health Services Manager appointed
Department should . Four nursing divisions have been consolidated into Personal Health
combine the four Services Division to include 6 nursing teams: Child Service Coordination,
Nursing Divisions Clinic Services. Community Services Maternal Health Team, School Health
to report to a Teams 1 & 2, plus Laboratory and Nutrition.
newly designated . One Personal Health Services Manager w~h 8 supervisors
Associate Director . Personal health services workgroups
of Population- . Clinic and commun~y workgroups made recommendations for
Based Services. services, which resulted in new teams
. Reviewing clinic services
. Cross training staff
. Combined child health services into one clinic, while bringing the
well baby clinic in-house
. Brought the orthopedic clinic in-house
. Open access clinic in planning process
. Held first month of Flu vaccine clinics in auditorium for better
customer service
. School health nurse worked clinic during summer break
. School health positions: nurse in every school!!!
. Jail Health contracted to Prison Heallh Services in July 2003
We believe the . Ongoing fine-tuning.
NHCHD should . In process (Target Date: July 2004)
consider moving to
an "open clinic"
format.
We suggest that . Ongoing, fine-tuning.
clinic reception . Centralized annointment and reaistration syStem beino
11
NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
and registration implemented
activities should be . Registration Staff is cross-training to learn registration processes
centralized. for each clinic type.
. Privacy Film is being installed in each registration window so that if
a registration window is closed, customers will not be able to view
registration area.
Recommendation . Co-payment policies developed:
7: Centralize . Determined sliding fee scale does not apply to co-payments
finance, . Billing system and billing staff centralized
budgeting, and . Grants/contracts procedures centralized:
billing systems . Accountant coordinates contracts
. Student fees reviewed
. Travel/training to be consolidated
. Purchasing: Gathering data, vendor listings, what is ordered, etc.
. Established Central Supply Room
. Consolidated financial system:
. Consolidated budget process
. Standardized fee policy
. Evaluate accounts receivable:
. County review: Business Manager met with Bruce Shell regarding
process for utilizing County resources
. Business Manager met with Penny Lewis, State Consultant
regarding training in eligibilities, etc.
. Evaluated accounts payable
. Creation of Accountant position
. -Creation of Fiscal Operations Unit
. Transitioning of centralized purchasing and processing of
PV's/PO's to Finance Office
. Progressing towards online keying in LGFS
. Creation of Billing Unit
. Processing of invoices for swimming pool permits for EHS
The NHCHD . Support Services Division created
should consider . Human Services Agency Business Manager appointed.
appointing an . All Finance and Budget monetarily related processes/procedures
Associate Director fall under the umbrella of the Business Manager to include purchasing,
of Budget and processing of payment vouchers, daily deposits, petty cash, grants,
Finance to be contracts, budget preparation, budget amendments and budget
responsible for maintenance.
overseeing all
monetarily related
activities within the
Department.
We suggest that . Patient Care Management System is used for daily collections and
one of the near billing for patient accounts.
term priorities of . Microsoft Excel is used to balance Daily Revenues received
this position are to . Chameleon is used for daily collections at Animal Control Services.
establish a system
to monitor and
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NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
collect accounts
receivable.
The budgeting . Should review now, since budgeting process completed since
process should be suggestion was made.
examined and . Budgeting process was somewhat different for the FY 2004-05
revised as budget. Fewer copies of the Budget Workbook were made for FY05 due
necessary to to streamlining of the budget process. This was a cost savings to the
reflect and department.
reinforce the . Business Manager and the Accountant, and other Fiscal Operations
strategic plan. Staff worked with each Division Manager to compile the budget for FY
2004-05
. Should probably review now, since budgeting process completed
since suggestion was made.
. Budgeting process was somewhat different for the FY 2004-05
budget. Fewer copies of the Budget Workbook were made for FY05 due to
streamlining of the budget process. This was a cost savings to the
department.
. Business Manager, the Accountant, and other Fiscal Operations
Staff worked with each Division Manager to compile the budget for FY
2004-05
. Business Manager met with County Budget Personnel regarding
FY05 Budget for Health Department.
. Several existing budgets were consolidated for FY05. This should
allow for ease in auditing and tracking revenues and expenditures for these
programs.
All billing, . Billing Unit reviews daily activity for patient accounts.
accounts payable . Grants and Contracts are now centralized with Accountant.
and receivable, . Purchasing is being centralized in Fiscal Operations Unit (to date
budgeting, and Animal Control Services, Health Promotions, Dental, WIC, Nutrition and
grant and contract Laboratory purchasing has been transferred to Fiscal Operations.
administration
should be united in
the Finance and
Budoet Office.
Grants and . To be addressed
contracts should
be viewed as
endeavors and
commitments of
the Department.
The Department
should develop a
policy and process
for reviewing all
grant or contract
applications to
determine their
appropriateness
and ootential
13
NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
contribution within
the context of the
mission and
priorities of the
Department and
for the
administration of
grants and
contracts.
The Health . To be addressed
Department should
develop a
consistent,
reasoned
approach to
determining the
indirect costs of
grants and
contracts and
distinguish
between
recoverable
indirect costs and
matching funds.
A consistent fee . Ongoing. Many changes already implemented.
policy, including . This process is initiated with our Multi-disciplinary Committee with
the applicability of recommendations being brought forward to the Board of Health and
co-payments, ultimately the County Commissioners for their approval.
should be
developed and
adhered to
uniformly across
the Health
Department.
The policy . Ongoing. Many changes already implemented.
regarding fees
paid by UNC-
Wilmington and
Cape Fear
Community
College students
should be
reexamined.
The NHCHD . Business Manager met with County Budget Personnel to discuss
should initiate a expectations, responsibility and accountability.
joint meeting with . Business Manager and Hea~h Director met with County Finance
County Finance Director to discuss expectations, responsibility and accountability
and Budnet staff to
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NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
clearly identify . Business Manager met with County Finance Director to discuss
roles, Fiscal Operations Staff being able to key on-line into LGFS system.
responsibilities, Finance Office working through details.
expectations, and
accountability.
Recommendation . Training of staff:
8: Strengthen . as Technologies provided training to data entry staff
information . Software applications in place according to need
systems . Using new technology continually under review
management and . Hardware applications in place according to need
resources. . Centralized administrative support
. Assessing staff skills in information technology
. Reclassified an Administrative Support Supervisor position to an
Information Systems Support Specialist
. Addition of Information Systems Support Technician (funded
through Schools) requested
. Improved EquipmenVSoftware Inventory database
. Testing use of GWI for Program Support Requests
. Acquisition and implementation of HART System for Vital Records
(on-line with Register of Deeds)
. Health IT met with County IT to discuss technology plans for the
health department.
. Health IT staff were invited to participate in the County Database
Document Management System (DDMS) Committee in which they attended
meetings and demonstrations presented from various vendors being
considered for their Database Document Management Software.
. The DDMS Committee has reached a decision and the bid is being
awarded to One Source, Inc. for their Laser fiche application. Additional
components available with the Laser fiche application include workflow and
electronic forms.
. The Health Department has been selected to serve as a pilot for
this project.
. HIPAA privacy in place; security issues being addressed.
The Office of . Need full staff before it can be implemented fully. Have found
Information alternate resources and other instructors outside HD
Services and . New position created during reorganization; second new pos~ion
Administrative being requested from school health; recruitment ongoing
Services should
have as one of its
primary functions
the training of staff
in the use of
technology
hardware and
software.
The skills of . In process. Some skills identified, but could do more networking.
current staff,
reoardless of
IS
NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
position, should be
engaged to the
greatest extent
possible so as to
leverage current
Department
resources.
We strongly . Ongoing review
suggest that the
roles,
responsibilities,
and reporting
relationships of the
Administrative
Support
Technicians be
examined and
clarified.
The as system . To be addressed
should be
subjected to a
cost-benefit
analysis to
determine its
relative value to
the department. If
the system is
maintained,
training in as
access should be
provided to all
management staff
in order to
encourage access
and use of the
data.
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NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
Recommendation . Reclassified Assistant Health Director position to Health Programs
9: Centralize and Administrator
strengthen health . Reclassified Senior Health Educator to Health Education
education, Supervisor
training, and . Installation of Video-conferencing equipment
communications . County government education: In process (what our staff should do
capabilities. to educate the county)
. Marketing to be addressed
. Health Programs Administrator to coordinate media contacts
. Relocation of Health Promotion staff
. Health Programs Administrator will coordinate with staff
. Continuing education opportunities:
. Coordinating workshops for e.g.. Emerging Infectious Diseases to
be held at Cape Fear Hospital 9/16/03
. Internet access to educational opportunities for ex: UNC Institute of
Public Health available on web
. Myers Briggs Training for Staff
. Incident Command Training for Staff
. County Training Sessions for Staff
. Media Communications Plan Policy adopted on February 10, 2004
The Health . Reclassified Assistant Health Director position to Health Programs
Department should Administrator
consider . Health Programs Administrator will coordinate media contacts
appointing an . Dental health addressed by coordinating a grant proposal for
Associate Director pediatric dental health services
of Education, . Created new Health Planner position
Training, and . Continuing education opportunities: Internet access to educational
Development to be opportunities for ex: UNC Institute of Public Health available on web
responsible for . Working closely with AHEC for workshops (Meyer's Briggs,
health education Bioterrorism)
and health
promotion
activities, staff
training and
development, and
public relations
and public
information. The
Human Relations
staff should report
to this position.
The relocation of . Relocated Health Promotion staff in January 2004
health education to
a more central role
in the Department
and co-location
w~h training and
public information
and
communications
]7
NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
functions would
serve the citizens
more effectively
and represent
more effective
utilization of staff.
The Health . To be addressed
Department should . Quality assurance committed being formed
develop a . Accreditation will require standardization and we are looking at
mechanism to these issues for the future
plan, coordinate,
and evaluate
continuing
education and
training for its staff.
One major priority . To be addressed
in this area should . Accreditation involved county commissioner and Board of Health,
be to educate along with Assistant County Manager
County
government staff
and the County
Commissioners
about the services
and impacts of the
NHCHD.
Recommendation . Revised Dress Code policy on April 15, 2003
10: Conduct a . Adopted Flexible Workweek Schedule policy on November 18,
comprehensive 2003
review of . Adopted Fund Raising policy on May 6, 2003
person nel . Adopted Media Communications Plan policy on February 10, 2004
(human . Revised Parking policy on February 10, 2004
resources) . Board of Health adopted Public Contact with Board of Health policy
policies and on September 3, 2004
procedures and . Board of Health adopted Reduction in Force policy on June 4, 2003
develop a written . Revised Sick Leave Policy on April 22, 2003
handbook of
them that is . Supervisory training: Myers Briggs
consistently . Basic Supervision Wkshps. - two have been held at Cape Fear
interpreted and Hospital, one in December 2002 and February 2003
applied . Single phone/voice mail reviewed: EH moving; open access clinics
consistently . County has devised form to be signed when hiring with grant
throughout the monies
organization. . On-going process with policy, changes in old and developing new
. Personal Health Services: Less divisions, less interpretations
. More in-depth discussion
. Lunch periods addressed
. Uniform time accounting:
. Exempt/non-exempt flexibility reviewed
. Flex-time schedules: Surveys of staff completed
. Overtime/compensatory time reviewed
18
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NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
The purpose of . Currently reviewing this issue.
time accounting . New teams, new supervisors in transition
should be clearly . Added categories of coding daily activities so as to capture time
identified and spent evaluating food services plans and issuing/denying food service
articulated to all permits
staff, particularly . Developed cost centers to account Mosquito Control Program staff
emphasizing time spent fulfilling US Army COE contract
procedural
differences
resulting from job
functions and
responsibilities.
The Department . Management team discussed; staff express discontent with
should develop, accounting of time between exempt and non exempt personnel; no change
apply, and enforce made
a consistent and
uniform policy for
accounting for staff
time.
Consistent with
coverage and . Adopted Flexible Workweek Schedule policy on November 18,
service 2003
requirements,
establish and
implement a
consistent policy of
"flex time" in the
Health
Department,
including giving
employees the
option of 30 or 60
minute lunch
periods.
Positions that . To be addressed
require evening
and weekend work
should be
systematically
assessed to
determine a fair
and equitable
policy for either
overtime payor
compensatory time
off.
19
NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
We suggest . Revised Sick Leave Policy on April 22, 2003
establishing a
more "user
friendly" procedure
for employees who
have to report in
sick.
We encourage the . County has devised form to be signed when hiring with grant
Health Department monies
to work with the
New Hanover
County Human
Resource
Department in
developing a clear
and consistent
policy regarding
staff hired on the
basis of grants and
contacts.
We suggest the . Uniform allowance eliminated on June 30, 2003
NHCHD Eliminate . Revised Dress Code policy on April 15, 2003
the "Uniform . Purchased lab coats w/logo; shirts with logo to be ordered
Allowance" and
reexamine the
dress (color) code
for public health
nurses.
Each employee . Reviewed. Cannot address without adequate funding.
should have one
phone number and
one voice mailbox.
We suggest . Ongoing
training all . County workshops attended by supervisors
supervisors in the
appropriate
Department and
County personnel
policies to assure
consistent and
uniform application
across the Health
Department.
20
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NEW HANOVER COUNTY HEALTH DEPARTMENT
Organizational Analysis Update - April 2004
Recommendation . Space Allocation & Utilization Team in place (C. Hewett, J.
11: Review McCumbee, D. Rice, County IT Rep. And Property Mgmt. Rep.)
current space . Vector Control Building to be built
allocation and . Spay-Neuter Facility to be completed by June 30, 2004
use and explore . Physical relocation of Environmental Health Services to
alternatives for Marketplace Annex
improvement . Request made not to overlook mail area re: security purposes for
given existing incoming/outgoing and possibly centralizing mailboxes
funding and . Clinic space: Space Allocation & Utilization Team
resources. . Physical relocation of Care Coordination, IT, Stockroom/Supplies
and Billing Staff to 2nd floor
. Physical relocation of Community Health, Health Promotion and
Program Support Staff to 1s1 floor
. Relocation and realignment of Customer Care staff
. Expansion of registration area
. Checkout Counter for Clinic Services
. New furniture for Auditorium
. New Copier for Medical Records and General Staff
. Relocation of Inactive Medical Records to 2nd floor
. Clean-up of Hallways
. Disposal of un-needed furnishings and equipment
. Installation of Building Security System
The Health . Done (Space Committee.)
Department should . EHS relocation in August 2003 to Market Place Annex freed space
develop a in Health Department for other uses
rationale, criteria, . Space Allocation & Utilization Team (C. Hewett, J. McCumbee, D.
and mechanism Rice, County IT Rep. And Property Mgmt. Rep.), looked at team numbers,
for the allocation services provided, etc. to allocate new space; supervisors assigned
and utilization of cubicles and offices, arrange files etc. in their space
space in the . Space Team and staff have completed moves, teams are together
building. (for the most part)
. Clinic space still under going changes for Open Access clinic
. Major clean up of facilities, much improvement, no hallway clutter
New stockroom, and new store room
2]
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NEW HANOVER COUNTY
INTER-OFFICE MEMORANDUM
MEMORANDUM:
TO:
FROM:
Dave Rice, Health Director
Kemp P. Burpeau, Deputy County Attorney.1f;
RE:
DATE:
Board of Health Meetings
March 8, 2004
You have asked to what extent you may discuss with the Board of Health specific
situations arising out of current or threatened litigation. Any discussions regarding such
suits or claims could be prejudicial to the interests of New Hanover County and staff as
admissions against interest or otherwise adverse to our legal defenses. Plaintiffs
through the discovery process might obtain any such disclosures. Accordingly, we ask
that you refrain from any such conversations. Of course, this request does not pertain
to situations constituting present or future public health concerns with resulting need for
public disclosure.
KPB/kc
NEW HANOVER COUNTY
INTER-OFFICE MEMORANDUM
MEMORANDUM:
TO:
Dave Rice, Health Department Director
FROM:
RE:
DATE:
Kemp P. Burpeau, Deputy County Attorney y.ry
Litigation Confidentiality
March 31, 2004
I wish to follow up on my memo to you of March 8, 2004. As indicated, it would
be most advisable for you to refrain from discussing litigation with Board members, as
such conversations might be discoverable. However, our office can prepare case
summaries to notify you and the Board about threatened or pending litigation. Such
communication coming from our office would be entitled to attorney-client confidential
protection.
KPB/kc
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NEW HANOVER COUNTY
OFFICE OF THE COUNTY ATTORNEY
320 CHESTNUT STREET. ROOM 309
WILMINGTON, NORTH CAROLINA 28401-4095
--------TELEPHONE (9/0)34/-7 /jJ-----
CO!.V r.~~: ~t1''<<~9.J.~)/W-4170
I ~ i I ~~, , l ./":'-
AttoI'lleY' Cia'll- M.,ii"ec
N.ot Public: R'!'~C'rcl
WANDA M- COPLEY
c....,,~
ICEM1' P. BUIlPCAU
1>opoIyc....,._
to HOLT 1Il00kl, III
AIIis1aD.c...."A_
FAX TRANSMISSION COVER SHEET
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&L/ ( - 41i./v,
-Wr f &up< a~_
TO:
FAX NO.:
"ROM:
FAX NO.:
DATE:
NUMBER OF PAGES INCLUDING THIS COVER SHEET: 3
910 341-4170
PHONE NO.: (910) 341-7153
COMMENTSIMESSAGE:
CO~~r:-;lr.'~ -"I r*::-'''f:'!
.1 I" :'. 1 . ~ f: I' .:,.:
111 ,_ ._G 4 t.. 4;"
Attorney. cr.",,,;. Mattec
N9t. P/JbR~ r-...eor;i
THIS FACSIMILE TRANSMISSION CONTAINS CONFIDENTIAL AND/OR LEGAI..I.Y PRIVILEGED INFORMATION
INTENOEO ONLY FOR THE USE OF THE INDIVIDUAL(S) NAMED ON THE TRANSMISSION COVER SHEET IF
YOU ARE NOT THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT JWY DISCLOSURE,
COPYING, DISTRIBVtlON OR THE TAKING OF JWY ACTION IN RElIANCE ON THE CONTENTS OF THIS
FACSIMILE TRANSMISSION IS STRICTLY PROtllsrrED. IF you HAVE RECEIVED THIS TRANSMISSION IN
ERROR, PLEASE NOTIFY US BY TELEPHONE IMMEDlATa Y SO THAT WE CAN ARRANGE FOR RETURN OF
THE DOCUMENTS TO US AT NO COST TO YOU.
In 'A
nllb lbj:' nlR 'nfJ \IH~
';lr1r~~n l';lIDlnJlll 1 ''''nn'l I.IJ Ic.rn ':In I hnn.,_nn_\lJU
~
It
NEW HANOVER COUN1Y
INTER-OFFICE MEMORANDUM
MEMORANDUM:
TO:
New Hanover County Board of Health
Dave Rice, Health Department Director
FROM: Kemp P. Burpeau, Deputy County Attomey IfJ1
CONFIDENTIAL
Attomey..Client Matter
Not Publ/t: Record
RE: Litigation Update
DATE: April 6, 2004
A. Teresa H. Satorre. et al. VB. New Hanover County. et al.:
Several plalntllrs, paralegals for private law flnns and govemment
employees who regularly worked In the New Hanover County Judicial
Building at 316 Princess street, Initiated the suit. The plaintiffs alleged the
Courthouse was a .slck building," causing their acute health symptoms. _
The Illnesses were allegedly the result of alrbome building contaminates.
Purported symptoms were headaches, lethargy, bad taste in mouth,
drowsiness, dizzinesB. congestion. swelling. itching or irritation of eyes,
nose and throat, coughing and shOrtn888 of breath, A one-time accidental
release of a chemleel .Supco 88. and growth of fungi. mold and toxins
from water Intrusion were claimed to have caused the symptoms.
Plaintiffs asked for damages and a court order directing mold remediation.
The County retained counsel, through our carner, and flied an answer.
The Court ruled that the County's exposure for damages was limited by
sovereign Immunity. Such ruling Is now under consideration by the Court
of Appeals. The County has addresses all water Intrusion Issues, cleaned
HVAC ducts, and perfonned mold remediation. We are not aware of any
present mold conditions.
B. Gary Rummer v. t!lm.Hanover County:
Suit was filed against New Hanover County for this alleged wrongful death
of New Hanover County Jail Inmate Gary Rummer. who died while
Incarcerated In the County Jail. The suit alleged Improper perfonnance of
duties by Jailers and nurses. Mr. Rummer was incarcerated on January
14, 2003, and observed by deputies to be exhibiting abnormal behavior
consistent with alcohol-related withdrawal, The jail nurse then saw him.
While being moved to an isolation cell, he engaged In a physical 61rUggle _
with deputies and fell on a mat in a cell. The Inmate was observed to _
have a minor scratch and 8 few drops of blood above his eye, He was
t--~ ~-"
"
,
~
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again taken to the medical unit and his face and head were examined for
bruises and bumps, and the scratch was cleaned. Due to his erratic
behavior, transportation to Central Prison in Raleigh was arranged.
About one hour aftef the medical treatment, deputies found him In a deep
sleep, apparently snoring, and put him In a wheelchair and placed him in
the van to Raleigh. About one hour after arrival, Central Prison I!ilrsonnel ,
. -stated he was In a coma. He-died several days later. The County,
through counsel appointed by our insurance carrier, has flied an answer.
Discovery will now be ongoing.
Please contact me should you have any questions or concems regarding these
cases.
KPB/kc
EO 'd
OLlv Ivf. nlR 'nN ~~
';Ir\TJJf'I I'Jl..nJnlIU JILlnrv' 11.1 nf'!.I", .,,,,, J..^^"" ^^ .....
lVatiOlJa/.4SS0ciatiOIJ of Local
Boards of lIealtb
2004 InStitUtional Memher
in gOOd standing
Si~fzt"e
Our miss/ou i. to ......gth.. IDea' hoard. of hea'th, ''''''iug th.m
to Promote aud prot'ct ",. hea'", of ",.ir commuuities, through
education, technical assistance aod advOCac:-y.
MMlb.ers Onlv &ction (Visit -WWw.nalhoh.org..;..)
Password: AssodatioD
.
'.
Washington DC Office
1350 Connecticut Ave., NW
Suite 850
Washington, DC 20036
Pb.: (202) 223-4034
Fax: (202) 223-4035
nalbohdc@earthliok.nel
Ex<<utive Officen
PresUlmt
Connie Tanon (lJJ)
(435)654-2416
P,.,ident-EI6<t
Ronald C. Bu'ger (GA)
(770) 760-9647
Post 1+esidmt
Phil Lyons (U1)
(435)654-2940
Secrelarynreasurer
Gladys Curley (MD)
(410) 740.7739
Regional Directon
NonhA1/anJicRegion
~an1 N. Cohen (MA)
..)237.9852
Mui Atlantic Region
Walter Stein (NJ)
(732) 446-3220
Southeast Region
Lee K. Allen (NC)
(252) 447-3684
E4'II Grellt. Lakes Region
JUn Reccl1io (OH)
(330) 454-5698
West Grellt. Ltlkes Region
Sharon Hampson (WI)
(608) 785-2022
Mubom R"lIUm
!..any Hodlcins (Nt)
(402) 796-2254
West Region
Cuolyn Meline (ID)
(208) 233.9080
SlI1u Affi/iD1e
John F Gwinn (OH)
(330) 678-2239
SlI1u A/fiJi6Ie
Donna Rozu (WI)
')387-8121
National Association of Local Boards of Health
1840 East Gypsy Lane Road
Bowling Green, OH 43402
Phone: (419) 353-7714. Fax: (419) 352-{;278
E-mail: nalboh@nalboh.org Web: www.nalboh.org
Marie M. Fallon
Executive Director
March 1, 2004
Dear Member'
Welcome! And thank you for your 2004 membership in the National Association of
Local Boards of Health (NALBOH) - the only national organization specifically
dedicated to helping local health boards improve health in their communities. Your
membership entitles you 10 a variety of benefits, such as a copy of the quarterly
NALBOH NewsBrief for each member of your board, discounted registrations for all
your board members at NALBOH's annual meeting, and information about current
issues in public health of interest to local boards of health.
Whether you are a new or renewing member, you will find NALBOH is the source for
information about issues that affect local health boards and public health. Experienced
NALBOH board members and a professional staff ensure that services and activities
are focused on the interests and priorities of local boards of health. We strive to
provide our members with high quality, current and accurate information on public
health issues through a wide range of educational programs and services.
We look forward to your participation in two upcoming events:
. Ned E. Baker Lecture Series - April 9th, 2004 at 1 p.m. Eastern Time. lbis is a
free public health lecture that will be broadcast by satellite and web cast over the
internet for local boards of health throughout the country The featured speaker
will be Dr Richard Jackson, Senior Advisor to the Director of the Centers for
Disease Control and Prevention. lbis annual lecture is held during Public Health
Week as an opportunity for you to come together and celebrate public health week
in your community
. NALBOH's 12th Annual Conference - July 28th - 31", 2004 at the Omni
Interlocken Resort in Denver (Broomfield), Colorado. Special discounts and
exceptional educational opportunities are being planned. Wear your denim and
cowboy boots!
For more information on these and other training and education initiatives, please call
the NALBOH office, at (419) 353-7714 or check our website at <www.nalboh.org>
Please contact us if there is anything with which we may assist you. Once again, we
thank you for your support.
Best wishes,
(lU,H: ~#cM-
Connie T anon
President
National Association of Local Boards of Health
r
'UnitealVe Stand"
,<.....)
. ~, ...:.::::--
-...~.....~,~-::.
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Publishedfor Members of Local Boards of Health
First Quarter. 2004
President's Message
Connie Tatton
Boards of health around the United States have different authority for
carrying out their responsibilities. Some boards enact rules and regulations,
while others advise or make recommendations to the local governing body
for public health. All boards of health, regardless of the extent of their legal
authority, are obligated to either enact or recommend policies that serve
the interest of the public's health.
All board members are responsible for: determining or advising on public health agency policy;
adopting or making recommendations on the annual budget; determining, monitoring and
evaluating the goals of the agency and the programs implemented to meet them; and ensuring
there is adequate funding for the agency.
The primary responsibility of a board of health member is to study and learn everything possible
about the obligations of the board, health department and staff; health problems in the community;
and the need for planning solutions to address identified problems.
Board members fulfill these expectations by'
Regularly preparing for, attending, and actively participating in board of health meetings;
Understanding the meeting process and following the rules of order;
Ensuring that time at board of health meetings is set aside for updates on public health problems
and what the health department is doing, or needs to do, in regard to such challenges;
Supporting majority opinions of the board;
Continued on page 2
Rockdale County (GA) Board of Health's Sanitation and
Food Safety Excellence Award (SAFE)
Submitted by Ronald Burger, Chair, Rockdale County Georgia Board of Health, NALBOH President-Elect
The Rockdale County (GA) Board of Health recently implemented its Sanitation and Food Safety
Excellence Award (SAFE). This awards serves to recognize food service establishments that have
demonstrated outstanding food handling and sanitation practices. Prevention is the key and the
inaugural SAFE awardees in Rockdale County earned this recognition as they worked to ensure a safe
dining experience and were considered as models for others to follow. Our inaugural honorees were
provided a framed, handsome certificate during a reception in their honor. They were also
recognized in the local newspaper. They shall be permitted to display the SAFE Award certificate
along with their inspection certificate for as long as they meet the following requirements for the
award.
The parameters for our SAFE Award are as follows:
the establishment must be permitted for at least one year under current ownership and must
serve potentiality hazardous food items to the public;
the establishment shall have no confirmed food borne illness or validated complaints within the
past year;
Continued on page 2
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I NALBOHNewsBrlef
First Quarter, 20041
National Association of Local Boards of Health
Boards of Health: Prevention, Preparedness &. Power
July 28-31, 2004
Omni Interlocken Resort
Denver, Colorado
Continue to visit <www.nalboh.org> for conference 'Updates or to view hotel information visit
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Introducing Living Well,
a quarterly publication dedicated
to your well-being. A collaboration
between Cape Fear Memorial
Foundation and the New Hanover
County Health Department, Living
Well will include tips to help your
family stay healthy, information on
where to go for help in New Hanover
County, and features of interest.
Uving Well is for general information only and
should not be construed as medical advice or
diagnosis, nor as advice about treatment of any
specific medical condition.
Cape Fear Memorial Foundation was
established in 1996 with proceeds
from the sale of Cape Fear Memor-
ialHospital. Dr. R. T. Sinclair, J r.led
the establishment of the foundation
as a way to continue the hospital's
philosophy of caring. To that end,
the Foundation's primary purpose
is to serve the health and medical
needs of the people of Southeastern
North Carolina. In its first eight
years, the Foundation has worked
with over 125 charitable not-for-
profit organizations providing $15
million in support. The Foundation
rontinually seeks to partner with
well run organizatiolls that demon-
stmte an ability to provide quality
health services in our conununity;
i
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New Hanover County
Health Department
VISION
Healthy People,
Healthy Environment,
Healthy Community
MISSION
Our mission is to assure a
safe and healthy commwVty:
MOTTO
Your Health. Our Priority
'fi4itor: 1ri~h Snyder i
'~ .1.
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A day in the life of...YOU
What are the daily routines or health habits
we should practice for optimum well-being?
We asked the experts.
f
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Remember
when you
were little
and Mom
told you to
cover your
mouth
when you
sneeze or
cough?
She was right! If you have a tissue, use
that.to rover your mouth and nose, and
then throw it away. If you don't have a
tissue, cough or sneeze into your upper
sleeve, NOT your bare hands. TO HELP
STOP THE SPREAD OF GERMS,
WASH YOUR HANDS with soap and
warm water after coughing or sneezing,
or use an alcohol based hand cleanser.
Betsy Summey, Family Nurse Practitioner
New Hanover County Health Department
PLAN FOR
EXERCISE
TO BE PART
OF EACH
DAY and
make it
convenient.
Don't wait for it to be convenient.
Lori Campbell, Wellnes, Coordinator
Wilmington Family YMCA
READ DAILY. Read so that you can
make better decisions about your health.
Read so that you can support your children's
education. Read to keep your mind young
and flexible. Read to explore new worlds.
Read for fun.
Katie Morrow, Cape Fear literacy Council
^~""'~'~'"""'-"'-
TAKE TIME TO CONNECT WITH
NATURE EACH DAY - a walk on the
beach, time in the garden, or tending to a
plant on the windowsill of your apartment.
Phylis Meole, Horticultural Therapist
Ability Garden Program Director
.
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KEEP YOUR WEIGHT DOWN.
It helps to regulate blood pressure, helps
your joints, gives you a sense of personal
well-being, reduces your chances of
diabetes and coronary artery disease.
Limit your carbs, salt, sugar, processed
foods and fried foods. You'll feel better
- and be better.
Rodney Despaigne, PA-C, Navas,a Heallh Clinic
SAVE FOR
A RAINY
DAY. How
much money
have you
saved for an
emergency
such as a
jO,b loss
or sickness? It is recommended'that
every family save 3 to 6 months of
living expenses to cover expenses in
an emergency:
Diane Gatewood, Extension Agent
North Carolina Cooperative Exten!ion
'j
,
Smoke alarms save lives. Install a smoke
alarm outside each sleeping area and on each
additional level of your home.
If people sleep with doors closed, install smoke
alarms inside sleeping areas.
Use the test button to check each smoke
alarm once a month. When necessary, replace
batteries immediately. Replace all batteries at
least once a year.
Vacuum away cobwebs and dust from your
smoke alarms monthly.
Smoke alarms become less sensitive over time.
Replace your smoke alarms every ten years.
Consider having one or more working fire
extinguishers in your home. .Get training from
the fire department on how to use them.
Consider installing an automatic fire sprinkler
system in your home.
Plan Your Escape Routes_
Determine at least two ways to escape from
every room of your home.
Consider escape ladders for sleeping areas on
the second or third, floor. Learn how to use them
and store them near the window.
Select a location outside your home where
everyone would meet after escaping.
Practice your escape plan at least twiCe a
year.
Escape Safely
Once you are out, stay out! Call the fire
department from a neighbor's home.
If you see smoke OL fire in your first escape
route, use your second way out. If you must exit
through smoke, crawl low under the smoke to
your exit.
If you are escaping through a closed door, feel
the door before opening it. If it is warm, use
your second way out.
If smoke, heat, or flames block your exit routes,
stay in the room with the door closed. Signal for
help using a bright-colored cloth at the window.
If there is a telephone in the room, call the fire
department ;lnd tell them where you are.
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What's In Your First Aid Kit?
Every Family Needs One
Being properly prepared with first aid supplies makes it easier and less stressful to deal with an
emergency. Always keep your first aid kit in the same place. That way it will be easy to find even
during an emergency. Anyone who is old enough to stay home alone, should be old enough to
know where the kit is, and how to use i>--~ A typical kit should include medicines, bandages,
and certain tools. The items listed ~ below fit in a shoebox size container.- aspirin,
and acetaminophen, such as / ."';:, Tylenol- an antiseptic such as hydrogen
peroxide- an antihistamine, ~ such as Benadryl, that can be taken by
mouth- Calamine or Caladryl O. lotion- a medicine to treat diarrhea
such as Lomotil, Immodium, or'Oo Pepto Bismol- an antibiotic ointment
such as Neosporin- sterile 4 by 4 inch gauze pads, and roller
gauze- various sizes of adhesive bandages, such as Band-Aids- an
elastic compression bandage such as an Ace wrap- cotton swabs- non-
allergenic adhesive tape- scissors, tweezers, and several needles- matches-
a thermometer- safety pins- a spoon.
There are many good first aid books at local bookstores. Be sure to include one in your ,kit. Post
emergency phone numbers by each telephone. Most of all, be sure your family members know how
to prevent fires, broken bones and drowning. Should a serious event occur, make sure they know
how to safely respond. Consider taking a First Aid and/or a CPR course. Holding first aid drills will
help your family prepare for emergencies.
Protect
Yourself
Agai nst Cancer:(
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Test or Procedure Sex Age Frequency
Sigmoidoscopy M&F Over 50 Yearly for 2 negative years, then
every 5 years
Stool guaiac (blood) M&F Over 40 Every year
test
Finger rectal M&F Over 40 Every year
examination
Pap smear F 20-100; under 20 'Yearly over 20
if sexually active
Pelvic exam F Over 20 Yearly over 20. If hysterectomy
(but ovaries still in place) then
every 2 - 3 years
, Endometrial biopsy F If abnormal bleeding only
Breast, self.exam F Over 20 Every month
Breast, physical F Over 40 Annual
examination by M.D.
Mammogram - F Over 40 Annual
Chest x-ray M&F As recommended by physician
Health counseling M&F Over 20 Every 3 years
and cancer M&F Over 40 Every year
checkup"
PSA (prostate M Baseline at 50; then every 2-
antigen blood test) 3 years (more often over 60)
depending on digital rectal exam
'summary of American Cancer Society and National Cancer Institute
.. To """'''" _0. of ."",d, ....,., pro_ 0....., lymph...... ... ".~ ... \ .
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Being Active - ANYWHERE!!
Being physically active is much easier than you
thought possible. You don't have to join a health
club or spend hours doing exercises you hate. You
don't even have to change your clothes. Best of
all, you can get fit ANYWHERE - ANYTIME of day!
Check with your physician before beginning an
exercise program.
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WHY make physical
activity part of your day?
ENJOY the pleasure that comes
from getting stronger and healthier.
BOOST your brainpower and your energy levels
all day long.
IMPROVE your strength and endurance (both
physical and mental).
ENHANCE your natural good looks from the
inside out.
PROTECT yourself from the pain of heart
disease, cancer and osteoporosis.
WHAT activities are the healthiest
choices?
For overall health, your best bet is to enjoy a
wide variety of physical activities, just follow
the 30-10-5 rule: at least 30 minutes of physical
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activity a day, at least 10 minutes at a time, at
least 5 days a week. For best results, give your
body what it deserves. '
Fun activities - because they are the ones you'll
stick with!
Aerobic activities - that get your heart pumping,
like brisk walking or dancing.
Body-shaping activities - to maintain muscles,
like lifting weight or groceries
Stretching activities - for flexibility and tone,
like water aerobics or gardening.
Balance activities - to strengthen bones and
prevent falls, like yoga or bicycle riding.
HOW can I make activity part of
every day?
With a few simple guidelines, you can make
physical activity part of your day even with a
hectic schedu~e. Look for all the easy ways to
include fitness into your life.
Play more: Feel like a kid again by skating,
swimming, playing ball or flying a kite.
Use leg.power: Walk the dog, walk to the store,
walk around the mal, just walk.
Hide the remote: Change the channels the old
fashioned way - by getting up!
Practice inefficiency: Make multiple trips on
the stair's or to the car for groceries.
Pick up the pace: Use a longer stride when you
walk - everywhere, all the time.
Eating Well - Anytime
Making healthful food choices is much easier than
you thought possible. There's no need to follow
a complicated diet, to count every calorie or to
avoid your favorite foods. Even better, it's easy to
eat healthfully ANYTIME of day - ANYWHERE you
decide to eat.
Why make healthier food choices
everyday?
ENJOY great taste and
good health in every
bite you take.
BOOST your brainpower
for learning, working
and playing.
ENERGIZE your body
and mind for all the
things you want to do.
ENHANCE your health
from head to toe, on
the inside and the
outside.
PROTECT your whole body - heart, bones,
muscles, eyes, ski n and more!
WHAT foods are the healthiest
choices?
For high-energy health, choose minimally
processed, whole foods. These are the best
sources of the 70+ nutrients your body needs every
day. Whole foods are cheaper than supplements
and the nutrients in them are usually better
~
..
absorbed. Your best bets are:
Fruits and vegetables (fresh, frozen, canned and
dried) - 5 to 9 servings a day
Whole grains (breads, cereals, rice, pasta arid
snacks) . 3 servings a day ...
Low-fat dairy foods (1% or less milk, yogurt and
cheese) - 2 to 3 servings a day
Legumes and plant proteins (beans, peas, nuts
and seeds) - 1 to 2 servings a day
Lean animal proteins (meat, poultry, fish and
eggs) - 2 to 3 servings a day
HOW can I make these foods part-of
my day?
With a few simple guidelines, you can enjoy POwtoT
foods from morning 'til night. Look for tasty
choices everywhere - at home, in restaurants and
at the supermarket.
Eat early: Start every day with a protein, a whole
grain and a piece of fruit
Snack regularly: Include a protein for maximum
satisfaction and lasting energy.
Select bright colors: Pick colorful fruits and
vegetables to fill half your plate.
Go for lean: Choose lean meats and skinless
poultry to minimize your saturated fat.
Choose crunchy: Go for grains, nuts, seeds aoo
vegetables to pump up your fiber.
Used by permission from NC DHHSIDivision of Public Health
FOR MORE INFORMATION
Ability Garden
(910) 452-6393
American Red Cross
(910) 762-2683
Cape Fear Healthy Carolinians
(910) 790-9949
Cape Fear Literacy Council
(910) 251-0911
Cooperative Extension Service
(910) 452-6393
Navassa Health Clinic
(910) 383-6981
New Hanover Community Health Center
(910) 343-0270
New Hanover County Health Department
(910) 343.6500
New Hanover Regional Medical Center
(910) 343-7000
Wilmington Family YMCA
(910) 251-9622
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EMERGENCY NUMBERS
FOR WILMINGTON AND VICI~ITY
Fire, Police and Ambulance 911
Carolinas Poison Center 1-800-848-6946
Crisis Line (910) 392-7408
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A day in the life of...YOU
What are the daily routines or health habits
we should practice for optimum well-being?
We asked the experts.
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TAKE TIME FOR YOURSELF each
day, I am a firm adherent to the early
morning. No telephone ringing..,no
requests being made of me except me
requesting my body to move. I have a cup
of coffee, pray, do my sit -ups, then hit the
ell~tical machine in my bedroom, I find
this time to be crucial to how centered
I am for the rest of the day. I focus on
God as the center of my life, then I ask
my body to get on board, Doing this
deliberately and not as an afterthought
helps me be the best I can be.
Susan Dillard, Preschool teacher
HUG THE PEOPLE
YOU LOVE everyday,
Anne and John Colter, Happily Married Couple
BE AWARE
OF YOUR
POSTURE
AND
BREATHING;
maintain
I flexibility
I throughout
I
----~7-...' your lifetime.
Lorrie Wagner, 0'~~~ed Yoga Teacher
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PRACTICE
GOOD
POSTURE.
In addition to
making you
appear taller
and 5 pounds
thinner, it will
help reduce
the likelihood of -acquiring back and neck
injuries, reduce spinal degeneration, and
help keep your spine and body happy and
healthy. By standing tall you will contract
your abdominal muscles, shoulders will
stay back and you will be looking forward
instead of down at the ground.
Marci Fontaine, Exercise Physiologist
HOW
YOU
TAKE
CARE
OF YOUR
HEALTH
TODAY IS HOW YOU WILL LIVE
TOMORROW. If you think it's too late to
take charge of your health, think again! It
is never too early or too late to begin.
Many of us feel that good health is simply
a matter of being lucky or uulucky. We
forget that an investment from us into our
body's health ''bank'' will keep it running
smoothly. There's always time to create a
healthier you, no matter how many years
of neglect might be behind you. Many
resources exist in our community to help
you achieve your health goals, If you are
already there, consider volunteering your
time to help others achieve theirs!
Barbara Shel4 Chair
Cape Fear Healthy Carolinians
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i BRUSH YOUR
I TEETH DAILY
I with a fluoride
\ toothpaste,
\ It's important
I , j'", for your dental
Ii:. . health. Equally
I I'
\ ._' important is
maiiitaining a normal, healthy saliva flow.
There are many medical conditions and
medications, both prescribed and over
the counter, that can diminish saliva flow,
This can have disastrous consequences.
It is imperative that you discuss this with
your dentist in order that preventative
measures may be taken to avoid problems
with teeth and gums.
Greg Howard, DDS
I
LET THE
CHILD IN
YOU COME
! ' OUT,lighten
f up and see the
humor in things.
Make every day a
I happy one, Laugh
--'---~"""""~, - it's healthy, it's
a stress reliever, it's exercise, iI's healing,
and it makes you feel soooo good,
Stephanie Carr
Certified Laugh Therapist
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IT'S
IMPORTANT
TO GET ?TO
8 HOURS OF
SLEEP each
night. Don't
drink alcohol
at bedtime...
and don't smoke!
Doug Lee, M,D,
,_ Wilmington Health Associates
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I I
I !
Too much I II!
stress for I
too long a ~___.__ !
time can affect your health, -
Take action to KEEP STRESS FROM
TAKING OVER YOUR LIFE. That
might mean closing your eyes and
picturing yourself in a peaceful place,
taking a walk or doing yoga.
Carolina Hernandez, MD
New Hanover Community Health Center
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To be as fit and healthy as you can be
EAT VEGETABLES AND FRUIT
with every meal and top it off with a
cup of tea.
Heidi Kaufman, outpatient dietitian
New Hanover Regional Medil:aI Center
STARTING
yoUR DAY
WITH 30
MINUTES
OF PHYSICAL ACTIVITY could
be the most important thing you do
for yourself that day,
John Rader, Ed.D" Dean of Education,
New Hanover Health Network
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