Local Health Care - Looking Down the Road
The Health Planning Council for
Central North Carolina presented to the
Durham County Commissioners this week
a set of far-reaching recommendations
concerning the total health care needs of
the county.
The report is the product of nine
months of exhaustive study by more than
100 people. Including many from Duke.
It was prompted fay the question of
what to do with Watts Hospital and
Lincoln Hospital when the new Durham
County General Hospital is completed in
1976. The council undertook the study
last summer with financing from the
County Commissioners.
What has emerged is a plan for a
coordinated system of primary health
care services that would be available to all
county residents. The recommendations
are practically all in the direction of
ambulatory services rather than inpatient
services. They are also In the direction of
health education, prevention of disease
and health maintenance rather than on
treatment after diseases have occurred.
The council believes, therefore, that in
the long run these recommendations
should not increase the overall per capita
cost of personal health services in the
county.
The major problems which the council
found in Durham County are similar to
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VOLUME 20, NUMBER 19
MAY 11, 1973
DURHAM, NORTH CAROLINA
Dr. Albert Heyman Cautions 'PilV Users
The coordinator of a study linking oral
contraceptives with an increased risk of
strokes says the findings should caution
physicians and patients regarding use of
"the pill."
Dr. Albert Heyman, professor of
neurology at Duke, said doctors
prescribing birth control pills should "be
aware of any previous blood vessel disease
or clotting problems a patient may have
had" and should be wary of prescribing
the pills for women with high blood
pressure.
Heyman also noted that since the
estrogen content in the oral
contraceptives has been thought to be
related to increased risk of blood clotting
disorders, the use of low-estrogen brands
is important.
Heyman coordinated a collaborative
study at 12 university medical centers in
the United States which showed that
women who use birth control pills face a
nine times greater risk of strokes than
women in the same age group who do not
use the pills.
The study was published in the current
issue of The New England Journal of
Medicine.
Before the end of the year, Heyman
said, more data from the study will be
reported which should help to clarify the
risks involved.
This information will include findings
on women who may be at greatest risk of
a stroke. Heyman said the relation of
clinical disorders such as hypertension,
diabetes and migraine to pill-taking and
DR. ALBERT HEYMAN
Commencement Exercises
(This is not the complete commencement program for the university, but relates
only to events involving students from the medical center.)
Saturday, May 12 *
11:00 A.M. Hippocratic Oath Ceremony. Graduates in Medicine. University Chapel.
Speaker: Dr. Thomas D. Kinney, director of medical and allied health
education.
Recognition ceremony for graduates in nursing. University Chapel.
Presiding: Dr. Ruby L. Wilson, dean. Speaker: Dr. Lois Pounds, assistant
professor of pediatrics and .assistant professor of nursing. A reception
will follow the service. Union Ballroom.
Baccalaureate Service for the graduating classes receiving advanced
degrees. University Chapel. Sermon delivered by The Rev. Professor Hugh
Anderson, B.D., Ph.D., D.D., New College, University of Edinburgh,
Edinburgh, Scotland.
Outdoor reception in honor of all graduating classes. East Duke Lawn.
East Campus. (In case of rain, the location will be the East Campus
Union.)
Sunday, May 13
10:00 A.M. Baccalaureate service for the graduating classes receiving Bachelor's
Degrees. University Chapel. Sermon delivered by The Rev. Hugh
Anderson, B.D., Ph.D., D.D., New College, University of Edinburgh,
Edinburgh, Scotland.
3.00 P.M. Graduation exercises. Cameron Indoor Stadium. Presiding: President
Terry Sanford. Commencement address. Conferring of degrees.
Presentation of the Graduate School doctoral diplomas.. Paul M. Gross
Chemical Laboratory. Presiding: Dr. John C. McKinney, dean. Remarks
by President Terry Sanford.
1:00 P.M.
3:30 P.M.
6:00 P.M.
5:30 P.M.
the risk of stroke is being evaluated.
In the study the authors emphasized
that strokes in women of childbearing age
are still very uncommon even though the
risk in those taking "the pill" is greatly
increased.
In an editorial accompanying the
report, it was noted that research in
Britain has found that about one woman
in 10,000 who take oral contraceptives
may suffer a stroke because of them. An
estimated six million married American
women use the pills.
Other recent studies have linked the
use of oral contraceptives with increased
risks of other clotting disorders such as
thromboembolism, in which a clot
develops in a leg vein. When such a clot
breaks loose and lodges in the lungs, it is
called a pulmonary embolism. A
relationship between pills and strokes had
been suspected, but had not been defined
or confirmed previously.
The collaborative study involved 598
young women who were admitted to 91
participating hospitals in 12 cities after
suffering strokes in the two-year period
from 1969 to 1971. Each stroke victim
was matched with two controls—one a
woman with an illness other than stroke
who was admitted to the same hospital,
and one a woman from the same
neighborhood as the stroke victim.
The stroke patients ranged in age from
15 to 44, although well over half were 35
to 44 years old.
The data showed that the risk of a
thrombotic stroke—one involving a clot in
an artery of the brain—is nine times
greater among women using oral
contraceptives than among non-users.
Approximately 9 per cent of the patients
who suffered thrombotic strokes died as
compared to about 44 per cent of those
with brain hemorrhage.
The study also found that pill users
developed hemorrhagic strokes, in which
an artery in the brain bursts, twice as
frequently as nonusers. The researchers
said "no explanation for this finding is
apparent at present." But they noted that
it could be explained by the increase in
blood pressure which is sometimes
associated with pill use.
Interviews with women, included in the
study also indicated a possible
relationship between cigarette smoking
and pill-induced clotting disorders.
"One of the striking findings in this
study is the high proportion of women
with stroke (73.8 p>er cent) who currently
or at one time smoked cigarettes
regularly,"the study said. Only 43.4 per
cent of the neighbor controls smoked.
(Continued on page 3)
those found elsewhere in the nation.
There are plenty of specialists, but few
primary care physicians; inpatient care is
excellent, but out-patient departments
are geared to specialty programs;
ambulatory care is fragmented and
unsatisfactory. The council found that
the Duke Hospital Emergency Room is
still the major source of ambulatory
patient care in the county.
Because of the finding that inpatient
services in the county are more than
adequate, one of the council's major
recommendations is that acute inpatient
care be phased out at Lincoln and Watts
Hospitals when the new county hospital
is completed. The study suggests a variety
of primary care services as well as
preventive care, health maintenance and
health education services for which the
two hospitals could be used.
Here are the major recommendations:
—Hospitals:
For Lincoln Hospital, the major
recommendations are, that the Lincoln
Community Health Center expand into
the total usable area of the building and
that community mental health services
there be expanded. The present health
center has an enrolled population of
14,000, and it is estimated that the
expanded center could care for 20,000 to
25,000 persons.
For Watts Hospital, the committee
recommends several community needs
that could be met using the facilities.
These include a neighborhood health
center similar to the one .at Lincoln; a
wide range of special outpatient programs
headed by the Durham County
Community Mental Health Center; and
retention of the School of Nursing.
The council has recommended that a
building study be made of both hospitals
to determine the practicability of
renovating the structures to meet
proposed uses.
— Durham Health Council: That a
Durham Health Council be formed as a
branch of the Health Planning Council for
Central North Carolina to see that the
recommendations of the report are
carried out by the responsible authorities.
The council would also be responsible
(Continued on page 3)
’Acting Dean?’
More than That
In a recent issue of "Intercom,"
Professor Ann Jacobansky of the School
of Nursing was referred to as having been
an "acting dean" of the school.
That was true as far as it went, because
Miss Jacobansky was acting dean for a
year and a half in 1970-71.
But "Intercom" failed to point out
that Miss Jacobansky earlier had served as
dean for nearly 13 years—the longest
period of service of any dean in the
School of Nursing's history.
Here is a list of the deans of the
School of Nursing and their years of
service:
—Miss Bessie Baker (who organized the
School of Nursing), April 29, 1929 to
July 1, 1938. Miss Baker died June 23
1942.
-Miss Margaret I. Pinkerton, Oct. 1,
1939 to Oct. 1, 1946. She died Jan. 31
1973.
-Miss Florence K. Wilson, Oct. 1,
1946 to Nov. 6, 1954. She died May 6
1960.
-Miss Ann Jacobansky, Jan. 1, 1955
to Aug. 31, 1967.
—Dr. Myrtle Irene Brown, Sept. 1,
1967 to Jan. 31, 1970.
-Miss Jacobansky, acting dean from
Feb. 1, 1970 to June 30, 1971.
—Dr. Ruby Wilson, dean since July 1
1971.