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PubMed1999

Survey of the stocking of poison antidotes in Alabama hospitals.

BACKGROUND: We wanted to estimate the current antidote supply in Alabama hospitals, establish if certain antidotes were stocked more than others, and identify certain parameters (eg, treatment level of care, licensed bed size, or county population) as predictors for the current antidote supply. METHODS: We faxed surveys to treatment level I/II hospitals and a random sample of treatment level III hospitals. Antidote supply was reported for digoxin immune Fab, pyridoxine, ethanol, pralidoxime, antivenin (Crotalidae), deferoxamine, cyanide, naloxone, and fomepizole. RESULTS: Of treatment level I/II and level III hospitals surveyed, 28 (100%) and 20 (71.4%) responded, respectively. None (0%) of the hospitals surveyed had adequate stocking for all nine antidotes. The results illustrate the common practice of understocking poison antidotes. CONCLUSIONS: Hospitals must reevaluate their current antidote inventories for meeting the needs of acutely poisoned patients. Policy containing specific guidelines must be developed and uniformly adopted as standard of practice.

Alabama↗
PubMed2001

Opportunities to improve prevention and services for HIV-infected women in nonurban Alabama and Mississippi.

OBJECTIVE: The intent of this study was to identify opportunities for improving the effectiveness of HIV prevention before nonurban (rural and small-city resident) Southern women are infected and the medical and social services offered to them after they are infected. METHODS: At several HIV clinics in nonurban Alabama and Mississippi, women with HIV infection (who reside in small cities and towns outside of Birmingham) were identified and interviewed about the period during which they probably acquired HIV and about their needs and the services provided after they were found to be infected with HIV. RESULTS: Before they were infected, these 211 young (mean age, 33 years), mainly African-American (67%) women often reported being seen at HIV testing sites (37%) and, among drug users, at drug treatment facilities (30%), where they presumably received counseling to prevent becoming infected. Once infected, many (21%) said they were not directed to HIV treatment sites, half (50%) were sexually active in the month before they were interviewed, many (13%) sought treatment of sexually transmitted diseases in the 12 months before the interview, and many (36%) reported unmet needs for HIV treatment related to having no insurance or Medicaid. CONCLUSIONS: Prevention and treatment of HIV for nonurban Southern women are not fully effective. Given the continued sexual activity of these women, more focus on preventing transmission from persons who are already infected is warranted.

Adult↗
PubMed2004

Syphilis outbreak among Hispanic immigrants in Decatur, Alabama: association with commercial sex.

BACKGROUND: Despite national progress in syphilis control, increases in rates have recently occurred, and syphilis is still an endemic problem in the southern United States. An outbreak of infectious syphilis among Hispanics was identified in Decatur, Alabama. GOAL: An investigation was initiated to describe the outbreak and to assist with prevention activities. STUDY DESIGN: We reviewed case interview records and syphilis surveillance data. The Morgan County Health Department (MCHD) performed voluntary door-to-door syphilis screening in neighborhoods where a large number of cases had been identified. During screening activities, sociodemographic and behavioral data were collected. RESULTS: From June 2000 to February 2001, 49 cases of syphilis were reported; 26 (53%) were primary or secondary, 17 (35%) were early latent, and 6 (12%) late latent. Of the early syphilis cases, 70% were male and half were Hispanic; 93% of cases were linked to commercial sex and 70% of female cases reported crack cocaine use. During the screening, 172 individuals completed a questionnaire; 70% of participants were male, 83% were Hispanic, 17% of Hispanic participants spoke English, 21% reported sex with a commercial sex worker, and 8 (5%) had positive syphilis serology. Among men, factors associated with commercial sex were not having a regular partner (odds ratio [OR], 3.9; confidence interval [CI], 1.1-14.3), not living with a family member in the United States (OR, 4.5; CI, 1.6-12.8), and having visited their country of origin since arrival to the United States (OR, 9.2; CI, 2.3-36.5). CONCLUSIONS: Factors contributing to this outbreak were crack cocaine use and increased prostitution in close proximity to the Hispanic community. At present, there are an increasing number of Hispanic immigrants in the United States, the majority of whom do not speak English. To prevent similar outbreaks in the future, public health officials need to be aware of the health and health education needs of these populations.

Adolescent↗
PubMed2006

Association of Chlamydia trachomatis Serovar Ia infection with black race in a sexually transmitted diseases clinic patient population in Birmingham, Alabama.

BACKGROUND: Black race is a risk marker for Chlamydia trachomatis infection. Because chlamydial serovar and race could both influence the transmission dynamics of chlamydia, studies characterizing serovars in a predominantly black population are of interest, yet remain sparse. STUDY DESIGN AND GOALS: C. trachomatis isolates collected consecutively from 109 female and 98 male patients presenting to a sexually transmitted disease clinic in Birmingham, Alabama, were serotyped. Our goal was to evaluate serovar distribution and associated demographic characteristics in a predominantly black population. RESULTS: The median age was 23 years and 91% were black. Serovars E (29%), D (19%), F (19%), Ia (16%), and J (9%) were the most prevalent. Blacks were less often infected with serovar E (30% vs. 41%) and J (9% vs. 24%), but more often infected with serovar Ia (17% vs. 0%) compared with individuals of other racial groups (P = 0.07). The overall serovar distribution did not significantly differ by gender or age; however, serovar Ia infections were associated with older age (21% in age >or=23 years vs. 10% in those age <23 years; P = 0.03). CONCLUSIONS: Although the overall C. trachomatis serovar distribution in this predominantly black population in Birmingham was similar to that reported elsewhere, serovar Ia was only found in blacks, in whom it was commonly isolated. Finding differences in serovar distribution by race, particularly serovar Ia, may be of epidemiologic significance and deserves verification in similar cohorts.

Adolescent↗
PubMed1995

Risk factors for death in the 27 March 1994 Georgia and Alabama tornadoes.

Field surveys were made one week after tornadoes killed 40 persons and injured over 300 in rural regions of Alabama and Georgia, USA, on 27 March 1994. Surveys were completed for samples of 20 persons who were killed and 31 persons who were in the paths of the tornadoes but survived to determine whether there were differences in personal characteristics, behavior or location between the two groups. Persons who died were significantly older than persons who survived, more likely to be in mobile homes or in rooms above ground with windows, less likely to be watching television before the tornado, and were aware of the approaching tornado for less time than survivors. There was no difference in gender, race, marital status, education, disability or previous experience with tornadoes between those who died and survivors.

Adult↗
PubMed2004

The impact of S-CHIP enrollment on physician participation in Medicaid in Alabama and Georgia.

OBJECTIVE: To assess whether increasing enrollment in State Children's Health Insurance Programs (S-CHIPs) has an impact on the number of office physicians participating in Medicaid and the extent of their participation. Effects are measured for a freestanding S-CHIP program with an open provider panel and an S-CHIP program that uses the state's Medicaid provider panel. DATA SOURCES: Children's Medicaid claims data for primary care services were used to measure physician participation in the program; census and enrollment data were used to describe market area characteristics. Study Design. This is a time series study of communities in two states, measuring physician Medicaid participation quarterly between 1998 and 2001, controlling for changes in community characteristics and children's program enrollment as well as other factors by quarter. DATA COLLECTION/EXTRACTION: Office physician participation is measured by practice site. Claims data are aggregated to the level of the community and reflect the number of limited practice sites, the ratio of Medicaid office sites to the number of primary care physicians in the community as reported by the American Medical Association (AMA), and the mean number of Medicaid office visits made to physician sites in the community in the quarter. FINDINGS: In Alabama, the state with a freestanding S-CHIP program, there is little association between increased S-CHIP enrollment and physician participation in Medicaid. In Georgia, where the same provider network serves both programs, increases in S-CHIP enrollment are associated with a decline in office-based physician participation in Medicaid in urban areas. CONCLUSION: Linkage of S-CHIP and Medicaid programs through the use of the same provider network, in the absence of market conditions that encourage the expansion of the network, can lead to a negative impact on access for Medicaid enrollees.

Adolescent↗
PubMed2005

Cancer risk factors of Vietnamese Americans in rural south Alabama.

PURPOSE: To identify aggregate-specific cancer risk factors of Vietnamese Americans in south Alabama and present a comparison with available national data and Healthy People 2010 targets. DESIGN: Cross-sectional survey. METHODS: A convenience sample of 284 Vietnamese community residents 18 years and over completed an investigator-designed questionnaire. Data were analyzed using descriptive correlational analysis. FINDINGS: Aggregate-specific cancer risk factors included high prevalence of hepatitis, high smoking and drinking rates in men, extended sun exposure without protection, knowledge deficit of cancer and cancer screenings, and low cancer screening rates. Educational level was significantly related to many cancer risk factors. CONCLUSIONS: Significant cancer risk factors exist in the target population in comparison to available national data and Healthy People 2010 targets. More focused cancer prevention and early detection efforts should be initiated for this underserved population. Future research is needed to (a) determine the effect of acculturation on cancer risk factors and (b) develop culturally appropriate interventions to improve the effectiveness of cancer prevention and early detection interventions in this subgroup of Asian Americans.

Acculturation↗
PubMed1997

Recruitment issues in school-based research: lessons learned from the High 5 Alabama Project.

School-based research requires a multi-level recruitment process to ensure an adequate sample. This article describes the High 5 Alabama recruitment experience at four levels; district, school, classroom and individual. One hundred percent of 28 schools across three districts and 108 classroom teachers contacted agreed to participate. Moderate success (69%) at the individual level, which required active parental consent for the student and parent to participate, resulted in 1,698 student/parent participants. An examination of differences between participants and nonparticipants revealed under-representation of a subsample of the population in the project sample. Suggestions obtained from project staff and teachers intended to enhance future school-based recruitment strategies include enlistment of a district advocate; meeting with teachers to solicit support; using incentives with students and teachers; direct contact with parents; having teachers keep rosters of students returning consent forms; and tailoring recruitment strategies for specific subpopulations.

Adolescent↗
PubMed2002

Using technology to teach health: a collaborative pilot project in Alabama.

The Centers for Disease Control and Prevention (CDC) identified six adolescent risk behaviors that contribute to chronic diseases and disorders, including poor dietary habits, sedentary lifestyle, and abuse of alcohol, tabacco, and other drugs. This project pilot-tested a "train-the-trainer" model to diffuse an interactive health education software program into Alabama middle schools during a school year. Developmentally appropriate content included nutrition, physical activity, and prevention of substance use. Twenty-four site facilitators selected from 18 public school systems trained 364 colleagues and 2,249 students to use the software. During a school year, facilitators created 150 student assignments; they reported increased interest among students in health instruction. An essential feature of the project involved an active partnership among the funder, state department of education, university, and public schools. Planners provided technical assistance through face-to-face interaction, distance learning, telephone and e-mail communications, and a Web site. Planners and facilitators worked together to overcome barriers to the use of technology for health instruction.

Alabama↗
PubMed1992

Entrance and exit of obstetrics providers in rural Alabama.

In Alabama between 1985 and 1989, a total of 94 physicians outside of the four largest cities in the state dropped the obstetrics portion of their practices or left practice in their communities altogether. During the same period 82 physicians entered obstetrics practice in this area. The study presented here used survey and archival data to compare practice characteristics of generalists and specialists in rural and town counties who made different decisions about providing obstetrics care. More generalists left and more specialists entered practice both in town and in rural counties. Rural counties lost more obstetrics providers because more generalists provided the obstetrics care in these areas. Across both specialty and county categories, physicians in group practice who accepted Medicaid and had local access to larger numbers of patients were more likely to remain or begin new obstetric practices. During this period, some obstetrics specialists moved into rural communities that had previously supported only generalist physicians. These findings suggest that the options for organizing successful obstetrics practices have narrowed, putting solo and generalist physicians who operate small-scale obstetrics practices at a disadvantage. These physicians also face competition from obstetrics specialists who are beginning to enter practice in the rural areas of the state. Designing policies that effectively improve geographic access to care requires a realistic understanding of the practice constraints faced by obstetrics providers. For example, as centralized specialist group practices serve residents from surrounding rural areas, programs that facilitate linkages, such as satellite clinics and use of mid-level practitioners, can be promoted.(ABSTRACT TRUNCATED AT 250 WORDS)

Alabama↗
PubMed2003

Children's health insurance status, access to and utilization of health services, and unmet health needs in a rural Alabama school system.

PURPOSE: This study examines the relationship between children's health insurance status and utilization of health services, establishment of a medical home, and unmet health needs over a 3-year period (1996-1998) in a rural Alabama K-12 school system. METHODS: As part of a children's health insurance outreach program, questionnaires were administered to parents of 754 children regarding health and health care access. In addition, noninvasive head-to-toe physical assessments of children were conducted on-site at 4 schools. FINDINGS: A relationship between health care utilization and insurance status was observed. Results found that insured children had 1.183 (P < .0115) times the number of medical visits as uninsured children. Among uninsured children, the time since last dental visit was 1.6 (P < .001) times longer than that of insured children. Also, insured children were 5.21 times more likely than uninsured (P < .0001) to report having a medical home. No significant differences between insured and uninsured children were found regarding unmet health needs as measured by referrals made after the children's physical assessments. CONCLUSIONS: Child health coverage is an important determining factor in the ability of families to access and utilize health care services. These findings have implications for populations in similar rural communities across the nation.

Adolescent↗
PubMed2003

The Southern Rural Access Program and Alabama's Rural Health Leaders Pipeline: a partnership to develop needed minority health care professionals.

Rural Health Leaders Pipeline programs are intended to increase the number of youth interested in and pursuing health professions in rural communities. This paper presents 2 complementary approaches to Rural Health Leaders Pipeline programs. Two different organizations in Alabama recruit students from 18 specified counties. One organization is a rural, community-based program with college freshmen and upperclassmen from rural communities. Students shadow health professionals for 6 weeks, attend classes, visit medical schools, complete and present health projects, and receive support from online tutors. The second organization is a university-based program that supplements an existing 11th grade-medical school rural medicine pipeline with 10 minority students from rural communities who have graduated from high school and plan to enter college as premedical students in the following academic year. Students participate in classes, tutorials, seminars, and other activities. Students earn college credits during the 7-week program, maintain contact with program staff during the school year, and by performance and interest can continue in this pipeline program for a total of 4 consecutive summers, culminating in application to medical school. Each organization provides stipends for students. Early experiences have been positive, although Rural Health Leaders Pipeline programs are expensive and require long-term commitments.

Adolescent↗
PubMed1988

Symmetrical erosive peripheral polyarthritis in the Late Archaic Period of Alabama.

Rheumatoid arthritis was first described unambiguously in 1800, but its etiology and historical origins are still obscure. Definite rheumatoid arthritis has not been demonstrated in pre-19th century Old World skeletal remains. Six individuals who lived 3000 to 5000 years ago in northwestern Alabama and present erosive polyarthritis characteristic of rheumatoid arthritis are described. The diagnosis raises the possibility that rheumatoid arthritis can be associated with a New World pathogen or allergen.

Alabama↗
PubMed1999

Syphilis, gonorrhoea, and drug abuse among pregnant women in Jefferson County, Alabama, US, 1980-94: monitoring trends through systematically collected health services data.

OBJECTIVE: To assess the association between self reported drug abuse and syphilis and gonorrhoea among pregnant women, Jefferson County, Alabama, United States, 1980-94. STUDY DESIGN: We analysed a prenatal care database and assessed the association of self reported drug use with seropositive syphilis and gonorrhoea using prevalence rates, multiple logistic regression models, and the Pearson correlation coefficient (r) for trends. RESULTS: Overall, 5.5% of the women acknowledged drug abuse, 1.4% had seropositive syphilis, and 4.8% had gonorrhoea. In a multivariate analysis, drug abuse was associated with syphilis (odds ratio 2.9, 95% confidence interval 1.6, 5.3) but not with gonorrhoea. Trends in the annual prevalence of drug abuse closely paralleled trends in the annual prevalence of syphilis, including simultaneous peaks in 1992 (drug abuse, 9.1%; syphilis, 3.2%). There was no such parallel trend between drug abuse and gonorrhoea. Annual prevalence of drug abuse correlated with the prevalence of syphilis (r = 0.89, p = 0.001) more than with the prevalence of gonorrhoea (r = 0.45, p = 0.201). CONCLUSION: Among pregnant women, an increase in drug abuse was closely associated with an epidemic of syphilis, but not of gonorrhoea. Systematically collected prenatal care data can usefully supplement surveillance of diseases and behavioural risk factors associated with them.

Adult↗
PubMed2005

Effect of environmental characteristics on Pythium and Mesocriconema spp. in golf course greens in Alabama.

The role the environment has on populations of Pythium and Mesocriconema spp. was investigated at 5 golf course locations in east central Alabama. Every 4 to 5 weeks soil samples were collected from 3 golf greens on each of the 5 golf courses. Environmental data, including air and soil temperature, pH and relative humidity, were also collected. Dilution plating and a combined sieving and sugar flotation procedure were conducted to determine the populations of Pythium and Mesocriconema spp. for each month. Isolates of Pythium from 4 months were also identified. Pythium spp. populations increased as soil temperature and ambient air temperature prior to sampling decreased (P < 0.05). Pythium spp. populations were highest in the winter and lowest in the spring. At some locations, populations of Mesocriconema spp. increased as soil acidity and populations of Pythium spp. decreased (P < 0.05) and as ambient air temperature prior to sampling increased (P < 0.05). Eight species of Pythium were isolated from 4 months, with Pythium rostratum being the most commonly isolated. Results suggest that Pythium and Mesocriconema spp. prefer different soil environments.

Alabama↗
PubMed1977

Community mental health services in Alabama after Wyatt.

The author believes that the growth of the community mental health system in Alabama has suffered as a result of the Wyatt decision. The state has a limited number of dollars to invest in mental health, and the Wyatt court order requires that the state allocate a large portion of its resources to upgrade its institutional system. That demand on resources has interfered with the development of community services, and it comes at a time when many patients are being released from institutions and need such services. Because the centers must care for increasing numbers of released patients, other important preventive services, such as consultation and education, are receiving less attention than they should.

Alabama↗
PubMed2004

Idiopathic thrombocytopenic purpura: a 10-year natural history study at the childrens hospital of alabama.

Childhood idiopathic thrombocytopenic purpura (ITP) is a common disorder. However, single-institution, long-term, natural history data are limited. The objective of this paper is to review presenting features, response to therapy, and natural history of ITP treated at a single pediatric academic medical center. A retrospective chart review was made for all children (ages birth-18 years) diagnosed with ITP (ICD 287.3) and treated at the Childrens Hospital of Alabama/University of Alabama at Birmingham between 1993 and 2003. Four hundred nine patients were identified (49% male, 51% female; mean age: 5.85 years; range: 1 month-17 years). There was no seasonal variation of presentation. The mean platelet count was 19k (0-120k). Bone marrow aspiration (BMA) was performed in 72% but altered the diagnosis or therapy in no patient. Treatment consisted of corticosteroids in 256 (92% response), intravenous immunoglobulin (IVIG) in 125 (87% response), Win-Rho D in 58 (91% response), and no therapy in 71 (100% response). Response was defined as increase in platelet count to > 50k. There was no difference in response to any therapy. No patients died. One patient presented with a CNS hemorrhage at presentation, responded to therapy, and survived. Twenty-three of 409 patients (6%) experienced clinical bleeding requiring hospitalization or blood transfusion. Chronic ITP (persistence > 6 months) was noted in 99 patients (24%). Chronic patients presented at an older age (7.8 vs 5.2 years for acute only, p<0.001), and with higher platelet counts (27k vs 17k, p<0.001). The risk of chronic ITP was partially predicted by presenting platelet count > 50k and age > 10 years, or both; 50% of patients presenting with these features developed chronic ITP vs 24% overall rate. Splenectomy was curative in 30/31 (97%) patients. There was no postsplenectomy sepsis. Of 99 patients with chronic ITP, 25 responded to splenectomy, 37 resolved at a mean of 20.3 months after diagnosis (7-96 months), 36 had persistent mild thrombocytopenia (50k-125k), and 1 failed to respond to any treatment including splenectomy. Overall, 91% of cases resolved with therapy or observation. ITP is a common pediatric disease presenting at any age with low morbidity and mortality. Most cases can be managed by pediatricians without hematology referral. Several equally successful therapeutic options exist. Chronic cases present at an older age with higher platelet counts. Up to 50% of cases of chronic ITP will resolve with ongoing follow-up. The overall prognosis in childhood ITP is excellent.

Academic Medical Centers↗
PubMed2002

Breastfeeding initiation and duration among low-income women in Alabama: the importance of personal and familial experiences in making infant-feeding choices.

To gain perspective on breastfeeding initiation and duration among poor women in the southeastern United States, the authors interviewed a random sample of 150 mothers (93% African American) at a county health clinic in Birmingham, Alabama. Forty-one percent of women initiated breastfeeding, 24% breastfed for at least 1 month, and 8.3% breastfed for 3 months or more. Initiation of breastfeeding was positively associated with the mother having been breastfed herself and having breastfed a previous infant, and negatively associated with premature delivery. Breastfeeding at 1 month was more likely among older women and women with close relatives who breastfed. Duration of breastfeeding beyond 1 month was associated only with the mother having been breastfed and having breastfed a previous infant. Maternal and familial breastfeeding experiences eliminated the effect of more distal factors, such as income or education, on some feeding decisions. The strong influence of breastfeeding experiences must be considered in infant feeding interventions.

Adult↗