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PubMed1990

Indigent health care plan for Tennessee.

The author describes the development of an Indigent Health Care Program for the State of Tennessee from the campaign pledge of the Governor, through the development of an Indigent Care Cabinet Council, to the development and enactment of appropriate legislation required to implement this program. The program deals with availability of health care services, accessibility to health care services and funding mechanisms. The backbone of the program is the involvement of the local community and the coordinating and networking of the existing private, community and state health care providers.

Community Health Centers↗
PubMed2005

Explaining race differences in mortality among the Tennessee Medicare elderly: the role of physician services.

We investigated the impact of socioeconomic conditions, patterns of morbidity, and physician service utilization on race differences in rates of mortality, and mortality associated with specific diagnoses. Longitudinal data from the Center for Medicare and Medicaid Services (CMS) Physician Billing File data and the Medicare Enrollment Database (EDB) were analyzed to assess physician-diagnosed morbidity, health service use, and mortality, among the population of Medicare beneficiaries in Tennessee (N=665,887). Proportional hazards models were used to examine the effects of race, socioeconomic status, morbidity, and physician service utilization on mortality. Race differences in physician visits explain the largest portion of mortality differentials between African Americans and Whites. Race disparities in mortality associated with particular forms of morbidity are also mostly a function of differences in physician service use. Our examination suggested that race differences in patterns of physician service use principally explain race disparities in mortality. Further, race differences in the use of physician services were substantially responsible for race disparities in mortality associated with particular forms of morbidity.

Black or African American↗
PubMed1997

The role of managed care: the national and Tennessee experiences.

The United States is the only developed country with no national health care policy. What exists is a national health insurance system. The problem with this system arises when paying for health care for the poor, who often require the most expensive type of care for acute or episodic ailments. Managed care, though not a panacea, has the potential of providing the organization to effectively control costs and change the existing health care paradigm from one of fee-for-service inpatient care to one of ambulatory care, home-based care, and physician office-based procedures. An example of a state-based initiative that has cut medical costs is Tennessee's TennCare. Under TennCare, approximately 1.2 million Tennesseans are covered, nearly 400,000 of whom were previously uninsured. Such programs, both state and national, must now look to including prevention and wellness care to effectively change the underlying epidemiology of illness among the poor.

Adolescent↗
PubMed1997

Stroke Belt initiative: the Tennessee experience.

African Americans have a higher rate of stroke than other U.S. population groups. As part of the 11-state "Stroke Belt" region, Tennessee has the fifth highest death rate from stroke in the country. In 1993, a two-year community-based project was initiated to reduce the incidence of stroke and its associated risk factors among African Americans. Three counties, Shelby (Memphis), Davidson (Nashville), and Hamilton (Chattanooga), were selected as project sites because of their large African American populations. Specific objectives of the project were to promote risk factor awareness in African Americans, assist African American churches and community groups in developing and implementing intervention programs, and build the capacity for intervention programs within African American communities by collaborating with a variety of community organizations. This article describes the program's approach, which included using both adults and youth as mentors. In addition, it presents major accomplishments and lessons learned in project implementation.

Adolescent↗
PubMed2001

Spotted fever group Rickettsia in Dermacentor variabilis (Acari: Ixodidae) infesting raccoons (Carnivora: Procyonidae) and opossums (Marsupialia: Didelphimorphidae) in Tennessee.

Spotted fever group Rickettsia were present in 13 of 1,171 (1.1%) of adult Dermacentor variabilis Say removed from raccoons (Procyon lotor L.) and Virginia opossums (Didelphis virginiana Kerr) in western Tennessee. Spotted fever group Rickettsia were detected by amplification of a 617-bp segment of the citrate synthase gene by polymerase chain reaction.

Animals↗
PubMed1976

Serosurvey of dogs for Brucella canis infection in Memphis, Tennessee.

Following occurrence of a rare case of human Brucella canis in Memphis, Tennessee, the free roaming and confined dog populations of that community and a similar geographical location were surveyed for B canis positivity to identify the foci of infection and to compare positivity rates. Three hundred and two dogs were sampled. Positivity was found only in free roaming dogs in both communities. It is concluded that presence of B canis positivity in free roaming dogs may pose an additional medical threat to communities, thus providing one more sound reason for controlling strays and confining dogs.

Animals↗
PubMed1991

Preventing and postponing death: trends in Tennessee infant mortality.

Infants born in Tennessee between 1984 and 1988 experienced reduced mortality compared with those born in the 5 years previous. For all birthweight singleton infants, the reduction from 10.2 to 8.4 deaths per 1000 live births represents an 18% decline in mortality. The most impressive gain made was for very low birthweight (less than 1500 g) infants in the neonatal period, where mortality was reduced 24%. However, for these infants there was nearly a sixfold increase in the postneonatal mortality associated with prematurity-related causes.

Birth Weight↗
PubMed1994

Cancer mortality near Oak Ridge, Tennessee.

Oak Ridge, Tennessee, is the site of one of the two oldest nuclear facilities in the United States. Although precise records have not been maintained, low levels of radioactive products have been released into the environment since the facility began operation in World War II. Changes in age-adjusted cancer mortality rates for whites between the periods 1950-1952 and 1987-1989 were analyzed to assess whether these radioactive releases have had any adverse effects on the population living near Oak Ridge. Results indicate that the increases in the local area (under 100 miles from Oak Ridge) exceeded regional increases and far exceeded national increases. Within the region, increases were greatest in rural areas, in Anderson County (where Oak Ridge is located), in mountainous counties, and in the region downwind of Oak Ridge. Each of these findings suggest that low levels of radiation, ingested gradually by local residents, were a factor in the increases in local cancer death rates. Results indicate that more studies of this type are called for and that cessation of all future radioactive emissions from nuclear facilities should be considered.

Air Pollution, Radioactive↗
PubMed2003

Predictors of substance abuse treatment outcomes in Tennessee.

In planning and implementing programs to treat substance abuse, it is important to understand which factors influence post-treatment abstinence. This article identifies and analyzes several variables important in predicting the likelihood of abstinence among substance abuse clients. The data used in this study was collected from 1,350 clients treated for alcohol or drug abuse in residential, halfway house, or outpatient facilities in Tennessee. We analyzed 22 variables as possible treatment outcome predictors by using two statistical procedures: stepwise logistic regression analysis and Quick, Unbiased, Efficient, Statistical Tree (QUEST) analysis, a tree-structured classification algorithm analysis. We found one pretreatment, five in-treatment, and three post-treatment variables to be significant predictors of treatment outcome: previous treatment history, perceived helpfulness of the treatment, simultaneous treatment for mental health, number of days in treatment,completion of treatment, special skills training during treatment, obtaining healthcare services for major physical health problem after treatment, living with someone using alcohol or drugs post treatment, and arrest record since treatment.

Adolescent↗
PubMed2005

Practice patterns in treating high-risk patients with hyperlipidemia at a northeast Tennessee university clinic.

BACKGROUND: This study was conducted to test the hypothesis that internal medicine residents at a northeast Tennessee university clinic were not compliant with the latest National Cholesterol Educational Program Adult Treatment Panel (NCEP-ATP) guidelines in treating hyperlipidemia in patients with diabetes and coronary artery disease. METHODS: A retrospective medical record survey was conducted to evaluate residents' pattern in lowering low-density lipoprotein (LDL) cholesterol to below 100 mg/dL in patients with diabetes and coronary artery disease. The survey covered a 5-year period, from July 1998 to June 2003, and included 15 randomly chosen residents who were in training for 3 consecutive years. Charts were randomly selected from residents' clinics using International Classification of Diseases-9 codes for coronary artery disease or diabetes mellitus with hyperlipidemia. Five hundred fifty charts were reviewed. Only 41 (7.45%) met the inclusion criteria. RESULTS: Analysis of data using Epi-Info 2002 (Centers for Disease Control and Prevention, Atlanta, GA) revealed that only 68.3% of patients with diabetes and coronary artery disease reached target LDL cholesterol levels. Of the patients who reached target levels, only 42.9% maintained them. Analysis of variance and chi-square tests revealed that the frequency of cholesterol measurement, but not the frequency of physicians' visits, was associated with a higher likelihood of reaching the target LDL level. CONCLUSION: There was a suboptimal compliance among internal medicine residents in the frequency of screening for, reaching, and maintaining the target LDL cholesterol level, according to the latest NCEP-ATP guidelines, among high-risk patients with hyperlipidemias.

Cholesterol, LDL↗
PubMed2002

Integration of problem-based learning in a veterinary medical curriculum: first-year experiences with Application-Based Learning Exercises at the University of Tennessee College of Veterinary Medicine.

In 1999 problem-based learning experiences were introduced into the professional curriculum at the University of Tennessee College of Veterinary Medicine as part of an overall curricular modification. Problem-based learning (PBL) was introduced into the traditional curricular format in dedicated week-long experiences (Application-Based Learning Exercises) at specific points during the first six semesters. Methods to assess the success of this integration and other curricular changes included ongoing program assessment throughout the implementation of the modified curriculum. Program assessment engaged faculty facilitators and students, who were involved in a process unfamiliar to both. Results of preliminary assessment indicate mostly positive reaction to problem-based learning, while identifying other areas of concern.

Animals↗
PubMed2006

Evidence for environmental contamination in residential neighborhoods surrounding the defense depot of Memphis, Tennessee.

An interdisciplinary environmental assessment team from the Howard University Environmental Justice Partnership (HUEJP) conducted a site visit and assessment of the Defense Depot of Memphis, Tennessee in February of 2000. This depot was built in the late 1940's for storage of numerous chemicals and munitions. As the years progressed, many Memphis citizens have grown to believe that the activities and chemical stockpile located at this site have negatively affected the health environment of their residents. There is anecdotal evidence and documentation of numerous cancers and other illnesses in those local territories, and specifically, at the Memphis Depot site. Currently, this depot is closed and in remediation by the local government. Particularly, citizens of the Rozelle community have started a campaign to investigate any signs of exposure pathways to noted health risks. The HUEJP was contacted and asked to investigate the community concerns. Obliging to the request, we aimed to sample at three drainage sites and a residential site, talk to local citizens, and gain any additional information that would be helpful in relieving anxiety in the Rozelle community. Soil, sediment, and water samples were collected and analyzed for total organic carbon, inorganic anions, and heavy metals. These data show that for the four sites sampled, the highest concentrations of organic compounds and heavy metals were located either within a residential area or in an area with a direct transport pathway to the community. Atomic absorption analysis revealed detectable amounts of cadmium, lead and chromium metals at all sites with direct transport pathways into the residential community, with chromium concentrations being far in excess of the EPA standard limits.

Environmental Pollutants↗
PubMed2002

Prevalence and molecular characterization of Escherichia coli O157:H7 in bulk tank milk and fecal samples from cull cows: a 12-month survey of dairy farms in east Tennessee.

A study on the prevalence of Escherichia coli O157:H7 was conducted on 30 dairy farms in east Tennessee between May 2000 and April 2001. This pathogen was isolated from 8 of 30 (26.7%) dairy farms at various sampling times. A total of 415 fecal samples from cull dairy cows and 268 bulk tank milk samples were analyzed. Overall, 10 of 683 (1.46%) samples (2 of 268 [0.75%] milk samples and 8 of 415 [1.93%] fecal samples) tested positive for E. coli O157:H7. Food and Drug Administration Bacteriological Analytical Manual protocols were used for the conventional isolation and confirmation of E. coli O157:H7. Samples were shake cultured (150 rpm) at 42 degrees C for 24 h in tryptic soy broth containing 2 mg of novobiocin per liter. White colonies isolated on cefixime-tellurite sorbitol MacConkey agar plates were evaluated for fluorescence on sorbitol MacConkey agar supplemented with 0.025 g of methylumbelliferyl-beta-D-glucuronide per liter. Nonfluorescing white colonies were biochemically typed and serologically confirmed. Multiplex polymerase chain reaction profiles of E. coli O157:H7 isolates indicated the presence of common virulence factors (Shiga toxin, enterohemolysin, and intimin) of Shiga toxin-producing E. coli, suggesting the potential human pathogenicity of bacterial isolates. Pulsed-field gel electrophoresis profiles of SpeI and XbaI restriction enzyme-digested genomic DNA were used to establish relatedness among bacterial isolates. Data from this study indicate that both cull dairy cows and bulk tank milk pose a potential hazard with regard to human foodborne illness. It is therefore imperative to develop on-farm and preharvest pathogen reduction programs to control the carriage of E. coli O157:H7 pathogens.

Animals↗
PubMed1976

Prescribing of chloramphenicol in ambulatory practice. An epidemiologic study among Tennessee Medicaid recipients.

During the 1-year period from July 1973 through June 1974, 1761 chloramphenicol prescriptions were written for 992 outpatients in the Tennessee Medicaid program. Sxi percent (250 of 3409) of participating physicians prescribed chloramphenicol; 20 physicians wrote 55% of the prescription. Both family practice and rural location were independently associated with increased rates of prescribing chloramphenicol for outpatients. Among rural family practitioners, 21% prescribed chloramphenicol. Physicians graduating since 1955 were as likely to have prescribed chloramphenicol as were earlier graduates. Almost half the adult patients received 6 grams or less, while 2 received more than 250 grams. Approximately half of the prescriptions were for treatment of upper respiratory infections. Most prescriptions were interdicted by good medical practice. Analysis of the prescribing of chloramphenicol (and perhaps other drugs) in ambulatory practice will help identify those physicians most in need or remedial medical education.

Adolescent↗
PubMed1979

Legionnaires' disease in Kingport, Tennessee.

In August and September 1977 a discrete cluster of 27 serologically or pathologically confirmed cases of Legionnaires' disease, plus six highly presumptive cases were identified in the area of Kingsport, Tennessee. Three patients died. Most patients manifested severe pneumonia and fever; no mild or asymptomatic disease forms were recognized despite intensive case-finding efforts. Illness was epidemiologically associated with residing, visiting, or working in one geographic area of Kingsport, residence there being the factor most strongly associated. Although the attack rate for area residents was 0.64%, the randomly determined prevalence of serologic reactors was 5.2%, which is not significantly different from that in a nonimplicated control neighborhood. The epidemic did not correlate temporally with any identified environmental or demographic event. No source of the bacterium was found either by a detailed case-control study of area associations or by bacterial isolation from sentinel guinea pigs or environmental specimens. There was no evidence of person-to-person spread.

Disease Outbreaks↗
PubMed1983

Mercury residues in wood ducks and wood duck foods in eastern Tennessee.

Liver, breast muscle and body fat from 50 juvenile and five adult wood ducks (Aix sponsa) collected on the Holston River, Tennessee were analyzed for total mercury content. Black fly larvae (Simulium vittatum) sago pondweed (Potamogeton pectinatus), tapegrass (Vallisneria americanus), water stargrass (Heteranthera dubia), Elodea canadensis, and river bottom sediments were also analyzed to elucidate the distribution of mercury in the wood duck's environment. Liver tissues of juveniles contained the highest mean concentration of mercury (0.42 ppm). Mercury in breast muscle and body fat of juveniles averaged 0.15 and 0.10 ppm, respectively. Residues in corresponding tissues of adults were lower. Of environmental components tested, sediments had the highest mean concentration (0.76 ppm). Black fly larvae and aquatic plants had mean levels below 0.10 ppm.

Adipose Tissue↗
PubMed1992

Lead exposure and recovery rates of black ducks banded in Tennessee.

American black ducks (Anas rubripes) wintering in Tennessee during 1986 to 1988 were tested for exposure to lead. Twelve percent of the birds had blood lead concentrations exceeding 0.2 ppm. Significant differences in the prevalence of lead exposure were found for adults (14.4%) and juveniles (8.2%). Exposed birds had higher blood lead concentrations at one study site, corresponding with a lower survival index.

Age Factors↗