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PubMed2005

North Mississippi Medical Center: a focus on quality, safety, and financial critical success factors.

BACKGROUND: North Mississippi Medical Center (NMMC), the largest rural hospital in the United States, offers a continuum of health care services stretching from high-tech trauma and/or cardiac care through to compassionate home, long-term, or hospice care. OVERALL APPROACH TO QUALITY AND SAFETY: NMMC uses a care-based cost management (CBCM) approach to performance improvement, which is used to look beyond traditional cost drivers (people, equipment, supplies) to the care issues that have a much greater impact on the actual cost of care-practice variation, complications, and social issues. APPROACH TO ADDRESSING THE SIX IOM QUALITY AIMS: The CBCM approach addresses NMMC's quality, safety and financial critical success factors and is applied to address the six Institute of Medicine quality aims. For example, by conceptualizing "patient safety" to include appropriate care for every patient, CBCM leads directly to IOM aims and evidence-based practice. Physician champions and nurse outcomes managers liaison with providers to achieve decreased complications, analyze practice variation from best practice, and address social issues that impair care improvement. CHALLENGES AND LESSONS LEARNED: One of NMMC's greatest challenges is to continuously improve the health of the people in its region. Since 1995, it has partnered in periodic community health assessments to examine its wellness initiatives and plan programs.

Hospital Bed Capacity, 500 and over↗

PubMed2006

New Orleans soil lead (Pb) cleanup using Mississippi River alluvium: need, feasibility, and cost.

In New Orleans, LA prior to hurricane Katrina 20-30% of inner-city children had elevated blood Pb levels > or =10 microg/ dL and 10 census tracts had a median surface soil level of Pb >1000 mg/kg (2.5 times the U.S. standard). This project tests the feasibility of transporting and grading contaminated properties (n = 25) with 15 cm (6 in.) of clean Mississippi River alluvium from the Bonnet Carré Spillway (BCS) (median soil Pb content 4.7 mg/kg; range 1.7-22.8). The initial median surface soil Pb was 1051 mg/kg (maximum 19 627). After 680 metric tons (750 tons) of clean soil cover was emplaced on 6424 m2 (69 153 ft2), the median surface soil Pb decreased to 6 mg/kg (range 3-18). Interior entrance wipe samples were collected at 10 homes before and after soil treatment and showed a decreasing trend of Pb (p value = 0.048) from a median of 52 microg/ft2 to a median of 36 microg/ft2 (25th and 75th percentiles are 22 and 142 microg/ft2 and 12 and 61 microg/ft2, respectively). Average direct costs for properties with homes were $3,377 ($1.95 per square foot), with a range of $1,910-7,020, vs $2,622 ($0.61 per square foot), with a range of $2,400-3,040 for vacant lots. Approximately 40% (86,000) of properties in New Orleans are in areas of >400 mg Pb/kg soil and estimated direct costs for treatment are between $225.5 and $290.4 million. Annual costs of Pb poisoning in New Orleans are estimated at approximately $76 million in health, education, and societal harm. Urban accumulation of Pb is an international problem; for example, the new Government of Norway established a policy precedence for an isolated soil cleanup program at daycare centers, school playgrounds, and parks to protect children. New Orleans requires a community-wide soil cleanup program because of the extent and quantity of accumulated soil Pb. The post-Katrina benefits of reducing soil Pb are expected to outweigh the foreseeable costs of Pb poisoning to children returning to New Orleans.

Child↗

PubMed2001

Fungal occurrence, disease incidence and severity, and yield of maize symptomatic for seedling disease in Mississippi.

A study was conducted in Mississippi from 1995 to 1997 comparing soil rhizosphere fungi isolated from Pioneer 3167 hybrid maize (Zea mays L.) planted on Brooksville silty clay and Memphis silt loam soils. Maize seedlings were collected over four sampling dates from conventional and no-tillage plots. Eleven fungal genera consisting of nineteen species were isolated from these plants; Trichoderma spp. were most frequently isolated, followed by Fusarium spp. The highest disease incidence occurred in tilled plots of the latest planting date on Brooksville silty clay when samples were collected 17 days after planting. Root disease was most severe in 1996 from seedlings planted on the last planting date in tilled plots sampled 17 days after planting. Yields were significantly (P < or = 0.05) higher on Brooksville silty clay soil than on Memphis silt loam in both 1995 and 1996. Yields were highest from no-tillage plots and from maize planted on the earliest date. There was a significant correlation between incidence of root infection and disease severity. There was no correlation between the incidence of root infection and yield or between disease severity and yield at either location.

Agriculture↗

PubMed1997

An evaluation of breastfeeding promotion through peer counseling in Mississippi WIC clinics.

OBJECTIVE: This study evaluates the effectiveness of a peer counseling program at increasing breastfeeding by participants in the Mississippi Special Supplemental Nutrition Program for Women, Infants and Children (WIC). METHODS: Data from the 1989-1993 Pediatric Nutrition Surveillance System were analyzed to compare breastfeeding rates in clinics with and without peer counseling programs. A questionnaire completed by program staff to describe the program in greater detail helped identify characteristics associated with greater success. RESULTS: The incidence of breastfeeding rose from 12.3% to 19.9% in those clinics with peer counseling programs, but only from 9.2% to 10.7% in clinics without a program. Clinics that started a program earlier showed greater changes in breastfeeding incidence. However, the presence of lactation specialists or consultants in the clinic appeared to be more important than the presence of less-trained peer counselors. Peer counselors who spent more than 45 minutes per participant were more effective than those spending less time. CONCLUSIONS: The peer counseling program significantly increased the incidence of breastfeeding, particularly in clinics with lactation specialists and consultants. Success can be enhanced by ensuring that peer counselors spend a great deal of time with the participants.

Adult↗

PubMed2004

Prevalence of mental illness and substance abuse disorders among incarcerated juvenile offenders in Mississippi.

The prevalence of psychiatric disorders among incarcerated juveniles in Mississippi was examined. A total of 482 adolescents completed a diagnostic questionnaire and a subset (N = 317) was assessed with face-to-face semi-structured interview. Most of the study participants met criteria for one mental disorder, 71-85% depending on assessment method, one-third have co-occurring mental health and substance abuse disorders. Gender and placement site differences in rates of some psychiatric disorders were also noted. Routine mental health screening should be performed on all juveniles placed in secure detention facilities to identify those who need treatment services.

Adolescent↗

PubMed2004

Concentrations of Arsenic, Cadmium, Copper, Lead, Selenium, and zinc in fish from the Mississippi River basin, 1995.

Fish were collected in late 1995 from 34 National Contaminant Biomonitoring Program (NCBP) stations and 12 National Water Quality Assessment Program (NAWQA) stations in the Mississippi River basin (MRB), and in late 1996 from a reference site in West Virginia. The NCBP sites represented key points (dams, tributaries, etc.) in the largest rivers of the MRB. The NAWQA sites were typically on smaller rivers and were selected to represent dominant land uses in their watersheds. The West Virginia site, which is in an Eastern U.S. watershed adjacent to the MRB, was selected to document elemental concentrations in fish used for other aspects of a larger study and to provide additional contemporaneous data on background elemental concentrations. At each site four samples, each comprising (nominally) 10 adult common carp (Cyprinus carpio, 'carp') or black bass (Micropterus spp., 'bass') of the same sex, were collected. The whole fish were composited by station, species, and gender for analysis of arsenic (As), lead (Pb), and selenium (Se) by atomic absorption spectroscopy and for cadmium (Cd), copper (Cu), and zinc (Zn) by inductively-coupled plasma emission spectroscopy. Concentrations of most of the elements examined were lower in both carp and bass from the reference site, a small impoundment located in a rural area, than from the NCBP and NAWQA sites on rivers and larger impoundments. In contrast, there were few overall differences between NCBP sites NAWQA sites. The 1995 results generally confirmed the continued weathering and re-distribution of these elemental contaminants in the MRB; concentrations declined or were unchanged from 1984-1986 to 1995 at most NCBP sites, thus continuing two-decade trends. Exceptions were Se at Station 77 (Arkansas R. at John Martin Reservoir, CO), where concentrations have been elevated historically and increased slightly (to 3.8-4.7 microg g-(1) in bass and carp); and Pb, Cd, and Zn at Station 67 (Allegheny R. at Natrona, PA), where levels of these metals were high in the past and increased from 1986 to 1995.

Age Factors↗

PubMed2004

Evaluation of the Mississippi PTSD Scale--Revised using Rasch measurement.

This study used Rasch measurement theory to examine the Mississippi Scale--Revised for its utility in the development of an interval measure of posttraumatic stress disorder (PTSD). Rasch is a probability-based theory that provides both a measure of the person responding to the instrument and the location of each item calibration on one common construct or dimension. The study used a largely male sample of 153 veterans to evaluate the quality of the items defining PTSD, to describe how the items represent the symptom range of the disorder, and to assess the functioning of items in evaluating PTSD with and without comorbid MDD. Sixteen items were found to fit the measurement model. These items may be used to develop an interval scale of the PTSD construct that is generalizable across diverse populations and that can be used for individualized comparable assessments.

Adult↗

PubMed2004

Pod and seed mycoflora on transgenic and conventional soybean [Glycine max (L.) Merrill] cultivars in Mississippi.

A 2-year (1999-2000) study was conducted at Starkville and Stoneville, MS to determine if the occurrence of the mycoflora varied on Roundup Ready (transgenic) compared to conventional soybean (Glycine max) cultivars. A total of 7,658 fungal isolates were identified from the pod and seed tissues of four cultivars compared at growth stages R6 and R8. Ninety-nine percent of all fungi isolated were mitosporic fungi and ascomycetes. In both years, total fungal isolates from the two locations were greater from the pod (65%) than from seed (33%) tissues. Isolation frequency from conventional cultivars was 54% compared to 46% for the transgenic cultivars. The most common fungi identified that are reported pathogens of soybean included Alternaria, Cercospora, Cladosporium, Diaporthe, Fusarium and Verticillium spp. When main effects and interactions were compared among the frequency data for the fungal genera, significant differences occurred, but consistent trends were not noted. Isolation frequencies of Diaporthe spp. during the R6 growth stage, were significantly greater on the conventional than on the transgenic cultivars in both years of the study, but only at Starkville. Isolation frequencies from samples taken during the R8 growth stage were similar at both locations in 1999 and 2000. Fusarium spp. isolated at R6 and R8 growth stages from pod and seed tissues were significantly greater on conventional than on transgenic cultivars in 2000. Even though frequencies were often significantly different between the transgenic and conventional cultivars, the data was not consistent between locations, pod and seed tissues, or growth stages. The pod and seed mycoflora of transgenic and conventional soybean cultivars was, therefore, similar in Mississippi.

Antifungal Agents↗

PubMed1990

Black English in a Mississippi prison population.

Nine linguistic features unique to Black English were examined in the speech of 87 Black and 77 White inmates of a Mississippi prison population. The purpose of the study was to determine whether Black inmates could be distinguished from White inmates by their use of the present progressive, final stops, distributive be, remote aspect been, noun plurals, third person singular present tense, possessives, consonant clusters, and the copula. Results showed that use of eight of the nine features accurately predicted the ethnicity of the subjects. Only remote aspect been failed to identify ethnic differences. Identification of dialect variation among minority populations and more specifically among prison populations is an important step toward providing effective remediation programs.

Adult↗

PubMed1996

Sociocultural and behavioral influences on health status among the Mississippi Choctaw.

Native American populations in North America are at increased risk of a variety of health problems, including (but not limited to) diabetes. This risk is presumed to be a result of the interaction of environmental influences with a population genetic susceptibility. Anthropologists have subsumed those environmental influences under the term "acculturation." Here, we break that broad concept into physical, behavioral, and sociocultural components in an examination of the correlates of arterial blood pressure and plasma glucose among the Mississippi Choctaw. In a sample of 93 adults, higher plasma glucose was associated with the lower physical activity, higher body mass index, and higher lifestyle incongruity, after controlling for age, sex, and recency of food consumption. Higher arterial blood pressure was associated with higher body mass index and being single. These results suggest that the risk of disordered glucose metabolism within this Native American population is associated with acculturation broadly construed, but that refined models of health and disease must take into account the multiple dimensions of this concept. Physical, behavioral, and sociocultural factors combine to describe more precisely the concept of acculturation, and hence the factors contributing to the risk of disease in Native American communities.

Acculturation↗

PubMed2000

Impact of redox conditions on metolachlor and metribuzin degradation in Mississippi flood plain soils.

The effect of soil redox conditions on the degradation of metolachlor and metribuzin in two Mississippi soils (Forrestdale silty clay loam and Loring silt loam) were examined in the laboratory. Herbicides were added to soil in microcosms and incubated either under oxidized (aerobic) or reduced (anaerobic) conditions. Metolachlor and metribuzin degradation under aerobic condition in the Forrestdale soil proceeded at rates of 8.83 ngd(-1) and 25 ngd(-1), respectively. Anaerobic degradation rates for the two herbicides in the Forestdale soil were 8.44 ngd(-1) and 32.5 ngd(-1), respectively. Degradation rates for the Loring soil under aerobic condition were 24.8 ngd(-1) and 12.0 ngd(-1) for metolachlor and metribuzin, respectively. Metolachlor and metribuzin degradation rates under anaerobic conditions in the Loring soil were 20.9 ngd(-1) and 5.35 ngd(-1). Metribuzin degraded faster (12.0 ngd(-1)) in the Loring soil under aerobic conditions as compared to anaerobic conditions (5.35 ngd(-1)).

Acetamides↗

PubMedDate not supplied

An examination of factors influencing black fertility decline in the Mississippi Delta, 1880-1930.

Although the fertility decline in the black population in the Mississippi Delta between the late 1870's and early 1930's closely paralleled that of the national black population, it rose much more dramatically in the 1940's and 1950's to almost 1880 levels. Given the especially rural and oppressed conditions of blacks there, the initial decline seems puzzling. Low fertility rates in the 1930's reflected a large proportion of childless females. Investigations of changing contraceptive usage and mate exposure suggest both were minor components at most. Several physiological impairments were investigated including dietary deficiences, malaria, tuberculosis, and sexually transmitted diseases (STD). Evidence suggests STD played the major role, facilitated by nutritional and other health problems. Models relying heavily on those developed by McFalls and McFalls (1984) suggest 50-80 percent of the decline could have been due to the spread of STD. Age-specific birth rates for different periods and post-World-War-II fertility increases seem consistent with this finding.

Adolescent↗

PubMed2001

Evaluation of a social norms marketing campaign to reduce high-risk drinking at The University of Mississippi.

A social marketing campaign to change perceptions of peer drinking norms was conducted by the National Golden Key Honor Society at the University of Mississippi during the 1995-1996 school year. To assess the campaign's impact on perceptions of student drinking norms and alcohol consumption, Golden Key's national office administered a survey three times during the school year to all students enrolled in a random sample of required freshmen English courses. Regression analyses suggest that exposure to the marketing campaign may be associated with lower (and more accurate) estimates of student drinking norms. While offering promising results, this study was limited due to shortcomings in the research design. Future evaluations of social norms marketing campaigns should adhere to basic evaluation principles, such as using comparison groups, collecting contextual data, using a valid and reliable survey instrument, and ensuring proper survey administration techniques.

Adolescent↗

PubMed1999

Molecular characterization of Haemophilus ducreyi strains from Jackson, Mississippi, and New Orleans, Louisiana.

Chancroid, a sexually transmitted disease caused by Haemophilus ducreyi, is one of the most common genital ulcer diseases in developing countries. In the United States, while less common, the disease has been associated with outbreaks in inner cities, particularly among persons who engage in sex for drugs or money. Two outbreaks of chancroid were recently studied in the United States, one in New Orleans (from 1990 to 1992) and one in Jackson, Mississippi (from 1994 to 1995). By use of ribotyping, plasmid content, and antibiotic susceptibility, the chancroid cases in New Orleans were found to be due to a limited number of strains, consistent with a limited introduction of H. ducreyi into this community. The H. ducreyi isolates from New Orleans and Jackson had different ribotype patterns, suggesting that the two outbreaks were probably not linked.

Bacterial Typing Techniques↗

PubMed1998

An investigation of genital ulcers in Jackson, Mississippi, with use of a multiplex polymerase chain reaction assay: high prevalence of chancroid and human immunodeficiency virus infection.

In 1994, an apparent outbreak of atypical genital ulcers was noted by clinicians at the sexually transmitted disease clinic in Jackson, Mississippi. Of 143 patients with ulcers tested with a multiplex polymerase chain reaction (PCR) assay, 56 (39%) were positive for Haemophilus ducreyi, 44 (31%) for herpes simplex virus, and 27 (19%) for Treponema pallidum; 12 (8%) were positive for > 1 organism. Of 136 patients tested for human immunodeficiency virus (HIV) by serology, 14 (10%) were HIV-seropositive, compared with none of 200 patients without ulcers (P < .001). HIV-1 DNA was detected by PCR in ulcers of 6 (50%) of 12 HIV-positive patients. Multivariate analysis indicated that men with chancroid were significantly more likely than male patients without ulcers to report sex with a crack cocaine user, exchange of money or drugs for sex, and multiple sex partners. The strong association between genital ulcers and HIV infection in this population highlights the urgency of preventing genital ulcers in the southern United States.

Chancroid↗

PubMed1979

Geophagia in rural Mississippi: environmental and cultural contexts and nutritional implications.

We investigated geophagia in the black population of rural Holmes County, Mississippi. Twenty-five sources of geophagical clays were located and most of the sources are associated with rural settlements throughout the county. Clays are taken from subsurface soil horizons, and all but one of the sources come from the upland portion of the county. Geophagia occurs among 57% of women and 16% of children of both sexes, but it is not found among adult males or adolescents. Average daily comsumption of clay is 50 g. Our data indicate geophagia is not correlated with hunger, anemia, or helminthic problems, but it may contribute to the common problem of hypertension. Geophagia has been suggested as one of the factors leading to hyperkalemia, but our data do not support this notion.

Adolescent↗

PubMed2000

Increased risk of agricultural injury among African-American farm workers from Alabama and Mississippi.

Research on the epidemiology of agriculture-related injuries has largely ignored African-Americans and farm workers. This cohort study is the first to estimate injury rates and to evaluate prospectively risk factors for agriculture-related injuries and compare them among African-American and Caucasian farmers and African-American farm workers. A total of 1,246 subjects (685 Caucasian owners, 321 African-American owners, and 240 African-American workers) from Alabama and Mississippi were selected from Agricultural Statistics Services databases and other sources and were enrolled between January 1994 and June 1996. Baseline data included detailed demographic, farm and farming, and behavioral information. From January 1994 to April 1998, subjects were contacted biannually to ascertain the occurrence of an agriculture-related injury. Injury rates were 2.9 times (95% confidence interval (CI): 2.0, 4.3) higher for African-American farm workers compared with Caucasian and African-American owners. Part-time farming (relative risk (RR) = 2.0, 95% CI: 1.3, 2.5), prior agricultural injury (RR = 1.5, 95% CI: 1.0, 2.1), and farm machinery in fair/poor condition (RR = 1.8, 95% CI: 1.2, 2.7) were also independently associated with injury rates. The results demonstrate the increased frequency of agricultural injury among farm workers and identify a number of possible ways of reducing them.

Accidents, Occupational↗

PubMed2006

Radical redesign of nursing homes: applying the green house concept in Tupelo, Mississippi.

PURPOSE: We present the concept of the Green House, articulated by William Thomas as a radically changed, "deinstitutionalized" nursing home well before its first implementation, and we describe and discuss implications from the first Green Houses in Tupelo, Mississippi. DESIGN AND METHODS: Green Houses are small, self-contained houses for 10 or fewer elders, each with private rooms and full bathrooms and sharing family-style communal space, including hearth, dining area, and full kitchen. Line staff at the level of certified nursing assistants, called Shahbazim, are "universal workers," who cook meals, do laundry, provide personal care, assist with habilitation, and promote the elders' quality of life. Nurses, doctors, and other professionals comprise a visiting clinical support team for the residents and Shahbazim. Multiple Green Houses comprise a nursing home, meeting all nursing facility regulations and working within state-reimbursement levels. In 2003, four Green Houses were built on the campus of a retirement community; in June of that year, 40 residents relocated from the 140-bed nursing home to the Green Houses, including 20 residents previously living in the locked dementia unit. RESULTS: Experiences to date are positive for residents, family, and staff. The sponsor is converting the entire facility to Green Houses, and other providers around the country plan to implement Green House variants. IMPLICATIONS: Because nursing home stock is aging, many physical plants are or soon will be slated for major rebuilding, thereby providing sponsors with an opportunity to consider Green Houses. Early experience suggests that Green Houses are feasible and that outcomes are likely to be positive, and it also suggests that there are some potential issues to overcome in such a dramatic reengineering of nursing homes.

Assisted Living Facilities↗