Joseph Francis Volker. Alabama's most distinguished adopted son. Part I--The pre-Alabama years.
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Education, Dental↗
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A proposal for the management of Hodgkin's disease at The University of Alabama Medical Center Birmingham, Alabama.
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Hodgkin Disease↗
Address to graduating class at the School of Medicine convocation University of Alabama School of Medicine, Birmingham, Alabama December 18, 1976.
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Physician-Patient Relations↗
Characterization of the functional defect in factor IX Alabama. Evidence for a conformational change due to high affinity calcium binding in the first epidermal growth factor domain.
Factor IX Alabama is a factor IX variant in which a glycine has been substituted for Asp47 in the first epidermal growth factor (EGF) domain. The structural defect in factor IX Alabama results in a molecule with 10% of normal coagulant activity. The interactions of immunoaffinity-purified factor IX Alabama with its activator, cofactors, and substrate have been investigated to determine the functional defect in the variant. Factor IX Alabama is activated by factor XIa/calcium at near normal rates. Calcium fluorescence-quenching experiments indicate that high affinity calcium binding in the first EGF domain is not altered in factor IX Alabama. The active site of factor IXa Alabama is fully competent to activate factor X in the absence of calcium when using polylysine as a surface to catalyze the reaction. Factor IXa Alabama has only 64% of normal factor IXa activity in the presence of 300 microM CaCl2 in the polylysine-catalyzed system although apparent high affinity calcium binding constants are similar. Factor IXa Alabama has 52-60% of normal activity in a calcium/phospholipid vesicle system. The addition of factor VIIIa to the phospholipid vesicle system decreases the relative rate of factor IXa Alabama to 18-19% of normal. Three-dimensional computer-aided models of the first EGF domain of normal factor IX and factor IX Alabama indicate no major structural alterations resulting from the glycine substitution for Asp47. The model of the first EGF domain of normal factor IX predicts a calcium-binding site involving Asp47, Asp49, Asp64, and Asp65. Our binding data, however, indicate that Asp47 is not necessary to form the high affinity binding site. We conclude that Asp47 in normal factor IX coordinates to the bound calcium, inducing a conformational change in the molecule essential for proper interaction with factor X and factor VIIIa.
Binding Sites↗
Acquired immunodeficiency syndrome in Alabama: special concerns for black women.
BACKGROUND: Among AIDS case reports from rural and small town areas of the United States, rates are higher in the South than in any other part of the country. METHODS: For this study, we analyzed AIDS surveillance statistics from the state of Alabama for trends, distributions, and populations affected. We aggregated Alabama AIDS surveillance data in 5-year intervals--1981 to 1985, 1986 to 1990, 1991 to 1995--and made comparisons based on geographic area of residence of people diagnosed with AIDS. RESULTS: Of the 3,558 cases of AIDS reported in Alabama in the period 1981 to 1995, 86% were men and 14% were women. Among women, 69.7% were black and 29.1% were white. Among men, 48.4% were black and 50.9% were white. We compared these figures with 1995 Alabama population estimates of 26.2% black, 73.7% white, and < 1% another race. The rates for black women and white women increased 170-fold and 23-fold, respectively, from the 1981 to 1985 period to the 1991 to 1995 period. For the same periods, case rates for black men and white men increased more than 80-fold and 50-fold, respectively. Black women showed a rise per 100,000 population-from 0.3 (1981 to 1985) in both northern and southern Alabama to 37 in northern Alabama and 64 in southern Alabama (1991 to 1995). CONCLUSIONS: Black women are at disproportionately high risk, particularly in the southern counties of Alabama. HIV is increasingly prevalent in rural and small town communities in Alabama and is more often transmitted heterosexually than it has been previously.
Acquired Immunodeficiency Syndrome↗
Alabama coronary artery bypass grafting project: results of a statewide quality improvement initiative.
CONTEXT: Efforts to improve quality of care in the cardiac surgery field have focused on reducing the risk-adjusted mortality associated with common surgical procedures, such as coronary artery bypass grafting (CABG). However, the best methodological approach to improvement is under debate. OBJECTIVE: To test an intervention to improve performance of CABG surgery. DESIGN AND SETTING: Quality improvement project based on baseline (July 1, 1995-June 30, 1996) and follow-up (July 1-December 31, 1998) performance measurements from medical record review for all 20 Alabama hospitals that provided CABG surgery. PATIENTS: Medicare patients discharged after CABG surgery in Alabama (n = 5784), a comparison state (n = 3214), and a national sample (n = 3758). INTERVENTION: Confidential hospital-specific performance feedback and assistance with multimodal improvement interventions, including the option to share relevant experience with peers. MAIN OUTCOME MEASURES: Duration of intubation, reintubation rate, aspirin therapy at discharge, use of the internal mammary artery (IMA), hospital readmission rate, and risk-adjusted in-hospital mortality. RESULTS: Proportion of extubation within 6 hours increased from 9% to 41% in Alabama, decreased from 40% to 39% in the comparison state, and increased from 12% to 25% in the national sample. Use of IMA increased from 73% to 84%, 48% to 55%, and 74% to 81%, respectively, in the 3 samples, but aspirin use increased only in Alabama (from 88% to 92%). The amount of improvement in all 3 of these process measures was greater in Alabama than in the other samples (IMA use for Alabama vs comparison state was P =.001 and for Alabama vs national sample, P =.02; and P<.001 for all other comparisons). Risk-adjusted mortality decreased in Alabama (4.9% to 2.9%), but this decrease was not statistically significantly different from mortality changes in the other groups (odds ratio, 0.76; 95% confidence interval, 0.54-1.07 vs national sample). CONCLUSION: Confidential peer-based regional performance feedback and process-oriented analysis of shared experience are associated with some improvement in quality of care for patients who underwent CABG surgery.
Aged↗
PMR study of mortality among Alabama workers and farmers.
Computerized records of all Alabama deaths occurring to persons 16 years of age and over for the 5-year period 1984-1988 were obtained from the Alabama Department of Public Health. Using proportionate mortality ratio (PMR) methodology and death certificate occupation, cause-specific mortality patterns were examined for all Alabama decedents (N = 182,178), for all Alabama workers (N = 125,369), and for the occupational group of "farm operators and managers" (N = 11,691). In comparison with the U.S. general population, little difference was found between cause-specific PMR results for the total Alabama population and those for all workers, suggesting the absence of a generalized "healthy worker effect." In comparison with the U.S. population, PMR results for farmers suggested lowered mortality from all malignant neoplasms and all heart disease, and elevated mortality from all external causes of death. In comparison with the Alabama population, PMR results for farmers continued to suggest lowered mortality from all malignant neoplasms, specifically for cancers of the respiratory, digestive and lymphopoietic systems. However, significantly elevated PMRs for external causes of death appeared only among nonwhite female farmers. Further investigation of these deaths suggested that this finding was more likely attributable to an increased risk of housefire deaths associated with rural lifestyle than with occupational factors.
Accidents, Home↗
Medical College of Alabama in Mobile, 1859-1920: a legacy of Dr. Josiah Clark Nott.
The first legislated orthodox medical school within Alabama was founded in Mobile in 1859, a legacy of Dr. Josiah Clark Nott. That it developed later than other Southern medical schools has been attributed to multiple factors, among them rural isolation, restricted communication, limited transportation, sparse population, cultural deprivation, and climatologic enervation. The rationale for a medical school within Alabama was also multifactorial: to supply physicians to rural Alabama, to reverse the economic and cultural drain among Alabamians that out-of-state education implied, and to educate medical students regarding the unique health care requirements of a predominantly rural Alabama populace. A medical school building was constructed east of the Mobile City Hospital, and was equipped with an elegant collection of anatomic models acquired by Nott during his travels in western Europe in 1859. After only two sessions, however, the War Between the States (1861 to 1865) forced the medical school to close, as faculty and students joined the Confederate forces. In 1868, with the continued involvement of Dr. W. H. Anderson as Dean, the institution was reopened. During the succeeding 52 years of its existence, the financially strapped medical school attempted to cope with evolving medical technologies and educational philosophies. Despite the commitment of the administrators and faculty, sociopolitical factors and insufficient economic support militated against the school's continued existence. Nott has been characterized as a physician, anatomist, anthropologist, and ethnologist. His opinions as revealed in his writings were controversial because they addressed sociopolitical and racial issues. Nevertheless, his commitment to the Medical College of Alabama in Mobile was unstinting, and he provided the major leadership role in its establishment.
Alabama↗
Allele frequencies of hemojuvelin gene (HJV) I222N and G320V missense mutations in white and African American subjects from the general Alabama population.
BACKGROUND: Homozygosity or compound heterozygosity for coding region mutations of the hemojuvelin gene (HJV) in whites is a cause of early age-of-onset iron overload (juvenile hemochromatosis), and of hemochromatosis phenotypes in some young or middle-aged adults. HJV coding region mutations have also been identified recently in African American primary iron overload and control subjects. Primary iron overload unexplained by typical hemochromatosis-associated HFE genotypes is common in white and black adults in Alabama, and HJV I222N and G320V were detected in a white Alabama juvenile hemochromatosis index patient. Thus, we estimated the frequency of the HJV missense mutations I222N and G320V in adult whites and African Americans from Alabama general population convenience samples. METHODS: We evaluated the genomic DNA of 241 Alabama white and 124 African American adults who reported no history of hemochromatosis or iron overload to detect HJV missense mutations I222N and G320V using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Analysis for HJV I222N was performed in 240 whites and 124 African Americans. Analysis for HJV G320V was performed in 241 whites and 118 African Americans. RESULTS: One of 240 white control subjects was heterozygous for HJV I222N; she was also heterozygous for HFE C282Y, but had normal serum iron measures and bone marrow iron stores. HJV I222N was not detected in 124 African American subjects. HJV G320V was not detected in 241 white or 118 African American subjects. CONCLUSIONS: HJV I222N and G320V are probably uncommon causes or modifiers of primary iron overload in adult whites and African Americans in Alabama. Double heterozygosity for HJV I222N and HFE C282Y may not promote increased iron absorption.
Adolescent↗
Geocoding and social marketing in Alabama's cancer prevention programs.
The Alabama Department of Public Health (ADPH) is collaborating with the National Cancer Institute to develop detailed profiles of underserved Alabama communities most at risk for cancer. These profiles will be combined with geocoded data to create a pilot project, Cancer Prevention for Alabama's Underserved Populations: A Focused Approach. The project's objectives are to provide the ADPH's cancer prevention programs with a more accurate and cost-effective means of planning, implementing, and evaluating its prevention activities in an outcomes-oriented and population-appropriate manner. The project links geocoded data from the Alabama Statewide Cancer Registry with profiles generated by the National Cancer Institute's cancer profiling system, Consumer Health Profiles. These profiles have been successfully applied to market-focused cancer prevention messages across the United States. The ADPH and the National Cancer Institute will evaluate the efficacy of using geocoded data and lifestyle segmentation information in strategy development and program implementation. Alabama is the first state in the nation not only to link geocoded cancer registry data with lifestyle segmentation data but also to use the National Cancer Institute's profiles and methodology in combination with actual state data.
Alabama↗
Pharmacists as HIV/AIDS information resources: survey of Alabama pharmacists.
Alabama pharmacists were surveyed by researchers from the University of Alabama at Birmingham's School of Public Health in collaboration with investigators at the Schools of Pharmacy at Auburn University and Stamford University as part of a statewide pharmacists' demonstration project to mobilize pharmacists and pharmacy locations as information resources for HIV/AIDS education and prevention. The objectives of the survey were to: (1) establish a baseline of knowledge and attitudes among Alabama pharmacists about HIV/AIDS; (2) to assess Alabama pharmacists' willingness to assume the role of HIV/AIDS information resources in their communities; and (3) to identify perceived barriers to assuming the role of information resources. The results of the survey were used in the development of an educational intervention program and will be used subsequently to assess the impact of the implementation of the Alabama demonstration project. Findings from this project will serve as a basis for development of a nationwide project as part of a collaborative agreement between the Centers for Disease Control and Prevention's National Partnership Program and the Foundation of Pharmacists and Corporate America for AIDS Education.
Acquired Immunodeficiency Syndrome↗
Transferrin receptor-2 (TFR2) mutation Y250X in Alabama Caucasian and African American subjects with and without primary iron overload.
Most cases of hemochromatosis are associated with mutations of the HFE gene on Ch6p. In southern Italy and central Alabama, the percentages of patients with hemochromatosis who have "atypical" HFE genotypes (defined as lack of C282Y homozygosity, C282Y/H63D compound heterozygosity, or H63D homozygosity) are relatively great. A mutation of the transferrin receptor-2 gene (TFR2; exon 6, nt 750 C --> G, replaces TAC with stop signal TAG; Y250X) on Ch7q22 was recently identified in two Sicilian families with HFE mutation-negative hemochromatosis. We wanted to estimate the frequency of this mutation in persons from central Alabama. We evaluated Caucasian hemochromatosis probands with atypical HFE genotypes and African Americans with primary iron overload. We also studied control Caucasians, including persons of southern Italian/Sicilian heritage, and control African Americans. Analysis of genomic DNA was performed using a PCR-sequence-specific priming assay and positive control specimens from Sicilian hemochromatosis subjects heterozygous and homozygous for Y250X. Among Alabama subjects, this allele was not detected in 113 Caucasians, including 21 hemochromatosis probands with atypical HFE genotypes and 92 normal control subjects (including 27 of southern Italian/Sicilian descent). In African Americans, Y250X was not detected in 20 index cases with primary iron overload or in 274 unrelated control subjects. We conclude that Y250X is uncommon in Caucasians with hemochromatosis associated with atypical HFE genotypes, in African Americans with primary iron overload, and in the general Caucasian and African American population subgroups in central Alabama.
Alabama↗
Surveillance of cryptococcosis in Alabama, 1992-1994.
PURPOSE: Although cryptococcosis is a significant opportunistic infection among patients with human immunodeficiency virus (HIV), there is conflicting information on rates of cryptococcosis among HIV-positive and HIV-negative patients. Precise state-wide epidemiologic data for cryptococcosis are not available in Alabama. METHODS: We conducted an active laboratory and hospital medical record-based surveillance for cryptococcosis in Alabama from October 1, 1992 to September 30, 1994. A case of cryptococcosis was defined as a patient's initial episode of cryptococcal disease and based on either a positive culture for C. neoformans from any normally sterile site, a positive latex agglutination serologic test for cryptococcal antigen in CSF or serum, or histopathologic findings consistent with C. neoformans. RESULTS: Over the two year period, 153 cases were identified. The diagnosis was based on positive culture (37%), positive antigen (24%), positive autopsy culture (2%), and histopathologic findings (4%). Further, 33% of the total cases were diagnosed from combined positive culture, antigen, or histopathology. Of the total 153 cases, 55% were in HIV-positive patients and 44% were in HIV-negative individuals and one case (1%) had an unknown HIV status. The overall annual incidence rate of cryptococcosis was 1.89 cases per 100,000 population. The incidence was 1638.7 per 100,000 in the HIV-positive population and 0.84 per 100,000 in the HIV-negative population. CONCLUSION: The first Alabama statewide active surveillance system for cryptococcosis confirms previous observations that rates of cryptococcosis are consistently higher in HIV-infected individuals than in their HIV-negative counterparts. In Alabama, cryptococcosis occurs more commonly in urban residents and in men. Cryptococcosis in HIV-positive persons is more likely to occur in the 20 to 44 year age group, whereas cryptococcosis in HIV-negative persons is more likely to occur in those greater than 45 years old.
AIDS-Related Opportunistic Infections↗
Population-based study of the geographic variation in colon cancer incidence in Alabama: relationship to socioeconomic status indicators and physician density.
OBJECTIVES: The objective of this population-based study was to examine the relationship between race, socioeconomic characteristics (socioeconomic status, SES), physician density, and colon cancer incidence in Alabama. METHODS: Data for 5,788 colon cancer cases from 1996 to 1999 provided by the Alabama Statewide Cancer Registry are linked to county-level measures of SES, including median household income, percentage of high school graduates, percentage of families below poverty level, and occupational and health care factors. Poisson regression is used to model the predictors adjusting for age, gender, and race. RESULTS: Blacks had higher incidences of colon cancer compared with whites and presented with later stages (20.4% versus 14.8% for distant disease (P = 0.0089). After controlling for race, gender, and age at diagnosis, significant associations were detected between colon cancer incidence and higher education (RR = 1.10; 95% CI, 1.03-1.17), and increased number of physicians per 1,000 (RR = 1.14; 95% CI, 1.06-1.22). The county percentage of families below poverty is associated inversely with localized disease and positively with distant stage. CONCLUSIONS: Colon cancer incidence varies geographically across Alabama and is positively related to aggregate SES factors, including education and physician density. A higher incidence of distant disease is related to black race and increased poverty. Health disparities in colon cancer across Alabama warrant further investigation.
Adolescent↗
Employee care, a vital antecedent to customer care in the health care industry: an exploratory investigation of the employee satisfaction construct at North East Alabama Regional Medical Center.
PURPOSE: The paper reports on the conceptualization and measurement of the employee satisfaction construct at North East Alabama Regional Medical Center (RMC), Anniston, Alabama. The study sought to take a global attitudinal measure of employee satisfaction. DESIGN/METHODOLOGY/APPROACH: The employee satisfaction construct was evaluated through the use of an amended Brayfield-Rothe Index (BRI). The Index, in its original form, comprises an 18-item five-point Likert scale with items listed in both positive and negative format. The amended instrument comprised an additional 12 items addressing such issues as organizational culture and satisfaction with existing orientation, human resource policy and practice. The sample was drawn from all employees of the North East Alabama Regional Medical Center, Anniston, Alabama over a two-week period in November 2003. FINDINGS: The results have proved beneficial in revealing those core dimensions that comprise the employee satisfaction construct, at least as defined through the use of BRI at RMC. The Center has been able to identify those areas where performance should be maintained at present levels and those where improvement is needed. RESEARCH LIMITATIONS/IMPLICATIONS: The research is limited by the fact that it was cross-sectional in nature and in order to track real change/improvement over time, it should be repeated annually. It should also be stressed that the BRI was used to provide a global attitudinal measure of employee satisfaction only. When used as such, the author would recommend a certain amount of qualitative follow-up with willing participants in a focus group forum. This should allow for a richer interpretation of the results. PRACTICAL IMPLICATIONS: The results have proved beneficial in revealing those core dimensions that comprise the employee satisfaction construct, at least as defined through the use of BRI at RMC. The Center has been better placed to identify those areas where performance should be maintained at present levels and those where improvement is needed. ORIGINALITY/VALUE: The research demonstrates the value and relative simplicity of the BRI method.
Adult↗
Phylogeny and biogeography of Croton alabamensis (Euphorbiaceae), a rare shrub from Texas and Alabama, using DNA sequence and AFLP data.
Croton alabamensis (Euphorbiaceae s.s.) is a rare plant species known from several populations in Texas and Alabama that have been assigned to var. texensis and var. alabamensis, respectively. We performed maximum parsimony, maximum likelihood, and Bayesian analyses of DNA sequences from the nuclear ribosomal internal transcribed spacer (ITS) and 5.8S regions and chloroplast trnL-trnF regions from collections of the two varieties of C. alabamensis and from outgroup taxa. C. alabamensis emerges alone on a long branch that is sister to Croton section Corylocroton and the Cuban endemic genus Moacroton. Molecular clock analysis estimates the split of C. alabamensis from its closest relatives in sect. Corylocroton at 41 million years ago, whereas the split of the two varieties of C. alabamensis occurred sometime in the Quaternary. Amplified fragment length polymorphism (AFLP) analyses were performed using two selective primer pairs on a larger sampling of accessions (22 from Texas, 17 from Alabama) to further discriminate phylogenetic structure and quantify genetic diversity. Using both neighbour joining and minimum evolution, the populations from the Cahaba and Black Warrior watersheds in Alabama form two well-separated groups, and in Texas, geographically distinct populations are recovered from Fort Hood, Balcones Canyonlands, and Pace Bend Park. Most of the molecular variance is accounted for by variance within populations. Approximately equal variance is found among populations within states and between states (varieties). Genetic distance between the Texas populations is significantly less than genetic distance between the Alabama populations. Both sequence and AFLP data support the same relationships between the varieties of C. alabamensis and their outgroup, while the AFLP data provide better resolution among the different geographical regions where C. alabamensis occurs. The conservation implications of these findings are discussed.
Alabama↗
Prevalence of parkinsonism and relationship to exposure in a large sample of Alabama welders.
OBJECTIVE: To estimate the prevalence of parkinsonism in welders in Alabama and to compare this prevalence with that in a general population sample. METHODS: The authors screened 1,423 welders from Alabama who were referred for medical-legal evaluation for Parkinson disease (PD). Standardized videotaped assessments using the Unified Parkinson's Disease Rating Scale motor subsection 3 (UPDRS3) were obtained. Patients provided information regarding exposure to welding fumes and job titles. Job titles were matched with Department of Labor Standard Occupational Codes (SOCs). Diagnoses were assigned based on quantitative criteria for the diagnosis of PD using two thresholds for diagnosis. With use of the number of active welders in this screening with parkinsonism as the numerator and the age-adjusted number of welders in each SOC as the denominator, the prevalence of parkinsonism in Alabama welders was estimated using conservative assumptions and compared with general population data from Copiah County, MS. RESULTS: With use of conservative and liberal case definitions of parkinsonism, the estimated prevalence of parkinsonism among active male welders age 40 to 69 statewide was 977 to 1,336 cases/100,000 population. The prevalence of parkinsonism was higher among welders vs age-standardized data for the general population (prevalence ratio = 10.19, 95% CI 4.43 to 23.43). CONCLUSION: The estimated prevalence of parkinsonism was higher within a sample of male Alabama welders vs the general population of male residents of Copiah County, MS.
Adult↗
Temperature-related deaths in Alabama.
BACKGROUND: Mortality rates for hyperthermia and hypothermia are higher in Alabama than nationally, and Alabama has twice as many hypothermia deaths as hyperthermia deaths. These causes of death have not been studied in the southeastern United States. We describe the epidemiology of heat- and cold-related deaths in Alabama. METHODS: We examined state mortality data for the years 1987 through 1998 and calculated mortality rates by age, race, and sex. RESULTS: Approximately half the hyperthermia-related deaths were among whites, and approximately two thirds were among males. Of the hypothermia-related deaths, 61.5% were among blacks, and approximately three fourths were among males. The highest rates of hyperthermia- and hypothermia-related death were among black males. Mortality rates increased with age for both causes of death. CONCLUSIONS: In Alabama, the elderly and black males are most likely to die of hyperthermia or hypothermia. Public health interventions must be directed toward these groups.
Adolescent↗