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PubMed1999

Cancer pain assessment and management recommendations by hospice nurses. University of Kentucky, Lexington, Kentucky.

Pain is often the most prevalent symptom among cancer patients referred to hospice or palliative care programs. This study was designed to use performance-based testing to evaluate the skills of hospice nurses in assessing the severe pain of a cancer patient and the pain management recommendations they would present to the patient's primary care physician. Twenty-seven hospice nurses (ranging in experience from 1 month to 10 years) were presented with the same standardized patient with cancer pain. In Part A (7 minutes), one of the investigators checked for predetermined behaviors as the nurses performed the clinical pain assessment. In Part B (7 minutes), the nurses answered questions regarding their recommendations for pain management for the patient seen in Part A. In the admission pain assessment, hospice nurses did well in assessing pain intensity (85%), pain location (70%), and pain-relieving factors (59%). However, only 48% of the nurses adequately assessed the pain onset, and only 44% adequately assessed other symptoms the patient might be experiencing. In Part B, 96% of the nurses recommended opioids, 96% recommended the oral route of administration, and 82% recommended regular dosing of the opioids. Fifty-six percent of nurses included a breakthrough medication in their analgesic recommendations. All of the hospice nurses treated the patient's fear of addiction in an appropriate manner, and 93% of the nurses recommended increasing the patient's opioid dosage to treat the persisting pain problem. There were no significant differences among nurses with regard to length of time as a hospice nurse or hospice certification on any of the items in either Part A or Part B. Most practicing hospice nurses were judged to be competent in the assessment and management of the severe pain of the standardized cancer patient, although some deficits were noted. Regular oral opioids were the analgesics of choice. Co-analgesics were rarely recommended.

Hospice Care↗
PubMed2003

Kentucky breast cancer report card.

The Kentucky Breast Cancer Task Force in conjunction with the Kentucky Cancer Registry and the Kentucky Cancer Program has prepared a Breast Cancer Report Card concerning the incidence and mortality of this disease among Kentucky women for the period of 1995 to 2000. Comparison of Kentucky data with those from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute reveals that the incidence rate of breast cancer in Kentucky is lower than that for the SEER population. The incidence of "early" stage disease is significantly lower among Kentucky women, but the incidence of "late" stage disease is similar in both data sets. The incidence rate is lower in rural than urban Kentucky, and is lowest in rural Appalachian Kentucky. The ratio of "early" to "late" stage breast cancer is lower for Kentucky women than for the SEER population and lowest in women over age 65, the group in which approximately half of the new cases of breast cancer are detected each year. Mortality rates are similar for Kentucky and for the SEER population. Improving the breast cancer mortality rate in Kentucky will depend on increased case-finding of "early" stage disease and increasing the ratio of "early" to "late" stage incident cases.

Adolescent↗
PubMed2004

Prevalence of overweight, obesity, and comorbid conditions among U.S. and Kentucky adults, 2000-2002.

INTRODUCTION: Obesity rates for adults in Kentucky are regularly among the highest in the nation. Since 1991, adult obesity in Kentucky and the United States has nearly doubled. This trend is of great concern because excess weight has been associated with several chronic diseases and conditions. This paper reports on the prevalence of overweight and obesity among adults in Kentucky between 2000 and 2002. The estimates produced by this study will provide baseline figures for developing Kentucky's statewide obesity action plan. METHODS: A secondary data analysis was performed using the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System. Prevalence estimates and odds ratios were calculated for the United States and Kentucky. RESULTS: In Kentucky, 24.2% of adults were obese, compared with 21.9% nationally (P < .001). There were also significantly more overweight adults in Kentucky than there were nationwide (P < .001). Logistic regression showed that overweight and obese adults were more likely to report various comorbid conditions. CONCLUSION: Overweight and obesity estimates in Kentucky were significantly higher than nationwide figures. However, overweight/obese adults in Kentucky were no more likely than their U.S. counterparts to report selected comorbid conditions.

Adolescent↗
PubMed1990

Suicide mortality among Kentucky farmers, 1979-1985.

Farmers may be at high risk for suicide because of their social environment and because of chemical exposure resulting in neurotoxic effects in the workplace. Age-specific suicide rates are compared for Kentucky white farmers, Kentucky white males, and U.S. white males. Data for suicides occurring in Kentucky represent the 7-year period between 1979 and 1985; data for the United States suicides represent the period 1980. Overall, suicide rates were highest for Kentucky farmers, followed by Kentucky males and then by U.S. males. All males were most likely to use firearms as the mode of suicide, but the farmers used firearms significantly more often than the U.S. males, as did the other Kentucky males. These findings and other evidence support the need to assess suicide rates in this occupational group in other states, to begin suicide prevention programs for Kentucky, and to work to identify risk factors contributing to the Kentucky farm suicides.

Adult↗
PubMed2001

Black cutworm (Lepidoptera: Noctuidae) larval emigration and biomass in mixtures of endophytic perennial ryegrass and Kentucky bluegrass.

Studies examined the possibility that mixtures of endophytic perennial ryegrass and Kentucky bluegrass provide resistance against larvae of the black cutworm, Agrotis ipsilon (Hufnagel). We hypothesized that resistance against A. ipsilon in such stands would stem from the influence of Kentucky bluegrass on A. ipsilon growth and behavior rather than the influence of endophytic perennial rvegrass. In replicated greenhouse experiments, black cutworm larvae initially emigrated more quickly from pots containing monocultures of endophytic perennial ryegrass than from Kentucky bluegrass monocultures or polycultures of Kentucky bluegrass and endophytic perennial ryegrass. However, biomass of emigrating larvae decreased linearly as the proportion of Kentucky bluegrass increased. Turfgrass mixtures containing endophytic perennial ryegrass and Kentucky bluegrass may provide resistance against A. ipsilon mainly through the physiological effects of Kentucky bluegrass on A. ipsilon growth and development, but possibly through the influence of endophytic perennial ryegrass on A. ipsilon movement and foraging behavior as well.

Animal Migration↗
PubMed1999

Kentucky legislators' views on tobacco policy.

CONTEXT: Kentucky leads the nation in adult and teen smoking prevalence. Even though Kentucky is one of the most tobacco-dependent states, tobacco policy is subject to change in light of possible national tobacco legislation. OBJECTIVE: To describe the degree of agreement among Kentucky legislators regarding tobacco control and tobacco farming policy, and to discover whether use of the policy Delphi method produces a shift toward consensus on tobacco policy. DESIGN: A two-round policy Delphi study was conducted using in-person interviews. SETTING: Legislators' offices in Frankfort, Kentucky. PARTICIPANTS: Volunteer sample of 116 Kentucky legislators (84% response rate). MAIN OUTCOME MEASURES: Degree of agreement on tobacco control and tobacco farming policies. RESULTS: Lawmakers were highly supportive of policies to lessen the state's dependence on tobacco, and were favorable toward stronger tobacco control policies. There were discrepancies, however, between what policies legislators thought were desirable and what policies were realistic. Tobacco interests were identified as possible explanations for this disparity. Tobacco allotment ownership was associated with less support for tobacco control and tobacco farming policies. A shift toward consensus on tobacco policy was achieved in the second round for 45% of the interview items common to both rounds. CONCLUSIONS: Kentucky legislators were highly supportive of reducing the state's dependence on tobacco and more supportive of tobacco control policies than expected. The policy Delphi method has the potential for shifting opinions about tobacco policies among state legislators. The findings of this study identify opportunities for public health policy change in one of the most tobacco-dependent states in the United States.

Adult↗
PubMed2003

Characterization of fatal occupational versus nonoccupational motor vehicle collisions in Kentucky (1998-2000).

Motor vehicle collisions (MVCs) are the leading cause of occupational fatalities in Kentucky as well as in the nation. The characteristics of and contributing factors for occupational versus nonoccupational MVC fatalities in the Commonwealth of Kentucky were examined from 1998 to 2000. Semi trucks were most frequently involved in fatal occupational MVCs, and passenger cars were most frequently involved in nonoccupational MVCs. More than half of the decedent drivers resided outside of Kentucky. The percentage of occupational fatalities occurring on a four-lane highway was double the percentage observed for nonoccupational MVC fatalities. In addition, an increased proportion of occupational MVC deaths occurred on limited access highways compared to nonoccupational fatalities. When human factors contributing to these fatal incidents were examined, the two primary human factors involved in occupational motor vehicle fatalities were driver distraction/inattention and falling asleep, whereas unsafe speed and alcohol were the primary human factors contributing to a nonoccupational fatality. These results suggest that semi drivers traveling on four-lane highways are more at risk for a fatal occupational injury in Kentucky. Therefore, additional epidemiological studies are needed to further examine human factors, the nature of the Kentucky highway system, and trucking controls (e.g., weigh station hours of operation) within the Kentucky transportation industry.

Accidents, Occupational↗