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The literature review indicates that changes in Medicaid/Medicare reimbursement, large numbers of uninsured patients, the legal climate, and largely rural and chronically ill populations create a challenging environment for physicians practicing in Mississippi. As a largely rural state, many Mississippians find medical care to be physically distant, with most care being concentrated in a couple areas of the state. Given these factors, the legal climate in Mississippi and the top relocation decision factors, Mississippi will be further challenged in recruiting and retaining the numbers of general practitioners and specialists necessary to provide care to the state's population. The challenges that physicians are facing have led to challenges for health policy makers, in that physicians are difficult to recruit to Mississippi and, once here, difficult to retain as practitioners throughout their career. Four datasets were used in conjunction to analyze the demographic characteristics of Mississippi's physicians, including the age structure disaggregated by several other variables. Ultimately, the results were extended to impacts of recruitment, relocations, and retirement decisions of physicians who participated in the MSMDS. Briefly, demographic results indicate that Mississippi has a largely white physician population serving a nearly 40% minority population in Mississippi. The under representation of women within the medical profession in Mississippi means that women in the state might find it unusually challenging to find a female physician, particularly in rural areas where access to physicians is more limited in the first place. Mississippi has a high concentration of African-American patients with a low African-American physician presence. The proportion of physicians who are female is on the rise nationwide and within Mississippi, largely due to increasing enrollments of women in medical schools. Though variations exist within the groups of physicians identified as generalists, Mississippi is only slightly more likely than the nation to have specialists, rather than generalists (see Table Seven). Age structure analysis indicates that Delta physicians are older than physicians elsewhere in the state, that urban physicians are younger than rural physicians, and that our physician labor force is more highly concentrated between the ages of 35 and 54 than in the nation as a whole. Analyses concerning the future of the physician labor force indicate that a near majority of Mississippi's practicing physicians received their MD degree at UMC, but younger physicians are more likely to have been educated out-of-state than older physicians. Those who received their degrees elsewhere and chose to practice in Mississippi are more likely to be specialists (60%) than generalists (40%). Those physicians practicing in the state who were educated in-state are nearly equally as likely to be generalists (47%) as they are to be specialists (53%). Additionally, those approaching retirement are more likely to be generalists, yet the state is recruiting more generalists from recent medical school classes than in the past. Variations in intentions to recruit, relocate, and retire exist. However, most of the substantively important variation is across age groups and time in practice. There is little relevance of specialty or location within the state when examining variation in recruitment, relocation or retirement plans. Given the findings, policy research recommendations focus on improving the retention of UMC's graduates for practice in the state, improving retention of active physicians, increasing the recruitment of physicians from out of state, and easing difficulties associated with working part-time as a step toward retirement. With these changes in policy, it is possible that Mississippi can thwart a physician workforce shortage; however, without changes, with more physicians relocating, retiring early, or opting out of practicing in the state, the extant physician shortage will become more severe. Furthermore, without the data collection efforts mentioned here, there will be no means to assess whether policy changes are actually impacting the physician labor force.
CONTEXT: Beginning August 8, 1992, a woman in the state of Mississippi had to wait 24 hours after in-person receipt of state-mandated information regarding abortion and birth complications, fetal development, and alternatives to abortion before an abortion could be performed. OBJECTIVE: To analyze the effect of the law on the abortion and birth rates of Mississippi residents. DESIGN: A retrospective analysis of abortion and birth rates before and after the law in Mississippi as contrasted with abortion and birth rates in 2 comparison states, Georgia and South Carolina. Neither Georgia nor South Carolina enforced a mandatory delay law, but both states began enforcement of parental notification statutes during the study period. PATIENTS: Female residents of reproductive age in Mississippi, Georgia, and South Carolina between 1989 and 1994. MAIN OUTCOME MEASURES: We compared birth rates, abortion rates, the percentage of late abortions, and the percentage of abortions performed outside the state of residence for all women and then by age and race before and after August 1992 among women of Mississippi, Georgia, and South Carolina. RESULTS: We found that rate ratios (RRs) of resident abortion rates (rate after law implementation/rate before law implementation) declined 12% more in Mississippi than in South Carolina (95% confidence interval [CI], 8%-15%) and 14% more in Mississippi than in Georgia (95% CI, 10%-17%) in the 12 months after the law went into effect. Rate ratios for white adults declined 22% more in Mississippi than in South Carolina (95% CI, 17%-27%) and 20% more in Mississippi than in Georgia (95% CI, 15%-25%). Changes among nonwhite adults and white teens were more modest but also statistically significant (P<.05). For all women, RRs of the percentage of abortions performed after 12 weeks' gestation increased 39% more in Mississippi than in either South Carolina or Georgia (P<.05); the increase in the percentage of abortions after 12 weeks' gestation was observed for white and non-white adults (P<.05). We also show that the percentage of abortions performed out of state increased 42% more among women in Mississippi relative to women in South Carolina after the law (95% CI, 34%-50%). CONCLUSION: The timing of the decline in abortion rates in Mississippi, the lack of similar declines in comparison states, the rise in percentage of late abortions and abortions performed out of state and the apparent completeness of abortion reports suggest that Mississippi's mandatory delay statute was responsible for a decline in abortion rates and an increase in abortions performed later in pregnancy among residents of Mississippi. The effect of delay laws in other states will likely depend on whether statutes require 2 separate visits to the abortion provider (ie, clinics, hospitals, or physicians' offices where abortions are performed) and the availability of abortion services.
BACKGROUND: Cardiovascular disease rates are improving in the United States, but not for certain subgroups, especially some African Americans. The objective of the study is to assess current levels and trends in cardiovascular disease mortality in Mississippi. METHODS: Mortality statistics from the U.S. vital statistics system for the period 1979-95 were used. Comparison of age-adjusted mortality rates in Mississippi with the other states for the year 1995 and with the nation as a whole over the period of 1979-95 was performed. RESULTS: Mississippians had the highest age-adjusted cardiovascular disease morality rates in the nation in 1995. Overall, the cardiovascular rates in Mississippi were 37% higher than for the U.S. African American men and women from Mississippi had especially high cardiovascular mortality rates, approximately 50% and 70% higher than their white counterparts, respectively. The higher burden of cardiovascular disease in African Americans from Mississippi was especially marked in the younger age groups. Since about 1984-85, cardiovascular mortality rates in Mississippi have been increasing for African Americans, whereas nationally they have been decreasing. In contrast, cardiovascular mortality rates for whites in Mississippi have been declining, but at a much slower rate than seen nationally. The wide divergence in trends for African American and white men and women over that period in Mississippi has lead to an estimated 19,400 excess cardiovascular deaths. Virtually identical trends were found for heart disease. CONCLUSIONS: Cardiovascular diseases are a major public health problem in Mississippi that is especially severe in African American residents, and the problem is growing worse each year. It is important to identify the determinants of and solutions for this enormous public health problem in Mississippi.
Human activities are affecting the environment at continental and global scales. An example of this is the Mississippi basin where there has been a large scale loss of wetlands and water quality deterioration over the past century. Wetland and riparian ecosystems have been isolated from rivers and streams. Wetland loss is due both to drainage and reclamation, mainly for agriculture, and to isolation from the river by levees, as in the Mississippi delta. There has been a decline in water quality due to increasing use of fertilizers, enhanced drainage and the loss of wetlands for cleaning water. Water quality has deteriorated throughout the basin and high nitrogen in the Mississippi river is causing a large area of hypoxia in the Gulf of Mexico adjacent to the Mississippi delta. Since the causes of these problems are distributed over the basin, the solution also needs to be distributed over the basin. Ecotechnology and ecological engineering offer the only ecologically sound and cost-effective method of solving these problems. Wetlands to promote nitrogen removal, mainly through denitrification but also through burial and plant uptake, offer a sound ecotechnological solution. At the level of the Mississippi basin, changes in farming practices and use of wetlands for nitrogen assimilation can reduce nitrogen levels in the River. There are additional benefits of restoration of wetland and riverine ecosystems, flood control, reduction in public health threats, and enhanced wildlife and fisheries. At the local drainage basin level, the use of river diversions in the Mississippi delta can address both problems of coastal land loss and water quality deterioration. Nitrate levels in diverted river water are rapidly reduced as water flows through coastal watersheds. At the local level, wetlands are being used to treat municipal wastewater. This is a cost-effective method, which results in improved water quality, enhanced wetland productivity and increased accretion. The problems in the Mississippi basin serves as an example for other watersheds in the Gulf of Mexico. This is especially important in Mexico, where there is a strong need for economical solutions to ecological problems. The Usumacinta delta-Laguna de Terminos regional ecosystem is an example where ecotechnological approaches offer realistic solutions to environmental problems.
Over the last 10 years, solid organ transplantation has become increasingly successful and, in 1996, is the recognized standard of care for many end-stage organ diseases. Unfortunately, as this therapy has become more desirable, the demand for transplants has far outpaced the available supply of transplantable organs. Advances in organ preservation, surgical recovery techniques, centralized placement services and communication systems, as well as increased public awareness of the need have helped to increase organ availability. In addition, many transplant programs are now willing to make use of organs from "marginal" or "expanded" donors, particularly in urgent settings for liver and heart transplant recipients. The primary source of organs for Mississippi patients awaiting transplants is Mississippi donors. The Mississippi Organ Recovery Agency, an independent, non-profit agency, is the federally designated recovery organization for the state of Mississippi. This agency and the wait-listed recipients of the University of Mississippi Medical Center's Transplant Programs are critically dependent on appropriate recognition and referral of potential donors by the health professionals of Mississippi. Historically, Mississippi has one of the lowest organ donation rates in the United States. This will only change if physicians make every effort to offer their patients the option of organ and tissue donation, and if the organ and tissue recovery programs are successful in ongoing educational projects for health professionals and the general public.
The proportion of chloroacetanilide herbicide degradates, specifically the ethane sulfonic (ESA) and oxanilic (OA) acids, averaged 70% of the total herbicide concentration in samples from the Upper Mississippi River. In samples from the Missouri River and the Ohio River, the proportion of chloroacetanilide degradates in the total herbicide concentration was much less, 24% and 41%, respectively. The amount of tile drainage throughout the Mississippi River Basin appeared to be related to the occurrence and distribution of chloroacetanilide degradates in water samples. Pesticide concentrations in streams of the Mississippi River Basin have been well characterized. However, recent research demonstrates that in order to more fully understand the fate and transport of pesticides, the major pesticide degradates need to be included in the analysis. From March 1999 through May 2001, water samples from four major junctures of the Mississippi River Basin were collected and analyzed for a suite of herbicides and their degradate compounds. Each sampling site was selected to represent a major part of the Mississippi River: upper and lower Mississippi, Missouri and Ohio Rivers. Each basin has unique landscape variables, geology, hydrology, precipitation, and land use, which is reflected in the pesticide content at the most downstream sample site near the mouth of the Mississippi River. Atrazine was the most frequently detected herbicide (detected in 97% of the samples), followed by metolachlor (60%), and acetochlor (31%). The most frequently detected degradates were metolachlor ESA (69%), followed by deethylatrazine (62%), metolachlor OA (37%), and alachlor ESA (37%). Metolachlor ESA was detected more frequently than its parent compound (69 vs. 60%), as was alachlor ESA (37 vs. 9%). After an improvement was made in the analytical method, metolachlor ESA was detected in every sample, metolachlor OA in 89% of the samples, alachlor ESA in 84%, acetochlor ESA in 71%, and acetochlor OA in 66%.
Suspended sediment samples from approximately 30 locations along the Mississippi River and six of its major tributaries were collected during July and August 2002 and March 2003 to investigate the distribution and transport of toxaphene in the Mississippi River. The concentration of toxaphene was measured, and the load of toxaphene carried by the river at each site was calculated using water discharge and suspended sediment concentrations. Results indicate that toxaphene is widespread throughout the Mississippi River Basin with the highest concentrations and loads observed for samples collected in the Lower Mississippi River. Among the tributaries, the Yazoo River carried the largest load, amounting to approximately 21% of the estimated load carried by the Mississippi River just below Vicksburg, MS. The majority of the contamination is most likely from nonpoint source runoff from agricultural lands. We also found evidence of a localized toxaphene source in the vicinity of Memphis, perhaps coming from the Wolf River. From our data we estimate that between 200 and 1000 kg of toxaphene were released into the Gulf of Mexico in 2002 from the main stem of the Mississippi River.