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PubMed1997

The impact of system design on the characteristics of Missouri's insanity acquittees.

This study describes the characteristics of Missouri insanity acquittees, which numbered 797 on July 1, 1992. Unlike reports of characterization data from other states, the study endeavors to link the characteristics to the design of Missouri's insanity acquittee system. This is accomplished by analyzing Missouri's insanity acquittee system and comparing it with the system designs and characteristics of insanity acquittees from other states. Overall, Missouri has a high number of annual insanity acquittals, inpatient hospitalization is used as the primary residential setting for insanity acquittees, most insanity acquittees have severe mental illnesses, the majority of insanity acquittees committed serious crimes, most insanity acquittees are hospitalized for extended periods of time, and insanity acquittees now occupy over 50 percent of Missouri's long-term public psychiatric hospital beds. Evidence did not exist for a linkage between the design of Missouri's insanity acquittee system and most of the insanity acquittee characteristics. Further research is needed to identify system designs that can shape insanity acquittee characteristics in intended ways, to assess the degree to which policy implementors may influence the policy implementation process, and to explore the role of symbolic politics in shaping insanity acquittee systems.

Adolescent↗
PubMed2005

Microbiologic evaluation of patients from Missouri with erythema migrans.

BACKGROUND: Borrelia lonestari infects Amblyomma americanum, the tick species that is the most common cause of tick bites in southeast and south-central United States, and this spirochete has been detected in an erythema migrans (EM)-like skin rash in 1 patient. Therefore, B. lonestari is considered to be a leading candidate for the etiologic agent of EM in this region. METHODS: Skin biopsy specimens obtained from patients from the Cape Girardeau area of Missouri who had EM-like lesions were cultured in Barbour-Stoenner-Kelly medium and evaluated by polymerase chain reaction (PCR) targeting multiple genes. Serum specimens were tested by enzyme-linked immunosorbent assay for antibodies against sonicated whole-cell Borrelia burgdorferi. Results were compared with those obtained over the same period for patients from New York State who had EM. RESULTS: B. lonestari was not detected by PCR in any of 31 skin biopsy specimens collected from 30 Missouri patients. None of 19 cultures of Missouri skin samples that were suitable for evaluation were positive for B. burgdorferi, compared with 89 (63%) of 142 cultures of samples collected from New York State patients (P<.001). None of the 25 evaluable Missouri patients were seropositive for antibodies against B. burgdorferi, compared with 107 (75%) of 143 New York State patients (P<.001). CONCLUSIONS: Neither B. lonestari nor B. burgdorferi is likely to be the cause of EM-like skin lesions in patients from the Cape Girardeau area of Missouri. The etiology of this condition remains unknown.

Borrelia↗
PubMed1995

Introgression of Luxilus cornutus mtDNA into allopatric populations of Luxilus chrysocephalus (Teleostei: Cyprinidae) in Missouri and Arkansas.

The cyprinid fishes Luxilus cornutus and Luxilus chrysocephalus hybridize extensively in a zone extending through the Great Lakes region with extensive introgression of L. cornutus mtDNA occurring in populations of L. chrysocephalus south of the present hybrid zone in Ohio. Western populations of these two species occur adjacent to one another in Missouri but hybridization has never been observed. In order to determine if hybridization has occurred historically in Missouri, allopatric populations of L. chrysocephalus were analysed for mtDNA introgression. Extensive introgression of L. cornutus mtDNA was observed in most populations of L. chrysocephalus in Missouri resulting in the elimination of L. chrysocephalus mtDNA in many populations. Luxilus cornutus mtDNA in L. chrysocephalus is found approximately 300 km south of extant L. cornutus populations in Missouri. Luxilus chrysocephalus mtDNA was replaced by four unique L. cornutus mtDNA haplotypes, with one particular haplotype becoming fixed in several L. chrysocephalus populations. The pattern of introgression suggests that historically L. cornutus occupied a more southern distribution in Missouri bringing it into contact with western populations of L. chrysocephalus and resulting in a hybrid zone.

Animals↗
PubMed2000

Description of Missouri children who suffer burn injuries.

OBJECTIVE: This study uses Missouri's inpatient and outpatient E code data system to describe the demographic characteristics of Missouri children who suffered burn injuries during 1994 and 1995. METHODS: Retrospective review of Missouri E code data. RESULTS: Altogether 8,404 children aged 0-14 years were treated for burn injuries in Missouri hospitals during 1994 and 1995. The rate of burn injury in Missouri children was 339 per 100,000/year. African-American boys 0-4 years living in urban counties were at increased risk. In addition, African-American girls ages 0-4 years living in counties with a high poverty rate had raised burn injury rates. Burns from hot objects and scalds from hot liquids caused more than half of the burns. CONCLUSIONS: Hospital based E coding has proven an invaluable tool for the study of burns and will, no doubt, prove equally useful for other injuries.

Burns↗
PubMed1999

Trends in Missouri lung cancer rates.

This study presents trend analysis of Missouri lung cancer incidence and mortality, and makes comparisons to U.S. rates. Utilizing 1985-1992 data from the Missouri Cancer Registry, we calculated incidence rates by disease diagnosis year. Missouri Center for Health Information Management and Epidemiology data were used to calculate 1980-1996 mortality rates. Missouri's overall yearly lung cancer incidence rate increased from 60.5 to 62.5 per 100,000 during 1985-1992, while lung cancer mortality increased 25% from 1980-1996. The best method to reduce Missouri's rates of lung cancer is tobacco-use prevention and cessation.

Adult↗
PubMed2006

Racial disparities in diabetes-related preventive care: results from the Missouri Behavioral Risk Factor Surveillance System.

INTRODUCTION: Racial disparities exist in the rates of diabetes complications in the United States and in the state of Missouri. It is unclear to what degree such disparities involve diabetes-related preventive care. We sought evidence for racial disparities in diabetes-related preventive care between non-Hispanic blacks and whites in Missouri. METHODS: We analyzed data from the Missouri Behavioral Risk Factor Surveillance System from 1994 through 2002. This state-specific survey is conducted annually among a representative sample of Missourians. We examined data from 842 Missourians who reported a diagnosis of type 1 or type 2 diabetes and who had consulted a health professional in the 12 months before they were interviewed. We analyzed reported receipt of glycosylated hemoglobin testing, foot examinations, and dilated eye examinations in the year before interview. RESULTS: Non-Hispanic blacks were significantly less likely than whites to report having had glycosylated hemoglobin testing (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.22-0.99) but more likely to report having received foot examinations (OR, 1.99; 95% CI, 1.21-2.39). There was no difference between blacks and whites in the probability of dilated eye examinations (OR, 1.49; 95% CI, 0.94-2.36). CONCLUSION: Compared with whites, non-Hispanic blacks in Missouri receive adequate screening for diabetic complications but not for glycemic control. Further studies are needed to investigate whether these disparities are linked to differences in the rate of diabetes complications in Missouri.

Black or African American↗
PubMed1993

Morbidity surveillance following the midwest flood--Missouri, 1993.

Heavy spring and summer rains during 1993 caused flooding by both the Mississippi and Missouri rivers and by streams in 84 of the 115 counties in Missouri; all 84 were declared federal disaster areas. The Mississippi River attained flood stage during July 15-August 2, and the Missouri River, during July 25-August 2; a total of 2,060,757 acres were submerged, and approximately 60,000 persons throughout Missouri were displaced (National Weather Service, unpublished data, 1993). At the request of the Missouri Department of Health, CDC provided assistance in implementing a surveillance system to monitor flood-related injuries and illnesses in the affected areas. This report presents preliminary findings of these surveillance efforts.

Disasters↗
PubMed1999

The Missouri Disability Epidemiology and Health Project.

INTRODUCTION: Estimates of disability in this country are as high as 20%. State health departments need to provide the core activities to deal with this public health problem including assessment, policy development, and assurance. A collaboration among academic institutions and the Missouri Department of Health (MDOH) is a model for providing this core. METHODS: A disability workgroup was established among bureaus of the MDOH and three universities. This group selected the disability domain of mobility impairments for initial work. Existing data from the Centers for Disease Control and Prevention's (CDC) Behavioral Risk Factor Surveillance System (BRFSS) in Missouri and data from the 1990 Census were analyzed. Dissemination of the findings involved community and consumer participation via an advisory group and a public health-sponsored conference on disability. In addition, new data collection efforts are underway using the BRFSS. Education and training activities include both public health students and public health practitioners in learning the content and methodology associated with disability epidemiology. RESULTS: Data analyses have identified rural geographic areas of the State with high levels of disability and a trend of increasing work disability since 1993. A selected key condition, arthritis, has been confirmed as having a high prevalence (28%) in Missouri. These data also demonstrate that there is a strong risk of limitations associated with arthritis [adjusted odds ratio (OR) 3.57; 95% confidence intervals 3.0, 4.2]. These results will be applied to program planning. CONCLUSIONS: The Missouri program is succeeding in providing both academic and public health practice partners with a productive experience that meets the needs of each.

Data Interpretation, Statistical↗
PubMed2000

Phlebotomy skills expected of career entry CLS/CLT graduates: a Missouri hospital perspective.

OBJECTIVE: To determine how much, what type, and what proficiency of phlebotomy experience CLS/CLT students should have during the training program to be prepared to meet the needs of the majority of Missouri hospital employers. DESIGN: Survey to determine the role healthcare professionals, inside and outside the laboratory, play in today's blood collection patterns and phlebotomy management. SETTING/PARTICIPANTS: The Missouri Organization of Clinical Laboratory Science mailed 204 surveys to the Missouri Hospital Association member laboratories. MAIN OUTCOMES/CONCLUSIONS: This research examined the need for modifying phlebotomy skills of clinical laboratory science students. Data gathered from employers support the premise that entry-level competencies of CLS/CLT graduates will vary according to clinical facility size. CLS/CLT programs may use data from this study to plan phlebotomy practicums. It can be extrapolated that Missouri employers who are most likely to employ career entry graduates expect them to draw blood from 9.3 patients within one hour. Fifty-three percent of 40 to 400 bed hospitals expect graduates to perform difficult draws in at least eight types of hospital units. Laboratories are the major managers of hospital wide phlebotomy services; thus, CLS/CLT curricula should include phlebotomy management methods.

Curriculum↗
PubMed1994

Evidence supporting the presence of Borrelia burgdorferi in Missouri.

Although Lyme disease is commonly seen in the southcentral United States, the epidemiology of the disease is poorly defined there. The purpose of this study was to document the presence of Borrelia burgdorferi in ticks collected in southeastern Missouri and around the city of St. Louis. Spirochetes were detected and identified as B. burgdorferi by immunofluorescent antibody (IFA) tests using the monoclonal antibody H5332 in 1.9% of Amblyomma americanum and 2.0% of Dermacentor variabilis ticks collected. The identity of IFA-positive organisms was verified by polymerase chain reactions (PCRs) with two different sets of B. burgdorferi-specific primers followed by Southern blotting. The DNA sequences of amplified 371-basepair PCR products from two positive Missouri ticks showed 97-98% identity with that obtained by the same method for the B31 strain of B. burgdorferi. These results confirm that B. burgdorferi is present in questing D. variabilis and A. americanum ticks in areas of Missouri where Lyme disease occurs. Additional studies are needed to determine the role of these ticks in the epidemiology of Lyme disease in Missouri and neighboring states.

Animals↗
PubMed1993

The Missouri child fatality study: underreporting of maltreatment fatalities among children younger than five years of age, 1983 through 1986.

Estimates of the incidence of child maltreatment fatalities vary widely; most experts believe they are underreported. To investigate the suspicion that fatal maltreatment was underreported in Missouri preschool children, a statewide, population-based study was conducted using nine data sources. The study cases included the 384 children younger than age 5 who died from 1983 through 1986 and whose death certificates were coded with an external cause (injury) or whose deaths were substantiated as abuse or neglect fatalities by the Missouri Division of Family Services. Each fatality was categorized as one of the following: definite maltreatment, probable maltreatment, possible maltreatment, non-maltreatment, or inadequate information. Of the 121 cases classified as definite maltreatment, only 47.9% had codes consistent with maltreatment on their death certificates. The Division of Family Services had substantiated 79.3% of definite maltreatment cases as abuse or neglect fatalities. The Federal Bureau of Investigation Uniform Crime Reports database reported only 38.8% of these cases as homicides. In 37.2% of the cases, there was at least one criminal conviction. Child maltreatment fatalities are drastically underreported as such in Missouri because of inadequate investigations, lack of information-sharing between investigators and agencies, and reporting systems that fail to capture the contribution of maltreatment as a cause of death. Missouri has created a statewide system of child fatality review panels and a child fatality surveillance system to address the problems documented in this study.

Abstracting and Indexing↗
PubMed1991

Hemoglobin Columbia Missouri or alpha 2[88 (F9) Ala----Val]beta 2: a new high-oxygen-affinity hemoglobin that causes erythrocytosis.

A previously undescribed hemoglobin variant, hemoglobin Columbia Missouri, alpha 88 (F9) Ala----Val, was detected in a 22-year-old white man who was undergoing assessment for erythrocytosis. This new hemoglobin variant does not separate from hemoglobin A by electrophoresis in conventional media, by isoelectric focusing, or by electrophoresis of purified globin chains in 8 M urea. It exhibits a high oxygen affinity, with a P50 (oxygen tension at 50% saturation) of 19.3 torr for the patient's whole blood. The substitution of hemoglobin Columbia Missouri is an internal residue near the end of the F helix of the alpha chain. Hemoglobin Okazaki has an arginyl residue substitution for a cysteinyl residue at F9 (beta 93) in the beta chain. In comparison with hemoglobin Okazaki, the substitution in hemoglobin Columbia Missouri has a more pronounced effect on oxygen affinity. Consequently, hemoglobin Columbia Missouri is associated with erythrocytosis, whereas hemoglobin Okazaki is not.

Adolescent↗
PubMed1999

Quality of stallion semen obtained by a new semen collection phantom (Equidame) versus a Missouri artificial vagina.

A study was performed to test a new semen collection device (Equidame phantom) that fractionates the ejaculate by comparing the quality of semen obtained by the Equidame phantom with that obtained by a Missouri artificial vagina. Semen from 4 Finnhorse stallions was collected 4 times per stallion by both methods. Half of the ejaculate was frozen and the other half extended and loaded into 2 Equitainer transport containers (24- and 48-h samples). Motility parameters were determined by a Hamilton-Thorn motility analyzer after cooled storage for 24 and 48 h and again after freezing/thawing. Raw and chilled semen samples were cultured and the number of bacterial colonies counted after incubations of 24 and 48 h. After a 24-h incubation the number of colony-forming units (CFU) in raw semen was significantly higher (P<0.01) when collected by the Missouri artificial vagina than by the Equidame phantom. After cooled storage, 75% of the semen samples contained no bacteria after an incubation of 24 h, and 69% yielded no growth after 48 h. The sperm-rich fractions (Cup 2) collected by the Equidame phantom had lower mean volumes (22.1 +/- 2.3 mL [+/- SEM] versus 101.6 +/- 9.3 mL) and significantly higher mean sperm concentrations (218.0 +/- 25.8 x 10(6) vs 86.2 +/- 8.1 x 10(6) cells/mL; P<0.05) than the total ejaculates collected by the Missouri device. The total and progressive motility of chilled and frozen-thawed semen did not differ significantly between collection methods. The Equidame phantom yielded semen that was of a lower bacteriological colony counts, but had sperm motility similar to that of semen collected with the traditional method by the Missouri artificial vagina.

Animals↗
PubMed1989

Will Webster redefine Roe v. Wade? The Supreme Court could use a Missouri case to begin limiting abortion rights.

The U.S. Supreme Court's decision to review Webster v. Reproductive Health Services, a Missouri case that challenges the validity of legislative direction of public policy as outlined in Roe v. Wade, has fueled speculation that the Court will use the case to reconsider, and perhaps reverse, Roe. When the Supreme Court in Roe v. Wade opened the door to legalized abortion, it guaranteed only a woman's right to choose to terminate or continue a pregnancy without undue interference by the state--citing legitimate grounds for "due" interference by the state. In 1986 the Missouri legislature passed a statute that regulated medical practices related to abortion, including broad restrictions on the expenditure of state funds. Further, the state attempted to protect viable fetuses and directed physicians to perform certain tests to ascertain the baby's gestational age. It also contained a legislative finding that "life begins at conception." A challenge was filed almost immediately. In its application for Supreme Court review, Missouri questioned whether the Roe "trimester approach for selecting the test for which state regulation of abortion services is reviewed should be reconsidered and discarded in favor of a rational basis test." It further argued that if Missouri's statutory provisions are unconstitutional under Roe, then "Roe v. Wade should itself be reconsidered." Under current jurisprudence, it is debatable whether this formulation of the case will invite direct review of Roe. For the foreseeable future, the law will likely protect the notion that an abortion decision implicates a fundamental liberty interest.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Legal↗
PubMed2005

Survival analysis for a large-scale forest health issue: Missouri oak decline.

Survival analysis methodologies provide novel approaches for forest mortality analysis that may aid in detecting, monitoring, and mitigating of large-scale forest health issues. This study examined survivor analysis for evaluating a regional forest health issue - Missouri oak decline. With a statewide Missouri forest inventory, log-rank tests of the effects of covariates on the survivor function and equality of the survivor function among classes were conducted for selected oak species. Additionally, hazard functions were determined for diameter classes for damaged and undamaged oaks. Results indicate that mortality appears to vary significantly among some inventory classes such as oak species, but not among other classes such as ownership class. Indicators of individual tree vigor (i.e., crown class and ratio) were more significant predictors of oak tree mortality than site/stand attributes (i.e., density and aspect). Finally, results indicate that even fast-growing oak trees are at high risk of mortality if damaged by disease. Survival analyses, such as those applied in this study, may enable testing of forest health hypotheses using large-scale inventories. In the context of Missouri's oak forest decline, study results suggest management efforts should focus on limiting the spread of disease damage, increasing the vigor of residual trees, and emphasizing small trees when developing stand prescriptions.

Conservation of Natural Resources↗
PubMed2007

Missouri casino self-excluders: distributions across time and space.

According to public health research, exposure to casinos is a risk factor for disordered gambling. Consequently, casino self-exclusion programs, which provide gamblers with the opportunity to voluntarily seek limits on their access to gambling venues, can serve as a barometer of the concentration of disordered gambling in an area. This study reports on the distribution, both temporally and geographically, of 6,599 people who applied to exclude themselves from Missouri casinos between November, 1996 and February, 2004. Analyses used Microsoft MapPoint to plot the location of casinos and self-excluders (SEs) across Missouri and its constituent counties. These regional exposure analyses showed that the Western region around Kansas City is an epicenter of disordered gambling as, to a lesser extent, is the Eastern region around St. Louis. The annual number of SE enrollments increased during the first few years of the Missouri self-exclusion program and then leveled off during the later years. These findings have important implications for public health and the development of public health interventions for disordered gamblers.

Adult↗
PubMed2005

Perinatal periods of risk: analysis of fetal-infant mortality rates in Kansas City, Missouri.

OBJECTIVES: The Perinatal Periods of Risk (PPOR) technique was used to analyze resident fetal and infant death data from Kansas City, Missouri, for the period 1998-2002. Results offer important information that can be used to develop community-based prevention strategies related to racial/ethnic disparities in infant mortality rates (IMR). METHODS: The PPOR approach for fetal and infant mortality can be mapped by birthweight at delivery and time of death into four strategic prevention areas: 1) Maternal Health/Prematurity (MHP), 2) Maternal Care (MC), 3) Newborn Care (NC), and 4) Infant Health (IH). For this analysis, all fetal and infant death certificates from the metropolitan Kansas City area were linked to their birth certificates and those associated with residents of Kansas City, Missouri, proper were used to create the dataset used in this analysis. Due to the small number of fetal and infant deaths among other ethnic groups, the analysis was restricted to a comparison of the disparity of IMR between Blacks, Whites, and a national non-Hispanic white reference group. The Kitagawa formula was used to determine contribution to excess deaths from birthweight-specific mortality and birthweight distribution rates. Logistic regression techniques were used to identify risk factors for death among Black fetuses and infants with very low birthweights and also deaths due to sudden infant death syndrome (SIDS). RESULTS: The PPOR analysis showed that of the excess deaths among black infants, when compared to a national reference group, 47% was attributable to MHP and another 29% was attributable to IH. Differences in MC and NC only accounted for 27 and 8% of the total excess deaths. During the study period, rates of sudden infant death syndrome (SIDS) were found to be significantly higher among Blacks as compared to Whites (2.12 vs. 0.81 per 1,000). An analysis of maternal characteristics for SIDS deaths among blacks using a step-wise logistic regression model, found that maternal age less than 20 years old, previous births, inadequate prenatal care, and being a Medicaid recipient were significant-adjusted odds ratios of 23.7 (95% Cl 10.48, 53.67), 8.4 (95% Cl 3.64, 19.21), 2.9 (95% Cl 1.38, 6.05) and 2.5 (95% Cl 1.04, 5.84), respectively. CONCLUSIONS: PPOR is an easy to use approach that helps focus community initiatives for improving maternal and infant health. In Kansas City, Missouri, efforts to further lower IMR in blacks can be achieved through the reduction of risk factors affecting maternal health and through maternal education to improve infant health.

Adolescent↗
PubMed2003

Blastomycosis in Missouri: epidemiology and risk factors for endemic disease.

Between 1992 and 1999, 93 cases of blastomycosis, including 25 laboratory confirmed cases, were identified in Missouri (annual incidence, 0.2/100,000 population). Mississippi County in southeastern Missouri had the highest incidence (12/100,000) with a much higher rate among blacks than whites in this county (43.21/100,000). The mortality rate, 44% was also higher among blacks. To determine risk factors for endemic blastomycosis, a case-control study was conducted among southeastern Missouri residents. Independent risk factors for blastomycosis were black race and a prior history of pneumonia. No environmental exposures or socioeconomic factors were significantly associated with increased risk. The increased risk among blacks may possibly be related to genetic factors, but further studies are needed to clarify this. However, heightened awareness of the disease and a better understanding of the risk factors are important and may lead to earlier diagnosis and start of treatment, possibly improving outcome.

Adolescent↗