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PubMed1998

Lifetime and annual incidence of intimate partner violence and resulting injuries--Georgia, 1995.

Incidence data for intimate partner violence (IPV) at the national and state levels are limited. CDC and the Division of Public Health, Georgia Department of Human Resources (GDHR), analyzed data from the 1995 Georgia Women's Health Survey (GWHS) to 1) estimate the lifetime and annual incidence of physical IPV in Georgia among women aged 15-44 years, 2) examine sociodemographic risk factors for abuse committed during the previous year, and 3) determine the likelihood of injury resulting from IPV. This report summarizes the results of this survey, which indicate that 1) 6% of reproductive-aged women in Georgia had experienced IPV during the previous year, 2) low socioeconomic status was a risk factor for IPV during the previous year, and 3) 63% of women who experienced abuse during the previous year suffered physical injuries.

Adult↗
PubMed1999

Natural and anthropogenic inputs of hydrocarbons to the Strait of Georgia.

Sediment cores from the Fraser estuary, Vancouver Harbour and Strait of Georgia, suspended sediment samples from the Fraser River and sediment grabs from Vancouver Harbour have been analyzed for alkanes and parent and alkyl PAHs (polycyclic aromatic hydrocarbons). Principal components analysis (PCA) clearly distinguishes mixed sources by separating parent PAHs according to molecular size, and separating alkyl substituted PAHs from higher plant PAHs. We find the Fraser River to be the predominant source for natural and anthropogenic hydrocarbons to the Strait of Georgia. The natural hydrocarbon burden from the Fraser River is augmented principally by petroleum hydrocarbons and combustion PAHs from Vancouver. Contaminated sediments from Vancouver Harbour very likely have also been transported to a major ocean disposal site off the Fraser estuary. Petroleum alkanes, which dominate Fraser River suspended sediment samples, are lost by processes such as dissolution or microbial degradation during transport and sedimentation, while PAHs from the river are delivered essentially unchanged to sediments in the strait. Hydrocarbon composition undergoes little change with depth at a reference location in the Strait of Georgia, indicating that PAH inputs have changed very little since the early part of this century. In Vancouver Harbour the low rate of sediment accumulation coupled with surface mixing has led to the retention of contaminant PAHs within the surface mixed layer, while the rapid delivery of sediments from the Fraser River has buried contaminant PAHs from historical ocean disposal in the Strait of Georgia.

Alkanes↗
PubMed2002

An evaluation of hospitalizations for Kawasaki syndrome in Georgia.

OBJECTIVE: To evaluate and describe the epidemiologic characteristics of Kawasaki syndrome (KS) hospitalizations in Georgia. DESIGN: We reviewed hospital discharge data and corresponding medical records for Georgian patients discharged with a KS diagnosis during 1997 and 1998. RESULTS: During the study period, 233 KS hospital discharges were recorded in Georgia; 177 (76%) were for children younger than 5 years. Twenty-one (9%) of 233 of the hospital discharges represented multiple hospitalizations. Medical records for 211 KS discharges (91%), representing 197 patients (93%), were reviewed. For those 189 patients whose medical records were reviewed and had sufficient information, 139 (74%) either had a documented illness that met the Centers for Disease Control and Prevention (CDC) definition for KS (n = 135) or had coronary artery abnormalities without meeting the CDC definition for KS (atypical KS; n = 4). Eight patients had only a history of KS. Excluding multiple hospitalizations and patients with only a history of KS, 158 hospitalizations were for patients younger than 5 years (14.0 per 100 000 children); 110 of these patients met the KS or atypical KS definition (9.8 per 100 000 children). CONCLUSIONS: Hospital discharge data are useful for KS surveillance. However, analysis of hospital discharge data may slightly overestimate the KS hospitalization rates because some discharges may represent multiple hospitalizations or hospitalizations of patients with only a history of KS. The incidence and epidemiology of KS in Georgia are consistent with findings from other continental US studies. Physicians should exercise their best clinical judgment in identifying and treating patients with KS who may not meet standard case definitions.

Age Distribution↗
PubMed2005

An epidemiological investigation of off-label anticonvulsant drug use in the Georgia Medicaid population.

PURPOSE: The primary objective was to determine the prevalence of off-label anticonvulsant drug use in the Georgia Medicaid population and establish what percentage of this off-label use is evidence-based. The second objective was to investigate differences in the prevalence of off-label use among anticonvulsants marketed before and after 1993. The third objective was to identify patient and physician characteristics associated with off-label use. METHOD: The study design was a retrospective study utilizing pharmacy, inpatient, outpatient and long-term care claims linked with eligibility files for persons with Georgia Medicaid benefits in 1999 through 2000. An anticonvulsant recipient was considered an off-label anticonvulsant user if their anticonvulsant use did not match age or medical diagnoses in the product label. An evidence-based off-label use was defined as off-label anticonvulsant use supported by at least one randomized controlled clinical trial. Logistic regression analysis was used to identify patient and physician characteristics associated with off-label use. RESULTS: 34 676 (71.3%) of 48 648 patients on one or more anticonvulsants received an off-label prescription for an anticonvulsant. Gabapentin was the anticonvulsant most widely used off-label (86%). After accounting for labeled and all evidence-based uses for the six most frequently prescribed anticonvulsants, there was a moderate to large percentage of anticonvulsant use not supported by any evidence from controlled trials (range: 19.09-57.07%). The most common comorbidities among patients prescribed the top six anticonvulsants were diabetes mellitus, depression, schizophrenia and pain. Anticonvulsants launched after 1993 had a higher prevalence of off-label use than anticonvulsants marketed before 1993. Off-label drug use varied by age with children and adolescents being the most likely to receive an off-label anticonvulsant. Compared with other practitioners, neurologists were more likely to prescribe anticonvulsants off-label. CONCLUSIONS: The anticonvulsant off-label use in the Georgia Medicaid population is very high (71%). Only a modest proportion of these off-label uses are supported by evidence from controlled trials.

Adolescent↗
PubMed2005

Fusarium species of the Gibberella fujikuroi complex and fumonisin contamination of pearl millet and corn in Georgia, USA.

This study was designed to identify and compare the Fusarium species of the Gibberella fujikuroi complex on pearl millet (Pennisetum glaucum (L.) R. Br) and corn (Zea mays L.) crops grown in southern Georgia, and to determine their influence on potential fumonisin production. Pearl millet and corn samples were collected in Georgia in 1996, 1997 and 1998. Three percent of the pearl millet seeds had fungi similar to the Fusarium species of the G. fujikuroi species complex. One hundred and nineteen representative isolates visually similar to the G. fujikuroi species complex from pearl millet were paired with mating population A (Fusarium verticillioides (Sacc.) Nirenberg), mating population D (F. proliferatum (Matsushima) Nirenberg) and mating population F (F. thapsinum (Klittich, Leslie, Nelson and Marasas) tester strains. Successful crosses were obtained with 50.4%, 10.1% and 0.0% of these isolates with the A, D and F tester strains, while 39.5 of the isolates did not form perithecia with any tester strains. Two of the typical infertile isolates were characterized by DNA sequence comparisons and were identified as Fusarium pseudonygamai (Nirenberg and O'Donnell), which is the first known isolation of this species in the United States. Based on the pattern of cross-compatibility, conidiogenesis, colony characteristics and media pigmentation, a majority of the infertile isolates belong to this species. Fumonisins FB(1) and FB(2) were not detected in any of the 81 pearl millet samples analyzed. The species of the G. fujikuroi species complex were dominant in corn and were isolated from 84%, 74% and 65% of the seed in 1996, 1997 and 1998, respectively. Representative species of the G. fujikuroi species complex were isolated from 1996 to 1998 Georgia corn survey (162, 104 and 111 isolates, respectively) and tested for mating compatibility. The incidence of isolates belonging to mating population A (F. verticillioides) ranged from 70.2% to 89.5%. Corn survey samples were assayed for fumonisins, and 63% to 91% of the 1996, 1997 and 1998 samples were contaminated. The total amount of fumonisins in the corn samples ranged from 0.6 to 33.3 microg/g.

Agriculture↗
PubMed1981

Maternal death after cesarean section in Georgia.

Few reliable data exist on the risk of maternal death from cesarean section. To identify more deaths after cesarean section than reported by vital records alone, we linked data from Georgia resident live-birth certificates to those from death certificates of Georgia women aged 10 to 44 years. We found 16 maternal deaths after cesarean section in Georgia during 1975 and 1976, five more (45%) than the 11 reported through vital records alone. We attributed nine of these 16 deaths to the cesarean section per se. We than calculated a total death-to-case rate of 105.3 deaths per 100,000 cesarean sections and a rate attributable to cesarean section of 59.3 deaths per 100,000 procedures. Pulmonary embolism and cardiopulmonary arrest during general anesthesia were the leading causes of death in this series. Preventive measures aimed at reducing these complications may reduce deaths after cesarean section.

Adolescent↗
PubMed2006

Risk behaviors and HIV, hepatitis B, and hepatitis C seroprevalence among injection drug users in Georgia.

INTRODUCTION: HIV is an emerging epidemic in Eastern Europe. Most HIV infections in this region have occurred among injection drug users (IDUs) and their sexual partners. The objective of this study was to determine the seroprevalence and risk behaviors for HIV, HBV, and HCV infection among IDUs in Georgia. METHODS: Between 2000 and 2001, we studied 583 IDUs aged 18 to 46 years from 3 cities in Georgia. Tbilist, Poti, and Batumi, Structured questionnaires were administered to measure risk behaviors, including IDU, sexual, and other risks. Blood was drawn for HIV hepatitis B (HBV), and hepatitis C (HCV) serologies. RESULTS: 401 (68.8%) participants were seropositive for HCV; 322 (55.2%) for HBV (HBsAg or anti-HBc): and 10 (1.7%) for HIV, Heroin (58.7%) was the most frequently used drug, followed by homemade drugs (31.6%) and opium, (9.8%). In multivariate analysis, risk factors, for HCV and HBV infection included unsafe cleaning practices for injection parapheralia. The number of drug-using partners was associated with HCV infection. Sexual risk factors (i.e., the number of sex partners, paying for sex, and a history of sexually transmitted infections [STIs] were associated with HIV but not with HCV infection. Those injecting homemade drugs and optium most frequently reported risky drug-using behavior. DISCUSSION: Our data suggest a high prevalence of HBV and HCV infection among IDUs in Georgia associated with significant drug- and needle-sharing behaviors. HIV seroprevalence appears to be relatively low and is associated with risky sexual behaviors, rather than drug-using behaviors. Further research is needed among Georgian IDUs to develop effective prevention strategies and limit the transmission of HIV in this population.

Adolescent↗
PubMed2000

Telepsychiatry: addressing mental health needs in Georgia.

Creation of a comprehensive mental health telecommunications system to serve isolated persons in Georgia, resulting in a more equitable distribution of mental health resources, is the goal of the telepsychiatry program at the Medical College of Georgia. Although telepsychiatric consultation is not a new idea, the "distribution" of telepsychiatry through additional integrated telecommunications channels such as the World Wide Web is a distinctive approach. This report describes the history of the development of the MCG Telepsychiatry Program. Through the use of a multichanneled telecommunications system, a more equitable distribution of mental health resources is underway in Georgia.

Adolescent↗
PubMed1998

Sequence characteristics of natural populations of tomato spotted wilt tospovirus infecting flue-cured tobacco in Georgia.

Using primers from conserved regions, the nucleocapsid (Nc) gene sequences of naturally occurring tomato spotted wilt tospovirus (TSWV) isolates from flue-cured tobacco (Nicotiana tabacum) grown in several Georgia counties were amplified by immunocapture-reverse transcription-polymerase chain reaction. The resulting amplicons were cloned and sequenced. Sequence analyses showed a high degree of sequence conservation among the Nc genes of the tobacco isolates, and those reported from other parts of the world. However, distinct differences that were unique to these tobacco isolates as well as the previously studied peanut, tomato and pepper isolates from Georgia were present. The Georgia isolates formed a distinct cluster that was clearly resolved from the rest of the TSWV isolates based on sequence phylograms.

Base Sequence↗
PubMed2003

The aftermath of health sector reform in the Republic of Georgia: effects on people's health.

After the collapse of the Former Soviet Union a health reform process was undertaken in Georgia beginning in 1994. This process was intended to encompass all aspects of the health-care sector and to transform the Soviet-style health system into one that was directed towards quality of care, improved access, efficiency, and a strengthened focus on Primary Health Care (PHC). Health sector reform fundamentally changed the ways health care is financed in Georgia. There has been a transition to program-based financing, and payroll-tax-based social insurance schemes have been introduced. Despite these measures, the performance of the health system is still disappointing. All health programs are severely under-funded, and when the majority of the population is unemployed or self-employed, collection of taxes seems impossible. Overall, Georgian consumers are uninformed about the basic principles of health reforms and their entitlements and therefore do not support them. The analysis introduced in this paper of the current situation in Georgia establishes that the rush to insurance-based medicine was more a rush from the previous system than a well-thought-out policy direction. After 70 years of a Soviet rule, the country had no institutional capacity to provide insurance-based health care. To achieve universal coverage, or at least ensure that the majority of the population has access to basic health services, government intervention is essential. In addition, educating the public on reforms would allow the reform initiators to fundamentally change the nature of the reform process from a "top-down" centralized process to one that is demand-driven and collaborative.

Cause of Death↗
PubMed2004

Risk factors for hepatitis C virus infection among blood donors in Georgia.

BACKGROUND: Growing awareness about the importance of blood safety for controlling the transmission of hepatitis C virus (HCV) has helped to decrease the spread of this virus in many settings. This study was conducted in order to evaluate potential risk factors for HCV infection among blood donors in Georgia. METHODS: The study population consisted of 553 blood donors in three major Georgian cities: Tbilisi, the capital city and Batumi and Poti, naval port cities. Risk factors were examined using a behavior questionnaire. All blood samples were initially tested using 3rd generation anti-HCV enzyme-linked immunosorbent assays and confirmed using recombinant immunoblot assays and nucleic acid testing. RESULTS: Forty-three blood donors, 7.8%, were confirmed HCV positive. Significant risk factors included: drug injection ever (OR: 42; 95% CI: 3.2-550.7); history of hepatitis (OR: 25.9; 95% CI: 4.6-145.5); history of a previous surgical procedure (OR: 148.4; 95% CI: 26.9-817.4); blood transfusion (OR: 25.9; 95% CI: 3.2-210.9). CONCLUSIONS: This study found a very high prevalence of HCV among blood donors in Georgia. The main risk factor for HCV infection in this population of blood donors was previous contact with contaminated blood or blood products. Reliable screening of donors and their blood is critical for controlling the further spread of HCV in Georgia.

Adolescent↗
PubMed1998

Primary-care delivery for sickle cell patients in rural Georgia using telemedicine.

BACKGROUND: Advances in newborn screening and pediatric management of sickle cell disease have resulted in patients living well into adulthood. For adults, preventive care and medication monitoring are crucial for optimal health maintenance. The Medical College of Georgia (MCG) in Augusta provides consultative services and comprehensive medical care to about 1200 sickle cell patients residing in middle and southern Georgia. An increase in the demand for clinical services in this patient population has resulted in expansion of sickle cell outreach efforts throughout the state. OBJECTIVE: A telemedicine clinic for adult sickle cell patients was established in order to meet the growing clinical demands. METHODS: An on-site outreach clinic was introduced in the target area. After 10 months of operation, a monthly telemedicine clinic was offered to patients as an option for routine medical follow-up. A clinic model was used, with scheduled appointments and a public health nurse assisting at the remote site. Phlebotomy and laboratory services enhanced the telemedicine encounter. RESULTS: Over a 12-month period, 52 encounters for 28 patients from 17 medically underserved counties were completed. All patients were African-American, and 89. 3% had Medicaid or Medicare insurance coverage or both. The clinic encounter time was 24 +/- 7.9 minutes (mean +/- SD), comparable to that for all telemedicine clinic encounters during the same period. CONCLUSIONS: The adult sickle cell population in rural Georgia accepts innovative health care delivery using telemedicine. Thus, the telemedicine sickle cell clinic has increased access to care for rural patients in underserved areas. For providers, it has allowed greater clinical productivity and diminished travel time to outreach clinics.

Adult↗
PubMed2006

West Nile virus antibodies in avian species of Georgia, USA: 2000-2004.

West Nile virus (WNV) was first isolated in the state of Georgia in the summer of 2001. As amplifying hosts of WNV, avian species play an important role in the distribution and epidemiology of the virus. The objective of this study was to identify avian species that are locally involved as potential amplifying hosts of WNV and can serve as indicators of WNV transmission over the physiographic and land use variation present in the southeastern United States. Avian serum samples (n=14,077) from 83 species of birds captured throughout Georgia during the summers of 2000-2004 were tested by a plaque reduction neutralization test for antibodies to WNV and St. Louis encephalitis virus. Over the 5-year period, WNV-neutralizing antibodies were detected in 869 (6.2%) samples. The WNV seroprevalence increased significantly throughout the study and was species dependent. The highest antibody prevalence rates were detected in rock pigeons (Columba livia), northern cardinals (Cardinalis cardinalis), common ground doves (Columbina passerina), grey catbirds (Deumetella carolinensis), and northern mockingbirds (Mimus polyglottos). Northern cardinals, in addition to having high geometric mean antibody titers and seroprevalence rates, were commonly found in all land use types and physiographic regions. Rock pigeons, common ground doves, grey catbirds, and northern mockingbirds, although also having high seroprevalence rates and high antibody titers against WNV, were more restricted in their distribution and therefore may be of more utility when attempting to assess exposure rates in specific habitat types. Of all species tested, northern cardinals represent the best potential avian indicator species for widespread serologic-based studies of WNV throughout Georgia due to their extensive range, ease of capture, and high antibody rates and titers. Due to the large geographic area covered by this species, their utility as a WNV sentinel species may include most of the eastern United States.

Age Factors↗
PubMed2006

Factors affecting the geographic distribution of West Nile virus in Georgia, USA: 2002-2004.

The distribution of West Nile virus (WNV) is dependent on the occurrence of both susceptible avian reservoir hosts and competent mosquito vectors. Both factors can be influenced by geographic variables such as land use/landcover, elevation, human population density, physiographic region, and temperature. The current study uses geographic information systems (GIS) and logistic regression analyses to model the distribution of WNV in the state of Georgia based on a wild bird indicator system, and to identify human and environmental predictor variables that are important in the determination of WNV distribution. A database for Georgia was constructed that included (1) location points of all the avian samples tested for WNV, (2) local land use classifications, including temperature, physiographic divisions, land use/landcover, and elevation, (3) human demographic data from the U.S. Census, and (4) statistics summarizing land cover, elevation, and climate within a 1-km-radius landscape around each sample point. Logistic regression analysis was carried out using the serostatus of avian collection sites as the dependent variable. Temperature, housing density, urban/suburban land use, and mountain physiographic region were important variables in predicting the distribution of WNV in the state of Georgia. While weak, the positive correlation between WNV-antibody positive sites and the urban/suburban environment was consistent throughout the study period. The risks associated with WNV endemicity appear to be increased in urban/ suburban areas and decreased in the mountainous region of the state. This information may be used in addressing regional public health needs and mosquito control programs.

Animals↗
PubMed2004

Current and future forecasts of service use and expenditures of Medicaid-eligible schizophrenia patients in the state of Georgia.

This study linked all claims data for reimbursable medical services and drugs of a cohort of 16,227 Medicaid-eligible recipients diagnosed with schizophrenia residing in the State of Georgia, with the treatment history file and Hospital Medical Information System file of each of the ten Georgia State psychiatric hospitals (Georgia Department of Human Resources [DHR]), which do not routinely bill Medicaid for services rendered. This provided a comprehensive picture of the medical resources consumed for each schizophrenia patient, allowing determination of expenditure use patterns, as well as forecast of future medical costs. Patient-level data were aggregated by category of service and reported as costs per member per month (PMPM). Autoregressive integrated moving average time series models described the temporal pattern of expenditures for 8 years of total cost data and were used to forecast expenditures 5 years into the future. From 1990 to 1997, total cumulative expenditures were over 1.09 billion dollars, expressed in 1995 constant dollars. DHR institutional care dominated the cost of care, but expenditures significantly decreased over time. Apparently offsetting this decrease was an increase in prescription drug cost between 1990 and 1995, from 5.7 percent of total expenditures to 10.5 percent. Total Medicaid and Medicare expenditures in 1995 dollars were relatively constant at approximately 700 dollars PMPM. Prescription expenditures increased from 50 dollars in 1990 to 100 dollars PMPM in 1997 and were projected to increase to 150 dollars in 2002. Expenditures were lower for persons continuously eligible for Medicaid than for the total cohort. Trends include a significant increase in prescription expenditures over time concurrent with decreases in inpatient expenditures and relatively stable changes in community mental health center expenditures.

Adolescent↗
PubMed1976

An analysis of practice in Georgia and South Dakota.

Family practitioners in Georgia and South Dakota were surveyed in order to ascertain percentage of practice devoted to various specialty areas, daily case loads, type of diagnoses, method of handling telephone calls, and patterns of agency utilization. Questionnaires were sent to all South Dakota and Georgia family practitioners. In Georgia 22% of family practitioners do no surgery and 55% do no obstetrics, while in South Dakota 90% practice obstetrics. Differences in availability of specialists and in pysician referral patterns caused marked variations in family practice patterns. Diagnoses showing geographic differences included chronic lung disease, arthritis, sore throat, heart disease, and neuroses. About 50% of all physicians handled medical phone calls personally. Less than half the respondents in each state used some agency or resource in this time period. The distribution of specialists affects the patient load and needs to be considered when primary care is planned.

Community Health Services↗
PubMed1992

HIV seroprevalence in hospital patients in rural Georgia.

To determine human immunodeficiency virus (HIV) seroprevalence among hospital patients in three rural community-based hospitals in southern Georgia, we anonymously tested patients 15 to 54 years old for antibodies to HIV-1 from residual blood specimens collected for routine diagnostic purposes. Data collected included age, sex, race, hospital service, presenting condition, physician's knowledge of HIV infection status, and discharge diagnosis. Of 1319 patients tested, seven (0.5%, 95% confidence interval = 0.2% to 1.1%) had antibodies to HIV-1. Of those seven, five had HIV infection unsuspected by their physicians, and four had an infectious disease. HIV seroprevalence was 0.5% for both men and women, 1.0% for blacks, and 0.3% for whites. HIV-positive patients were found on all hospital services. These results suggest that in rural southern Georgia hospitals, HIV should be routinely considered in the differential diagnosis of conditions that may be related to HIV. In addition, these data demonstrate a need for medical services or referral networks for HIV-related illnesses and a need for continuing HIV counseling and testing offered by local health departments in rural southern Georgia.

Adolescent↗
PubMed1994

Physical activity patterns among adults in Georgia: results from the 1990 Behavioral Risk Factor Surveillance System.

Regular physical activity increases a person's ability to perform daily activities more efficiently, reduces the risk of specific chronic diseases, including coronary artery disease, and lowers death rates in general. The Healthy People 2000 Physical Activity and Fitness Objectives underscored the importance of monitoring and tracking the prevalence of physical activity and fitness in the United States population for the purpose of planning, implementing, and evaluating efforts to improve the public's physical activity habits. This report examines the prevalence of self-reported leisure-time physical activity (LTPA) among southeastern adults aged 18 years and older living in the state of Georgia. Using data from the 1990 Behavioral Risk Factor Surveillance System (BRFSS) surveys from Georgia, we describe the LTPA patterns of Georgia adults aged 18 years and older. A total of 1,723 adults were interviewed during 1990. Results show the following: women are less active than men, blacks are less active than whites, persons of lower socioeconomic status (SES) are less active than those of higher SES, and older adults are less active than younger adults. These results suggest that a more concerted effort needs to be made in promoting physical activity for women, persons of lower SES, and older adults.

Adolescent↗