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PubMed1996

Extrapulmonary tuberculosis in Tennessee: lessons from the last decade.

In conclusion, extrapulmonary TB remains a significant fraction of the total TB cases in Tennessee. During the last few years, the percentage of extrapulmonary TB in Tennessee has been on the increase. Understanding these changes in the epidemiology of extrapulmonary TB will help the clinician in making a prompt diagnosis, leading to appropriate therapy. Understanding the changing trends at the national level may aid state health departments in reorganizing disease control programs, thus, facilitating the eradication of TB and other communicable diseases in Tennessee.

AIDS-Related Opportunistic Infections↗
PubMed1996

Outbreak of Escherichia coli O157:H7 infection--Georgia and Tennessee, June 1995.

On June 26, 1995, the Division of Public Health, Georgia Department of Human Resources (GDPH), was notified of three cases of Escherichia coli O157:H7 infection among residents of a community in north Georgia who had onsets of illness within a 24-hour period (onset during June 19-20); in comparison, during 1993-1994, only two cases of this infection had been reported in the same community. Because of the proximity of this community to the Tennessee border, on June 28 GDPH notified the Tennessee Department of Health (TDH) about these cases. TDH subsequently identified two confirmed cases with onsets of illness during June 23-24. Both of these cases were among persons residing in eastern Tennessee approximately 100 miles from the community in Georgia, and one occurred in an 11-year-old boy who was hospitalized with hemolytic uremic syndrome (HUS). This report summarizes the investigation of this outbreak, which implicated eating hamburgers purchased at a fast-food restaurant chain (i.e., chain A) as the source of infection.

Adolescent↗
PubMed1988

Crop loss due to ambient ozone in the Tennessee Valley.

Rural and urban ozone (O3) monitoring data for the Tennessee Valley and crop loss models developed under the National Crop Loss Assessment Network (NCLAN) were used to estimate potential yield reductions for winter wheat, corn, soybean, cotton, and tobacco during the 1982 to 1984 growing seasons. Reductions from 0 to 20% of potential crop yields were estimated due to ambient O3. Rural O3 exposures measured in the Tennessee Valley were significantly higher than the measured urban exposures, suggesting that spatial interpolation from urban O3 records may underestimate rural O3 and thereby potential crop loss. Seasonal mean O3 exposures were highest in summer 1983, and similar in 1982 and 1984. Although a consistent inverse relationship was found between measured crop yields in the Tennessee Valley and seasonal O3 exposures, annual variation in yields was much greater than attributable to the annual variation in O3. Moisture stress, as indicated by the Palmer Drought Severity Indices, is likely the major determinant for yields of nonirrigated crops. This is consistent with field studies that demonstrate that ambient O3 levels can reduce crop yields under ideal soil moisture conditions, but cause little to no detectable yield reduction for nonirrigated crops. These models could be improved if crop response to O3 were allowed to vary as a function of environmental factors such as moisture stress.

Journal Article↗
PubMed1982

[alpha 1-fetoprotein and Tennessee antigen in hepatocellular carcinomas and in metastatic liver cancer (author's transl)].

alpha 1-fetoprotein and Tennessee Antigen were evaluated in sera of 23 patients with hepatocellular carcinomas as well as in 20 patients with extrahepatic carcinomas and liver metastases. The diagnosis as histologically verified in all cases. Altogether 87% out of all hepatoma patients showed increased alpha 1-fetoprotein levels, whereby the concentrations were in the range which is highly suggestive of hepatoma in 65% of all patients with hepatoma. Tennessee Antigen concentrations were increased in 87% of hepatoma patients and in 85% of patients with metastatic liver cancer. Tennessee Antigen is an unspecific tumour marker, which can be used in control assessment during chemotherapy or after tumour resection and is of particular value in the follow up of those patients whose serum alpha 1-fetoprotein concentrations are normal or only slightly increased.

Antigens, Neoplasm↗
PubMed2006

Resident physician mentoring program in ophthalmology: the Tennessee experience.

OBJECTIVE: To establish a mentoring program to provide resident physicians in ophthalmology with career guidance in practice management and to identify new and creative ways to involve future eye physicians in the legislative and political process. METHODS: A multicenter prospective study was conducted of the mentorship experiences of 24 (88.9%) of 27 resident physicians in Tennessee during the 2000-2001 academic year. Participants were assigned into 1 of 3 groups: an active mentorship group, a passive mentorship group, and a no mentorship group. The active mentorship group participated in preceptorship activities with "mentor" community-based eye physicians and scheduled meetings with state legislators and regulators. The active mentorship and passive mentorship groups attended a 1-day practice management seminar, but the no mentorship group received no formal mentorship during the 4-month study period. A survey instrument was given to all participants before and after the 4-month study period. RESULTS: Following completion of the mentorship program, the active mentorship group had favorable changes in perceptions and attitudes toward medical organizations (P<.03) when compared with baseline prementorship responses. Compared with the no mentorship group, the active mentorship group also reported an increased willingness to make political campaign donations (P<.05) and expressed an increased desire for the Tennessee Academy of Ophthalmology to offer practice management programs (P<.02). CONCLUSION: A short 4-month mentorship program can elicit favorable changes in residents' perceptions and attitudes toward medical professional organizations. Additional opportunities may lie with a lengthier and more intensive mentoring program.

Career Choice↗
PubMed1995

TennCare--health system reform for Tennessee.

TennCare, the health care system reform plan implemented in Tennessee on January 1, 1994, was developed with the dual objectives of controlling the rapidly rising cost of the state's Medicaid program and extending health insurance coverage to most Tennesseans without access to employer-sponsored or other government-sponsored health insurance. Beneficiaries enroll in competing, state-chartered managed care organizations that are responsible for providing broad preventive, inpatient, and outpatient services and are reimbursed by the state on a capitation basis at a rate based on a statewide global budget for health care. The program initially proposed to enroll up to 1,775,000 citizens and was projected to result in a cumulative cost savings to Tennessee and the federal government of $7.2 billion by the end of the 5-year demonstration period. However, major start-up problems encountered by the state and by managed care organizations and limitations imposed by the government have significantly constrained these expectations. At the end of its first year, more than 1.2 million citizens were enrolled, but the program incurred a $99 million deficit. Managed care organizations and hospitals have reported major financial problems, and constituency groups--especially those representing physicians--have attempted to block the program. Our objective is to describe the design and rationale of TennCare and discuss key issues the plan continues to face that may affect its long-term success.

Capitation Fee↗
PubMed1999

Academic managed care organizations and adverse selection under Medicaid managed care in Tennessee.

CONTEXT: Health plans competing in a managed care system may face serious financial consequences if they are disproportionately selected by enrollees with expensive health conditions. Academic medical centers (AMCs) have traditionally provided medical care for the sickest patients and may be at particularly high risk for adverse selection, but whether this occurs is not known. OBJECTIVE: To determine whether managed care organizations (MCOs) representing AMCs are adversely selected by Medicaid managed care (MMC) enrollees with expensive chronic health conditions. DESIGN AND SETTING: Observational study using state Medicaid claims data from all of 1994 and January to August 1995 for Tennessee's statewide MMC program (TennCare). PARTICIPANTS: All 12 capitated MCOs in Tennessee, which collectively provided services for 1.2 million Medicaid enrollees from January 1994 through August 1995 following the initiation of TennCare. MAIN OUTCOME MEASURES: Prevalence of 6 state-specified high-cost chronic conditions-acquired immunodeficiency syndrome (AIDS), coagulation defects, cystic fibrosis, pregnancy, prematurity, and organ transplantation-and 27 additional high-cost conditions compared by academic, statewide, and regional MCOs. RESULTS: The prevalence of state-specified high-cost chronic conditions was generally higher for academic MCOs compared with other MCOs. Specifically, prevalence of AIDS was 14.1 times higher in academic MCOs than in statewide MCOs; coagulation defects, 6.4 times higher; transplantations, 4.4; pregnancy, 3.3; cystic fibrosis, 2.4; and prevalence of prematurity was equivalent. Prevalence was higher for academic than for statewide MCOs for 22 of the additional 27 high-cost conditions considered and similar for the remaining 5 conditions. CONCLUSIONS: Our results suggest that academic MCOs in an MMC system are selected by a large percentage of the sickest patients. Adverse selection may present serious financial risks for AMCs participating in managed care.

Academic Medical Centers↗
PubMed2006

Treponemal disease in the middle Archaic to early Woodland periods of the western Tennessee River Valley.

The high frequency of late prehistoric New World treponemal disease is attributable to the demographic changes concomitant with the adoption of agriculture. However, these demographic changes in group mobility and site density episodically preceded intensive plant domestication, suggesting possible staggered temporal change in observed treponemal disease case frequency. Thirteen convincing and an additional two probable (N = 581) cases of treponemal disease were identified in an eight-site skeletal sample spanning the Middle (6,000-3,000 BCE) to Late (2,500-ca. 1,000 to 500 BCE) Archaic and Early Woodland (500 BCE-0 CE) periods from the western Tennessee River Valley. Treponemal disease cases are infrequent in both the Middle (3/115, 2.6%) and Late (2 to 4 cases, <or=1%, N = 378) Archaic horizons, and more frequent (8/88, 9.1%) in the Early Woodland horizon. As the subsistence economy across the Archaic-Woodland temporal boundary in the western Tennessee River Valley remained, as elsewhere, based on intensive hunting and collecting, the demographic corollaries of treponemal disease would apparently not be met. However, the traditional horizon marker of the Woodland period is the adoption of pottery, an activity associated with sedentism.

Agriculture↗
PubMed1983

The epidemiology of giant cell arteritis. Report of a ten-year study in Shelby County, Tennessee.

We have studied the epidemiology of giant cell arteritis (GCA) in an urban population in south central United States. The incidence of GCA in Shelby County, Tennessee for the years 1971 through 1980 was determined for the total population and for age-, sex-, and race-specific groups. Over this period 26 cases were identified. The average annual incidence was 0.35/100,000. This was increased to 1.58/100,000 for those over the age of 50. The incidence was 7 times greater in whites than in blacks and 7 times greater in females than in males. Clinical and laboratory features of the patients were reviewed and found to be similar to those in other populations. GCA is considerably less frequent in Shelby County, Tennessee than in other areas where similar epidemiologic studies have been performed. This difference can be accounted for only in part by racial distributions. Similar studies in southern geographic areas are needed to place our findings in perspective and point to specific factors which may have etiologic significance in GCA.

Adult↗
PubMed2005

Use of Central stonerollers (Cyprinidae: Campostoma anomalum) from Tennessee as a bioindicator of metal contamination.

We compared the levels of arsenic, cadmium, chromium, lead, manganese, mercury and selenium in a small species of fish (Central stonerollers, Campostoma anomalum) collected from East Fork Poplar Creek (EFPC) and a reference site in eastern Tennessee. Stonerollers are minnows in the Cyprinidae family that serve as prey for many carnivores in aquatic systems. Fish were collected from East Fork Poplar Creek within the U.S. Department of Energy's Y-12 National Security Complex, part of the Oak Ridge Reservation, and from a reference stretch of the Little River in East Tennessee. Whole fish were homogenized for analysis. Concentrations of all metals (except arsenic) were significantly higher in stonerollers from EFPC compared to the reference site. Mercury levels in minnows from EFPC averaged 0.4 ppm (microg/g), four times higher than the average for fish in the U.S. in general. This was higher than levels in fish from the nearby Clinch River and higher than fillets of white bass (Morone chrysops) from the same creek. Most metal levels were inversely related to size and weight of the stonerollers, perhaps due to growth dilution.

Animals↗
PubMed1982

Survey of tampon use and toxic shock syndrome, Tennessee, 1979 to 1981.

Thirty-eight cases of toxic shock syndrome were reported in Tennessee between January 1, 1979, and March 31, 1981. Thirty-one of these cases (82%) occurred in white women less than 30 years of age; none occurred in black women. We suspected that age and racial differences in tampon use could contribute to the relatively high risk of toxic shock syndrome in young white women. In March, 1981, we surveyed 1,136 Tennessee women regarding their past and current used of tampons. Age and race were related, not only to whether or not tampons were used but to the way tampons were used. "Continuous" tampon use during the most recent menstrual period was most common among young white women (61%), less common among older white women (42%), and least common among black women (23%). On the other hand, the brands, absorbency types, numbers, and usage patterns did not vary greatly with respect to age or race. Comparing each woman's tampon habits in March, 1981, with her usual habits in June, 1980, suggested a striking effect of publicity about the toxic shock syndrome. We estimate that 23% to 39% of the women surveyed changed their tampon habits in an attempt to reduce their risk of toxic shock syndrome.

Adolescent↗
PubMed1982

Blindness from presumed ocular histoplasmosis in Tennessee.

Tennessee has the highest histoplasmosis infection incidence in the United States. Over 60% of the population reacts positively to skin tests and more than 60 new patients require hospitalization for the treatment of this disorder each year. However, the presumed ocular histoplasmosis syndrome (POHS) remains an uncommon cause of blindness in this state. A retrospective analysis performed with the assistance of 173 Tennessee Ophthalmologists identified 98 new POHS cases in 1980. A similar study, performed in a prospective manner, found 44 new POHS cases in the first six months of 1981. An analysis of recipients of Aid to the Blind revealed 0.5% with POHS; while 2.8% of new applicants for Aid to the Blind had POHS.

Adolescent↗
PubMed2003

Clinical comparisons of La Crosse encephalitis and enteroviral central nervous system infections in a pediatric population: 2001 surveillance in East Tennessee.

BACKGROUND: La Crosse encephalitis (LAC) is a mosquito-borne illness that primarily affects children. In 1997, an initial cluster of cases was identified by the regional pediatric referral center in East Tennessee. Since that time, public health officials, pediatric infectious disease physicians, infection control nurses, laboratory personnel, entomologists, and Centers for Disease Control and Prevention consultants have collaborated to provide ongoing surveillance activities. Studies comparing LAC cases with non-LAC (no etiologic diagnosis) central nervous system infections have yielded no statistical significance in signs and symptoms or laboratory values. OBJECTIVE: To determine any differences in signs, symptoms, and/or diagnostic laboratory values between LAC cases and enteroviral central nervous system (EV-CNS) infections. METHODS: In 2001, descriptive public health surveillance for LAC was performed concurrent with an outbreak investigation of EV-CNS infections at a pediatric referral center in East Tennessee. All patients being evaluated for suspected meningitis and/or encephalitis were interviewed for signs and symptoms of illness. Patients with positive test results for LAC and negative results for EV or positive results for EV and negative results for LAC were included in the study. RESULTS: Compared with patients with EV-CNS infection, patients with LAC were significantly more likely to have aphasia (P=.001), loss of consciousness (P=.0003), seizure (P=.0003), and admission to the pediatric intensive care unit (P=.02). Presence of fever, headache, vomiting, stiff neck (subjective), photophobia, behavioral changes, confusion, need for mechanical ventilation, age, and sex showed no statistical significance (P>.05). Statistical differences were not demonstrated in cerebrospinal fluid laboratory values (P>.05). CONCLUSION: Patients with LAC demonstrated more severe symptoms on presentation to the hospital than did patients with EV-CNS infection. A possible advantage of identifying specific viral etiologic factors of pediatric CNS disease by clinical characteristics may be the ability to take advantage of emerging antiviral therapies.

Adolescent↗
PubMed1989

Public and private responsibility for mental health services. A report on the Tennessee Task Force.

The "privatization" of mental health services during the last decade has literally reshaped the way state and county departments of mental health go about fulfilling their statutory responsibilities. In Tennessee, a conference and later a task force examined the implications of this trend for the future. Two issues came to the forefront: Is it appropriate or possible for the private sector to take over the delivery of all mental health services, and if so, who will ensure that the poor receive adequate care? The Tennessee task force concluded that the privatization trend is appropriate and should be encouraged by government. It further concluded that government is ultimately responsible for ensuring access to care for the poor and uninsured although private facilities should provide some free care. Government best serves the poor by providing them the financial means to purchase care from private providers.

Community Mental Health Services↗
PubMed2000

Serological survey and active surveillance for La Crosse virus infections among children in Tennessee.

In 1998 and 1999, we performed a serosurvey and active surveillance for La Crosse encephalitis at a children's hospital in eastern Tennessee. Fifteen cases of La Crosse encephalitis were confirmed. Only 5 (0.5%) of 1000 serum samples being tested at the state laboratory for other diseases had evidence of antibodies to La Crosse virus. These findings suggest that La Crosse virus is newly endemic to eastern Tennessee.

Adolescent↗
PubMed2004

Reduction in high rates of antibiotic-nonsusceptible invasive pneumococcal disease in tennessee after introduction of the pneumococcal conjugate vaccine.

BACKGROUND: Invasive pneumococcal disease (IPD) is a burgeoning problem, with rates of antibiotic-nonsusceptible IPD, in particular, increasing during the past decade. One measure to combat IPD is vaccination with the recently introduced 7-valent pneumococcal conjugate vaccine (PCV). METHODS: To evaluate the effects of the introduction of PCV in 2000 on the epidemiology of antibiotic-nonsusceptible IPD, a database of IPD cases from January 1995 through December 2002 identified through active surveillance in 5 Tennessee counties was examined. For each case, clinical data were collected, and antibiotic susceptibility testing and serotyping were performed on available isolates. RESULTS: Among children younger than 2 years, IPD rates peaked at 235 cases per 100,000 in 1999 before decreasing, after PCV licensure, to 46 cases per 100,000 in 2002 (P<.001). The proportion of penicillin-nonsusceptible IPD isolates from this age group declined from 59.8% in 1999 to 30.4% in 2002 (P<.01). After 2001, similar decreases in IPD rates and in the proportion of antibiotic-nonsusceptible isolates recovered were seen among persons aged 2 years and older (P<.01). Rates of IPD due to PCV-associated serotypes declined after PCV introduction in all age groups (P<.001), whereas the rate of IPD due to nonvaccine serotypes increased among persons aged 2 years and older. CONCLUSIONS: In the 2 years since licensure, widespread PCV vaccination of children has resulted in dramatic declines in the proportion of antibiotic-nonsusceptible isolates in Tennessee. PCV vaccination of children also appears to be a highly effective method for reducing the burden of IPD in adults.

Anti-Bacterial Agents↗
PubMed1999

Newly recognized focus of La Crosse encephalitis in Tennessee.

La Crosse virus is a mosquito-borne arbovirus that causes encephalitis in children. Only nine cases were reported in Tennessee during the 33-year period from 1964-1996. We investigated a cluster of La Crosse encephalitis cases in eastern Tennessee in 1997. Medical records of all suspected cases of La Crosse virus infection at a pediatric referral hospital were reviewed, and surveillance was enhanced in the region. Previous unreported cases were identified by surveying 20 hospitals in the surrounding 16 counties. Mosquito eggs were collected from five sites. Ten cases of La Crosse encephalitis were serologically confirmed. None of the patients had been discharged from hospitals in the region with diagnosed La Crosse encephalitis in the preceding 5 years. Aedes triseriatus and Aedes albopictus were collected at the case sites; none of the mosquitos had detectable La Crosse virus. This cluster may represent an extension of a recently identified endemic focus of La Crosse virus infection in West Virginia.

Adolescent↗
PubMed1998

Nosocomial transmission of a drug-sensitive W-variant Mycobacterium tuberculosis strain among patients with acquired immunodeficiency syndrome in Tennessee.

OBJECTIVE: To use DNA fingerprinting to characterize nosocomial spread of Mycobacterium tuberculosis following hospitalization of a patient with acquired immunodeficiency syndrome and active pulmonary tuberculosis, for whom respiratory isolation was not initiated promptly. DESIGN: Epidemiological investigation. SETTING: A tertiary-care medical center in Tennessee. PARTICIPANTS: Patients and healthcare workers potentially exposed to the infectious patient in 1992. RESULTS: Of 172 healthcare workers exposed, 35 (20%) were judged to have acquired tuberculous infection. Risk of acquisition was greatest for nurses and medical receptionists. Active tuberculosis later developed in one healthcare worker and one hospitalized patient. Nosocomial transmission was supported by epidemiological evidence and DNA fingerprinting. The outbreak strain of Mycobacterium tuberculosis differed from other isolates at this hospital, but its DNA hybridization pattern was highly similar to that of the multidrug-resistant outbreak strain W that has been prevalent in New York City, suggesting a common strain ancestry. However, the Tennessee isolates were susceptible to all first-line antituberculous agents. CONCLUSIONS: This report suggests the possibility that a molecular characteristic(s) shared by these successful outbreak strains is associated with increased transmissibility or pathogenicity and emphasizes the need for continued vigilance for tuberculosis in the nosocomial setting.

AIDS-Related Opportunistic Infections↗