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At least 91 records · Page 5Linked to original sources
PubMed1998

Missouri Firearm-Related Injury Surveillance System.

CONTEXT: The Missouri Department of Health collects hospital inpatient and emergency room records statewide. With mortality data, they make up a population-based surveillance system of firearm-related injuries. Much information is not captured by these data, however. OBJECTIVE: During a three-year project we attempted to develop a timely, representative, and sensitive surveillance system of firearms-related injuries and their circumstances. DESIGN: The surveillance system consisted of Missouri's hospital and mortality records linked to police records of firearm incidents. SETTING: Lack of standardization of police department data precluded a statewide surveillance system; therefore, we concentrated on the two largest urban areas, St. Louis and Kansas City. PARTICIPANTS: Firearm-related injuries occurring during crimes in the surveillance area in 1994 were recorded. Wounds inflicted unintentionally or during suicide attempts were excluded. MAIN OUTCOME MEASURES: We evaluated the system according to its simplicity, flexibility, acceptability, sensitivity, predictive value positive, representativeness, and timeliness. RESULTS: The surveillance system was neither timely nor simple. Though estimated to represent 95% of the desired cases, information about the firearms and the circumstances was relatively scant. CONCLUSIONS: Police records as they now exist cannot be included in a statewide firearms surveillance system. The cost/benefit ratio does not justify even a regional surveillance system. Standardization of police records would be helpful, but some information will always be lacking unless the perpetrator is arrested.

Adolescent↗
PubMed2002

Lead concentrations in fish and river sediments in the old lead belt of Missouri.

Although active mining activities in the Old Lead Belt of Missouri ceased in 1968, old tailings piles remain and continue to impact the lead (Pb) concentrations in sediments and fish in the Big River and Flat River Creek in Missouri. A 3-year study was conducted that examined the Pb concentrations in organic-rich sediments, fish fillets, and fish whole bodies at 13 sites in these two rivers. The results showed that the sediments had significantly elevated Pb concentrations near and beyond the tailings piles compared with control sites upstream from the mining activity. The results also showed the Pb concentration in sediments correlated well with Pb concentrations in suckers (r = 0.86, p < 0.0001) and small sunfish (r = 0.82, p < 0.0001). Annual average Pb concentrations in sucker fillets ranged up to 0.67 microg/g (wet weight basis) and exceeded the World Health Organization guidelines of 0.3 microg/g (wetweight basis) at many of the sample sites. Fillets of bass, which feed at a higher trophic level, had much lower Pb concentrations than either suckers or small sunfish, and no bass fillet samples exceeded the WHO guideline. Whole body Pb concentrations in small sunfish were also determined and correlated strongly (r = 0.92, p = 0.0004) with sediment concentrations before leveling at a maximum of approximately 20 microg/g (wet weight basis).

Animals↗
PubMed2003

Watershed vulnerability to herbicide transport in northern Missouri and southern Iowa streams.

Herbicide contamination of streams has been well documented, but little is currently known about the specific factors affecting watershed vulnerability to herbicide transport. The primary objectives of this study were (1) to document herbicide occurrence and transport from watersheds in the northern Missouri/southern Iowa region; (2) to quantify watershed vulnerability to herbicide transport and relate vulnerability to soil properties; and (3) to compute the contribution of this region to the herbicide load of the Missouri and Mississippi Rivers. Grab samples were collected under baseflow and runoff conditions at 21 hydrologic monitoring stations between April 15 and July 15 from 1996 to 1999. Samples were analyzed for commonly used soil-applied herbicides (atrazine, cyanazine, acetochlor, alachlor, metolachlor, and metribuzin) and four triazine metabolites (deisopropylatrazine, deethylatrazine, hydroxyatrazine, and cyanazine amide). Estimates of herbicide load and relative losses were computed for each watershed. Median parent herbicide losses, as a percentage of applied, ranged from 0.33 to 3.9%; loss rates that were considerably higher than other areas of the United States. Watershed vulnerability to herbicide transport, measured as herbicide load per treated area, showed that the runoff potential of soils was a critical factor affecting herbicide transport. Herbicide transport from these watersheds contributed a disproportionately high amount of the herbicide load to both the Missouri and Mississippi Rivers. Based on these results, this region of the Corn Belt is highly vulnerable to transport of herbicides from fields to streams, and it should be targeted for implementation of management practices designed to reduce herbicide losses in surface runoff.

Agriculture↗
PubMed2002

The prevalence of arthritis and activity limitation and their predictors in Missouri.

Arthritis and other rheumatic conditions comprise the leading cause of disability in the United States. In 1990, an estimated 16.7% of Missourians had arthritis. By 2020, an estimated 20% of Missourians will have this condition. We examined Missouri's prevalence of self-reported physician-diagnosed arthritis, chronic joint symptoms, and activity limitation due to joint symptoms and their associations with selected predictors (i.e., socio-demographic, access to health care, risk factor, and comorbidity indicators) from Missouri's 1996 Behavioral Risk Factor Surveillance System. We conducted logistic regression analysis to generate Odds Ratios and 95% Confidence Intervals of arthritis and activity limitation across levels of predictors. Analysis indicates arthritis is under-diagnosed in younger individuals and that arthritis and activity limitation due to joint symptoms are significant contributors to functional limitation, enhancing dependency while decreasing the quality of life. As the population ages, arthritis, chronic joint symptoms, and activity limitation will become a larger public health problem.

Activities of Daily Living↗
PubMed1998

Prostate cancer screening--a physician survey in Missouri.

This study investigated prostate cancer screening practices using prostate specific antigen testing (PSA), digital rectal examination (DRE), and transrectal ultrasonography (TRUS) by primary care physicians in Missouri. In 1993, a mail survey was sent to a stratified random sample of 750 physicians whose primary specialty was general practice, family practice, or internal medicine. Three separate mailings resulted in an overall adjusted response rate of 60 percent. Ninety-five percent of physicians were more inclined to use PSA compared with three years previously, with only 45 percent of physicians more inclined to use DRE. An increase in the use of PSA following a negative DRE was reported by 85 percent and a greater inclination to use TRUS following a positive PSA was reported by 90 percent Eighty-six percent agreed with the American Cancer Society (ACS) guidelines on prostate cancer screening. Using logistic regression adjusted across levels of demographic and practice factors, prevalence odds ratios were derived with results indicating that agreement with ACS guidelines and being in private practice are strong predictors of a physician's inclination to routinely screen asymptomatic patients for prostate cancer. Our findings have provided baseline information on prostate cancer screening in Missouri and suggest that primary care physicians view PSA testing as a useful procedure and appear to be using it in a manner similar to the general pattern seen across the country.

Adult↗
PubMed1997

The impact of insanity acquittees on Missouri's public mental health system.

Even though state departments of mental health have primary responsibility for the care, custody, and treatment of insanity acquittees, the impact of insanity acquittees on the public mental health system is generally lacking in policy discussions and as a topic for policy research. This issue has received increased attention in Missouri, where insanity acquittees now occupy half of the long-term public psychiatric hospital beds. This article examines the presence of Missouri's insanity acquittees on the state's public mental health system and includes the impact on goals, fiscal costs, inpatient and community psychiatric services, and inpatient treatment staff. As states consider managed care and other cost containment measures, it remains to be seen if the high costs associated with extensive use of hospitalization of insanity acquittees to promote public safety will influence policy changes to more community-based insanity acquittee systems.

Bed Occupancy↗
PubMedDate not supplied

An overview of the Missouri dioxin studies.

Among the problems inherent in evaluating public health impacts around toxic waste sites are the difficulties in measuring exposure, our incomplete understanding of low-dose effects, the low frequency of disease incidence, the long latency period and silent course of disease development, the nonspecificity of clinical findings, and the probable multifactorial nature of diseases of interest. A multiphase approach for implementing epidemiologic studies in such settings was used in assessing the 2,3,7,8-tetrachlorodibenzodioxin (TCDD, or dioxin) contaminations in Missouri, where waste oil mixtures contaminated with dioxins were sprayed on various sites throughout the state for dust control in 1971. Although the toxic effects of dioxin have been studied extensively in animals and documented in cases of accidental high-level exposure in humans, very little is known of the human health effects, if any, produced by long-term exposure to relatively low levels of dioxin. In addition to medical epidemiologic studies, which were done to evaluate the types of problems present in groups of individuals with high-risk of environmental dioxin exposure, other studies to characterize dioxin levels in adipose tissue and serum are under way in a sample of potentially exposed (as well as in unexposed) Missouri residents. Research in these areas will continue to be pursued to develop a more complete understanding of the risks and appropriate public health interventions in situations of community exposure to environmental dioxins and other environmental contaminants.

Adipose Tissue↗
PubMed1994

Formation of the School of Optometry at the University of Missouri-St. Louis.

This article traces the formation of the School of Optometry at the University of Missouri-St. Louis. The research was conducted by interviewing knowledgeable persons, using the archives at The International Library, Archives and Museum of Optometry and UM-St. Louis, and using the private papers of Dr. Gordon Heath. The review covers three periods from 1968 to 1980: Initial, In-Between, and Final. An appropriation for the School was made in each period, but only the last one lead to the founding of the School. The political and educational climate of St. Louis influenced the development of the School. However, the political activism of Missouri optometrists in a receptive state legislature was the main reason for the formation of the School.

History, 20th Century↗
PubMed1975

Goals and teaching methods of the urologic core curriculum at the University of Missouri, Columbia.

Urology is a highly specialized surgical subspecialty, but most urologic patients present to the primary physician with variable signs and symptoms. As medical school educators, we are obligated to furnish the students with the knowledge and skills required to handle the patient's initial problem, and refer the patient to a urologic specialist at the optimal time. The Section of Urology, University of Missouri, Columbia, has developed a core urologic curriculum for junior and senior medical students. The goals and methods used to accomplish these goals are presented in conjunction with the goals for the Department of Surgery, University of Missouri, Columbia.

Curriculum↗
PubMed1983

Orf occurring in Missouri.

We report two cases of orf, a common viral disease of sheep, which occurred in residents of Missouri. A survey taken among sheep raisers in Missouri revealed that many were unaware of this as a potential human disease. It is important for physicians to be able to recognize this lesion so that radical methods of therapy are not employed. The lesion heals without scarring and without specific therapy. Complications are rare.

Adolescent↗
PubMedDate not supplied

Application of the Concerns-Based Adoption Model to the installation of telemedicine in a rural Missouri nursing home.

The Concerns-Based Adoption Model (C-BAM) was developed in education for the purpose of implementing innovations and change within the school/college system. This study used the principles of the C-BAM and, for the first time, applied them to the process (implementation/training) and product (computer) of the telemedicine technologies in a rural nursing home setting in Missouri. Three rural counties of the 23 Missouri Telemedicine Network sites were chosen to pilot implementation of the computer as one mode of telemedicine technology. One rural nursing home was enlisted for an in-depth study to examine how telemedicine would affect communication between and among community health professionals. Methodological triangulation was used to study individuals' concerns about and utilization of telemedicine through interviews, participant observations, chart reviews, and the Stages of Concern (SOC) survey. Responses to the SOC over time are reported here. The participants consisted of nursing home employees: administration, nursing, housekeeping, and dietary. Forty-three of 52 employees participated in the SOC survey at Time 1 (preimplementation). Twelve months later, 40 participated in the SOC survey at Time 2. While the majority of respondents expressed awareness of the technology, they also expressed a high concern for informational and personal implications. Concern scores in all subscales decreased at Time 2. Findings from this study provided feedback for the implementation and training phases of the project. Most importantly, findings support the appropriateness of this educational model to the healthcare setting.

Adaptation, Psychological↗
PubMed1995

Developing an integrated public health information system for Missouri.

The Missouri Department of Health realized it had a problem with 67 different information systems that ran on different platforms and could not communicate with one another. A new, integrated information system, the Missouri Health Strategic Architectures and Information Cooperative (MOHSAIC) is being developed based on information engineering (IE). This article describes IE, the process of developing MOHSAIC, and some key lessons learned in developing the system. Some of the lessons learned include the importance of executive sponsorship, tension between efficiency and program accountability, importance of confidentiality, and difficulties of funding an integrated system. The article stresses how integrated information systems will be important for the viability of public health under health care reform.

Computer Communication Networks↗
PubMed1997

Missouri's Take a Seat, Please! and program evaluation.

In Missouri, injuries from motor vehicle crashes are the leading cause of death to children aged one to four. In 1984, the state legislature enacted child passenger safety legislation, but by 1992, compliance with the law was still disappointingly low. The Missouri Department of Health implemented a program called Take a Seat, Please! in which concerned citizens reported motorists who transported children under age four in a way not compliant with the state law. Two years later, a telephone survey and a pre- and postobservation study at child care centers did not show that the intervention had any effect. The program was discontinued in September 1995.

Accident Prevention↗
PubMed1998

Predictors of mammography utilization in Missouri, 1993-1994.

Mammography utilization data were studied for 915 women from a combined sample of 1994 Missouri Behavioral Risk Factor Surveillance System and a Special Breast and Cervical Cancer Control Project Evaluation Survey, as well as similar data from 6,784 new participants in Missouri's Breast and Cervical Cancer Control Project during 1993-1994. Among women aged 40 and over, having some college education and having health insurance coverage were associated with a higher likelihood of ever having a mammogram. Education, age, health care, Pap testing, and smoking were identified as important predictors of compliance with recommended schedule of yearly mammography among women aged 50 and over.

Adult↗
PubMed2002

The Missouri experience in providing tools and resources to promote community assessment.

The Missouri Department of Health (MDOH) has dedicated staff that provides technical assistance to communities that are conducting assessments and intervention strategies to meet community health needs. The MDOH developed a web site that is designed to make health data easily available at the local level. The Missouri Hospital Association partners in the process by making funds available to communities that have proposed interventions in response to their community assessment. This article describes this public/private relationship and some of the state and local experiences.

Community Health Planning↗
PubMed1997

Superintendents' perceptions of schoolsite health promotion in Missouri.

This study assessed school district superintendents' perceptions of schoolsite health promotion in Missouri using a telephone survey method. Superintendents of 150 school districts were surveyed using The Worksite Health Promotion for Faculty and Staff section of the Eight-Component Assessment. Staff identification of blood pressure, healthful cafeteria menus, and smoke-free school policies were perceived as the most frequently offered health-promoting activities. Quality of programs as perceived by district superintendents ranged from "average" to "exemplary." For school districts not offering programs, healthful cafeteria menus, staff identification of blood pressure, and stress management were perceived by superintendents as highly necessary. The number of programs offered in each area differed significantly by demographic characteristics: accreditation classification, assessed valuation, size, and residence. Supportive attitudes by superintendents are critical to attain schoolsite health promotion programs for faculty and staff as part of a comprehensive school health program in Missouri.

Administrative Personnel↗
PubMed1989

Closure of rural hospital obstetric units in Missouri.

We studied 65 rural hospitals in Missouri that provided obstetric services in 1986. The hospitals were divided into three groups on the basis of their physician obstetric staff: family or general practitioners only (38 hospitals), family practitioners and obstetricians (22 hospitals), and obstetricians only (five hospitals). From birth certificate data, we detected a decline in the mean number of births in all groups of rural hospitals comparing 1980-1983 with 1984-1987. Births in family practice only hospitals declined most over the past four years (35%), whereas there was only a 4 percent decline in the number of births to rural Missouri women. In 1987, 10 of the 38 family practice only hospital obstetric units closed due to loss of physician services, whereas none of the other hospitals stopped providing obstetric care (X2 = 8.40, p less than 0.005). These findings suggest that rural hospitals with family and general practitioners exclusively on their obstetric staffs are at significant risk of closing their obstetric units.

Evaluation Studies as Topic↗
PubMed2001

A survey of general surgeons in rural Missouri: potential for rapid decrease in work force.

General surgeons have an essential role in the rural health care system. This telephone survey of 39 rural general surgeons in Missouri found that more than half were 55 or older. Most reported they practiced a broader scope of surgery than colleagues in urban areas, and half believed that current residency graduates are not prepared for surgical practice in rural areas. One-fifth had sought special training experiences to prepare them for rural practice. On balance, 70 percent of the respondents' practices was general surgery, 13 percent "specialty surgery" and 17 percent primary care. Many reported feeling professionally isolated. One-fourth had literally "returned home" to practice. The results suggest that if present trends continue, the next 10 years will see a substantial reduction in the number of general surgeons in rural Missouri.

Adult↗