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PubMed2002

La Crosse encephalitis in Eastern Tennessee: clinical, environmental, and entomological characteristics from a blinded cohort study.

A blinded cohort study was conducted in 2000 to better understand the emergence of La Crosse virus infection in eastern Tennessee, with special emphasis on the potential mosquito vector(s). Children with suspected central nervous system infection were enrolled at the time of clinical presentation at a large pediatric referral hospital. Clinical, environmental, and entomological data were collected prior to case confirmation. Sixteen of the 40 children included in the final analysis were confirmed to have La Crosse infection by a fourfold increase in antibody titers between collection of acute- and convalescent-phase sera. Factors significantly associated with La Crosse infection included average number of hours per day spent outdoors (5.9 for La Crosse virus cases vs. 4.0 for noncases, p = 0.049); living in a residence with one or more tree holes within 100 m (relative risk = 3.96 vs. no tree holes within 100 m, p = 0.028); and total burden of Aedes albopictus (number of female and male larvae and adults collected at a site), which was more than three times greater around the residences of La Crosse virus cases versus noncases (p = 0.013). Evidence is accumulating that the newly introduced mosquito species Ae. albopictus may be involved in the emergence of La Crosse virus infection in eastern Tennessee.

Aedes↗
PubMed1996

Relational database for drug-use review of Tennessee Medicaid claims.

The development of a relational database from Tennessee Medicaid files for the purpose of retrospective drug-use review (DUR) and application of the database for DUR of angiotensin-converting-enzyme inhibitors (ACEIs) are described. Computer queries were designed to create profiles of physicians' or pharmacies' experiences from claims data and other Medicaid data. Outlying patients (patients for whom at least one DUR criterion was unmet) were grouped according to their physicians or pharmacies. Thresholds for defining outlying physicians and pharmacies (i.e., those with more than a specified number of outlying patients) were based on the provider population instead of the patient population as a whole; aggregating patient outliers by provider allowed trends of inappropriate practices to be detected. As the threshold for outlying providers rose, the number of such providers fell, as did the number of outlying patients with whom they were associated. Stratification of the outliers by provider for specific drug-drug interactions and drug-disease complications afforded the option to set individual thresholds for outlying providers based on individual subsets; for example, for ACEIs, a threshold of greater than five patient outliers could be set for the criterion of no concurrent potassium supplements and a threshold of greater than three, for the criterion of no unmonitored concurrent lithium therapy. Tennessee patients formerly covered by Medicaid are now enrolled in managed care plans, and the flexibility of the database has allowed it to be modified accordingly. The relational database allows flexibility in the analysis of certain patterns of drug use. Such a database may be useful to other Medicaid programs that are converting to managed care models.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2005

Mutant allele frequencies in domestic cat populations in Arkansas and Tennessee.

We conducted surveys of mutant allele frequencies of four cat populations in Arkansas and Tennessee during 2002. Our calculations and analyses support that Southwestern cat populations were relatively more genetically similar to each other than compared to cat populations in other areas of North America. However, the cat population of Fort Smith is slightly different from the other cat populations studied in the Southwestern United States. Although there is a clear significant spatial geographic pattern for many mutant coat allele frequencies in the United States and Canada cat populations (d, l, S, and W), our results revealed that there is not a significant isolation-by-distance model affecting these cat populations. Our data also support the historical migration hypothesis because our calculated allele frequencies were genetically similar to cat populations located in ancestral areas of Europe. Different phenograms, including new European cat genetic profiles, showed that the Southwestern cat populations studied are of a clear British origin. Therefore, migration routes of early Arkansas and Tennessee settlers help explain the similarities of allele frequencies among domestic cat populations.

Animals↗
PubMed1992

New host of Ixodes dentatus (Acari: Ixodidae), and first record in Tennessee.

Two specimens of Ixodes dentatus Marx were found in southwestern Tennessee in Shelby County during a 14-mo tick survey. This was the first record for this tick in Tennessee. An adult female was found on a dry ice trap and one larva was found on a live-trapped Peromyscus leucopus, the first time this tick has been reported from P. leucopus. This may be another combination of vector and host in the ecology and transmission of B. burgdorferi in the wild.

Animals↗
PubMed2001

The Community Partnerships Experience: a report of institutional transition at East Tennessee State University.

The Community Partnerships Program, sponsored by the W. K. Kellogg Foundation, served as a catalyst for significant changes within East Tennessee State University (specifically its schools of medicine, nursing, and public and allied health) and the rural communities involved. The authors describe the development and implementation of the program and its effects on the students, faculty, communities, and the three participating schools over the period 1992-1999. They also review the changes the program fostered in health professions education and the resulting institutional changes at their university. The primary motivation for change at East Tennessee State University was the desire to develop primary care providers who could more effectively function in an interdisciplinary and interprofessional health care system and who would be sensitive to community needs in rural and underserved areas. The planning process, curricular transformation, implementation of inquiry-based learning, community collaboration, and interdisciplinary education involving students from the three health professions schools are described, including challenges and difficulties (e.g., student attrition; retention of volunteer community-based clinical preceptors; initial faculty resistance; a climate of competition rather than cooperation). Outcomes are described, including students' enrollment and attrition in the program over time, performances on the U.S. Medical Licensing Examination, program graduates' career choices, and the types and locations of their practices. The program's students performed as well on professional licensing examinations as did their peers enrolled in traditional programs. Program graduates have been much more likely to select primary care careers and to practice in rural locations than have their non-program peers. The development strategies and experience gained could give useful insights to other universities contemplating a community-based component for health professionals within their existing curricula.

Community Participation↗
PubMed1976

Medicaid records as a valid data source: the Tennessee experience.

Health care researchers rarely employ Medicaid claim files as a data base, in part because they are designed to serve fiscal and administrative ends. Indeed, some investigators have emphasized the deficiencies in such records. In contrast, we have found Tennessee Medicaid data to be suitable for research. A statewide automated data processing system reduces the occurrence of many of the errors noted by others. Further, analysis of the July 1974 month of payment file illustrates the accuracy and internal consistency of Tennessee Medicaid data. Specimen legend drug results for ambulatory patients suggest investigations of physician prescribing patterns. Evaluation of the Medicaid claims processing system suggests other applications in health care administration and research. In a time when available resources are dwindling, the incisive use of Medicaid claims files offers an attractive alternative to expensive new systems of data collection and analysis.

Aged↗
PubMed1993

Genetic conditions among patients receiving genetic services in middle Tennessee.

We reviewed genetics charts of 2235 patients seen from 1985 to 1990 at Vanderbilt University Medical Center, Nashville, Tennessee, and summarized the 20 most common reasons for referral (occurring in 1138 of the patients) and the diagnoses or conditions among patients receiving genetic services in one of four clinical settings (prenatal counseling clinics, general genetics clinics, outreach genetics clinics, and ward consultations). The five most common reasons for referral were advanced maternal age (> or = 35 years) (203/1138, or 18% of patients), followed by dysmorphic features/multiple congenital anomalies (MCA) (185/1138; 16%), developmental delay/mental retardation (MR) (168/1138; 15%), Down's syndrome (103/1138; 9%), and abnormal maternal serum alpha-fetoprotein (MSAFP) (74/1138; 7%). The five most common diagnoses or conditions identified for all genetics patients were advanced maternal age (> or = 35 years) (195/906; 22%), developmental delay/MR (111/906; 12%), dysmorphic features/MCA (107/906; 12%), Down's syndrome (88/906; 10%), and multiple fetal losses (57/906; 6%). Of the 20 most common diagnoses or conditions categorized in 602 of the 906 patients, a multifactorial cause was observed in 25% of those patients; a chromosomal cause was observed in 26% of cases of Down's syndrome, accounting for 55% of the chromosomal disorders; a single gene disorder was observed in 17% of patients; an environmental cause was seen in 4%; and an unknown cause was noted in 28%. We hope this study will help physicians in middle Tennessee and surrounding areas by increasing their awareness of the types and frequencies of genetic diseases so that misdiagnoses and delayed referrals can be avoided.

Abnormalities, Multiple↗
PubMed2005

Healthy life expectancy for selected race and gender subgroups: the case of Tennessee.

OBJECTIVE: To analyze healthy life expectancy (HLE) for major racial and gender subgroups, based on the diverse population of Tennessee and compared with the United States. MATERIALS AND METHODS: We use life table methodology and the HLE calculation model of the National Center for Health Statistics (NCHS), using two databases for 2001: NCHS National Vital Statistics Reports life tables and CDC Behavioral Risk Factor Surveillance System (BRFSS) survey. RESULTS: For Tennessee, although average total life expectancy (TLE) is 73.6 years at birth, only 61.1 years of "good" health are expected. Substantial racial and gender differences are found in both TLEs and HLEs with black males having the lowest and white females the highest. Although females have longer TLE, they spend more years in an unhealthy state than males. CONCLUSIONS: The findings raise new challenges for researchers and health policy makers for accomplishing the dual goals of longer life expectancy and elimination of health disparities among population subgroups.

Adolescent↗
PubMed2002

Rapidly increasing prevalence of penicillin-resistant Streptococcus pneumoniae in middle Tennessee: a 10-year clinical and molecular analysis.

The clinical and molecular epidemiology of penicillin-resistant Streptococcus pneumoniae and the diagnostic accuracy of a six-primer PCR assay in identifying penicillin resistance were analyzed by using clinical isolates recovered over a 10-year period in middle Tennessee. The prevalence of non-penicillin-susceptible S. pneumoniae isolates (MIC, > or =0.1 microg/ml) increased from 10% in 1990 to 70% in 1999 (P < 0.001). Among S. pneumoniae isolates for which the penicillin MIC was > or =2 microg/ml (highly penicillin-resistant S. pneumoniae [PRSP]), 23 and 5% were resistant to at least three and at least five other antimicrobial classes, respectively. Pulsed-field gel electrophoresis identified 13 unique strain types, with type B accounting for 33% of PRSP isolates. The sensitivity, specificity, and negative and positive predictive values of the PCR assay in detecting PRSP were 99, 100, 99, and 100%, respectively. Penicillin resistance is rapidly increasing among S. pneumoniae isolates in Tennessee. The simultaneous detection of S. pneumoniae and high-level penicillin resistance can be accurately performed with the six-primer PCR assay.

Adolescent↗
PubMed2026

Sex-Specific Diagnostic Inequality in Fabry Disease: Lessons Learned from Analysis of Newborn Screening and Cascade Testing in Tennessee from 2017 to 2024.

INTRODUCTION: Fabry disease (FD) is an X-linked lysosomal storage disease caused by alpha-galactosidase A (aGAL) deficiency. Newborn screening (NBS) programs for FD have been implemented in several US states; however, its effectiveness in identifying affected females remains uncertain. We hypothesized that sex-specific inequality of NBS-based detection of FD results in different diagnostic pathways for males and females with FD. METHODS: We compared diagnostic approaches for males and females with FD using Tennessee NBS results and Vanderbilt Lysosomal Storage Disorders Database (VLSDD). Sex-specific detection differences were assessed using Fisher's exact test (&#x3b1; = 0.05). RESULTS: Tennessee NBS identified 25 males but no females with FD from 2017 to 2024. In VLSDD, among 81 individuals with FD, sex distribution was nearly equal (42 males, 39 females). Among males, 26/42 (62%) were diagnosed via NBS, 7/42 (17%) through known family history, and 9/42 (21%) based on clinical symptoms. All 16 males diagnosed through non-NBS were born before its implementation. In contrast, none of the 39 females were diagnosed through NBS (p value <0.05). Of these, 13/39 (33%) were diagnosed through cascade testing following their sons' detection by NBS, with a median age at diagnosis of 28 years (25th-75th percentile: 24.5-34.0). Of the remaining 26 females, 12/26 (46%) were diagnosed after a family member was diagnosed through clinical symptoms and 14/26 (54%) were diagnosed through clinical symptoms. CONCLUSIONS: NBS effectively identifies affected males but fails to detect females with FD, though it can indirectly facilitate diagnosis of older female relatives.

Humans↗
PubMed1983

Predicting recidivism among first admissions at Tennessee's state psychiatric hospitals.

Using data from computerized patient records, the authors attempted to identify characteristics of first admissions to state psychiatric facilities who would later become recidivists. In an examination of 22,062 first admissions to all state hospitals in Tennessee, they found six variables with significant ability to predict recidivism: age, delusional beliefs, assaultive acts, out-of-state residence, indigence, and living with parents. A risk profile that predicted future recidivism with statistical significance at all five Tennessee state hospitals was subsequently developed, but the predictive accuracy was too low for the profile to be clinically useful. The authors believe the benefits of early identification of patients at risk justify further research.

Age Factors↗
PubMed1980

State health care policymaking: the Tennessee Primary Care Act of 1973.

Departments of public health have played a relatively limited direct role in providing primary care to medically underserved areas, a function which has long been the province of the private medical practitioner. This article reports on the personal experiences of the author in investigating the circumstances which led the state of Tennessee to deviate from this norm with its Primary Care Act of 1973. The limited scope of the measure and the timing of its introduction, together with careful attention to the dynamics of health care politics, were critical to the passage of the Act. Even though considerable time has elapsed since this article was written, and increased interest in primary care is evident in other areas and at various levels of government, the obstacles and issues involved in providing care to underserved areas remain topics of debate in Tennessee and elsewhere.

Health Planning↗
PubMed1992

The reduction of black infant mortality: an eighteen month evaluation of three Tennessee Black Health Care Task Forces' demonstration projects.

The problem of low birth weight has emerged as the single most important cause of infant death or subsequent handicaps in infancy and childhood. Although low birth weight babies (below 5.5 pounds) represent a small percentage of all babies born, well over half of all infant deaths occur among this group. The problem is even more serious for tiny infants. The relationship between infant mortality/morbidity and low birth weight has been known for many years and despite dramatic overall changes and medical advances, the incidence of low birth weight among high-risk populations continues to be a perennial problem. Efforts have been made nationally to develop programs that identify the conditions which increase the risk of having a low birth weight infant; programs that seek to reduce the risk of low birth weight; and research on new approaches to prevent premature labor as well as promoting the normal growth and development of a fetus. Since 1987, the Black Health Care Task Force, established by the Tennessee Department of Health and Environment has funded three infant mortality reduction pilot projects (Alton Park/Dodson Avenue Health Care in Hamilton County, Memphis Health Center and, Memphis-Shelby County Health Department) that operated in the two Tennessee counties where the Black infant mortality rates were extremely high. The projects goals were (1) to improve birth weight and survival rates of black infants born to indigent and Medicaid women; (2) to reduce maternal morbidity among indigent and Medicaid women; (3) to enhance the participation of indigent and Medicaid maternity clients in the appropriate and timely prenatal intrapartum and postpartum services; (4) to reduce the incidence of unplanned pregnancies among adolescents; and (5) to increase the utilization of family planning services by indigent and Medicaid women. Data will be reported and analyzed to assess whether or not the projects had a positive effect on birth outcome and a subsequent reduction in infant mortality. The data for this analysis is based on enrollment data provided by the projects, and linked birth and infant death certificates for project and nonproject comparisons, as retrieved from the Department of Health and Environment's Vital Records.

Adolescent↗
PubMed1993

Targeting needs of the underserved: current programs in Tennessee.

Health care needs of indigents are a major force driving the need for health care reform in the U.S. Governor McWherter of Tennessee and his Administration have highlighted the need for available, affordable, and accessible health care services for all Tennesseans and especially for the medically indigent. This paper describes programs developed and implemented during the McWherter administration. These programs include community health agencies, placement of health care providers in underserved areas, increasing the number of citizens served by the Medicaid program, coordination of high-risk prenatal and child care to year one, and special demonstration projects in various African-American communities. Major reform is needed at the national level. In the meantime, the McWherter Administration will continue to develop new and innovative ways to increase the availability, accessibility, and affordability of health services in Tennessee.

Community Health Services↗
PubMed2007

Improvement in booster seat use in Tennessee.

OBJECTIVE: Tennessee enacted an enhanced child safety restraint law in July 2004, which included new requirements for booster seat use among 4- to 8-year-old children. The goal of this study was to evaluate the appropriate use of child safety restraints and knowledge of the enhanced law before and after its implementation. METHODS: On-site child safety restraint assessments and brief driver interviews for cars with passengers 0 to 8 years of age were conducted at 34 sites in 3 urban counties in Tennessee. Assessments were conducted 2 to 3 months before implementation of the law and 1 year after implementation of the law. Appropriateness of restraint use was defined on the basis of language in the enhanced law. RESULTS: Data were obtained for 1247 child passengers transported by 1191 drivers; 333 of the children were 0 to 3 years of age, and 914 were 4 to 8 years of age (the primary age group targeted by the enhanced law). Significant improvement in appropriate booster seat use was seen for 4- to 8-year-old passengers after implementation (39%), compared with use before implementation (29%). There was no improvement in the rate of appropriate restraint use for younger children (<4 years of age) after implementation. Black passengers 4 to 8 years of age were twice as likely as white child passengers to be unrestrained, before and after implementation. Seventy-nine percent of drivers reported awareness of the new restraint law after implementation; the majority of drivers obtained information from television advertisements. CONCLUSIONS: Improvements in booster seat use were seen after adoption of an enhanced state law requiring use; however, racial differences in restraint use persisted among 4- to 8-year-old passengers. Additional study of barriers to booster seat use among drivers of black child passengers and unrestrained children is warranted.

Black People↗
PubMed1982

Family planning and abortion: have they affected fertility in Tennessee?

In Tennessee between 1975 and 1978, birth rates among teenagers decreased while they increased among older age groups. This trend was unlike previous years and coincided temporally with the increased availability of legal abortion services in Tennessee and the special efforts to prevent unwanted pregnancies among teenagers. Increased use of family planning services was significantly associated with the drop in the fertility rate for Black teenagers; legal abortion use was significantly associated with the change in the fertility rate for Black females aged 20 years or older.

Abortion, Legal↗
PubMed1991

Urolithiasis in Tennessee: an occupational window into a regional problem.

BACKGROUND: Urinary tract stones (stones) are believed to be unusually common in the southeastern United States but neither the incidence of nor the risk factors for stones are known. METHODS: In three well-defined occupational populations in eastern Tennessee, we assessed the prevalence, incidence, and cumulative incidence of stones and measured biochemical risk factors for lithogenesis. RESULTS: The age-adjusted prevalence of stones was 18.5 percent in Tennessee compared to 7.7 percent among White males in US NHANES (prevalence ratio 2.4, 95% CI 1.7, 3.3). The cumulative incidence (risk) was 27.8 percent by age 65, higher than in any other reported population. Risk factors were age, a family history, and urinary saturation with calcium-oxalate (COAX). Persons with a positive family history and the highest measured CAOX index had a predicted lifetime risk of 88.8 percent. Biochemical factors affecting lithogenesis were hypercalciuria, hyperoxaluria, and low urine volume. CONCLUSION: Future research should characterize the geographic boundaries of a southeastern "stone-belt" and explore genetic and dietary hypotheses that might explain it.

Adult↗
PubMed1984

An analysis of the relationship of seven selected variables to State Board Test Pool Examination performance of the University of Tennessee, Knoxville, College of Nursing.

The study was designed to determine whether any one of seven selected variables or a combination of the variables is predictive of performance on the State Board Test Pool Examination. The selected variables studied were: high school grade point average (HSGPA), The University of Tennessee, Knoxville, College of Nursing grade point average (GPA), and American College Test Assessment (ACT) standard scores (English, ENG; mathematics, MA; social studies, SS; natural sciences, NSC; composite, COMP). Data utilized were from graduates of the baccalaureate program of The University of Tennessee, Knoxville, College of Nursing from 1974 through 1979. The sample of 322 was selected from a total population of 572. The Statistical Analysis System (SAS) was designed to accomplish analysis of the predictive relationship of each of the seven selected variables to State Board Test Pool Examination performance (result of pass or fail), a stepwise discriminant analysis was designed for determining the predictive relationship of the strongest combination of the independent variables to overall State Board Test Pool Examination performance (result of pass or fail), and stepwise multiple regression analysis was designed to determine the strongest predictive combination of selected variables for each of the five subexams of the State Board Test Pool Examination. The selected variables were each found to be predictive of SBTPE performance (result of pass or fail). The strongest combination for predicting SBTPE performance (result of pass or fail) was found to be GPA, MA, and NSC.

Education, Nursing, Baccalaureate↗