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PubMed1978

Commercial national board review programs. A case study at the Medical College of Georgia.

For a long period, students have been taking national board examination review programs offered by commercial firms. The one question to which faculty and students would like the answer is, "Do the national board review programs offered by these commercial firms do any good?" Events at the Medical College of Georgia have provided an opportunity to gather data toward an answer to this question. In 1976, thirty-three medical students at the Medical College of Georgia enrolled in a commercial national board review program. Performance of these students was compared with the predicted performance of these students had they not taken the national board review program. The results suggest that the commercial review program did not notably help these students.

Education, Medical↗

PubMed1980

Prenatal chromosomal diagnosis. Racial and geographic variation for older women in Georgia.

In a study of Georgia women aged 40 years and older, 15% made use of prenatal chromosomal diagnosis. There was, however, substantial racial and geographic variation, ranging from a use ratio of 60% among whites in two large urban counties to 0.5% among blacks outside Augusta and Atlanta health districts. This simple population-based epidemiologic analysis suggests that future program planning for genetic services in Georgia should address ways to increase access by rural women, especially blacks. Similar analyses in other states could be used for planning genetic services.

Abortion, Therapeutic↗

PubMed1994

African-American factor VII-deficient variants in Georgia (FVII variants).

We studied African-American Factor (FVII)-deficient variants and carriers in Georgia by measuring their levels of FVII antigen (FVIIAG) and FVII procoagulant (FVIIC). Factor VIIAG was determined using enzyme-linked immunoassay (ELISA), whereas FVIIC was measured in two ways: 1) by fibrin clotting methods that employed human recombinant (HRFVIIC), human placental (HPFVIIC), rabbit brain (RBFVIIC), and bovine brain (BBFVIIC) thromboplastins; and 2) by an amidolytic method (AMFVIIC). Prothrombin time tests (PT) were also performed by standard methods. These 4 FVII-deficient patients and 3 carriers demonstrated the following results: PT: 18.2 +/- 6.5 sec; FVIIAG: 73.0 +/- 14.9%; HRFVIIC: 30.6 +/- 20.3%; HPFVIIC: 30.5 +/- 21.4%; RBFVIIC: 25.3 +/- 21.4%; BBFVIIC: 30.6 +/- 17.5%; AMFVIIC: 44.1 +/- 18.3%. We conclude that a group of clinically mild African-American FVII-deficient variants exists in Georgia. This group is characterized by the presence of FVIIAG and decreased FVIIC, using a variety of thromboplastins; and excellent correlation was noted for both human thromboplastins.

Antibodies↗

PubMed1984

Structural changes in the femur with the transition to agriculture on the Georgia coast.

Structural characteristics of the femur are compared in preagricultural (2200 B.C.-A.D. 1150) and agricultural (A.D. 1150-1550) subsistence strategy groups from the Georgia coast. Using an automated technique, cross-sectional geometric properties used in structural analyses (areas, second moments of area) were determined at midshaft and distal to the lesser trochanter in 20 adults from each group. A significant decline in magnitude of almost every geometric property occurs in the agricultural group. The differences between groups are reduced but still significant for many properties after standardizing for bone length differences. In addition, a remodeling of the femoral cortex to one of relatively smaller medullary and subperiosteal diameter, as well as a more circular cross-sectional shape, is characteristic of agricultural femora. Thus, while the relative cross-sectional area of bone remains the same, the spatial distribution of bone area is different in the two groups. The results strongly suggest a relative reduction in mechanical loadings of the femur in the agricultural group, implying different levels and possibly types of activity involving the lower limb in the two groups. The data are also compared with similar data available for the Pecos Pueblo (agricultural) sample. The comparison indicates that types of activity may have been more similar in the two agricultural samples, but that general levels of activity were more similar in the Pecos Pueblo and Georgia coast preagricultural samples.

Agriculture↗

PubMed1995

The decline of mink in Georgia, North Carolina, and South Carolina: the role of contaminants.

Since the 1960s, mink (Mustela vision) populations in Georgia, North Carolina, and South Carolina have declined, especially in the coastal plain. A prior study suggested that the decline may stem from environmental contaminants. Based on water quality data from each state, we identified 17 substances potentially related to the decline: aldrin, dieldrin, endrin, DDD, DDE, DDT, PCBs, chlordane, alpha-BHC, toxaphene, dibenzofuran, copper, chromium, cadmium, lead, arsenic, and mercury. Mink livers were analyzed for PCB and organochlorine pesticides, and kidneys and femurs were analyzed for metals. Reference sample concentrations from piedmont, mountain, and foothill locations were compared to state coastal plain totals and counties. PCBs for Georgia, dieldrin for South Carolina, and endrin and aldrin for North Carolina were significantly higher than the piedmont reference group. Liver PCB concentrations were higher than those known to cause mink reproductive dysfunction. Mercury concentrations were significantly higher in coastal plain mink from all three states and were in the range of those known to cause impacts to reproduction, growth, and behavior to wild mink. It is unknown what concentrations of cyclodienes cause reduced reproduction or other physiological effects in mink, but the levels reported here probably indicate background concentrations that do not contribute to the decline.

Air Pollutants↗

PubMed1995

Reforming Georgia's mental health system.

Legislation passed in 1993 makes sweeping administrative structural changes in Georgia's mental health system. Underlying these changes is the core value that consumers and families should be empowered to participate in the design, contracting, and evaluation of services. The key structural component is the creation of regional boards, comprised of at least 50% consumers and family members, which have the capacity to plan and contract for services and to evaluate the outcomes of those services. This paper describes Georgia's mental health system before these changes, the development of the initiative for reform, the process and problems associated with the passage of the legislation, and the current status of the implementation of the legislation.

Community Mental Health Services↗

PubMed2006

Control strategy optimization for attainment and exposure mitigation: case study for ozone in Macon, Georgia.

Implementation of more stringent 8-hour ozone standards has led the U.S. Environmental Protection Agency to designate nonattainment status to 474 counties nationwide, many of which had never previously violated air quality standards. As states select emission control measures to achieve attainment in these regions, their choices pose significant implications to local economies and the health of their citizens. Considering a case study of one such nonattainment region, Macon, Georgia, we develop a menu of potential controls that could be implemented locally or in neighboring parts of the state. The control menu offers the potential to control about 20-35% of ozone precursor emissions in most Georgia regions, but marginal costs increase rapidly beyond 15-20%. We link high-order ozone sensitivities with the control menu to identify cost-optimized strategies for achieving attainment and for alternative goals such as reducing spatially averaged or population-weighted ozone concentrations. Strategies targeted toward attainment of Macon ozone would prioritize local reductions of nitrogen oxides, whereas controls in the more densely populated Atlanta region are shown to be more effective for reducing statewide potential population exposure to ozone. A U.S. EPA-sanctioned approach for demonstrating ozone attainment with photochemical models is shown to be highly dependent on the choice of a baseline period and may not foster optimal strategies for assuring attainment and protecting human health.

Air Pollution↗

PubMed2006

Leaf litterbag sampling for larval plethodontid salamander populations in Georgia.

Survey techniques for larval salamanders vary in their effectiveness and efficiencies. In this study, the leaf litterbag sampling technique was employed to gather data on larval salamander populations in perennial streams of southern Georgia. Salamanders were collected monthly for 12 months to analyze capture counts and population size-class structure. Simultaneous dipnet sweep data were used to examine potential count data biases of the leaf litterbag sampling technique. In both leaf litterbag and dipnet sweep surveys, adult and larval Southern Two-lined Salamanders (Eurycea cirrigera) and larval Southern Red Salamanders (Pseudotriton ruber) were sampled. In leaf litterbags, larval E. cirrigera were captured most frequently, followed by adult E. cirrigera and larval P. ruber, respectively. However, the efficiency of collecting adult E. cirrigera and larval P. ruber could not be determined because of small sample sizes. Larval E. cirrigera counts detected from leaf litterbags were frequently lower than those associated with dipnet sweeps, suggesting that the former may underestimate larval salamander counts. Leaf litterbags successfully detected all E. cirrigera size-classes (i.e., first-year, second-year, and adult), further indicating that larvae in Georgia spend 2 years in the aquatic phase. Leaf litterbags are an effective method of sampling larval salamanders when used to assess species assemblage and age-class distribution.

Animals↗

PubMed2006

Prevalence of hepatitis C, HIV, and risk behaviors for blood-borne infections: a population-based survey of the adult population of T'bilisi, Republic of Georgia.

Injection drug use and associated hepatitis C virus (HCV) and HIV infections are on the rise in Russia and the republics of the former Soviet Union. While small targeted studies have found widespread drug use and disease among at-risk populations, there have been few attempts to comprehensively evaluate the extent of these epidemics in general post-Soviet societies. We conducted a two-stage cluster randomized survey of the entire adult population of T'bilisi, Republic of Georgia and assessed the burden of HCV, HIV, and risk behaviors for blood-borne infections in 2,000 study participants. Of the 2,000 surveyed individuals, 162 (8.1%) had injected illicit drugs during their lifetimes. Of the individuals who had injected illicit drugs, 138 (85.2%) reported sharing needles with injection partners. HCV was found in 134 (6.7%) of the total surveyed population, but in 114 (70.4%) of those who had injected illicit drugs. We found HIV in only three (0.2%) individuals, all of whom had injected illicit drugs. Injection drug use and high-risk injection practices are very common in Georgia and may be harbingers of a large burden of HCV-associated liver diseases and a potentially serious HIV epidemic in the years to come.

Adult↗

PubMed1983

Fatal child abuse in Georgia: the epidemiology of severe physical child abuse.

Decisions about the occurrence of child abuse are increasingly difficult to make because concepts of what qualifies as reportable child abuse may be broadening. We examined this question by comparing 51 fatal child abuse cases occurring in Georgia between July 1975 and December 1979 to non-fatal cases and to the Georgia population. Overall rates of fatal child abuse were higher for male perpetrators compared with female and black perpetrators compared with white. However, the latter finding varied with economic and geographic status. The highest child abuse fatality rates were found in poor, rural, white families (3.3/100,000 children) and in poor, urban, black families (2.4/100,000 children). Risk factors for fatal abuse included early childhood (RR 6:1), parental teenage childbearing (RR 4:1), and low socioeconomic status. These characteristics were similar to those of the severe child abuse cases noted in the early child abuse literature. Non-fatal cases did not clearly share these risk factors. Severe abuse, here represented by fatal cases, is a distinct subset of reported child abuse, but characteristics associated with it are frequently attributed to all reportable child abuse. Medical personnel should be aware that they cannot rely on the presence or absence of these characteristics in screening for risk of reportable child abuse. Child abuse research should use restricted, stated case definitions. When intervention and prevention programs are being organized, they should not generalize research findings to all forms of child abuse.

Adolescent↗

PubMed2004

Out-of-pocket and informal payments in health sector: evidence from Georgia.

This study presents an in-depth investigation of out-of-pocket payments for health services, formal and informal, in the Republic of Georgia. The main purpose of the study is to: (a) analyze the process of collection and distribution of out-of-pocket or direct payments and particularly of the informal component; (b) explain why they seem to be so prevalent; (c) investigate their consequences, especially on access and quality of health care services. The findings of this study are derived from in-depth interviews and focus group discussions with users as well as providers. The study found that in general paying for health services in Georgia has become a really common and mostly accepted practice, and that a significant share of these payments are completely unrecorded. The extent of direct payments for health services are producing severe consequences on both equity and efficiency, making services unaffordable for most people, and leading to under funding of essential inputs. The policy implications of the study findings are challenging. First, the study clearly points out the deep-rooted and multidimensional reasons why out-of-pocket payments are pervasive, and why an important share of them is collected informally. Second, the study highlights that there is no simple solution. In particular, some of the solutions frequently proposed in the international debate, such as simply formalizing user charges, in the Georgian context appear impractical.

Financing, Personal↗

PubMed2006

Farm-level irrigation and the marginal cost of water use: evidence from Georgia.

We create a proxy for the cost of irrigation water in Georgia from a sample of Georgia irrigators by investigating the marginal cost of pumping groundwater. We then combine this proxy with agronomic and climatic variables to estimate the response of agricultural water use to differences in the marginal cost of irrigation. The results show that pumping costs are a significant determinant of water use, and imply that agricultural water use would be moderately affected by institutional changes that would explicitly price water.

Agriculture↗

PubMed2005

Reform strategies in Georgia and their impact on health care provision in rural areas: evidence from a household survey.

The transition resulting from the break-up of the Soviet Union significantly affected the health care systems and population health status in the newly independent States. The available body of evidence suggests that contraction of public resources resulting from economic slowdown has led to the proliferation of out-of-pocket payments and private spending becoming a major source of finance to health service provision to the population. Emerging financial access barriers impede adequate utilization of health care services. Most transition countries embarked on reforming health systems and health care financing in order to tackle this problem. However, little evidence is available about the impact of these reforms on improved access and health outcomes. This paper aims to contribute to the assessment of the impact of health sector reforms in Georgia. It mainly focuses on changes in the patterns of health services utilization in rural areas of the country as a function of implemented changes in health care financing on a primary health care (PHC) level. Our findings are based on a household survey which was carried out during summer 2002. Conclusions derived from the findings could be of interest to policy makers in transitional countries. The paper argues that health financing reforms on the PHC level initiated by the Government of Georgia, aimed at decreasing financial access barriers for the population in the countryside, have rendered initial positive results and improved access to essential PHC services. However, to sustain and enhance this attainments the government should ensure equity, improve the targeting mechanisms for the poor and mobilize additional public and private funds for financing primary care in the country.

Adolescent↗

PubMed2004

Prevalence of Dirofilaria immitis and gastrointestinal helminths in cats euthanized at animal control agencies in northwest Georgia.

Cats euthanized at six northwest Georgia animal control agencies were examined for adult Dirofilaria immitis in heart and lung tissue and presence of gastrointestinal helminth ova by fecal flotation. D. immitis were found in 4 of 184 cats (2.1%). The prevalence of feline dirofilariasis in northwest Georgia was lower than that found in other studies conducted in the southeastern United States, but closer to the prevalences occurring in areas of similar topography. Heartworm antigen and antibody tests performed on batched serum samples resulted in low sensitivity and high specificity. Gastrointestinal helminth ova were found in 39.6% of the fecal samples examined and 6.1% of the samples contained two or more species.

Animals↗

PubMed1995

Dental surgery standards for perioperative nurses. Medical Center of Central Georgia.

Practice standards for dental surgery are necessary to maintain quality care for dental patients. Specific standards or recommended practices for dental surgery have not been addressed by AORN, and none are available from the American Dental Association or the Georgia Dental Association. We incorporated the Centers for Disease Control and Prevention guidelines, and Occupational Safety and Health Administration regulations had to be incorporated into existing perioperative standards to institute dental surgery standards for our facility. The standards for dental surgery at the Medical Center of Central Georgia, Macon, evolved with the leadership of perioperative nurses.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Determinants and consequences of health worker motivation in hospitals in Jordan and Georgia.

Health worker motivation reflects the interactions between workers and their work environment. Because of the interactive nature of motivation, local organizational and broader sector policies have the potential to affect motivation of health workers, either positively or negatively, and as such to influence health system performance. Yet little is known about the key determinants and outcomes of motivation in developing and transition countries. This exploratory research, unique in its broader study of a whole range of motivational determinants and outcomes, was conducted in two hospitals in Jordan and two in Georgia. Three complementary approaches to data collection were used: (1) a contextual analysis; (2) a qualitative 360-degree assessment; and (3) a quantitative in-depth analysis focused on the individual determinants and outcomes of the worker's motivational process. A wide range of psychometric scales was used to assess personality differences, perceived contextual factors and motivational outcomes (feelings, thoughts and behaviors) on close to 500 employees in each country. Although Jordan and Georgia have very different cultural and socio-economic environments, the results from these two countries exhibited many similarities among key determinants: self-efficacy, pride, management openness, job properties, and values had significant effects on motivational outcomes in both countries. Where results were divergent, differences between the two countries highlight the importance of local culture on motivational issues, and the need to tailor motivational interventions to the specific issues related to particular professional or other groupings in the workforce. While workers themselves state that financial reward is critical for their work satisfaction, the data suggest a number of non-financial interventions that may be more effective means to improve worker motivation. This research highlights the complexity of worker motivation, and the need for a more comprehensive approach to increasing motivation, satisfaction and performance, and for interventions at both organizational and policy levels.

Attitude of Health Personnel↗

PubMed1999

No fathers' names: a risk factor for infant mortality in the State of Georgia, USA.

Many studies have explored maternal and infant factors as risks for infant mortality, but little attention is given to paternal factors. In Georgia, listing a father's name on the birth certificate is optional for married couples and possible after paternal acknowledgment for unmarried couples. The authors evaluated father's name reporting as a paternity measure and risk for infant mortality. Using the linked 1989-1990 birth and death certificates of singleton Georgia infants to calculate relative risks (RRs), infant mortality rates for 38,943 infants with no father's names listed were compared to rates for 178,100 with father's names listed. Compared with the rate for married women listing names, the death rates were higher for unmarried mothers not listing fathers (relative risk, RR = 2.5; 95% CI 2.3-2.7), unmarried mothers listing fathers (RR = 1.4; 95% CI 1.3-1.6), and married women not listing fathers (RR = 2.3; 95% CI 1.6-3.1). Increased risks remained after stratifying by maternal race, age, adequacy of prenatal care and medical risks; and congenital malformations, birthweight, gestational age, and small-for-gestational age. Using logistic regression to examine for effect modification and to adjust for these factors together, the adjusted relative risks for death varied across different groups without fathers' names, regardless of marital status. For example, it remained statistically higher for infants with no father listed and without effect-modifying conditions such as low birthweight (estimated RR = 2.0; 95% CI 1.6-2.4). Although these findings suggest paternal involvement, as measured by listing fathers' names, is protective against low birthweight and infant mortality, further evaluation is needed.

Adolescent↗

PubMed2002

An evaluation of compliance with occupational exposure limits for crystalline silica (quartz) in ten Georgia granite sheds.

Since the 1920s, industrial hygiene studies have documented granite shed workers' exposures to crystalline silica, and the data from these studies have contributed to a better understanding of the relationship between silica exposures and adverse health effects, such as silicosis. The majority of these studies were conducted in the Barre, Vermont, granite sheds. However, a second major granite processing region is located in Elberton, Georgia, where approximately 1800 workers are employed in 150 granite sheds and 45 quarries. The current study reports the exposures of 40 workers in 10 granite sheds in Elberton, Georgia. The arithmetic mean exposure to silica for all monitored employees was 0.052 mg/m3. Employees were classified into one of seven job task groups. The job task group with the greatest exposure was the top polish group, which had a mean exposure of 0.085 mg/m3. Among the top polish workers, the greatest percentage of exposures above the Occupational Safety and Health Administration's permissible exposure limit (OSHA PEL) occurred among the workers who used dry grinders. Wet methods were effective in reducing these exposures to below the OSHA PEL. The mean exposure of Elberton granite shed workers was less than the OSHA PEL, but was not below the threshold limit value of the American Conference of Industrial Hygienists (ACGIH TLV), which was lowered in the year 2000 to 0.05 mg/m3. The Elberton granite shed workers provide a valuable cohort for research on the effects of exposure to crystalline silica at levels between the ACGIH TLV and the OSHA PEL. They are a relatively permanent worker population, are concentrated geographically, and have a quantitatively documented exposure to crystalline silica over the past twenty years.

Environmental Monitoring↗