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At least 127 records · Page 7Linked to original sources
PubMed1999

The unconditional release of mentally ill offenders from indefinite commitment: a study of Missouri insanity acquittees.

Using a database of all Missouri insanity acquittees committed on July 1, 1997 (N = 873) and all insanity acquittees unconditionally released from 1986 through 1997 (N = 193), this study calculated the lengths of commitment and identified variables associated with the unconditional release of insanity acquittees from indefinite commitment by the mental health and criminal justice systems. The study found that 85 percent of insanity acquittees were still under commitment 5 years after acquittal and 76 percent 10 years after acquittal. Factors that decreased the odds of being unconditionally released included never having been married; having a psychotic disorder, a mood disorder, a substance abuse disorder, or mental retardation/borderline intellectual functioning; and having committed a serious crime. These results support achievement of the intended goal of Missouri's insanity acquittee statute, which is to maximize public safety considerations, but have had the unintended effect of increasing the inpatient insanity acquittee population, resulting in fewer resources for voluntary patients.

Adult↗
PubMed2000

Missouri practitioners show notable improvement in diabetic kidney disease screenings.

Missouri practitioners participating in a cooperative Diabetic Kidney Disease Project, organized by the Missouri PRO, showed significant improvement in screening for nephropathy among diabetic patients following a quality improvement intervention. This project provides a solid basis for the National Diabetes Project initiated by HCFA as part of the PRO's Sixth Statement of Work.

Diabetic Nephropathies↗
PubMed1976

Effects of subtoxic lead levels on pregnant women in the state of Missouri.

Cords, placentas, placental membranes, and maternal and fetal blood were collected from 249 women delivered in Columbia, Missouri (Region I). The same samples were obtained from 253 women delivered in Rolla, Missouri (Region II), near lead mining areas. The incidence of term pregnancies with early membrane rupture was 0.41% in Region I and 17% in Region II. The incidence of premature deliveries was 3% and 13.04% respectively. Lead concentration in blood and placental tissues of term pregnancies revealed no significant changes. In term with early membrane rupture, blood concentration of lead was higher, as was the case in placental tissues and cord. Lead concentration was highest in membrane tissues, in mug/100 grams (Regions I and II respectively): placenta, 6.0 +/- 0.01 and 7.0 +/- 0.03; cord, 11.0 +/- 0.34 and 12.0 +/- 0.18; membrane, 38.9 +/- 2.64 and 45.3 +/- 3.12. A high positive correlation (r = 0.2941) between lead concentration in maternal and fetal blood existed. Both were significantly (P less than 0.01) higher in preterm pregnancies and early membrane ruptures than in term pregnancies. These data suggest that subtoxic levels of lead could increase the incidence of early membrane rupture and premature deliveries.

Ceruloplasmin↗
PubMed1992

Cardiovascular disease control efforts among primary-care physicians--Missouri, 1990.

Nearly half (43%) of all deaths in the United States each year are related to cardiovascular diseases (CVD), including coronary heart disease and cerebrovascular disease (1). CVD is linked to certain risk factors and behaviors, including high blood pressure, elevated total serum cholesterol, cigarette smoking, and physical inactivity (2). Because approximately 70% of the population has at least one contact with a physician each year (3), primary-care physicians are central to health promotion and disease-prevention efforts and early detection of CVD. In May and August 1990, the Missouri Department of Health (MDH) conducted a survey of practicing Missouri physicians to characterize their efforts to identify and control CVD risk factors among their patients.

Cardiovascular Diseases↗
PubMedDate not supplied

Weighing costs and benefits of adequate prenatal care for 12,023 births in Missouri's Medicaid program, 1988.

Numerous studies have shown that the receipt of adequate prenatal care is associated with improvements in pregnancy outcome, particularly a reduction in the risk of low birth weight. Since medical costs for these low birth weight infants are several times higher than for normal birth weight infants, one would expect that medical costs for newborns would be lower for babies whose mothers have had adequate prenatal care than for those with inadequate prenatal care. Explored in this paper is whether the reduction in Medicaid costs for newborn and post-partum maternal care is greater than the increase in prenatal costs for a Medicaid population. The analysis used a file of 12,023 Missouri Medicaid records linked with the corresponding 1988 birth certificates. A modified version of the Kessner index was used to define the adequacy of prenatal care. Prenatal care costs were $233 higher for pregnancies with adequate prenatal care than for those in which prenatal care was inadequate. Newborn and post-partum costs starting within 60 days after the birth were $347 lower for the adequate prenatal care pregnancies, resulting in a savings of $1.49 for each extra $1 spent on prenatal care. Among the other factors studied in determining this benefit to cost ratio were global billing, Supplemental Food Program for Women, Infants, and Children (WIC), and participation in Medicaid under the expanded eligibility provisions that were effective in Missouri in 1988.

Analysis of Variance↗
PubMed2003

A needs assessment study for the Missouri Tele-hospice Project.

Hospice care focuses on palliation and the relief of suffering aiming to improve the quality of patients' last days. Telemedicine is considered to be a tool that can address challenges such as staff shortage, funding limitations and limited access to services in rural areas. Hospice services via telemedicine can be delivered directly into a patient's home by utilizing videoconferencing technology. The Missouri Telehospice Project aims to investigate the impact of a telehospice model on satisfaction with delivered care, caregiver burden, crisis prevention rates and overall cost of delivered care. Five urban and rural hospice agencies in Missouri are participating. A needs assessment study was conducted where hospice staff members responded to a set of questions within focus group and interview sessions providing feedback about the design, type of technology, frequency of usage and perceived impact on quality of hospice care.

Aged↗
PubMedDate not supplied

Melanoma reporting in Missouri.

Thorough reporting of the diagnosis and treatment of various cancers in underserved and rural communities is perhaps one of the greatest challenges to the Missouri physician. We introduce and discuss the use of a new reporting mechanism for registering melanoma cases with the Missouri Cancer Registry in an effort to assess trends in melanoma incidence, improve standards of care, and develop strategic plans for melanoma prevention and screening in the future.

Disease Notification↗
PubMedDate not supplied

Addressing the insidious health and financial burden of tobacco use in Missouri: the role of medical and public health professionals.

Despite the widespread knowledge that tobacco use causes death and debilitating disease, tobacco control efforts in Missouri remain inadequate. No other health issue combines the prevalence, lethality, and neglect of tobacco addiction. This paper discusses comprehensive tobacco-use prevention and cessation programs that could, if implemented, effectively reduce tobacco-related health problems. Successful tobacco control efforts change society by creating an environment in which nonsmoking is the norm and quitting smoking is supported. This paper concludes that it is time for medicine and public health professionals to communicate, collaborate, and assume leadership in reducing the health burden of tobacco use in Missouri.

Cost of Illness↗
PubMed2006

Outbreaks of multidrug-resistant Shigella sonnei gastroenteritis associated with day care centers--Kansas, Kentucky, and Missouri, 2005.

Infection with Shigella sonnei that is resistant to antibiotics commonly used in pediatric practice has become more common during the past decade. In 2005, Kansas, Kentucky, and Missouri reported increases in shigellosis cases associated with day care centers caused predominantly by multidrug-resistant (MDR) (i.e., resistant to ampicillin and trimethoprim-sulfamethoxazole [TMP/SMX]) strains of S. sonnei. Pulsed-field gel electrophoresis (PFGE) patterns for isolates from Kansas and Missouri were similar, suggesting a common outbreak in the Kansas City area, whereas isolates from Kentucky had a different pattern. This report describes the investigation of two outbreaks of MDR shigellosis associated with day care centers and reviews measures for prevention and control of S. sonnei infection in these settings. Given the current rates of resistance to antibiotics available to treat children with shigellosis safely, public health measures initiated during shigellosis outbreaks should focus on promoting appropriate handwashing and diapering practices in day care centers.

Adolescent↗
PubMedDate not supplied

The long road to patient safety: A status report on Missouri acute-care hospitals.

We surveyed Missouri's acute-care hospitals twice to assess the "state of the art" in patient safety systems. We found improvements in all areas studied, but progress is modest and falls short of national recommendations. We urge all Missourians to become more knowledgeable and assertive consumers of hospital care, and we ask them to support Missouri hospitals in their patient safety efforts, including provision of financial resources to put necessary systems in place.

Critical Care↗
PubMed1991

HIV/AIDS in Missouri: an assessment of physician attitudes and practices.

Fewer than half of Missouri physicians responding to a statewide survey are willing to treat patients with HIV infection, and even fewer are willing to treat patients with AIDS. The authors discuss these survey results and their implications for patient care in Missouri.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Vector competence of Aedes albopictus for a newly recognized Bunyavirus from mosquitoes collected in Potosi, Missouri.

The vector competence of a Kentucky strain of Aedes albopictus was assessed for a newly recognized Bunyavirus isolated from Ae. albopictus collected in Potosi, Missouri. Females are susceptible to peroral infection and 44.7% became infected after ingesting about 15 Vero cell plaque-forming units (PFU) of virus. Virus replicated and reached average titers of 10(5.4)-10(6.0) PFU/mosquito by day 7 postfeeding. Fourteen (40%) of 35 females tested in an in vitro virus transmission experiment were infected, and 3 (21.4%) of the infected females transmitted virus. There was no evidence of vertical transmission among 1,196 progeny of a group of mothers exposed to infection perorally or among 6,635 progeny of mothers infected by parenteral inoculation. The absence or infrequency of vertical transmission suggests that the virus was not introduced into Missouri via infected Ae. albopictus eggs. Nonetheless, Ae. albopictus is a competent vector of this virus and we provide the first experimental evidence for incriminating Ae. albopictus as a vector in a natural arbovirus transmission cycle in the United States.

Aedes↗
PubMed1990

Obstetric care in rural Missouri: the loss of rural general and family practitioners.

Family and general practitioners have historically provided a substantial portion of obstetric care in rural parts of the United States, including Missouri. The authors surveyed 328 rural general physicians to determine their participation in obstetrics. Their findings show a dramatic loss of physician obstetric services in rural Missouri and suggest that the dilemma is not likely to be easily remedied.

Adult↗
PubMedDate not supplied

Prenatal participation in WIC related to Medicaid costs for Missouri newborns: 1982 update.

This study replicates a 1980 evaluation of WIC prenatal participation in Missouri by using a file of 9,086 Missouri Medicaid records matched with the corresponding birth records. This file was divided into a WIC group containing 3,261 records and a non-WIC group of 5,825 records. The 1982 results generally confirm the 1980 results, with the 1982 findings showing slightly improved pregnancy outcomes for WIC participants and slightly reduced benefit-to-cost ratios compared with the 1980 findings. In 1982, WIC participation was found to be associated with an increase in mean birth weight of 31 grams and reductions in low birth weight rates (statistically significant) and in neonatal death rates (not statistically significant). The reduction in each rate was 23 percent. WIC participation was also associated with a reduction in Medicaid costs for newborns reported within 45 days of birth amounting to $76 per participant. For every dollar spent on WIC, about 49 cents in Medicaid costs were apparently saved. However, wide 95 percent confidence intervals ($.07, $.90) make it difficult to determine precisely what impact WIC has on Federal and State budget outlays.

Birth Weight↗
PubMedDate not supplied

Cancer mortality and the method of chlorination of public drinking water: St. Louis City and St. Louis County, Missouri.

St. Louis City and St. Louis County, Missouri share the same public drinking water source, namely the Missouri River. The 'all cancer' and most organ specific cancer mortality rates have been consistently and considerably higher for St. Louis City than for St. Louis County for the period 1960 through 1972. A change in the St. Louis County water treatment process, which included increasing the chlorine dosage and delaying the addition of ammonia to form chloramines until just prior to distribution, was instituted in 1955. St. Louis City has, by contrast, continued the lower chlorine level and early ammoniation. Trend analysis using the period 1960-67 and 1972-76 showed higher percentage as well as net cancer mortality rate per million increases for large bowel, liver and bladder cancers for St. Louis County. An apparent association between a probable increase in trihalomethane production in the St. Louis County water since 1955 and an increase in these specific cancer rates which exceed the increases in the St. Louis City rates appears to have been shown. This does not imply causality but is in general agreement with other studies which have examined water chlorination and cancer mortality.

Adult↗
PubMedDate not supplied

The public health response to 2,3,7,8-TCDD environmental contamination in Missouri.

In 1971, waste oil containing 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) was sprayed for dust control on a number of residential, recreational, and work areas in Missouri. In several of them, the level and extent of environmental contamination were not known until late 1982 or 1983. Extrapolation from existing toxicological data indicated the potential for substantial adverse health effects in highly exposed populations. As a result, the Missouri Division of Health and the Centers for Disease Control initiated close collaboration with the Environmental Protection Agency (EPA) on review and evaluation of environmental data, the development of health advisories to EPA on the need for remedial or preventive actions at specific contaminated sites, a health education effort for the medical community and general public, establishment of a dermatological screening clinic, establishment of a central listing of potentially exposed persons through administration of a health effects survey questionnaire, and a pilot medical study of a "highest risk" cohort. Strategies for additional interventions will continue to be based on findings derived from this first phase of the investigation.

Animals↗
PubMedDate not supplied

High-frequency hearing loss in male farmers of Missouri.

Farmers are exposed to noise that is potentially hazardous to hearing. We measured the hearing of 161 male farmers and 75 male nonfarmers at the 1979 Missouri Farmers Association Agri-Fair and compared it with the hearing of 129 office workers from central Missouri. Fixed-level screening tests were conducted in both ears at three stimulus frequencies: 1000 and 2000 hertz at 20 decibels hearing level and 4000 hertz at 25 decibels hearing level. Audiometers were calibrated in accordance with the ANSI-1969 standard. The results show that farmers are at risk for hearing loss at 2000 and 4000 hertz when compared with office workers. The prevalence of hearing loss was greater for farmers at both frequencies in every decade age group from 25 to 64 years. Using screening failure at 2000 and 4000 hertz in both ears as a criterion for a loss that would affect communication ability, we found that the failure rate was 16.8 percent for farmers and 6.2 percent for office workers. As other investigators have found, the prevalence of high-frequency hearing loss in male nonfarmers who associate with farmers was nearly as great as for farmers.

Adult↗
PubMed1995

Prevalence of smoking by area of residence--Missouri, 1989-1991.

Variation in smoking prevalence by area of residence may be an important consideration in the development, implementation, and management of programs that promote nonsmoking. In general, the prevalence of cigarette smoking is highest among persons at economic, educational, and social disadvantage (1,2), and the proportion of persons who are disadvantaged is greater in urban and nonmetropolitan areas. Because smoking prevalence varies by area of residence and characterization of these differences can assist in directing efforts to promote nonsmoking, the Missouri Department of Health compared urban, suburban, and nonmetropolitan areas using data from two sources: the Behavioral Risk Factor Surveillance System (BRFSS) for Missouri from 1989 through 1991 (suburban and nonmetropolitan areas) and a survey specially commissioned in 1990 (Smoking Cessation in Black Americans [SCBA]) of persons living in low-income census tracts in north St. Louis and central Kansas City (urban areas). This report summarizes the results of this analysis.

Adult↗