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PubMedDate not supplied

Issues in assessing satisfaction: findings of the arkansas medicaid family planning demonstration waiver evaluation.

Arkansas was one of the first states to expand family planning services under its state Medicaid plan through a Section 1115 Demonstration Waiver. In addition to an assessment of other outcome measures, evaluators used exit interviews, which had been designed to reduce courtesy bias, to assess client satisfaction with family planning services available under the waiver in public health units. Client satisfaction with family planning services can serve as a simple measure of one dimension of perceived quality of care. Findings indicate overall client satisfaction with family planning services. However, noted methodological issues may limit the generalizability of these findings. Potential corrective measures are suggested for improving client satisfaction with family planning services and for increasing the utility of survey instrument utilized in this effort.

Adolescent↗
PubMed2000

Predictors for people's response to a tornado warning: Arkansas, 1 March 1997.

On 1 March 1997, powerful tornadoes touched down in Arkansas (USA) on a Saturday afternoon. Twenty-six fatalities and 400 non-fatal injuries were reported. We performed a population-based cross-sectional study to determine factors associated with appropriate responses to tornado warnings. Of 146 survey participants, 140 (96 per cent) knew the difference between 'tornado watch' and 'tornado warning' and were aware of when the warning was announced. Of those 140 participants, 64 (45.7 per cent) responded to the warning by seeking shelter, and 58 (90.6 per cent) of those 64 acted within five minutes of hearing the warning. Four factors were positively associated with those seeking shelter: having graduated from high school (OR = 4.2, 95 per cent CI = 1.1-15.5); having a basement in one's house (OR = 3.8, 95 per cent exact CI = 1.1-17.1); hearing a siren (OR = 4.4, 95 per cent CI = 1.3-18.9); and having prepared a household plan of response when tornadoes occur (OR = 2.6, 95 per cent CI = 1.1-6.3). On the basis of these findings, we recommend: first, that people who live in tornadoprone areas have a personal plan of action to help them respond immediately to warnings; second, public-health education officials in areas with frequent tornadic activity should do more to educate the public about what they can do to protect themselves from a tornado; and third, that emergency-management officials planning protection measures for vulnerable communities should consider that most people have limited time (our study documented five minutes) in which to respond to a tornado warning. Thus, shelters in tornado-prone areas should be quickly accessible by residents.

Arkansas↗
PubMed2004

Determining personal care consumers' preferences for a consumer-directed cash and counseling option: survey results from Arkansas, Florida, New Jersey, and New York elders and adults with physical disabilities.

OBJECTIVE: To assess Medicaid consumers' interest in a consumer-directed cash option for personal care and other services, in lieu of agency-delivered services. DATA SOURCES/STUDY SETTING: Telephone survey data were collected from four states from April to November 1997. Postsurvey focus groups were conducted in four states in 1998. Early implementation experiences are drawn from three states from 1999 to 2002. STUDY DESIGN: Participants (N=2,140) were selected for a structured telephone survey interview from a probability-sampling frame of current Medicaid consumers in Arkansas, Florida, New Jersey, and New York. Key variables include interest in the cash option, demographic and background characteristics of consumers, as well as previous experience and training needed. Postsurvey focus groups were also conducted with current Medicaid consumers. DATA COLLECTION/EXTRACTION METHODS: Interviewers read the telephone survey from computer screens and entered responses directly into the database of the Macintosh Computer Assisted Telephone Interview software. Data were analyzed using SPSS 10.0 (http://www.spss.com) for Windows. PRINCIPAL FINDINGS: Cash option interest was positively associated with experience hiring and supervising workers, more severe levels of disability, having a live-in caregiver, living in Florida, and minority status. Age of the client was also a significant factor. CONCLUSIONS: There is significant interest in the cash option, although interest varies among subgroups of consumers. Future research should continue to evaluate interest in the cash option among different groups of consumers, as well as actual experience with the option when the Cash and Counseling Demonstration and Evaluation (CCDE) evaluation findings are completed.

Adult↗
PubMed2000

The distribution of advanced practice nurses in Arkansas: gaps in the care of rural underserved populations.

PURPOSE: To examine the relationships between advanced practice nurses' (APN) practice sites and economic factors, racial and ethnic characteristics of the populations they serve, and the likelihood of APNs practicing in underserved areas. DATA SOURCES: Retrospective analysis of U.S. census data and records supplied by the Arkansas State Board of Nursing. CONCLUSIONS: Nurse practitioners (NPs) were the only APN group with equal distribution in rural or urban areas. Overall, APNs and NPs were more likely to practice in counties with higher rates of poverty and lower education levels. IMPLICATIONS FOR PRACTICE: More effort needs to be made in recruiting and retaining APNs in rural and underserved areas.

Arkansas↗
PubMed2002

Participant satisfaction with a school telehealth education program using interactive compressed video delivery methods in rural Arkansas.

Socioeconomic and demographic factors can affect the impact of telehealth education programs that use interactive compressed video technology. This study assessed program satisfaction among participants in the University of Arkansas for Medical Sciences' School Telehealth Education Program delivered by interactive compressed video. Variables in the one-group posttest study were age, gender, ethnicity, education, community size, and program topics for years 1997-1999. The convenience sample included 3,319 participants in junior high and high schools. The School Telehealth Education Program provided information about health risks, disease prevention, health promotion, personal growth, and health sciences. Adolescents reported medium to high levels of satisfaction regarding program interest and quality. Significantly higher satisfaction was expressed for programs on muscular dystrophy, anatomy of the heart, and tobacco addiction (p < 0.001 to p = 0.003). Females, African Americans, and junior high school students reported significantly greater satisfaction (p < 0.001 to p = 0.005). High school students reported significantly greater satisfaction than junior high school students regarding the interactive video equipment (p = 0.011). White females (p = 0.025) and African American males (p = 0.004) in smaller, rural communities reported higher satisfaction than White males. The School Telehealth Education Program, delivered by interactive compressed video, promoted program satisfaction among rural and minority populations and among junior high and high school students. Effective program methods included an emphasis on participants' learning needs, increasing access in rural areas among ethnic groups, speaker communication, and clarity of the program presentation.

Adolescent↗
PubMed2003

Participant satisfaction in an adult telehealth education program using interactive compressed video delivery methods in rural Arkansas.

CONTEXT: Rural Americans have less access than their urban counterparts to health promotion information. PURPOSE: To assess differences in program satisfaction associated with age, gender, ethnicity, community size, and education among participants in an Arkansas adult telehealth education program that utilized interactive video technology. METHODS: A program evaluation instrument was administered to a convenience sample of 2567 people who participated in the program from 1996 through 1999. FINDINGS: The evaluation instrument demonstrated adequate internal consistency reliability (Cronbach's alpha = 0.85) and construct validity. Older adults, blacks, American Indians, and participants from smaller rural communities and with a high school degree or less had significantly greater satisfaction (P < .001 to P = .03). CONCLUSIONS: The findings suggest that socioeconomic and demographic factors can affect satisfaction with telehealth education programs.

Adolescent↗
PubMed2002

Molecular subtype analyses of Campylobacter spp. from Arkansas and California poultry operations.

Campylobacter isolates from diverse samples within broiler production and processing environments were typed by using flaA short variable region DNA sequence analysis. Sixteen flocks from four different farms representing two broiler producers in Arkansas and California were analyzed. Fourteen of the flocks (87.5%) were Campylobacter-positive; two remained negative throughout the 6-week rearing period. In general, multiple clones were present within a flock. Additionally, clones found within a flock were also present on the final product, although the diversity of Campylobacter spp. on the final product appeared to be reduced relative to that observed within the flock. Comparison of clones between flocks on the same farm revealed that some clones of Campylobacter persisted in multiple flocks. Furthermore, some clones were identified across the two farms that were under the same management. In two sampling periods, environmental isolates were positive for Campylobacter prior to flock shedding. Environmental samples associated with five additional flocks were positive for Campylobacter concomitantly with recovery of Campylobacter from the birds. Analysis of the environmental isolates that were positive prior to flock shedding demonstrated that in some instances the environmental isolates possessed genotypes identical to those of isolates originating from the flock, while in other cases the environmental isolates possessed genotypes that were distantly related to isolates obtained from the flock. Analyses of environmental isolates that tested positive concurrently with the positive isolates from the flocks demonstrated varied results; in some instances the environmental isolates possessed genotypes identical to those of isolates originating from the flock, while in other cases the environmental isolates possessed genotypes that were distantly related to isolates obtained from the flock. These data suggest that the external environment may contribute to Campylobacter contamination during poultry production and processing. However, environmental contamination with Campylobacter does not appear to be the sole contributing factor.

Animals↗
PubMed2003

Invasive disease due to nontypeable Haemophilus influenzae among children in Arkansas.

In this study, we reviewed cases of invasive disease due to nontypeable Haemophilus influenzae among children hospitalized at Arkansas Children's Hospital from 1993 to 2001. A total of 28 cases were examined, including 21 associated with bacteremia and 4 associated with meningitis. Of the patients examined, 86% were </=4 years of age, and 68% had underlying medical conditions. Characterization of the bacterial isolates by multilocus sequence type genotyping revealed significant overall genetic diversity, similar to the diversity in the general population structure for nontypeable H. influenzae. However, four separate pairs of isolates were closely related genetically, a relationship confirmed by pulsed-field gel electrophoresis and Southern hybridization studies using probes for the major H. influenzae adhesin genes. These results suggest that selected strains of nontypeable H. influenzae may have more invasive potential, especially in young children and patients with underlying medical conditions. At this point, the specific factors that contribute to enhanced virulence remain unclear.

Adolescent↗
PubMed2005

Disparities in use of antipsychotic medications among nursing home residents in Arkansas.

Pilot work was conducted to determine whether there were racial disparities in the use of second-generation antipsychotic medications in a sample of 2,717 residents of nursing homes in Arkansas in 2001. Chi square analysis and a logistic regression model were used to examine the relationship between residents' race and likelihood of receiving a second-generation antipsychotic. Other independent variables included in the model were age, gender, and the location of the nursing home. The results indicated racial disparities in use of second-generation antipsychotics among the nursing home residents, with African-American residents less likely to receive these medications than residents from other racial or ethnic groups.

Aged↗
PubMed1998

Non-insulin dependent diabetes mellitus in African-American youths of Arkansas.

Non-insulin dependent diabetes mellitus (NIDDM) occurs more frequently in certain adult populations, including African-Americans. Recently an increase in the incidence of NIDDM has been observed among African-American youths in Arkansas. Clinical presentations among these youths vary from asymptomatic to severe diabetic ketoacidosis. From a chart review, data were examined to determine which physical, biochemical, and autoimmune characteristics were most helpful in appropriate classification of NIDDM vs insulin dependent diabetes mellitus (IDDM). It is apparent that several diagnostic and treatment issues need to be addressed to improve the management of African-American youths with NIDDM.

Adult↗
PubMed2006

Equity in the development of telemedicine sites in an Arkansas high-risk pregnancy programme.

We investigated where telemedicine sites were placed in a telemedicine network to assist high-risk pregnancies in Arkansas. There were 14 telemedicine sites in 75 counties, excluding the central site in Pulaski county. Logistic regression was used to examine site placement. Five potential predictors of site placement were examined: (1) the logarithm of the number of births in the county (LOGBIRTHS); (2) an indicator of whether a county had an abnormal rate of low birthweight babies (HIGHLBW); (3) the proportion of the county population below the government's poverty level; (4) the ratio of black to white births; (5) an indicator of whether the county bordered the telemedicine hub site county. The results suggested that telemedicine sites were placed where there were more births (LOGBIRTHS, P = 0.001) and more low birthweight babies (HIGHLBW, P = 0.004). After controlling for these variables, the county poverty level did not reduce the likelihood of site placement. Thus telemedicine sites had been established in those areas where the need was great both in terms of immediate risk (rate of low birthweight babies) and in terms of the continuing pressure of large numbers of births. This is significant in view of the concentration of poor minorities in certain areas, which historically have not been matched by past distribution of resources.

Arkansas↗
PubMed1995

Effects of polychlorinated dibenzo-p-dioxins and dibenzofurans on nesting wood ducks (Aix sponsa) at Bayou Meto, Arkansas.

Wood ducks (Aix sponsa) nesting along Bayou Meto downstream from a hazardous waste site in central Arkansas were contaminated with polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs). Residues in eggs, based on 2,3,7,8-tetrachlorodibenzo-p-dioxin equivalents (TCDD-EQ), ranged up to 611 parts per trillion (ppt), and egg arithmetic means were 90-fold higher at the site nearest the point source compared with a reference site. We monitored productivity of wood ducks in artificial nest boxes at three sites on the bayou and at a reference site on a separate drainage during 1988-1990. Productivity was suppressed (p < 0.05) at the bayou sites compared with the reference site, and egg TCDD-EQs were inversely correlated (p < 0.001) with productivity in corresponding nests. The threshold range of toxicity, where reduced productivity was evident in wood ducks (based on TCDD-EQs), was > 20 to 50 ppt. Oxidative stress and teratogenic effects occurred in ducklings at the more contaminated nesting sites nearest the point source. These findings suggest that wood ducks may be more sensitive to PCDD and PCDF contamination than some other aquatic birds and could serve as an indicator species for monitoring biological impacts from these contaminants.

Animals↗
PubMed2006

Agricultural pesticide use and hypospadias in eastern Arkansas.

INTRODUCTION: We assessed the relationship between hypospadias and proximity to agricultural pesticide applications using a GIS-based exposure method. METHODS: We obtained information for 354 cases of hypospadias born between 1998 and 2002 in eastern Arkansas; 727 controls were selected from birth certificates. We classified exposure on pounds of pesticides (estimated by crop type) applied or persisting within 500 m of each subject's home during gestational weeks 6 to 16. We restricted our analyses to 38 pesticides with some evidence of reproductive, developmental, estrogenic, and/or antiandrogenic effects. We estimated timing of pesticide applications using crop phenology and published records. RESULTS: Gestational age at birth [odds ratio (OR) = 0.91; 95% confidence interval (CI), 0.83-0.99], parity (OR = 0.79; 95% CI, 0.65-0.95), and delaying prenatal care until the third trimester (OR = 4.04; 95% CI, 1.46-11.23) were significantly associated with hypospadias. Risk of hypospadias increased by 8% for every 0.05-pound increase in estimated exposure to diclofop-methyl use (OR = 1.08; 95% CI, 1.01-1.15). Pesticide applications in aggregate (OR = 0.82; 95% CI, 0.70-0.96) and applications of alachlor (OR = 0.56; 95% CI, 0.35-0.89) and permethrin (OR = 0.37; 95% CI, 0.16-0.86) were negatively associated with hypospadias. CONCLUSIONS: Except for diclofop-methyl, we did not find evidence that estimated exposure to pesticides known to have reproductive, developmental, or endocrine-disrupting effects increases risk of hypospadias. Further research on the potential effects of exposure to diclofop-methyl is recommended.

Agricultural Workers' Diseases↗
PubMedDate not supplied

Arkansas fights fat: translating research into policy to combat childhood and adolescent obesity.

National recommendations to address the emerging obesity epidemic include increased awareness, individual interventions, and environmental changes. However, guidance for translating public health and clinical evidence into meaningful policies has been limited. Arkansas formulated and passed simple yet powerful legislation to combat childhood obesity through actions in public schools. Specific legislative requirements were straightforward. Importantly, the act included an independent mechanism to identify, examine, debate, and develop further action steps. Based on our experience, we present a framework for developing a cross-sector approach to translating science into policy and practice, and we offer this guide to other states facing similar health threats.

Adolescent↗
PubMed1990

Testing for isoniazid. An evaluation of the Arkansas method.

To better treat and eliminate tuberculosis, patient compliance must be improved. Compliance can be evaluated by measuring a drug or its metabolite in the urine. In Arkansas, a simple colorimetric method of checking the urine for isoniazid (the Potts-Cozart test) has been used for many years, but it is relatively unknown outside that state and its reliability has not been confirmed. To evaluate this test, urine was blindly tested from patients from a tuberculosis clinic. Controls included urine from patients from a substance abuse clinic and Veterans Medical Center. In more than 200 urine samples tested, no false-positives were found. Urinalysis showed normal values for three patients who were supposed to be receiving antituberculosis medication, but it is likely that these patients were noncompliant. A peculiarity of the test was that the color change with positive tests varied. To investigate this variation, absorption spectroscopy of many substances was performed. Nicotine accounted for the different shade of blue associated with the positive test, but the color produced and the absorption spectroscopy were different from isoniazid, so it did not confuse the interpretation of the results. This test for isoniazid in the urine is simple, quick, inexpensive, easy to interpret, and reliable. It also can be used to detect nicotine and its metabolites.

Arkansas↗
PubMed1981

Neonatal mortality by the day of the week in the 1974-75 Arkansas live birth cohort.

This study is an analysis of daily variations in neonatal mortality among 66,049 live births in the 1974-75 Arkansas live birth cohort. Weekends and holidays in general, and Sundays in particular, were found to have the fewest number of deliveries. Variations in deliveries by the day of the week were attributed to obstetric practices. Births weighing less than 2500 gms. were over-represented among weekend deliveries as were infants experiencing a birth-related injury. Neonatal mortality was found to be higher among weekend deliveries with a Sunday rate that was 27 per cent above the weekly average. Separate analysis by race and birth weight revealed the weekend peak to be more pronounced among non-whites. Analysis of daily variations by cause of death showed that Sundays exceeded the overall average for seven of the eight cause of death categories examined. (Am J Public Health 1981;71:601-605.)

Arkansas↗
PubMed2002

Transmission of Mycobacterium tuberculosis in a rural community, Arkansas, 1945-2000.

A cluster of tuberculosis cases in a rural community in Arkansas persisted from 1991 to 1999. The cluster had 13 members, 11 linked epidemiologically. Old records identified 24 additional patients for 40 linked cases during a 54-year period. Residents of this neighborhood represent a population at high risk who should be considered for tuberculin testing and treatment for latent tuberculosis infection.

Adolescent↗
PubMed1993

Epidemiologic aspects of a St. Louis encephalitis epidemic in Jefferson County Arkansas, 1991.

In 1991, the first epidemic of St. Louis encephalitis (SLE) ever reported in Arkansas resulted in 25 cases in Pine Bluff (attack rate: 44 per 100,000; 95% confidence interval [CI] 28-65). To identify risk factors for SLE viral infection and risk factors for neuroinvasive illness, we conducted a community-based, cross-sectional study of noninfected and asymptomatically infected persons and a case-control study of asymptomatically and symptomatically infected persons. The SLE viral infection rate was similar in all age groups and in all studied census tracts. Risk factors for asymptomatic infection included: living in a low income household (relative risk [RR] = 2.6, 95% CI 1.1-6.0), sitting outside in the evening (RR = 2.1, 95% CI 1.0-4.8), and living in homes with porches (RR = 2.9, 95% CI 0.9-9.3) or near open storm drains (RR = 2.2, 95% CI 1.0-4.9). Compared with asymptomatically infected persons, symptomatic persons were older (odds ratio [OR] for age > or = 55 years = 13.0, 95% CI 1.2-334) and more likely to have a previous history of hypertension (OR = 8.5, 95% CI 1.1-72). Our results indicate that advanced age is the most important risk factor for developing encephalitis after infection with SLE virus. Hypertension and vascular disease may predispose to neuroinvasive disease, but this epidemiologic study has not ruled out the confounding effects of age.

Adolescent↗