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PubMed2006

Performance assessment of major wastewater treatment plants (WWTPs) in the state of Georgia.

A survey was conducted to report on the types and efficiencies of various treatment technologies being used at major wastewater treatment plants (WWTPs) in the state of Georgia. Twenty-four, full-scale wastewater treatment facilities with a design capacity of 37,850 m(3) d(-1) (10 Mg d(-1)) or greater were evaluated. One year of operating data for the 2003 calendar year was obtained from discharge monitoring reports (DMRs) provided by the Georgia Environmental Protection Division (EPD) in Atlanta. Additional information was gathered about facility operations and the types of chemicals used through review of EPD files and interviews with plant personnel. Data evaluated were: influent and effluent five-day Biochemical Oxygen Demand (BOD(5)), influent and effluent total suspended solids (TSS), effluent ammonia nitrogen (NH(3)-N), and effluent Total Phosphorus (TP). Effluent requirements for BOD(5) or five-day carbonaceous biochemical oxygen demand (CBOD(5)), TSS, ammonia nitrogen (NH(3)-N), TP, and dissolved oxygen (DO) vary by facility. Time series plots showing average effluent parameter concentrations versus month indicate the effectiveness of wastewater treatment as a function of type of treatment technology and temperature. Probability plots highlight the relationship between various effluent parameters and associated treatment technology. Fourteen facilities met all permit requirements, whereas ten of the facilities reported violations with regard to flow and/or effluent parameters. Chemicals utilized, design capacity, and monthly effluent concentrations are presented in this study.

Ammonia↗
PubMed2001

Agricultural exposure history among African-American farmers in Georgia.

Agricultural exposures differ across the United States by region, calendar time period, and agricultural practice, but most of the published literature focuses on white men in the Midwest. A pilot study was conducted to explore the breadth and diversity of farming practices over time among African-American farmers in Georgia whose exposures may differ in important ways. Using a comprehensive life events calendar questionnaire, 17 male African-American farmers aged 36 to 86 yr residing in southeastern Georgia were interviewed regarding their agricultural history in July 1997. Most men (15/17) reported working on multiple farms in their lifetime; 3 men worked on 5 different farms during their lifetime. These farmers reported using more chemicals during their lifetime than farmers in the Midwest. Used motor oil was the most frequently reported insecticide applied to animals; this apparently common practice has not been described in the literature and should be better understood since its use may result in dermal exposure to polyaromatic hydrocarbons. Better characterization of regionally specific farming history and individual farming practices will facilitate studies of the health effects of farming.

Adult↗
PubMedDate not supplied

The location and incidence of out-of-hospital cardiac arrest in Georgia: implications for placement of automated external defibrillators.

OBJECTIVE: Prior studies of automated external defrillator placement strategies for public access defibrillation (PAD) have addressed only the venue of out-of-hospital cardiac arrest (OOHCA) in large urban areas. This study evaluates the relationship between population density and the incidence and location of OOHCA. METHODS: This study was a retrospective analysis of 624,199 Georgia state emergency medical services patient care reports (PCRs) in 2000. The PCR categorized these cardiac arrests by county into 12 location options. Counties were divided into population densities of <100, 100-400, 400-1,000, and >1,000 persons per square mile. The incidence of cardiac arrest for each location type was calculated for each population density group. RESULTS: The <100 density group had only 21.77% of the state's population but 30.96% of the state's cardiac arrests, whereas the >1,000 density group had 35.46% of the population but only 23.55% of the cardiac arrests (p<0.0001). The relative risk (95% confidence interval) for OOHCA in the <100 density group compared with the >1,000 density group was 2.14 (2.00, 2.29). The percentage of OOHCAs that occurred in the home for each population density group was: <100 persons per square mile, (67.67%); 100-400 persons per square mile, (68.83%); 400-1,000 persons per square mile, (65.75%); and >1,000 persons per square mile (62.09%) (p=0.0001). CONCLUSIONS: There are variations in incidence and location of OOHCA based on population density in Georgia. As population density increases, the incidence percentage of OOHCAs decreases. However, as population density increases, there is an increase in the percentage of cardiac arrests occurring outside the home, where more OOHCAs could potentially benefit from PAD.

Electric Countershock↗
PubMed2000

Diphtheria epidemic in the Republic of Georgia, 1993-1997.

Epidemic diphtheria reemerged in the republic of Georgia in 1993. From 1993 to 1997, 1405 cases were reported (28 in 1993, 312 in 1994, 429 in 1995, 348 in 1996, and 288 in 1997), with a cumulative incidence of 25.8/100,000 and a case fatality ratio of 9.5%. During 1993-1997, 53% of the diphtheria cases occurred among persons >/=15 years of age. Unvaccinated patients were more likely to have toxic forms (relative risk=2.24; 95% confidence interval=1.69-2.96) or to die of diphtheria (relative risk=2.24; 95% confidence interval=1. 36-3.68) than those who had received at least one dose of diphtheria toxoid. Improvement in routine childhood vaccination coverage and implementation of mass adult vaccination campaigns have been critical to bringing the epidemic under control. By mid-1998, the overall diphtheria situation in Georgia appeared to have been controlled. Only 53 cases were reported from January to June 1998, representing a 64% decrease from the 148 cases during the corresponding period in 1997.

Adolescent↗
PubMed2004

Signs and symptoms predictive of death in patients with foodborne botulism--Republic of Georgia, 1980-2002.

Foodborne botulism is a severe, potentially fatal disease characterized by cranial nerve palsies and descending paralysis. Little is known about signs and symptoms predictive of death from botulism. We studied patients with botulism in the Republic of Georgia, which has the highest reported rate of foodborne botulism in the world. After abstracting medical records of patients with botulism who were hospitalized during 1980-2002, we performed classification-and-regression-tree analysis to identify clinical syndromes predictive of survival and death. We identified records for 706 patients hospitalized for foodborne botulism from 1980-2002. Trivalent antitoxin was administered to 623 patients (88%). Fifty-four (8%) died. Patients with shortness of breath and impaired gag reflex and without diarrhea were 23 times more likely to die than were patients without this syndrome. Validating this clinical prediction rule may help reduce mortality from botulism in Georgia. Validation in other settings could help public health preparations for large outbreaks of naturally occurring or bioterrorism-related botulism.

Adolescent↗
PubMed2006

HIV-1 genetic diversity and genotypic drug susceptibility in the Republic of Georgia.

The genetic diversity and genotypic drug susceptibility of HIV-1 strains circulating in the Republic of Georgia, formerly part of the Soviet Union, were investigated for first time. Forty-eight HIV-positive drug-naive Georgian individuals contributed PBMC DNA between 1998 and 2003. On the basis of phylogenetic analyses of partial pol sequences, the predominant HIV-1 genetic forms were subtype A (70%), followed by subtype B (26%); both genetic forms were carried by injecting drug users and heterosexuals. There was also one subtype C (2%) and one CRF18_cpx (2%). The Georgian subtype A strains clustered with subtype A from Russia, designated A(FSU). Twelve of the subtype A strains (25%) contained the secondary protease inhibitor mutation V77I and 9 also had two other silent mutations. This "V77I haplotype" marks one particular genetic lineage of the epidemic in the former Soviet Union. Two strains (4%) carried antiretroviral (ARV) drug resistance mutations. Nearly full-length genome sequences of five Georgian strains were also completed. Two, 98GEMZ011 (subtype A) and 98GEMZ003 (subtype B), closely resembled the parental strains that recombined to create CRF03_AB. The use of these parental strains in the analysis revealed an additional segment of subtype A in CRF03_AB. Thus, the HIV-1 epidemic in Georgia was composed of a mixture of subtype A(FSU) and subtype B.

Adult↗
PubMed1995

The Georgia State Telemedicine Program: initiation, design, and plans.

This paper describes the genesis, implementation, and operation of the Georgia Statewide Telemedicine Program, a full-service system that provides a comprehensive range of clinical and consultative services to all residents of the state through a hub-and-spoke network. When completed, it will consist of several tertiary-care centers and a set of secondary hubs at medical centers throughout the state. Each hub will, in turn, serve several remote sites. The system enables connectivity throughout the network, and the overall coordination, implementation, and oversight is provided by the Center for Telemedicine at the Medical College of Georgia. The evolution of the system is described, together with lessons learned from the experience.

Academic Medical Centers↗
PubMed2001

Validity of birth certificate data for the outcome of the previous pregnancy, Georgia, 1980-1995.

The author evaluated the validity of four historically based variables collected on Georgia birth certificates: outcome of preceding pregnancy, history of delivery of a low- (<2,500 g) or high- (>4,000 g) birth-weight infant, and death of the baby resulting from the preceding pregnancy. Data were derived from birth and fetal death certificates that were linked for the first and second deliveries of 231,075 women in Georgia from 1980 through 1995. Deaths that occurred during the infant's first year of life were also linked to the birth certificate. For all but the survival variable, the outcome of the first birth as reported on the certificate for the second birth was compared with the outcome recorded on the certificate for the first birth, which was assumed to be correct. Except for ascertainment of death of the firstborn infant, sensitivities for the history of poor outcomes were low. Furthermore, sensitivities were higher when an extremely adverse outcome occurred in the first pregnancy or an adverse outcome recurred. The only high sensitivity was for past infant death (85.4%). These results suggest caution when using these variables to identify high-risk subsets for further research or control for confounding.

Birth Certificates↗
PubMed2005

Health care-seeking behaviour and out-of-pocket payments in Tbilisi, Georgia.

Based on a household survey conducted in Tbilisi, Georgia, in 2000, this paper examines current patterns of health care-seeking behaviour and the extent of out-of-pocket payments. Results show that health care services are a financial burden and that private (out-of-pocket) payment creates financial barriers to accessing health services. Members of the poorest households are less likely to seek care than people from more affluent households, and devote a higher share of household monthly expenditure to health care. Households have adopted various strategies to overcome these financial barriers, but the strategies are likely to contribute to both declining economic status and worsening health outcomes. The paper provides an evidence base to help direct future policy reform in Georgia. Government needs to: (1) prioritize public financing of services for the poor, in particular through amending the Basic Benefit Package so that it better reflects the needs of the poor; (2) promote the quality and utilization of primary care services; (3) address the issue of rational drug use; and (4) consider mobilizing out-of-pocket payments on a pre-paid basis through formal or community-based risk pooling schemes.

Adolescent↗
PubMed1994

Ectoparasites of opossums and raccoons in southeastern Georgia.

Twelve species of ectoparasites (four fleas, three ticks, three chiggers, one macronyssid mite, and one atopomelid mite) were recovered from 42 opossums, Didelphis virginiana Kerr, live-trapped from September 1992 through April 1994 in southeastern Georgia. The fleas, Ctenocephalides felis (Bouché) (prevalence = 19%) and Polygenis gwyni (C. Fox) (36%); the ticks, Dermacentor variabilis (Say) (40%) and Ixodes scapularis Say (19%); and the macronyssid mite, Ornithonyssus wernecki (Fonseca) (21%), exhibited the highest infestation prevalences on opossums. The atopomelid mite, Didelphilichus serrifer Fain, and the chigger mite Leptotrombidium peromysci Vercammen-Grandjean & Langston, both ectoparasites of opossums, are reported from Georgia for the first time. Six species of ectoparasites (one chewing louse, four ticks, and one macronyssid mite) were collected from 58 raccoons, Procyon lotor (L.), examined between October 1992 and September 1993 in the same region. The chewing louse, Trichodectes octomaculatus Paine (prevalence = 24%); and the ticks, Amblyomma americanum (L.) (69%), D. variabilis (55%), and Ixodes texanus Banks (24%), exhibited the highest infestation prevalences on raccoons. Three species of ticks, A. americanum, D. variabilis, and I. scapularis, were the only ectoparasites recovered from both host species. Several of the ectoparasites collected are proven vectors of pathogenic agents that affect humans and animals.

Animals↗
PubMed1994

Murder-suicide in Fulton County, Georgia, 1988-1991. Comparison with a recent report and proposed typology.

Our study of the characteristics of murder-suicide in Fulton County, Georgia is compared with published data, and the usefulness of a proposed typology for classifying murder-suicides is evaluated. Twelve murder-suicides involving 26 decedents occurred in Fulton County (Atlanta), Georgia, during 1988-1991. Similar to national statistics, most offenders were male (100%), there was usually one victim (83%) who was most often female (71%), a spousal or love relationship often existed between the victim and offender (64%), and a firearm was the lethal weapon in almost all incidents (92%). Important differences from published data included a higher incidence of murder-suicide (0.46/100,000), which accounted for a lower proportion of all homicides (1.4%) and a higher proportion of all suicides (3.6%) than is reported nationally, and a lower proportion of white offenders (17%) and higher proportion of male victims (29%). A total of 83% of incidents were intraracial. Murder-suicide in Fulton County was different from national data in ways that might be due to local demographics, the local homicide rate, and the local suicide rate. The proposed typology for classification of murder-suicides is in need of more precise definitions of terminology; further, it does not permit inclusion of some major details that might be useful for study. An alternative classification scheme is offered that enables documentation of more comprehensive information.

Adult↗
PubMed1982

Transportation of radioactive material in Georgia.

A 3-yr study of radioactive materials transportation examined the magnitude of radioactive materials shipments in terms of numbers of packages and motor vehicle trips and types of materials; compliance with regulations for packaging, labelling, handling, external radiation exposure, and surface contamination; and dose to workers as measured with personnel dosimeters. Much of the information was obtained at the Atlanta airport and its vicinity, a package distribution center for the southeastern U.S., and at the Barnwell, S.C. radioactive waste burial site, the destination of most shipments of radioactive waste from or through Georgia. Approximately 12,000 packages in radioactive material categories I, II and III were handled in Georgia each year. Motor vehicles made approximately 3300 trips per year. Some instances of noncompliance were observed, but few of them had the potential for elevated radiation exposure of persons. Several incidents associated with radioactive material transport are reported, of which one may have resulted in slightly elevated exposures to persons. Among drivers and handlers who worked with radioactive material shipments, dosimeters showed that less than one-half of them received radiation doses above background levels. The highest doses were found for drivers who transported large numbers of 99Mo generators.

Georgia↗
PubMed1983

Radium and uranium concentrations in Georgia community water systems.

The first cycle of statewide radionuclide concentration measurements of public drinking water supplies was completed in accord with the Federal and Georgia Safe Drinking Water Acts. The recommended pattern of analysis is initial screening for gross alpha-particle activity, followed by measuring 226Ra if the gross alpha-particle activity is above 5 pCi/l. and then measuring 228Ra if the 226Ra concentration is above 3 pCi/l; and uranium analysis if the gross alpha-particle activity exceeds 15 pCi/l. Surface water supplies for more than 100,000 persons are analyzed for 3H and 90Sr and screened for gross beta-particle activity, with additional analytical requirements if the latter is above 50 pCi/l. Specified supplies downstream for nuclear facilities are analyzed for 3H, 90Sr and 131I, and further analyses are required if the gross beta-particle activity is above 15 pCi/l. More thorough screening was applied for 1400 public water supplies in Georgia, of which about 90% use groundwater. Radium concentrations exceeded the maximum contaminant level (MCL) of 5 pCi/l. in 24 groundwater supplies, mostly due to elevated 226Ra. The gross alpha-particle activity minus uranium concentrations exceeded the 15 pCi/l. MCL in 3 additional samples. No MCL was exceeded in surface water. The S.D.s of analytical results estimated from replicate analyses were approximately twice those based on counting statistics, suggesting that screening levels should be lowered to assure detection of 226Ra at MCL values.

Georgia↗
PubMed1985

Contraceptive use in Georgia: estimation by telephone survey.

Because household surveys are expensive and time consuming, determination of state or local family planning needs is based on national household survey estimates of contraceptive use rather than state-specific estimates. In June 1982, the University of Georgia Survey Research Center invited the Georgia Department of Human Resources (DHR) to add questions to a Statewide Omnibus Telephone Survey to obtain information on contraceptive use, source of contraception, and reasons for not using contraception. The survey used two-stage random digit dialing to select 1,737 households. From these households, we have complete information on 332 women aged 18 to 44. The definition of contraception included use by either the respondent or partner. Fifty-six percent of female respondents were using contraception; oral contraceptives (22%) and contraceptive sterilization (21%) were the primary methods used. Private sources provided 78% of nonpermanent contraceptive methods. The majority of women not using contraception reported a noncontraceptive sterilization or infertility (31%) or were pregnant, desiring a pregnancy, or not sexually active (29%). The advantages of this method over household surveys are rapid turnaround of data and relatively low cost.

Adolescent↗
PubMed1986

Motorcycle-associated fatalities in Georgia, 1980-1981.

In 1980-1981, 158 motorcycle-associated fatalities occurred in Georgia, accounting for an estimated 6,113 lost years of productive life. Death ratios were highest for men 20 to 29 years of age, and motorcycle-associated fatalities occurred most frequently during summer months, on weekends, and during afternoon and evening hours. Forty-six percent of motorcycle-associated fatalities did not involve another vehicle, and head injuries alone or in combination with other injuries were responsible for death in approximately half. Helmet use, an effective measure for preventing motorcycle-associated fatalities, is required in Georgia; additional injury prevention strategies are discussed.

Accidents, Traffic↗
PubMed1992

Comparison of AIDS in women in rural and urban Georgia.

Through 1990, 308 cases of AIDS had been reported in female residents of Georgia (aged 13 years and older); 77 (25%) were white and 228 (75%) black. The mean age of the white women (43.8 years) was greater than that of the black women (34.5 years). One hundred sixty-six women were from Atlanta (metro Atl), the major metropolitan center in Georgia, and 142 (46%) from other regions of the state (other areas). Blacks represented 74% and 76% of all cases in women in metro Atl and other areas respectively. Of the 308 cases, 178 (58%) were related to intravenous (IV) drug use (99 metro Atl, 79 other areas), including 104 (58%) women who were IV drug users and 74 who were sexual partners of IV drug users. These proportions were similar in the two regions. Among cases related to IV drug use, 85 (86%) women in metro Atl and 69 (87%) women elsewhere in the state were black. The cumulative rate of AIDS in women in metro Atl (14.4/100,000) was twice that of women in the rest of the state (6.7/100,000). The rate for AIDS cases related to IV drug use in black women (27.8/100,000 population) was 19 times that in white women (1.5/100,000). The median survival of all women was significantly greater in metro Atl than in other areas (400 and 296 days respectively), with a difference also in those reported only with Pneumocystis carinii pneumonia (466 and 373 days respectively).

Acquired Immunodeficiency Syndrome↗
PubMed1999

Chalk eating in middle Georgia: a culture-bound syndrome of pica?

BACKGROUND: Although geophagia (earth eating) has been observed and documented in many areas of the world, the specific preference for consuming kaolin is less well known. The ingestion of kaolin, also known as white dirt, chalk, or white clay, is a relatively common type of pica found in the central Georgia Piedmont area. METHODS: We reviewed the literature, made informal contacts with Georgia physicians, and arranged semistructured interviews with 21 individuals with a history of chalk eating; we gathered both quantitative and qualitative information. RESULTS: Kaolin ingestion appears to be a culturally-transmitted form of pica, not selectively associated with other psychopathology. CONCLUSION: Kaolin ingestion appears to meet the DSM-IV criteria for a "culture-bound syndrome."

Adult↗
PubMedDate not supplied

Local public health cost study in Georgia.

Development of a uniform cost study methodology for local health department services in Georgia began with a desire to negotiate cost-based reimbursement from Medicaid. Managed care and the Health Insurance Portability and Accountability Act requirements for common coding standards added impetus to Georgia's efforts to document the cost of local public health. With a determination that the result was achievable, the Division of Public Health contracted with a medical practice management firm. What followed included a major team effort with active working groups of county, district, and state representatives. A template was developed by the consultants to compile the cost report and automated applications were installed. Statewide training engaged the local public health workforce and led to a successful pilot project. This article describes the interactive process that led ultimately to the ability of every county in the state to produce a valid cost report. The cost of direct services provided for individuals by county health departments can now be calculated with a cost per relative value unit. The cost report also includes the cost of environmental health, dental health, population-based services and all other local public health services. A brief description of the methodology is presented.

Accounting↗