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PubMed1994

E. coli O157:H7 is an emerging pathogen in Missouri.

Dramatic media reports of recent outbreaks of illness caused by Escherichia coli O157:H7 have drawn national attention to this emerging pathogen. In 1993, a widely publicized outbreak of over 500 culture-confirmed cases was traced to fast-food hamburgers in Washington, Idaho, Nevada and California. Closer to home, the first (and still the largest) reported waterborne outbreak of this disease occurred in Cabool, Missouri in 1989. That outbreak affected 243 people, of whom 32 were hospitalized, 2 had hemolytic uremic syndrome, and 4 died. E. coli O157:H7 was added to the list of reportable diseases in Missouri in mid-1992, but its importance is still not widely recognized. This article reviews the results of state and national surveillance for the disease, and suggests methods for improving diagnosis and reporting.

Adolescent↗
PubMed1994

Syphilis in Missouri: a continuing problem.

Syphilis has re-emerged as a significant public health problem in the United States and Missouri. Reported cases of primary and secondary (P&S) syphilis and congenital syphilis in Missouri have been increasing since the late 1980s, and a major outbreak of these diseases continues in the St. Louis area. The nature of syphilis combined with certain characteristics of those populations at highest risk of infection can make prevention and control difficult. Achieving success requires the cooperative efforts of practicing physicians and public health professionals.

Adolescent↗
PubMed1994

The impaired physician, Part II: Missouri State Physicians Health Program.

Missouri Physicians Health Program (MPHP) was established to help impaired physicians return to healthy personal and professional lives. One percent of Missouri physicians will suffer some sort of impairment; ie: substance abuse, or dependency of drugs or alcohol within a year. This is a confidential voluntary program. This program of early referral, intervention, treatment and monitoring advocacy has been highly successful. The average recovery rate in this study of 75 participants was 92%.

Female↗
PubMed1994

Histoplasmosis in Missouri: historical review and current clinical concepts.

Histoplasmosis is particularly common in Missouri, and many important clinical observations about the disease were made in this state in the 1950s and 1960s. When the AIDS epidemic spread to Missouri in the mid-1980s, histoplasmosis became recognized as a common and important opportunistic infection among Missourians with AIDS. Clinicians must maintain a high level of suspicion for histoplasmosis in any HIV-infected patient who presents with unexplained fever, particularly if the patient has evidence of hepatosplenomegaly, generalized lymphadenopathy, pancytopenia, abnormal liver function tests, or bilateral pulmonary infiltrates. The diagnosis of histoplasmosis can be established rapidly by observation of organisms on peripheral blood smear or bone marrow biopsy specimens or by Histoplasma Polysaccharide Antigen testing. The diagnosis can be confirmed by blood cultures in most cases. Histoplasmosis in AIDS is invariably fatal if not treated. Treatment consists of two phases: initial induction therapy and subsequent lifelong maintenance therapy. Amphotericin B and itraconazole are extremely effective for induction and maintenance therapy; fluconazole appears to be effective maintenance therapy. Strategies for the prevention of histoplasmosis in high risk patients are being evaluated currently.

Histoplasmosis↗
PubMed1993

Exposure to environmental tobacco smoke among Missouri children.

Childhood exposure to environmental tobacco smoke (ETS) increases the risk of lower respiratory infections (e.g., bronchitis and pneumonia), exacerbates childhood asthma, and increases the prevalence of fluid in the middle ear. Using self-reported telephone survey data, we examined the attitudes and practices of Missouri residents related to ETS exposure of children. Ninety-five percent of all respondents believed that ETS exposure is harmful to children and the percentage was similar for households with children (96%) and without children (94%). ETS was present in 42% of households and the percentage was similar for households with children (41%) and without children (44%). Childhood exposure to ETS remains a problem in Missouri, despite widespread awareness of the hazards. More active intervention is needed to reduce ETS exposure in the home.

Adult↗
PubMed1993

Patterns of obesity in Missouri.

Obesity is a major preventable health problem in Missouri and in the nation. Using survey data, we examined the prevalence of obesity in population subgroups and the overall trend. Prevalence of obesity was higher among blacks, middle-aged persons, and persons with less education or lower family income. Without additional attention, Missouri is unlikely to achieve the year 2000 objective of < or = 20% prevalence of obesity.

Adult↗
PubMed1995

Prostate cancer incidence in Missouri: an updated analysis.

Prostate cancer incidence increased dramatically in Missouri in the 1990s. However, this study demonstrates that the increased incidence parallels the dramatic increase in the earliest stage of the disease. Increased detection for prostate cancer is believed to play a strong role in this rising incidence. Continued surveillance for prostate cancer is necessary to determine the significance of the sharp rise in the incidence in Missouri.

Adolescent↗
PubMed1995

The Missouri Medical Informatics Thesaurus.

The Missouri Medical Informatics Thesaurus, containing approximately 2,000 sorted terms, arranged within a hierarchical structure, covers the multi-disciplinary medical informatics field more accurately than anything else available. Researchers at the University of Missouri-Columbia developed this thesaurus using the four primary methods of thesaurus construction to assure both literary and user warrant in the final terminology. The thesaurus can also be quickly revised to include the rapidly evolving terminology of the discipline.

Medical Informatics↗
PubMed1997

Improving the health of Missouri communities: a process approach.

It is important to note that while many states have communities involved in processes similar to CHART, few, if any, offer a team of professionals to support these initiatives, and none have a statewide partnership that is as committed to the process as Missouri does. The relationship between the key partner organizations is a unique phenomenon, and is certainly a key success factor for the process. CHART is an active member of the Coalition for Healthier Cities and Communities, a national network that exists as a multi-sector partnership to service the widespread communities movement in the U.S. The Coalition serves as both a link to resources, and as a voice for policy and action. The issues and concerns, as well as the successes, of Missouri communities are carried to this national Coalition to present a unified voice for communities nationwide. CHART is an innovative approach to empowered community development. It provides communities the opportunity to participate in the process of change. The CHART process provides a vehicle for communities to take charge of the future, to determine locally how issues are addressed, and to set a course that assures improved health, quality of life, and sustainable community systems for the 21st century.

Benchmarking↗
PubMed1997

Fleas and lice parasitizing mammals in Missouri.

Three species of chewing lice, 11 species of sucking lice, and 28 species of fleas are recorded from mammals in Missouri. Of these, seven species of sucking lice (Hoplopleura acanthopus, Hoplopleura hesperomydis, Hoplopleura sciuricola, Neohaematopinus sciuri, Neohaematopinus sciurinus, Neohaematopinus sciuropteri, and Solenopotes ferrisi) and one species of flea (Doratopsylla blarinae) represent new state records. From 1993 to 1995, 773 individual mammals were examined for ectoparasites in southeastern Missouri. One species of chewing louse, 6 species of sucking lice, and 11 species of fleas were recovered from 18 of the 21 mammal species examined. Ctenophthalmus pseudagyrtes was recovered from more mammal species (6) than any other flea species; and the white-footed mouse, Peromyscus leucopus, was parasitized by more flea species (5) than other hosts examined. Except for H. sciuricola, which was recovered from two congeneric species of tree squirrels, each species of louse was confined to a separate host species.

Animals↗
PubMed1998

Thrombolytic therapy in Missouri hospital emergency departments: compliance with the National Heart Attack Alert Program guidelines.

A self-administered questionnaire concerning the current practice of thrombolytic administration, and the use of National Heart Attack Alert Program (NHAAP) guidelines was mailed to the medical directors of Missouri acute care emergency departments (EDs). Responses from 75% of the EDs surveyed were received. There were standing orders to perform an electrocardiogram at 92% of the EDs surveyed. Thrombolytics were stocked in 80% of EDs and thrombolytics were administered in the ED rather than the ICU or CCU at 98%. The emergency physician (EP) was authorized to make thrombolytic treatment decisions at 87% of the institutions; however, in 24% of the hospitals EPs were required to contact another physician prior to giving thrombolytics. An Acute Myocardial Infarction (AMI) Continuous Quality Improvement (CQI) program was in place at 67%, and 44% of the institutions had an interdepartmental AMI protocol. Less than half of the EDs reported a door-to-drug time of less than 30 minutes. The primary delay in starting thrombolytic therapy was identified as decision-making on the part of the emergency physician and/or consultants. Missouri EDs report that they generally follow the NHAAP guidelines for rapid identification and treatment of AMI, but, there were still significant delays reported in the administration of thrombolytics.

Chi-Square Distribution↗
PubMed1998

Prevalence changes in modifiable cardiovascular disease risk factors in three Missouri regions, 1990-1996.

OBJECTIVES: To determine the prevalence and prevalence trend of modifiable cardiovascular disease (CVD) risk factors among African Americans and whites/others from 1990-1996. We also examined differential changes between African Americans and whites/others during the same time period. METHODS: This study used data from two special Behavioral Risk Factor Surveillance System (BRFSS) based surveys in 1990 (N = 3,000+) and one in 1996 (N = 2,095) that targeted two metropolitan and one rural region in Missouri with substantial minority populations. Risk factors included physical inactivity, obesity, hypertension, unmonitored cholesterol and smoking. The percent change in prevalence estimates and corresponding confidence intervals between survey years were calculated for each of the above risk factors. RESULTS: When compared with Missouri BRFSS data, overall prevalence of smoking, obesity, hypertension and unmonitored cholesterol was higher in the three-region study population than the state as a whole. African-American males did not experience any statistically significant reductions in CVD risk factor prevalence rates between 1990 and 1996, while the increase in obesity was driven mostly by the African-American female subgroup. The least amount of reduction in CVD risk factors was seen in individuals aged 55 or older, with a high school education or less and/or without health insurance. CONCLUSIONS: Individuals of African-American ethnicity, aged 55 or older, with a high school education or less and/or without health insurance need to be the focus of future public health initiatives designed to reduce the prevalence of CVD risk factors.

Adolescent↗
PubMed1986

The Missouri Alcoholism Severity Scale: relationship with type of alcohol consumption.

Data on 10,562 alcoholics treated in public programs in Missouri were retrieved from a statewide computerized mental health information system. Scores on the Missouri Alcohol Severity Scale were correlated with various symptom data, including average amount of beer, wine and distilled spirits ingested. Severity scores were primarily related to consumption of distilled spirits and the emergence of physical-medical symptoms. Correlations with beer drinking were higher for women than for men. A subsample of 889 alcoholics who drink beer only tended to be middle-aged, relatively stable, White men with less severe symptoms than other alcoholics.

Alcoholic Beverages↗
PubMed1983

The Missouri Alcoholism Severity Scale as a predictor of transfer from outpatient to inpatient treatment.

102 patients (41 women) who were enrolled in Appleton 's Outpatient Treatment service between June 1, 1977 and June 1, 1978 required transfer to an inpatient setting. This comprised 17% of all admissions. The entry records of these individuals were scored for the Missouri Alcohol Severity Scale by entering retrospectively the data collected on admission. When, some time after their entry to the outpatient service, these individuals were transferred to an inpatient setting, they became part of the study sample. A like number of controls was also scored for alcoholism severity. The controls remained in the outpatient program successfully. Comparing the score of transferees and controls, the individuals had a statistically significant higher score on the Missouri Alcohol Severity Scale when they had first entered the outpatient clinic (p + 0.03). With addition of other questions, the Appleton Modification, the probability of this happening by chance was 0.001. The data support the concept that inpatient units may play a meaningful role in the course of alcoholism treatment. High dropout rates from outpatient treatment were among the limiting factors of the outpatient setting.

Adolescent↗
PubMed1989

Cancer risks among Missouri farmers.

A series of case-control studies was conducted to investigate cancer risks among farmers. These studies were based on Missouri Cancer Registry data for 15,000 white male patients, including 1720 subjects classified as farmers, registered between 1984 and 1988. For each cancer site, all other cancer registrations formed the control group. The largest risks among farmers were found for lip cancer (odds ratio [OR], 3.07; 95% confidence interval [CI], 1.99 to 4.73) and cancer of the bone (OR, 2.02; 95% CI, 0.66 to 5.81). Elevated risks were observed for several other sites, including the nasal cavity and sinuses (OR, 1.66; 95% CI, 0.54 to 4.70), prostate (OR, 1.33; 95% CI, 1.18 to 1.51), non-Hodgkin's lymphoma (OR, 1.40; 95% CI, 1.04 to 1.85), and multiple myeloma (OR, 1.40; 95% CI, 0.87 to 2.24). Other smaller elevations in risk were noticed for cancer of the rectum (OR, 1.21; 95% CI, 0.95 to 1.53), liver (OR, 1.19; 95% CI, 0.58 to 2.37), malignant melanoma (OR, 1.26; 95% CI, 0.63 to 2.45), kidney (OR, 1.21; 95% CI, 0.89 to 1.65), and leukemia (OR, 1.12; 95% CI, 0.81 to 1.55); however, some of these estimates were imprecise due to small numbers. The overall OR for lymphatic and hematopoietic cancers was 1.28 (95% CI, 1.06 to 1.56). Consistent with previous studies, a decreased risk of lung cancer was observed among farmers (OR, 0.67; 95% CI, 0.60 to 0.76). The current findings are presented in the context of other recent studies, including discussions of possible causes of farming-associated excess cancer risk and possible sources of bias.

Adult↗
PubMed1987

Pilot study on health effects of environmental 2,3,7,8-TCDD in Missouri.

Waste oil contaminated with 2,3,7,8-TCDD was sprayed at various sites in the state of Missouri. Eighty-two individuals who reported living or working in TCDD-contaminated areas and 40 individuals with little or no exposure to TCDD were selected for study; 85% elected to participate in the study. Data were obtained from medical histories, general physicals, neurological and dermatological examinations, and laboratory tests. There were no cases of chloracne reported. The only hematologic comparison that was significant was a higher mean platelet count in the exposed group. This study did not produce any firm indication of increased disease prevalence related to environmental TCDD exposures. Since this was a pilot study, it is important that we continue to limit human exposure to dioxin to the lowest levels technologically feasible until definitive answers to the health consequences of exposure are determined.

Dioxins↗
PubMed1989

Study of lung cancer histologic types, occupation, and smoking in Missouri.

A case-control study of lung cancer was conducted to evaluate the relationship between lung cancer histologic types and occupation, adjusted for smoking. A total of 4,431 white male cases and 11,326 cancer controls, diagnosed between 1980 and 1985, were identified through the Missouri Cancer Registry. For all histologic types combined, excess risk was observed among many a priori suspected high-risk occupations. Lung cancer was elevated among men employed as insulators (odds ratio [OR] = 6.0; 95% confidence interval [CI] = 0.7, 137.8), carpenters (OR = 1.3; 95% CI = 1.0, 1.7), painters, plasterers, and wallpaper hangers (OR = 2.0; 95% CI = 1.2,3.3), structural metal workers (OR = 1.9; 95% CI = 0.6,6.0), mechanics and repairers (OR = 1.3; 95% CI = 1.0,1.7), motor vehicle drivers (OR = 1.5; 95% CI = 1.2,1.8), police and firefighters (OR = 1.6; 95% CI = 1.1,2.3), and food service personnel (OR = 1.8; 95% CI = 1.0,3.5). A deficit of lung cancer was observed among farmers (OR = 0.9; 95% CI = 0.7,1.0). Adenocarcinoma of the lung was elevated among carpenters (OR = 1.6; 95% CI = 1.0,2.5) and cabinet and furniture makers (OR = 2.0; 95% CI = 0.4,8.1), which is interesting because of the previous reports of excess adenocarcinoma of the nasal cavity associated with wood dust exposure. Adenocarcinomas were also elevated among plumbers (OR = 2.0; 95% CI = 1.0,3.8) and printers (OR = 1.8; 95% CI = 0.7,4.2). Electricians were at slightly increased risk for adenocarcinoma (OR = 1.5; 95% CI = 0.7,2.8) and "other" or mixed cell types of lung cancer (OR = 1.5; 95% CI = 0.8,2.9) but at decreased risk for small cell (OR = 0.8; 95% CI = 0.3,2.0) and squamous cell (OR = 0.8; 95% CI = 0.4,1.6) tumors. Among welders, adenocarcinoma (OR = 1.7; 95% CI = 0.7,3.8) and squamous cell (OR = 1.7; 95% CI = 0.9,3.3) cancers were elevated, but small cell and "other" lung cancers were not. Despite the limitations of the Cancer Registry data, some interesting associations were observed that merit further study, particularly the association between lung adenocarcinoma and occupational exposure to wood and wood dust.

Adenocarcinoma↗
PubMed1988

The effect of geochemical factors on prevalences of dental diseases for prehistoric inhabitants of the state of Missouri.

In previous epidemiological studies, it has been suggested that geochemical factors besides fluoride may affect the prevalences of dental diseases. Our objective in this study was to determine whether the prevalences of periodontal diseases, coronal caries, and root caries for prehistoric inhabitants vary between geochemical regions of the state of Missouri. Burial sites were located on unique maps that depict geochemical variation among regions of the state. Data on dental caries and alveolar bone loss were gathered from 179 of the best preserved skeletal remains of the Late Woodland (A.D. 400-900) and Mississippian (A.D. 900-1700) periods. Mean caries scores and proportions of individuals with caries were calculated for these geochemical regions. Average alveolar bone loss was regressed on age for the individuals of these regions. Significant differences in caries and bone loss were found between several regions. These differences cannot be adequately explained by fluoride concentrations or by diet. It is suggested that geochemical factors, in addition to fluoride, may have affected the prevalences of dental diseases.

Dental Caries↗