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At least 19 recordsLinked to original sources
PubMed1998

Transforming rural health care: Appalachian Regional Healthcare.

Appalachian Regional Healthcare is in the midst of transforming itself into a new organization in terms of culture, professional practice, and work processes. Just a few years ago, many members of its work force had never used computer technology. Today, nearly all employees, including nurses, have been trained in basic computer skills and are transitioning into an era when this rural integrated health care delivery system will employ a completely electronic medical record.

Appalachian Region↗
PubMed2002

Geographic disparities in heart disease and stroke mortality among black and white populations in the Appalachian region.

In this paper, we examine geographic and racial/ethnic differences in heart disease and stroke mortality in the Appalachian region. Initial comparisons are made between national rates for heart disease and stroke mortality and those for the Appalachian region. County-level analyses were performed to examine the relative mortality experience of populations in Appalachian counties compared to other counties in the United States and to assess the degree of geographic disparity in mortality from heart disease and stroke among these race/ethnic and gender groups within Appalachia. The Appalachian region exhibits higher rates of both heart disease and stroke mortality for all race/ethnic, gender, and age groups examined. We found that many counties in the Appalachian region endure a considerable burden of the national excess in both heart disease and stroke mortality, and these counties tend to be aggregated in particular areas as opposed to being dispersed regionwide. Finally, we compare 2 groups of counties in Appalachia based on the designation as an "economically distressed county," defined by the Appalachian Regional Commission. As a group, distressed counties in Appalachia exhibit higher rates of both heart disease and stroke mortality than the rest of Appalachia.

Adult↗
PubMed2000

Breast and cervical carcinoma mortality among women in the Appalachian region of the U.S., 1976-1996.

BACKGROUND: Previous studies have shown high cervical carcinoma mortality and increasing breast carcinoma mortality in the Appalachian region of the U.S. (which includes parts of 12 states and all of West Virginia). In the current study the authors report trends in breast and cervical carcinoma death rates among women in Appalachia for 1976-1996. METHODS: Death rates were calculated from information provided on death certificates and reported to the National Center for Health Statistics for Appalachian women and for women living elsewhere in the U.S. ("other U.S. women"). Trends were examined with joinpoint regression techniques overall and by age and race. Average annual mortality rates were calculated by state for 1992-1996 for each state's Appalachian and non-Appalachian areas. RESULTS: Overall breast carcinoma mortality was lower among Appalachian women than among other U.S. women throughout the study period; however, after rates decreased among both groups in the 1990s, the difference appears to have narrowed. No such decline was observed for women age >/= 70 years. Overall cervical carcinoma mortality was higher among Appalachian women than among other U.S. women but decreased during the study period to rates closer to those for other U.S. women. No significant decrease was observed among women age < 50 years. Overall, for both black and white women, breast carcinoma mortality was lower and cervical carcinoma mortality higher among women in Appalachia compared with their counterparts elsewhere in the U.S. For both breast and cervical carcinoma, the average annual death rates (1992-1996) varied by geographic areas within the Appalachian states, but most differences were not significant. CONCLUSIONS: Analysis of mortality trends in breast and cervical carcinoma may provide guidance for prevention and control activities to reduce premature mortality from these diseases.

Adult↗
PubMed2001

Patterns of breast, cervical, colorectal, and prostate cancer in the Appalachian region of South Carolina.

OBJECTIVES: This study examined the relationship between demographic factors and other correlates of late stage diagnoses among residents in the Appalachian region of South Carolina. DESIGN: The study employed a cross-sectional study design. METHODS: Regional data from 4,928 prostate, breast, cervical, and colorectal cancer registry cases were examined as part of a statewide pilot registry effort. Frequencies and logistic regression procedures were performed to compute risk estimates for non-local stage of diagnosis across all four cancers, and for each of the four cancers by age and race. RESULTS: African Americans were 1.6 times more likely than Whites to be diagnosed with a non-local stage of cancer. For breast and prostate cancer, those 65 and older were significantly more likely to receive non-local state stage of diagnosis than those under 50. For cervical cancer, the odds of receiving a non-local stage diagnosis declined with advancing age, with those over 65 being significantly less likely than those under 50 to receive non-local stage diagnoses. CONCLUSIONS: It is necessary to identify sub-populations experiencing high rates of non-local stage diagnoses of cancer to form the basis for the development of more effective cancer prevention and treatment programs.

Aged↗
PubMed2004

Colorectal carcinoma mortality among Appalachian men and women, 1969-1999.

BACKGROUND: Colorectal carcinoma screening can reduce mortality, but residents of poor or medically underserved areas may face barriers to screening. The current study assessed colorectal carcinoma mortality in Appalachia, a historically underserved area, from 1969 to 1999. METHODS: All counties within the 13-state Appalachian region, which stretches from southern New York to northern Mississippi, were used to calculate annual death rates for the 31-year period. Joinpoint regression analysis was used to examine trends by age and race for the Appalachian region and the remainder of the United States. Five-year rates for 1995-1999 age-adjusted to the 2000 U.S. standard population were calculated by race and age group for the Appalachian region and elsewhere in the United States. RESULTS: Trend analysis showed that colorectal carcinoma death rates among both racial and gender groups studied had declined in recent years. Despite this, the rates for white males and white females were still significantly higher in Appalachia than in the rest of the country at the end of the study period, 1999. Five-year colorectal carcinoma death rates among white males (ages < 50, 50-59, and 70-79 years) and white females (ages < 50, 50-59, 70-79, > or = 80 years) were significantly higher in Appalachia than elsewhere in the United States, whereas rates among black females 60-69 and 70-79 years old were significantly lower in Appalachia. CONCLUSIONS: The Appalachian region may benefit from targeted prevention efforts to eliminate disparities in the colorectal carcinoma death rates among subgroups. Further studies are needed to determine whether the higher death rates in specific Appalachian subgroups are related to a higher incidence of the disease, the cancer being at a later stage at diagnosis, poorer treatment, or other factors.

Black or African American↗
PubMed2006

Trends in controlled-release oxycodone (OxyContin) prescribing among Medicaid recipients in Kentucky, 1998-2002.

CONTEXT: Prescription opioid abuse has emerged as a public health problem, particularly in rural America. PURPOSE: To examine temporal and geographic trends in rates of controlled-release oxycodone (OxyContin) prescribing for Kentucky Medicaid recipients. METHODS: A cross-sectional analysis was completed in which the state was divided into 3 regions (distressed Appalachia, Appalachia, and other Kentucky), and data from Medicaid pharmacy claims from 1998 to 2002 were analyzed. Claims were further stratified by disability status. FINDINGS: Temporary Assistance for Needy Families Medicaid recipients in distressed Appalachia were more likely than those in other Kentucky regions to file controlled-release oxycodone claims in 1999, 2001, and 2002. Even after adjusting for the proportion of Temporary Assistance for Needy Families recipients in each region, the distressed region still had significantly higher rates (P< .05) than the non-Appalachian region of controlled-release oxycodone prescription claims among Temporary Assistance for Needy Families recipients. Similar findings were observed for disabled Medicaid recipients in 2002. CONCLUSIONS: Higher rates of claims for controlled-release oxycodone in the distressed Appalachian region of Kentucky suggest that economic and health factors unique to this area may be contributing to increased use of this product. The increased availability of controlled-release oxycodone in distressed Appalachian regions may facilitate abuse.

Analgesics, Opioid↗
PubMed2003

Underserved region recruitment and return to practice: a thirty-year analysis.

The purpose of this investigation was a retrospective analysis of a select group of graduates from the University of Kentucky College of Dentistry (UKCD) over a thirty-year history to determine how many of these individuals came from the Appalachian Region of Eastern Kentucky, which historically has been economically depressed and underserved by health care practitioners including dentists. This same group of dental school graduates was then tracked to see if they established dental practices in the Appalachian region of the state. Recruiting trends were investigated by reviewing student records regarding county of origin from targeted classes at UKCD in 1969, 1979, and 1989 to gain ten-year incremental, historical perspectives. To identify more recent trends, classes graduating in 1994 through 1999 were reviewed. Once identified, the databank of the Kentucky Board of Dentistry was used to determine if these individuals reported practicing in counties of Kentucky designated by the Appalachian Regional Commission (ARC). The findings of this study indicate an alarming decline both in numbers of students being recruited from this underserved area and a concomitant decline in those recruits returning to ARC-designated counties in the state. This study establishes the need for persistent diligence in recruitment of students from underserved areas and challenges dental schools to create strategies that will encourage their graduates to establish practices in these regions.

Appalachian Region↗
PubMed2002

Breast and cervical cancer screening among Appalachian women.

Medical service shortages, rural residence, and socioeconomic and cultural factors may pose barriers to breast and cervical cancer screening among women living in the Appalachian region of the United States. This study determined the rates of breast and cervical cancer screening in Appalachia and identified factors associated with screening. Data from the Behavioral Risk Factor Surveillance System, 1996 to 1998, for the Appalachian region were analyzed to determine the percentage of women > or =40 years of age who had had a mammogram or clinical breast examination (CBE) within the past 2 years and the percentage of women > or =18 years of age who had had a Pap test within the past 3 years. Screening rates were compared with those for women living elsewhere in the United States. Screening rates were further assessed according to demographic, socioeconomic, and physical and behavioral health factors. Multiple logistic regression analyses were conducted to examine the predictors of screening. Overall, 14,520 Appalachian women > or =18 years of age reported on Pap tests; 13,223 women > or =40 years of age reported on mammogram screening, and 13,124 women reported on CBE screening. Among Appalachian women, 68.8% [95% confidence interval (CI), 67.8-69.9] had a mammogram, 75.1% (95% CI, 74.1-76.1) had a CBE in the past 2 years, and 82.4% (95% CI, 81.5-83.3) had a Pap test in the past 3 years. These rates were at most approximately 3% lower than those for women living elsewhere in the United States, but these differences were statistically significant. Older women and women with less education or income were screened less commonly. Women who had visited a doctor within the past year were more likely to have been screened. Additional interventions are needed to increase breast and cervical cancer screening rates for Appalachian women to meet the goals of Healthy People 2010, targeting in particular population groups found to have lower screening rates.

Adult↗
PubMed2000

Metropolitan and non-metropolitan trends in coronary heart disease mortality within Appalachia, 1980-1997.

OBJECTIVES: In this article, we report on metropolitan and non-metropolitan trends in coronary heart disease (CHD) mortality within the Appalachian Region for the period 1980 to 1997. We hypothesized that trends in CHD mortality would be less favorable in non-metropolitan populations with diminished access to social, economic, and medical care resources at the community level. METHODS: Our study population consisted of adults aged 35 years and older who resided within the 399 counties of the Appalachian Region between 1980 and 1997. We examined mortality trends for sixteen geo-demographic groups, defined by gender, age, race, and metropolitan status of county of residence. For each geo-demographic group, we calculated annual age-adjusted CHD mortality rates. Line graphs of these temporal trends were created, and log-linear regression models provided estimates of the average annual percent change in CHD mortality from 1980 to 1997. Data on social, economic, and medical care resources for metropolitan vs. non-metropolitan counties were also analyzed. RESULTS: Rates of CHD mortality were consistently higher in non-metropolitan areas compared with metropolitan areas for blacks of all ages and for younger whites. CHD mortality declined among almost all geo-demographic groups, but rates of decline were slower among non-metropolitan vs. metropolitan residents, blacks vs. whites, women vs. men, and older vs. younger adults. Non-metropolitan areas had fewer socioeconomic and medical care resources than metropolitan areas in 1990. CONCLUSIONS: Appalachia, particularly non-metropolitan Appalachia, needs policies and programs that will enhance both primary and secondary prevention of CHD, and help diminish racial inequalities in CHD mortality trends.

Adult↗
PubMed2005

Knowledge and perceptions of diabetes in an Appalachian population.

INTRODUCTION: Qualitative research on knowledge and perceptions of diabetes is limited in the Appalachian region, where social, economic, and behavioral risk factors put many individuals at high risk for diabetes. The aim of this study was to gain a culturally informed understanding of diabetes in the Appalachian region by 1) determining cultural knowledge, beliefs, and attitudes of diabetes among those who live in the region; 2) identifying concerns and barriers to care for those with diabetes; and 3) determining the barriers and facilitators to developing interventions for the prevention and early detection of diabetes in Appalachia. METHODS: Thirteen focus groups were conducted in 16 counties in West Virginia in 1999. Seven of the groups were composed of persons with diabetes (n = 61), and six were composed of community members without diabetes (n = 40). Participants included 73 women and 28 men (n = 101). RESULTS: Findings show that among this population there is lack of knowledge about diabetes before and after diagnosis and little perception that a risk of diabetes exists (unless there is a family history of diabetes). Social interactions are negatively affected by having diabetes, and cultural and economic barriers to early detection and care create obstacles to the early detection of diabetes and education of those diagnosed. CONCLUSION: Public health education and community-level interventions for primary prevention of diabetes in addition to behavior change to improve the management of diabetes are needed to reduce the health disparities related to diabetes in West Virginia.

Culture↗
PubMed2004

Geographic trends in cervical cancer incidence and mortality in Kentucky, 1995-2000.

BACKGROUND: Kentucky's elevated cervical cancer incidence and mortality rates are well documented. However, in Kentucky, as in the United States as a whole, cervical cancer incidence and mortality have been decreasing. METHODS: To determine if the incidence and mortality declines in Kentucky are similar in different geographic regions of the state, incidence and mortality data for the six-year period 1995-2000 were analyzed by five geographic subdivisions. RESULTS: Overall, both incidence and mortality rates declined during the six-year period; however, there were variations in the decline by geographic subdivisions. In 1995-2000, the greatest percentage decrease (43%) in incidence rates among the geographic subdivisions occurred in Fayette/Jefferson counties while their mortality rates increased (12%). Conversely, the Appalachian region of the state had a lower percentage decrease (11%) in incidence with a concurrent percentage decrease in mortality (45%). CONCLUSIONS: Intensified screening efforts may have resulted in increased detection of early stage cervical disease; which provided a subsequent reduction in mortality for the Appalachian region of the state, while Fayette/Jefferson County has a mortality rate that slopes upward necessitating additional investigation.

Female↗
PubMed1999

Pediatric diabetes management in Appalachian Kentucky: adherence of primary care physicians to ADA guidelines.

OBJECTIVE: The prevalence of diabetes mellitus in Eastern Kentucky is estimated at nearly three times the national average. Unfortunately, Eastern Kentucky's Appalachian region also faces poverty levels of at least twice the national average, a factor which could adversely affect the ability of families of pediatric diabetic patients in this region to access remote pediatric diabetes subspecialty programs. Therefore, the objective of this study was to survey current pediatric diabetes practice standards among Eastern Kentucky's primary care physicians and compare them to guidelines for diabetes management set forth by the American Diabetes Association (ADA). RESEARCH DESIGN AND METHODS: Surveys were sent to 402 primary care physicians practicing in 25 Kentucky counties designated as rural by the Appalachian Regional Commission (ARC). Information was sought to determine the frequency of diabetes-related office visits, recommendations for glucose monitoring, typically prescribed insulin regimens, monitoring of diabetes-related complications, and the availability of diabetes-care support staff. RESULTS: It was found that the majority of primary care physicians in this region met ADA guidelines for frequent follow-up evaluation of diabetes. However, they generally did not meet ADA guidelines for intensive management of diabetes by typically recommending self blood-glucose monitoring < or = 2 times/day, the use of < or = 2 insulin injections/day to maintain glycemic control, and inconsistent screening for the occurrence of diabetes-related complications. CONCLUSIONS: These results support the need for further medical education of primary care physicians in Eastern Kentucky in the management of children with Type 1 diabetes.

Adolescent↗
PubMed1989

Regional differences in death rates among postneonatal infants in Kentucky, 1982-1985.

Our objective was to analyze differences in postneonatal mortality rates between the southeastern (Appalachian) region of Kentucky and the remainder of the state to identify factors associated with increased mortality in the Appalachian (AP) region. The relative risk of postneonatal deaths in the AP region when compared with the remainder of Kentucky (KY) was 1.38 (95% confidence interval = 1.15-1.65). Adjustment for birth weight, maternal age, and marital status of the parents had no appreciable effect on the risk ratio; however, adjustment for maternal education negated the increased risk of postneonatal death among the AP region births. When causes of postneonatal death were compared, three specific disease groupings were disproportionately represented among AP infants: Sudden Infant Death Syndrome (SIDS); congenital malformations; and infections. Most striking was the excess risk of infection-related death because it represents a preventable component in the postneonatal mortality excess of the AP region; and, because of the apparent association with maternal "under education." These findings are discussed within a public health intervention context.

Appalachian Region↗