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PubMedDate not supplied

The prevalence of diabetes and related services in Missouri and Missouri's progress towards meeting the Healthy People 2010 goals.

Since 1988, diabetes in Missouri increased by almost 50%. We examined diabetes' prevalence and associations with sociodemographic, risk factor, and comorbidity variables in Missouri. Additionally, we examined Missouri's progress towards Healthy People 2010 diabetes-related goals and prevalence of risk factor counseling. Analysis indicates diabetes is an increasing public health problem in Missouri. To stem increases in the prevalence of diabetes and its costs, delivery of, and access to, preventative care and counseling should be improved.

Adolescent↗
PubMed1980

Normative data on the Missouri Children's Picture Series and the Missouri Children's Behavior Checklist with Southern black children.

Normative data are presented for Southern black children on two objective personality inventories for children: the Missouri Children's Picture Series (MCPS), a child picture-sorting task, and the Missouri Children's Behavior Checklist (MBCL), a parent rating scale. The MCPS was administered to 615 black children attending public schools in a low socioeconomic area of the southeast United States. Parents returned the MBCL on 437 of the children. Means and standard deviations on eight MCPS personality scales and six MCBL behavior rating scales are presented for black males and females at ages 5 through 16, and effects of age, sex, and various scale intercorrelations are discussed. Results suggest systematic age and sex differences on the various scales for black children that are quite atypical when compared with the MCPS in other samples. Various empirical questions regarding the validity of these instruments when used with Southern black children are raised.

Adolescent↗
PubMed2005

Prospective clinical evaluation of patients from Missouri and New York with erythema migrans-like skin lesions.

BACKGROUND: The most common and most recognizable feature of Borrelia burgdorferi infection (Lyme disease) is the skin lesion erythema migrans (EM). An illness associated with an EM-like skin lesion, but which is not caused by B. burgdorferi, occurs in many southern states in the United States (southern tick-associated rash illness [STARI], also known as Masters disease). METHODS: Clinical features of 21 cases of EM-like skin lesions in 21 patients from Missouri were compared in a prospective study with those of 101 cases in 97 patients with EM-like skin lesions from New York. RESULTS: Among Missouri cases, the peak incidence of EM-like skin lesions occurred earlier in the year than it did among New York cases (P<.001). Case patients from Missouri were more likely to recall a tick bite than were case patients from New York (85.7% and 19.8%, respectively; P<.001), and the time period from tick bite to onset of the skin lesion was shorter among Missouri case patients (6.1+/-4.2 days and 10.4+/-6.1 days, respectively; P=.011). Missouri case patients were less likely to be symptomatic than were New York case patients (19.0% and 76.2%, respectively; P<.001), and Missouri case patients were less likely to have multiple skin lesions (4.8% and 26.7%, respectively; P=.042). EM-like lesions in Missouri cases were smaller in size than those in New York cases (8.3+/-2.2 cm and 16.4+/-11.5 cm, respectively; P<.001), more circular in shape (P=.004), and more likely to have central clearing (76.2% and 21.6%, respectively; P<.001). After antibiotic treatment, Missouri case patients recovered more rapidly than did New York case patients (P=.037). CONCLUSION: Cases of EM-like skin lesion in patients from Missouri and New York have distinct clinical presentations.

Adult↗
PubMed1981

Life-style and death patterns of the Missouri RLDS church members.

Members of the Reorganized Church of Jesus Christ of Latter-Day Saints (RLDS) are dissuaded from the use of tobacco, alcohol, and hot drinks. A well-balanced diet is also stressed. This study compares the 1972-78 mortality experience of the Missouri RLDS with three other population groups. The findings show Missouri RLDS experiencing age-adjusted death rates which are 22.6 percent lower than rates for Missouri non-RLDs whites; 19.6 per cent lower than the non-RLDS of Independence, Missouri; and 14.4 per cent lower than Utah residents. The RLDS display lower death rates than the two Missouri comparison groups for each of seven selected causes-particularly lung cancer, pneumonia/influenza, and violent deaths. Comparisons between the Missouri RLDS and Utah residents show an inconsistent pattern, with Utah residents having non-significantly lower death rates for lung cancer and ischemic heart disease, but with the Missouri RLDS having significantly lower rates for pneumonia/influenza and violent deaths. These inconsistencies are of interest because 72 per cent of Utah's population belong to the Mormon Church which advocates life-styles similar to the RLDS. If these disparate mortality patterns persist under a more direct comparison between the Missouri RLDS and Utah Mormons, they could provide the opportunity to assess the impact of similar life-styles in separate settings.

Adult↗
PubMed1998

Trends in cancer incidence and mortality in Missouri.

BACKGROUND: Cancer is the second leading cause of death in Missouri. Several factors influence public health planning and policy-making decisions, including assessment of the trends in disease and in related risk factors, of overall disease burden on the population, and of the effectiveness of intervention programs. To assess the influence of statewide cancer screening, education, and intervention programs on Missouri's cancer burden, recent trends in cancer incidence and mortality rates among Missourians were analyzed. METHODS: Age-standardized cancer incidence rates from 1985-1992 and cancer mortality rates from 1985-1994 and 1990-1996 were calculated by race, age group, and sex using data collected by the Missouri Cancer Registry and the Missouri Center for Health Statistics. Rates for each year examined were logged and regressed onto year. RESULTS: Between 1985 and 1992, the rate of cancer incidence increased by 16.1% (p < .05). From 1985-1994, cancer mortality rate increased by 3.5% (p < .05). Mortality among males, however, decreased between 1990 and 1996. This decrease was particularly pronounced among African-American males. Missouri males endured greater incidence of and mortality from cancer than Missouri females. Elderly males (both African American and white) exhibited the greatest increase in cancer incidence over the periods examined (+27.3% and +31.8% increase respectively, p < .05). Racial differences were nonexistent for cancer incidence rates, but the cancer mortality rate for African Americans was 45% greater than that for whites. CONCLUSIONS: Although Missouri cancer incidence and mortality rates are higher now compared to 16 years ago, data are presented that indicate a slight decline in mortality rates over the past six years. The recent decline (1990-96) in mortality was present only among men, particularly African-American men. The incidence increase was particularly important for women. Despite the implementation of some programs designed to target minorities and undeserved populations at greater risk, these data indicate that large demographic differences in cancer incidence and mortality still persist. A greater commitment to cancer screening, access to treatment, and cancer prevention programs are necessary to meet Missouri's year 2000 goals for cancer incidence and mortality.

Adolescent↗
PubMedDate not supplied

Changes in characteristics of women who smoke during pregnancy: Missouri, 1978-88.

The Missouri birth certificate has had a question, "cigarettes smoked per day?" since 1978; the current data base contains more than 800,000 records. A comparison of the Missouri data for married mothers with the National Natality Survey (NNS) data shows mainly consistent findings between the two data sets. The Missouri data, however, also provided information on the smoking status during pregnancy of unmarried women that is not available from the NNS. The Missouri data show a substantial difference in the smoking rates of married (23.2 percent) and unmarried (40.9 percent) women. The highest smoking rates during pregnancy are found among unmarried women, ages 20-24, with less than a high-school education, and those with a fourth or higher order child. There has been a relatively small overall drop in the smoking rate from 1978-80 to 1986-88 (31.1 percent versus 27.5 percent). However, blacks and teenagers have had very substantial drops in smoking rates. There has been only a slight decrease for other high-risk groups such as white unmarried women, women with less than a high-school education, and those having a fourth or higher order birth. Missouri started using the new national standard birth certificate in 1989 with a differently worded smoking question. The percentage of women smoking and those smoking less than one pack per day in 1989 went down more than would be expected from the trend data. It appears that the new birth certificate question will provide a lower estimate of the percentage of mothers who smoke cigarettes than was acquired from the previous version on the Missouri certificate. The births in Missouri for which mothers' rate of smoking was unknown increased nearly fourfold to 0.9 percent.

Adolescent↗
PubMed1998

Breast cancer incidence and mortality trends in Missouri.

Among women in Missouri as in the United States (U.S.), breast cancer is the leading site of new cancer cases and the second leading cause of cancer deaths. This study examined patterns of breast cancer incidence and mortality among Missouri women. Age-adjusted Missouri incidence (1985-1992) and mortality (1985-1994) data were compared with Surveillance, Epidemiology, and End Results (SEER) data (1985-1992) by race and diagnosis year. Missouri Cancer Registry (MCR) data indicate that there have been no significant changes in breast cancer incidence and mortality rates through the time periods. Incidence rates for Missouri females (White, African-American and All) are significantly lower than SEER rates for all age groups, with greater differences in all races among women over 65. Incidence rates for African-Americans are significantly lower than for whites. However, Missouri mortality rates for African-Americans fluctuate over the period, but are consistently higher than for whites. In addition, African-Americans over age 65 have higher mortality rates in Missouri than in the U.S.

Adult↗
PubMed1998

Trends in breast cancer screening in Missouri from 1987 to 1995, and predictions for the years 2000 and 2010.

BACKGROUND: Breast cancer is a major cause of morbidity and mortality in the United States (U.S.) and Missouri. In 1992, 3,915 new breast cancer cases were diagnosed and in 1995, 1,006 deaths from breast cancer were reported in Missouri. Although breast cancer incidence has increased in Missouri in the past 20 years, there are indications that early detection has also increased during the same period. Knowledge about which segments of the population have experienced the greatest increase in mammography screening rates helps in planning and implementation of breast cancer control programs at the state level. OBJECTIVES: Examine the prevalence and trends of lifetime mammography and 2-year mammography compliance in Missouri by age, race, and education from 1987 to 1995 and make predictions for the years 2000 and 2010. METHODS: We used data from the Missouri Behavioral Risk Factor Surveillance System (BRFSS), 1987 to 1995, to estimate the prevalence of ever having had a mammogram and compliance with mammography screening guidelines within two years by race, age, and education status among Missouri women over age 18. Using linear models, we regressed breast cancer screening prevalence estimates on time to obtain trends and predictions. RESULTS: Overall, African-American women were more likely to have had a lifetime mammogram than white women. However, we found a steady increase in the prevalence of ever having had a mammogram for all groups of women defined by age and education status, except among African Americans. Increase in the prevalence of ever having had a mammogram was much higher in women age 50 and older and slightly higher among women with a high school education or less. The average prevalence of 2-year mammography screening compliance was about 60% for all groups, a rate which did not significantly change between 1987 and 1995. By the year 2000, white women will have mammography rates equal to or higher than African-American women, and the majority of all women age 50 and older (98.3% to 100%) will have had a lifetime mammogram. CONCLUSION: Missouri target populations are predicted to attain Year 2000 National Health Objectives concerning lifetime mammography. Current efforts should be continued in order to maintain levels of mammography, particularly among African-American women.

Adolescent↗
PubMed1993

Who cares for Missouri's Medicaid nursing home residents? Characteristics of attending physicians.

OBJECTIVE: To describe the characteristics of physicians attending Medicaid recipients in Missouri's certified nursing homes (NH). DESIGN: Retrospective survey of multiple data sources. SETTING: Missouri's certified nursing homes. PARTICIPANTS: 1,339 physicians attending 22,452 Medicaid recipients. MEASUREMENTS: Physician characteristics were determined by reviewing a roster of medical directors of NHs compiled by the Missouri Department of Social Services' Division of Aging and physician directories compiled by the Missouri State Board of Registration for the Healing Arts, the AMA, the AOA, the ABFP, and the ABIM. Physician clinical activity was determined by examining NH inspection of care reports compiled by the Missouri Department of Social Services' Division of Aging. RESULTS: Each physician attended a mean of 16.8 and a median of six Medicaid recipients in the nursing home. The skewed distribution is reflected by 426 (31.8%) of the physicians attending only one or two residents, and 28 (2.1%) of the physicians attending 100 or more residents. Twenty-seven percent of the state's licensed osteopaths (DOs, 362) attended nursing home patients, compared with 11% of allopathic physicians (MDs, 977). Significantly more DOs than MDs attended more than the median number of patients (57% vs 45%, P < 0.001). Half were attended by the 605 (45%) physicians without board certification. Of those who were board certified, family physicians were more likely to include Medicaid nursing home patients in their practices than internists (43% vs 18%, P < 0.001). Physicians licensed for 11 to 20 years and rural physicians had the heaviest patient loads. CONCLUSIONS: Many doctors are caring for very few nursing home residents while a few doctors may be caring for too many patients. In addition, half the Medicaid recipients residing in Missouri's nursing homes in 1988 were attended by physicians without board certification, and almost one-third were attended by physicians who may be retiring between 2000 and 2010.

Aged↗