Educating Missouri health professionals about HIV/AIDS: the Missouri MATEC Program.
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Acquired Immunodeficiency Syndrome↗
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Intestinal microecology. V International Symposium held at University of Missouri Medical School Columbia, Missouri May 31 to June 1, 1978.
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Animals↗
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↗
Hemoglobin Columbia Missouri or alpha 2[88 (F9) Ala----Val]beta 2: a new high-oxygen-affinity hemoglobin that causes erythrocytosis.
A previously undescribed hemoglobin variant, hemoglobin Columbia Missouri, alpha 88 (F9) Ala----Val, was detected in a 22-year-old white man who was undergoing assessment for erythrocytosis. This new hemoglobin variant does not separate from hemoglobin A by electrophoresis in conventional media, by isoelectric focusing, or by electrophoresis of purified globin chains in 8 M urea. It exhibits a high oxygen affinity, with a P50 (oxygen tension at 50% saturation) of 19.3 torr for the patient's whole blood. The substitution of hemoglobin Columbia Missouri is an internal residue near the end of the F helix of the alpha chain. Hemoglobin Okazaki has an arginyl residue substitution for a cysteinyl residue at F9 (beta 93) in the beta chain. In comparison with hemoglobin Okazaki, the substitution in hemoglobin Columbia Missouri has a more pronounced effect on oxygen affinity. Consequently, hemoglobin Columbia Missouri is associated with erythrocytosis, whereas hemoglobin Okazaki is not.
Adolescent↗
Increased cholesterol awareness in urban and rural areas--Missouri, 1988-1991.
Elevated serum cholesterol is a risk factor for coronary heart disease (CHD) (1,2). From 1983 through 1990, the percentage of persons who had their cholesterol measured--a first step in reducing risk for CHD from serum cholesterol-increased nationwide (3). Changes in patterns had not been monitored specifically in rural areas, where access to medical care and other socioeconomic barriers may hinder receipt and use of cholesterol screening (4,5). To monitor trends in cholesterol awareness and other risk factors for cardiovascular disease among persons who live in rural and urban settings in Missouri, Washington University and the Missouri Department of Health (MDH) analyzed 1988-1991 Behavioral Risk Factor Surveillance System (BRFSS) data for Missouri (6).
Adolescent↗
Association of brain cancer with dental X-rays and occupation in Missouri.
This investigation of a brain cancer cluster in Missouri used two approaches to investigate associations with potential risk factors. In a case-control study in a rural town, we interviewed surrogates of cases and controls about potential risk factors. We found a statistically significant positive association of brain cancer with reported exposure to dental X-rays. Occupation was not associated with the cluster in the rural town. In a standardized proportional mortality study for the state of Missouri, we calculated the observed and expected proportion of brain cancers by occupation and industry in Missouri decedents. We found that motor vehicle manufacturers, beauty shop workers, managers and administrators, elementary school teachers, and hairdressers and cosmetologists had significantly elevated proportions of brain cancer. Brain tumors are inconsistently associated with occupation in the literature. Further study of brain cancer etiology with respect to dental X-ray exposures seems warranted.
Adult↗
Occupation, smoking, and the risk of high-grade invasive bladder cancer in Missouri.
Numerous epidemiological studies have established that occupational exposures and smoking are the two major known risk factors for the development of bladder cancer. Using data from the Missouri Cancer Registry, we investigated the hypothesis that individuals with occupationally-related bladder cancer are more likely to have a more invasive form of the disease. Data were analyzed for 2,893 white males diagnosed with primary bladder cancer in Missouri between 1984 and 1988. Of the 1,415 cases whose occupational status was recorded, 236 (17%) were employed in high-risk occupations. Cases with high-grade disease were more likely to have been employed in a high-risk occupation, after adjustment for age and smoking (adjusted odds ratio [AOR] = 1.7, 95% confidence interval [CI] = 1.1-2.6). High-risk workers under 60 years of age were most at risk for developing high-grade bladder tumors (AOR = 2.3, 95% CI = 1.0-5.3). There was no overall association between high-risk occupation and late-stage disease (AOR = 1.1, 95% CI = 0.7-1.5), but it was present in the men younger than 60 years of age (AOR = 2.0, 95% CI = 1.0-3.8). No association was found between tobacco use and grade (AOR = 1.1, 95% CI = 0.8-1.5), but cases with late-stage disease were more likely to be smokers (AOR = 1.5, 95% CI = 1.1-1.9). When occupations were examined individually, motor vehicle operators, truck drivers, vehicle mechanics, other mechanics, and janitors were among those most likely to be diagnosed with high-grade or late-stage tumors. Although further studies are necessary to confirm these results, they suggest that surveillance and targeted screening of workers in high-risk occupations may result in a greater yield of early invasive cancers and possibly decrease the mortality associated with this disease.
Aged↗
Caries prevalences among geochemical regions of Missouri.
Our objectives were to determine how the prevalences of caries in elementary school children vary between geochemically defined regions of the state of Missouri and to compare this variation with that found for prehistoric Missouri inhabitants (Hildebolt et al.: Am. J. Phys. Anthropol. 75:1-14, 1988). Caries data on 6,584 school children were used in the study of second and sixth graders drinking optimally and suboptimally fluoridated water. Geochemical regions were based on maps recently published by the United States Geological Survey. Differences in mean caries scores and proportions of children with caries were tested by analysis of covariance, analysis of variance, Student t, and chi-squared tests. We found that caries prevalences do vary between the geochemical regions of the state. In the total sample, however, there were no significant differences between those children drinking optimally fluoridated water and those drinking suboptimally fluoridated water. We conclude that there is variation in caries rates among geochemically defined regions of the state and that geochemical factors associated with young parent materials may be antagonizing the action of fluoride.
Child↗
Echinococcosis (hydatid disease) in Missouri: diagnosis by fine-needle aspiration of a lung cyst.
Echinococcus granulosus was diagnosed by fine-needle aspiration cytology of a lung cyst in a 6-yr-old white female in central Missouri. No adverse reaction occurred following the aspiration. The cytologic sample yielded clear fluid containing numerous clearly identifiable protoscoleces diagnostic for echinococcosis using routine PAP staining. Since hydatid disease is extremely uncommon in the Midwest, it had not initially been considered in the differential diagnosis. The infection was probably not indigenous to Missouri, since the patient lived the first 3 1/2 yr of life in Alaska, where the organism is endemic. This can only be speculative, however, since echinococcal organisms are found in wildlife in the Midwest.
Biopsy, Needle↗
Goals and teaching methods of the urologic core curriculum at the University of Missouri, Columbia.
Urology is a highly specialized surgical subspecialty, but most urologic patients present to the primary physician with variable signs and symptoms. As medical school educators, we are obligated to furnish the students with the knowledge and skills required to handle the patient's initial problem, and refer the patient to a urologic specialist at the optimal time. The Section of Urology, University of Missouri, Columbia, has developed a core urologic curriculum for junior and senior medical students. The goals and methods used to accomplish these goals are presented in conjunction with the goals for the Department of Surgery, University of Missouri, Columbia.
Curriculum↗
A waterborne outbreak in Missouri of Escherichia coli O157:H7 associated with bloody diarrhea and death.
OBJECTIVE: To describe and determine the source of a large outbreak of Escherichia coli O157:H7 (ECO157) infections in Missouri. DESIGN: A case-control study and a household survey. SETTING: A small city in a rural Missouri township that had an unchlorinated water supply. PATIENTS: Case patients were residents of or visitors to Burdine Township with bloody diarrhea or diarrhea and abdominal cramps occurring between 15 December 1989 and 20 January 1990. MEASUREMENTS: Escherichia coli O157 was isolated from 21 stool specimens. All isolates were resistant to sulfisoxazole, tetracycline, and streptomycin; produced Shiga-like toxins I and II; and had one 60-megadalton plasmid. RESULTS: Among the 243 case patients, 86 had bloody stools, 32 were hospitalized, 4 died, and 2 had the hemolytic uremic syndrome. In the case-control study, no food was associated with illness, but ill persons had drunk more municipal water than had controls (P = 0.04). The survey showed that, during the peak of the outbreak, bloody diarrhea was 18.2 times more likely to occur in persons living inside the city and using municipal water than in persons living outside the city and using private well water (P = 0.001). Shortly before the peak of the outbreak, 45 water meters were replaced, and two water mains ruptured. The number of new cases declined rapidly after residents were ordered to boil water and after chlorination of the water supply. CONCLUSIONS: This was the largest outbreak of ECO157 infections, the first due to a multiply resistant organism, and the first shown to be transmitted by water. System-wide chlorination as well as hyperchlorination during repairs might have prevented this outbreak. Both bloody and nonbloody diarrhea may be common manifestations of this infection, which is probably underdiagnosed because of the failure of routine stool cultures to identify the organism. Cities with deteriorating water systems using untreated water risk widespread illness from contaminated drinking water.
Adolescent↗
Effects of subtoxic lead levels on pregnant women in the state of Missouri.
Cords, placentas, placental membranes, and maternal and fetal blood were collected from 249 women delivered in Columbia, Missouri (Region I). The same samples were obtained from 253 women delivered in Rolla, Missouri (Region II), near lead mining areas. The incidence of term pregnancies with early membrane rupture was 0.41% in Region I and 17% in Region II. The incidence of premature deliveries was 3% and 13.04% respectively. Lead concentration in blood and placental tissues of term pregnancies revealed no significant changes. In term with early membrane rupture, blood concentration of lead was higher, as was the case in placental tissues and cord. Lead concentration was highest in membrane tissues, in mug/100 grams (Regions I and II respectively): placenta, 6.0 +/- 0.01 and 7.0 +/- 0.03; cord, 11.0 +/- 0.34 and 12.0 +/- 0.18; membrane, 38.9 +/- 2.64 and 45.3 +/- 3.12. A high positive correlation (r = 0.2941) between lead concentration in maternal and fetal blood existed. Both were significantly (P less than 0.01) higher in preterm pregnancies and early membrane ruptures than in term pregnancies. These data suggest that subtoxic levels of lead could increase the incidence of early membrane rupture and premature deliveries.
Ceruloplasmin↗
Cardiovascular disease control efforts among primary-care physicians--Missouri, 1990.
Nearly half (43%) of all deaths in the United States each year are related to cardiovascular diseases (CVD), including coronary heart disease and cerebrovascular disease (1). CVD is linked to certain risk factors and behaviors, including high blood pressure, elevated total serum cholesterol, cigarette smoking, and physical inactivity (2). Because approximately 70% of the population has at least one contact with a physician each year (3), primary-care physicians are central to health promotion and disease-prevention efforts and early detection of CVD. In May and August 1990, the Missouri Department of Health (MDH) conducted a survey of practicing Missouri physicians to characterize their efforts to identify and control CVD risk factors among their patients.
Cardiovascular Diseases↗
Weighing costs and benefits of adequate prenatal care for 12,023 births in Missouri's Medicaid program, 1988.
Numerous studies have shown that the receipt of adequate prenatal care is associated with improvements in pregnancy outcome, particularly a reduction in the risk of low birth weight. Since medical costs for these low birth weight infants are several times higher than for normal birth weight infants, one would expect that medical costs for newborns would be lower for babies whose mothers have had adequate prenatal care than for those with inadequate prenatal care. Explored in this paper is whether the reduction in Medicaid costs for newborn and post-partum maternal care is greater than the increase in prenatal costs for a Medicaid population. The analysis used a file of 12,023 Missouri Medicaid records linked with the corresponding 1988 birth certificates. A modified version of the Kessner index was used to define the adequacy of prenatal care. Prenatal care costs were $233 higher for pregnancies with adequate prenatal care than for those in which prenatal care was inadequate. Newborn and post-partum costs starting within 60 days after the birth were $347 lower for the adequate prenatal care pregnancies, resulting in a savings of $1.49 for each extra $1 spent on prenatal care. Among the other factors studied in determining this benefit to cost ratio were global billing, Supplemental Food Program for Women, Infants, and Children (WIC), and participation in Medicaid under the expanded eligibility provisions that were effective in Missouri in 1988.
Analysis of Variance↗
HIV/AIDS in Missouri: an assessment of physician attitudes and practices.
Fewer than half of Missouri physicians responding to a statewide survey are willing to treat patients with HIV infection, and even fewer are willing to treat patients with AIDS. The authors discuss these survey results and their implications for patient care in Missouri.
Acquired Immunodeficiency Syndrome↗
Vector competence of Aedes albopictus for a newly recognized Bunyavirus from mosquitoes collected in Potosi, Missouri.
The vector competence of a Kentucky strain of Aedes albopictus was assessed for a newly recognized Bunyavirus isolated from Ae. albopictus collected in Potosi, Missouri. Females are susceptible to peroral infection and 44.7% became infected after ingesting about 15 Vero cell plaque-forming units (PFU) of virus. Virus replicated and reached average titers of 10(5.4)-10(6.0) PFU/mosquito by day 7 postfeeding. Fourteen (40%) of 35 females tested in an in vitro virus transmission experiment were infected, and 3 (21.4%) of the infected females transmitted virus. There was no evidence of vertical transmission among 1,196 progeny of a group of mothers exposed to infection perorally or among 6,635 progeny of mothers infected by parenteral inoculation. The absence or infrequency of vertical transmission suggests that the virus was not introduced into Missouri via infected Ae. albopictus eggs. Nonetheless, Ae. albopictus is a competent vector of this virus and we provide the first experimental evidence for incriminating Ae. albopictus as a vector in a natural arbovirus transmission cycle in the United States.
Aedes↗
Obstetric care in rural Missouri: the loss of rural general and family practitioners.
Family and general practitioners have historically provided a substantial portion of obstetric care in rural parts of the United States, including Missouri. The authors surveyed 328 rural general physicians to determine their participation in obstetrics. Their findings show a dramatic loss of physician obstetric services in rural Missouri and suggest that the dilemma is not likely to be easily remedied.
Adult↗
Prenatal participation in WIC related to Medicaid costs for Missouri newborns: 1982 update.
This study replicates a 1980 evaluation of WIC prenatal participation in Missouri by using a file of 9,086 Missouri Medicaid records matched with the corresponding birth records. This file was divided into a WIC group containing 3,261 records and a non-WIC group of 5,825 records. The 1982 results generally confirm the 1980 results, with the 1982 findings showing slightly improved pregnancy outcomes for WIC participants and slightly reduced benefit-to-cost ratios compared with the 1980 findings. In 1982, WIC participation was found to be associated with an increase in mean birth weight of 31 grams and reductions in low birth weight rates (statistically significant) and in neonatal death rates (not statistically significant). The reduction in each rate was 23 percent. WIC participation was also associated with a reduction in Medicaid costs for newborns reported within 45 days of birth amounting to $76 per participant. For every dollar spent on WIC, about 49 cents in Medicaid costs were apparently saved. However, wide 95 percent confidence intervals ($.07, $.90) make it difficult to determine precisely what impact WIC has on Federal and State budget outlays.
Birth Weight↗