Breast and cervical cancer screening among Appalachian women.
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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. (+info)
Cancer death rates--Appalachia, 1994-1998.
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Cancer is the second leading cause of death in the United States. Although descriptive analyses of mortality data are used often to identify variations by time and person, analyses that focus on regional variations are less common. Appalachia is a U.S. region with a high prevalence of risk factors for cancer (e.g., tobacco use, physical inactivity, and inadequate access to medical care). Analyses that focus on Appalachia provide valuable information for cancer control, research, and intervention. To assess the impact of cancer in Appalachia, researchers from the University of Kentucky and Pennsylvania State University, in collaboration with CDC, analyzed mortality data from CDC's National Center for Health Statistics for 1994-1998. This report summarizes the results of that analysis, which indicate elevated cancer mortality, underscoring the need for ongoing cancer prevention and control programs as a major public health priority in this region. (+info)
Costs of providing dental services for children in public and private practices.
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This study compares the costs of providing children's dental services in three practice settings: private practices, public mobile clinics, and public fixed clinics. Some 15,000 children were provided comprehensive dental care over a three-year period. Results indicate that costs per visit and per child were lowest in mobile clinics and highest in private practices. The differential was partially explained by differences in productivity but mostly by the fact that the price of services in public practices represented costs of production, whereas in private practices they represented market values. (+info)
Improving the oral health knowledge of osteopathic medical students.
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Due to a complex set of circumstances including culture, poverty, low educational achievement, and limited access to dental care, the oral health of rural Appalachians is poorer than that of people in other parts of Kentucky. Limited health care dollars go to primary medical care which may be the only contact these individuals have with the health care system. Consequently, primary care physicians can help improve oral health. The University of Kentucky College of Dentistry (UKCD) and the Pikeville College School of Osteopathic Medicine (PCSOM) developed an oral health education block for third-year PCSOM students. Eleven UKCD faculty and one PCSOM faculty participated in the two-day, sixteen-hour oral health curriculum. Knowledge retention data from the post-tests was collected four months after the educational program. Students significantly improved their performance in six of the topic areas, with performance staying the same in one area and dropping significantly in one area. Focus groups were conducted with sixteen (two groups of eight) randomly selected students one year after the educational program. Students reported using the knowledge and oral exam techniques included in the course and felt that it was a valuable addition to their curriculum. (+info)
Underserved region recruitment and return to practice: a thirty-year analysis.
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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. (+info)
van der Waals and hygroscopic forces of adhesion generated by spider capture threads.
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Cribellar thread is the most primitive type of sticky prey capture thread found in aerial spider webs. Its outer surface is formed of thousands of fine fibrils that issue from a cribellum spinning field. The fibrils of primitive cribellar thread are cylindrical, whereas those of derived threads have nodes. Cribellar threads snag on insect setae but also adhere to smooth surfaces. A previous study showed empirically that cylindrical fibrils use only van der Waals forces to stick to smooth surfaces, as their stickiness is the same under different humidity. By contrast, noded fibrils are stickier under high humidity, where they are presumed to adsorb atmospheric water and implement hygroscopic (capillary) adhesion. Here, we model thread stickiness according to these two adhesive mechanisms. These models equate stickiness with the force necessary to overcome the adhesion of fibril contact points in a narrow band along each edge of the contact surface and to initiate peeling of the thread from the surface. Modeled and measured thread stickiness values are similar, supporting the operation of the hypothesized adhesive forces and portraying an important transition in the evolution of spider threads. Cribellar threads initially relied only on van der Waals forces to stick to smooth surfaces. The appearance of fibril nodes introduced hydrophilic sites that implemented hygroscopic force and increased thread stickiness under intermediate and high humidity. (+info)
Appalachian teen smokers: not on tobacco 15 months later.
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High school smokers from 2 central Appalachian states received the American Lung Association's 10-session Not On Tobacco (N-O-T) program or a 15-minute brief self-help intervention. Our study compared the efficacy of N-O-T with that of the brief intervention by examining group differences in the 15-month-postbaseline (12-month-postprogram) smoking quit rates. N-O-T youths had higher overall quit rates. Review of end-of-program (3-month-postbaseline) and 3-month-postprogram (6-month-postbaseline) follow-up data showed state-level differences and positive cessation trends over time, regardless of treatment intensity. Quit rates were lower than rates found in other N-O-T studies of nonrural youths, suggesting that Appalachian youths are a recalcitrant smoking sample. Findings suggest that N-O-T is one option for long-term smoking cessation among rural teens. (+info)
Gender differences among long-distance backpackers: A prospective study of women Appalachian Trail backpackers.
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OBJECTIVE: Backpacking is a popular recreational activity, yet the differential experiences of women are unknown. The objective was to compare women with men backpackers to determine the extent to which injuries and illnesses limit endurance outdoor recreational activities. METHODS: This was a prospective cohort surveillance survey of 334 persons who hiked the Appalachian Trail for > or =7 days. At the end of their hike, 280 subjects completed a questionnaire. Male hikers served as controls for injury and illness. RESULTS: Women comprised 26% (72 of 280) of the sample. The mean (+/-SD) duration of hiking was 144 +/- 66 days covering 1570 +/- 680 miles. Fifty-seven percent (41 of 72) of women and 72% (150 of 208) of men attained their goal (P = .02). The occurrence of individual musculoskeletal problems, such as strains, sprains, arthralgias, tendonitis, and fractures, were similar (P = .9) between sexes. The occurrence of diarrhea (56%) was also similar (relative risk [RR] 1.0; P = .9) between sexes. Of regularly menstruating women, 87% (43 of 49) had menstrual changes while hiking, such as change in frequency (45%) or character (43%) (RR 3.1; 95% CI, 2.0-4.8; P < .001). Shortened duration of menses was most common (41%). Amenorrhea occurred in 22% (11 of 49) of women, including 5 of 25 taking oral contraceptive pills (OCPs). Breakthrough, midcycle bleeding occurred in 20% (10 of 49) of women. CONCLUSIONS: Women had similar experiences as compared with men when backpacking. Menstrual changes were very common including amenorrhea. Prolonged amenorrhea raises concern for potential bone mineral density loss, and OCPs should be considered to prevent such loss. (+info)