Barriers to care-seeking for children's oral health among low-income caregivers. (65/365)

OBJECTIVES: We identified psychosocial, structural, and cultural barriers to seeking dental care among nonutilizing caregivers of Medicaid-enrolled children. METHODS: We used Medicaid utilization records to identify utilizing and nonutilizing African American and White caregivers of Medicaid-enrolled children in Jefferson County, Kentucky. We conducted 8 focus groups (N=76) with a stratified random sample of responding caregivers; transcripts were qualitatively analyzed. RESULTS: Psychosocial factors associated with utilization included oral health beliefs, norms of caregiver responsibility, and positive caregiver dental experiences. Utilizing groups reported higher education; health beliefs included identifying oral health with overall health and professional preventive dental care with caregiver responsibility for children's overall health. These beliefs may mediate shared structural barriers, including transportation, school absence policies, discriminatory treatment, and difficulty locating providers who accept Medicaid. Expectation of poor oral health among some low-income caregivers was among factors identified with nonutilization. CONCLUSIONS: Disadvantaged caregivers reported multiple barriers to accessing dental care for their children. Providers, Medicaid administrators, and schools must coordinate steps to encourage caregiver-controlled dental care, build trust, and link professional preventive dental care with caregiver responsibility for children's overall health.  (+info)

Mercury exposure--Kentucky, 2004. (66/365)

In November 2004, a student aged 15 years brought a small vial of liquid mercury onto a school bus and into a high school in Kentucky. A subsequent investigation revealed that mercury had been in the student's possession for more than a year and that substantial amounts had been spilled in multiple locations. This report describes the results of that investigation, which indicated that 1) duration of exposure was associated with the amount of mercury absorbed by exposed persons and 2) extensive multiagency collaboration facilitated an efficient response. The investigation further revealed that, although mercury exposure is common, clinicians might not be aware of how to evaluate and treat patients with mercury exposure. State and federal health agencies should provide schools, clinicians, and local health department staff with readily accessible guidelines for use in mercury spills and exposures.  (+info)

Potential applicability of recombinant factor VIIa for intracerebral hemorrhage. (67/365)

BACKGROUND AND PURPOSE: To date, there are no proven, effective treatments for intracerebral hemorrhage (ICH) beyond supportive medical care. A recent randomized, blinded, placebo-controlled trial of recombinant factor VIIa (rFVIIa) administered intravenously within 4 hours of ICH onset reported a reduction in morbidity and mortality compared with placebo. We sought to determine the potential applicability of rFVIIa in a large, population-based cohort of ICH patients. METHODS: All of the patients age > or =18 years hospitalized with nontraumatic ICH in the Greater Cincinnati region were identified from May 1998 to July 2001 and August 2002 to April 2003. Patient demographics were compared with the inclusion and exclusion criteria from the rFVIIa trial to determine eligibility for treatment and reasons for exclusion. Mortality in the eligible patient group was compared with the placebo group in the rFVIIa trial. RESULTS: Over 4 calendar years, 1018 ICH patients were identified; of these, 133 (13.1%) had no exclusions and presented within the prescribed time window. An additional 45 patients (4.4%) may have been eligible but had uncertain onset or computed tomography scan times. The most common reasons for exclusion (not mutually exclusive) were late presentation (n=398), vaso-occlusive disease (n=369), deep coma (n=219), and prolonged international normalized ratio or partial thromboplastin time (n=200). Mortality at 90 days among potentially eligible patients was the same as for the placebo group in the rFVIIa trial (29% versus 29%; P=0.99). CONCLUSIONS: In this large, population-based ICH cohort, 13.1% to 17.5% of patients would have qualified for treatment with rFVIIa by trial criteria.  (+info)

Patients, practices, and relationships: challenges and lessons learned from the Kentucky Ambulatory Network (KAN) CaRESS clinical trial. (68/365)

The Cardiovascular Risk Education and Social Support (CaRESS) study is a randomized controlled trial that evaluates a social support intervention toward reducing cardiovascular risk in type 2 diabetic patients. It involves multiple community-based practice sites from the Kentucky Ambulatory Network (KAN), which is a regional primary care practice-based research network (PBRN). CaRESS also implements multiple modes of data collection. The purpose of this methods article is to share lessons learned that might be useful to others developing or implementing complex studies that consent patients in PBRNs. Key points include building long-term relationships with the clinicians, adaptability when integrating into practice sites, adequate funding to support consistent data management and statistical support during all phases of the study, and creativity and perseverance for recruiting patients and practices while maintaining the integrity of the protocol.  (+info)

Evaluation of educational materials on colorectal cancer screening in Appalachian Kentucky. (69/365)

INTRODUCTION: Despite the availability of preventive screening for colorectal cancer, compliance with screening recommendations in Appalachian Kentucky is low. Although there are various cancer education materials available, none focus on Appalachian populations and few on low-literacy populations. The purpose of this study was to assess the type of information needed in written educational materials about colorectal cancer for Appalachian populations in Kentucky. METHODS: Seven focus groups were held in two Appalachian regions of Kentucky. Thirty-four members of the community participated in four focus groups held for the general public, and 15 staff members of primary care physicians' offices participated in three focus groups. One facilitator led all seven focus groups using a moderator's guide. Participants were asked to review and rank two fact sheets and two brochures about colorectal cancer according to perceived effectiveness. RESULTS: There was consensus between the general public focus groups and physician office staff focus groups about the ranking of materials. All groups preferred the Centers for Disease Control and Prevention's Screen for Life: National Colorectal Cancer Action Campaign fact sheet and brochure to the other materials. They indicated that factors such as print size, inclusion of diagrams, and clear and simple presentation of the information were important and made the materials easier to use and understand. A consensus was also reached among groups on the relative importance of types of information that should be provided in the materials. CONCLUSION: The use of educational materials to communicate messages about cancer screening is important in increasing awareness and providing valuable health information. Members of the Appalachian community and staff members of physicians' offices preferred and recommended use of Screen for Life materials for low-literacy and Appalachian populations over other educational materials.  (+info)

Brief report: respiratory illness associated with boot sealant products--five states, 2005-2006. (70/365)

During February 2005-February 2006, six regional poison control centers in five states were consulted regarding 172 human and 19 animal (i.e., pet cat or dog) exposures to shoe or boot leather protection or sealant products resulting in respiratory illness. One product was associated with 126 cases of human illness and another product with seven cases. An ongoing investigation, begun in December 2005, is being conducted by the poison centers. The majority of cases occurred in Michigan, where poison control centers are collaborating with the Michigan Department of Community Health to further document exposures and adverse health effects from the products. Results of the investigation of the 150 cases reported during 2005 underscore the continuing need to assess the magnitude of the problem, evaluate the toxic etiology of the products involved, and determine how to prevent further cases of illness resulting from use of the products.  (+info)

Methicillin-resistant Staphylococcus aureus skin infections among tattoo recipients--Ohio, Kentucky, and Vermont, 2004-2005. (71/365)

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have emerged as a major cause of skin disease in the United States. Outbreaks of CA-MRSA have occurred among athletes, inmates at correctional facilities, and military recruits. This report summarizes investigations of six unlinked clusters of skin and soft tissue infections caused by CA-MRSA among 44 recipients of tattoos from 13 unlicensed tattooists in three states (Ohio, Kentucky, and Vermont); use of nonsterile equipment and suboptimal infection-control practices were identified as potential causes of the infections. Clinicians should consider CA-MRSA in their differential diagnosis for staphylococcus diseases, including skin infections. Clinicians can contact their local health departments to determine the prevalence of CA-MRSA in their community and whether the disease is reportable. MRSA infections should be added to education and prevention campaigns highlighting the risks of unlicensed tattooing.  (+info)

The unchanging incidence and case-fatality of stroke in the 1990s: a population-based study. (72/365)

BACKGROUND AND PURPOSE: Many advances were made in stroke prevention strategies during the 1990s, and yet temporal trends in stroke incidence and case-fatality have not been reported in the United States. Blacks have a 2-fold higher risk of stroke; however, there are no data over time showing if any progress has been made in reducing racial disparity in stroke incidence. The objective of this study was to examine temporal trends in stroke incidence and case-fatality within a large, biracial population during the 1990s. METHODS: Within a biracial population of 1.3 million, all strokes were ascertained at all local hospitals using International Classification of Diseases, 9th Revision codes during July 1993 to June 1994 and again in 1999. A sampling scheme was used to ascertain cases in the out-of-hospital setting. Race-specific incidence and case-fatality rates were calculated and standardized to the 2000 US Census population. A population-based telephone survey regarding stroke risk factor prevalence and medication use was performed in 1995 and 2000. RESULTS: There were 1954 first-ever strokes in 1993-1994 and 2063 first-ever strokes in 1999. The annual incidence of first-ever hospitalized stroke did not significantly change between study periods: 158 per 100,000 in both 1993-1994 and 1999 (P=0.97). Blacks continue to have higher stroke incidence than whites, especially in the young; however, case-fatality rates continue to be similar between races and are not changing over time. Medication use for treatment of stroke risk factors significantly increased in the general population between study periods. CONCLUSIONS: Despite advances in stroke prevention treatments during the 1990s, the incidence of hospitalized stroke did not decrease within our population. Case-fatality also did not change between study periods. Excess stroke mortality rates seen in blacks nationally are likely the result of excess stroke incidence and not case-fatality, and the racial disparity in stroke incidence did not change over time.  (+info)