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Biomedical subjects

P L Jenkins

Publications and source records attributed to P L Jenkins.

At least 19 recordsLinked to original sources
PubMed2006

Rollover protection on New York tractors and farmers' readiness for change.

Tractor overturns contribute significantly to fatalities in New York State agriculture. On-site inspections a decade ago indicated that approximately 60% of tractors were without effective rollover protection. Our objectives were: to describe the current prevalence and distribution of rollover protective structures (ROPS) on New York farm tractors, to identify characteristics associated with the absence of ROPS, to explore segmenting the New York farm community on readiness for ROPS retrofitting, and to identify demographic characteristics that might assist in this segmenting. A random selection of 644 livestock, dairy, fruit, cash crop, vegetable, and organic farms were contacted for a telephone survey. Of 562 farms (87%) participating, 102 (18.1%) had all tractors equipped with ROPS and 138 (24.6%) had none. A disproportionate number of livestock, cash crop, and organic operations had no ROPS. Rates of ROPS-equipped tractors correlated directly with farm size and annual hours of tractor operation. Older farmers had a lower proportion of ROPS tractors. The presence of a child operator did not affect the proportion of ROPS tractors. After weighting the sample, the total number of non-ROPS tractors in New York is estimated at more than 80,000. In addition to providing key farm demographics, the survey enabled placement of farmers on a "stage of change" continuum related to readiness for retrofitting. Three-quarters of New York farmers are in the "precontemplation" stage of change relative to ROPS retrofitting, and this varies little by size of operation, age of farmer, or the presence of child tractor operators. Stage of change may relate to hours of tractor operation (p = 0.05) and does relate to commodity (p = 0.003) due primarily to the higher proportion of crop farmers in the earliest stage of change. The goal of retrofitting all New York farm tractors with ROPS appears nearly as daunting as it did a decade ago.

Accidents, Occupational↗
PubMed2006

Risk perceptions, barriers, and motivators to tractor ROPS retrofitting in the New York state farm community.

The prevalence of tractor rollovers among agricultural workers has made the retrofitting of tractors with rollover protective structures (ROPS) and seat belts a public health priority for agricultural health and safety specialists. To address this concern, the New York Center for Agricultural Medicine and Health (NYCAMH) developed a seven-question survey, designed to assess perceptions of risk as well as potential motivators and barriers to retrofitting. Data from 465 phone surveys were gathered from New York State farmers representing various commodities and farm sizes. Analysis of responses to three qualitative questions contained in the survey indicated that most farmers in New York understand the importance of ROPS but lack the proper motivation to consider retrofitting. It appears that more convenient safety strategies, cost, and age of the tractor compete with a farmer's initiative to retrofit. In addition, survey responses illustrate that although many farmers believe ROPS are important in a general sense, many believe that this safety measure is not necessary for them in particular. Frequent motivators to retrofitting are concerns about safety, although the authors conclude that a more thorough analysis of these "general safety concerns" in qualitative interviews is important.

Accident Prevention↗
PubMed2005

Estimating farmworker population size in New York State using a minimum labor demand method.

Assessment of health needs and services for hand-harvest farmworkers requires reliable population estimates. In New York State, the only publicly available source for these is the Department of Labor (DOL). However, published production data exist that may enable estimation of minimum labor demand (MLD) for hand-harvest labor. Our objective was to develop an estimation process for minimum labor demand (MLD) for hand-harvested crops in NYS and contrast the results with DOL estimates. Four crop strata (below ground, ground, bush/vine, and orchard) were identified. MLD (measured in worker-seasons) was estimated by dividing the total annual harvest hours required for each crop stratum by the total hours worked by one worker in a season for that crop stratum. The MLD estimate of the total number of worker seasons combined for all strata (14,121) was higher than that of the DOL (8,230). Harvest acreage was unavailable for 21% of the 991 county-crop combinations studied; therefore, data were imputed from other sources. Within these strata, the greatest difference was found for ground crops, where the DOL count was 28% of the size of the MLD estimate. DOL and MLD estimates were closest in orchard crops (DOL 109% of MLD). Publicly available data provide a potentially valuable source of informationfor estimation of the MLD. Use of these methods implies that the DOL may substantially underestimate the size of this population. Differences seen between the two methods were sensitive to the crop type. County-level farm surveys to verify MLD estimation factors would enhance the method's accuracy.

Agriculture↗
PubMed2001

Socioeconomic status as an independent risk factor for hospital readmission for heart failure.

The management of heart failure is characterized by high rates of hospital admission as well as rehospitalization after inpatient treatment of this disorder, whereas skillful medical care may reduce the risk of hospital admission. The purpose of this study was to examine the relation between income (as a measure of socioeconomic status) and the frequency of hospital readmission among a large and diverse group of persons treated for heart failure. We analyzed administrative discharge data from 236 nonfederal acute-care hospitals in New York State, involving 41,776 African-American or Caucasian hospital survivors with International Classification of Diseases, Ninth Revision, Clinical Modification codes for heart failure in the principal diagnosis position between January 1 and December 31, 1995. Household income was derived from postal ZIP codes and census data. We found that patients residing in lower income neighborhoods were more often women or African-Americans, had more comorbid illness, had higher use of Medicaid insurance, and were more often admitted to rural hospitals. There was a stepwise decrease in the crude frequency of readmission from the lowest quartile of income (23.2%) to the highest (20.0%) (p <0.0001 for Mantel-Haenszel chi-square test for trend across all quartiles; p <0.0001 for comparison between quartiles 1 and 4). After adjustment for baseline differences and process of care, income remained a significant predictor, with an increase in the risk of readmission noted in association with lower levels of income (adjusted odds ratio for quartile 1:4 comparison, 1.18; 95% confidence interval, 1.10 to 1.26, p <0.0001). We conclude that lower income patients hospitalized for treatment of heart failure in New York differ from higher income patients in important clinical and demographic comparisons. Even after adjustment for these fundamental differences and other potential confounding factors, lower income is a positive predictor of readmission risk.

Aged↗
PubMed2001

Predictors of dietary milk fat intake by preschool children.

BACKGROUND: High-fat whole milk is the major dietary source of total and saturated fat for young children. Children from low-income families have higher total and saturated fat intakes and their parents have higher rates of cardiovascular disease compared with children from higher income families. We identified factors that predict the use of either high-fat whole milk or low-fat (1% and/or skim) milk by children to facilitate the development of targeted intervention strategies to reduce their dietary fat intakes. METHODS: Adults (91% mothers) with children > or =1 through <5 years of age, participating in the Supplemental Nutrition Program for Women, Infants, and Children (WIC) at 50 agencies throughout New York State, completed questionnaires. RESULTS: Most (75%) of the 1,938 children drank whole milk, while only 6.9% consumed exclusively 1% and/or skim milk. The children tended to drink the same type of milk as other family members. In multivariate logistic regression, use of whole milk was associated with younger child age, black race or Hispanic ethnicity, parent/guardian belief that whole milk was healthier for children over 2, and parent/guardian having never tried reduced-fat milks (all P < 0.0001). In contrast, use of 1% and/or skim milk was associated with older child age, female gender, nonblack race, older parent/guardian age, parent/guardian belief that reduced-fat milks were healthier for children over 2, and parent/guardian having tried 1%-fat milk (all P < 0.01). CONCLUSIONS: Individualized family-based strategies are needed to target specific behaviors and/or health beliefs held by different parent groups. For example, taste testing might be an effective strategy for parents who have never tasted reduced-fat milk. Interventions to overcome cultural barriers to the use of low-fat milk may require changing parental health beliefs, in addition to providing education about the health benefits of low-fat milk.

Adult↗
PubMed2001

Underuse of invasive procedures among Medicaid patients with acute myocardial infarction.

OBJECTIVES: The purpose of this study was to determine whether underuse of cardiac procedures among Medicaid patients with acute myocardial infarction is explained by or is independent of fundamental differences in age, race, or sex distribution; income, coexistent illness; or location of care. METHODS: Administrative data from 226 hospitals in New York were examined for 11,579 individuals hospitalized with a primary diagnosis of acute myocardial infarction. Use of various cardiac procedures was compared among Medicaid patients and patients with other forms of insurance. RESULTS: Medicaid patients were older, were more frequently African American and female, and had lower median household incomes. They also had a higher prevalence of hypertension, diabetes, lung disease, renal disease, and peripheral vascular disease. After adjustment for these and other factors, Medicaid patients were less likely to undergo cardiac catheterization, percutaneous transluminal coronary angioplasty, and any revascularization procedure. CONCLUSIONS: Factors other than age, race, sex, income, coexistent illness, and location of care account for lower use of invasive procedures among Medicaid patients. The influence of Medicaid insurance on medical practice and process of care deserves investigation.

Angioplasty, Balloon, Coronary↗
PubMed2001

The Otsego-Schoharie healthy heart program: prevention of cardiovascular disease in the rural US.

OBJECTIVES: To describe a rural, hospital-based public health intervention program and to evaluate its effectiveness in cardiovascular disease (CVD) risk reduction using cross-sectional studies and a panel study. METHODS: A rural population of 158,000 located in New York state comprised the intervention population. A similar but separate population was used for reference. A multifaceted, multimedia 5-year program provided health promotion and education initiatives to increase physical activity, decrease smoking, improve nutrition, and identify hypercholesterolemia and hypertension. To evaluate the effectiveness of the intervention, surveys were conducted at baseline in 1989 (cross-sectional) and at follow-up in 1994-95 (cross-sectional and panel). For cross-sectional studies, a random sample of adults was obtained using a three-stage cluster design. Self-reported and objective risk factor measurements were obtained. Comparison of pre- to post- changes in intervention versus reference populations was done using 2 x 2 randomized block ANOVA, 2 x 2 mixed ANOVA. and extension of the McNemar test. RESULTS: Smoking prevalence declined (from 27.9% to 17.6%) in the intervention population. Significant adverse trends were observed for high-density lipoprotein cholesterol and triglycerides. Systolic blood pressure was reduced while diastolic blood pressure remained stable. Body mass index increased significantly in both populations. CONCLUSIONS: This rural. 5-year CVD community intervention program decreased smoking. The risk reduction may be attributable to tailoring of a multifaceted approach (multiple risk factors, multiple messages, and multiple population subgroups) to a target rural population. The study period was too short to identify changes in CVD morbidity and mortality.

Adult↗
PubMed2001

Design issues in the combination of international data from two rural community cardiovascular intervention programs.

OBJECTIVES: To compare and contrast two rural cardiovascular community intervention programs (CCIP) in northern Sweden and the US by discussing the methods used to select and combine similar data from two separately designed and implemented CCIP in order to describe and evaluate their effectiveness in reducing cardiovascular risk. METHODS: Two rural intervention populations and their reference populations were compared. A comparison was made of the intensity and duration of the intervention programs using an overall intervention intensity score. Population-based surveys were conducted at 5-year intervals in both countries. The methods used for data pooling and comparison are described. A description of statistical analyses using a mixed analysis of variance model is provided. RESULTS: The data were pooled. taking into consideration comparable ages. New variables were created in order to define the relationship between similar data that did not permit direct comparison. CONCLUSIONS: Combination and comparison of international data from two programs allowed evaluation of community intervention programs that were developed independently for similar communities. The effectiveness of interventions can be compared using such methods.

Adult↗
PubMed2001

The Norsjö-Cooperstown healthy heart project: a case study combining data from different studies without the use of meta-analysis.

OBJECTIVES: This paper aims to develop and describe a method for combining. comparing, and maximizing the statistical power of two longitudinal studies of risk factors for cardiovascular disease that did not have identical data collection methodologies. METHODS: Subjects from a 1986 cross-sectional study (n = 180) were pair-matched with subjects of corresponding gender and age (+5 years) from a 1990 cross-sectional study. The methodology is described and results are calculated for various measures of cardiovascular risk or risk factors (e.g. cholesterol. Finnish Risk Score). RESULTS: Box's test of equality and symmetry of covariance matrices gave chi-square values of 223.8 and 710.0 for two cardiovascular risk factors (cholesterol and cardiac risk score, respectively); these values were highly significant (p=0.0001) For the North Karelia Risk Score, repeated measures ANOVA revealed a borderline significant interaction for treatment by time (p=0.054) and a significant interaction for treatment by time by country (p=0.035). These probabilities compared favorably with a randomized blocks model. CONCLUSIONS: Creation of a synthetic longitudinal control group resulted in a statistically valid ANOVA model that increased the statistical power of the study.

Adult↗
PubMed2001

Different outcomes for different interventions with different focus!--A cross-country comparison of community interventions in rural Swedish and US populations.

OBJECTIVES: There is a need among healthcare providers to acquire more knowledge about small-scale and low budget community intervention programmes. This paper compares risk factor outcomes in Swedish and US intervention programmes for the prevention of cardiovascular disease (CVD). The aim was to explore how different intervention programme profiles affect outcome. METHODS: Using a quasi-experimental design, trends in risk factors and estimated CVD risk in two intervention areas (Norsjö. Sweden and Otsego-Schoharie County, New York state) are compared with those in reference areas (Northern Sweden region and Herkimer County, New York state) using serial cross-sectional studies and panel studies. RESULTS: The programmes were able to achieve significant changes in CVD risk factors that the local communities recognized as major concerns: changing eating habits in the Swedish population and reducing smoking in the US population. For the Swedish cross-sectional follow-up study cholesterol reduction was 12%, compared to 5% in the reference population (p for trend differences <0.000). The significantly higher estimated CVD risk (as assessed by risk scores) at baseline in the intervention population was below that of the Swedish reference population after 5 years of intervention. The Swedish panel study provided the same results. In the US, both the serial cross-sectional and panel studies showed a > 10% decline in smoking prevalence in the intervention population, while it increased slightly in the reference population. When pooling the serial cross-sectional studies the estimated risk reduction (using the Framingham risk equation) was significantly greater in the intervention populations compared to the reference populations. CONCLUSIONS: The overall pattern of risk reduction is consistent and suggests that the two different models of rural county intervention can contribute to significant risk reduction. The Swedish programme had its greatest effect on reduction of serum cholesterol levels whereas the US programme had its greatest effect on smoking prevention and cessation. These outcomes are consistent with programmatic emphases. Socially less privileged groups in these rural areas benefited as much or more from the interventions as those with greater social resources.

Adult↗
PubMed2000

Systolic versus diastolic heart failure in community practice: clinical features, outcomes, and the use of angiotensin-converting enzyme inhibitors.

BACKGROUND: Among patients with heart failure, there is controversy about whether there are clinical features and laboratory tests that can differentiate patients who have low ejection fractions from those with normal ejection fractions. The usefulness of angiotensin-converting enzyme (ACE) inhibitors among heart failure patients who have normal left ventricular ejection fractions is also not known. METHODS: From a registry of 2,906 unselected consecutive patients with heart failure who were admitted to 10 acute-care community hospitals during 1995 and 1997, we identified 1291 who had a quantitative measurement of their left ventricular ejection fraction. Patients were separated into three groups based on ejection fraction: < or =0.39 (n = 741, 57%), 0.40 to 0.49 (n = 238, 18%), and > or =0.50 (n = 312, 24%). In-hospital mortality, prescription of ACE inhibitors at discharge, subsequent rehospitalization, quality of life, and survival were measured; survivors were observed for at least 6 months after hospitalization. RESULTS: The mean (+/- SD) age of the sample was 75+/-11 years; the majority (55%) of patients were women. In multivariate models, age >75 years, female sex, weight >72.7 kg, and a valvular etiology for heart failure were associated with an increased probability of having an ejection fraction > or =0.50; a prior history of heart failure, an ischemic or idiopathic cause of heart failure, and radiographic cardiomegaly were associated with a lower probability of having an ejection fraction > or =0.50. Total mortality was lower in patients with an ejection fraction > or =0.50 than in those with an ejection fraction < or =0.39 (odds ratio [OR] = 0.69, 95% confidence interval [CI 0.49 to 0.98, P = 0.04). Among hospital survivors with an ejection fraction of 0.40 to 0.49, the 65% who were prescribed ACE inhibitors at discharge had better mean adjusted quality-of-life scores (7.0 versus 6.2, P = 0.02), and lower adjusted mortality (OR = 0.34, 95% CI: 0.17 to 0.70, P = 0.01) during follow-up than those who were not prescribed ACE inhibitors. Among hospital survivors with an ejection fraction > or =0.50, the 45% who were prescribed ACE inhibitors at discharge had better (lower) adjusted New York Heart Association (NYHA) functional class (2.1 versus 2.4, P = 0.04) although there was no significant improvement in survival. CONCLUSIONS: Among patients treated for heart failure in community hospitals, 42% of those whose ejection fraction was measured had a relatively normal systolic function (ejection fraction > or 0.40). The clinical characteristics and mortality of these patients differed from those in patients with low ejection fractions. Among the patients with ejection fractions > or =0.40, the prescription of ACE inhibitors at discharge was associated favorable effects.

Aged↗
PubMed2000

Socioeconomic status is an important determinant of the use of invasive procedures after acute myocardial infarction in New York State.

BACKGROUND: Patient and hospital characteristics influence the use of invasive cardiac procedures. Whether socioeconomic status (SES) has an influence that is independent of these other determinants is unclear. The purpose of the present study was to examine the influence of household income as a measure of SES on the use of invasive cardiac procedures among a large group of patients with acute myocardial infarction. METHODS AND RESULTS: We analyzed administrative discharge data from 231 nonfederal acute care hospitals in New York State that involved 28 698 black or white inpatients with International Classification of Diseases, Ninth Revision, Clinical Modification code 410.XX in the principal diagnosis position between January 1 and December 31, 1995. Household income was derived from postal ZIP codes and census data. The use of cardiac catheterization, PTCA, CABG, and any revascularization procedure was examined across groups stratified by income. Patients who resided in lower-income neighborhoods were more often female or black, had a higher prevalence of coexistent illness, had a higher use of Medicaid insurance, and were less often admitted to urban hospitals or hospitals that provide on-site CABG and PTCA. Crude and adjusted odds ratios for catheterization, PTCA, CABG, and any revascularization procedure were related to income in a graded fashion. After adjustment, patients in the highest quintile of income were 22% more likely to undergo catheterization, 74% more likely to undergo PTCA, 48% more likely to undergo CABG, and 76% more likely to undergo any revascularization procedure than were patients in the lowest quintile. The difference in cardiac catheterization did not fully account for income-based differences in revascularization, because income remained a significant determinant of revascularization after accounting for whether a catheterization was performed. Even among patients treated in hospitals that provide on-site CABG and PTCA, income was a significant determinant of procedures. CONCLUSIONS: Lower-income patients hospitalized for acute myocardial infarction are more often female or black, have more coexisting illnesses, and are less often admitted to urban hospitals or hospitals that provide CABG and PTCA. Even after adjustment for these and other factors, lower income is a negative predictor of procedure use.

Black or African American↗
PubMed2000

The results of a randomized trial of a quality improvement intervention in the care of patients with heart failure. The MISCHF Study Investigators.

PURPOSE: Quality improvement and disease management programs for heart failure have improved quality of care and patient outcomes at large tertiary care hospitals. The purpose of this study was to measure the effects of a regional, multihospital, collaborative quality improvement intervention on care and outcomes in heart failure in community hospitals. PATIENTS AND METHODS: This randomized controlled study included 10 acute care community hospitals in upstate New York. After a baseline period, 5 hospitals were randomly assigned to receive a multifaceted quality improvement intervention (n = 762 patients during the baseline period; n = 840 patients postintervention), while 5 were assigned to a "usual care" control (n = 640 patients during the baseline period; n = 664 patients postintervention). Quality of care was determined using explicit criteria by reviewing the charts of consecutive patients hospitalized with the primary diagnosis of heart failure during the baseline period and again in the postintervention period. Clinical outcomes included hospital length of stay and charges, in-hospital and 6-month mortality, hospital readmission, and quality of life measured after discharge. RESULTS: Patients had similar characteristics in the baseline and postintervention phases in the intervention and control groups. Using hospital-level analyses, the intervention had mixed effects on 5 quality-of-care markers that were not statistically significant. The mean of the average length of stay among hospitals decreased from 8.0 to 6.2 days in the intervention group, with a smaller decline in mean length of stay in the control group (7.7 to 7.0 days). The net effects of the intervention were nonsignificant changes in length of stay of -1.1 days (95% confidence interval [CI]: -2.9 to 0.7 days, P = 0.18) and in hospital charges of -$817 (95% CI: -$2560 to $926, P = 0.31). There were small and nonsignificant effects on mortality, hospital readmission, and quality of life. CONCLUSIONS: The incremental effect of regional collaboration among peer community hospitals toward the goal of quality improvement was small and limited to a slightly, but not significantly, shorter length of stay.

Aged↗
PubMed2000

Development and validation of an instrument to assess child dietary fat intake.

BACKGROUND: brief dietary assessment instrument to assess dietary intakes of total fat, saturated fatty acids (SFA), and cholesterol in young children was developed and validated. METHODS: Young children and their parent or primary caretaker were recruited from a general primary care health center and local Head Start programs. Dietary records, entered and analyzed using the Minnesota Nutrition Data System, were used to calculate children's mean dietary intakes. Stepwise linear regression analysis was used to select questionnaire items that best predicted total fat, SFA, and dietary cholesterol intakes. RESULTS: This yielded a 17-item Child Dietary Fat Questionnaire (CDFQ); 9 questions correlated with total fat intake (r = 0.68, P < 0.0001); 15 questions correlated with SFA intake (r = 0.75, P < 0.0001); and 4 questions correlated with dietary cholesterol intake (r = 0.57, P < 0.0001). The test-retest reliabilities of the CDFQ in predicting children's dietary intakes of total fat, SFA, and cholesterol were 0.41, 0.66, and 0.64, respectively. The criterion-based validity of the CDFQ, evaluated against 4 days of dietary records, yielded correlations of 0.54 (P < 0.0001) for total fat, 0.36 (P < 0.01) for SFA, and 0.55 (P < 0. 0001) for dietary cholesterol intake. CONCLUSIONS: The 17-item CDFQ is a brief, easy-to-use dietary assessment instrument that could be used to identify children with high, as well as low, dietary intakes of total fat, SFA, and/or cholesterol.

Child Nutritional Physiological Phenomena↗
PubMed2000

Differences between patients with heart failure treated by cardiologists, internists, family physicians, and other physicians: analysis of a large, statewide database.

BACKGROUND: The management of heart failure (HF) by cardiologists may be better than that of other physicians in that cardiologists' treatment choices more frequently conform with published guidelines and the results of clinical trials. Whether cardiologists' management of HF is more or less cost-effective is up for debate. METHODS: Information on all 1995 New York state hospital discharges assigned ICD-9-CM codes indicative of HF in the principal diagnosis position was obtained. Demographic and clinical characteristics, process of care, resource utilization, and short-term HF-related outcomes were compared between patients of cardiologists and patients of other physicians. RESULTS: A total of 44,926 patients were identified, with 10,506 (23%) receiving care from cardiologists, 28,300 (63%) from internists, 4812 (11%) from family practitioners, and 1308 (3%) from other physicians. Patients of cardiologists were younger, more frequently male, and less frequently residents of nursing homes. They were more likely to have associated cardiovascular diagnoses but less likely to have comorbid general medical conditions. Patients of cardiologists were more likely to undergo cardiac catheterization (9%) than those of internists (3%) and family practice (2%) physicians but had similar adjusted hospital length of stay and charges. Mortality and hospital readmission rates for HF were similar among the groups. Patients in the "other" group (managed mostly by surgeons) were the youngest, underwent more invasive and cardiac surgical procedures, and had the longest length of stay and highest hospital charges. CONCLUSIONS: Cardiologists' management of HF is not economically disadvantageous. The relations among physician specialty, process of care, resource utilization, and clinical outcomes require further study before rational and evidence-based health care staffing recommendations can be formulated.

Aged↗