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Biomedical subjects

T F Jones

Publications and source records attributed to T F Jones.

At least 19 recordsLinked to original sources
PubMed2001

Miniature chest radiograph screening for tuberculosis in jails: a cost-effectiveness analysis.

Jails are an important reservoir of tuberculosis infection in the United States. Screening for active disease in these high-risk settings is difficult. We used decision analysis to assess the cost effectiveness of routine miniature chest radiography for screening for tuberculosis on admission to jail. Infection rates, probabilities, and costs associated with detecting and treating tuberculosis were derived from published studies. We calculated an average total cost of $6.60 per inmate for routine radiograph screening on admission to jail. The cost of screening for active tuberculosis with miniature chest radiography was estimated to be $9,600 per case identified, compared with $32,100 per case with tuberculin skin testing and $54,100 per case with symptom screening. Chest radiography would also identify substantially more cases than other methods of screening. Screening for tuberculosis with miniature chest radiography is cost effective even under a wide range of assumptions regarding risk factors and prevalence of disease. Miniature chest radiography should be strongly considered as an important tool in the fight to eliminate tuberculosis from the high-risk populations that may be reached through screening in jails.

Cost-Benefit Analysis↗
PubMed2000

Mass psychogenic illness: role of the individual physician.

Mass psychogenic illness is characterized by symptoms, occurring among a group of persons with shared beliefs regarding those symptoms, that suggest organic illness but have no identifiable environmental cause and little clinical or laboratory evidence of disease. Mass psychogenic illness typically affects adolescents or children, groups under stress and females disproportionately more than males. Symptoms often follow an environmental trigger or illness in an index case. They can spread rapidly by apparent visual transmission, may be aggravated by a prominent emergency or media response, and frequently resolve after patients are separated from each other and removed from the environment in which the outbreak began. Physicians should consider this diagnosis when faced with a cluster of unexplained acute illness.

Acute Disease↗
PubMed2000

Mass psychogenic illness attributed to toxic exposure at a high school.

BACKGROUND AND METHODS: Mass psychogenic illness may be difficult to differentiate from illness caused by bioterrorism, rapidly spreading infection, or toxic substances. We investigated symptoms attributed to exposure to toxic gas at a high school in Tennessee. In November 1998, a teacher noticed a 'gasoline-like' smell in her classroom, and soon thereafter she had a headache, nausea, shortness of breath, and dizziness. The school was evacuated, and 80 students and 19 staff members went to the emergency room at the local hospital; 38 persons were hospitalized overnight. Five days later, after the school had reopened, another 71 persons went to the emergency room. An extensive investigation was performed by several government agencies. RESULTS: We were unable to find a medical or environmental explanation for the reported illnesses. The persons who reported symptoms on the first day came from 36 classrooms scattered throughout the school. The most frequent symptoms (in this group and the group of people who reported symptoms five days later) were headache, dizziness, nausea, and drowsiness. Blood and urine specimens showed no evidence of carbon monoxide, volatile organic compounds, pesticides, polychlorinated biphenyls, paraquat, or mercury. There was no evidence of toxic compounds in the environment. A questionnaire administered a month later showed that the reported symptoms were significantly associated with female sex, seeing another ill person, knowing that a classmate was ill, and reporting an unusual odor at the school. CONCLUSIONS: The illness attributed to toxic exposure had features of mass psychogenic illness - notably, widespread subjective symptoms thought to be associated with environmental exposure to a toxic substance in the absence of objective evidence of an environmental cause. Alleviation of the anxiety surrounding an episode of mass psychogenic illness requires prompt recognition and a detailed investigation.

Disease Outbreaks↗
PubMed2000

Serological survey and active surveillance for La Crosse virus infections among children in Tennessee.

In 1998 and 1999, we performed a serosurvey and active surveillance for La Crosse encephalitis at a children's hospital in eastern Tennessee. Fifteen cases of La Crosse encephalitis were confirmed. Only 5 (0.5%) of 1000 serum samples being tested at the state laboratory for other diseases had evidence of antibodies to La Crosse virus. These findings suggest that La Crosse virus is newly endemic to eastern Tennessee.

Adolescent↗
PubMed2000

The Tennessee Foodborne Illness Surveillance Network (FoodNet).

Participation in FoodNet allows the Tennessee Department of Health to contribute to cutting-edge developments in monitoring and responding to foodborne illness in our own state and nationally. Tennessee-specific data on foodborne and other reportable diseases is available via the internet, by going to http://www.state.tn.us/health/, selecting "Programs and Services," then "Communicable Diseases," and then "Statistics." More information on the FoodNet program is available at: www.cdc.gov/ncidod/dbmd/foodnet or by calling the Tennessee FoodNet Program at (615) 741-7247.

Food Microbiology↗
PubMed1999

Transmission of tuberculosis in a jail.

BACKGROUND: Outbreaks of tuberculosis are uncommonly recognized in jails. In 1996, an increase in active tuberculosis cases was noted among inmates of a large urban jail. OBJECTIVES: To determine the source and extent of a tuberculosis outbreak in an urban jail and to recommend control measures. DESIGN: Retrospective cohort study. SETTING: Urban jail. PATIENTS: Inmates and guards with tuberculosis. INTERVENTION: Outbreak evaluation and control. MEASUREMENTS: Medical records of inmates and guards with tuberculosis were reviewed, and inmates were interviewed. DNA fingerprinting was performed on Mycobacterium tuberculosis isolates. RESULTS: From 1 January 1995 through 31 December 1997, active tuberculosis was diagnosed in 38 inmates and 5 guards from the jail. Nineteen (79%) of the 24 culture-positive inmates had isolates with DNA fingerprints matching those of other inmates. Isolates from both culture-positive guards matched the predominant inmate strain; only 6 (14%) of 43 isolates from infected persons in the community had this pattern. The median length of incarceration of all inmates in the jail was 1 day; the median length of continuous incarceration before diagnosis of tuberculosis in inmates was 138 days. Inmates with tuberculosis had been incarcerated a median of 15 times. Forty-three percent of persons in this city with tuberculosis diagnosed from January 1995 through July 1997 had been incarcerated in the jail at some time before diagnosis. CONCLUSIONS: Traditional and molecular epidemiologic investigations suggest that tuberculosis was transmitted among inmates and guards in an urban jail. Aggressive measures to screen for active tuberculosis upon incarceration are important for preventing spread of disease in jails and to the surrounding community.

Cohort Studies↗
PubMed1999

Newly recognized focus of La Crosse encephalitis in Tennessee.

La Crosse virus is a mosquito-borne arbovirus that causes encephalitis in children. Only nine cases were reported in Tennessee during the 33-year period from 1964-1996. We investigated a cluster of La Crosse encephalitis cases in eastern Tennessee in 1997. Medical records of all suspected cases of La Crosse virus infection at a pediatric referral hospital were reviewed, and surveillance was enhanced in the region. Previous unreported cases were identified by surveying 20 hospitals in the surrounding 16 counties. Mosquito eggs were collected from five sites. Ten cases of La Crosse encephalitis were serologically confirmed. None of the patients had been discharged from hospitals in the region with diagnosed La Crosse encephalitis in the preceding 5 years. Aedes triseriatus and Aedes albopictus were collected at the case sites; none of the mosquitos had detectable La Crosse virus. This cluster may represent an extension of a recently identified endemic focus of La Crosse virus infection in West Virginia.

Adolescent↗
PubMed1999

Family cluster of Rocky Mountain spotted fever.

Soon after a patient from Tennessee died of Rocky Mountain spotted fever (RMSF), several family members developed symptoms suggestive of the disease and were treated presumptively for RMSF. Fifty-four persons visiting the index patient's home were interviewed; serum samples were collected from 35. Three additional cases of RMSF were confirmed, all of which occurred in first-degree relatives. Time spent at the family home and going into the surrounding woods were significantly associated with developing antibodies to Rickettsia rickettsii. Ticks were collected and examined for rickettsiae by polymerase chain reaction analysis. Because hyperendemic foci and family clusters of RMSF can occur, when a case is suspected clinicians should be vigilant for signs and symptoms consistent with R. rickettsii infection in other persons who may have been similarly exposed.

Antibodies, Bacterial↗
PubMed1999

Reliability of foot trajectory measures within and between testing sessions.

BACKGROUND: Impaired control of foot trajectory during the swing phase of gait is hypothesized to increase the risk of slipping or tripping. Before assessing the predictive validity of foot trajectory measures with respect to incidence of falls, it is necessary to establish their reliability. The purpose of this study is to assess within- and between-session reliability of foot trajectory measures and traditional temporal-distance measures in healthy elderly women during gait. METHODS: Sixteen healthy, elderly women (ages 65-79 years) completed six sets of five trials each of natural and fast cadence gait during a 3.5-hour period on each of 4 days. An optoelectric motion analysis system and heel switches were used to obtain both foot trajectory (minimum toe clearance during swing, vertical, and horizontal heel contact velocities) and temporal-distance measures (step width, cadence, velocity, stride length, and time). RESULTS: Within-session test-retest reliability of all variables at natural and fast speeds was good to excellent, with intraclass correlation coefficients (ICCs) of greater than 0.9 for all but one measure (fast cadence stride time). ICCs for between-session test-retest reliability were slightly lower, but still greater than 0.9 for all but two measures (fast cadence stride time and natural cadence vertical heel contact velocity). Heel contact velocities quantified at the instant of heel contact correlated strongly with values obtained by averaging over the last 2% of the gait cycle. DISCUSSION: The good to excellent within- and between-session reliability of these foot trajectory measures supports their use as a possible means of assessing subtle changes in gait motor control. Confirmation of an association between alterations in foot trajectory measures and incidence of falls awaits further study.

Aged↗
PubMed1997

The cost of outpatient training of residents in a community health center.

BACKGROUND: The system of paying for graduate medical education is undergoing reform. As financing changes, understanding the costs of training family practice residents in the outpatient setting will be critical. METHODS: A financial model was used to analyze retrospective data from an existing residency and community health center linkage in Utah. Data from 1994 were used to estimate fixed and variable costs and income associated with the training program. The net cost of training residents was determined, as well as the cost of replacing their services with staff physicians. RESULTS: This outpatient program generated an average of $1,933 per resident in annual revenues above expenses. If staff physicians replaced residents in providing the same services, the health center would have generated an additional $5,033 per resident in income. If precepting faculty were paid rather than volunteer, the program would cost $7,912 per resident per year. Under baseline assumptions, an educational supplement of $9.52 per patient would be required for the residents to break even relative to staff physicians. CONCLUSIONS: Graduate medical education reform will need to include provisions for reimbursing host facilities for the increased cost of outpatient care provided by residents.

Ambulatory Care↗
PubMed1995

Analysis of the cost of training residents in a community health center.

BACKGROUND: Currently one federal program funds community health centers (CHCs) to provide services in underserved communities, and a second supports development of primary care teaching programs. Teaching CHCs respond to both program's goals, but their development is hindered by restrictive regulations of the two programs and lack of information regarding cost. METHOD: Spreadsheet software was used to develop a model that allocates cost components of a CHC-based residency. Productivity and staffing data from a teaching CHC program were used to estimate the cost of training and its sensitivity to selected variables. Data from 1992 through 1994 were collected from the family practice residency sponsored by the Brown University School of Medicine, the Memorial Hospital of Rhode Island, and the Blackstone Valley Community Health Center. RESULTS: An educational supplement of $13.21 per visit would be required for the program to be cost-neutral relative to staff. The cost of outpatient training for a resident averaged $13,935 per year. Residents would "break even" if they saw patients at 19% above the average rate recommended by the residency review committee. If staff physicians instead of residents had provided the patient care, the CHC would have saved $6,171 per resident. Additional savings from improved physician recruiting and decreased turnover would increase the value of the program to the CHC. Cost was most sensitive to resident productivity, precepting arrangements, nursing staff support, and staff turnover. CONCLUSION: Developing graduate medical education programs in CHCs can be a cost-effective way of increasing the pool of appropriately trained primary care physicians and increasing health care access for underserved populations. If teaching CHCs are to expand, provisions will need to be made for adequate reimbursement of their costs.

Community Health Centers↗
PubMed1995

Exercise prescription.

Exercise can increase longevity and improve overall health and quality of life. Since a large proportion of Americans have a sedentary lifestyle, exercise counseling should be a part of routine health maintenance. Physicians need to provide patients with information about the specific benefits of exercise and motivate them to increase their physical activity. Physicians should encourage all adults, including those who elect not to participate in a formal exercise program, to accumulate 30 minutes or more of moderate-intensity physical activity on most days of the week. Before beginning an exercise program, selected higher risk patients may need to be evaluated with a physical examination and a treadmill test. Many patients benefit from a preexercise determination of fitness and specific instructions for monitoring their heart rate to maintain exercise within appropriate target ranges. A formal exercise prescription should include specific advice about the type, frequency, intensity, duration and progression of physical activity. Once an exercise regimen has begun, injury prevention and adherence to the program become important.

Algorithms↗
PubMed1994

Cost-benefit analysis of walking to prevent coronary heart disease.

OBJECTIVE: To quantify the cost-benefit relationship of walking to prevent coronary heart disease. DESIGN: Cost-benefit analysis. PARTICIPANTS: Hypothetical cohorts of sedentary men and women aged 35 to 74 years. MAIN OUTCOME MEASURES: Decision-analysis simulation was used to evaluate the cost-benefit relationship of walking, varying level of benefit from exercise, frequency of exercise to achieve benefit, participation rates, and costs of exercise and injury. RESULTS: At a relative risk of 1.9 for heart disease associated with sedentary behavior, $5.6 billion would be saved annually if 10% of adults began a regular walking program. A $4.3 billion savings is predicted if the entire sedentary population began walking regularly and the cost of the time an individual spends exercising is accounted for in those who dislike exercising. According to our baseline assumptions, walking is economically beneficial for men aged 35 to 64 years and for women aged 55 to 64 years. The threshold of relative risk at which economic benefit is found for walking in this population overall is estimated at 1.7, and under a volunteer model, most adults would benefit even at a relative risk of 1.15. CONCLUSIONS: There are significant sex and age differences in the economic benefits of walking to prevent heart disease. The value assigned to the time an individual spends exercising has a significant impact on the results. Overall, a substantial savings is predicted from encouraging sedentary individuals to participate in a regular walking program.

Adult↗