Interprofessional Code of Cooperation between the Tennessee Bar Association and the Tennessee Medical Association.
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Confidentiality↗
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Evaluation of the Tennessee Child Restraint Law.
In Tennessee a law came into force January 1, 1978 requiring parents to use child restraints properly when transporting their children who are less than four years old. Alternatively, the law permits children to be held in arms, a practice known to be hazardous rather than protective. Before and after the law went into force, observations were made of children in cars exiting from shopping centers in Knoxville and Nashville, Tennessee, and in Lexington and Louisville, Kentucky, an adjacent state not having a child restraint law. More than 80 per cent of Tennessee children observed in the fourth month the law was in force were not using child restraints anchored by seat belts, although use rates increased in Tennessee (8 to 16 per cent) to a greater extent than in Kentucky (11 to 15 per cent). Moreover, due to a large increase in children traveling in arms in Nashville, there was an increase in such travel in the two Tennessee cities studied (23 to 28 per cent) relative to a decrease in those studied in Kentucky (19 to 14 per cent).
Child Welfare↗
Dental caries and sealant prevalences in schoolchildren in Tennessee.
This article presents findings on the prevalence of dental caries and dental sealants from the 1988 oral health survey of schoolchildren in Tennessee. The purpose of the study was to describe the prevalence of dental caries, dental sealants, and periodontal disease, as well as the need for restorative, exodontia, and periodontal treatment among schoolchildren. A multistage probability sample was designed to represent 927,000 children enrolled in grades K-12 in public and private schools across the state. Analyses of the data collected from the examination of 2,588 children aged 5-17 revealed that 55 percent were caries free in their permanent dentition and that the mean DMFS score was 2.86. For those aged 5-9, the mean dfs score was estimated to be 5.52. Only 10 percent of schoolchildren in Tennessee had dental sealants on their teeth. Comparisons of the results of this survey with those reported from earlier state surveys indicated that caries levels have declined steadily. We assumed that the reduction in caries experience observed in Tennessee is the result of widespread exposure of children to systemic and topical fluorides. Further reduction in caries experience is possible with continued fluoridation of community water supplies, in conjunction with increased utilization of pit and fissure sealants.
Adolescent↗
New host of Ixodes dentatus (Acari: Ixodidae), and first record in Tennessee.
Two specimens of Ixodes dentatus Marx were found in southwestern Tennessee in Shelby County during a 14-mo tick survey. This was the first record for this tick in Tennessee. An adult female was found on a dry ice trap and one larva was found on a live-trapped Peromyscus leucopus, the first time this tick has been reported from P. leucopus. This may be another combination of vector and host in the ecology and transmission of B. burgdorferi in the wild.
Animals↗
Medicaid records as a valid data source: the Tennessee experience.
Health care researchers rarely employ Medicaid claim files as a data base, in part because they are designed to serve fiscal and administrative ends. Indeed, some investigators have emphasized the deficiencies in such records. In contrast, we have found Tennessee Medicaid data to be suitable for research. A statewide automated data processing system reduces the occurrence of many of the errors noted by others. Further, analysis of the July 1974 month of payment file illustrates the accuracy and internal consistency of Tennessee Medicaid data. Specimen legend drug results for ambulatory patients suggest investigations of physician prescribing patterns. Evaluation of the Medicaid claims processing system suggests other applications in health care administration and research. In a time when available resources are dwindling, the incisive use of Medicaid claims files offers an attractive alternative to expensive new systems of data collection and analysis.
Aged↗
Sex-Specific Diagnostic Inequality in Fabry Disease: Lessons Learned from Analysis of Newborn Screening and Cascade Testing in Tennessee from 2017 to 2024.
INTRODUCTION: Fabry disease (FD) is an X-linked lysosomal storage disease caused by alpha-galactosidase A (aGAL) deficiency. Newborn screening (NBS) programs for FD have been implemented in several US states; however, its effectiveness in identifying affected females remains uncertain. We hypothesized that sex-specific inequality of NBS-based detection of FD results in different diagnostic pathways for males and females with FD. METHODS: We compared diagnostic approaches for males and females with FD using Tennessee NBS results and Vanderbilt Lysosomal Storage Disorders Database (VLSDD). Sex-specific detection differences were assessed using Fisher's exact test (α = 0.05). RESULTS: Tennessee NBS identified 25 males but no females with FD from 2017 to 2024. In VLSDD, among 81 individuals with FD, sex distribution was nearly equal (42 males, 39 females). Among males, 26/42 (62%) were diagnosed via NBS, 7/42 (17%) through known family history, and 9/42 (21%) based on clinical symptoms. All 16 males diagnosed through non-NBS were born before its implementation. In contrast, none of the 39 females were diagnosed through NBS (p value <0.05). Of these, 13/39 (33%) were diagnosed through cascade testing following their sons' detection by NBS, with a median age at diagnosis of 28 years (25th-75th percentile: 24.5-34.0). Of the remaining 26 females, 12/26 (46%) were diagnosed after a family member was diagnosed through clinical symptoms and 14/26 (54%) were diagnosed through clinical symptoms. CONCLUSIONS: NBS effectively identifies affected males but fails to detect females with FD, though it can indirectly facilitate diagnosis of older female relatives.
Humans↗
Chlorinated hydrocarbon insecticide residues in Tennessee honey and beeswax.
Several samples of commercial grade honey collected from different parts of tennessee during the summer of 1973 were analyzed for chlorinated hydrocarbon insecticide (CHI) residues. A "Modified Mill's Procedure" was used to cleanup the samples prior to gas chromatographic analysis using electron capture (EC) detection. The presence of CHI residues was confirmed by analysis on three different columns of widely varying polarity. Most of the samples contained CHI residues at 0.01-0.30 parts per billion (ppb) level. Beeswax produced during the same season contained several times higher levels of the residue than the honey samples. Recoveries of CHI residues varied from 81-95 percent by the procedure employed.
Bees↗
Investigation of a Mycobacterium fortuitum prosthetic joint infection outbreak at two ambulatory surgery centers in Tennessee.
OBJECTIVE: This study outlines the investigation into an outbreak of Mycobacterium fortuitum infections involving 17 cases undergoing hip or knee surgeries at two ambulatory surgery centers (ASCs) in Tennessee from January 2023 to November 2024. Notably, the outbreak could not be attributed to contaminated water sources, which are typically associated with non-tuberculous mycobacteria (NTM) outbreaks, presenting a unique challenge. METHODS: Outbreak investigation steps included Infection Prevention (IP) assessments, case-control study, environmental sampling, whole genome sequencing, and a healthcare personnel (HCP) exposure questionnaire. RESULTS: IP assessment highlighted several concerns, including no formal facility water management program (WMP), a lack of dedicated IP personnel and certified sterile processing staff, the absence of a formalized system for tracking surgical site infections, and a notable gap in understanding the requirements for reporting diseases. The case-control findings revealed a significant association between the presence of a surgical technologist in the operating room during the procedures and the occurrence of NTM infections, indicated by an odds ratio of 55.77 (95% CI [3.16-985.44]; P = 0.0097). Thirteen clinical isolates collected at one ASC and three additional isolates collected at a second ASC were highly related by whole genome sequencing. CONCLUSION: The study further elucidates valuable insights gained from the outbreak response, including the gaps in surveillance within the ambulatory surgical setting and systematic collection of cultures from environmental sources. It emphasizes the importance of thorough vetting, onboarding, continuing education, and practice monitoring for HCP.
Humans↗
Lead levels in human deciduous teeth in Tennessee.
Deciduous teeth were analyzed by atomic absorption spectroscopy for lead content to ascertain the extent of lead exposure in certain areas in Tennessee. The data were analyzed to clarify the relationships between tooth lead content and race, sex, age, tooth type, economic status, and place of residence. Results indicated that blacks had slightly higher lead concentrations than whites; however, the age and sex of the person or the type of tooth analyzed had little effect upon the lead content. The major factors were shown to be economic status and, indirectly, place of residence.
Black or African American↗
So-called accidental firearm fatalities in children and teenagers in Tennessee, 1961-1988.
Tennessee State medical examiner reports of firearm fatalities classified as accidents involving victims aged 19 year or less from 1961 through 1988, were reviewed to evaluate circumstantial and contributing factors. A total of 225 were analyzed. The peak age for victims was 17 years, and there were more than five times more male than female victims. In Shelby County (Memphis), the racial distribution of fatalities was approximately that of the general population. Playing with a gun was the most frequent circumstance. The person responsible for pulling the trigger was equally likely to be a friend, a family member, or the victim. Head or neck were injured in most cases. The urban mortality rate was nearly twice that of the rural rate. More than half of the deaths in urban counties occurred indoors and involved handguns, whereas in rural counties only a third were due to handguns and the location was more often outdoors. Deaths in rural counties showed a seasonal variation that corresponded with the hunting season; by contrast, a peak in early summer was noted in the urban deaths. Defective guns or guns unsafe in design caused several deaths. (Semiautomatic pistols, which can be fired after unloading the ammunition magazine, are conspicuous examples of guns unsafe in design.) An important observation of this study is that medical examiners vary considerably in their classification of accidental manner, particularly when children are involved. Furthermore, medical examiner reports need to include much more information than is currently recorded if they are to be useful in guiding public policy to reduce firearm injuries.
Accidents↗
St. Louis encephalitis in Memphis-Shelby County, Tennessee, 1975: epidemiologic aspects of human cases.
An epidemic of St. Louis encephalitis (SLE) occurred in Memphis-Shelby County, Tennessee, in the summer of 1975, as part of an outbreak involving large portions of the Eastern United States. A total of 187 suspected cases were reported, of which 62 were laboratory-confirmed or presumptive SLE. The overall attack rate was 8.1/100,000; rates were higher in lower socioeconomic districts. The case fatality rate was 19.4%. Climatologic data and related factors favoring the occurrence of this outbreak are discussed.
Acute Disease↗
Increased incidence of syphilis in Tennessee during the 1980s: challenges for a new decade.
Although recent increases in the incidence of syphilis are well known to public health officials, the general medical community is less well informed regarding the dramatic rise in cases. We present trend data from Nashville and Tennessee over the past decade. These statistics emphasize specific factors, such as drug abuse, that contribute to new difficulties in controlling this sexually transmitted disease.
Contact Tracing↗
Dimensionality of the perceived self: the Tennessee Self Concept Scale.
The 12 indices of self-perception in the Tennessee Self Concept Scale, together with the Eysenck Personality Inventory, were factor analysed using data obtained from psychiatric day-care patients (n = 131). Separate item- and scale-level factor analyses revealed that: (1) the five external and three internal domains of self-concept, hypothesized as distinct, may be accurately viewed as lying in one-dimensional space; (2) the conflict, variability and distribution scores are unrelated to subtype of self-esteem; (3) extraversion and neuroticism form a bipolar factor that is orthogonal to self-concept; and (4) the emergence of 30 item-factors with a 30 per cent factorial overlap implies a good deal of spuriously shared variance, low inter-scale homogeneity and sizable redundancy in the TSCS scales. Owing to these results, the construct and factorial validity of the TSCS is seriously questioned. It is suggested that future researchers develop more sensitive, treatment-oriented (or idiographic) measures to compare man's less conspicuous and more private 'self-image feelings and cognitions' against his public self-disclosure in the interests of facilitating more rapid behavioural change.
Adolescent↗
Serosurvey of dogs for Brucella canis infection in Memphis, Tennessee.
Following occurrence of a rare case of human Brucella canis in Memphis, Tennessee, the free roaming and confined dog populations of that community and a similar geographical location were surveyed for B canis positivity to identify the foci of infection and to compare positivity rates. Three hundred and two dogs were sampled. Positivity was found only in free roaming dogs in both communities. It is concluded that presence of B canis positivity in free roaming dogs may pose an additional medical threat to communities, thus providing one more sound reason for controlling strays and confining dogs.
Animals↗
Prescribing of chloramphenicol in ambulatory practice. An epidemiologic study among Tennessee Medicaid recipients.
During the 1-year period from July 1973 through June 1974, 1761 chloramphenicol prescriptions were written for 992 outpatients in the Tennessee Medicaid program. Sxi percent (250 of 3409) of participating physicians prescribed chloramphenicol; 20 physicians wrote 55% of the prescription. Both family practice and rural location were independently associated with increased rates of prescribing chloramphenicol for outpatients. Among rural family practitioners, 21% prescribed chloramphenicol. Physicians graduating since 1955 were as likely to have prescribed chloramphenicol as were earlier graduates. Almost half the adult patients received 6 grams or less, while 2 received more than 250 grams. Approximately half of the prescriptions were for treatment of upper respiratory infections. Most prescriptions were interdicted by good medical practice. Analysis of the prescribing of chloramphenicol (and perhaps other drugs) in ambulatory practice will help identify those physicians most in need or remedial medical education.
Adolescent↗
Legionnaires' disease in Kingport, Tennessee.
In August and September 1977 a discrete cluster of 27 serologically or pathologically confirmed cases of Legionnaires' disease, plus six highly presumptive cases were identified in the area of Kingsport, Tennessee. Three patients died. Most patients manifested severe pneumonia and fever; no mild or asymptomatic disease forms were recognized despite intensive case-finding efforts. Illness was epidemiologically associated with residing, visiting, or working in one geographic area of Kingsport, residence there being the factor most strongly associated. Although the attack rate for area residents was 0.64%, the randomly determined prevalence of serologic reactors was 5.2%, which is not significantly different from that in a nonimplicated control neighborhood. The epidemic did not correlate temporally with any identified environmental or demographic event. No source of the bacterium was found either by a detailed case-control study of area associations or by bacterial isolation from sentinel guinea pigs or environmental specimens. There was no evidence of person-to-person spread.
Disease Outbreaks↗
Lead exposure and recovery rates of black ducks banded in Tennessee.
American black ducks (Anas rubripes) wintering in Tennessee during 1986 to 1988 were tested for exposure to lead. Twelve percent of the birds had blood lead concentrations exceeding 0.2 ppm. Significant differences in the prevalence of lead exposure were found for adults (14.4%) and juveniles (8.2%). Exposed birds had higher blood lead concentrations at one study site, corresponding with a lower survival index.
Age Factors↗
Human psittacosis linked to a bird distributor in Mississippi--Massachusetts and Tennessee, 1992.
During April-May 1992, CDC was notified of a possible outbreak of psittacosis involving members of two families in Massachusetts and Tennessee who had recently purchased birds as pets. In the subsequent investigation of this problem, human psittacosis was defined as a fourfold rise in complement-fixing antibody titer to > or = 32 or a single titer of > or = 32 in a patient with fever and/or respiratory symptoms. This report summarizes the investigation of this problem.
Adult↗