State licenses for medical marijuana dispensaries: neighborhood-level determinants of applicant quality in Missouri

BACKGROUND

When state governments impose quotas on commercial marijuana licenses, regulatory commissions use an application process to assess the feasibility of prospective businesses. Decisions on license applications are often met with formal appeals and legal challenges from rejected applicants. Although prior research has examined substate disparities in the availability of marijuana dispensaries, less attention has been given to the quality of license applications. The present study analyzed the relationship between neighborhood-level characteristics and the quality of prospective dispensary businesses.

METHODS

During Missouri's first applicant pool for medical marijuana dispensaries in 2019, a total of 606 census tracts contained the location site of at least one dispensary applicant. Using data from the Missouri Department of Health and Senior Services and the American Community Survey, fractional and binary logistic regression models were used to estimate the relationship between census-tract characteristics and application outcomes.

RESULTS

License applications received higher evaluation scores when proposed dispensary sites were in census tracts with greater population densities and no majority in racial/ethnic composition. Census tracts with poorer socioeconomic conditions attracted a disproportionate share of low-scoring applicants from the bottom quartile of scores. These effects were stronger for certain application subsections, particularly those assessing the quality of an applicant's business plan and on-site security.

CONCLUSIONS

Some communities tend to attract prospective license holders who possess better quality resources, business practices, and industry experience. State disparities in commercial licensing requirements and application processes may lead to the inequities in legal product access found in some prior studies.

Geographic disparities and predictors of COVID-19 vaccination in Missouri: a retrospective ecological study

Background

Limited information is available on geographic disparities of COVID-19 vaccination in Missouri and yet this information is essential for guiding efforts to improve vaccination coverage. Therefore, the objectives of this study were to (a) investigate geographic disparities in the proportion of the population vaccinated against COVID-19 in Missouri and (b) identify socioeconomic and demographic predictors of the identified disparities.

Methods

The COVID-19 vaccination data for time period January 1 to December 31, 2021 were obtained from the Missouri Department of Health. County-level data on socioeconomic and demographic factors were downloaded from the 2020 American Community Survey. Proportions of county population vaccinated against COVID-19 were computed and displayed on choropleth maps. Global ordinary least square regression model and local geographically weighted regression model were used to identify predictors of proportions of COVID-19 vaccinated population.

Results

Counties located in eastern Missouri tended to have high proportions of COVID-19 vaccinated population while low proportions were observed in the southernmost part of the state. Counties with low proportions of population vaccinated against COVID-19 tended to have high percentages of Hispanic/Latino population (p = 0.046), individuals living below the poverty level (p = 0.049), and uninsured (p = 0.015) populations. The strength of association between proportion of COVID-19 vaccinated population and percentage of Hispanic/Latino population varied by geographic location.

Conclusion

The study findings confirm geographic disparities of proportions of COVID-19 vaccinated population in Missouri. Study findings are useful for guiding programs geared at improving vaccination coverage and uptake by targeting resources to areas with low proportions of vaccinated individuals.

Spatial Epidemiologic Analysis and Risk Factors for Nontuberculous Mycobacteria Infections, Missouri, USA, 2008-2019

Nontuberculous mycobacteria (NTM) infections are caused by environmental exposure. We describe spatial distribution of NTM infections and associations with sociodemographic factors and flooding in Missouri, USA. Our retrospective analysis of mycobacterial cultures reported to the Missouri Department of Health and Social Services surveillance system during January 1, 2008-December 31, 2019, detected geographic clusters of infection. Multilevel Poisson regression quantified small-area geographic variations and identified characteristics associated with risk for infection. Median county-level NTM infection rate was 66.33 (interquartile range 51-91)/100,000 persons. Risk of clustering was significantly higher in rural areas (rate ratio 2.82, 95% CI 1.90-4.19) and in counties with >5 floodings per year versus no flooding (rate ratio 1.38, 95% CI 1.26-1.52). Higher risk for NTM infection was associated with older age, rurality, and more flooding. Clinicians and public health professionals should be aware of increased risk for NTM infections, especially in similar environments.

Tarasoff in Missouri: The jurisprudence of a mental health provider's duty to warn and protect non-patients of potential risks from patients

In 1976, the Supreme Court of California issued its well-known Tarasoff Principle. From this principle, other courts found a duty to warn, and some found more than just a duty to warn, a duty to protect. As courts in other states adopted a version of the Tarasoff Principle, they issued a wide variety of third-party liability rules. In light of the dynamic, everchanging Tarasoff jurisprudence in the United States and recent relevant appellate court opinion in Missouri, a timely updated summary and update of Tarasoff-related jurisprudence in Missouri is warranted. In the present analysis, we compiled the four appellate court decisions that pertained to the questions of Tarasoff-like third-party liability in the State of Missouri: Sherrill v. Wilson (1983), Matt v. Burrell (1995), Bradley v. Ray (1995), and Virgin v. Hopewell (2001). We reviewed all legal measures for clinicians to protect nonpatients in Missouri, not just those that relate to protecting nonpatients from violence as in a Tarasof-like scenario. Thus, this paper concisely provides a compendium of such options and allows for a meaningful comparison of which legal, protective measures are mandatory and which are permissive, thereby evoking the question of whether measures of protecting nonpatients from a patient's violent acts ought to be mandatory duties or permissive application of professional judgment.

One Health Approach for Reporting Veterinary Carbapenem-Resistant Enterobacterales and Other Bacteria of Public Health Concern

A carbapenem-resistant Enterobacterales outbreak at a veterinary teaching hospital in the United States increased urgency for improved communication among diagnostic laboratories, public health authorities, veterinarians, and pet owners. Kansas State University, University of Missouri, Kansas Department of Health and Environment, and Veterinary Laboratory Investigation and Response Network created a surveillance, storage, and reporting protocol for veterinary antimicrobial-resistant bacteria; determined frequency of those bacteria in companion animals during 2018-2021; and created educational flyers for veterinarians and pet owners. We recommend a One Health strategy to create efficient surveillance programs to identify and report antimicrobial-resistant bacteria and educate veterinarians and pet owners about transmission risks.

Neutralizing Enterovirus D68 Antibodies in Children after 2014 Outbreak, Kansas City, Missouri, USA

Antibodies to B1, B2, and D clade viruses were detected.

Enterovirus D68 (EV-D68) causes severe respiratory illness outbreaks among children, particularly those with asthma. We previously detected neutralizing antibodies against the predominant EV-D68 B1 clade in the 2014 outbreak in serum collected before the outbreak (2012–2013) from persons 24 months to 85 years of age. We recently detected neutralizing antibodies to the 2014 B1, B2, and D clade viruses in serum collected after the 2014 outbreak (April–May 2017) from 300 children 6 months to 18 years of age. B1 virus neutralizing antibodies were found in 100% of patients, even children born after 2014; B2 in 84.6%, and D in 99.6%. In 2017, titers increased with patient age and were higher than titers in 2012–2013 from comparably aged children. Rate of seronegativity was highest (15.3%) for B2 virus. Multivariate analysis revealed an association between asthma and higher titers against B2 and D viruses. EV-D68 seems to have circulated during 2014–2017.

Louis Area, Missouri (USA)

Background

There is evidence of geographic disparities in COVID-19 hospitalization risks that, if identified, could guide control efforts. Therefore, the objective of this study was to investigate Zip Code Tabulation Area (ZCTA)-level geographic disparities and identify predictors of COVID-19 hospitalization risks in the St. Louis area.

Methods

Hospitalization data for COVID-19 and several chronic diseases were obtained from the Missouri Hospital Association. ZCTA-level data on socioeconomic and demographic factors were obtained from the American Community Survey. Geographic disparities in distribution of COVID-19 age-adjusted hospitalization risks, socioeconomic and demographic factors as well as chronic disease risks were investigated using choropleth maps. Predictors of ZCTA-level COVID-19 hospitalization risks were investigated using global negative binomial and local geographically weighted negative binomial models.

Results

COVID-19 hospitalization risks were significantly higher in ZCTAs with high diabetes hospitalization risks (p < 0.0001), COVID-19 risks (p < 0.0001), black population (p = 0.0416), and populations with some college education (p = 0.0005). The associations between COVID-19 hospitalization risks and the first three predictors varied by geographic location.

Conclusions

There is evidence of geographic disparities in COVID-19 hospitalization risks that are driven by differences in socioeconomic, demographic and health-related factors. The impacts of these factors vary by geographical location implying that a ‘one-size-fits-all’ approach may not be appropriate for management and control. Using both global and local models leads to a better understanding of geographic disparities. These findings are useful for informing health planning to identify geographic areas likely to have high numbers of individuals needing hospitalization as well as guiding vaccination efforts.

First Record of the Asian Longhorned Tick Haemaphysalis longicornis in Missouri

The Asian longhorned tick, Haemaphysalis longicornis, is an invasive species, originally from eastern Asia, and was first reported in the USA in New Jersey. It is now reported in several eastern states. In 2018, researchers reported H. longicornis in northwest Arkansas (Benton County). This tick species is a proven vector of livestock and human diseases, which prompted the current survey of ticks in southwest Missouri. A tick drag in Greene County, Missouri, produced 2 H. longicornis nymphs on June 9, 2021. This is the first report of this species for both the state and county.

Concentration dataset of 8 selected trace elements in cultured rainbow trout (Oncorhynchus mykiss) and dietary exposure risks in the Missouri adult population

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Concentrations of eight trace elements in O. mykiss from aquaculture.

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Only Cr, in some samples, exceeded the permissible limit.

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EWI values of analyzed trace elements were below the PTWIs.

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Arsenic was the highest contributor to non-carcinogenic risk in adult consumers.

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Cancer risk of As, Cd, Cr, and Pb in the adult population is probable.

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High intake per week of O. mykiss posed health risks to the adult risk group.

Aquaculture contributes to the global animal protein supply and the prevention of malnutrition and diet-related diseases (FAO (Food and Agriculture Organization of the United Nations); Fiorella et al., 2021). In particular, fish is a significant source of animal protein, fatty acids (e.g., docosahexaenoic acid, eicosapentaenoic acid), vitamins, and essential trace elements in the human diet. Nonetheless, fish bioaccumulates metals from their diet and habitat. This data article includes information on the concentrations of 4 essential and 4 non-essential trace elements in cultured rainbow trout (Oncorhynchus mykiss) and the human health risks through fish consumption in the adult population. Concentrations of four essential (Cr, Cu, Ni, and Zn) and four non-essential (As, Cd, Pb, and Hg) elements were quantified in ninety-one O. mykiss samples from an in-door production system. Total mercury (THg) levels in samples were determined by AAS, and other analyzed trace elements were measured by ICP-OES after microwave-assisted acid digestion. The highest concentrations of metals/metalloid (mg/kg wet weight) in fish muscle were Cr (0.44), Cu (4.21), Ni (1.01), As (0.47), Cd (0.045), Pb (0.65), THg (0.029), and Zn (6.21). The average concentrations of Cr and Pb exceeded their respective maximum limit. In most cases, median metal concentrations significantly (p < 0.05) differed across the fish size groups (small: 264–295 mm; medium: 300–395 mm; and large: 400–552 mm). The median concentrations of Cd, Zn, and THg in the large size group differed significantly (p < 0.05) between genders. The estimated weekly intake values of quantified elements from muscle were below the provisional tolerable weekly intakes. Non-carcinogenic risk assessment in adult consumers, being below one (THQ ≤ 1; and TTHQ ≤ 1), indicated an insignificant health hazard. The estimated incremental and cumulative cancer risks in the adult class through Cr, As, Ni, and Pb exposure were greater than the benchmark (10⁻⁵). Accordingly, high dietary intake of metals/metalloid from cultured O. mykiss posed a risk of carcinogenesis in the adult risk class.

Spontaneous Bacterial Peritonitis Caused by Bordetella hinzii

Although Bordetella hinzii coccobacilli is most commonly identified in respiratory tracts of birds and rodents, this organism has occasionally been isolated in human infections. We describe a case of B. hinzii spontaneous bacterial peritonitis in Missouri, USA. Whole-genome sequencing of blood and peritoneal fluid isolates confirmed B. hinzii infection.

Human health risk assessment of selected metal(loid)s via crayfish (Faxonius virilis; Procambarus acutus acutus) consumption in Missouri

Farmed crustaceans are an important component in addressing the rising animal protein demand. The present study determined the concentrations of fourteen elements (Ag, As, Be, Cd, Co, Cr, Cu, Fe, Mn, Mo, Ni, Sn, Pb, and Zn) in the edible abdominal muscle of cultured freshwater crayfish species (Faxonius virilis; Procambarus acutus acutus) from Missouri. Also, this paper describes the dietary intake and the human health risks from the consumption of crayfish muscle in the adult population. Overall, 172 animals were captured between February 2017 and January 2018 for assessment. Concentrations of metals (Ag, Be, Cd, Cu, Co, Cr, Fe, Mn, Ni, Pb, Sn, Mo, and Zn) and metalloid (As) in the muscle tissue were determined after microwave-assisted acid digestion by ICP - OES. Health indices (EDI/EWI: estimated daily/weekly intakes; THQ: target hazard quotient; TTHQ: total target hazard quotient; ILCR: incremental lifetime cancer risk; and ∑ILCR: cumulative lifetime cancer risk) were calculated and compared to thresholds. Of all samples, the highest concentrations (mg kg -1 wet weight) of metal(loid)s in muscle were Ag (0.11), As (3.15), Be (0.21), Cd (0.11), Co (0.32), Cr (1.22), Cu (107), Fe (23.0), Mn (8.54), Mo (0.62), Ni (2.65), Pb (1.76), Sn (5.91), and Zn (19.2). In both species, the average As, Cd, and Zn concentrations were below the legal limits. However, the levels of Cu, Pb, and As, in some samples, were in exceedance of the maximum levels. In both species, a significant correlation (p < 0.05) was observed between the carapace length (CL) and animal body weight (BW). In P. acutus, CL, BW, and animal total length were homogenous (p > 0.05) among the sexes. Non-parametric Kruskal-Wallis test results indicated significant differences (p < 0.05) in the levels of As, Be, and Zn in F. virilis, and Be and Cr in P. a. acutus among the genders. Significant inter-species differences (p < 0.05) were observed in the levels of Be, Ni, and Pb and the growth factors. The EDI/EWI values were below the permissible limits. THQ and TTHQ values, being below 1.0, indicated no probabilistic health risk. Regarding carcinogenic risk, only As and Ni indicated cancer risk (ILCR >10-5 and ∑ILCR >10-5) to the adult population. High metals/metalloid exposure from crayfish muscle consumption posed potential health hazards to the adult population.

Medication Adherence and Characteristics of Patients Who Spend Less on Basic Needs to Afford Medications

INTRODUCTION

Among individuals with low income, cost is a well-established barrier to medication adherence. Spending less on basic needs to pay for medication is a particularly concerning cost-coping strategy and may be associated with worse health outcomes. The aims of this study were (1) to describe the demographic and health status characteristics of those who report spending less on basic needs to pay for medication, and (2) to understand the associated psychosocial and financial challenges of these individuals.

METHODS

We administered a survey to primarily low-income adults (n = 270) in St. Louis, MO, as part of a larger study from 2016 to 2018. Logistic regression was used to model odds of reporting spending less on basic needs to pay for medication.

RESULTS

Spending less on basic needs to pay for medication was significantly more likely in individuals with fair or poor health status, greater number of chronic conditions, greater medication expenditure, and difficulty paying bills. Individuals who spent less on basic needs were less likely to be fully adherent to their medication regimen.

CONCLUSIONS

Screening for unmet basic needs and offering referrals to social safety net programs in the primary care setting may help patients achieve sustainable medication adherence.

The National Death Index as a Source of Homicide Data: A Methodological Exposition of Promises and Pitfalls for Criminologists

Criminologists largely rely on national de-identified data sources to study homicide in the United States. The National Death Index (NDI), a comprehensive and well-established database compiled by the National Center for Health Statistics, is an untapped source of homicide data that offers identifiable linkages to other data sources while retaining national coverage. This study's five aims follow. First, we review the data sources in articles published in Homicide Studies over the past decade. Second, we describe the NDI, including its origins, procedures, and uses. Third, we outline the procedures for linking a police gang intelligence database to the NDI. Fourth, we introduce the St. Louis Gang Member-Linked Mortality Files database, which is composed of 3,120 police-identified male gang members in the St. Louis area linked to NDI records. Finally, we report on preliminary cause-of-death findings. We conclude by outlining the benefits and drawbacks of the NDI as a source of homicide data for criminologists.

Relationship between insurance status and outcomes for patients with breast cancer in Missouri

BACKGROUND

The cancer stage at diagnosis, treatment delays, and breast cancer mortality vary with insurance status.

METHODS

Using the Missouri Cancer Registry, this analysis included 31,485 women diagnosed with invasive breast cancer from January 1, 2007, to December 31, 2015. Odds ratios (ORs) of a late-stage (stage III or IV) diagnosis and a treatment delay (>60 days after the diagnosis) were calculated with logistic regression. The hazard ratio (HR) of breast cancer mortality was calculated with Cox proportional hazards regression. Mediation analysis was used to quantify the individual contributions of each covariate to mortality.

RESULTS

The OR of a late-stage diagnosis was higher for patients with Medicaid (OR, 1.72; 95% confidence interval [CI], 1.56-1.91) or no insurance (OR, 2.30; 95% CI, 1.91-2.78) in comparison with privately insured patients. Medicare (OR, 1.21; 95% CI, 1.10-1.37), Medicaid (OR, 1.60; 95% CI, 1.37-1.85), and uninsured patients (OR, 1.58; 95% CI, 1.18-2.12) had higher odds of a treatment delay. The HR of breast cancer-specific mortality was significantly increased in the groups with public insurance or no insurance and decreased after sequential adjustments for sociodemographic factors (HR, 2.39; 95% CI, 1.96-2.91), tumor characteristics (HR, 1.28; 95% CI, 1.05-1.56), and treatment (HR, 1.23; 95% CI, 1.01-1.50). Late-stage diagnoses accounted for 72.5% of breast cancer mortality in the uninsured.

CONCLUSIONS

Compared with the privately insured, women with public or no insurance had a higher risk for advanced breast cancer, a >60-day treatment delay, and death from breast cancer. Particularly for the uninsured, Medicaid expansion and increased funding for education and screening programs could decrease breast cancer disparities.

Bourbon Virus in Wild and Domestic Animals, Missouri, USA, 2012-2013

Since its recent discovery, Bourbon virus has been isolated from a human and ticks. To assess exposure of potential vertebrate reservoirs, we assayed banked serum and plasma samples from wildlife and domestic animals in Missouri, USA, for Bourbon virus–neutralizing antibodies. We detected high seroprevalence in raccoons (50%) and white-tailed deer (86%).

Louis, Missouri, USA, 2016

A fall 2016 outbreak of enterovirus D68 infection in St. Louis, Missouri, USA, had less effect than a fall 2014 outbreak on hospital census, intensive care unit census, and hospitalization for a diagnosis of respiratory illness. Without ongoing surveillance and specific testing, these cases might have been missed.

Rural-Urban Trends in Opioid Overdose Discharges in Missouri Emergency Departments, 2012-2016

Purpose

Opioid overdose death rates rose 36% from 2015 to 2016 in Missouri, indicating a worsening of the opioid overdose epidemic. To better understand urban and rural differences in nonfatal opioid overdoses treated in Missouri emergency departments, this paper analyzed hospital billing data from emergency departments due to opioid overdose from 2012 to 2016.

Methods

Emergency department records meeting the opioid overdose case definition were aggregated into 6 progressively rural groups using the National Center for Health Statistics (NCHS) urban‐rural county classification from 2013. These data were analyzed to determine significant trends amongst and between the geographic groups.

Findings

Generally, the magnitude of opioid overdose morbidity decreased as levels of rurality increased, using annual percentage change as the metric of change. Over the study period, Missouri's most urban counties had significantly higher rates of opioid overdose and saw larger percentage increases in rates compared to more rural areas. Statewide, all rural‐urban classifications experienced increases in heroin overdose morbidity; however, there was extreme variation in the trajectory of those increases. Heroin overdose rates were much higher in urban areas than rural areas. Conversely, rural and urban areas saw relatively similar patterns for non‐heroin opioid overdoses, though overall magnitude of these increases was more modest across all geographic groups.

Conclusions

The results from this analysis can help inform prioritization of strategies and resources to implement activities addressing the opioid overdose epidemic. Using a rich hospital discharge database could allow for further analysis of subpopulations to enhance personalization and customization of care.

Quantifying relationships between urban land use and flow frequency of small Missouri streams

Flow frequency is an important hydrologic statistic to consider in environmental flows assessment. However, there is a paucity of focused interdisciplinary hydrologic assessments that quantify human development influence on flow frequency of small streams (drainage area < 282 km²). Relationships between urban land use and land cover (LULC) and flow frequency were assessed for general trends at current gauged watersheds (n = 32) of Missouri, USA. Urban land use - flow frequency relationships changed from linear in developed areas with <50% total impervious surfaces (i.e. low density urban areas), to non-linear in developed areas with >50% total impervious surfaces (i.e. high density urban areas). Urban land use influence on flow frequency was not detected in events below median flow (0.02510 < R² > 0.03356; n = 32). Conversely, urban land use - flow frequency relationships were relatively strong above median flow (0.55500 < R² > 0.78703; n = 32). Further, explained variance generally increased to meso-scale flows (0.58350 < R² > 0.82470; n = 32), and then, decreased during high flows (0.34912 < R² > 0.61805; n = 32). More specifically, the greatest observed influence of urban land use on flow frequency increased from a 0.2 to 1 year return period in low density urban areas, to a 1 to 2 year return period in high density urban areas in small Missouri streams. Thus, results indicate that management efforts should focus on reducing the frequency of 1 year events in low density urban land use areas, and 2 year events in high density urban areas to secure environmental services of small urban streams in Missouri, USA. These results hold important implications for other regions globally, where urban land use has increased the frequency of streamflow response.

Seasonality and trends in incidence of human ehrlichiosis in two Missouri ecoregions

Ehrlichiosis is a zoonotic illness caused by Ehrlichia pathogens transmitted by ticks. Case data from 1999 to 2015, provided by the Missouri Department of Health and Senior Services (DHSS), were used to compare the seasonality and the change in incidence over time of ehrlichiosis infection in two Missouri ecoregions, Eastern Temperate Forest (ETF) and Great Plains (GP). Although the number of cases has increased over time in both ecoregions, the rate of change was significantly faster in ETF region. There was no significant difference in seasonality of ehrlichiosis between ecoregions. In Missouri, the estimated ehrlichiosis season begins, on average, in mid-March, peaks in June, and concludes in mid-October. Our results show that the exposure and risk season for ehrlichiosis in Missouri is at least 7 months long.

Neutralizing Antibody against Enterovirus D68 in Children and Adults before 2014 Outbreak, Kansas City, Missouri, USA1

We evaluated enterovirus D68 seroprevalence in Kansas City, Missouri, USA, from samples obtained during 2012-2013. Neutralizing antibodies against Fermon and the dominant 2014 Missouri isolate were universally detected. Titers increased with age. Widespread circulation of enterovirus D68 occurred before the 2014 outbreak. Research is needed to determine a surrogate of protection.

Seroprevalence of Heartland Virus Antibodies in Blood Donors, Northwestern Missouri, USA

We estimated the seroprevalence of Heartland virus antibodies to be 0.9% (95% CI 0.4%–4.2%) in a convenience sample of blood donors from northwestern Missouri, USA, where human cases and infected ticks have been identified. Although these findings suggest that some past human infections were undetected, the estimated prevalence is low.

Influenza C Virus in Cattle with Respiratory Disease, United States, 2016-2018

We identified influenza C virus (ICV) in samples from US cattle with bovine respiratory disease through real-time PCR testing and sequencing. Bovine ICV isolates had high nucleotide identities (≈98%) with each other and were closely related to human ICV strains (≈95%). Further research is needed to determine bovine ICV's zoonotic potential.

Cluster analysis of hemorrhagic disease in Missouri's white-tailed deer population: 1980-2013

Background

Outbreaks of deer hemorrhagic disease (HD) have been documented in the USA for many decades. In the year 2012, there was a severe HD outbreak in Missouri with mortalities reaching approximately 6.9 per thousand. Moreover, Missouri accounted for more than 43% of all reported epizootic HD cases in captive white-tailed deer. Using the data of suspected HD occurrence in Missouri, the primary goal of this paper was to determine if HD in Missouri’s white-tailed deer occurs in spatial clusters.

Results

The main results of the cluster analysis are as follows. First, the spatial clusters of years 1980, 1988, 2005–2007, 2010, 2012, and 2013 suggest patterns of outbreaks every 6–8 years, with a potential outbreak in years 2018–2020. Secondly, these spatial clusters were more frequent in the central and southern counties.

Conclusions

The clustering analyses employed in this study have potential applications for improving surveillance programs and designing early warning systems for effective deer population management and potentially reducing the number of HD cases.

Bourbon Virus in Field-Collected Ticks, Missouri, USA

Bourbon virus (BRBV) was first isolated in 2014 from a resident of Bourbon County, Kansas, USA, who died of the infection. In 2015, an ill Payne County, Oklahoma, resident tested positive for antibodies to BRBV, before fully recovering. We retrospectively tested for BRBV in 39,096 ticks from northwestern Missouri, located 240 km from Bourbon County, Kansas. We detected BRBV in 3 pools of Amblyomma americanum (L.) ticks: 1 pool of male adults and 2 pools of nymphs. Detection of BRBV in A. americanum, a species that is aggressive, feeds on humans, and is abundant in Kansas and Oklahoma, supports the premise that A. americanum is a vector of BRBV to humans. BRBV has not been detected in nonhuman vertebrates, and its natural history remains largely unknown.

A Survey of Mosquitoes in Southern and Western Missouri

A survey of adult and immature mosquitoes in southern and western Missouri conducted from June 14 to September 23, 2016, yielded 32 species and 7 genera. The invasive species Aedes albopictus and Ae. japonicus were dispersed widely in the state, but the survey failed to collect any Ae. aegypti. This note discusses the impact of changes in the Missouri mosquito fauna on the risk of human disease transmission.

Improving Visualization of Female Breast Cancer Survival Estimates: Analysis Using Interactive Mapping Reports

Background

The Missouri Cancer Registry collects population-based cancer incidence data on Missouri residents diagnosed with reportable malignant neoplasms. The Missouri Cancer Registry wanted to produce data that would be of interest to lawmakers as well as public health officials at the legislative district level on breast cancer, the most common non-skin cancer among females.

Objective

The aim was to measure and interactively visualize survival data of female breast cancer cases in the Missouri Cancer Registry.

Methods

Female breast cancer data were linked to Missouri death records and the Social Security Death Index. Unlinked female breast cancer cases were crossmatched to the National Death Index. Female breast cancer cases in subcounty senate districts were geocoded using TIGER/Line shapefiles to identify their district. A database was created and analyzed in SEER*Stat. Senatorial district maps were created using US Census Bureau’s cartographic boundary files. The results were loaded with the cartographic data into InstantAtlas software to produce interactive mapping reports.

Results

Female breast cancer survival profiles of 5-year cause-specific survival percentages and 95% confidence intervals, displayed in tables and interactive maps, were created for all 34 senatorial districts. The maps visualized survival data by age, race, stage, and grade at diagnosis for the period from 2004 through 2010.

Conclusions

Linking cancer registry data to the National Death Index database improved accuracy of female breast cancer survival data in Missouri and this could positively impact cancer research and policy. The created survival mapping report could be very informative and usable by public health professionals, policy makers, at-risk women, and the public.

Genetic polymorphism of Baylisascaris procyonis in host infrapopulations and component populations in the Central USA

Baylisascaris procyonis is a nematode of significant concern to public and domestic animal health as well as wildlife management. The population genetics of B. procyonis is poorly understood. To gain insights into patterns of genetic diversity within (infrapopulation level) and among (component population level) raccoon (Procyon lotor) hosts, and specifically to assess the relative importance of indirect and direct transmission of the parasite for explaining observed population structure, we collected 69 B. procyonis from 17 wild raccoons inhabiting five counties in Missouri and Arkansas, USA. Informative regions of mitochondrial (CO1, CO2) and nuclear (28S, ITS2) genes were amplified and the distribution and genetic variability of these genes were assessed within and across raccoons. Concatenation of the CO1 and CO2 mtDNA sequences resulted in 5 unique haplotypes, with haplotype diversity 0.456 ± 0.068. The most common haplotype occurred in 94% of raccoons and 72.5% of B. procyonis. Sequences for 28S rDNA revealed four unique nuclear genotypes, the most common found in 100% of raccoons and 82.6% of B. procyonis. ITS2 genotypes were assessed using fragment analysis, and there was a 1:1 correspondence between 28S and ITS-2 genotypes. Infrapopulation variation in haplotypes and genotypes was high and virtually all hosts infected with multiple sequenced nematodes also harbored multiple haplotypes and genotypes. There was a positive relationship between the size of the analyzed infrapopulation (i.e., the number of nematodes analyzed) and the number of haplotypes identified in an individual. Collectively this work emphasizes the importance of indirect transmission in the lifecycle to this parasite.

Haemophilus influenzae Type b Invasive Disease in Amish Children, Missouri, USA, 2014

During 5 months in 2014, three Amish children in Missouri, USA, were diagnosed with invasive Haemophilus influenzae type b infection. Two were rural neighbors infected with a genetically similar rare strain, sequence type 45. One child had recently traveled, raising the possibility of maintenance of this strain among unvaccinated carriers in Amish communities.

Gestational Weight Gain in the First Two Pregnancies and Perinatal Outcomes in the Second Pregnancy

BACKGROUND

Gestational Weight Gain (GWG) below or above the Institute of Medicine (IOM) recommendations increases the risk of adverse pregnancy outcomes. However, it remains unknown whether the risk of adverse outcomes is affected by GWG in a previous pregnancy. We examined associations between GWG in the index (second) pregnancy and pregnancy outcomes, including preterm delivery and small for gestational age (SGA), while taking into consideration GWG in the first pregnancy.

METHODS

In a population-based cohort study (n = 210 564), using the Missouri maternally-linked birth registry (1989-2005), we used multivariable Poisson regression with robust error variance stratified by prepregnancy body mass index (BMI) to evaluate associations between GWG in the index pregnancy and a composite indicator of GWG in the first and second pregnancies and our outcomes of interest, after controlling for sociodemographic and pregnancy-related confounders.

RESULTS

Associations between GWG in the index pregnancy and pregnancy outcomes were moderated by GWG in the first pregnancy. Despite having GWG within recommendations in the index pregnancy, women had increased risk of preterm delivery and SGA if they had suboptimal GWG in their first pregnancy. Also, women having suboptimal GWG in the index pregnancy had increased risk of preterm delivery only if their GWG in the first pregnancy was also suboptimal.

CONCLUSIONS

The observation that women who have GWG within recommendations in a current pregnancy may still have increased risk of adverse outcomes if they had suboptimal GWG in the first pregnancy has considerable clinical and public health implications.

Decoupling biogeochemical records, extinction, and environmental change during the Cambrian SPICE event

Several positive carbon isotope excursions in Lower Paleozoic rocks, including the prominent Upper Cambrian Steptoean Positive Carbon Isotope Excursion (SPICE), are thought to reflect intermittent perturbations in the hydrosphere-biosphere system. Models explaining these secular changes are abundant, but the synchronicity and regional variation of the isotope signals are not well understood. Examination of cores across a paleodepth gradient in the Upper Cambrian central Missouri intrashelf basin (United States) reveals a time-transgressive, facies-dependent nature of the SPICE. Although the SPICE event may be a global signal, the manner in which it is recorded in rocks should and does vary as a function of facies and carbonate platform geometry. We call for a paradigm shift to better constrain facies, stratigraphic, and biostratigraphic architecture and to apply these observations to the variability in magnitude, stratigraphic extent, and timing of the SPICE signal, as well as other biogeochemical perturbations, to elucidate the complex processes driving the ocean-carbonate system.

Energy input in conventional and organic paddy rice production in Missouri and Italy: A comparative case study

The expected decline in availability of fossil fuels over the next several decades, either because of resource depletion or because of limits on carbon emissions, is leading to a keen interest in finding more sustainable energy sources. For this reason, it is useful to assess the energy footprint of alternative agricultural systems for crops and animal production and to identify potential transition scenarios to systems largely based on renewable energy. The present work aims to assess for the first time a comparative analysis of energy inputs in rice production systems in Southern Europe (Piemonte, Italy) and in North America (Missouri, USA). A total of twelve rice farms, either conventional or organic, were selected, collecting detailed data on direct (fuel and electricity) and indirect (machinery, fertilizers, pesticides, and seeds) energy inputs. While energy input of conventional farms ranged from 3.5 to 7 MJ/kg paddy rice, organic farming could reduce inputs by more than 50% with only 8% yield decrease. A significant reduction in fuel or electricity use can be achieved also with no till and surface irrigation. The use of renewable energy sources, as already practiced by some farms, could more than cover their electrical energy requirements.

Medicaid Expansion in a Litmus State: The Missouri Struggle

For a century Missouri was a bellwether state in presidential elections, always picking the winner. Since 2008 it has been experiencing a partisan divide along urban/rural lines with President Obama losing the state twice. The battle over Medicaid expansion found a Democratic governor unable to convince a Republican legislative majority to support ACA-based expansion. The more highly partisan legislative environment has rendered traditional bargaining and negotiations impossible on the controversial question of Medicaid expansion.Despite supportive advocacy by hospitals and the business community, the Republican legislative leaders have opposed any movement on Medicaid expansion over the past four years. There will be a new occupant in the governor's mansion in 2017, which may create a fork in the road. Democrats are unlikely to regain a legislative majority, and one path is continued Republican refusal to consider expansion. The other path features the new governor responding to the national 2016 election outcome, and creating the prospects for a deal, perhaps around a waiver plan.

in ticks in northeast Missouri

We evaluated Amblyomma americanum (lone star tick) and Dermacentor variabilis (American dog tick) in northeast Missouri for the presence of Borrelia, Ehrlichia, and Rickettsia bacteria. We collected actively questing ticks from four sites within Adair County, Missouri. A total of 15,162 ticks were collected, of which 13,980 were grouped in 308 pools (lone star ticks, 288 pools; American dog ticks, 20 pools) and tested for presence/absence of bacteria using polymerase chain reaction. Infection rates were calculated as the maximum likelihood estimation (MLE) with 95% confidence intervals (CI). Of the 308 pools tested, 229 (74.4%) were infected with bacteria and the overall MLE of the infection rate per 100 ticks was calculated as 2.9% (CI 2.61-3.21). Infection rates varied among life stages, 28.6% (CI 23.89-33.97) in adults, 7.0% (CI 5.10-9.86) in nymphs, and 1.0% (CI 0.75-1.20) in larvae. In the 116 adult lone star pools, infection rates were calculated for Borrelia lonestari (1.4%), Borrelia spp. (2.7%), Ehrlichia chaffeensis (6.1%), Ehrlichia ewingii (3.3%), Rickettsia amblyommii (18.3%), and Rickettsia montanensis (0.4%). Infection rates for the 52 nymphal lone star pools were calculated as B. lonestari (1.03%), Borrelia spp. (0.40%), E. chaffeensis (2.02%), E. ewingii (0.24%), and R. amblyommii (2.70%). In the 20 adult American dog tick pools, infection rates were determined as E. chaffeensis (9.47%), E. ewingii (5.47%), and R. montanensis (8.06%). Eight Borrelia samples were sequenced with five 99-100% identical to B. burgdorferi (s.l.) and three 99% identical to B. lonestari. Eight samples were sequenced for E. chaffeensis (all 99-100% identical) and one sample was sequenced for E. ewingii (99% identical). Seven samples were sequenced for Rickettsia and three were 99% identical to R. montanensis and four were 100% identical to R. amblyommii. This study demonstrates B. lonestari, E. chaffeensis, E. ewingii, R. amblyommii, and R. montanensis in northeast Missouri ticks for the first time. Understanding the presence and epidemiology of these causative (E. chaffeensis and E. ewingii) and suspected (B. lonestari and R. amblyommii) agents in Missouri should increase awareness of potential tick-borne disease in the medical community.

Influenza A Virus Surveillance in Waterfowl in Missouri, USA, 2005-2013

Missouri, United States, is located within the Mississippi Migratory Bird Flyway where wild waterfowl stop to feed and rest during migration and, weather permitting, to overwinter. Historically, Missouri has experienced sporadic influenza A virus (IAV) outbreaks in poultry and commercial swine. The introduction of IAVs from wild, migratory waterfowl is one possible source for the IAV, IAV genomic segments, or both involved in these outbreaks in key agricultural species. During 2005 through 2013, 3984 cloacal swabs were collected from hunter-harvested waterfowl in Missouri as part of an active IAV surveillance effort. Twenty-four avian species were represented in the sample population and 108 (2.7%) of the samples tested positive for IAV recovery. These IAV isolates represented 12 HA and nine NA subtypes and at least 27 distinct HA-NA combinations. An H14 IAV isolate recovered in Missouri during the sample period provided evidence for further establishment of the H14 subtype in North American wild waterfowl and gave proof that the previously rare subtype is more genetically diverse than previously detected. The present surveillance effort also produced IAV isolates that were genomically linked to the highly pathogenic H7N3 IAV strain that emerged in 2012 and caused severe disease in Mexico's domestic poultry. The presence of antigenically diverse IAV's circulating in wild waterfowl in the vicinity of commercial poultry and swine, along with the association of several wild-bird-lineage IAV genomic segments in viruses infecting poultry in North America, justifies continued attention to biosecurity efforts in food animal production systems and ongoing active IAV surveillance in wild birds.

United States. Missouri. Act of 15 July 1987

The text of this Act on artificial insemination is as follows: "1. If, under the supervision of a licensed physician and with the consent of her husband, a wife is inseminated artificially with semen donated by a man not her husband, the husband is treated in law as if he were the natural father of a child thereby conceived. The husband's consent must be in writing and signed by him and his wife. The physician shall certify their signatures and the date of the insemination, and file the husband's consent with the bureau, where it shall be kept confidential and in a sealed file. The physician's failure to comply with this section shall not affect the father and child relationship. All papers and records pertaining to the insemination, whether part of the permanent record of a court or of a file held by the supervising physician or elsewhere, are subject to inspection only upon an order of the court for good cause shown. 2. The donor of semen provided to a licensed physician for use in artificial insemination of a married woman other than the donor's wife is treated in law as if he were not the natural father of a child thereby conceived."

Reproductive Health Services v. Webster, 17 March 1987, amended on 30 April 1987

The plaintiff physicians and organizations providing abortion-related services challenged the constitutionality of provisions of a Missouri statute that a) state that life begins at conception and that unborn children have a protectable interest in life, health, and well being; b) require a physician to inform a woman seeking an abortion of certain facts; c) require all post sixteen-week abortions to be performed in a hospital; d) require certain tests to be performed in order to determine gestational age and viability; and e) prohibit the use of public funds, public employees, and public facilities for performing or assisting an abortion or encouraging or counseling an abortion except to save a woman's life. The Court ruled that all of these provisions were unconstitutional and in conflict with its previous rulings on a woman's right to obtain an abortion. In a related case the United States District Court, E.D. Missouri, E.D., held that the plaintiff physicians could not attack a statement of intent of the same law, which provides that "It is the intention of the general assembly of the state of Missouri to grant the right to life to all humans, born and unborn, and to regulate abortion to the full extent permitted by the Constitution of the United States, decisions of the United States Supreme Court, and federal statutes." See Women's Health Ctr. of West Cty. v. Webster, 24 September 1987, 670 F.Supp. 845.

Factors affecting contraceptive use in women seeking pregnancy tests: Missouri, 1997

CONTEXT

If the national health objective of reducing unintended pregnancy is to be met, a better understanding is needed of barriers to women's acquisition and use of contraceptives.

METHODS

A sample of 311 Missouri women who were seeking pregnancy tests in public health department clinics in 1997 and who said their potential pregnancy was unintended were asked about potential barriers to family planning. Factors affecting contraceptive use among these women were examined by frequency of use, insurance status, education and race.

RESULTS

In general, the women mostly disagreed that particular factors were potential barriers to contraceptive use. For only one item--worry over the potential side effects of the hormonal injectable contraceptive--did a majority agree or strongly agree that it was a barrier to method use in the previous six months. Women who used a contraceptive infrequently were more likely than frequent users to identify 33 factors in nine areas as being potential barriers to contraceptive use. These ranged from factors involving access to services and condom-specific issues to cost-related concerns, social norms, pregnancy denial, embarrassment over discussing or obtaining birth control, worry about side effects and experience with forced sex, among others. Perceived barriers differed somewhat by insurance status in the areas of access, embarrassment, side effects and forced sex. For example, women with no insurance coverage reported a higher level of agreement that transportation problems had hindered their access to a clinic than did women with private insurance. Level of education affected agreement only in the area of side effects, with more-educated women expressing greater concern about side effects than less-educated women. The respondent's race affected agreement in six areas: access, social norms, pregnancy denial, embarrassment, forced sex and other miscellaneous concerns, such as condom use and relationship issues.

CONCLUSION

Better education and improved access to and delivery of services might address several factors affecting contraceptive use that are associated with unintended pregnancy. Some barriers, however, such as those related to self-efficacy, self-esteem and fatalistic attitudes about pregnancy, would be much harder for family planning providers to resolve.

Changes in Heterodera glycines Egg Population Density in Continuous Glycine max over Four Years

Soybean cyst nematode, Heterodera glycines, is found throughout soybean production areas of the United States, but the nematode's distribution is not uniform within states, counties, and individual fields. The goal of this research was to determine the spatial pattern of H. glycines population density in a field in southeastern Missouri and whether it changed over time in the absence of management practices. Geostatistical methods were used to describe and map the distribution of H. glycines over 4 years in a soybean (Glycine max) field in southeastern Missouri. Semivariograms and kriging, an interpolation method, were used to prepare isoarithmic contour maps and associated error maps. In the field studied, fall H. glycines population density (Pf) was poorly related to density the following spring (Pi). The distribution of peak H. glycines population density within the field changed from year to year, although high densities were often detected in the same general region of the field. The patchiness of H. glycines distribution within a field was verified. Yield was not related to H. glycines egg population density at planting, indicating that unmeasured variables were also reducing yield.

Women's interest in natural family planning

BACKGROUND

In the United States, approximately 4% of women of reproductive age use natural family planning (NFP) to avoid pregnancy. It is unclear whether this low number is related to a lack of available information, women's lack of interest, or other factors. Our study examined women's interest in using NFP either to become pregnant or to avoid it.

METHODS

A questionnaire was mailed to 1500 women, aged 18 to 50, who were randomly selected from driver's license renewal records in Missouri for the year beginning July 1991 and ending June 1992.

RESULTS

Of the 747 returned questionnaires, 484 were from women who were still potentially fertile. Of these women, 22.5% indicated that they would be likely or very likely to use NFP in the future to avoid pregnancy, and 37.4% indicated that they would be likely or very likely to use NFP in the future to become pregnant. Only 2.8% were currently using a method of NFP. Past use of any method of NFP (including the outdated calendar rhythm method) to avoid pregnancy was associated with interest in future use of modern methods of NFP to avoid pregnancy. Past use of NFP to become pregnant and the possible desire for future pregnancy were associated with interest in future use of NFP to conceive.

CONCLUSIONS

Many women who are not currently using NFP indicated that they are interested in doing so in the future, either to avoid pregnancy or to conceive. Interest in future use of NFP is associated with, but not limited to, those who have previously used NFP.

Pregnancy wantedness and adverse pregnancy outcomes: differences by race and Medicaid status

The relationship between pregnancy wantedness and adverse pregnancy outcomes was studied using data from 2,828 mothers who participated in the Missouri Maternal and Infant Health Survey. The wantedness of a pregnancy was measured using traditional classifications of mistimed and unwanted, as well as additional measures gauging how the woman felt about the pregnancy while she was pregnant. Fifty-eight percent of the very low birth weight infants and 59% of the moderately low birth weight infants resulted from unintended pregnancies, as did 62% of the normal-birth-weight infants. Logistic regression showed that mothers of very low birth weight infants were significantly more likely than those who had a normal-weight baby to report that they had felt unhappy about the pregnancy (odds ratio of 1.53). Very low birth weight was also associated with early denial of the pregnancy (1.54). Odds ratios associating these two unwantedness categories with low-birth-weight babies were higher among Medicaid recipients than among women not receiving Medicaid. Associations between very low birth weight and the denial variable were also significant among white women when very low birth weight outcomes were compared with normal outcomes, but there was no significant association among black women. There were no significant associations between low birth weight and the traditional unwantedness variables.

Adolescent age at first pregnancy and subsequent obesity

Adolescent pregnancy has been associated with subsequent obesity. This paper examines the patterns of obesity for second and third pregnancies among women who had their first singleton pregnancy as teenagers. We used maternally-linked data from 1978 to 1990 among 43,160 Missouri resident women. Age, parity, interpregnancy interval and prior body mass index were significantly associated with subsequent obesity among adolescents. Race, marital status and smoking had significant interactions with age. Among older women, being African-American and never having married was associated with an increased probability of obesity, and smoking had a greater effect on obesity at higher maternal age. Race and marital status did not have significant effects on obesity among younger women. The most important predictor of obesity was prior body mass index. Body mass index before the first pregnancy had a greater effect on subsequent obesity if the intervening interpregnancy weight gains were large. Excessive weight gain during pregnancy presents the health care provider with a dilemma. An increase in birthweight associated with high prenatal weight gains may diminish the risk of infant mortality and morbidity in an index pregnancy, but subsequent obesity may increase perinatal mortality rates, the rates of obstetric problems and neural tube defects.

Zinc acetate and lyophilized aloe barbadensis as vaginal contraceptive

Twenty samples of fresh ejaculate, donated by healthy volunteers ranging in age from 20-30 years, were obtained from the Center for Fertility & Cryobiology, University of Missouri, Columbia, Missouri. Average semen volume was 2.49 ml; average sperm motility was 71.32%; and average sperm density was 113.71 x 10(6) /ml. Testing for spermicidal effectiveness of a 1% concentration of zinc acetate, zinc sulfate, zinc chloride, and zinc gluconate proved that only zinc acetate was spermicidal. It appears this is due to the acetate in zinc acetate which may decrease oxygen utilization by sperm. Zinc acetate in vitro was antiviral while lyophilized aloe barbadensis was not. Lyophilized aloe barbadensis at concentrations of 7.5% and 10% proved to be spermicidal due to the multiple micro elements (boron, barium, calcium, chromium, copper, iron, potassium, magnesium, manganese, phosphorus, and zinc) which were toxic to the tail causing instant immobilization. The two compounds did not irritate or cause ulceration of rabbit vaginal epithelium. These results suggest the possibility of using zinc acetate and lyophilized aloe barbadensis as a new, effective and safe vaginal contraceptive.

Interest in natural family planning among female family practice patients

OBJECTIVE

Although modern methods of natural family planning (NFP) are effective both to avoid and to achieve pregnancy, relatively few women use these methods. It is not known whether this is due primarily to lack of interest or to other factors. We therefore explored the level of interest in NFP among female family practice patients.

METHODS

We mailed information about NFP to 400 female patients between ages 21 and 42 and conducted follow-up interviews by telephone. We excluded 162 women for whom we could not obtain accurate addresses or phone numbers, 68 women we could not reach by telephone, 67 women who were not currently at risk of pregnancy, and 15 women for other reasons. Twenty-eight women refused to participate in the study. Sixty women completed telephone interviews.

RESULTS

Forty-three percent of respondents (n = 60) were interested in learning more about NFP, 24% said they were likely to use NFP to avoid pregnancy, and 32% were likely to use NFP to achieve pregnancy. Younger women and women who were Christian but not Catholic and not of a major Protestant denomination were more interested in NFP.

CONCLUSION

Some female family practice patients are interested in learning and using NFP.