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PubMed2001

Practice-based research: the Oregon experience.

BACKGROUND: Practice-based research links community-based physicians and their patients with investigators at academic institutions. In 1992, Western States Chiropractic College developed an infrastructure, the Center for Outcomes Studies, to support practice-based research. The Low Back Pain Study, undertaken in collaboration with Oregon Health Sciences University, 111 medical physicians, and 60 chiropractors, relied on the Center for Outcomes Studies infrastructure for support in project implementation and maintenance. RESULTS: Challenges, many of them critical, were a regular occurrence: dealing with unforeseen obstacles, establishing and maintaining physician buy-in, establishing and maintaining staff buy-in, implementing the protocol as directed and with minimal intrusiveness, maintaining enthusiasm for the project over time, and knowing where (and where not) to allocate the Study's time, energy, and money. Strategies were developed to overcome or minimize the impact of problems on a case-by-case basis. CONCLUSIONS: Successful practice-based research requires an awareness of study design issues and an appreciation of clinical practice logistics and priorities. Every effort must be made to include doctors and office staff in the implementation of the study in a manner that minimizes the study's intrusiveness and its economic impact on office organization, routine, and personnel. Investigators must understand and accept that there will be areas of the research environment over which they have no direct control. The challenges will be many, but they will be diminished by the rewards.

Algorithms↗
PubMed1992

Oregon Hospice Association: statewide data set.

The Oregon Hospice Association (OHA) has developed a statewide data set on persons who die while receiving hospice services. The work to date is described, including the development and refinement of data collection forms, and selected results from 1989 and 1990. Although the data set is limited, the information generated does provide OHA staff and board members, and hospice programs in the state, baseline information to use with legislators, funding sources, and the media.

Adolescent↗
PubMedDate not supplied

A critical analysis of criticisms of the Oregon Death with Dignity Act.

This article critically examines the validity of common criticisms of the Oregon Death with Dignity Act, primarily through reviewing published research and analyses. After summarizing the law and recent developments, 11 areas of concerns are examined: (a) the amount of data collected, (b) the availability of the data, (c) the reporting process, (d) protection of physicians, (e) terminal illness as a requirement, (f) the amount of data on palliative care interventions, (g) data on lethal prescriptions, (h) data on psychological/psychiatric evaluations, (i) whether the decision to request medication is informed, (j) whether the request is voluntary, and (k) financial factors. The authors examine each of these areas of concern and find criticisms to be unfounded given the research and analyses conducted to date.

Death↗
PubMed1991

Fogwater chemistry in a wood-burning community, western Oregon.

Fogwater chemistry in Corvallis, Oregon, a wood-burning community (pop. approximately 43,000) was compared with the chemistry of fogwater collected in more remote and in more highly industrialized areas. The fogwater was not acidic (median pH = 5.7) and was usually dominated by SO4=, NO3-, and NH4+ whose concentrations were generally lower than in fogwater in other urban areas but higher than in remote areas. Concentrations of formic and acetic acids (medians = 61 and 52 microN, respectively) were comparable to those in fogwater in Los Angeles, California and were typically much higher than concentrations in fogwater from more remote areas. Formate and acetate concentrations were often comparable to those of SO4= and NO3-. Formaldehyde concentrations (range = 0.4-3.0 mg L-1) were comparable to those in fogwater in some urban areas of southern California, yet lower than concentrations in highly industrialized areas of southern California. Because concentrations of organic compounds in Corvallis fogwater were often comparable to those in larger urban areas, sources in addition to motor vehicles must be important in Corvallis. Additional sources may be natural and anthropogenic, the latter including residential wood burning and wood products industries.

California↗
PubMed1979

Prevalence of antibodies to Toxoplasma gondii in pregnant women in Oregon.

Sera from 95,929 pregnant women were screened for antibodies to Toxoplasma gondii with the indirect hemagglutination test (IHA) at a 1:64 dilution of the sera. An indirect fluorescent antibody-IgM specific test (IFA-IgM) was used on all sera found to have an IHA titer of greater than or equal to 1:256. From August 1973 to December 1976, 8.1% of pregnant women had IHA titers of greater than or equal to 1:64. In addition, 129 (18.4%) of 700 pregnant women with IHA titers of greater than or equal to 1:256 had IFA-IgM titers of greater than or equal to 1:4. The IHA test was an acceptable test for mass screening of sera from pregnant women. In Oregon, one in every 200 women contracts toxoplasmosis during her pregnancy.

Adolescent↗
PubMed2005

Phenology of Lacanobia subjuncta (Lepidoptera: Noctuidae) in Washington and Oregon apple orchards.

The phenology of Lacanobia subjuncta (Grote & Robinson) (Lepidoptera: Noctuidae) was investigated in 30 apple orchards in central Washington state and northeastern Oregon from 1998 to 2001 (57 total orchard-yr). Adult captures in pheromone-baited traps were fit to a Weibull distribution to model emergence of the first and second generations. Initial capture of first generation adults was observed at 216.2 +/- 2.6 degree-days (DD) (mean +/- SEM) from 1 March by using a base temperature of 6.7 degrees C. The model predicted that flight was 5 and 95% complete by 240 and 700 degree-days (DD), respectively. Monitoring of oviposition and hatch was used to establish a protandry plus preoviposition degree-day requirement of 160.0 +/- 7.7 DD, as well as to provide data to describe the entire hatch period. Egg hatch was 5 and 95% complete by 395 and 630 DD, respectively. The start of the second flight was observed at 1217.1 +/- 8.3 DD by using an upper threshold for development of 32 degrees C and a horizontal cutoff. The model indicated that the second flight was 5 and 95% complete by 1220 and 1690 DD, respectively. Second generation hatch was 5 and 95% complete by 1440 and 1740 DD, respectively. A discussion of the potential uses of these detailed phenology data in optimizing management strategies is presented.

Agriculture↗
PubMedDate not supplied

Genetic differentiation among Oregon lake populations of the Daphnia pulex species complex.

Gene flow among invertebrate populations inhabiting bodies of nonflowing freshwater such as ponds or lakes must at some stage involve transport across habitat unsuitable for adult stages. Consequently the potential for interpopulational differentiation is high in these species, yet empirical studies of lake populations of Cladocerans such as Daphnia have failed to reveal high levels of genetic distinctiveness among populations and have led to much speculation about how these populations exchange genes and remain cohesive evolutionary units. In this study we surveyed 42 Oregon lake populations of Daphnia from the D. pulex species complex for genetic variation within the mitochondrial DNA control region. We have used this data to test the relative abilities of various ecological factors to explain the observed patterns in genetic differentiation among lakes. Despite limited genetic variation detected among our samples--11 very similar RFLP-defined mtDNA genotypes from 388 individuals--analyses of nucleotide variance using analogs to Wright's F statistics indicate that when multilake populations are defined in terms of the river drainage basin to which they belong, strong and significant amounts of among-population genetic variation can be detected at this locus (F(ST) estimates between 0.5 and 0.6). In contrast, we fail to detect consistent significant among-population variation when populations are defined on the basis of regional physical geography, bird migratory flyways, or lake trophic status. The manner in which the data are compiled, that is, whether RFLPs or nucleotide sequences are used, has little effect on the overall conclusions, yet it is clear that nucleotide sequence data would lower the standard errors of F(ST) estimates. We propose that periodic widescale flooding during the late Pleistocene may be an important mechanism to homogenize genetic differences among lake Daphnia continent-wide south of the southern-most extent of Pleistocene glaciation.

Animals↗
PubMed1994

Acute encephalopathy and seizure rates in children under age two years in Oregon and Washington state.

A surveillance network was established in Oregon and Washington state to identify cases of certain neurologic illnesses during a one-year period (August 1, 1987 to July 31, 1988) among children 1-24 months of age. Reported here are the observed case occurrence rates and findings from capture-recapture analyses used to predict rates that would have been observed had ascertainment been complete. The network consisted of a hospital component involving 98% of all eligible facilities, a provider component involving 93% of all eligible pediatricians and neurologists, and a research staff component of record abstractors. Of 3,876 potential cases reported, 626 met the study criteria. The observed rates for the primary diagnostic groups were: encephalopathies, 16 per 100,000 children; infantile spasms, 10 per 100,000 children; afebrile seizures, 159 per 100,000 children; and complex febrile seizures, 101 per 100,000 children. Of the 626 qualifying cases, 41% were reported by two or more surveillance components. Capture-recapture analyses with log-linear modeling to control for source dependence suggested 80% of all study cases were detected. Comparable percentages for the four illness groups were: encephalopathies, 82%; infantile spasms, 94%; afebrile seizures, 69%; and complex febrile seizures, 91%. The predicted rate for afebrile seizures, corrected for under-ascertainment, exceeded the upper 95% confidence interval bound around the observed rate. For all other conditions, predicted rates fell within the 95% confidence intervals around the observed rates. These findings suggest capture-recapture analyses should be applied to the full sample of cases and to relevant disease substrata.

Acute Disease↗
PubMed1995

On the Oregon trail.

On the eve of the 21st century, governments around the world are struggling to resolve the dual problems of health care cost and access. My own experience in addressing these issues as they manifest themselves in the US, and particularly in the state of Oregon, convinces me that successful health care reform, anywhere in the world, must sooner or later grapple with two questions: what are we buying with our health care dollars, and how do these expenditures relate to health?

Decision Making↗
PubMed2004

Structural and compositional controls on transpiration in 40- and 450-year-old riparian forests in western Oregon, USA.

Large areas of forests in the Pacific Northwest are being transformed to younger forests, yet little is known about the impact this may have on hydrological cycles. Previous work suggests that old trees use less water per unit leaf area or sapwood area than young mature trees of the same species in similar environments. Do old forests, therefore, use less water than young mature forests in similar environments, or are there other structural or compositional components in the forests that compensate for tree-level differences? We investigated the impacts of tree age, species composition and sapwood basal area on stand-level transpiration in adjacent watersheds at the H.J. Andrews Forest in the western Cascades of Oregon, one containing a young, mature (about 40 years since disturbance) conifer forest and the other an old growth (about 450 years since disturbance) forest. Sap flow measurements were used to evaluate the degree to which differences in age and species composition affect water use. Stand sapwood basal area was evaluated based on a vegetation survey for species, basal area and sapwood basal area in the riparian area of two watersheds. A simple scaling exercise derived from estimated differences in water use as a result of differences in age, species composition and stand sapwood area was used to estimate transpiration from late June through October within the entire riparian area of these watersheds. Transpiration was higher in the young stand because of greater sap flux density (sap flow per unit sapwood area) by age class and species, and greater total stand sapwood area. During the measurement period, mean daily sap flux density was 2.30 times higher in young compared with old Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco) trees. Sap flux density was 1.41 times higher in young red alder (Alnus rubra Bong.) compared with young P. menziesii trees, and was 1.45 times higher in old P. menziesii compared with old western hemlock (Tsuga heterophylla (Raf.) Sarg.) trees. Overall, sapwood basal area was 21% higher in the young stand than in the old stand. In the old forest, T. heterophylla is an important co-dominant, accounting for 58% of total sapwood basal area, whereas P. menziesii is the only dominant conifer in the young stand. Angiosperms accounted for 36% of total sapwood basal area in the young stand, but only 7% in the old stand. For all factors combined, we estimated 3.27 times more water use by vegetation in the riparian area of the young stand over the measurement period. Tree age had the greatest effect on stand differences in water use, followed by differences in sapwood basal area, and finally species composition. The large differences in transpiration provide further evidence that forest management alters site water balance via elevated transpiration in vigorous young stands.

Alnus↗
PubMed1991

A 28-year (1963-90) study of homicide in Marion County, Oregon.

We describe 240 consecutive homicidal deaths that occurred in Marion County, Oregon, over a 28-year period (1963-90). An epidemiological assessment of the homicides yielded the following information: More than 91% of these deaths were primary homicides. In primary homicide, 63% of the victims and 88% of the offenders were male. In secondary homicide, 76% of the victims and all of the offenders were male. A high percentage of victims (83%) and offenders (84%) in primary homicide were Caucasian, as were 100% of victims and offenders in secondary homicide. About 12% of victims and 10% of offenders in primary homicide were Hispanic. Fifty-nine percent of primary homicides were intrasexual, as compared to 87% of secondary homicides. An intraracial pattern was found in 90% of primary homicides and in 100% of secondary homicides. The most frequent means of death in both primary and secondary homicides were firearms, physical beating, and stabbing. Strangers committed 80% of secondary homicides. This was in marked contrast to the victim-offender relationship found in primary homicides, where strangers were responsible for approximately 16% of the total, acquaintances for approximately 36%, and family members for approximately 48%. The overall clearance rate (i.e., the identification and charging of a suspect for the death) was 88%.

Black or African American↗
PubMed1992

A model for faculty practice teaching clinics developed at the Oregon Health Sciences University.

In 1988 the Oregon Health Sciences University established its first faculty practice teaching clinic wherein physicians in training were incorporated into a faculty private practice clinic; this pilot project proved very successful and has been subsequently adopted as the model for essentially all outpatient clinics (both medical and surgery) in the university system. The model encourages efficiency, overhead control, and appropriate staffing; it also compensates faculty members for their additional time spent teaching. The authors conclude this model may help other academic training centers adapt to the changing demands of medical education.

Academic Medical Centers↗
PubMed1992

A tutorial for students demonstrating adequate skills but inadequate knowledge after completing a medicine clerkship at the Oregon Health Sciences University.

Upon completing a clinical clerkship, some students demonstrate adequate clinical skills appropriate for that clerkship but do not demonstrate an adequate fund of knowledge or ability to apply their knowledge clinically. For such students, repeating all or a portion of the clerkship may not be appropriate. This study describes a tutorial provided such students after they had completed the medicine clerkship at the Oregon Health Sciences University. During a two-year period (academic years 1988-89 and 1989-90), six students were identified as needing remediation, and were enrolled in a tutorial coordinated by one faculty member with support from others. The experience was highly successful for all but one student, and the tutorial was uniformly viewed by the students who took it as one of their best experiences in medical school.

Clinical Clerkship↗
PubMed1998

Principles of clinical medicine: Oregon Health Sciences University School of Medicine.

In 1992, the School of Medicine at Oregon Health Sciences University inaugurated a Principles of Clinical Medicine (PCM) course as part of an overall curricular revision. The PCM course, which covers the first and second years of medical school, integrates material from ten separate courses in the previous curriculum. Students learn longitudinally over the two years, rather than "cramming" discrete areas of knowledge and then moving on. Course sessions are related to concurrently taken basic science classes. Meeting two afternoons per week, the PCM course offers preceptorships, health care issues sessions, and patient examination sessions. The PCM course aims to encompass the body of knowledge, skills, and attitudes necessary to become a competent physician. First- and second-year students have more opportunities than previously to interact with patients and practicing physicians in the community. Competition between learning areas, student perceptions of "soft" and "hard" courses, teacher recruitment, and administrative burnout are ongoing difficulties, while faculty recognition and development, administrative commitment and flexibility, and student and faculty feedback all contribute to the success of the course. The PCM course is now the backbone of the first two years of medical school and creates a solid foundation for the third and fourth years.

Attitude of Health Personnel↗
PubMed1997

The substitutability of adult foster care for nursing home care in Oregon.

OBJECTIVES: This study investigates the degree of substitutability of adult foster care for nursing home care in Oregon. METHODS: Using three tests, the authors determined (1) the extent to which an additional adult foster care resident in a county reduces the number of nursing home residents in that county, (2) which characteristics of residents and facilities are important in sorting residents into either nursing homes or adult foster care facilities, and (3) the price elasticity of demand for adult foster care, using the county as the unit of observation. RESULTS: It was found that for every additional foster care resident in a county, a nursing home loses 0.85 residents-almost a one-to-one substitution ratio. CONCLUSIONS: Despite the high degree of substitutability, residents perceive important differences in the characteristics of the two forms of care. Indeed, private residents are, on average, willing to pay twice as much for nursing home care as for adult foster care, suggesting that these differences are important. Finally, private consumers are sensitive to price differences among adult foster care facilities. The implications for policy are discussed.

Adult↗
PubMed1998

Elimination of over-the-counter medication coverage in the Oregon Medicaid population: the impact on program costs and drug use.

OBJECTIVES: To reduce program costs, the Oregon Medicaid program eliminated reimbursement for over-the-counter (OTC) medications. Considering that physicians might substitute more expensive prescription-only products for eliminated OTC therapy, this investigation evaluates the policy's impact on medication costs. METHODS: This retrospective investigation examines pharmacy claims for adult Medicaid eligible recipients between March 1992 and February 1994 using an interrupted time-series analysis. The policy's impact on program costs and on the number of submitted claims was evaluated separately for prescription-only and total prescribing in nine therapeutic categories. RESULTS: In the preintervention period, OTC products comprised 36% (213,516 of 592,672) of drug claims and 9% ($1.36 million of $14.58 million) of medication costs in the nine therapeutic categories. Decreased program costs were noted in five categories and no significant changes were found in four others; overall, medication costs decreased from $7.86 to $7.39 per eligible recipient per month. A significant increase in prescription-only prescribing was noted in the hematinics category, but the net effect on total costs demonstrated a significant decrease. CONCLUSIONS: The OTC elimination policy was successful in reducing program drug costs with limited evidence for substitution of prescription-only products. Further study is needed to determine the impact on patients who regularly received OTC medications and to evaluate secondary effects on outpatient visits, hospitalization, and clinical outcomes.

Adult↗
PubMed1997

Trends in HIV counseling and testing of clients attending a public sexually transmitted disease clinic in Portland, Oregon, 1989-1995.

To assess the trend in acceptance of human immunodeficiency virus counseling and testing (HIV-CT) among clients attending a public sexually transmitted disease (STD) clinic, 13,139 clients who visited the largest STD clinic in Oregon at least once from 1989 through 1995 were investigated. Overall, 6236 (47.5%) of the clients accepted HIV-CT, and 98 (0.7%) clients reported having previously tested positive for HIV infection. The proportion of clients accepting HIV-CT increased from 28.2% in 1989 to 60.1% in 1995 (trend: p < 0.001). Among those who had never tested for HIV, acceptance of HIV-CT increased from 28.4% in 1989 to 60.9% in 1995 among HIV-uninfected clients (trend: p < 0.001) and from 20.6% in 1989 to 43.8% in 1995 among HIV-infected clients (trend: p = 0.13). The proportion increased from 25.9% in 1989 to 59.4% in 1995 (trend: p < 0.001) among those who previously tested negative for HIV and from 8.3% in 1989 to 25.0% in 1995 (trend: p = 0.03) among those who previously tested positive for HIV. Increases were seen in both sexes across all age and racial or ethnic groups. Acceptance of HIV testing increased among gay or bisexual men from 29% in 1989 to 57% in 1995 (trend: p < 0.001), and among IDUs from 49.5% to 78.8% (trend: p < 0.001). We conclude that HIV-CT is becoming more acceptable among public STD clinic clients, although extra efforts must be made to reach the clients who know they carry the virus but continue to practice unsafe sex.

Adolescent↗
PubMedDate not supplied

Quantification and risk analysis of occupational burns: Oregon workers' compensation claims, 1990 to 1997.

This study examined all accepted Oregon workers' compensation claims for occupational burn injuries during the period of 1990 to 1997 (N = 3,158). The Current Population Survey was used to derive employee population baselines for establishing rate estimates. It was estimated that the average occupational burn claim rate was 2.89 per 10,000 workers (95% confidence interval [CI] 2.76, 3.02). The majority of claimants (71.7%) were males, the largest proportion (32.6%) was aged 25 years or less, and almost half (48.7%) had less than 1 year of job tenure. The most frequent burn type cited was heat/scald burns (78.9%) followed by chemical burns (19.3%). Costs averaged over 1.6 million dollars annually. The average indemnity period was 16 days. Higher relative risks were found for evening workers (2.97, 95% CI 2.96, 2.98) and night workers (2.13, 95% CI 2.12, 2.13) compared with dayshift workers. Kitchen workers had the highest burn rate of all occupations, with 62.5 claims per 10,000 workers.

Accidents, Occupational↗