Child health and pediatric education in Oklahoma.
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Motor vehicle collisions (MVCs) resulting in death have been a serious concern for many years. However, the placement of roadside death memorials (RDMs) at collision sites has become increasingly common in the United States, in the memorialization of those deceased because of MVCs. This practice has been used in numerous countries for hundreds of years. Of the 78 sites observed, most were for males whose deaths had occurred in the past year and were placed by both family members and friends. The sites include the use of a cross and flowers whose meaning is obvious; however numerous other artifacts are found, the meaning of which is less obvious. Some of the functions served by these memorials are to prolong the memory of the deceased in a public place and to communicate with the deceased and to society. RDMs are used by mourners as a way of coping with the sudden and tragic nature of deaths from MVCs.
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OBJECTIVES: To characterize a multidrug-resistant Aeromonas hydrophila isolate (CVM861) that possesses a high-level macrolide inactivation gene cluster (mphA-mrx-mphR), previously only reported in Escherichia coli. METHODS: PCR fragment length mapping, gene sequencing and Southern blotting were used to map the mphA-mrx-mphR gene cluster and flanking elements in CVM861. Conjugation experiments were done to determine whether the multidrug resistance genetic element was mobile. RESULTS: The mphA-mrx-mphR gene cluster mapped downstream of a class 1 integron and upstream of an aph(3') gene, and was present on a Tn21-like element. The gene order determined by sequencing was intI1-dhfrXII-orfF-aadA2-qacDeltaE-sul1-orf5Delta178-tnpA-mphR-mrx-mphA. Horizontal transmission of high-level macrolide resistance from CVM861 to E. coli 47011 was inconsistent; however, a composite plasmid possessing the mphA gene cluster was transferred at a conjugation frequency of 2.02 x 10(-5) per recipient. CONCLUSIONS: An mphA-mrx-mphR gene cluster was present downstream of the In2 integron located on a Tn21-like transposon in an A. hydrophila isolate. Whether this recombination event resulted in the truncation of the orf5 sequence is unknown. The presence of other resistance genes downstream of the mphA-mrx-mphR gene cluster suggests that multiple recombination events have occurred on this genetic element. This is the first known report of the mphA-mrx-mphR gene cluster carried by A. hydrophila and the first known isolation of this cluster in the United States.
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Cancer epidemiology was studied from mortality data using age-specific and age-adjusted rates by sex and county of residence for 1956 to 1960 and 1961 to 1965. Geographic and time variations were examined as well as sex ratios and proportionate death rates. Age-adjusted rates for two time periods were used to examine Cramer's hypothesis which states that host susceptibility to cancer is predetermined and external factors determine the site of cancer occurrence. Elevation in total cancer mortality occurred in the urban northeast geographic area, reflecting perhaps the high rates for specific sites such as lung and cervix. Variations with time appeared for the different systems and the sex subgroups but not for total cancer. This finding is consistent with Cramer's hypothesis. Additional findings show an increase in susceptibility of men to cancer over women for most sites, and a proportionate death rate of about 33.4%, 23.2%, 16.1%, and 10.3% respectively for the gastrointestinal, reproductive, respiratory, and hematopoietic systems. Analysis of the data was limited to the white population.
We studied the clinical and epidemiologic characteristics of tularemia in 165 Oklahomans from 1979 to 1985. The ulceroglandular form of the disease was most common (60%), followed by typhoidal (18%), glandular (15%), oropharyngeal (7%), and oculoglandular (1%) forms. The male-female ratio was 3.7:1, and the highest rates of disease were found in the age groups 5 to 14, 35 to 44, and 55 to 74. Ticks were most frequently implicated as the source of infection (84/154 [55%]), followed by rabbits, (58/154 [38%]). Seventy percent of the patients were hospitalized, and four (2.5%) died. The annual number of patients who reported that rabbits were their probable source of exposure to Francisella tularensis and the estimated number of rabbits harvested (ie, killed by hunters) for the year correlated closely with the total number of cases reported from year to year.
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