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PubMed2004

State public policy: the impacts of Oklahoma's physician incentive programs.

The enactment of Medicare and Medicaid created a sudden and significant increase in demand for physician services in Oklahoma. As a response, the Oklahoma Legislature established the Physician Manpower Training Commission in 1975. The intent was to provide incentives for graduating physicians to remain in Oklahoma, especially in rural areas. This analysis examines the retention rates experienced during the 25-year period of 1976-2001. It is observed that 82% of program physicians are currently practicing in Oklahoma. This retention proportion compares to only 36% for National Health Service Corps physicians who were obligated to practice in Oklahoma. Additionally, Oklahoma has experienced a 67% retention proportion in rural areas. During this period, 633 physicians have received an estimated dollar 19 million in loans and scholarships. This is an average of dollar 30,000 per recipient. In return, each of these physicians will create 34 jobs and almost dollar 1 million of annual income.

Databases, Factual↗

PubMed2004

The economic impacts of Oklahoma's Family Medicine residency programs.

The enactment of Medicare and Medicaid created a new demand for medical services in Oklahoma, particularly in rural areas. The state of Oklahoma responded by creating The Oklahoma Physician Manpower Training Commission in 1975. The overall purpose of the Commission was to increase the number of primary care physicians and influence distribution into non-metro areas. This analysis concerns the public policy value of this ongoing program. The PMTC has provided resident stipend funding to each of Oklahoma's publicly funded Family Medicine residency programs. Since 1975, the PMTC has provided over 139 million dollars in resident stipend funding and support; and there have been 749 program graduates with 431 practicing in Oklahoma. This model calculates that the Oklahoma-based physicians have created a cumulative 3.7 billion dollars of economic impact on the state; and conservatively estimates that only 10% of the practice decisions/locations were influenced by the PMTC. This creates an estimated return of 370 million dollars on an "investment" of 139 million dollars. Additionally the model demonstrates that the current cohort of physicians is annually responsible for 15,530 jobs and an associated payroll of 428 million dollars.

Family Practice↗

PubMed2005

Oklahoma tobacco policy-making.

OBJECTIVES: To document and analyze comprehensive Oklahoma state tobacco policy-making trends and their link to public health trends. METHODS: A historical qualitative and archival content overview and analysis from 1985 to the present of previously secret tobacco industry documents. RESULTS: The 2002 Oklahoma State Plan for Tobacco Use Prevention and Cessation indicated tobacco use was the largest cause of annual preventable death in Oklahoma. The Oklahoma State Plan recommended a variety of proposals, including sales restrictions, youth access enforcement, repealing state preemption of stricter local tobacco control laws, adopting clean indoor air laws, increasing tobacco taxes, cessation programs, and anti-tobacco education efforts. CONCLUSIONS: Since 1985, the powerful tobacco lobby in Oklahoma has been highly successful in maintaining lower tobacco taxes and reduced regulations, which is a major impediment to the anti-tobacco public health goals of the Oklahoma State Plan and enhanced public health.

Adolescent↗

PubMed1991

The emerging profile of dental manpower in Oklahoma. 2. Tulsa county.

This is the second report of a three part study. Part I focused upon the dental manpower profile of Oklahoma County between the years 1972-1989. Part II emphasizes the dental manpower profile of Tulsa County. Part III, will be inclusive of the dental manpower profile of all other Oklahoma counties. In all phases of the study, data has been assessed for general practitioners, specialists, full-time general practice dental faculty, full-time specialist dental faculty, and public health dentists. The demographic data analyzed in Part I, revealed an increasing average of the dentists from 45.33 years of age in 1972 advancing to 48.83 years of age in 1989 for Oklahoma County. The data presented in Part II documents that in Tulsa County there was an increase in age from 45.68 in 1972 to 50.60 in 1989. Trends in location of dental school education, demonstrated that the University of Oklahoma College of Dentistry is currently the primary resource for the dental manpower pool in Tulsa and Oklahoma Counties. Changes in the dental manpower pool indicate a downward turn in the percentage of dentists choosing to locate in either Tulsa or Oklahoma County.

Dentistry↗

PubMed1994

Infant mortality in Oklahoma, 1970-1990.

Patterns of infant mortality in Oklahoma are unlike the rest of the United States. Oklahoma has a significantly higher post neonatal mortality rate than the United States, with SIDS and congenital disorders being the leading causes of death in that age group. Conversely, Oklahoma has a significantly lower neonatal mortality rate than the United States. Vital statistics information for the period 1970-1990 are examined to describe patterns of infant death in Oklahoma. Despite long-term decreasing trends in infant death, disconcerting trends were observed in 1990 suggesting that a stronger infant mortality reduction strategy is needed in Oklahoma. Potential areas for public health intervention are suggested based on Oklahoma-specific data.

Cause of Death↗

PubMed1997

Injuries to rescue workers following the Oklahoma City bombing.

The objective of this study was to identify and describe physical injuries to rescue workers in the aftermath of the Oklahoma City bombing. Data were obtained from medical records from 16 hospital emergency departments and specialty clinics in the Oklahoma City area, and reported visits to medical providers at the bombing site. Participants were rescue personnel from the Oklahoma City Fire Department, the mutual aid fire stations in the Oklahoma City area, the Federal Emergency Management Agency's Urban Search and Rescue teams, and military personnel stationed near Oklahoma City. All participants were involved in the rescue and recovery operation. The two main outcome measures were (1) the number, types, and rates of injuries; and (2) comparisons of case-finding methods, including medical chart review and telephone interview. The most common injuries were strains and sprains (21.4%), foreign bodies in eyes (14.5%), and laceration/crush/puncture wounds (18.4%). Of the four case-finding mechanisms, telephone interviews following the event identified the largest number of cases (84.5%). Most injuries were minor; some injuries such as chemical burns were preventable. The potential utility of other data collection mechanisms is considered.

Eye Foreign Bodies↗

PubMed2002

Racial misclassification of American Indians in Oklahoma State surveillance data for sexually transmitted diseases.

The burden of sexually transmitted diseases (STDs) is high in American Indian/Alaska Native (AI/AN) populations. In addition, race is often misclassified in surveillance data. This study examined potential racial misclassification of American Indians in STD surveillance data in Oklahoma. Oklahoma State STD surveillance data for 1995 were matched with the Oklahoma State Indian Health Service Patient Registry to determine the number of AI/AN women who had one of three STDs but were not listed in Oklahoma surveillance data as AI/AN. Accounting for racial misclassification increased the rate of chlamydia for AI/AN women in Oklahoma by 32% (342/100,000 vs. 452/100,000) in the overall population. For gonorrhea, the rate increased by 57% (94/100,000 vs. 148/100,000) and for syphilis by 27% (15/100,000 vs. 19/100,000). Misclassified AI/AN women most often were classified as "White," and the likelihood of misclassification increased with a lower percentage of AI/AN ancestry. These findings indicate that STD rates may be underestimated for AI/AN populations nationwide. Racial misclassification in state surveillance data causes inaccuracies in characterizing the burden of infectious diseases in minorities.

Female↗

PubMed1990

Potential for the spread of Fasciola hepatica in cattle in Oklahoma.

In 29 central and western Oklahoma counties, 42 ranches were investigated for indigenous Fasciola hepatica infections and their suitability for the transmission of liver fluke. A 10-year retrospective study of Oklahoma cattle based on samples submitted to the Oklahoma Animal Disease Diagnostic Laboratory also was done. Indigenous fascioliasis was found in cattle in 12 counties (9 central and western counties identified in the combined field and retrospective studies and 3 additional eastern counties identified on the basis of the retrospective study). Factors essential for survival of free-living stages of F hepatica and for snail species necessary for propagation of the fluke existed in much of Oklahoma. Snails capable of serving as intermediate hosts for transmission of the fluke reportedly have been found in 41 of the 77 Oklahoma counties. Lymnaeid snails were detected in 4 counties in the field study.

Animals↗

PubMed1995

Gastroschisis: a birth defect seen in increasing numbers in Oklahoma?

OBJECTIVE: To identify if an actual increase in children born with gastroschisis is occurring in Oklahoma. To compare findings with historical and current literature concerning the incidence of this congenital malformation of the abdominal wall. DATA: Derived from Children's Hospital of Oklahoma (CHO) medical records, inventory sheets completed by nurses and resident physicians on admission of gastroschisis infants at CHO, hospital records of Tulsa pediatric surgeons (Subramania Jegathesan, MD, and Richard Ranne, MD), and the state health departments of Oklahoma and Iowa. FINDINGS: 1. Increase in number of gastroschisis children born in Oklahoma. 2. Comparable findings in the state of Iowa. 3. No specific maternal or environmental factor to account for increase. CONCLUSIONS: Children born with gastroschisis in Oklahoma and other areas of the country, as well as internationally, have shown an increase in number over the past two decades. This increase cannot be attributed to any one identifiable factor.

Abdominal Muscles↗

PubMedDate not supplied

Professional resistance to managed care in Oklahoma: an issue of quality.

Anecdotally one hears a great deal of concern and anger expressed by Oklahoma health care professionals over the growth of managed care in Oklahoma. Little has been in the professional literature, however, that explains the source of this resistance. The Oklahoma Rural Research and Demonstration Center sponsored a project to explore the opinions of Oklahoma health care professionals in regard to managed care. A 38-item written questionnaire was distributed to Oklahoma health care providers, health professions faculty, and health professional students. The results showed widespread concern about managed care across each of the groups. Primarily, these concerns were about the issue of quality. Differences between groups are also highlighted. Discussion centers around health professionals' lack of trust in managed care systems to do what is medically appropriate when cost is a counter consideration. Further discussion outlines what might be done to alleviate concerns and train new health professionals for a managed care environment.

Attitude of Health Personnel↗

PubMed1998

Comparison of influenza immunization rates for Oklahoma Medicare patients: 1995, 1996 and 1997.

The Health Care Financing Administration has reported influenza immunization rates since 1994. The Department of Health and Human Services has set a minimum national target rate for the annual immunization of the elderly population at 60 percent, as published in Healthy People 2000. The Oklahoma Foundation for Medical Quality analyzed the Medicare claims data for Oklahoma for the 1995, 1996, and 1997 influenza seasons. Additionally, we reviewed the Behavioral Risk Factor Surveillance System influenza immunization data for 1995. Claims data for the 1997 influenza season show the immunization rate for the Medicare population of Oklahoma is 41.4 percent. The immunization rate for the African-American Medicare population was 22.3 percent for 1997, compared with 42.2 percent for the Caucasian population. The ten most populous counties in the state had a 9-percent higher rate of immunization than the other 67 counties. The Medicare population in Oklahoma is not receiving the influenza vaccination at the target rate. Especially underserved are the African-American and non-urban populations. There appear to be opportunities for improvement in the provision of the influenza vaccination for the Medicare population of Oklahoma.

Black or African American↗

PubMed1987

Blood types of the native Americans of Oklahoma.

Large numbers of Indians from Oklahoma were screened for a variety of red cell antigens. Sufficient numbers of Cherokees, Creeks, and Choctaws were studied to calculate gene frequencies. These tribes originated in the Southeastern United States and were forcibly moved to Oklahoma. The Creeks and Choctaws have not been studied previously. A small number of Cherokees remained in North Carolina, and their blood types have been reported. The blood types of the Oklahoma Cherokees are quite similar to those observed there but one important difference was discovered. The data previously reported concerning the Eastern Cherokees revealed the absence of the Dia antigen. The present study found that the Oklahoma Cherokees do have the Dia antigen, although in a lower percentage than the other southeastern tribes. The Creeks and Choctaws share a linguistic heritage as well as having similar red cell phenotypes.

Blood Group Antigens↗

PubMed1996

Increased prevalence of systemic sclerosis in a Native American tribe in Oklahoma. Association with an Amerindian HLA haplotype.

OBJECTIVE: To investigate a high prevalence of systemic sclerosis (SSc; scleroderma) in a well-defined population of 21,255 Choctaw Indians residing in 8 southeastern Oklahoma counties who were "users" of Indian Health Services. METHODS: A case-control study of 12 SSc cases and 48 matched non-SSc controls (4 per case) was conducted to investigate potential occupational, residential, and infectious exposures, as well as genetic factors which might predispose to SSc. HLA class II alleles were determined by DNA oligotyping, and class I and III alleles were defined serologically. RESULTS: The prevalence of SSc in full-blooded Choctaws was at least 8/1,704, or 469/100,000 (95% confidence interval [95% CI] 203-930) over the 4-year interval 1990-1994 and was significantly higher than that among non-full-blooded Choctaws (6/19,551, or 31/100,000) (P = 0.00001, odds ratio [OR] = 15.4, 95% CI 4.9-49.8). The overall prevalence of SSc in Oklahoma Choctaws (66/100,000) also was significantly higher than that in other Native Americans in Oklahoma (9.5/100,000) (P = 10(-6), OR = 6.95, 95% CI 3.3-13.7), who showed a prevalence similar to that reported for whites (2.1-25.3/100,000). Among the SSc cases, there was striking homogeneity of disease expression with the majority exhibiting diffuse scleroderma, pulmonary fibrosis, and autoantibodies to topoisomerase I. No environmental exposures were found to be in excess among cases versus controls. The strongest risk factor for SSc in cases (100%) versus controls (54%) was an HLA haplotype bearing the alleles B35, Cw4, DRB1*1602 (DR2), DQA1*0501, and DQB1*0301 (DQ7) (P = 0.002, Pcorr = 0.036, OR = 21, 95% CI 2.9-437). Survey of another group of Choctaws residing in another state revealed no cases of SSc despite a high frequency of the same HLA haplotype. CONCLUSION: Full-blooded Choctaw Native Americans living in southeastern Oklahoma have the highest prevalence of SSc yet found in any population. A major risk factor for disease is a uniquely Amerindian HLA haplotype; however, additional genes and/or an as-yet-unidentified environmental exposure seem likely.

Adult↗

PubMed2003

A support group for patients who have recovered from thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS): The six-year experience of the Oklahoma TTP-HUS Study Group.

A support group for patients who have recovered from thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS), named The Oklahoma TTP-HUS Study Group, has been a successful program for 6 years. This group has met 3 times each year with an average attendance of 16 former patients; in addition, an average of 14 family members and friends have attended each meeting. Eighty-four percent of patients who attended a meeting were women as compared to 68% women among those who did not attend (P = 0.016). Twenty-three percent of patients who attended a meeting have relapsed as compared to 8% among those who did not attend (P = 0.006). There was also a difference in the rates of attendance among the different clinical categories of patients (P < 0.001). A survey of former patients, as well as their families and friends, documented that interest in learning more about TTP-HUS and talking with other people who have had TTP-HUS were principal motivations for attending the meetings. The meetings of The Oklahoma TTP-HUS Study Group have been successful not only for support of former patients but also for research. Long-term patient follow-up has been facilitated and the group discussions have revealed previously unreported persistent problems with cognitive ability and endurance. A survey of member centers of the American Association of Blood Banks and America's Blood Centers revealed no similar programs for patients who have recovered from TTP-HUS. The absence of a support group for TTP-HUS in the national survey contrasts to the 274 patient support groups and related wellness/education classes, including some for rare disorders, currently active in the Oklahoma City metropolitan area. The experience of The Oklahoma TTP-HUS Study Group suggests that it serves a previously unmet need.

Adult↗

PubMed1987

A thirty-year review of maternal mortality in Oklahoma, 1950 through 1979.

Oklahoma's Maternal Mortality Committee has been active since 1941. During the 30-year period 1950 through 1979, the committee reviewed in detail 75.9% of the pregnancy-related deaths that occurred in Oklahoma. The maternal mortality ratio in 1950 was 95.1/100,000 live births, and for 1979 it was 8.1/100,000 live births, a decrease of 91.5%. The risk of death from childbearing remained greater for black women than for American Indian or white women throughout the three decades. For American Indian women, the risk of death associated with pregnancy has decreased and is almost equal to the risk for white women. The Maternal Mortality Committee estimated that two thirds of Oklahoma's maternal deaths were preventable. The proportion of deaths judged preventable did not vary substantially during the study period. We conclude that maternal mortality in Oklahoma can be reduced to fewer than three deaths per 100,000 live births. Intensive monitoring and investigation of deaths and their causes by local maternal mortality committees continues to be an important mechanism for obtaining information to assist health workers in the prevention of deaths.

Black or African American↗

PubMed1996

Sadness, tragedy and mass disaster in Oklahoma City: providing critical incident stress debriefings to a community in crisis.

Shortly after 09:00 h on 19 April 1995, the Alfred P. Murrah Federal Building, located in downtown Oklahoma City, was devastated with a bomb blast of such gigantic proportions that it was heard 60 miles away in neighbouring Norman, Oklahoma. Oklahomans routinely commuting to work on that sunny Wednesday morning went about their business as usual. A crude bomb chemically comprised of various organic compounds, chemical fertilizer, ammonium nitrate and diesel fuel, weighing an estimated 4800 pounds or more, was transported in a vehicle the size of a truck. It blew open a crater 6-8 ft deep in the street floor. The Murrah Federal Building was impacted immediately; floors, windows, communication equipment and almost all the innocent victims inside were razed to the ground. Outside the building, as far as 10 blocks away or more, hundreds of victims lay hurt, seriously injured or dead from shards of glass that flew from office windows hundreds of feet above the street floor. Without warning, the initial impact of the bomb immediately devastated the entire city. People were in a state of shock, disbelief and denial; acute symptoms of post traumatic stress disorder (PTSD) were commonplace. Oklahomans, 'numb' from the impact of the critical incident and ill-equipped to handle the chaos of such catastrophic proportions, struggled to regain control of their lives as friends, family and loved ones went unaccounted for or were found critically injured, dying or already dead. The critical incident on 19 April demanded the immediate attention of the nation, to come to the aid of the Oklahomans who were in desperate need. By 1 June, the exhaustive investigations revealed that 30 office buildings in downtown Oklahoma City had to be condemned, and as many as 300 others were damaged. In addition, 168 people had been found dead including 19 children and one nurse working as an emergency services rescue worker. Approximately 490 other victims had been reported injured from the blast. Countless others have been traumatised by the critical event and will need professional attention and care for weeks, months and years to come. The final extent of the impact on Oklahoma City is yet unknown and may never realistically be estimated in terms of personal trauma, loss and grief.

Crisis Intervention↗

PubMed2002

The impact of the 1995 Oklahoma City bombing on the partners of firefighters.

This study explored the impact of the 1995 Oklahoma City, Oklahoma, bombing on the spouses and significant others of a volunteer sample of Oklahoma City firefighters who participated in the bombing rescue effort. Twenty-seven partners of Oklahoma City firefighters participated in this study, conducted 42 to 44 months after the bombing. These partners were assessed using a structured diagnostic interview and a companion interview to examine exposure, rates of psychiatric disorders and symptoms, functioning, health, and relationships. Coping and perception of the firefighter partner's response were also examined. Some of the women were exposed directly; most knew someone who had been involved in the disaster, and all reported exposure through the media. The rate of psychiatric disorders in the women following the disaster was 22%, essentially unchanged from before the incident. One developed bomb-related posttraumatic stress disorder (PTSD). Most were satisfied with their work performance; 15% reported that their health had worsened since the bombing, and more than one third reported permanent changes in relationships as a result of the bombing. Most coped by turning to friends or relatives, with less than 10% seeking professional help. Many described symptoms in their firefighter mate; all reported that their mate had been affected by the experience, and one half said their mate had fully recovered. The mates of these firefighters fared relatively well in terms of psychiatric disorders, symptoms, and ability to function. The prevalence of bomb-related posttraumatic stress disorder was considerably lower in this sample than in samples of individuals more directly exposed to the bombing, although some reported changes in relationships and health. The results suggest the need for further study of the impact of interpersonal exposure in those who provide support for rescue-and-recovery workers in major terrorist incidents.

Adaptation, Psychological↗

PubMed2004

Tibor Greenwalt Award. The Oklahoma Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome Registry: a program for patient care, education and research.

The Oklahoma Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome (TTP-HUS) Registry was created by collaboration of the Oklahoma Blood Institute and the Colleges of Medicine and Public Health of the University of Oklahoma Health Sciences Center, combining their respective strengths of community service, patient care, education, and clinical research methodology. The organization of the Registry is based on the fundamental principles of patient-oriented research: 1) all consecutive patients are identified at a uniform time early in the course of their disease; 2) analysis of clinical data requires quantitative and reproducible definitions; 3) patient follow-up is complete; and 4) therefore the data are generalizable to community practice. A summary of 15 years experience with 301 consecutive patients is presented. Some of these results and interpretations are different from other case series. These differences emphasize the distinct perspective of the Registry that includes all patients in the community who have had a clinical diagnosis of TTP or HUS and for whom plasma-exchange treatment was requested. The Oklahoma TTP-HUS Registry provides educational and research opportunities, in addition to improved patient care, and serves as a model for productive collaboration of community blood centers and universities.

Awards and Prizes↗