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PubMedDate not supplied

Evaluation of death certificate-based surveillance for traumatic brain injury--Oklahoma 2002.

OBJECTIVES: Death certificate data are used to estimate state and national incidence of traumatic brain injury (TBI)-related deaths. This study evaluated the accuracy of this estimate in Oklahoma and examined the case characteristics of those persons who experienced a TBI-related death but whose death certificate did not reflect a TBI. METHODS: Data from Oklahoma's vital statistics multiple-cause-of-death database and from the Oklahoma Injury Surveillance System database were analyzed for TBI deaths that occurred during 2002. Cases were defined using the Centers for Disease Control and Prevention (CDC) ICD-10 code case definition. In multivariate analysis using a logistic regression model, we examined the association of case characteristics and the absence of a death certificate for persons who experienced a TBI-related death. RESULTS: Overall, sensitivity of death certificate-based surveillance was 78%. The majority (62%) of missed cases were due to listing "multiple trauma" as the cause of death. Death certificate surveillance was more likely to miss TBI-related deaths among traffic crashes, falls, and persons aged > or = 65 years. After adding missed cases to cases captured by death certificate surveillance, traffic crashes surpassed firearm fatalities as the leading external cause of TBI-related death. CONCLUSIONS: Death certificate surveillance underestimated TBI-related death in Oklahoma and might lead to national underreporting. More accurate and detailed completion of death certificates would result in better estimates of the burden of TBI-related death. Educational efforts to improve death certificate completion could substantially increase the accuracy of mortality statistics.

Adolescent↗
PubMed1994

Seroprevalence of bovine anaplasmosis in Oklahoma from 1977 to 1991.

The prevalence of anaplasmosis in Oklahoma cattle was determined on the basis of the standardized Anaplasma marginale complement fixation test on 20,155 sera submitted to the Oklahoma Animal Disease Diagnostic Laboratory during a 15-year period. Rates of seropositivity ranged from 4.7% to 17.6% on samples submitted for anaplasmosis testing of adult cows. The geographic distribution of recorded cases of anaplasmosis was 35 Oklahoma counties in 1977 and 48 Oklahoma counties in 1991.

Anaplasma↗
PubMed1992

Diabetic retinopathy in Oklahoma Indians with NIDDM. Incidence and risk factors.

OBJECTIVE: To determine the incidence rates and risk factors for development of diabetic retinopathy in Oklahoma Indians. RESEARCH DESIGN AND METHODS: Cohort follow-up study with baseline examination between 1972 and 1980 and follow-up examination between 1987 and 1991. Mean +/- SD follow-up time was 12.8 +/- 1.7 yr. Eleven Indian Health Service facilities (clinics and hospitals) in Oklahoma participated in the study. Study participants were a quasirandom sample of 1012 American Indians (379 men, 633 women) in Oklahoma with NIDDM, 927 of whom received a detailed eye examination at baseline. The mean age of participants was 52 yr with a duration of diabetes of 6.9 yr at baseline. The average quantum of Indian blood was 92% (77% full blood). At follow-up, 515 (55.6%) were alive, 408 (44.0%) were deceased, and 4 (0.4%) could not be traced. Of the living participants, 380 (73.8%) underwent an ophthalmoscopic examination. RESULTS: The incidence of retinopathy among the participants who were free of disease at baseline and who survived the follow-up interval was 72.3%. By multivariate analysis, significant independent predictors of retinopathy recorded at baseline were FPG level, therapeutic regimen, systolic blood pressure, and duration of diabetes. FPG levels > or = 11.1 mM (200 mg/dl) increased the risk of retinopathy 1.7 times that for levels < 7.8 mM (140 mg/dl). Insulin use was associated with a 20% greater incidence. Hypertension was a particularly significant risk factor for those with lower FPG levels. CONCLUSIONS: Given that NIDDM is reaching epidemic proportions in Oklahoma Indians and that most may be afflicted with retinopathy, frequent ophthalmological examinations are clearly indicated for this high-risk population. The role of intervention, namely glycemic and hypertensive control, deserves further study.

Blood Glucose↗
PubMed1993

A follow-up study of diabetic Oklahoma Indians. Mortality and causes of death.

OBJECTIVE: To determine the mortality rates and causes of death for diabetic Oklahoma Indian adults by sex and age. RESEARCH DESIGN AND METHODS: This was a cohort follow-up study with baseline examination between 1972-1980 and the mortality follow-up between 1986 and 1989. Mean follow-up time was 10 +/- 4 yr. A quasi-random sample of 1012 (379 men and 633 women) NIDDM American Indians in Oklahoma was performed. Mean age was 52 yr and duration was 7 yr at baseline. Mean degree of Indian blood was 92% (77% full blood). At follow-up, 548 (54%) were alive, 452 (45%) were decreased, and 12 (1%) could not be traced. RESULTS: Death certificates were obtained and coded (ICD-9) for 439 (97%) of the deceased. Mean annual mortality rates were 4.99% for men and 4.17% for women, with an increasing trend with age for both sexes. Compared with the general population of Oklahoma, the observed/expected ratios for number of deaths were 2.92 for men and 4.09 for women (P < 0.0001). The three leading causes of death were circulatory disease (38%), diabetes (24%), and malignant neoplasms (12%). CONCLUSIONS: There is an excessively high mortality among diabetic Oklahoma Indians compared with the general population in the state and with diabetic patients in other populations.

Adult↗
PubMed1999

Population effects of the bombing of Oklahoma City.

BACKGROUND AND PURPOSE: The explosion at the Murrah Federal Building in Oklahoma City on April 19, 1995, affected many members of the community as well as direct victims. Our goal was to measure the exposure and effects among the general population. METHODS: We conducted surveys of the Oklahoma City metropolitan area and a control area to measure exposure and impact, primarily stress and psychological distress. RESULTS: Of the adults in the Oklahoma City MSA, 61.5 percent (58.5 percent to 64.5 percent with 95 percent confidence) reported experiencing at least one direct result of the bombing. In population terms, about 433 thousand adults (between 412 thousand and 457 thousand, with 95 percent confidence) were exposed to one or more of the consequences of the bombing. Oklahomans reported higher rates (about double) of increased alcohol use, smoking more or starting smoking. They reported more stress (about double), psychological distress (about double), post-traumatic stress-disorder components, and intrusive thoughts (double) related to the bombing than in the control area. Oklahomans also reported higher rates of seeking help for their stress or taking steps to reduce stress. The differences persisted into 1996, more than a year after the bombing. CONCLUSION: The exposure to the bombing was widespread, including more than half the adults in the metropolitan area surrounding Oklahoma City. The psychological effects were high and, while decreasing, persisted more than a year after the bombing. Primary care practitioners should screen their patients, who may normally not be considered victims, for exposure to the effects of a terrorist disaster for an extended period of time.

Adult↗
PubMed1999

Oklahoma City's killer tornadoes: how local hospitals responded to yet another extreme disaster.

On the evening of May 3rd, a group of high-powered tornadoes tore through Oklahoma--leaving more than 40 people dead and hundreds injured. The main twister formed about 45 miles south of Oklahoma City and was classified F5, the most severe type of tornado, with winds of more than 260 mph. It cut a path one mile wide; stayed on the ground for more than four hours; and, along with other twisters, demolished 60 miles of countryside. More than 7,000 homes were destroyed or damaged, and more than 5,000 families were left homeless. Oklahoma City was hit the hardest, with about 1,500 homes leveled in the storm. A total of 755 people were injured in Oklahoma City and the surrounding area, testing local hospital disaster plans to the maximum. The same hospitals had been called on in April 1995 to handle the over 500 persons injured in the bombing of the Alfred P. Murrah Federal Building, a terrorist blast that killed 168. The hospitals' latest response to a disaster situation is recorded in this report.

Communication↗
PubMed2000

Immunization rate comparison for Oklahoma Medicaid managed care population by age two: 1995-1998.

Processes of care are used as one measure for the quality of care rendered by providers. One example is the immunization of children by the age of two. The Oklahoma Health Care Authority, with the Oklahoma Foundation for Medical Quality, has been tracking childhood immunization rates from 1995 through 1998. The rate calculated included the medical record data and the Oklahoma Statewide Immunization Information System (OSIIS) data set. The standards were based on Advisory Committee on Immunization Practices recommendations and Quality Assurance Reform Initiative standards. The rate of provision of documented immunizations in the Medicaid managed care population under the age of two has improved markedly from 1995 to 1998. The trend analysis suggests there might be areas for continued improvement in the provision of immunization to individuals in Oklahoma's Medicaid managed care population. Further, the OSIIS data is critical for maintaining a uniform data set for immunization information.

Humans↗
PubMed2000

The Oklahoma repair technique: a biomechanical study of a new suture repair technique.

We designed and evaluated the biomechanical advantages of a new (Oklahoma) suture technique for repairing flexor tendons in fresh, frozen cadaver specimens. Forty flexor digitorum profundi tendons from the middle three fingers were sharply cut and repaired with a number 3-0 braided polyester using the new technique and the Modified Kessler technique with and without an epitenon repair. The repaired tendons were then stressed to failure. The Modified Kessler with epitendon repair initiated gap formation on an average of 15.3 +/- 2.7 newtons and failed at 40.9 +/- 4.3 newtons. The Oklahoma suture technique with a running epitenon repair initiated gap formation on average of 48.6 (SD +/- 4.0) newtons and required an average load of 57.9 (SD +/- 3.0) newtons to fail. Thus, it was significantly stronger than the modified Kessler technique with epitendon repair (P < 0.01). The tendons repaired with the Oklahoma and epitenon repair suture technique did not form a 2 mm gap prior to failure. The epitendon repair increased the resistance to gap formation by 80% to 100% and the repair failure by 17.5% to 25% for both types of repairs. We concluded that the addition of the epitendon repair increases the tensile strength of the repair regardless of the core suture technique, and it should be used. In comparison with the Modified Kessler repair technique, the Oklahoma repair technique has superior tolerance to gap initiation, 2 mm gap formation, and physical failure of the repaired tendon.

Analysis of Variance↗
PubMed2002

Quality improvement efforts in prenatal care for Oklahoma Medicaid managed care patients: 1995-1998.

The Oklahoma Health Care Authority and the Oklahoma Foundation for Medical Quality analyzed documented patterns of care in the Oklahoma Medicaid urban managed care plans from 1995 through 1998. In 1995, 31.3% of the patients had started prenatal care in the first trimester, and 50.6% of the patients had first trimester prenatal care in 1998. No prenatal care was noted for 3.2% in 1995, which decreased to 2.9% for 1998. For 1995, 23.9% of the deliveries were operative and 20.8% for 1998. Similarly, the vaginal delivery after previous C-section (VBAC) rate was 36.5% for 1995, and increased to 41.0% in 1998. Very low birth weight (defined as below 1500 grams) rates were 3.7% for 1995 and 1.3% for 1998, while the low birth weight (between 1500 and 2499 grams) infants were recorded for 7.8% of the live births in 1995, and for 1998, 7.5%. While there has been improvement in rates over the four years of the study, opportunities for improvement in the provision of the prenatal care for the Oklahoma Medicaid managed care population remain.

Female↗
PubMed2002

Screening mammography for Oklahoma Medicare beneficiaries: a national priority for quality improvement.

Breast cancer is one of the most common malignancies diagnosed in women in the United States. It is estimated that more than 2,700 new cases of female breast cancer will be diagnosed in Oklahoma this year. Using the Medicare mammography denominator file and Medicare claims data (October 1999 through September 2001), we assessed the utilization of mammography for this population. The overall biennial mammography rate for Oklahoma Medicare patients was 46.9% (95% CI 46.7-47.1) and was 54.7% (95% CI 54.3-55.2) for Medicare patients aged 50-67 years. There were significant racial disparities in utilization of mammography. In addition, there was substantial county-to-county variation in the utilization of mammography in Oklahoma. When compared to other states and territories, Oklahoma mammography rates for this population were in the lowest quartile nationally, ranking 47th in the nation. Increasing the use of mammography services for Medicare patients is a national priority for healthcare quality improvement.

Breast Neoplasms↗
PubMed2003

Coronary artery bypass grafting surgery in Oklahoma: processes and outcomes of care.

Coronary artery bypass grafting (CABG) is a commonly performed operation on Oklahoma Medicare beneficiaries. In 1994, the Centers for Medicare & Medicaid Services funded a project to evaluate process-oriented quality improvement activities for this surgery. Structured medical record review was performed on the charts of 2,312 Oklahoma Medicare patients who had a CABG surgery between July 1, 1995, and June 30, 1996, and on 926 patients who had their surgery from July 1 through December 31, 1998. Demographic, procedural and outcome variables were abstracted from each medical record. In addition to summarizing the clinical and demographic characteristics, we evaluated inter-hospital variations in both processes and outcomes of care. Significant variations in care were demonstrated for the 13 Oklahoma hospitals in which this operation was performed. The results of this project suggest that there are substantial opportunities to improve the quality of care for CABG in Oklahoma.

Age Distribution↗
PubMed2004

Changing profile of Oklahoma physicians since 1928.

Physician characteristics and preferences continue to change. Between 1970 and 1999, the physician population more then doubled nationwide and the proportion of female MDs increased from 7.7% to 23.4%. This study examines the changing profile of Oklahoma physicians since 1928. Data on 14,314 MDs licensed by the Oklahoma State Board of Medical Licensure and Supervision between 1928 and 2001 were analyzed, and summary statistics on age, gender, race, specialty and board certification are reported by ten-year intervals. On average, Oklahoma physician are getting older. While the mean age in the 60s was 35 years, by the end of the last decade it had risen to 52. The number of women MDs started to increase in the 70s and has more then tripled in the last 30 years. The same pattern of growth has been witnessed for non-white physicians and international medical graduates (IMGs), who were practically non-existent before 1960. The proportion of board certified physicians has steadily increased, reaching the current level of 66%. Due to the increasing participation of females, non-whites and IMGs, the profile of the Oklahoma physician has radically changed during the last 70 years.

Adult↗
PubMed1992

The University of Oklahoma College of Public Health and the American Indian.

This article illustrates how the relationship between the University of Oklahoma College of Public Health, the American Indians, and the Indian Health Service is especially appropriate to the state of Oklahoma. It reviews the development of the College of Public Health as an important component of the university and the state of Oklahoma. Included are observations about the special contributions made by American Indians to both the nation and to the state, as well as reflections upon the development of public health in the young nation and in the newly forming state of Oklahoma.

History, 18th Century↗
PubMed2005

Intimate partner violence injuries--Oklahoma, 2002.

Intimate partner violence (IPV) is a serious public health problem in the United States and a common cause of injury. Prevalence rates of IPV vary by the surveillance methods and definitions used. National data from the 1995 National Violence Against Women Survey indicate that 22.1% of women and 7.4% of men experience IPV during their lifetimes and that 1.3% of women and 0.9% of men experience IPV annually. IPV results in an estimated 4.1 billion dollars each year in direct medical and mental health-care costs, including 159 million dollars in emergency department (ED) treatments for IPV physical assaults. IPV might constitute as much as 17% of all violence-related injuries treated in EDs. To determine the magnitude of the IPV problem in Oklahoma, including IPV-related injuries and medical service utilization, researchers analyzed injury surveillance data from ED medical records and data from the Oklahoma Women's Health Survey (OWHS). This report summarizes the findings, which indicated that, during 2002 in Oklahoma, approximately 16% of all ED visits for assaults were for IPV injuries, including 35% of assault visits among females and 3% of assault visits among males. In addition, results of the OWHS for 2001-2003 indicated that 5.9% of surveyed Oklahoma women aged 18-44 years sustained an IPV injury during the preceding year. Overall, IPV resulted in a substantial number of injuries, particularly to women, many of whom required treatment in EDs. Medical recognition and documentation of IPV are important for identification of persons in need of services.

Adult↗
PubMed1991

The economic impact of AIDS on Oklahoma hospitals.

This study reviewed data on all patients with acquired immunodeficiency syndrome (AIDS) reported by 19 hospitals in the state of Oklahoma from January 1, 1981, through August 31, 1988, which represented 68% of the 382 cumulative reported cases in the state to that date. The study results indicate that the average lifetime hospitalization costs of caring for an AIDS patient in Oklahoma was $31,544. As a group, these patients represented a statewide cumulative operating margin loss of negative 14% during the study period. The margin for inpatients was -11%, and the margin for outpatients was -42%. The authors suggest that operating margins will increase as care shifts from inpatient to outpatient settings due to improved community support services or better drug therapy which, while prolonging life span, at the same time may cause serious side effects requiring more inpatient care. At the present time, AIDS patients in Oklahoma are 84% white, homosexual or bisexual males, and 15% are from the minority community. As the profile of Oklahoma's AIDS patients begins to conform to the national pattern, affecting more of the uninsured--drug abusers, their sexual partners, teenagers, and children--it can be anticipated that hospital costs for these patients will increasingly be absorbed by public funds.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Firearm-related mortality in Oklahoma, 1985-1989.

To determine the extent of firearms as a cause of mortality, Oklahoma vital statistic records were analyzed. The annual mortality rate in Oklahoma between 1985 and 1989 was 20% higher than the U.S. rate. Firearms were the second leading cause of injury deaths; firearms were the leading cause of injury deaths among blacks and the leading cause of all deaths among blacks 15 to 29 years of age. Ninety-two percent of the firearm-related deaths were intentional; firearms accounted for 70% of suicides and 59% of homicides. The male death rate from firearms was 4.5 times the female death rate. Suicide rates were highest among white males 65 years and older; homicide rates peaked among black males 25 to 34 years of age. Residents of eastern Oklahoma had the highest rates. The magnitude and preventability of firearm-related deaths and injuries demand attention and collaboration from Oklahoma health care providers; public health, mental health, and education officials; and criminal justice professionals.

Adolescent↗
PubMed1997

Medicaid: a comparison of Oklahoma and surrounding states, 1990-1994.

Medicaid has been the "safety net" for certain low-income people. In recent years, many states, including Oklahoma, have determined to enroll beneficiaries in managed care plans in an attempt to hold down the costs. Oklahoma began enrolling people in 1995, and the issue will be: was the managed care approach successful at least in controlling costs? To prepare, expenditures for the four years prior to the managed care approach have been analyzed. Comparison with surrounding states indicates that Oklahoma was already successful with negative average annual growth rates for the period 1992-1994, and that Oklahoma was more successful than surrounding states.

Cost Control↗
PubMed1998

Ticks and tick-borne diseases in Oklahoma.

Tick-borne diseases are common in Oklahoma, especially the eastern part of the state where tick prevalence is highest. Three species of hard ticks are present in Oklahoma that are known vectors of human disease--the American dog tick (Rocky Mountain spotted fever; RMSF), the lone star tick (ehrlichiosis) and the black-legged tick (Lyme disease). Oklahoma consistently ranks among the top states in numbers of reported RMSF cases, and Ehrlichiosis may be as prevalent as RMSF. Although Lyme disease is frequently reported in Oklahoma, over-diagnosing of this disease due to false-positive test results is common; positive or equivocal screening tests should be confirmed by Western immunoblot. At present, it is unclear whether the disease seen here is Lyme disease or another Lyme-like disease. If true Lyme disease is present in the state, it is probably rare. Physicians should be aware of the most recent recommendations for diagnosis, therapy and prevention of tick-borne diseases.

Animals↗