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PubMed2003

Expanding metabolic screening of newborns: can the health care industry do better than public health?

In Oklahoma since the early 1990s, all newborns have been screened for four metabolic conditions: phenylketonuria, hypothyroidism, galactosemia and hemoglobinopathies. In 2002, 38 affected babies were diagnosed and one expects they are saved from the complications of late diagnosis such as mental retardation or death from sepsis. With advances in genetics and improved biochemical assays, 86% of states now screen for more disorders than Oklahoma, up to 37 in Mississippi. Six recent patient vignettes illustrate the mortality and morbidity of conditions that are screened for elsewhere but not in Oklahoma. In 2001, the Oklahoma Genetics Advisory Council recommended adding three disorders and the State Health Department forecasts that implementation may be complete in 2007. For now, when a patient asks, "Will my baby be screened for as many metabolic conditions as possible?", two answers represent either the public health or the private health care view. The public health answer is, "The state requires screening for four conditions." The health care system answer is, "We can work with you to get 44 conditions tested for, but it will cost money, may not be reimbursed, and has not been proven effective when done on an individual basis." This dilemma, not unique to newborn screening, might be resolved if professional and public opinion strongly supported early expansion.

Delivery of Health Care↗

PubMed2003

Smoke-Free Beginnings.

Because of the high prevalence of smoking in pregnant women in Oklahoma, the Oklahoma State Medical Association has received a grant funded by the Robert Wood Johnson Foundation to conduct a project aimed at system-level changes that promote smoking cessation. The Smoke-Free Beginnings project is emphasizing practical strategies that can be easily integrated into routine practice. Join colleagues statewide in thirty two different practices offering prenatal care in assisting pregnant women to live free of tobacco addiction. To participate, or for more information, please contact Sarah Jane Carlson at the Oklahoma State Medical Association at 405.843.9521 or 800.522.9452 or email at Carlson@osmaonline.org. Our newborns and mothers will benefit greatly from this project, and the state of Oklahoma will be a leader in the development of a system-wide intervention to aid in the dissemination of the Best Practice Guidelines.

Female↗

PubMed1985

Clinical evaluation and prerelease management of American river otters in the second year of a reintroduction study.

In the first year (1984) of a reintroduction study, 10 American river otters (Lutra canadensis) from Louisiana were transported to Oklahoma, held for 5 days for clinical evaluation, surgical implantation with intra-abdominal radiotelemetry devices, and then released in Oklahoma. Four of 10 otters released died within 32 days. Clinical evaluation indicated that respiratory tract disease, bacterial and parasitic infections, and inanition may have contributed to the death of these otters. In the second year (1985) of the study, an exotic feline diet was fed, and the holding period for 10 otters was increased to provide time for evaluation and treatment before surgery, postsurgical acclimation to Oklahoma, and reevaluation before release. Although the initial clinical findings on otters in the second year were similar to those found in the first year, otter body weights increased, and the prevalence and severity of clinical abnormalities decreased with treatment during the second-year holding period. Three of 10 second-year otters died during the holding period, and contributing causes of death were determined to be: trauma (hepatic hematoma), inanition, renal disease, pneumonia, salmonellosis (Salmonella anatum), and a retropharyngeal abscess (Klebsiella pneumoniae). Seven healthy otters were reintroduced into Oklahoma in 1985, and postrelease deaths were not experienced.

Acclimatization↗

PubMed1980

Prevalence of gentamicin- and amikacin-resistant bacteria in sink drains.

Sink drains from the Veterans Administration Medical Center, University of Oklahoma Health Sciences Center, and the Oklahoma City community were selectively cultured for gentamicin- and amikacin-resistant bacteria. Aminoglycoside-resistant organisms were found in 86% (Veterans Administration Medical Center, 88%; University of Oklahoma Health Sciences Center, 88%; and Oklahoma City community, 77%) of all 233 sink drains sampled. Of 207 sink drains harboring aminoglycoside-resistent organisms, 99% of the organisms were gentamicin resistant and 82% were amikacin resistant. These data suggest that aminoglycoside-resistent organisms are commonly present in the environment.

Amikacin↗

PubMedDate not supplied

Effect of hepatic disease on the pharmacokinetics and plasma protein binding of eprosartan.

STUDY OBJECTIVE: To evaluate the pharmacokinetics and plasma protein binding of eprosartan in hepatic disease. DESIGN: Single-dose, parallel-group study. SETTING: Oklahoma Foundation for Digestive Research, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. PATIENTS: Eight healthy subjects with normal hepatic function and eight patients with hepatic disease. INTERVENTION: All subjects received a single oral dose of eprosartan 100 mg. MEASUREMENTS AND MAIN RESULTS: Eprosartan plasma concentrations were quantified by high-performance liquid chromatography; plasma protein binding was determined by ultrafiltration. Using analysis of variance, point estimates (PE) and 90% CIs were calculated. Total and unbound maximum concentrations and degree of plasma protein binding were similar for both groups. Total area under the plasma concentration-time curve (AUC0-t) was approximately 40% higher for the group with hepatic disease (PE 1.42, 90% CI 0.94-2.14). Similarly, unbound AUC0-t was approximately 50% higher (PE 1.53, 90% CI 0.98-2.39). CONCLUSION: Eprosartan was safe and well tolerated by both groups. Based on the increase in AUC in patients with hepatic disease compared with those with normal hepatic function, the dosage of eprosartan in patients with hepatic disease should be individualized based on tolerability and response.

Acrylates↗

PubMed1996

The first isolation, in vitro propagation, and genetic characterization of Ehrlichia canis in Israel.

Ehrlichia canis, the etiologic agent of canine ehrlichiosis, was isolated in Israel from a naturally infected dog with acute signs of the disease. The organism designated E. canis 611, was passaged experimentally to a beagle, from which it was propagated in primary canine monocytes. The organism was then grown in vitro in a continuous canine cell line, DH82. Nine beagles subsequently injected with whole E. canis-infected blood all developed typical symptoms of ehrlichiosis. An indirect immunofluorescence antibody test to E. canis was developed and compared with a commercial kit, revealing a good correlation between the two assays. Transmission electron microscopy of DH82 cells infected with the Israeli strain of E. canis (611), revealed organisms similar to those described in the literature: two different forms of morulae appeared, one tightly, the other loosely, packed. The 16S rRNA gene sequence obtained from the Israeli Ehrlichia isolate was compared with other isolates, E. canis Oklahoma and E. canis Florida. The Israeli strain 16S rRNA had three nucleotide differences from the Oklahoma isolate, and four nucleotide differences from the Florida isolate, in addition to one nucleotide gap in each. The Israeli isolate was found to be 0.54% different from the Oklahoma strain, and 0.61% different from the Florida strain. There are the same magnitudes of differences displayed by the other most closely related group in the phylogenetic tree, namely Ehrlichia equi, Ehrlichia phagocytophilia and the human granulocytic ehrlichia.

Animals↗

PubMed2006

Intragastric acidity after switching from 5-day treatment with intravenous pantoprazole 40 mg/d to 5-day treatment with oral esomeprazole 40 mg/d or pantoprazole 40 mg/d: an open-label crossover study in healthy adult volunteers.

BACKGROUND: After a course of IV proton pump inhibitor therapy, patients might require continued oral antisecretory therapy. A direct comparison of therapeutic alternatives could assist physicians in decisions regarding optimal acid-suppressive therapy. Oral esomeprazole might control intragastric acidity more effectively compared with other acid-suppressive agents after IV therapy. OBJECTIVE: The aim of this study was to compare intragastric acid control on day 5 of administration of esomeprazole magnesium versus pantoprazole 40 mg PO QD after switching from 5 days of treatment with pantoprazole 40 mg IV in healthy volunteers. METHODS: This randomized, open-label, comparative, 2-way crossover study was conducted at the Oklahoma Foundation for Digestive Research, Oklahoma City, Oklahoma, between October and December 2004. Healthy, Helicobacter pylori-negative adults were randomly assigned to 1 of 2 dosing sequences: pantoprazole IV followed by esomeprazole PO or pantoprazole IV followed by pantoprazole PO. All study medications were administered for 5 days at a dose of 40 mg QD. IV pantoprazole was administered over 2 minutes; all medications were administered 30 minutes before breakfast. There was a 10- to 21-day washout period between each 10-day dosing period. All doses were administered at the study site. Before oral study drug administration on days 1 and 5, 24-hour pH monitoring was performed using a pH catheter positioned 10 cm distal to the lower esophageal sphincter in the stomach. The primary end point was percentage of time with pH >4 (%t pH >4) during the 24-hour pH-monitoring period. Tolerability was assessed using spontaneous reporting, laboratory analysis, and vital-sign measurement. RESULTS: Of 42 subjects randomized to treatment sequences, 4 were withdrawn during the study because of invalid pH data; 38 subjects (24 men, 14 women; mean [SD] age, 25.2 [8.1] years) had assessable data. Day-5 %t pH >4 was 68.5% with esomeprazole and 53.3% with pantoprazole (P < 0.001). Day-1 %t pH >4 was 62.5% with esomeprazole and 51.0% with pantoprazole (P < 0.001). The most common adverse events were rhinitis (2 subjects each with pantoprazole IV and PO; 1 subject with esomeprazole) and headache (2 subjects with esomeprazole; 1 subject with pantoprazole IV). CONCLUSIONS: The results of this study in healthy adult volunteers suggest that switching from pantoprazole 40 mg IV to esomeprazole 40 mg PO QD more effectively suppresses intragastric acid compared with switching from pantoprazole 40 mg IV to pantoprazole 40 mg PO QD. All 3 treatments were well tolerated.

2-Pyridinylmethylsulfinylbenzimidazoles↗

PubMed1998

Evaluation of three smoke detector promotion programs.

CONTEXT: Seventy percent of U.S. residential fire deaths occur in homes without a working smoke detector. To help prevent residential fire deaths, many programs have distributed or installed detectors in unprotected homes. Because persons receiving a detector may not install it and because detector batteries require annual replacement, the enduring effectiveness of these programs may be questioned. OBJECTIVE: We evaluated the long-term functional status of smoke detectors distributed to high-risk households in eight areas of Minnesota, Cherokee County (North Carolina), and Oklahoma City (Oklahoma). DESIGN: Cross-sectional. SETTING: Home visits were made to check the detectors that were distributed 3 to 4 years earlier. PARTICIPANTS: Randomly selected households from the three detector promotion programs. MAIN OUT-COME MEASURE: At least one working smoke detector. RESULTS: Participation rates ranged from 72% to 82%. The percentage of evaluation households with at least one working detector ranged from 58% in Oklahoma to 73% in North Carolina. In 76% of households with nonworking detectors, the batteries were either missing or disconnected. When batteries in nonworking detectors were replaced, 83% of the detectors regained function. CONCLUSIONS: Future programs should consider distributing detectors that do not require annual battery changes or find effective ways to ensure that batteries are routinely replaced. Programs should also provide each household with the number of detectors needed to meet the most current recommended standard of the National Fire Protection Agency. The evaluation's participation rates support the practicality of unannounced home visits to evaluate home injury prevention programs in high-risk groups.

Accident Prevention↗

PubMed2001

The influence of nitrate on microbial processes in oil industry production waters.

Sulfide accumulation due to bacterial sulfate reduction is responsible for a number of serious problems in the oil industry. Among the strategies to control the activity of sulfate-reducing bacteria (SRB) is the use of nitrate, which can exhibit a variety of effects. We investigated the relevance of this approach to souring oil fields in Oklahoma and Alberta in which water flooding is used to enhance oil recovery. SRB and nitrate-reducing bacteria (NRB) were enumerated in produced waters from both oil fields. In the Oklahoma field, the rates of sulfate reduction ranged from 0.05 to 0.16 microM S day(-1) at the wellheads, and an order of magnitude higher at the oil-water separator. Sulfide production was greatest in the water storage tanks in the Alberta field. Microbial counts alone did not accurately reflect the potential for microbial activities. The majority of the sulfide production appeared to occur after the oil was pumped aboveground, rather than in the reservoir. Laboratory experiments showed that adding 5 and 10 mM nitrate to produced waters from the Oklahoma and Alberta oil fields, respectively, decreased the sulfide content to negligible levels and increased the numbers of NRB. This work suggests that sulfate reduction control measures can be concentrated on aboveground facilities, which will decrease the amount of sulfide reinjected into reservoirs during the disposal of oil field production waters.

Alberta↗

PubMed1994

Seroprevalence of cryptosporidial antibodies during infancy, childhood, and adolescence.

Cryptosporidium parvum causes mild to moderately severe diarrhea in immunocompetent individuals. Cryptosporidial antibodies in the sera of 803 children seen at Children's Hospital of Oklahoma were measured by means of an ELISA. Thirteen percent of children younger than 5 years of age were seropositive for antibodies to C. parvum. The seropositivity rate for children who attended day-care facilities was higher than that for those who did not. In addition, children in this age group with a history of recent diarrhea were seropositive at a higher rate than were children without diarrhea. Thirty-eight percent of children (5-13 years of age) and 58% of adolescents (14-21 years of age) were seropositive for antibodies to C. parvum. Blacks and Native Americans in these age groups had higher seropositivity rates than did White non-Hispanics. There were no differences in seropositivity rates between sexes or between residents of the largest urban counties in Oklahoma and residents of the more rural counties. Exposure to C. parvum during childhood is common in Oklahoma. Socioeconomic factors may play a role in early exposure to this protozoal pathogen.

Adolescent↗

PubMed1993

Emergency medical services preparedness for pediatric emergencies.

The study objective was to examine emergency medical services (EMS) equipment and training preparedness for pediatric emergencies in Oklahoma. The participants were 202 administrators of licensed EMS agencies in the state of Oklahoma. A mailed questionnaire was used to obtain data from EMS agencies regarding emergency ambulance run characteristics, medical control, equipment, and personnel training. There were 130 questionnaires returned (response rate, 64%). Overall, 4% of EMS emergency runs were for children under 12 years. Family medicine and emergency medicine were the most frequent specialties of medical directors. Fewer services allow personnel to perform endotracheal intubation on children (35 services) than on adults (45 services). Fewer services allow personnel to start intravenous lines on children (40 services) than on adults (47 services). Equipment for pediatric care routinely stocked on ambulances was tabulated. Most services provided intraagency continuing education, but only 71 (54%) included pediatric topics in continuing education. Deficiencies in equipment and training for pediatric emergencies are a common problem for EMS agencies in Oklahoma. Barriers to preparedness include: 1) relative infrequency of pediatric runs and difficulty with maintenance of technical skills, 2) costs associated with increased equipment and training, and 3) hesitancy to allow personnel to perform advanced life support procedures on children.

Ambulances↗

PubMed1990

Syphilis, human immunodeficiency virus infection, and targeting prevention.

To examine the interaction between syphilis and human immunodeficiency virus-type 1 (HIV-1) infection in Oklahoma, we conducted an unlinked HIV seroprevalence survey using serum specimens submitted to the Oklahoma State Department of Health for serologic test for syphilis. Of specimens with positive results from fluorescent treponemal antibody absorption test (FTA-ABS), 6.3% were HIV-1 seropositive compared to 0.8% of those that had negative results from FTA-ABS. Among specimens positive for syphilis, HIV-1 seropositivity was found almost exclusively among those from persons 20 to 39 years of age and more often among those from men than those from women (9.9% vs 1.3%). Of syphilis-positive specimens from 20- to 39-year-old men, 17.6% were HIV-1 seropositive. In Oklahoma, an area with a relatively low overall prevalence of HIV-1 infection, targeting prevention efforts to young adults who test positive for syphilis should be an efficient way to reach some persons at high risk for HIV-1 infection.

AIDS Serodiagnosis↗

PubMedDate not supplied

Bridging the gap between public and private healthcare: Influenza-like illness surveillance in a practice-based research network.

This article describes the development, testing, and implementation of the OKAlert-ILI System, a bidirectional, dual-use influenza-like illness surveillance and messaging system, during the influenza seasons of 2003-2004 and 2004-2005 in the Oklahoma Physicians Resource/Research Network, a primary care practice-based research network. We describe how the Oklahoma Physicians Resource/Research Network connected 30 primary care providers to the Oklahoma State Department of Health and how surveillance results were analyzed and fed back to the clinicians on a weekly basis. We demonstrate the timeliness, sensitivity, specificity, acceptability, validity, flexibility, and cost of the system. Finally, we describe upgrades and enhancements to the system based on user evaluation and feedback.

Databases, Factual↗

PubMed1995

Diabetes and impaired glucose tolerance in three American Indian populations aged 45-74 years. The Strong Heart Study.

OBJECTIVE: To estimate prevalence rates of diabetes and impaired glucose tolerance (IGT) in three American Indian populations, using standardized diagnostic criteria, and to assess the association of diabetes with the following selected possible risk factors: age, obesity, family history of diabetes, and amount of Indian ancestry. RESEARCH DESIGN AND METHODS: This cross-sectional study involved enrolled members, men and women aged 45-74 years, of 13 American Indian tribes or communities in Arizona, Oklahoma, and South and North Dakota. Eligible participants were invited to the clinic for a personal interview and a physical examination. Diabetes and IGT status were defined by the World Health Organization criteria and were based on fasting plasma glucose and oral glucose tolerance test results. Data on age, family history of diabetes, and amount of Indian ancestry were obtained from the personal interview, and measures of obesity included body mass index, percentage body fat, and waist-to-hip ratio. RESULTS: A total of 4,549 eligible participants were examined, and diabetes status was determined for 4,304 (1,446 in Arizona, 1,449 in Oklahoma, and 1,409 in the Dakotas). In all three centers, diabetes was more prevalent in women than in men. Arizona had the highest age-adjusted rates of diabetes: 65% in men and 72% in women. Diabetes rates in Oklahoma (38% in men and 42% in women) and South and North Dakota (33% in men and 40% in women), although considerably lower than in Arizona, were several times higher than those reported for the U.S. population. Rates of IGT among the three populations (14-17%) were similar to those in the U.S. population. Diabetes rates were positively associated with age, level of obesity, amount of Indian ancestry, and parental diabetes status. CONCLUSIONS: Diabetes is found in epidemic proportions in Native American populations. Prevention programs and periodic screening should be implemented among American Indians. Standards of care and intervention have been developed by the Indian Health Service for individuals in whom diabetes is diagnosed. These programs should be expanded to include those with IGT to improve glycemic control or to reduce the risk of development of diabetes as well as to reduce the risk of diabetic complications.

Age Factors↗

PubMed1999

The role of the medical examiner in mass casualty situations with special reference to the Alfred P. Murrah Building bombing.

OBJECTIVE: To describe the events that shaped the investigation by the Oklahoma Office of the Chief Medical Examiner with regard to the terrorist bombing of the Alfred P. Murrah Federal Building in Oklahoma City in 1995 and to provide lessons learned for reinforcement and future planning. STUDY POPULATION: All persons known to have been killed by the blast. METHODS: Standard forensic techniques with regard to crime scene investigation, documentation, body identification and cause of death determinations were followed. MAIN OUTCOME MEASURES: Fatality injury and related evidence documentation. RESULTS: A total of 168 people died principally from secondary and tertiary injuries caused by projectiles, victim displacement, and crushing. Emphasis is placed on the methods of operation required to find, remove, identify, and determine cause of death in these individuals. Simultaneously, evidence must be identified and preserved in a homicide investigation of this type. Close cooperation must exist among multiple varied agencies and disciplines to accomplish the task and to prepare for subsequent analysis and courtroom testimony required by the criminal justice system. CONCLUSIONS: Terrorism, both foreign and domestic, is a current fact and will be a problem in many forms in the 21st century. No one is immune. The key to success is to plan ahead and be aware of available resources. Preplanning for short comings and difficult issues, and most importantly, relying on team work will allow future participants to successfully meet and complete the challenge. The investigation developed detailed injury data and mechanisms that were available for subsequent judicial proceedings and for in-depth epidemiological studies spearheaded by the Injury Prevention Service of the Oklahoma State Department of Health.

Coroners and Medical Examiners↗

PubMed1999

After the bombing: public scenarios and the construction of meaning.

In both our folk psychology and mental health practice, we adhere to the modernist view that a crisis is something that an individual has. A crisis is either something that happens to people or which people bring on themselves because of character pathology. On the other hand, postmodern theorists now draw our attention to how processes of interaction provide opportunities for certain characterizations to emerge and disipate. Both the conceptualization of an event as a crisis and the scenarios of how it is best understood arise within a community and emerge out of the communal construction of meaning. In this process in Oklahoma City, bystanders, politicians, pilgrims and news media played a role of great significance. Whether local or from afar, they became a community of observers who interacted with one another and looked to one another for verification as to what counted as a crisis and what behavior was appropriate. Lindy has observed that traumatized individuals are often surrounded quickly by a small network of trusted people who serve to buffer and protect them and who define what is helpful and what constitutes further trauma. Here, in Oklahoma, however, a wider public defined the event as a crisis, elaborated on it, and have gradually transformed it into almost mythic proportions, a process now exemplified in the construction of the Oklahoma City National Monument. However, they have also endorsed diverse other scenarios, not all of which have facilitated appropriate grieving, repair of life-disruption, or moving on. All, however, seem to have given a sense of meaning to the event. In this rich matrix, some survivors and their families have felt helped. Others have felt exploited. Still others have wanted to forget the whole thing and to avoid anything that reminded them of it. Of the would-be helpers, some felt unjustly rejected and unappreciated. Others felt appreciated, useful, and even enriched. However, a true legacy of the bombing may well be the metalogue it can precipitate and advance about the relationship between individuals and society, and especially the relationship between our individual life-stories and larger public scenarios, and the effects these scenarios have on the questions we can ask, what we can perceive and what solutions we can create.

Crime Victims↗

PubMed1999

Do not resuscitate (DNR): analysis of the DNR act.

Due to advances in technology, physicians and patients are being faced with the issue of do not resuscitate (DNR). DNR is an order that determines whether or not cardiopulmonary resuscitation (CPR) should be administered to a critically ill person. Within the state of Oklahoma, the Oklahoma DNR act was created in order to establish regulations regarding the decision-making of when to use CPR. This Act gives rise to legal and ethical problems, which have been taken into consideration by the Oklahoma Association for Healthcare Ethics (OAHE). The following article focuses on DNR with examples of case histories and possible recommendations for improvement to the current law. Furthermore, this article sets out to show why the decision of whether or not to resuscitate should be made by the patient or their family.

Female↗

PubMed2002

Nursing Home Reform and House Bill 2019: past, present, and future.

On May 25, 2000, in the wake of the scandal at the Oklahoma State Department of Health related to corruption on the inspection of nursing homes and assisted living facilities, the Oklahoma State Legislature passed House Bill 2019 (HB 2019). Known as the Oklahoma 2001 Healthcare Initiative, HB 2019 has as one of its main purposes the improvement of the public health care system (i.e. Medicaid) in the state through the provision of increased health services and benefits, especially to residents (Medicaid and non-Medicaid) in nursing homes. This article will review and discuss the past, present, and future implications of HB 2019 both on the care delivered to nursing home residents and on the providers of that care.

Forecasting↗