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PubMed1996

Variability in mammography use among older women.

OBJECTIVE: To determine rates of and explore factors associated with mammography use among older women. DESIGN: Retrospective review of part B (physician) bills submitted to Medicare during 1990. SETTING: Health Care Financing Administration (HCFA) data, including sociodemographic information and part B physician bills for all services delivered to Medicare-eligible women in 1990. PATIENTS/PARTICIPANTS: Women age 65 or older as of January 1, 1990, residing in one of 10 states with part B coverage through December 31, 1990. MEASUREMENTS AND MAIN RESULTS: The outcome was receipt of a mammogram (yes/no). We explored factors associated with mammography use within three age groups: 65 to 74, 75 to 84, and 85+. The factors considered were race, state, median income of ZIP Code of residence (from the 1990 US Census, and used to divide the population into quintiles within each state), and number of primary care visits (0, 1, 2, and 3+). Overall, 15% of women had a mammogram: 20% of women age 65 to 74, 12% of women age 75 to 84, and 4% of women age 85 and older. Mammography use was lowest in Oklahoma and highest in Washington. However, in each state the older the age category, the less the mammography use (e.g., 9% vs 5% vs 2% in Oklahoma and 25% vs 16% vs 5% in Washington for women 65-74, 75-84, and 85+, respectively). Mammography use was lower for black than for white women age 65 to 74 (14% vs 21%, P < .001) and 75 to 84 (9% vs 12%, P < .001). Women in each of these two age groups had lower mammography use if they resided in the lowest income quintile and highest if they resided in the highest income quintile (17% vs 23% 65-74, and 10% vs 13% 75-84, P values < .001). Among the oldest women (those 85+), mammography use was low (4%) and varied minimally by race and income (P = .907 and .003, respectively). In all age groups, mammography use was lowest among women who did not have a primary care visit, was greater among women who had at least one visit, and continued to rise with increasing numbers of visits (all P values < .001). For example, among women age 75 to 84, mammography use increased from 5% to 10%, 14%, and 17% for those with 0, 1, 2, and 3+ visits. CONCLUSIONS: We found that mammography use was less for women who were older, of black race, who did not visit a primary care provider, and who lived in areas with lower median income and certain geographic locations (states). Similar factors influenced mammography use in women age 65 to 74, where there is greater consensus as to who should receive a mammogram, and women age 75 to 84, where there is neither consensus nor data. Surprisingly, neither race nor income had much influence on mammography use among women age 85 or older.

Black or African American↗

PubMed1962

Nutritional requirements for the production of herpes simplex virus. I. Influence of glucose and glutamine of herpes simplex virus production by HeLa cells.

Lewis, Vester J., Jr. (University of Oklahoma School of Medicine, Oklahoma City) and L. Vernon Scott. Nutritional requirements for the production of herpes simplex virus. I. Influence of glucose and glutamine on herpes simplex virus production by HeLa cells. J. Bacteriol. 83:475-482. 1962.-The importance of glucose and glutamine in herpes simplex virus production by HeLa cells was evaluated by variation of the composition of Eagle's basal medium. Simultaneous omission of glucose and glutamine from the serum-containing medium resulted in marked curtailment of viral synthesis. The effect was attributable neither to decreased survival time of infectious particles or of cells, nor to decreased rate of viral adsorption or penetration in the presence of the deficient medium. Therefore, the effect was probably on intracellular viral replication.When the requirements for glucose and glutamine were determined separately, it was found that viral production was reduced in glucose-deficient medium. In contrast, a medium which was complete except for restriction of the glutamine content to that occurring naturally in the serum component supported significantly greater viral multiplication than did the complete medium. Limited viral replication occurred with medium which lacked both glutamine and serum. Viral multiplication in the presence of serum-free medium was stimulated by the addition of glutamine.

Carbohydrate Metabolism↗

PubMed1963

PRODUCTION OF DELAYED HYPERSENSITIVITY TO CRYPTOCOCCUS NEOFORMANS IN EXPERIMENTAL ANIMALS.

Lomanitz, Rachel (University of Oklahoma School of Medicine, Oklahoma City) and John M. Hale. Production of delayed hypersensitivity to Cryptococcus neoformans in experimental animals. J. Bacteriol. 86:505-509. 1963.-Rabbits and guinea pigs have been sensitized to somatic, as well as whole-cell, antigens of a small-capsuled variant of Cryptococcus neoformans ODH-DV. Rabbits have also been sensitized to soma and to whole cells of a large-capsuled patient isolate. The time required for appearance of skin reactivity, after intracutaneous injection of antigenic material, indicated that the hypersensitivity developed was of the delayed type. This was subsequently demonstrated in both rabbits and guinea pigs by passive transfer of the hypersensitivity to normal animals. Efforts to transfer the skin sensitivity to normal rabbits with serum from sensitized animals were unsuccessful, indicating that humoral antibodies are not involved. Preliminary studies suggest that the sensitizing antigen resides in the cell wall and is highly specific.

Animals↗

PubMed1963

EFFECT OF SODIUM CHLORIDE ON STAPHYLOCOCCUS-PHAGE RELATIONSHIPS.

West, B. (University of Oklahoma Medical Center, Oklahoma City), Florene C. Kelly, and Doris A. Shields. Effect of sodium chloride on staphylococcus-phage relationships. J. Bacteriol. 86:773-780. 1963.-Phage patterns of 21 phage-propagating strains of staphylococci on medium with high NaCl content appeared to be an expression of the staphylococcal cells, as well as of the salt tolerance of the phages. Serological group A phages, previously found to be NaCl-tolerant in the free state, were capable of lysing susceptible staphylococci on 3, 7.5, and 10% NaCl Trypticase Soy Agar. None of the other phages tested was active when the medium contained 7.5 and 10% NaCl. Increasing the NaCl content of the medium rarely resulted in nonspecific reactions; rather the effect was, generally, a narrowing of the phage spectrum of the cells, with persistence in the phage pattern of the phage, or phages, which were propagated on the cells being tested. Although NaCl tolerance of the phages was the chief limiting factor of phage activity in the presence of 7.5 and 10% NaCl, reactions on salt medium also depended on the degree of susceptibility of cells to phage on routine typing medium and to certain other unexplained factors. In some instances, under the influence of increased NaCl, significant lysis at 1000 RTD was replaced by thinning of growth (inhibition), with or without the presence of plaques. Conversely, certain phage-cell combinations, which gave inhibition at 1000 RTD on standard medium produced some degree of lysis when the NaCl concentration was increased. Studies of phage 81 and its propagating strain showed that replication of phage occurred in 10% NaCl medium, although adsorption diminished as salt concentration was increased, and the time required to reach maximal lytic activity was delayed.

Bacteriophages↗

PubMed1964

2-KETOGLUCONATE FERMENTATION BY STREPTOCOCCUS FAECALIS.

Goddard, J. L. (University of Oklahoma School of Medicine, Oklahoma City), and J. R. Sokatch. 2-Ketogluconate fermentation by Streptococcus faecalis. J. Bacteriol. 87:844-851. 1964.-Streptococcus faecalis 10Cl did not grow with 2-ketogluconate alone as an energy source, but did grow when gluconate was added. More growth was obtained than could be accounted for by the gluconate alone. The requirement for gluconate in the stimulation of growth on 2-ketogluconate was found to be stoichiometric, not catalytic. Glucose did not replace gluconate in this phenomenon, apparently owing to the repression of the 2-ketogluconate pathway by glucose. Resting cells grown on a combination of gluconate and 2-ketogluconate did ferment 2-ketogluconate without added gluconate. Fermentation balance studies with resting cells detected the following products in moles (per mole of 2-ketogluconate): carbon dioxide, 0.98; lactic acid, 0.19; formic acid, 1.42; acetic acid, 0.70; and ethanol, 0.42. 2-Ketogluconate-1-C(14) and -2-C(14) were prepared and fermented. The data were interpreted to show that 90% of the substrate was decarboxylated to carbon dioxide and pentose phosphate. Pentose phosphate was then fermented to pyruvate through the sedoheptulose diphosphate variation of the pentose phosphate pathway found in this organism. The other 10% of the substrate was converted to pyruvate by way of the Entner-Doudoroff pathway. Calculations of the energy available by the above combination of pathways indicated that about 2.3 moles of adenosine triphosphate per mole of 2-ketogluconate could be obtained if the energy available in acetate formation is conserved through the acetokinase reaction.

Acetates↗

PubMed1964

COLORADO TICK FEVER VIRUS IN CELL CULTURE. I. CELL-TYPE SUSCEPTIBILITY AND INTERACTION WITH L CELLS.

Trent, Dennis W. (University of Oklahoma School of Medicine, Oklahoma City) and L. Vernon Scott. Colorado tick fever virus in cell culture. I. Cell-type susceptibility and interaction with L cells. J. Bacteriol. 88:702-708. 1964.-Colorado tick fever (CTF) virus was serially propagated in monolayer cultures of L and FL cells. Early passages of virus in FL cells yielded viral titers 10(4)-fold greater than did the corresponding L-cell passages. During L-cell passage number 4, there was a 10(3)-fold increase in the amount of infectious virus produced as compared with virus cultured earlier in this cell line. Viruses from L-cell passages 8 and 12 were identified with specific immune serum to be CTF viruses which were antigenically similar, if not identical, to the mouse-adapted virus. Parallel titrations of mouse-, L cell-, and FL cell-adapted viruses were performed in mice and replicate monolayers of L, FL, HeLa, KB, chick embryo, and cotton rat kidney cells. Cytopathic effects and viral replication were noted in all cultures except HeLa and cotton rat kidney. Cultures of L, FL, and chick embryo cells were as sensitive to infection as were suckling or weanling mice. KB cells were the least susceptible of those cell types examined. In L-cell cultures, 90% of the input virus was adsorbed to the cells during the first 30 min of incubation. The latent period lasted 10 to 12 hr, and was followed by rapid viral synthesis for the next 10 to 24 hr, depending upon the multiplicity of infection. Curves describing exponential increase in cell-associated and cell-released virus were separated by 4 hr. When the maximal total virus titers were reached, 80 to 90% of the virus was released from the cell.

Adsorption↗

PubMed1966

Serological reactions associated with the clumping factor of Staphylococcus aureus.

Rotter, Joan (University of Oklahoma Medical Center, Oklahoma City), and Florene C. Kelly. Serological reactions associated with the clumping factor of Staphylococcus aureus. J. Bacteriol. 91:588-594. 1966.-Evidence that the substance which causes staphylococci to clump in the presence of fibrinogen (clumping factor) is antigenically similar in strains which are serologically diverse according to agglutination reactions has been obtained from fibrinogen-cell clumping inhibition tests. Antisera for clumping factor (CF)-positive strains inhibited the clumping reaction of all strains tested. After adsorption with homologous cells or with cells of other CF-positive strains, the antisera no longer inhibited clumping. When antisera were adsorbed with trypsin-treated, CF-positive cells, or with cells of CF-negative mutants, the ability to inhibit the clumping reaction persisted. Antibody to CF activity was not associated with coagulase. Latex coated with extracts derived from the cells of five CF-positive and six CF-negative strains was, in each instance, agglutinated by sera from rabbits immunized with CF-positive cells. After adsorption with trypsinized, CF-positive cells, antisera still agglutinated latex which had been treated with the CF-positive extracts, but not with the CF-negative extracts. Similar results were obtained after antisera were adsorbed with the cells of CF-negative mutants. Cell agglutination titers of sera from rabbits immunized with CF-negative staphylococci were significantly lower than those produced in response to CF-positive cells, regardless of their coagulase activity. If the CF-inhibiting antibody also functions as an agglutinin, it apparently is not solely responsible for this difference.

Agglutination↗

PubMed1966

Colorado tick fever virus in cell culture. II. Physical and chemical properties.

Trent, Dennis W. (University of Oklahoma School of Medicine, Oklahoma City), and L. Vernon Scott. Colorado tick fever virus in cell culture. II. Physical and chemical properties. J. Bacteriol. 91:1282-1288. 1966.-Heat-inactivation kinetics for Colorado tick fever (CTF) virus grown in L cells indicated that more than one rate constant was involved for inactivation at each exposure temperature. An Arrhenius plot of the data indicated the inactivation rate constants to be dependent on the absolute temperature. The energy of activation, for thermal inactivation of the virus, was 17,289 calories per mole, with the Q(10) being 2.6. The optimal pH range for maintenance of CTF viral infectivity was determined to be 7.5 to 7.8. The infectivity of CTF virus was stable to freezing and thawing in diluents which contained: 50% calf serum, 20% glucose, 20% glycerol, 10% bovine serum albumin, 20 mm glutamine, and 2% gelatin. CTF virus replication was insensitive to inhibition by 5-fluoro-2'-deoxyuridine and 5-bromo-2'-deoxyuridine, whereas herpes simplex virus was markedly inhibited, as reported by others. Actinomycin D inhibited CTF virus replication when cells were pretreated for 24 and 12 hr prior to infection, but not when the inhibitor was added at the time of infection. The nucleic acid of CTF virus appears to be of the ribose type.

Arboviruses↗

PubMed1966

Oxidation of D- and L-valine by enzymes of Pseudomonas aeruginosa.

Norton, J. E. (University of Oklahoma School of Medicine, Oklahoma City), and J. R. Sokatch. Oxidation of d- and l-valine by enzymes of Pseudomonas aeruginosa. J. Bacteriol. 92:116-120. 1966.-Cell-free extracts prepared from Pseudomonas aeruginosa grown on dl-valine catalyzed the consumption of oxygen with several d-amino acids, but not with the corresponding l-amino acids. The product of d-valine oxidation was identified as 2-oxoisovalerate by the preparation and characterization of 2-oxoisovalerate 2,4-dinitrophenylhydrazone. The enzyme catalyzing d-amino acid oxidation was present in extracts of cells grown on valine, but not on glucose, had a pH optimum of approximately 9.0, consumed 1 atom of oxygen per mole of keto acid produced, and was not stimulated by any of the usual electron transport cofactors. It was not possible to demonstrate either the direct oxidation of l-valine or the conversion of l- to d-valine by these enzyme preparations. However, a possible route of l-valine metabolism by transamination with 2-oxoglutarate with regeneration of the amino group acceptor by glutamate oxidation was established by identification of the transaminase and l-glutamate dehydrogenase in these enzyme preparations.

Amino Acids↗

PubMed1966

Alanine and aspartate formation during growth on valine-C14 by Pseudomonas aeruginosa.

Sokatch, J. R. (University of Oklahoma School of Medicine, Oklahoma City). Alanine and aspartate formation during growth on valine-C(14) by Pseudomonas aeruginosa. J. Bacteriol. 92:72-75. 1966.-Pseudomonas aeruginosa grown with dl-valine-4,4'-C(14) synthesized alanine labeled mainly in carbons 1 and 3, indicating that the isopropyl carbons of valine were the precursors of pyruvate for alanine formation by a pathway which did not involve randomization of isotope. Alanine from cells grown on valine-1-C(14) contained isotope only in the carboxyl carbon, suggesting another route to pyruvate from valine by carbon dioxide fixation. Oxidation of valine to propionyl-coenzyme A (CoA), as it occurs in animal tissues, followed by the oxidation of propionyl-CoA to acrylyl-CoA, lactyl-CoA, and pyruvate, would account for the isotope data. Cells grown on valine oxidized valine, isobutyrate, and propionate immediately, whereas cells grown on acetate did not oxidize valine or isobutyrate and required an induction period before propionate was oxidized. P. aeruginosa grown with propionate-1-C(14) or propionate-2-C(14) formed alanine-1-C(14) and alanine-2-C(14), respectively, which agrees with the contention that at least part of the propionate is oxidized via the acrylate pathway. Aspartate formed from valine-1-C(14) was labeled only in the carboxyl carbons, whereas that formed from valine-4,4'-C(14) was labeled in all four carbons, but most heavily in carbons 1 and 3. These data suggest that the main route for the formation of the carbon skeleton of aspartate was by a C(3) plus C(1) condensation, with the C(3) unit derived from the isopropyl carbons of valine and the C(1) unit probably from carbon dioxide.

Acetates↗

PubMed1983

Detection of Rickettsia rickettsii antibodies in human sera by crossed immunoelectrophoresis.

To identify Rickettsia rickettsii antigens of immunological importance, we examined sera from patients with serologically confirmed cases of Rocky Mountain spotted fever by crossed immunoelectrophoresis for antibodies to antigens extracted from the R strain of R. rickettsii with the detergent Triton X-100. Sixteen antigens were identified in the detergent extract by crossed immunoelectrophoresis with a hyperimmune rabbit serum raised against whole rickettsiae. When the rabbit antiserum was placed in the reference gel and patient sera were placed in the intermediate gel, antibodies to one or more antigens were detected in 61 of 71 North Carolina sera, all of 7 Oklahoma sera, and 9 of 10 Montana sera obtained from 1 day to 40 years after onset of Rocky Mountain spotted fever. Antibodies to antigens 1 and 16 were found as early as 1 day after onset of illness, and antibody to 16 was found in 20 of 29 sera obtained within the first 7 days of illness. Antibodies to antigens 2 and 3 generally did not appear until the third week of illness but were found in six of seven serum samples collected 4 to 40 years after onset of Rocky Mountain spotted fever. Antibodies to R. rickettsii antigens 1, 7, 8, and 16 were found in sera from patients with illnesses caused by other etiological agents. Four of the Oklahoma and Montana sera from Rocky Mountain spotted fever patients, but none of the North Carolina sera, had antibodies to antigen 12. Sera containing antibodies against antigens 3 and 14 prevented death of mice challenged with two 50% lethal doses of R. rickettsii.

Animals↗

PubMed1993

Ehrlichia chaffeensis and Rochalimaea antibodies in Kawasaki disease.

Sera from 38 patients with Kawasaki disease were tested for immunofluorescent antibodies to Ehrlichia chaffeensis, Rochalimaea henselae, and R. quintana Oklahoma. Only 2.5% of the patients tested positive for E. chaffeensis, and 5% were positive for R. henselae and R. quintana Oklahoma. Our data suggest that Ehrlichia and Rochalimaea spp. do not play a unique role in the etiology of Kawasaki disease.

Antibodies, Bacterial↗

PubMed2001

Molecular and antigenic comparison of Ehrlichia canis isolates from dogs, ticks, and a human in Venezuela.

We previously culture isolated a strain of Ehrlichia canis, the causative agent of canine ehrlichiosis, from a human in Venezuela. In the present study, we examined whether dogs and ticks are infected with E. canis in Venezuela and, if so, whether this is the same strain as the human isolate. PCR analysis using E. canis-specific primers revealed that 17 of the 55 dog blood samples (31%) and all three pools of four Rhipicephalus sanguineus ticks each were positive. An ehrlichial agent (Venezuelan dog Ehrlichia [VDE]) was isolated and propagated in cell culture from one dog sample and was further analyzed to determine its molecular and antigenic characteristics. The 16S rRNA 1,408-bp sequence of the new VDE isolate was identical to that of the previously reported Venezuelan human Ehrlichia isolate (VHE) and was closely related (99.9%) to that of E. canis Oklahoma. The 5' (333-bp) and 3' (653-bp) sequences of the variable regions of the 16S rRNA genes from six additional E. canis-positive dog blood specimens and from three pooled-tick specimens were also identical to those of VHE. Western blot analysis of serum samples from three dogs infected with VDE by using several ehrlichial antigens revealed that the antigenic profile of the VDE was similar to the profiles of VHE and E. canis Oklahoma. Identical 16S rRNA gene sequences among ehrlichial organisms from dogs, ticks, and a human in the same geographic region in Venezuela and similar antigenic profiles between the dog and human isolates suggest that dogs serve as a reservoir of human E. canis infection and that R. sanguineus, which occasionally bites humans residing or traveling in this region, serves as a vector. This is the first report of culture isolation and antigenic characterization of an ehrlichial agent from a dog in South America, as well as the first molecular characterization of E. canis directly from naturally infected ticks.

Animals↗

PubMed1996

Hypertension in adult American Indians. The Strong Heart Study.

Hypertension is a primary risk factor for cardiovascular disease in the United States. Although cardiovascular disease is the leading cause of death among American Indians, the prevalence of hypertension, its awareness and control, and its association with other cardiovascular disease risk factors and physiological variables have not been well studied in this population. The Strong Heart Study is a longitudinal study of cardiovascular disease and its risk factors in American Indians. Participants (2703 women and 1846 men) were members of 13 tribes in central Arizona, southwestern Oklahoma, and regions of South and North Dakota. At least 1500 individuals between 45 and 74 years of age participated from each center in a baseline clinical examination conducted between July 1989 and January 1992. The examination consisted of a personal interview and physical examination that included an oral glucose tolerance test and three consecutive blood pressure measurements. This study reports data from the baseline examination on the prevalence of hypertension and correlates of blood pressure. Results indicated that despite the high frequency of diabetes and obesity, prevalence rates of hypertension in Arizona and Oklahoma were similar to those in the US population in the Third National Health and Nutrition Examination Survey (NHANES III), and rates among South/North Dakota participants were significantly lower (P < .0001). Blood pressure was higher in individuals with diabetes (P < .0001) and was significantly correlated with age (P < .0001) and albuminuria (P < .0001) but only weakly related to obesity. There was no independent relation between blood pressure and insulin. Blood pressure seems to be less affected by obesity and hyperinsulinemia in American Indians compared with other populations. Nevertheless, hypertension should be aggressively treated and controlled in American Indians because it is a known precursor to morbidity and mortality associated with diabetes and cardiovascular disease.

Aged↗

PubMed1976

Kinetic properties of pyruvate kinase in human maternal leukocytes in fetal malnutrition.

Pyruvate kinase (PK) is one of the regulatory enzymes in glycolysis. The present study was undertaken to determine whether regulation of the enzyme by normally occurring metabolites was disturbed in leukocytes of mothers who delivered fetally malnourished (FM) babies. Kinetic studies of enzyme regulation by physiologic effectors approximated a potential regulating mechanism of the enzyme in its cellular environment. There are two isoenzymes of PK. Leukocytes contain an M2 enzyme with intermediate regulatory properties between the liver (type L) and the muscle (type M) enzymes. The presence in the cell of M2 PK in the A form leads to inhibition of glycolysis by amino acids, such as alanine, and therefore, to the sparing of glucose but probably inhibition of energy production from glucose. In this study, leukocytes were isolated from blood of six pregnant women and 11 women in the postpartum period in Oklahoma and at parturition from 31 women in Mexico. Fourteen of the latter group delivered FM babies. The kinetic characteristics of the nonpurified enzyme PK with respect to allosteric modulation in fructose-1, 6-phosphate (FDP) and L-alanine (Ala) were studied in the leukocyte extracts. Data for initial reaction velocities (v) vs substrate concentrations (s), double reciprocal Lineweaver-Burk plots, and Hill plots are presented. The equations for the double reciprocal plots were determined by linear regression analysis. The enzyme constants were derived by computer, and the values compared by the Mann-Whitney U-test. In all subjects studied, 0.5 mM FDP activated and 2 mM L-alanine inhibited the enzyme. During pregnancy, the v vs s concentration curves were hyperbolic (Hill coefficient, n is less than 1.0) except for the Ala-inhibited enzyme during pregnancy, which had a sigmoid curve, n=1.54. The interaction of FDP and Ala was dependent on the concentration of the substrate phosphoenolpyruvate (PEP) at low [PEP]. There was net activation, not inhibition, at high concentrations; the switchover was at 0.5 mM PEP during pregnancy. In Mexican mothers having normal babies (normal mothers) the maximum initial velocity, V (micromoles per min per mg of DNA), with respect to PEP, was 2.22+/-0.34; in FM mothers, V was 2.01+/-0.44. With respect to binding of the substrate, PEP, V of the leukocyte enzymes in FM mothers vs normal mothers was equally inhibited by Ala (deltaV=-50% vs -47%), but was significantly less responsive to stimulation by FDP (deltaV=+10% vs +75%). When both Ala and FDP were present, FDP less effectively overcame the inhibition by Ala (deltaV=-9% vs +54%). The K0.05 of the enzyme (molar concentration X 10(-4) PEP) was significantly reduced by FDP, whether Ala was present or not, during pregnancy and in the postpartum period in leukocytes of Oklahoma mothers and at term in Mexican mothers. The K0.5 for normal and FM mothers was similar. Thus, the enzyme in leukocytes of Mexican mothers who delivered FM and normal babies exhibited different kinetic responses to the allosteric modulators...

Alanine↗

PubMed1999

Hypoalbuminemia as a cause of pleural effusions.

BACKGROUND: Alterations in Starling forces that favor pleural fluid formation include an elevation in capillary hydrostatic pressure and a fall in plasma oncotic pressure. Although venous hypertension is a well-recognized cause of pleural effusion, the frequency with which hypoalbuminemia in the absence of volume expansion leads to pleural effusion is unclear. STUDY OBJECTIVE: We determined the frequency with which unexplained pleural effusions occur in patients with normal and low plasma oncotic pressures. DESIGN: A 2-month prospective screen of all admission patients to the University of Oklahoma Hospital and the Oklahoma City Veterans Administration (VA) Medical Center identified 152 patients who had chest radiographs and serum protein determinations on admission, but did not have an admission diagnosis that was a recognized cause of pleural effusion. In order to include more patients in the study with extremely low serum albumin levels, 20 additional study patients with serum albumin levels of < 2.0 g/dL were identified by a retrospective review of patients admitted during the previous 12 months. On the radiograph, pleural effusions were identified as a new blunting of the costophrenic angles. Study patients were divided into the following three groups: group 1 had serum albumin levels of > 3.5 g/dL; group 2 had serum albumin levels between 2.1 and 3.5 g/dL; and group 3 had serum albumin levels of < or = 2.0 g/dL. Finally, the frequencies with which pleural effusions occurred were compared among the three groups. RESULTS: Seven of 104 patients in group 1, 2 of 45 patients in group 2, and 3 of 21 patients in group 3 had pleural effusions. Within each group, there were no significant differences in serum albumin concentration or plasma oncotic pressure between patients with and without pleural effusions. In all but two study patients, a careful review of records and a prospective follow-up of the patients' clinical course identified a potential cause for the effusions other than hypoalbuminemia. None of the 68 study patients with serum albumin levels of < or = 3.5 g/dL had an unexplained pleural effusion. CONCLUSION: We conclude that hypoalbuminemia, per se, is an uncommon cause of pleural effusion. The recognition of pleural effusions in patients with low serum albumin levels should prompt careful clinical evaluations to identify other potential causes for the effusions.

Female↗

PubMed2001

Television exposure in children after a terrorist incident.

This study examined the influence of bomb-related television viewing in the context of physical and emotional exposure on posttraumatic stress symptoms--intrusion, avoidance, and arousal--in middle school students following the 1995 Oklahoma City bombing. Over 2,000 middle school students in Oklahoma City were surveyed 7 weeks after the incident. The primary outcome measures were the total posttraumatic stress symptom score and symptom cluster scores at the time of assessment. Bomb-related television viewing in the aftermath of the disaster was extensive. Both emotional and television exposure were associated with posttraumatic stress at 7 weeks. Among children with no physical or emotional exposure, the degree of television exposure was directly related to posttraumatic stress symptomatology. These findings suggest that television viewing in the aftermath of a disaster may make a small contribution to subsequent posttraumatic stress symptomatology in children or that increased television viewing may be a sign of current distress and that it should be monitored. Future research should examine further whether early symptoms predict increased television viewing and/or whether television viewing predicts subsequent symptoms.

Child↗

PubMed2006

"Tobacco has a purpose, not just a past": Feasibility of developing a culturally appropriate smoking cessation program for a pan-tribal native population.

Tobacco has long held spiritual significance to Native people of North America but, because of recreational use, it has become a health risk relatively recently. More Native people smoke than any other ethnic group (41 percent vs. 24 percent in whites and blacks), and death rates caused by tobacco-related diseases are disproportionately high. However, no tested, culturally tailored smoking cessation programs exist for this group. We used a critical-interpretive framework to understand the meaning of tobacco and the feasibility of smoking cessation interventions in a pan-tribal population. In June 2004, the University of Kansas Medical Center (KUMC) and the Oklahoma Area Indian Health Service (IHS) collaborated on six focus groups with (IHS) patients. The patients served represent over 200 different nations. Our participants provided us with modifications to a currently untested program designed by the Muscogee Nation of Oklahoma's Tobacco Prevention Program to enhance cultural appropriateness, including (1) an emphasis on visual presentation and a "Native" look to program educational materials; (2) comprehensive information about tobacco, quitting, and coping among Native people; (3) an acknowledgment and incorporation of traditional tobacco use and its diversity; and (4) the use of talking circles and counseling with Native facilitators.

Adult↗