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PubMed1990

Dementia and Alzheimer's disease: resources in Oklahoma.

Senile dementia and Alzheimer's disease (often considered a single process) rank as the fourth most common cause of death in the United States and outrank in cost to the nation the three leading causes of death combined. Autopsy studies of patients with the clinical diagnosis of dementia have clearly shown that a wide variety of pathological conditions can produce clinically similar symptomatology. In order to address the many possible causes and treatments of these various forms of dementia, the Alzheimer's Association (formerly known as the Alzheimer's Disease and Related Disorders Association), the Oklahoma Autopsy Assistance Network at the Oklahoma Medical Research Foundation, and The Alzheimer's Foundation (also known as the Familial Alzheimer's Disease Research Foundation) have begun a concerted effort to develop a regional network which can aid patients and their relatives in the diagnosis and management of dementia. Awareness of these organizations by all physicians will help in the development and dissemination of the newer and more specific treatments to patients (and their relatives) with Alzheimer's disease and other forms of dementia in Oklahoma.

Alzheimer Disease↗
PubMed1986

Pertussis epidemic in Oklahoma. Difficulties in preventing transmission.

From Jan 1 to Dec 31, 1983, 351 cases of pertussis were reported in Oklahoma. Overall, 59% of the cases were among children 3 months to 6 years of age, the target age group for pertussis vaccination; only 42% of the patients in this age group were appropriately immunized for age with diphtheria and tetanus toxoids and pertussis vaccine (DTP). A survey of 185 households in the neighborhoods of three cases found that only 65% of 57 children 3 months to 6 years of age were appropriately immunized for their age. Aggressive control of the outbreak was attempted in Oklahoma County with recommendations for widespread vaccination against pertussis. However, the effort failed to immunize 82% of the 931 children in the initial target group. Nonetheless, analysis of the reported cases suggested that less than one fourth of the cases were potentially preventable by a single additional dose of DTP, ie, in individuals 3 months to 6 years of age with a history of at least one prior dose of DTP who were not appropriately immunized for age. The optimal solution to outbreak control is outbreak prevention by ensuring that the maximal number of children younger than 7 years of age receive routine age-appropriate DTP vaccination.

Child↗
PubMed1999

Psychiatric disorders among survivors of the Oklahoma City bombing.

CONTEXT: Disasters expose unselected populations to traumatic events and can be used to study the mental health effects. The Oklahoma City, Okla, bombing is particularly significant for the study of mental health sequelae of trauma because its extreme magnitude and scope have been predicted to render profound psychiatric effects on survivors. OBJECTIVE: To measure the psychiatric impact of the bombing of the Alfred P. Murrah Federal Building in Oklahoma City on survivors of the direct blast, specifically examining rates of posttraumatic stress disorder (PTSD), diagnostic comorbidity, functional impairment, and predictors of postdisaster psychopathology. DESIGN, SETTING, AND PARTICIPANTS: Of 255 eligible adult survivors selected from a confidential registry, 182 (71%) were assessed systematically by interviews approximately 6 months after the disaster, between August and December 1995. MAIN OUTCOME MEASURES: Diagnosis of 8 psychiatric disorders, demographic data, level of functioning, treatment, exposure to the event, involvement of family and friends, and physical injuries, as ascertained by the Diagnostic Interview Schedule/Disaster Supplement. RESULTS: Forty-five percent of the subjects had a postdisaster psychiatric disorder and 34.3% had PTSD. Predictors included disaster exposure, female sex (for any postdisaster diagnosis, 55% vs 34% for men; chi2 = 8.27; P=.004), and predisaster psychiatric disorder (for PTSD, 45% vs 26% for those without predisaster disorder; chi2 = 6.86; P=.009). Onset of PTSD was swift, with 76% reporting same-day onset. The relatively uncommon avoidance and numbing symptoms virtually dictated the diagnosis of PTSD (94% meeting avoidance and numbing criteria had full PTSD diagnosis) and were further associated with psychiatric comorbidity, functional impairment, and treatment received. Intrusive reexperience and hyperarousal symptoms were nearly universal, but by themselves were generally unassociated with other psychopathology or impairment in functioning. CONCLUSIONS: Our data suggest that a focus on avoidance and numbing symptoms could have provided an effective screening procedure for PTSD and could have identified most psychiatric cases early in the acute postdisaster period. Psychiatric comorbidity further identified those with functional disability and treatment need. The nearly universal yet distressing intrusive reexperience and hyperarousal symptoms in the majority of nonpsychiatrically ill persons may be addressed by nonmedical interventions of reassurance and support.

Adaptation, Psychological↗
PubMed1995

Linkage studies in a kindred from Oklahoma, with familial benign (hypocalciuric) hypercalcaemia (FBH) and developmental elevations in serum parathyroid hormone levels, indicate a third locus for FBH.

A five-generation kindred (19 affected, two obligate carriers and 20 unaffected) from Oklahoma USA, in which familial benign (hypocalciuric) hypercalcaemia (FBH) was associated with a developmental elevation in serum parathyroid hormone (PTH) levels, has been investigated for linkage to the candidate chromosomal regions 3q21-q24 and 19p13.3, 11q13, and 11p15, to which the genes for FBH, multiple endocrine neoplasia type 1 (MEN1) and PTH have been mapped respectively. By means of 17 polymorphic markers from these regions, linkage was excluded [LOD scores < -2.00 at (theta) = 0.05-0.25]. In addition, an analysis of multipoint crossovers and use of the LINKMAP program confirmed the exclusion from these regions. Thus, this form of FBH, designated the Oklahoma variant FBH(Ok), is not linked to markers that segregate with FBH, MEN1 and PTH; our results indicate further genetic heterogeneity and the presence of a third locus for FBH.

Chromosome Mapping↗
PubMed1998

A molecular and serologic survey of Ehrlichia canis, E. chaffeensis, and E. ewingii in dogs and ticks from Oklahoma.

Polymerase chain reaction and Southern hybridization were used to survey for the presence of Ehrlichia canis, Ehrlichia chaffeensis, and Ehrlichia ewingii in blood samples of 65 dogs that harbored ticks from northcentral and northeastern Oklahoma. Dog blood samples were also examined for antibodies against E. canis and E. chaffeensis, using an immunofluorescent antibody test. Ten of 65 dogs (15.4%) examined were positive for Ehrlichia spp. by PCR. Four (6.2%) were positive for E. ewingii, 2 (3.1%) for E. canis, and 4 (6.2%) for E. chaffeensis. Seven dogs (10.8%) were seropositive for E. canis or E. chaffeensis. Ticks collected from PCR-positive dogs were examined by PCR for the presence of Ehrlichia DNA. Several groups of ticks were PCR-positive for E. ewingii or E. canis. E. canis was detected in Rhipicephalus sanguineus, which is considered the major vector for that organism. E. ewingii was detected in a larger variety of ticks, including the only known vector Amblyomma americanum, as well as in Dermacentor variabilis and R. sanguineus. Results suggest that Ehrlichia spp. which are canine and human pathogens circulate in dogs in Oklahoma and in several tick species that feed on dogs.

Animals↗
PubMed2000

Establishment and characterization of an Oklahoma isolate of Anaplasma marginale in cultured Ixodes scapularis cells.

Anaplasma marginale is a tick-borne hemoparasite of cattle worldwide. The Virginia isolate of A. marginale was propagated previously in a cell line derived from embryos of the tick, Ixodes scapularis. The cultured Anaplasma (VA-tc) was passaged continuously for over 4 years and retained its infectivity for cattle and antigenic stability. We report herein the continuous in vitro cultivation of a second isolate of A. marginale derived from a naturally infected cow in Oklahoma (OK-tc). Blood from the infected cow was subinoculated into a splenectomized calf and blood collected at peak parasitemia was frozen, thawed and used as inoculum on confluent tick cell monolayers. Colonies of Anaplasma were apparent in low numbers at 9 days post exposure (PE) and infection in monolayers reached 100% by 4-5 weeks PE. Cultures were passaged by placing supernatant onto fresh tick cell monolayers at a dilution of 1:5 or 1:10. By the third passage development of the OK-tc was similar to that of the VA-tc and a 1:5 dilution resulted in 100% infection in 10-12 days. Inoculation of OK-tc into a splenectomized calf caused clinical anaplasmosis and Dermacentor ticks that fed on this calf transmitted the organism to a second susceptible calf. Major surface proteins (MSPs) 1-5 of the OK-tc were compared with homologous proteins present on VA-tc and the erythrocytic stage of the Oklahoma isolate. The MSPs 1, 2, 4, 5 were conserved on the OK-tc but there was evidence for structural variation in MSP3 between the cultured and erythrocytic stage of Anaplasma. MSP2 and MSP3 were the major proteins recognized by serum from infected cattle. Two-dimensional gels also identified positional differences between VA-tc and OK-tc in MSP2 and MSP3. The OK-tc may have potential to be used as antigen for development of an improved vaccine for anaplasmosis in the South Central United States.

Anaplasma↗
PubMed2003

Predictors of postmenopausal body mass index and waist hip ratio in the oklahoma postmenopausal health disparities study.

OBJECTIVE: The goal of the current study has been to examine systematically the respective roles of nutrition, exercise, menopausal weight gain, moderate drinking and smoking as determinants of body mass index (BMI) and waist hip ratio (WHR) in a setting in which the role of race or ethnic group could be simultaneously or individually evaluated as predictors of BMI and WHR. Because the use of estrogen replacement has been reported to affect estimates of body fat mass in postmenopausal women, endocrine factors have also been evaluated. METHODS: The design is cross-sectional with historical prospective elements. The study has a biomedical focus and is not an epidemiologic study. Data are from 649 women recruited into The Postmenopausal Health Disparities Study in Oklahoma. The study population was composed of 649 postmenopausal women: American Indian: 226 (34.9%), Asian: 21 (3.2%), Black: 78 (12.0%), Hispanics: 54 (8.3%) and Whites: 270 (41.6%). Recruitment occurred between 1994 and late 1999 in Oklahoma. RESULTS: In this multi-racial, multi-ethnic study population, there was statistical heterogeneity in all nutrition/dietary and exercise variables as well as in other potential determinants of BMI and WHR. In contrast to the literature available for postmenopausal women in which postmenopausal status, estrogen replacement and race have rarely been taken into account, the results of multi-linear regression revealed the following: Significant predictors for BMI, with or without WHR specified, included the neuroendocrine factors, menopausal weight gain, smoking, mean fitness (i.e., difficulty performing physical activities), fat as percent of total calories, moderate drinking and being Asian or Black. When WHR was not included, total calories and socioeconomic status also entered the model. The statistical predictors of WHR in the total study population with BMI in the equation included BMI and the neuroendocrine variables of FSH, E2, but not ERT, as well as the interaction of higher intensity exercise fitness with frequency, socioeconomic status and being American Indian or Asian. When BMI was not included in the model, in addition to the neuroendocrine factors, the interaction of lower intensity exercise fitness with frequency, fat as percent of total calories, age living alone and being American Indian or and Black were significant predictors of WHR. The predictors of both BMI and WHR were found to differ among individual racial and ethnic groups. CONCLUSIONS: Given the role of increased body fat and obesity in disease risk and the substantial differences in life expectancy among the racial and ethnic groups, the findings of this study, particularly in contrast to literature reports, strongly suggest that a whole variety of factors including hormonal status and race need to be considered when examining the role of dietary factors and physical activity in relation to estimates of body fat mass and disease risk.

Alcohol Drinking↗
PubMed1993

Invasive pneumococcal disease in central Oklahoma: emergence of high-level penicillin resistance and multiple antibiotic resistance. Pneumococcus Study Group.

Relatively penicillin-resistant pneumococci have caused 10% of invasive pneumococcal disease in central Oklahoma during the last decade, but almost no high-level penicillin or other antibiotic resistance has been described. This study evaluated antibiotic susceptibility and serotype distribution in invasive pneumococcal disease in the Oklahoma City metropolitan area (1990 population 848,000). A total of 144 cases of invasive infection was collected in 1 year (17 with meningitis, 120 with other bacteremic infections, and 7 with other invasive infections), for a rate of 16.9/100,000 (95% confidence interval [CI], 14.0-19.5). For the population aged > or = 60, invasive pneumococcal disease rates were higher among nursing home residents (352/100,000) than among nonresidents (25.6/100,000; relative risk, 13.7; 95% CI, 7.7-24.7). Antibiotic-resistant organisms caused 19.4% of the cases: relative penicillin resistance, 7.6%; high-level penicillin resistance, 1.4% (2 cases), and 11% resistance to erythromycin, trimethoprim-sulfamethoxazole, or both, with 5% sharing both resistances plus a MIC of penicillin of 0.06 microgram/mL.

Adolescent↗
PubMed1992

Isolation of Borrelia burgdorferi (Spirochaetales: Spirochaetaceae) from Ixodes scapularis and Dermacentor albipictus ticks (Acari: Ixodidae) in Oklahoma.

Borrelia burgdorferi was isolated from Ixodes scapularis Say and Dermacentor albipictus Packard that were removed as partially fed adults from white-tailed deer, Odocoileus virginianus Zimmermann, in Oklahoma. Isolation in media was accomplished only after homogenates of pooled field-collected ticks were inoculated into laboratory-reared Peromyscus leucopus and reisolated from the urinary bladder into BSK II media. Both isolates were confirmed by western blot analysis and reactivity with monoclonal antibody H5332. These are the first reported isolates of B. burgdorferi from Oklahoma from these two tick species and are the first isolates from ticks from the south-central United States that were infective for laboratory-reared P. leucopus.

Animals↗
PubMed2002

Exposure and peritraumatic response as predictors of posttraumatic stress in children following the 1995 Oklahoma City bombing.

Studies have demonstrated a positive relationship between exposure and posttraumatic stress, but one's subjective appraisal of danger and threat at the time of exposure may be a better predictor of posttraumatic stress than more objective measures of exposure. We examined the role of peritraumatic response in posttraumatic stress reactions in over 2,000 middle school children 7 weeks after the 1995 Oklahoma City, Oklahoma, bombing. While many children reported hearing and feeling the blast and knowing direct victims, most were in school at the time of the explosion and therefore were not in direct physical proximity to the incident. Physical, interpersonal, and television exposure accounted for 12% of the total variance in our measure of posttraumatic stress when peritraumatic response was ignored. Peritraumatic response and television exposure accounted for 25% of the total variance, and physical and interpersonal exposure were not significant in this context. These findings suggest the importance of peritraumatic response in children's reactions to terrorism. These early responses can be used to help determine which children may experience difficulty over time.

Adolescent↗
PubMed1988

The epidemiology of Rocky Mountain spotted fever in Arkansas, Oklahoma, and Texas, 1981 through 1985.

From 1981 through 1985, a total of 851 laboratory-confirmed cases of Rocky Mountain spotted fever were reported in Arkansas, Oklahoma, and Texas. Annual incidence rates in each state increased from 1981 through 1983, ranging from a 17% increase in Arkansas to a 137% increase in Texas. In the period 1984 through 1985, the annual incidence rates in each state decreased over 50%. A total of 519 cases were males. A majority of cases (51%) were 19 years of age or younger. April through August were the months of onset of symptoms for 83% of the cases. Differences in distribution of month of onset of symptoms were noted when comparing age groups and state of residence of the cases. The case-fatality ratio was 4.7%. Case-fatality ratios were higher in blacks and in older age groups. An endemic focus of Rocky Mountain spotted fever exists in Arkansas, Oklahoma, and Texas. The annual incidence trend for spotted fever in these three states is dissimilar to the trends in other states.

Adolescent↗
PubMed1989

Fatal injuries in Oklahoma: descriptive epidemiology using Medical Examiner data.

To characterize mortality associated with injuries and other health problems in Oklahoma, we examined data from the Office of the Chief Medical Examiner of the State of Oklahoma for the years 1978 through 1984. Each year, approximately 1,500 and 800 deaths resulted from unintentional injury (UI) and intentional injury (ie, suicide and homicide), respectively. The medical examiner (ME) data differed substantially from the state's vital statistics (VS); over the seven years, the ME records showed 2,021 (16%) fewer UI deaths than did the VS, as well as 24 (1%) more cases of suicide and 499 (23%) more cases of homicide. Rates for UI and suicide were highest for young adults and for the elderly; in contrast, rates for homicide were highest for young adults, and then decreased with age. For each of the three categories of injury-related deaths, rates for male subjects were approximately three times those for female subjects; rates also varied by race-ethnic group. Deaths due to UI and homicide occurred more often in the summer and on weekends, though suicides did not vary by month and were slightly more common on weekdays. This study indicates that ME data represent an important source of epidemiologic information for the surveillance and study of injury-related mortality.

Adolescent↗
PubMed2005

Epidemiology of homicide-suicide events: Oklahoma, 1994-2001.

In Oklahoma, all nonnatural deaths must be reported to the Office of the Chief Medical Examiner (ME), whose trained investigators report cause of death using a centralized, statewide, standardized reporting system. The purpose of this study was to determine temporal trends of Oklahoma homicide-suicide events and characterize the epidemiology of these events. By reviewing all ME reports of homicides and suicides from 1994 through 2001, we identified 73 homicide-suicide events resulting in 73 suicides and 89 homicides. Suicidal perpetrators of homicide-suicide events were most often white men aged >or=30 years who killed a current or ex-spouse or intimate partner. Homicide victims tended to be younger women the same race as their killer. Firearms were the predominant method of death in both homicides and suicides, with handguns used most frequently. Divorce/estrangement was the main contributing factor to these events, and the most common relationship type was possessive. The existence of a statewide, centralized, and computerized ME system and the ability to access the detailed information in the ME narratives were critical to identifying homicide-suicide events and obtaining the type of detailed information necessary to fully investigate these events.

Adolescent↗
PubMed1999

The Oklahoma Postmenopausal Women's Health Study: recruitment and characteristics of American Indian, Asian, Black, Hispanic, and Caucasian women.

Since 1994, the National Institutes of Health has required the inclusion of women and minorities in all of its sponsored clinical research. This study describes a workable recruitment strategy that embraces the National Institutes of Health requirement. We describe the recruitment pattern of the Oklahoma Postmenopausal Women's Study conducted in the general community of Oklahoma City and in surrounding areas that are both urban and rural. For the period 1994 through 1997, 491 postmenopausal women from all racial/ethnic groups in the community have participated in this study. Over 4 years of recruitment, the percentage of minority women in the study population has risen annually from 31% in 1994 to 81% in 1997. The overall percentage of minority women in the study population is currently 63.3%: American Indian, 21.8%; Asian, 3.7%; Black, 14.9%; Hispanic, 9.4%; White/American Indian Blend, 13.6%; and White, 36.7%. The recruitment approach described may be implemented in a variety of research settings. Specific recruitment approaches are described, as well as the distribution of sociodemographic and health behaviors across and within ethnic/racial groups.

Black or African American↗
PubMed1992

Serological survey for Lyme disease in domestic dogs and white-tailed deer from Oklahoma.

Sera from 223 randomly selected dogs and 489 white-tailed deer (Odocoileus virginianus) were tested for antibodies to Borrelia burgdorferi using an indirect kinetic ELISA. Dog samples were obtained in 1989 whereas deer samples were obtained between 1975 and 1990. Ten known negatives and two known positives from each group were run on each plate as controls. Samples showing mean mOD values above the mean of negatives + 3 SD were considered positive. Twenty-six dog (11.7%) and 22 deer (4.5%) samples were positive. Deer reactors were first detected among 1978 samples. Reactive deer were from central and eastern Oklahoma whereas reactive dogs were mostly from central Oklahoma. Confirmed human cases between 1986 and 1989 were distributed throughout the state, thus showing no correlation with either deer or dog results.

Animals↗
PubMed1994

A comparison of dental caries experience in Native American and Caucasian children in Oklahoma.

OBJECTIVES: In 1989 the Oklahoma Area Indian Health Service conducted an oral health survey of children attending public schools in Oklahoma to determine the extent of caries experience in the Native American population. Results were to be used to establish program priorities, gather baseline data, and compare the oral health status of Native American children with their non-Indian peers. METHODS: A total of 934 elementary schoolchildren 5-6 years of age were examined along with 733 high school students 15-17 years of age. The study was designed so that approximately 50 percent of the students examined were Native American. RESULTS: The mean dmfs for the 5-6-year-olds was 5.06 for the Caucasian children and 10.35 for the Native American children, a statistically significant difference (P < .001). For the 15-17-year-olds the mean DMFS for the Caucasian students (5.99) was significantly lower (P < .001) than the mean DMFS for the Native American students (10.12). CONCLUSIONS: The prevalence and severity of caries in these Native American students appear to be substantially higher than in their non-Indian peers residing in the same communities. Further study is needed to identify factors contributing to these demonstrated differences in caries experience.

Adolescent↗
PubMed1998

Use of psychotropic medications for persons with mental retardation who live in Oklahoma nursing homes.

OBJECTIVE: The study examined the use of psychotropic medications to treat persons with mental retardation living in nursing homes in Oklahoma. METHODS: Data were gathered on all 1,056 individuals funded through the Oklahoma mental retardation service system in 1995 to live in nursing homes. The Developmental Disabilities Quality Assurance Questionnaire was used to assess adaptive behavior, living site conditions, health, use of medications, and other variables. RESULTS: The most frequently used class of psychotropic medications was antipsychotic medication, used by 31.8 percent of subjects. Sixteen percent received anxiolytic medication, and 6.1 percent received antidepressant medication. Stepwise multiple regression analysis indicated that use of antipsychotic medication was marginally predictable (less than 15 percent of the variance was explained) with a linear combination of six variables: mental health problems; violence toward others; adaptive behavior; screaming, yelling, or crying behavior; hyperactivity; and age. CONCLUSIONS: A relatively high percentage of subjects received various forms of psychotropic medications, especially antipsychotics. The presence of behavior problems or mental health problems did not sufficiently explain the high rate of use of antipsychotic medication. The risks of this type of medication and its lower rate of use in group homes raise the question of the appropriateness of placing persons with mental retardation in nursing homes as they are currently conceived.

Adolescent↗
PubMed1999

Lessons from the first two years of Project Heartland, Oklahoma's mental health response to the 1995 bombing.

On April 19, 1995, a terrorist bombing in Oklahoma City killed 168 people and injured 853 others. The Oklahoma Department of Mental Health and Substance Abuse Services was the lead agency in crafting a community mental health response to reduce impairment of those affected. The Project Heartland program, which opened on May 15, 1995, was the first community mental health program in the U.S. designed to intervene in the short to medium term with survivors of a major terrorist event. The authors describe lessons learned in the areas of planning and service delivery, as well as the types and extent of services provided in the project's first two years.

Community Mental Health Services↗