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PubMed2004

The impact of shift work on the risk and severity of injuries for hospital employees: an analysis using Oregon workers' compensation data.

BACKGROUND: While past research on health care workers has found that shift work can lead to negative physiological and psychological consequences, few studies have assessed the extent to which it increases the risk of specific work-related injuries, nor quantified and compared associated types, severity and costs. AIMS: This study aimed to derive and compare the rates, typologies, costs and disability time of injuries for various hospital worker occupations by day, evening and night shift. METHODS: This study used Oregon workers' compensation claim data from 1990 to 1997 to examine the differences in hospital employee claims (n = 7717) by shift and occupation. Oregon hospital employee claim data, hospital employment data from Oregon's Labor Market Information System and shift proportion estimates derived from the Current Population Survey (CPS) were used to calculate injury rate estimates. RESULTS: The injury rate for day shift per 10,000 employees was estimated to be 176 (95% CI 172-180), as compared with injury rate estimates of 324 (95% CI 311-337) for evening shift and 279 (95% CI 257-302), night shift workers. The average number of days taken off for injury disability was longer for injured night shift workers (46) than for day (38) or evening (39) shift workers. CONCLUSION: Evening and night shift hospital employees were found to be at greater risk of sustaining an occupational injury than day shift workers, with those on the night shift reporting injuries of the greatest severity as measured by disability leave. Staffing levels and task differences between shifts may also affect injury risk.

Adult↗
PubMed1986

A population-based study of hemolytic-uremic syndrome in Oregon, 1979-1982.

The authors conducted a retrospective hospital-based chart review of cases of hemolytic-uremic syndrome among children less than or equal to 18 years of age, hospitalized in Oregon during the four-year period from January 1979 to December 1982. Thirty children with hemolytic-uremic syndrome living in Oregon were hospitalized during this period, for an average annual incidence of 0.97 cases per 100,000 children. Seventy per cent of cases occurred in children under five years of age, for an incidence of 2.65 cases per 100,000 children. Twenty-seven (90%) of the 30 children were white, and 17 (57%) were female. Twenty-four (80%) had a diarrheal prodromal illness including 20 who had bloody diarrhea. Twelve children (40%) acutely required peritoneal dialysis, and two (7%) developed chronic renal failure. Three children died, for a case fatality ratio of 10%. Sixty per cent of the 30 cases occurred during the summer and early fall months. Geographic clustering was also evident. Hemolytic-uremic syndrome is a rare but endemic disease in Oregon and may occur in small clusters. Although descriptions of several large series of patients have been published, this study describes the first statewide population-based study of this syndrome.

Adolescent↗
PubMed1996

Advanced practice politics and the Oregon nurses' trail.

As health care reform continues to evolve, it is important to consider the context of politics, practice, and power through an examination of nursing's recent history and participation in legislative events. Through a retrospective chronicle that includes interviews, recorded events, and article reviews, the political and legislative history of Oregon nurses in establishing advanced practice for nurse practitioners within the Oregon Nurse Practice Act is described. Prescriptive authority, hospital admitting privileges, and important elements contained in the Oregon Health Plan and Medicare reform are discussed. Questions are posed for the future of health care reform, such as the role of government in determining the quality of care in managed health care.

Health Care Reform↗
PubMedDate not supplied

Diabetes preventive care in Oregon's Medicaid population.

The purpose of this study was to estimate the prevalence of diabetes in Oregon's adult Medicaid population and to compare the level of diabetes-related preventive care with the state's general population. Responses to telephone interviews conducted in 1999 among 2,770 randomly selected adult Medicaid beneficiaries and 7,229 Oregon residents were compared. Diabetes prevalence among adult Medicaid recipients (11.1% [95% Cl, 9.9% to 12.2%]) was more than twice that in the general population (4.7% [95% Cl, 4.2% to 5.3%]). During the year prior to the interview, adults with diabetes in the Medicaid and general populations reported performing the following preventive care, respectively: > or = 2 diabetes care visits (80%, 77%); foot examination (74%, 74%); dilated eye examination (73%, 68%); influenza vaccine (65%, 61%); self-monitored blood glucose daily (63%, 61%); pneumococcal vaccine (51%, 47%); regular aspirin use (48%, 53%); and awareness of Hemoglobin A1c (34%, 39%). Although the reported prevalence of diabetes in Oregon's Medicaid population is high, the prevalence of diabetes preventive care activities was similar to the state's general population. Nonetheless, specific services in both populations could be improved.

Adult↗
PubMedDate not supplied

Agreement between self-reported information and medical claims data on diagnosed diabetes in Oregon's Medicaid population.

Recent trends in Oregon indicated that diabetes is on the rise. Medicaid self-reported data estimated about 11 percent are affected by diabetes, which is twice the prevalence of the general population in Oregon. Little is known about the agreement between self-reported information and medical claims data in the Medicaid population. This study provides an opportunity to compare prevalence of diabetes when the estimates are computed from the two different data sources. A sample of 2,154 Medicaid adults in Oregon (18 to 64 years old) were identified in both the Medicaid claims and self-report survey. The result reported a strong agreement of diabetes definition between the Medicaid claim data and the self-reported survey.

Adolescent↗
PubMed1993

Prioritising health services in an era of limits: the Oregon experience.

How do we decide who should receive the benefits that medical science has to offer? One approach to this decision process, that used by the state of Oregon, is described: who and what are covered, and how health care is financed and delivered, are considered. Oregon's priorities were set on the basis of broad consensus. The objective of health care reform, it was agreed, is to improve, maintain, or restore health--not universal coverage, access to health care, or cost containment. A Health Services Commission was created to consider clinical effectiveness and, through public involvement, to attempt to integrate social values into the priority list. Oregon's legislature can use the list to develop an overall health policy which recognises that health can be maintained only if investments in several related areas are balanced.

Attitude to Health↗
PubMed2001

Comparison of physician based reporting of tobacco attributable deaths and computer derived estimates of smoking attributable deaths, Oregon, 1989 to 1996.

BACKGROUND: Tobacco use prevention programmes need accurate information about smoking related mortality. Beginning in 1989, Oregon began asking physicians to report on death certificates whether tobacco use contributed to the death. OBJECTIVE: To determine the long term comparability of this method of estimating tobacco attributable mortality to estimates of smoking attributable mortality derived from a computer model. DESIGN: For the period 1989 to 1996, we compared mortality resulting from tobacco use reported by Oregon physicians to estimates of smoking attributable deaths (SADs) derived by "Smoking attributable mortality, morbidity and economic costs" software version 3.0 (SAMMEC 3.0), a widely used software program that estimates SADs on the basis of smoking prevalence and relative risks of specific diseases among current and former smokers. MAIN OUTCOME MEASURES: Numbers of deaths, age, sex, and category of disease. RESULTS: Of 212, 448 Oregon deaths during 1989-1996, SAMMEC 3.0 estimated that 42, 778 (20.1%) were attributable to cigarette smoking. For the same 27 diagnoses, physicians reported that tobacco contributed to 42, 839 (20.2%) deaths-a cumulative difference of only 61 deaths over the eight year period. The age and sex distributions of tobacco and smoking attributable deaths reported by the two systems were also similar. By category of disease, the ratio of SAMMEC 3.0 estimates to physician reported deaths was 1.11 for neoplasms, 0.88 for heart disease, and 1.04 for respiratory disease. CONCLUSIONS: Physician reporting provides comparable estimates of smoking attributable mortality and can be a valuable source of data for communicating the risks of tobacco use to the public.

Adult↗
PubMed1998

Changes in public psychiatric hospitalization in Oregon over the past two decades.

OBJECTIVE: In 1988 a governor's commission in Oregon recommended dramatic changes in the state's approach to public psychiatric hospitalization. To evaluate the effect of the recommendations, this study examined characteristics of hospitalization for patients with schizophrenia and bipolar disorder in public psychiatric facilities between 1981 and 1984 and between 1991 and 1994. METHODS: Patients with schizophrenia and bipolar disorder (N=621) were identified as part of a larger study that examined civil commitment in one of Oregon's state hospitals in 1986. Data on the patients' hospitalizations were obtained from a statewide computerized mental health information system. RESULTS: The legal status of hospitalized patients differed between the two time periods, with voluntary hospitalizations overrepresented in 1981-1984 and civil commitments overrepresented in 1991-1994. The locus of hospitalization varied greatly between the two time periods. All hospitalizations in 1981-1984 took place in one of Oregon's three state hospitals. In 1991-1994, subjects were hospitalized in 13 different institutions, including state and community hospitals and specially designed nonhospital inpatient facilities. CONCLUSIONS: Patterns of inpatient hospitalization for public psychiatric patients changed dramatically from 1981-1984 to 1991-1994. The extensive use of community and nonhospital facilities raises questions about monitoring of quality of care in these diverse and decentralized facilities.

Adult↗
PubMed2004

Obstacles to dependent health care access in Oregon: health insurance or health care?

In the 1980s, Oregon was one of a handful of "states that could not wait" for national health care reform. Oregon's chosen approach to reform was predicated on two widely accepted assumptions. First, universal access to health care is best achieved by universal access to health insurance. Second, universal access to health care could best be achieved, at least politically, by incrementally building upon the existing health care delivery and insurance system. This article questions both of these assumptions in light of Oregon's decade-long experience in trying to expand access to health care among its dependent population.

Child↗
PubMed1977

Arsenic levels in Oregon waters.

The arsenic content of well water in certain areas of Oregon can range up to 30 to 40 times the U.S.P.H.S. Drinking Water Standard of 1962, where concentrations in excess of 50 ppb are grounds for rejection. The elevated arsenic levels in water are postulated to be due to volcanic deposits. Wells in central Lane County, Oregon, that are known to contain arsenic rich water are in an area underlain by a particular group of sedimentary and volcanic rocks, which geologists have named the Fischer formation. The arsenic levels in water from wells ranged from no detectable amounts to 2,000 ppb. In general the deeper wells contained higher arsenic water. The high arsenic waters are characterized by the small amounts of calcium and magnesium in relation to that of sodium, a high content of boron, and a high pH. Water from some hot springs in other areas of Oregon was found to range as high as 900 ppb arsenic. Arsenic blood levels ranged from 32 ppb for people living in areas where water is low in arsenic to 250 ppb for those living in areas where water is known to contain high levels of arsenic. Some health problems associated with consumption of arsenic-rich water are discussed.

Adult↗
PubMed2003

Public policy implications of elderly interstate migration to Oregon, 1985-1990.

Several Oregon counties received a noticeable influx of elderly migrants from other states during the 1980s. Oregon policy regarding taxes, land use, and long-term care is examined for possible influence on migration. Models of elderly migration are examined for insight into how public policy influences migration, and previous research regarding the effects of elderly migration on public policy is reviewed. Data regarding disability and financial vulnerability among elderly by migration status are analyzed for possible influence upon public policy. Change in the population aged 65 and older mirrored state and national patterns for 1980 to 1990 and 1990 to 1999. Interstate elderly arriving in attractive counties reported a low prevalence of disability and financial vulnerability, indicating a low risk of demanding public assistance. Interstate elderly arriving in population centers reported a relatively high prevalence of disability but a low prevalence of financial vulnerability. This may suggest that Oregon's long-term care policy influenced elderly migration.

Aged↗
PubMed2001

Impact of the Oregon Health Plan on children with special health care needs.

OBJECTIVE: Although an increasing number of Medicaid children are enrolled in Medicaid managed care plans, little is known about how children with special health care needs fare under such programs. Of particular concern is the ability of such children to navigate a managed care system and gain access to specialty and other services. This study compares the managed care experiences of children with and without special care needs in the Oregon Health Plan. METHODOLOGY: Telephone surveys were conducted with a sample of parents of children enrolled in the Oregon Health Plan. Three groups of children were sampled: Supplemental Security Income (SSI) children with disabilities, children with asthma, and children without special health care needs. Descriptive and multivariate analyses were conducted to determine the impact of Medicaid managed care on access and satisfaction. RESULTS: Children with disabilities in managed care plans did not experience any more difficulty accessing needed specialty care than did those without special health care needs. Children with asthma, however, reported higher levels of unmet need. There were no differences in access between children with disabilities enrolled in managed care and those children with disabilities remaining in fee-for-service. CONCLUSIONS: Unlike SSI children with disabilities, children who were not SSI-eligible but had asthma seemed to have difficulty obtaining some services. These children were not eligible for the same consumer protections afforded SSI children by Oregon. If states want to enroll all children with special health care needs into managed care programs, they must develop mechanisms for identifying such children and ensuring that they receive medically necessary services.

Asthma↗
PubMed2005

A pathogenic new species of Eimeria from the pygmy rabbit, Brachylagus idahoensis, in Washington and Oregon, with description of the sporulated oocyst and intestinal endogenous stages.

In January 2003, fecal samples from 13 live pygmy rabbits, Brachylagus idahoensis (Merriam, 1891), were collected at the Oregon Zoo in Portland, Oregon, and sent to the University of New Mexico (UNM), Albuquerque, New Mexico, to be examined for coccidia. In July 2004, 14 more fecal samples were collected and sent to UNM, 6 from some of the same rabbits and 8 from 16 other rabbits (4 were pooled samples from siblings). In addition, tissue sections from 3 dead rabbits (2 from the Oregon Zoo, 1 from Washington State University) also were examined. Two of 4 (50%) pooled fecal samples and 8 of 17 (47%) 1-rabbit samples were positive for a single species of Eimeria, which we describe here as a new species. Sporulated oocysts were subspheroidal, 25.6 x 23.8 (22-28 x 21-27) microm, with a length:width (L:W) ratio of 1.1 (1.0-1.2). A micropyle (approximately 2 microm wide) and 0-1 polar granules were present, but an oocyst residuum was absent. Sporocysts were ellipsoidal, 13.4 x 8.1 (11-16.5 x 7.5-9) microm, with a L:W ratio of 1.7 (1.3-2.2), and they had a Stieda body and sporocyst residuum. Tissue sections showed a heavy infection of the villous epithelial cells of the proximal and mid-small intestine with coccidial endogenous stages, but no stages were found in liver hepatocytes. Meronts with approximately 46 (26-70) merozoites per infected cell appeared to be fully developed and were subspheroidal, 14.8 x 13.9 (13-18 x 10.5-16.5) microm. Developing macro- and microgamonts were indistinguishable from each other and were spheroidal to subspheroidal, 10.4 x 9.5 (9-11 x 7.5-10.5) microm. Mature macrogamonts were spheroidal to subspheroidal, 14.2 x 13.7 (12-17 x 11-16) microm, and mature microgamonts were smaller and subspheroidal, 11.9 x 10.8 (10.5-13 x 9-12) microm. This eimerian seems to be extremely pathogenic to young pygmy rabbits, and given the precarious nature of this unique genetic population, it appears to be an emerging pathogen that deserves immediate further study.

Animals↗
PubMed1989

Survey of cause-of-death query criteria used by state vital statistics programs in the US and the efficacy of the criteria used by the Oregon Vital Statistics Program.

A survey of the 52 vital statistics registration areas in the United States revealed that at least 23 did not fulfill the minimum cause-of-death query guidelines recommended by the National Center for Health Statistics. The Oregon Center for Health Statistics is one of only a few that query certifying physicians at a comprehensive level. During August 1986-July 1987, a total of 2,453 of 23,238 death certificates were returned to the certifiers for additional information, not including those returned in a tobacco use study. More than one-half (56.1 per cent) resulted in new and more specific underlying cause-of-death data. Only 5.2 per cent of the queries were unanswered. One probable result of Oregon's program is that the state has the highest percentage of liver cirrhosis and disease deaths attributed to alcohol abuse in the United States. Nationally, 41.7 per cent of all liver disease and cirrhosis deaths in 1984 were listed as due to alcohol compared to 82.4 per cent in Oregon. The state's total liver cirrhosis and disease death rate (12.0 per 100,000 population) is only marginally higher than the United States rate (11.6). The query program also serves to locate maternal deaths that would otherwise not be reported, as well as to provide more accurate cause-of-death statistics in general.

Cause of Death↗
PubMed1991

Surveillance of attempted suicide among adolescents in Oregon, 1988.

In January 1988, Oregon became the first state to require hospital-based reporting of attempted suicide (AS) in all adolescents less than 18 years old. From January to December 1988, 644 cases of AS were reported (annual rate of 214 per 100,000 population, ages 10 to 17 years). We compared these 644 cases of AS with all 137 Oregon adolescents less than 18 years old who committed suicide in Oregon during the 10-year-period 1979 through 1988, and found that the strongest predictor of outcome was method used.

Adolescent↗
PubMed1994

Predicting the effect of the Oregon Health Plan on Medicaid coverage for outpatients with HIV.

The Oregon Health Plan, which took effect in February 1994, extends Medicaid eligibility but limits coverage to conditions and treatments above a certain threshold on a prioritized list. Retrospective analysis was conducted on records of visits to two Oregon human immunodeficiency virus (HIV) outpatient clinics in 1991 and 1992 to determine Medicaid coverage if the plan had been operational. Of 1129 patients, 21.1% were Medicaid-eligible; an additional 56.5% would have been eligible under the Oregon plan. Only 5.0% to 6.8% of these patients' visits were for conditions listed below the plan's coverage threshold; almost none of these were for HIV-specific conditions.

Ambulatory Care↗
PubMed1976

Isolation of a spotted fever group rickettsia from the Pacific Coast tick, Ixodes pacificus, in Oregon.

A rickettsia of the spotted fever group was isolated on three occasions from Ixodes pacificus in western Oregon. These isolations, and additional evidence furnished by complement fixation tests on guinea pigs inoculated with other Oregon ticks of this species, indicate that the association of this rickettsia with the Pacific Coast tick may be widespread. This is the first isolation of a spotted fever group rickettsia from I. pacificus. Because the Oregon isolates are mildly virulent for guinea pigs they resemble the Western U and Rickettsia montana strains of rickettsiae. However, preliminary evidence from cross-immunofluorescence tests of mouse antisera suggests the Tillamook and Grants Pass strains are antigenically different from all known spotted fever group agents.

Animals↗
PubMed1999

Isolation of Borrelia burgdorferi from Neotoma fuscipes, Peromyscus maniculatus, Peromyscus boylii, and Ixodes pacificus in Oregon.

The number of Lyme disease cases in Oregon has increased in recent years despite the fact that the pathogen, Borrelia burgdorferi, has never been isolated in the state. Rodent and tick surveys were undertaken in 1997 to isolate and characterize strains of B. burgdorferi from Oregon and to identify potential reservoirs and vectors of Lyme disease. Borrelia burgdorferi was isolated from Neotoma fuscipes, Peromyscus maniculatus, P. boylii, and Ixodes pacificus. Both N. fuscipes and P. maniculatus were infested with I. pacificus and I. spinipalpis. Although I. pacificus infested P. boylii, I. spinipalpis was not found on this rodent, and only 4% of the P. boylii were infected with B. burgdorferi compared with the 19% and 18% infection rates found in N. fuscipes and P. maniculatus, respectively. Variation in the molecular weights of the outer surface proteins A and B were found in these first confirmed isolates of B. burgdorferi from Oregon, as well as truncated forms of outer surface protein B.

Animals↗