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PubMed2000

Health risks, ability to pay, and the use of primary care: is the distribution of service effective and equitable?

BACKGROUND: This study clarifies the confusion about what factors are consistent predictors of primary care service use, of which preventive services are a major component. A variety of health risk, predisposing, and enabling characteristics were assessed for their association with the use of primary care. Variable selection was guided by the use of the Andersen-Newman Behavioral Model of health service utilization. METHODS: The responses of 1,512 residents of Oklahoma to the BRFS survey were used in this study. Both probit and logistic analyses were used to assess the use of nine preventive services and a summary index of service use. RESULTS: The results indicate that those at greater risk of illness and least able to use finance services have the lowest rates of use among the nine preventive services individually and when combined as an index of overall primary care use. CONCLUSIONS: Problems persist with the adequate distribution of primary care among the medically vulnerable. Furthermore, recent welfare and health reforms may present added obstacles to their access to quality primary care services. The paper concludes with a discussion of policy options that may improve the effectiveness of primary care and redress inequities in the use of these services.

Health Behavior↗
PubMed2002

Smoking restrictions in the home and car among rural Native American and white families with young children.

BACKGROUND: This paper examines the prevalence of household and car smoking restrictions, factors associated with these restrictions, and children's exposure to secondhand smoke in homes with varying levels of household smoking restrictions in rural Native American and White families. METHODS: In-person interviews were conducted with 380 rural, low-income Native American and White parents or guardians who were the primary caregivers of children aged 1-6 in northeastern Oklahoma. RESULTS: Prevalence of complete smoking bans was 49.1% in Native American homes and 42.7% in White homes. Car smoking bans were less common, with 34.9% of Native American and 39.6% of White caregivers reporting complete bans. Among nonsmoking households, the proportion of friends who smoked was associated with both car and home smoking bans. Race and education of the caregivers were also associated with car smoking bans in homes with no adult smokers. Among smokers, cigarettes smoked per day, quit attempts within the past year, and the strong belief that secondhand smoke harmed children and babies were related to household smoking bans, whereas cigarettes smoked per day and the proportion of friends who smoked were related to car smoking bans. CONCLUSIONS: Despite the relatively low prevalence of smoking bans in our population, factors associated with household and car smoking bans were similar to those found in the general population.

Adult↗
PubMedDate not supplied

Alcoholism and substance abuse among selected southern Cheyenne Indians.

This family and small community-based study reports the occurrence of alcoholism and co-occurring substance abuse in Southern Cheyenne Indians living in western Oklahoma. Sociocultural factors complicate operationalization of clinical data into standard (DSM-III-R) psychiatric disorder terminology; understanding sociocultural factors is essential for assessing the high rate of addictive disorders in this group. To obtain reliable and valid clinical diagnoses, data from several sources were utilized within a blind rating system: 1) SADS-L, a clinician-administered research diagnostic instrument; 2) MAST; 3) relatives; 4) medical records; 5) other official documents. The sample consisted of 69 males (45 alcoholics) and 97 females (36 alcoholics). Among clinically significant substance abusers (moderate impairment of function), 22 of 24 were alcoholics. In non-alcoholics, mean MAST scores were 8.8 (males) and 5.1 (females); in alcoholics, 32.0 (males) and 38.7 (females). Mean age of onset on heavy use of alcohol was 20.1 yrs. (males) and 22.8 (females) (p = 0.047); among all alcoholics, 86% (males) and 64% (females) had early onset (< 25 yrs. old). When data from 98 unrelated subjects were analyzed separately, similar findings were observed except that mean age of onset of heavy use of alcohol was more discrepant between males and females, viz. 20.1 versus 22.8 yrs. (p = 0.02). Among those with substance abuse disorders, early age of onset was present in all but one female. In these Cheyenne, alcoholism is usually clinically severe and early in onset; it often co-occurs with substance abuse, also early in onset.

Adolescent↗
PubMed1982

A one year study on the viability of Cryptococcus neoformans in nature.

Using four different assat procedures we found a 50 to 86% decrease in viability of Cryptococcus neoformans over a one year period after two towers in the Oklahoma City area were modified to exclude pigeons and weather elements, especially rain. In homogeneous pigeon dropping samples a sharp decrease in viability occurred after 7 to 9 months of storage. The decrease occurred in pigeon dropping samples maintained at the natural sites and at ambient temperature in the laboratory in the laboratory but not in droppings stored at -4 degrees C. Air sampling studies done at the natural sites before and after tower modifications also showed a decrease in C. neoformans viability. The decrease in viability cannot be explained by seasonal temperature variations that occurred at natural sites. Our findings suggest that death of C. neoformans occurred because of lack of available intracellular water exacerbated by low humidity, exclusion of precipitation and moisture from fresh pigeon droppings. In light of our experiences, at one site in south central United States, the feasibility of controlling C. neoformans at heavily contaminated sites, other than by the use of noxious or potentially dangerous chemicals, is discussed.

Air Microbiology↗
PubMed1976

Hemoglobin polymorphism in the encinal mouse, Peromyscus pectoralis.

Horizontal starch gel electrophoresis revealed five hemoglobin phenotypes in natural populations of the encinal mouse, Peromyscus pectoralis, from northeastern Mexico. Populations of the encinal mouse from Texas, Oklahoma, and northwestern and north central Mexico were monomorphic for multiple-band phenotypes. Analysis of the hemoglobin polymorphism indicates that two loci control this variation.

Animals↗
PubMed1984

Determination of settlement patterns in rapidly growing rural areas.

The primary factors affecting settlement patterns in rural areas of the United States are examined using factor analysis of survey responses from 1,156 households in Oklahoma. "Results indicate that quality of services, age of home and availability of services, rural atmosphere and job and family considerations impact most significantly. Analysis of variance indicates that differences exist in the relative weighting of factors by socio-economic, demographic and locational variables."

Americas↗
PubMed1982

Serologic grouping and sexual compatibility of airborne Cryptococcus neoformans.

Through the use of Anderson air samples, 214 isolates of Cryptococcus neoformans were cultured from the air in a vacant tower in a large complex of buildings in Oklahoma City. The tower contained hundreds of pigeons, a massive amount of droppings, nests with eggs and young, dying and dead pigeons. All isolates were serotype A-D and self-sterile for the production of basidiospores. Among these 193 were of the "alpha" mating type, producing basidiospores when paired with "alpha" mating type. No isolates of "alpha" mating type were found. The findings imply that the infectious particles of C. neoformans in nature are relatively small, nonencapsulated yeast cells and not basidiospores.

Air Microbiology↗
PubMed1996

Risk factors for cardiovascular disease in individuals with diabetes. The Strong Heart Study.

Coronary heart disease (CHD) is the leading cause of death among individuals with diabetes. However, information on CHD and its association with known risk factors in populations with high rates of diabetes is limited. The purpose of the Strong Heart Study is to quantify CHD and its risk factors among three geographically diverse groups of American Indians who have a high prevalence of diabetes. The study group consisted of 4549 adults between 45 and 74 years of age in 13 Indian communities in Arizona, Oklahoma, and South and North Dakota. Rates of diabetes ranged from 33% to 72% in men and women in the three centers. The prevalence rates of definite myocardial infarction (MI) and definite CHD were higher in men than in women in all three centers (P < 0.0001) and higher in those with diabetes (P = 0.002 and P = 0.0003 in women and men, respectively). Diabetes was associated with a relatively greater increase in prevalence of MI (PR = 3.8 vs 1.9) and CHD (PR = 4.6 vs 1.8) in women than in men. Logistic regression analysis indicated that prevalent CHD was significantly related to age, diabetes, hypertension, albuminuria, percent body fat, smoking, high concentrations of plasma insulin, and low concentrations of high-density lipoprotein (HDL)-cholesterol. These findings from the baseline Strong Heart Study examination emphasize the relative importance of diabetes-associated variables as risk factors for CHD among populations with high rates of diabetes.

Adult↗
PubMed1999

Characterization of Mhc-DRB allelic diversity in white-tailed deer (Odocoileus virginianus) provides insight into Mhc-DRB allelic evolution within Cervidae.

Although white-tailed deer (Odocoileus virginianus) are one of North America's best studied mammals, no information is available concerning allelic diversity at any locus of the major histocompatibility complex in this taxon. Using the polymerase chain reaction, single-stranded conformation polymorphism analysis, and DNA sequencing techniques, 15 DRB exon 2 alleles were identified among 150 white-tailed deer from a single population in southeastern Oklahoma. These alleles represent a single locus and exhibit a high degree of nucleotide and amino acid polymorphism, with most amino acid variation occurring at positions forming the peptide binding sites. Furthermore, twenty-seven amino acid residues unique to white-tailed deer DRB alleles were detected, with 19 of these occurring at residues forming contact points of the peptide binding region. Significantly higher rates of nonsynonymous than synonymous substitutions were detected among these DRB alleles. In contrast to other studies of Artiodactyla DRB sequences, interallelic recombination does not appear to be playing a significant role in the generation of allelic diversity at this locus in white-tailed deer. To examine evolution of white-tailed deer (Odvi-DRB) alleles within Cervidae, we performed a phylogenetic analysis of all published red deer (Ceel-DRB), roe deer (Caca-DRB), and moose (Alal-DRB) DRB alleles. The phylogenetic tree clearly shows a trans-species persistence of DRB lineages among these taxa. Moreover, this phylogenetic tree provides insight into evolution of DRB allelic lineages within Cervidae and may aid in assignment of red deer DRB alleles to specific loci.

Alleles↗
PubMed2006

Mapping stream habitats with a global positioning system: accuracy, precision, and comparison with traditional methods.

We tested the precision and accuracy of the Trimble GeoXTtrade mark global positioning system (GPS) handheld receiver on point and area features and compared estimates of stream habitat dimensions (e.g., lengths and areas of riffles and pools) that were made in three different Oklahoma streams using the GPS receiver and a tape measure. The precision of differentially corrected GPS (DGPS) points was not affected by the number of GPS position fixes (i.e., geographic location estimates) averaged per DGPS point. Horizontal error of points ranged from 0.03 to 2.77 m and did not differ with the number of position fixes per point. The error of area measurements ranged from 0.1% to 110.1% but decreased as the area increased. Again, error was independent of the number of position fixes averaged per polygon corner. The estimates of habitat lengths, widths, and areas did not differ when measured using two methods of data collection (GPS and a tape measure), nor did the differences among methods change at three stream sites with contrasting morphologies. Measuring features with a GPS receiver was up to 3.3 times faster on average than using a tape measure, although signal interference from high streambanks or overhanging vegetation occasionally limited satellite signal availability and prolonged measurements with a GPS receiver. There were also no differences in precision of habitat dimensions when mapped using a continuous versus a position fix average GPS data collection method. Despite there being some disadvantages to using the GPS in stream habitat studies, measuring stream habitats with a GPS resulted in spatially referenced data that allowed the assessment of relative habitat position and changes in habitats over time, and was often faster than using a tape measure. For most spatial scales of interest, the precision and accuracy of DGPS data are adequate and have logistical advantages when compared to traditional methods of measurement.

Environment↗
PubMed2003

Black-tailed prairie dogs and the structure of avian communities on the shortgrass plains.

We tested the hypothesis that black-tailed prairie dogs (Cynomys ludovicianus) influence avian community structure on the shortgrass prairie. We surveyed 36 prairie dog towns and 36 paired sites without prairie dogs during summer and fall of 1997, 1998, and 1999 in the Oklahoma Panhandle. Our surveys totaled 9,040 individual observations for 73 avian species. Significantly distinct avian communities were present on prairie dog towns when compared to sites within four different macrohabitats of the surrounding landscape: open rangeland, scrub/sandsage (Artemisia filifolia) habitats, Conservation Reserve Program (CRP) plots, and fallow crop fields. Relative densities of all bird species combined was higher on prairie dog towns versus paired sites in summer and fall. Mean species richness of birds was significantly higher on prairie dog towns than paired sites during summer, but there were no significant differences in fall. Open rangeland had the highest mean species richness in fall. Assemblages of avian communities differed significantly between prairie dog towns and the four macrohabitat types during summer. Burrowing owls (Athene cunicularia), killdeer (Charadrius vociferous), horned larks (Eremophila alpestris), and meadowlarks (Sturnella spp.) were positively and significantly associated with prairie dog towns during summer, while horned larks and ferruginous hawks (Buteo regalis) were significantly associated with prairie dog towns during fall. Even in their current remnant state, black-tailed prairie dogs continue to play a significant role in the assembly of ecological communities across the Great Plains. Conservation of prairie dogs goes well beyond a single species, and is an important strategy for the preservation of the prairie ecosystem as a whole.

Animals↗
PubMed2004

Density-dependent habitat selection by brown-headed cowbirds ( Molothrus ater) in tallgrass prairie.

Local distributions of avian brood parasites among their host habitats may depend upon conspecific parasite density. We used isodar analysis to test for density-dependent habitat selection in brown-headed cowbirds ( Molothrus ater) among tallgrass prairie adjacent to wooded edges, and prairie interior habitat (>100 m from wooded edges) with and without experimental perches. Eight study sites containing these three habitat treatments were established along a geographical gradient in cowbird abundance within the Flint Hills region of Eastern Kansas and Oklahoma, USA. The focal host species of our study, the dickcissel ( Spiza americana), is the most abundant and preferred cowbird host in the prairie of this region. Cowbird relative abundance and cowbird:host abundance ratios were used as estimates of female cowbird density, whereas cowbird egg density was measured as parasitism frequency (percent of dickcissel nests parasitized), and parasitism intensity (number of cowbird eggs per parasitized nest). Geographical variation in cowbird abundance was independent of host abundance. Within study sites, host abundance was highest in wooded edge plots, intermediate in the experimental perch plots, and lowest in prairie interior. Cowbirds exhibited a pattern of density-dependent selection of prairie edge versus experimental perch and interior habitats. On sites where measures of cowbird density were lowest, all cowbird density estimates (female cowbirds and their eggs) were highest near (< or =100 m) wooded edges, where host and perch availability are highest. However, as overall cowbird density increased geographically, these density estimates increased more rapidly in experimental perch plots and prairie interiors. Variation in cowbird abundance and cowbird:host ratios suggested density-dependent cowbird selection of experimental perch over prairie interior habitat, but parasitism levels on dickcissel nests were similar among these two habitats at all levels of local cowbird parasitism. The density-dependent pattern of cowbird distribution among prairie edge and interior suggested that density effects on perceived cowbird fitness are greatest at wooded edges. A positive relationship between daily nest mortality rates of parasitized nests during the nestling period with parasitism intensity levels per nest suggested a density-dependent effect on cowbird reproductive success. However, this relationship was similar among habitats, such that all habitats should have been perceived as being equally suitable to cowbirds at all densities. Other unmeasured effects on cowbird habitat suitability (e.g., reduced cowbird success in edge-dwelling host nests, cowbird despotism at edges) might have affected cowbird habitat selection. Managers attempting to minimize cowbird parasitism on sensitive cowbird hosts should consider that hosts in otherwise less-preferred cowbird habitats (e.g., habitat interiors) are at greater risk of being parasitized where cowbirds become particularly abundant.

Animals↗
PubMed2006

Development of a grassland integrity index based on breeding bird assemblages.

We utilized landscape and breeding bird assemblage data from three Breeding Bird Survey (BBS) routes sampled from 1965-1995 to develop and test a grassland integrity index (GII) in a mixed-grass prairie area of Oklahoma. The overall study region is extensively fragmented from long-term agricultural activity, and native habitat remnants have been degraded by recent encroachment of woody vegetation, namely eastern red cedar (Juniperus virginiana L.). The 50 individual bird survey points along the BBS routes, known as stops, were used as sample sites. Our process first focused on developing a grassland disturbance index (GDI) as a measure of cumulative landscape disturbances for these sites. The GDI was based on five key landscape variables identified in an earlier species-level study of long-term avian community dynamics: total tree, shrub, and herbaceous vegetation cover indices, overall mean landscape patch size, and grassland patch core size. The GII was then developed based on breeding bird assemblage data. Assemblages were based on commonly used response guilds reflective of five avian life history parameters: foraging mode/location, nesting location, habitat specificity, migratory pattern, and dietary guild. We tested the response of 78 candidate assemblage metrics to the GDI, and eliminated those with no or poor response or with high correlations (redundant), resulting in 13 metrics for use in the final index. Individual metric scores were scaled to fall between 0 and 10, and the cumulative index to range from 0 to 100. Although broader application and refinement are possible, the avian-based GII has an advantage over labor-intensive, habitat-based monitoring in that the GII is derived from readily available long-term BBS data. Therefore, the GII shows promise as an inexpensive tool that could easily be applied over other areas to monitor changes in regional grassland conditions.

Agriculture↗
PubMed2003

Rheumatic disease in Native American children: opportunities and challenge.

Rheumatic diseases are prevalent in Native American adults at rates five to seven times higher than those seen in the Caucasian population. Little, however, has been published concerning rheumatic diseases in Native American children. The authors' work in Oklahoma and with tribes on the northern Great Plains demonstrates high rates of childhood-onset rheumatic disease in this population. Familial disease is common, and large, multiplex kindreds showing strong founder effects are likely found within specific Native American tribes. However, a deeper understanding of the genetic and environmental triggers of rheumatic disease in Native Americans will require a respect and appreciation for the specific and unique cultural and social issues that impinge on research with Native Americans and other indigenous people.

Adolescent↗
PubMed1989

Identification of genetic variation between strains of bluetongue virus serotype 11 using cDNA probes.

Recombinant plasmids containing inserts representing genome segments 2, 5, 6, 8, and 9 of bluetongue virus (BTV) serotype 11, with tentative coding assignments for viral proteins P2, P5, NS1, NS2, and P6, respectively, have been used to study the genetic diversity within a BTV serotype using Northern blot hybridization. BTV 11 strains were isolated in California, Nevada, Oklahoma, and Mexico from elk, deer, and cattle. Diversity was indirectly indicated in the BTV 11 strains by comparisons of electropherotypes. Probes specific for segments 2, 6, 8, and 9 hybridized to all BTV 11 strains with only minor variation in hybridization signal. cDNA clones, representing 90 and 20% length copies of gene segment 5, detected a difference in the field isolates with hybridization signal correlating to mobility of this segment in SDS-PAGE. These two cDNA probes of genome segment 5 hybridized to BTV U.S. prototypic serotype 17 and not the remaining serotypes (BTV 2, 10, 13) or epizootic hemorrhagic disease virus (EHDV). These data suggest a close relationship between BTV-11 and 17 and/or alternatively are the result of genome segment reassortment between serotypes.

Animals↗
PubMedDate not supplied

Nursing service data for research in patient care.

Nursing service records from the nontechnical medical care program, an Oklahoma statewide Medicaid long-term community care program, provided a unique data base to gather information for research purposes and program improvement. This article describes the process of developing a data collection (coding) form to extract a minimum data set and a method of training lay coders to use the form. Inherent problems associated with this process from the beginning to the end are also shared.

Abstracting and Indexing↗
PubMed2005

Correlation between lipoprotein(a) and other risk factors for cardiovascular disease and diabetes in Cherokee Indians: the Cherokee Diabetes Study.

PURPOSE: To study the age and gender effects on the distribution of lipoprotein (a) [Lp(a)] and its relationship with other cardiovascular disease (CVD) and diabetes risk factors in the participants of the Cherokee Diabetes Study (CDS) (1995-2000). METHODS: The CDS is a population based cross-sectional study of diabetes and its risk factors in Cherokee Indians aged 5 to 40 years of Oklahoma. Lp(a) levels were measured in 2205 participants. RESULTS: The median Lp(a) (mg/dL) levels in the females were not significantly different among four age groups (5-9, 10-19, 20-29, and 30-40 years). However, the 20- to 29-year-old males had significantly lower Lp(a) levels than the males 10 to 19 and 30 to 40 years old. Females had significantly higher Lp(a) levels than males in the 20- to 29-year-old age group only. In the 5- to 19-year-old children/adolescents, Lp(a) levels were significantly negatively correlated with the degree of Indian heritage (DIH) and positively correlated with total cholesterol (TC), low-density lipoproteins (LDL), and apolipoprotein B (apoB) in girls, but not in boys. In the young adults aged 20 to 29 years, Lp(a) levels were significantly correlated with DIH, body mass index (BMI), waist-hip ratio (WHR), percentage of body fat (PBF), systolic blood pressure (SBP), triglycerides (TG), 2-hour plasma glucose (2hPG), and insulin in males, and DIH, PBF, TC, LDL, TG, and insulin in females. In adults aged 30 to 40 years, Lp(a) levels were significantly correlated with DIH, TG, and LDL in females, and DIH and insulin in males. CONCLUSION: In the girls, Lp(a) levels appear to be associated with several CVD and diabetes risk factors at an early age (5-19 years), while in the boys, the association occurs at older ages (> 19 years). There are significant age and gender differences regarding the distribution of Lp(a) and its correlates in the 5 to 9, 10 to 19, and 20 to 29-year-old age groups, but the differences tend to be weaker in the 30- to 40-year-old age group. For the same age and gender groups, Lp(a) concentrations in Cherokee Indians were much lower than those reported in blacks and slightly lower than those in whites. In Cherokee Indians, the Lp(a) levels were consistently and positively correlated with LDL, and negatively correlated with DIH, TG, and insulin.

Adolescent↗
PubMed2005

Dietary intakes of nutrients thought to modify cardiovascular risk from three groups of American Indians: The Strong Heart Dietary Study, Phase II.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality among American Indians. Rates of CVD appear to be increasing among American Indians while they are decreasing among other racial and ethnic groups in the United States. Rates of comorbid conditions associated with CVD, such as obesity, impaired glucose tolerance, and hypertension, are also higher among American Indians than among other racial and ethnic groups in the United States. Dietary factors play a role in the development of CVD and associated comorbid conditions, yet surprisingly few data exist to describe the dietary intakes and nutritional adequacy of American Indian adults at risk for CVD. OBJECTIVE: To describe intakes of nutrients that may affect CVD risk consumed by members of 13 nations of American Indian adults, aged 45 to 70 years, who reside in tribal communities in Arizona, North Dakota, South Dakota, and Oklahoma. A secondary objective was to compare dietary intake estimates to nationally representative data from adults of similar age to determine potential dietary differences that may account for the disparities seen in rates of CVD and related conditions. Finally, dietary intake estimates were compared with national dietary guidance to determine areas for improvement. METHODS: Data from a 24-hour dietary recall provided by 3,482 adults who participated in the Strong Heart Dietary Study, Phase II, were analyzed to describe dietary intakes of nutrients that may alter CVD risk. Nonparametric analyses of variance were used to compare data by center, age, and sex. Dietary intake data for each sex/center group were compared with data from the Third National Health and Nutrition Examination Survey (NHANES III), Phase I, dietary estimates, and to national dietary guidelines. RESULTS: Nutrient intakes varied little between centers. Sex differences were noted in energy and nutrient intakes across all centers. Age-related decreases in energy and total and saturated fat intakes were noted among all sex/center groups. Median intakes of vitamins A and C and folate were low among all sex/center groups. Remarkably few differences in dietary intake were noted between NHANES III and Strong Heart Dietary Study, Phase II, participants. Carbohydrate and sodium intakes were higher among participants compared with NHANES III estimates, whereas intakes of several vitamins were lower. CONCLUSIONS: Dietary intakes of American Indians vary by age, sex, and geographic location, but do not differ substantially from national estimates of dietary intake. The dietary differences noted between NHANES III and Strong Heart Dietary Study, Phase II, participants are not consistent with the remarkably different rates of CVD and associated comorbidities that currently exist.

Age Factors↗