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The medically vulnerable: their health risks, health status, and use of physician care.

Employing the Andersen/Neuman model of health behavior, this research compares the medically vulnerable (elderly, poor, and uninsured) with their less vulnerable counterparts with regard to (1) health and disability status, (2) likelihood of physician use, and (3) (among users) amount of physician use. Data were from the Oklahoma Behavioral Risk Factor Surveillance Survey and the Area Resource File. Findings indicate that the medically vulnerable are more likely to be disabled and to experience poorer health than the nonmedically vulnerable. The uninsured are less likely to have seen a physician in the past year. Among those who have seen a physician in the past year, the uninsured and Medicare recipients without supplemental insurance experienced fewer physician visits. The results point to inequalities in the distribution of physician care that may be exacerbated by federal policies that are currently under consideration.

Adult↗

Equity concerns with the use of hospital services by the medically vulnerable.

This study assessed distributional inequities in access to care among a representative sample of adults residing in Oklahoma. Inequities were identified by comparing the medically vulnerable to the less vulnerable with respect to their use or nonuse of hospital care and, among those admitted, the number of days of care consumed. The behavioral model was employed to guide the analysis and the development of hypotheses. Controlling for need, enabling, and predisposing factors, the results indicate that the use of service by the poor, the elderly who lack supplemental insurance, and the uninsured is incongruent with their health status and that current methods of financing care may contribute to distributional inequities. The implications of these findings are discussed in the context of options that may improve access to care by the medically vulnerable.

Adult↗

Alcohol consumption patterns among American Indian and white college students.

College students in Oklahoma completed a self-administered questionnaire to compare the drinking behaviors of culturally active American Indians (N = 34 men and 24 women) an Whites (N = 181 men and 250 women). Significantly more Indians were classified as drinkers, but they had begun drinking at a somewhat later age. Both groups indicated a preference for beer, and they were quite similar in quantity and frequency of beer consumption. White students reported drinking significantly more wine and distilled spirits, and drinking more often in public places, such as bars, pubs, restaurants and parked cars; Indians drank more in their own homes and in the homes of friends. White students tended to cite hedonistic reasons for drinking whereas Indians reported escapist or social reasons and drinking to "get high." Drinking-related problems were reported somewhat more often by Indian students, notably so by Indian women. Indians were more inclined to report the more serious drinking problems of being arrested, blacking out, interference with school or work, an difficulties in human relationships. White students more often cited problems of nausea or vomiting, drinking and driving, doing something that was later regretted and damaging property. It was suggested that the higher Indian arrest rate could be indicative of police bias and that the reports of problem drinking among Indian women be investigated further.

Adult↗

Development and validation of a binomial sequential sampling plan for the greenbug (Homoptera: Aphididae) infesting winter wheat in the southern plains.

From 1997 to 1999, Schizaphis graminum (Rondani), intensity (number per tiller) was estimated on 115 occasions from hard red winter wheat fields located throughout the major wheat growing regions of Oklahoma. A total of 32 and 83 fields was sampled during the fall and spring, respectively. The parameters of linear regressions relating the mean number of greenbugs per tiller (m) and the proportion of infested tillers (PT) differed significantly between fall and spring infestations. The PT-m linear model provided a good fit for data on S. graminum for fall and spring infestations at tally thresholds of 0, 1, 2, and 3. A tally threshold (T) represents the number of greenbugs present on a tiller before the tiller is classified as infested by >T greenbugs. A regression model with a tally threshold of 2 was the most precise for classifying S. graminum populations during fall growth of winter wheat because it explained a greater amount of the variation in the PT-m relationship (97%) than models with other tally thresholds. A separate spring model with a tally threshold of 1 was the most precise for classifying S. graminum populations during spring growth of winter wheat. Sequential sampling stop lines based on sequential probability ratio tests were calculated for economic thresholds of 3 or 6 greenbugs per tiller for fall infestations and 6 or 9 greenbugs per tiller for spring infestations. With the newly developed parameters, the average sample number required to classify greenbug populations near economic thresholds (as above or below the economic threshold) varied from 69 to 207. We expect that the sampling plans for greenbugs in winter wheat developed during this study will be efficient and useful tools for consultants and producers in the southern plains.

Animals↗

Cats surviving natural infection with Cytauxzoon felis: 18 cases (1997-1998).

Eighteen cats surviving natural infection with Cytauxzoon felis were identified. All cats came from a limited geographic area in northwestern Arkansas and northeastern Oklahoma. Clinical signs in most cats were similar to those described for cytauxzoonosis; however, 4 cats were asymptomatic. All cases were initially diagnosed by microscopic identification of signet ring-shaped piroplasms in erythrocytes of peripheral blood smears. Four of 4 cats tested had detectable serum antibodies to C felis. Four different cats were positive by polymerase chain reaction (PCR). Partial sequencing of the PCR product from 1 cat revealed >99% homology with the reported sequence of C felis. Repeated examination of blood smears from 12 cats revealed that the erythroparasitemia was generally persistent for the duration of follow-up (3-154 days). Survival did not seem dependent on treatment, as only 1 cat was treated with a drug with potential antiprotozoal activity (imidocarb dipropionate), and 4 cats received no treatment. The findings of this study may indicate the existence of a less virulent strain of C felis.

Animals↗

The Ottawa County project: a report of a tuberculosis screening project in a small mining community.

Following a retrospective review of tuberculosis cases reported from Ottawa County, Oklahoma, from 1969 through 1973, a selective tuberculosis screening project was implemented. Screening of a "target group" of the population, 519 former miners, greater than or equal to 50 years of age, resulted in the discovery of abnormal chest X-rays in 182; (103 with silicosis, 36 with silicotuberculosis, 12 with inactive tuberculosis, and 31 with other abnormalities). Eighty-five of these persons had positive tuberculin skin tests. Preventive therapy was recommended for 50, and 36 completed the prescribed course of treatment. Eight new bacteriologically confirmed cases of tuberculosis were found and treated. A large number of persons (1,904) residing in the same area who were not part of the target group were also screened for tuberculosis. This group contained a large number of positive tuberculin reactors but very few were candidates for isoniazid preventive therapy. Thirteen persons in this group had abnormal chest X-rays consistent with inactive tuberculosis but 12 had been identified and given preventive therapy before the project began. These data suggest that selective approaches to screening for tuberculosis in a community which are based on an in-depth retrospective review of the tuberculosis case register can be highly successful.

Aged↗

Evaluation of the costs and benefits of motorcycle helmet laws.

Since 1976, 28 states have repealed or significantly amended their motorcycle helmet laws. The change in legislation was not based on an evaluation of the costs and benefits of such laws. This paper attempts such an assessment by comparing the cost of motorcycle helmets with the medical costs averted due to helmet use using data primarily based on motorcycle crashes in Colorado, Oklahoma, and South Dakota. Nationwide, at least $61 million could be saved annually if all motorcyclists were to use helmets. Helmet law repeals have been observed to lead to a 40 to 50 per cent point reduction in helmet use. The associated additional medical care costs substantially exceed cost savings produced by reduced helmet use. It is estimated that helmet law repeals may produce annually between $16 and 18 million of unnecessary medical care expenditures. Several alternatives to increase motorcycle helmet use are briefly discussed. It is concluded that helmet laws are effective in encouraging helmet use among motorcyclists and will prevent unnecessary medical expenditures as well as unnecessary pain and suffering among injured motorcyclists.

Colorado↗

A nutritional analysis of the Food Stamp Program.

Conflicting claims made both for and against the Food Stamp program have never been based on empirical evidence of its effects on the adequacy and the quality of diets of poor people. In this study, individual diets are measured against dietary standards appropriate for individuals and models of nutritional adequacy are constructed which make possible a determination of the program's impact on many different components of human nutrition. Two types of multiple regression models of nutrient sufficiency--ratios of dietary intake to standard as well as nutrient densities--were developed with dietary recall data from 181 and 195 subjects, respectively. These subjects were selected in a random, probability sample of a low-income area of Tulsa. Oklahoma in 1978 and all had annual household incomes which placed them at or below the poverty level. Separate models were developed for each of six nutrients, calories, protein, calcium, iron, vitamin A and vitamin C, and a large number of covariates were included in these models to isolate the effects due to program participation. The results suggest that the effects of food stamps are not uniformly positive nor are they similar to the effects which could be expected under a less expensive system of direct cash payments.

Diet↗

On changing Indian eligibility for health care.

We analyzed the ramifications and potential effects of a pending regulation that restricts Indian eligibility for health care. The most serious implication is a dwindling of support for Indian health care while the health of Indians continues to lag behind that of all other groups in the United States. Empirical analysis in one service area of the Indian Health Service (IHS) in Oklahoma reveals Indians of lower blood quantum to be younger, lower utilizers of expensive medical services, especially hospitals. The sudden loss of health care benefits from IHS will be detrimental not only to this population and to an ever increasing number of Indians in the future but also to the local service units in the Indian Health Service.

Adolescent↗

Representativeness of deaths identified through the injury-at-work item on the death certificate: implications for surveillance.

BACKGROUND: This research investigated the accuracy of the injury-at-work item on the death certificate for surveillance of occupational injury deaths in Oklahoma during 1985 and 1986. METHODS: Representativeness of occupational injury deaths identified by death certificates was assessed by comparing these deaths with all occupational injury deaths identified through death certificates, workers' compensation reports, medical examiner reports, and OSHA records for categories of occupation, industry, and external causes of death. RESULTS: Certain external causes of death (e.g., motor vehicle traffic deaths) and certain occupations (e.g., farming) and industries (agriculture and services) are more often underidentified through death certificates. CONCLUSIONS: The findings of this study support Baker's observation that no single data source contains all deaths or all the data elements necessary to describe occupational injury deaths. Data sources may be combined to improve representativeness through more complete case ascertainment.

Accidents, Occupational↗

Productivity and economic burden associated with diabetes.

OBJECTIVES: This report assessed the cost and burden of diabetes in broad terms of economic status, underlying disability, and barriers to health care--that is, as reflected in employment, income, disability days, general health status, and access to medical care. METHODS: We used the 1990 to 1995 Behavioral Risk Factor Survey in Oklahoma to compare persons with diabetes with age-, sex-, and race/ethnicity-matched respondents without diabetes. RESULTS: Persons with diabetes were significantly and substantially worse off on all economic, disability, and access measures. CONCLUSIONS: Compared with nondiabetic persons, diabetic persons have fewer resources to deal with higher levels of disability and poorer health status.

Absenteeism↗

Fasting insulin and obesity-related phenotypes are linked to chromosome 2p: the Strong Heart Family Study.

To localize quantitative trait loci for insulin metabolism and obesity, genome scans/linkage analyses were performed on >900 members of 32 extended families participating in phase 3 of the Strong Heart Study, an investigation of the genetic and environmental determinants of cardiovascular disease in American-Indian populations from Arizona, Oklahoma, and North and South Dakota. Linkage analyses of fasting insulin and two obesity-related phenotypes, BMI and percent fat mass, were performed independently in each of the three populations. For log fasting insulin, we found a genome-wide maximum, robust logarithm of odds (LOD) score of 3.42 at 51 cM on chromosome 2p in the Dakotas. Bivariate linkage analyses of log fasting insulin with both BMI and fat mass indicate a situation of incomplete pleiotropy, as well as several significant bivariate LOD scores in the Dakotas.

Adolescent↗

Identification of apoB-containing lipoprotein families in NIDDM.

The purpose of this study was to determine the concentrations and composition of apoB-containing lipoprotein families in whole plasma and major lipoprotein density classes of a selected group of Native Americans from northeastern Oklahoma with non-insulin-dependent diabetes mellitus. The measurement of lipoprotein density classes showed that the total lipoprotein mass of very-low-density lipoproteins was significantly higher and that of high-density lipoproteins significantly lower in diabetic patients than nondiabetic control subjects regardless of their plasma triglyceride levels. The VLDLs were enriched with TG, free cholesterol, and apolipoproteins C-III and E. HDLs were enriched with TG but depleted of apoC-III and apoE. There was no change in the levels of TG-enriched low-density lipoproteins. Fractionation of VLDL by sequential immunoprecipitation with antisera to apoE and apoC-III established that increased concentrations of this density class in diabetic patients are due to elevated levels of TG-rich lipoprotein LP-B:C and lipoprotein LP-B:C:E. The levels of LP-B:C particles were increased more than the levels of LP-B:C:E particles. The LDLs were characterized by a slight increase in TG-enriched lipoprotein B and no change in the levels of LP-B:C and LP-B:C:E. There was no difference between diabetic patients with or without vascular disease in the levels of LP-B and LP-B:C:E. However, patients with vascular disease had higher concentrations of LP-B:C particles in VLDL and whole plasma than patients without vascular disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Epidemiology of lower-extremity amputations in the Indian Health Service, 1982-1987.

OBJECTIVE: To describe the LEA experience among IHS diabetic patients. RESEARCH DESIGN AND METHODS: A cross-sectional study of hospital discharges for nontraumatic LEAs from 1982 to 1987 in four IHS areas was conducted. RESULTS: Incidence rates of first LEA in the study period increased with increasing age. Compared with nondiabetic subjects, diabetic patients had increased risks in each age-group, with those between the ages of 15 and 44 yr having a 158-fold increased risk. The average annual age-adjusted incidence rates of all LEAs among diabetic subjects in the Tucson (240.8/10,000) and Phoenix (203.1/10,000) IHS areas were substantially higher than the rates for the U.S. (73.1/10,000), Navajo (74.0/10,000), and the Oklahoma (87.3/10,000) IHS areas. CONCLUSIONS: LEA rates varied in different IHS areas. Reasons for these findings need to be evaluated, but may include IHS area differences in preventive health-care practices or risk factors for LEA.

Adolescent↗

Glycemic control in diabetic American Indians. Longitudinal data from the Strong Heart Study.

OBJECTIVE: To describe glycemic control and identify correlates of elevated HbA1c levels in diabetic American Indians participating in the Strong Heart Study, which is a longitudinal study of cardiovascular disease in American Indians in Arizona, Oklahoma, South Dakota, and North Dakota. RESEARCH DESIGN AND METHODS: This analysis is based on data from the baseline (1989-1992) and first follow-up (1994-1995) examinations of the Strong Heart Study. The 1,581 diabetic participants included in this analysis were aged 45-74 years at baseline, were diagnosed with diabetes before and at baseline, and had their HbA1c levels measured at follow-up. HbA1c was used as the index of glycemic control. Characteristics that may affect glycemic control were evaluated for cross-sectional and longitudinal relationships by analysis of covariance and multiple regression. RESULTS: There was no significant difference between median HbA1c at baseline (8.4%) and at follow-up (8.5%). Sex, age (inversely), and insulin and oral hypoglycemic agent therapy were significantly related to HbA1c levels in both the cross-sectional and longitudinal analyses. Current smoking, prior use of alcohol, and duration of diabetes were significant only for the cross-sectional data. Baseline HbA1c significantly and positively predicted HbA1c levels at follow-up. Comparison of HbA1c by therapy type shows that insulin therapy produced a significant decrease in HbA1c between the baseline and follow-up examinations. CONCLUSIONS: Glycemic control was poor among diabetic American Indians participating in the Strong Heart Study. Women, patients taking insulin or oral hypoglycemic agents, and younger individuals had the worst control of all the participants. Baseline HbA1c, and weight loss predicted worsening of control, whereas insulin therapy predicted improvement in control. Additional therapies and/or approaches are needed to improve glycemic control in this population.

Administration, Oral↗

Managing replacement stock within the environment of the south--plant, soil, and animal interactions: a review.

The South extends from the Atlantic Coast and the Gulf of Mexico north through Virginia and Kentucky and west to the 100th meridian, which extends through Texas and Oklahoma. The soils, environment, and range of adapted forage species offer many and varied opportunities for designing forage-livestock systems for rearing replacement stock. Anti-quality factors of concern when using forages for replacement stock include the presence of Acremonium coenophialum (Morgan-Jones and Gams) in tall fescue (Festuca arundinacea Schreb.), phytoestrogens potentially in several species of Trifolium and Medicago, toxins in some species of brush that contribute to infertility, and imbalances of several minerals including Ca, P, K, Fe, I, Zn, Na, Cu, and Se. Systems should be designed to provide appropriate quality and quantity of forage to produce reproductively active female animals of the desired weight and condition for breeding at the target age, usually 15 mo for beef and dairy heifers and 8 to 9 mo for ewe lambs. Systems generally require sequence grazing of two or more forage species or mixtures to provide extended or year-round grazing opportunities. Stockpiling of tall fescue in the Upper South and use of cool-season annuals in the Lower South extend grazing in autumn, winter, and early spring. Successful systems coordinate plant growth potential with changing animal forage requirements for both quantity and quality of forage to achieve optimum growth rates for replacement stock.

Animal Husbandry↗

Comparison of performance of Boer and Spanish goats in two U.S. locations.

Information quantifying performance of Boer goats in the United States is lacking. To overcome this knowledge void a simulation study was performed to determine how Boer goats would compare to Spanish goats in two locations, Texas and Oklahoma. Within each of these locations forage conditions were altered from high forage (HF), medium forage (MF), and low forage (LF). Forage conditions were altered within location to emulate the variation in forage conditions that could occur in each location. Management varied from fall breeding (FB) to year-round breeding (YRB). Across breed and forage conditions, YRB resulted in higher levels of performance than FB for births per doe, number of kids sold per doe, sale weight per doe, and biological efficiency (weight sold[kg]/dry matter consumed [kg]). Boers did produce more sale weight per doe than Spanish on HF. However, the Boer's advantage was decreased or negated when exposed to MF or LF conditions. Both breeds had similar levels of performance for number of kids sold per doe under HF conditions. Under MF or LF the Spanish goats had greater levels of kids sold per doe. Neither breed simulated had a consistent advantage in both locations and varying forage conditions, but, in general, as forage conditions worsened Boer performance ranked below that of the Spanish goats. These results indicate that a complete endorsement of the Boer cannot be made. Effective use of the Boer goat will depend on the forage resource base and producers' ability to provide inputs, such as supplementation, to the goat production system.

Animal Feed↗