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PubMed1993

Laboratory-based surveillance for meningococcal disease in selected areas, United States, 1989-1991.

PROBLEM/CONDITION: Neisseria meningitidis is a leading cause of bacterial meningitis and septicemia in the United States. Accurate surveillance for meningococcal disease is required to detect trends in patient characteristics, antibiotic resistance, and serogroup-specific incidence of disease. REPORTING PERIOD COVERED: January 1989 through December 1991. DESCRIPTION OF SYSTEM: A case of meningococcal disease was defined by the isolation of N. meningitidis from a normally sterile site, such as blood or cerebrospinal fluid, in a resident of a surveillance area. Cases were reported by personnel in each hospital laboratory in the surveillance areas. The surveillance areas consisted of three counties in the San Francisco metropolitan area, eight counties in the Atlanta metropolitan area, four counties in Tennessee, and the entire state of Oklahoma. RESULTS: Age- and race-adjusted projections of the U.S. population suggest that approximately 2,600 cases of meningococcal disease occurred annually in the United States. The case-fatality rate was 12%. Incidence declined from 1.3/100,000 in 1989 to 0.9/100,000 in 1991. Seasonal variation occurred, with the highest attack rates in February and March and the lowest in September. The highest rates of disease were among infants, with 46% of cases affecting those < or = 2 years of age. Males accounted for 55% of total cases, with an incidence of 1.2/100,000, compared with 1.0/100,000 among females (relative risk (RR) = 1.3, 95% confidence interval (CI) 1.0-1.6). The incidence was significantly higher among blacks (1.5/100,000) than whites (1.1/100,000) (RR = 1.4 [95% CI 1.1-1.8]). Serogroup B caused 46% of cases and serogroup C, 45% Thirty-eight percent of isolates were reported to be resistant to sulfa; none were reported to be resistant to rifampin. INTERPRETATION: The decline in incidence of meningococcal disease from 1989 through 1991 cannot be explained by any change in public health control measures; this trend should be monitored by continued surveillance. The age, sex, and race distribution and seasonality of cases are consistent with previous reports. The proportion of N. meningitidis isolates resistant to sulfa continues to be substantial. A relatively small proportion of cases is potentially preventable by the use of the currently available polysaccharide vaccine, which induces protection against serogroups, A, C, Y, and W135 and is effective only for persons > 2 years of age. ACTIONS TAKEN: Current recommendations against the use of sulfa drugs for treatment or prophylaxis of meningococcal disease unless the organism is known to be sensitive to sulfa should be continued. Since resistance to rifampin is rarely reported, it continues to be the drug of choice for prophylaxis. The development of vaccines effective for infants and vaccines inducing protection against serogroup B would be expected to have a substantial impact on disease.

Adolescent↗
PubMed1977

Faculty evaluation by residents in a family medicine residency program.

Accountability in graduate medical education is dependent on the willingness of the residents and faculty to make their expectations and commitments explicit and to be held reponsible for fulfilling their commitments. In an effort to encourage accountability, residents in the University of Oklahoma Family Practice Residency Program evaluated the effectiveness of faculty members as learning facilitators. Several dimensions of the learning facilitator role were examined at a resident retreat and the results of the initial evaluations were discussed individually with each faculty member. A subsequent evaluation was conducted one year later, and a comparison of the results of the two evaluations suggests that such efforts can serve to stimulate modification of selected behaviors and thereby improve the quality of teaching in family practice residencies.

Evaluation Studies as Topic↗
PubMed1996

Coronavirus isolation from nasal swab samples in cattle with signs of respiratory tract disease after shipping.

OBJECTIVE: To monitor the prevailing viral respiratory tract infections in cattle after transportation to feedlots. ANIMALS: 100 cattle with signs of respiratory tract disease on arrival at 2 feedlots. PROCEDURES: Nasal swab samples were obtained from each animal and were used for inoculation of defined cell culture systems that detected bovine viruses known to cause respiratory tract infections, as well as viruses previously not recognized as respiratory pathogens for cattle. RESULTS: Bovine respiratory coronaviruses were isolated from 38 of the 100 cattle, including 6 of 50 cattle from California, 22 of 31 cattle from Oklahoma, 6 of 11 cattle from Texas, and 4 of 8 cattle of unknown origin. Parainfluenza 3 viruses also were isolated from 5 California cattle, but other bovine viruses were not detected. CLINICAL IMPLICATIONS: The high rate of coronavirus isolations from feedlot cattle with signs of respiratory tract disease implied wide distribution and high susceptibility among cattle to this infection, which had not been detected by use of viral isolation systems in previous etiologic evaluations of feedlot cattle affected with bovine respiratory disease complex.

Animals↗
PubMed1996

Prevalence and identity of Sarcocystis infections in armadillos (Dasypus novemcinctus).

Little is known about the prevalence or identity of Sarcocystis species infecting armadillos in North America. Sarcocysts were observed in the tongues of 23 (96%) of 24 armadillos collected between 1989 and 1994 from Texas, Oklahoma, Kansas, and Arkansas. The identity of the species present was determined in histological sections of tongue from armadillos. Sarcocystis dasypi was present in 21 (88%) and Sarcocystis diminuta was present in 5 (21%). Mixed infections with S. dasypi and S. diminuta were present in 3 (13%) armadillos. A single sarcocyst with ultrastructural features distinct from S. dasypi and S. diminuta was observed with transmission electron microscopy.

Animals↗
PubMed1996

The experience of psychiatric residents with disaster support: a descriptive report.

This study was designed to explore the experiences and reactions of psychiatric residents who provided support to victims at the Oklahoma City bombing site. Participants were seven residents who were surveyed eight months following the disaster. Results describe respondents' perceptions of stress and support factors at the time of participation as well as post-disaster symptoms. In the aftermath, only one respondent reported stress symptoms suggestive of a psychiatric diagnosis. Respondents reported a decrease in symptoms one month after the disaster. The majority acknowledged that they would participate in disaster relief in the future. These data confirm the importance of proper preparation, support, and debriefing for medical personnel attending a disaster as well as the probability that symptomatic reactions will be time-limited for most individuals.

Adult↗
PubMed1996

Case report: locally acquired trichinosis in an immigrant from Southeast Asia.

The authors report a case of trichinosis acquired in Oklahoma City by an immigrant from Southeast Asia. The 49-year-old female reported having abdominal discomfort, nausea, and vomiting, and had purchased and eaten lightly cooked pork. She also complained of fatigue, anorexia, and muscle aches for several months. An immigrant from Laos, she stated that she regularly eats pork and prefers it rare or mildly cooked. The authors caution local physicians to be aware of the increased risk of trichinosis among Southeast Asian immigrants in the area, particularly those from Laos and Cambodia. Continued emphasis on the need to thoroughly cook all pork products is necessary if the incidence of trichinosis in the U.S. is to be controlled.

Animals↗
PubMed1996

The merits of varicella vaccination for varicella non-immune health care workers.

Immunity against varicella can be reliably established by history and, if negative, confirmed or refuted by serology. If non-immune, the merits of varicella vaccine for a health care worker (HCW) can be stated clearly: Protection from a disease which may be particularly severe in an adult, and evading the inconvenience (investigation time and possible work restriction) and cost of managing an exposure. This paper discusses implementation of a varicella immunity program for HCWs at Columbia Presbyterian Hospital in Oklahoma City.

Adult↗
PubMed1997

The influence of muscle group location and race on the relationship between muscle strength and power.

OBJECTIVE: This study investigated the influence of muscle group location and racial background on the relationship between measures of muscle strength and power. It was hypothesized that both African American (AA) and Caucasian American (CA) males would exhibit similar strength-power relationships, but these relationships would be dependent upon muscle group location. EXPERIMENTAL DESIGN: A cross-sectional, comparative design was used. SETTING: The Human Performance Laboratory at the U. of Oklahoma. SUBJECTS: Normal, healthy college-aged AA (n = 14) and CA (n = 15) males volunteered for this study. MEASURES: Upper and lower body strength (IRM) was assessed using a Smithpress bench press and Polaris leg press, and upper and lower body power was measured with a piezoresistive accelerometer. RESULTS: When comparing power between upper and lower body muscle groups, both AA and CA groups exhibited similar relationships (r = 0.68 and r = 0.61, respectively), however, the relationship between upper and lower body strength was relatively stronger for the AA group (r = 0.65 vs r = 0.42). When evaluating the strength-power relationship within a given muscle group, i.e., upper or lower body, there were no racial differences, but the relationship between strength and power did differ with respect to muscle group location. CONCLUSIONS: There were stronger relationships between measures of muscular strength and power for the lower limbs when compared to the upper body indicating the importance of muscle group location rather than racial ethnicity as a confounding factor that can affect neuromuscular force production. This information is important when attempting to characterize neuromuscular function relative to specific skills or motor sport performance, thus emphasizing the principle of specificity.

Acceleration↗
PubMedDate not supplied

Methicillin-resistant Staphylococcus aureus at a Veterans Affairs Medical Center (1986-96).

Methicillin-resistant Staphylococcus aureus (MRSA) isolates are endemic at the Veterans Affairs Medical Center in Oklahoma City. Five hundred and four consecutively occurring pathogenic MRSA from 490 in-patients were characterized from 1986-96 in order to better understand their epidemiology. The percentage of S. aureus resistant to methicillin increased steadily for 8 years then unexpectedly began decreasing in 1994. During the study period there was a decrease in nosocomial MRSA from wounds and urines with an increase in community-acquired MRSA from sputa and wounds. However, 72% of all isolates from 1986-96 were nosocomial. MRSA from intensive care unit (ICU) patients were more likely to come from respiratory tract specimens than MRSA from non-ICU patients. During the study period, increases in the proportions of nosocomial MRSA from ICU patients and community acquired MRSA from ICU and non-ICU patients occurred. MRSA with many phenotypes (i.e., 69) were identified, suggesting a divergent (versus univergent) threat to patients. Phenotypic analyses, weekly tabulations, and other evidence suggested that MRSA from 3 of the 69 phenotypes were epidemic strains, occurring around 1989. This 11-year descriptive study revealed the epidemiology of MRSA to be a continuously evolving, complicated multifactoral process.

Community-Acquired Infections↗
PubMed1997

Cellular phones and traffic accidents.

Cellular phone use in motor vehicles is becoming an increasing world-wide phenomenon. Using data obtained from traffic accidents reported between 1992 and 1995 in the state of Oklahoma, USA, this study examined statistical rate-ratios of accident characteristics between drivers with or without cellular phones. Rates were calculated between cellular phone involvement and reported accident causes, types of collision, driver actions immediately prior to the accident, location of the accident, the extent of fatalities, and age and gender of drivers. Results indicated a significant increased rate among drivers with cellular phones for inattention, unsafe speed, driving on wrong side of road, striking a fixed object, overturning their vehicle, swerving prior to the accident, and running off the roadway. People with phones stood an increased risk of being killed in an accident over persons without phones. Males with phones had a significantly higher rate than females for many of accident characteristics mentioned above. Rate-ratios of some accident characteristics and fatalities increased as age increased, with the exception of drivers under age 20 yrs, who had the highest fatality rate. Limitations of the study and possible prevention alternatives are discussed.

Accidents, Traffic↗
PubMed1996

Tumors of minor salivary glands and the analysis of 106 cases.

This study is based on 106 cases of predominantly minor salivary gland tumors which were received at the University of Oklahoma College of Dentistry Department of Oral Pathology Biopsy Service from 1972 to 1995. (In this study), 55% of the cases were benign and 45% were malignant. Benign tumors include pleomorphic adenoma (68%), monomorphic adenoma (10%), oncocytoma/oncocytosis (7%), papillary cystadenoma (14%), and myoepithelioma (2%). Of the malignant tumors, 34% were mucoepidermoid carcinoma, 17% adenoid cystic carcinoma, 21% adenocarcinoma, not otherwise specified (N.O.S.), 21% polymorphous low-grade adenocarcinoma, and 6% malignant mixed tumors. There was no difference in relative incidence of benign or malignant tumors between males and females. The 7th decade was the peak occurrence age for both benign and malignant and the palate was the most frequent location.

Adolescent↗
PubMed1998

Medicaid managed care and the marketplace.

In 1994 and 1995, Tennessee, Hawaii, Rhode Island, and Oklahoma began massive expansions of Medicaid managed care, growing from three health plans covering a few enrollees to 27 plans covering the great majority a year later. Some firms aggressively pursued expansion, while others had very limited business objectives. Although established insurers often dominated the Medicaid markets, newly developed firms, some provider-sponsored, were also important. Despite the relatively low Medicaid capitation rates in the 1996-97 period, Medicaid plans in three states had an average 1% net profit margin.

Capitation Fee↗
PubMed1998

Mobile Outreach Crisis Services (MOCS): an innovative model for taking psychiatric care into the community.

Mobile outreach psychiatric services have become a popular model of providing care to the mentally ill. A mobile program has been instituted in Tulsa, Oklahoma, to provide care to homeless mentally ill in Tulsa County and to assist with emergency crisis intervention. The SPMI (Severely and Persistently Mentally III) have been a challenge for both medical and psychiatric providers, and MOCS (Mobile Outreach Crisis Services) was developed to address these problems. This article describes MOCS, briefly reviews recent literature, and discusses ways this program can benefit primary care physicians.

Adult↗
PubMedDate not supplied

Evaluation and treatment of urinary incontinence. Report of a physician survey.

OBJECTIVE: To determine practice patterns related to the evaluation and treatment of urinary incontinence (UI). DESIGN: Stratified random sample of physicians surveyed initially by mail with telephone follow-up. SETTING: Four counties in Central Oklahoma. PARTICIPANTS: One hundred fifty-five physicians in 4 specialties: family practice, internal medicine, obstetrics/gynecology, and urology. MEASUREMENTS: Self-reported evaluation and treatment of UI and training in treatment of UI. The overall rate of response was 80%. RESULTS: Physicians miss opportunities to identify patients with UI. Despite substantial specialty variation, behavioral treatments and medications for UI, relative to the Agency for Health Care and Policy Research clinical guidelines, are underused. More than 40% of internists and family practitioners routinely recommended absorbent pads. Only 17% of physicians were aware of the clinical guidelines. CONCLUSIONS: Physicians identified deficiencies in their level of preparation to evaluate and treat UI. Reports of practice patterns also suggest deficiencies.

Adult↗
PubMedDate not supplied

Sabotaging one's own medical care. Prevalence in a primary care setting.

This study determines the prevalence of medically self-sabotaging behaviors reported by patients in a primary care setting. A 19-item self-report survey was completed by patients on-site at the Family Medicine Clinic, University of Oklahoma College of Medicine-Tulsa. Four hundred eleven consecutive male and female patients were seen for nonemergent care. Each of the 19 items was endorsed by at least 1 respondent. The most commonly endorsed self-sabotaging behaviors were not seeking medical care when needed (37.2%) and not taking a prescribed medication (25.1%). Significantly more women (26.4%) than men (17.5%) reported not taking a prescribed medication (P < .05). After excluding these 2 commonly endorsed items, 27 (6.6%) of the respondents reported at least 1 other self-sabotaging behavior, with most indicating 1 (63.0%) or 2 (22.2%); the remaining 4 individuals reported 4 to 12 behaviors. Significantly more men (4.8%) than women (0.6%) reported not following instructions from a physician or nurse to prolong illness (P < .05). A few patients (6.6%) seen in a primary care university outpatient clinic acknowledged the active and intentional sabotage of their medical care, beyond not taking a prescribed medication or seeking medical care when needed. This is probably a conservative estimate and indicates that medical care is actively compromised by a few patients.

Female↗
PubMed1996

Genetic factors for the development of Alzheimer disease in the Cherokee Indian.

OBJECTIVE: To study the relationship between the genetic degree of Cherokee ancestry, the apolipoprotein E *E4 (APOE*E4) allele type, and the development of Alzheimer disease (AD) in individuals from the Cherokee Nation who reside in northeastern Oklahoma. SETTING: Alzheimer disease center satellite clinic and university departments of neurology, psychiatry, and academic computing. DESIGN: Standardized dementia evaluations based on criteria from the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association were performed on 26 patients aged 65 years or older to establish a diagnosis of AD. Twenty-six control subjects were recruited and similarly assessed. The APOE allele type determinations were obtained on all patients and control subjects. Appropriate statistical analyses were used to compare the genetic degree of Cherokee ancestry, the APOE allele type, and the development of AD. RESULTS: The data indicated that as the genetic degree of Cherokee Indian ancestry increased, the representation of AD decreased. The 9 patients with AD with a greater than 50% genetic degree of Cherokee ancestry constituted 35% of the group with AD. The 17 remaining patients with AD who were less than 50% Cherokee constituted 65% of the group with AD. In contrast, 17 (65%) of the control subjects were more than 50% Cherokee; only 9 (35%) were less than 50% Cherokee. These percentages of AD were not changed by the *E4 allele. This inverse relationship between the genetic degree of Cherokee ancestry and AD, independent of the APOE*E4 allele status, diminished with increasing age, suggesting an age-related protective effect of being Cherokee. For a decrease of 10% in Cherokee ancestry, the odds of developing AD are estimated to be 9.00 times greater at age 65 years but only 1.34 times greater at age 80 years. CONCLUSIONS: A greater genetic degree of Cherokee ancestry reduces the risk of developing AD and, thus, seems protective. This protective genetic factor is independent of APOE allele type and diminishes with age.

Aged↗
PubMed2002

Acute pain management following laryngectomy.

OBJECTIVES: To evaluate the adequacy of as-needed (prn) dosing of narcotics during the acute postoperative period following laryngectomy and to evaluate the role of nurses' interpretation and implementation of narcotic orders in postoperative pain management. STUDY DESIGN: A retrospective review of the medical records of 37 patients who underwent laryngectomy at the University of Oklahoma. The postoperative care was standardized through a clinical pathway to provide a uniform level of care. METHODS: The parameters reviewed include (1) the type and dose of analgesic prescribed, (2) the quantity and frequency of analgesic administered to each patient, and (3) the adequacy of the initial pain-control prescription. RESULTS: All physician orders for narcotics were at or above the minimum dosing guidelines; 68% met a recommended adequate postoperative prescription for moderate pain. However, none of the patients actually received the intended dose during a 24-hour period while hospitalized. Physicians were contacted about 13 patients (35%) because of inadequate pain relief, but only 8 patients (22%) had their narcotic dose increased appropriately. Patients were dosed below the minimum prescribed dose 19 times (2.8%), and in 24 instances (3.6%) the backup analgesic, designated as "prn breakthrough pain," was given as the primary analgesic. CONCLUSIONS: As-needed dosing of analgesia resulted in suboptimal pain control for at least 35% of patients undergoing laryngectomy. Inadequate prescription and variable implementation of prn orders contributed to this.

Adult↗
PubMed2002

Ehrlichia chaffeensis seroprevalence among children in the southeast and south-central regions of the United States.

BACKGROUND: The reported annual incidence of human monocytic ehrlichiosis, which is due to infection with Ehrlichia chaffeensis, is as high as 5.5 per million in some states, but serosurveys suggest much higher infection rates in some populations. OBJECTIVE: To estimate the prevalence of E chaffeensis infection among children aged 1 to 17 years living in the southeast and south-central United States. DESIGN: Cross-sectional serosurvey. SETTING: Seven academic pediatric medical centers in the southeastern and south-central United States. PATIENTS: Nineteen hundred ninety-nine children (approximately 300 at each center) having their blood drawn for any reason. MAIN OUTCOME MEASURE: The presence of antibody at 2 different cutoff titers to E chaffeensis, as detected by indirect immunofluorescence assay. RESULTS: Overall, 250 children (13%) had E chaffeensis antibody titers of 1:80 or higher and 61 (3%) had titers of 1:160 or higher. Age-adjusted seroprevalence rates varied widely between sites. At 1:80 or higher, the highest rate was in Winston-Salem, NC (22%), and the lowest was in Louisville, Ky (2%). At 1:160 or higher, the highest rate was in Kansas City, Mo (9%), and the lowest was in Oklahoma City, Okla (<1%). In univariate analyses, no associations were found between seroprevalence at either cutoff value and sex, race, source of specimen, or residence demographics. However, age was a significant predictor of seroprevalence at both cutoff values. In multiple logistic regression analysis, study site and age remained strong predictors of seroprevalence, but living in a nonurban ZIP code was not significantly related. CONCLUSION: Infection with E chaffeensis, or related ehrlichiae, may be more common in children than previously recognized.

Adolescent↗