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PubMed1986

Novel plasmid-mediated beta-lactamase in members of the family Enterobacteriaceae from Ohio.

Epidemiologic studies of plasmid-mediated resistance at the Cleveland Veterans Administration Medical Center revealed that related plasmids had disseminated among members of the family Enterobacteriaceae. We studied the beta-lactamases encoded by these plasmids in Escherichia coli C600 transformants or transconjugants. Substrate and inhibition profiles of the enzymes determined by two of these plasmids suggested an activity resembling TEM-1; however, isoelectric focusing revealed a pI of 7.0. These two plasmids were originally found in a Serratia marcescens (pDS076) and an Enterobacter cloacae (pDS075) strain isolated from the same sink in the medical intensive care unit and later, in an Enterobacter cloacae (pDS142 identical to pDS076) isolate colonizing a patient in the same unit. The plasmids also carried the aminoglycoside resistance determinant, 2"-aminoglycoside nucleotidyl transferase. A 2-kilobase AvaI restriction endonuclease digestion fragment of pSD075 known to carry the beta-lactamase determinant was used as a molecular probe. This probe did not recognize sequences of any plasmid-mediated beta-lactamase tested including the recently described determinants ROB-1, TLE-1, and OXA-4-7. A TEM-1 probe derived from the 0.7-kilobase PstI-EcoRI fragment of pBR322 failed to recognize the new beta-lactamase gene. Four additional Enterobacter cloacae and two Enterobacter aerogenes strains isolated in Columbus, Ohio, have been shown to produce a pI 7.0 beta-lactamase and to carry plasmids recognized by the 2-kilobase probe. These data suggest dissemination of a novel plasmid-mediated beta-lactamase among members of the family Enterobacteriaceae in Ohio and demonstrate the development and utility of a molecular probe for the new determinant. We suggest that the novel beta-lactamase be named OHIO-1.

DNA, Bacterial↗
PubMed2000

Determining needs and setting priorities for HIV-affected and HIV-infected persons: northeast Ohio and San Diego.

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1991 requires that communities receiving Title I funding engage in a needs assessment and priority process to guide the allocation of those funds to various services within the local community. This paper reports on the process and results of the needs assessments in northeast Ohio and San Diego County for 1996-1997 and 1998. Data from northeast Ohio's 1998 needs assessment indicated significant differences between whites and nonwhites in the utilization of HIV specialist care, HIV-related prescription medications such as antiretrovirals, and health insurance. A need for additional dental care, complementary therapies, housing, and assistance with utility payments was found in both geographic areas. Consumer participation in San Diego's health department-based needs assessment process was more extensive than in northeast Ohio's academic-based approach but was also related to increased community-borne expense.

Adult↗
PubMedDate not supplied

Underuse of controller medications among children with persistent asthma in the Ohio medicaid population: evolving differences with new medications.

BACKGROUND: Despite innovations in asthma care, morbidity and mortality have increased significantly. Underuse of controller medications is a major contributor to increased morbidity and mortality. OBJECTIVE: To determine the extent of underuse of asthma controller medications among Ohio Medicaid children and to determine if there are racial differences in controller medication claims. METHODS: We conducted a retrospective analysis of Ohio Medicaid claims data. The source data included all institutional, medical service, and pharmacy claims for fee-for-service patients between January 1, 1997, and December 31, 2001. We identified children with persistent asthma using Health Employer Data Information System criteria. The primary outcome was a controller medication claim. We used multivariable logistic regression to identify risk factors for underutilizing asthma controller medications and applied generalized estimating equations to account for repeated measures. RESULTS: The proportion of children with claims for a controller medication increased from 53% in 1997 to 67% in 2001. Although there were no racial differences in medication claims in 1997, a smaller proportion of African American children had a claim for a controller medication in 2001 (64.8% vs 67.8%, P < .001). Leukotriene antagonists (LTAs) were driving this difference. Individuals residing in urban areas were significantly less likely to have claims for LTAs when compared with those who resided in nonurban areas. CONCLUSIONS: Overall use of asthma controller medications among Ohio Medicaid children was poor. There was a widening racial difference in controller medication claims over the 5-year study. Regional differences in LTA claims were driving this racial difference.

Adolescent↗
PubMed2006

Pediatric all-terrain vehicle-related injuries in Ohio from 1995 to 2001: using the injury severity score to determine whether helmets are a solution.

OBJECTIVE: The goal was to identify regions in Ohio with severe pediatric all-terrain vehicle-related injuries and to determine whether helmet usage was associated with lower injury severity scores. METHODS: We performed a retrospective review of data for all patients entered into the registries of Ohio's major pediatric trauma centers for the period of January 1, 1995, to December 31, 2001. RESULTS: Seven hospitals participated. A total of 285 children were admitted; 2 patients died, and 13 required rehabilitation. The mean age was 11.1 years, with 76.1% of patients being male and 88.1% white. Most patients came from the central and southwestern regions of Ohio. An average of 30 admissions per year occurred from 1995 to 1998, but the number increased to 55 admissions per year from 1999 to 2001. Among the 285 injured children, 869 injuries were sustained; 57% of patients sustained multiple injuries. The most commonly injured body parts were the head (22.3%) and lower extremities (12.6%). The most common injuries sustained were fractures (31.4%) and contusions/abrasions (22.2%). Of patients for whom documentation was available, 72.2% (171 of 237 patients) were not helmeted. There was no significant difference in mean injury severity scores between helmeted and nonhelmeted riders (9.58 vs 9.12). Helmet usage was not associated with a reduction in head/facial injuries. CONCLUSIONS: All-terrain vehicle-related injuries to children nearly doubled between 1995 to 1998 and 1999 to 2001. Fewer than 30% of injured children were wearing helmets at the time of injury. With the injury severity score as an indicator, helmets provided no significant protection for all-terrain vehicle riders in this pediatric population.

Accidents↗
PubMed1988

Characteristics of childhood homicide in Ohio, 1974-84.

Childhood homicide deaths in Ohio from 1974 to 1984 were examined using Ohio Vital Statistics records and US Census Data. Homicide rates varied from 25/100,000 for Black infant males to 0.8/100,000 for White females ages 5-9. Child battering was the leading cause of death for children less than 5 years. Firearms accounted for 56 per cent of homicide deaths for children 10-14 years of age. The childhood homicide rates in the four largest Ohio cities were substantially higher in areas with low socioeconomic indicators.

Adolescent↗
PubMed2006

Demographic trends for animal care and control agencies in Ohio from 1996 to 2004.

OBJECTIVE: To examine changes between 1996 and 2004 in regard to numbers of animals handled, medical care provided, expenses, numbers of employees, and agency policies for animal care and control agencies in Ohio. DESIGN: Cross-sectional survey. SAMPLE POPULATION: 223 animal care and control agencies. PROCEDURES: A questionnaire was mailed to animal care and control agencies in Ohio to collect information for 2004; results were compared with published results of a similar survey. RESULTS: 165 of the 223 (74%) agencies responded. Estimated total number of animals handled in 2004 was 315,519, which represented a decrease of 7% compared with 1996. However, although number of dogs taken in decreased 17%, number of cats taken in increased 20%. Between 1996 and 2004, the euthanasia rate decreased from 65.3% to 56.8%, and the adoption rate increased from 24.5% to 33.6%. Number of dogs euthanatized decreased 39%, but number of cats euthanatized increased 14%. The proportion of agencies with a spay-neuter policy increased from 56% to 71%, and the proportion that maintained an association with a veterinarian increased from 39% to 80%. For dogs handled by county dog warden agencies, the odds of euthanasia were higher if the agency did not have a spay-neuter policy (odds ratio, 1.36). CONCLUSIONS: Results suggest that the status of dogs handled by animal care and control agencies in Ohio improved between 1996 and 2004, but that the status of cats deteriorated.

Animal Welfare↗
PubMed2003

Characteristics of physicians disciplined by the State Medical Board of Ohio.

Although physicians have been disciplined for a variety of offenses by state medical boards across the United States, limited information is available about the characteristics of these physicians. To assess the characteristics of, offenses committed by, and resulting disciplinary actions taken against a consecutive series of disciplined physicians in the state of Ohio, the authors conducted a case-control study of all 308 physicians publicly disciplined by the State Medical Board of Ohio (SMBO) from January 1997 to June 1999. Subjects were matched with two groups of control physicians--one matched by location only, and the second matched for location, gender, practice type, and self-designated specialty. The main outcomes measured were disciplinary actions, offenses leading to state medical board actions, and the characteristics of disciplined physicians. Of 340 physicians disciplined during these 30 months (approximately 0.37% per year), 308 committed 477 offenses requiring 409 actions by the SMBO. The most common offenses were impairment due to alcohol and/or drug use (21%), inappropriate prescribing or drug possession (14%), previous state actions (15%), negligence or incompetence (7%), and drug-related charges (7%). Although offenders were significantly less likely to be women (P < .05; odds ratio [OR], 0.46; 95% confidence interval [CI], 0.28-0.75), the authors found no difference in the severity of disciplinary action taken against offenders by gender (OR, 1.23; 95% CI, 0.54-2.82) or by type of medical training, ie, between osteopathic physicians and allopathic physicians (OR, 0.70; 95% CI, 0.39-1.26). Compared with controls matched for location, gender, practice type, and self-designated specialty, offenders were significantly less likely to be board certified (OR, 0.65; CI, 0.46-0.92) and significantly more likely to have been in practice 20 or fewer years (OR, 1.51; 95% CI, 1.08-2.13). Disciplinary actions in Ohio were more frequent, more severe, and more often in response to impairment due to alcohol and/or drug use and previous state actions than previously reported. No difference in the severity of disciplinary action was noted between men and women or between osteopathic and allopathic physicians.

Adult↗
PubMed1992

Chaperoning practices of Ohio family physicians.

BACKGROUND: The medical literature contains no consistent recommendations regarding chaperon practices during physical examination of patients. The objective of this study was to determine the chaperon practices of Ohio family physicians. METHODS: A questionnaire was mailed to all 1,786 active members of the Ohio Academy of Family Physicians. The questionnaire solicited information about the physicians' chaperon practices during physical examinations of the rectum, sexual and genital organs, and the female chest. RESULTS: The response rate was 74.6%. During female genital examinations, chaperons were used by 79.4% of male and 31.9% of female family physicians. Only 1.4% of male and 14.4% of female physicians used chaperons during male genital examinations. Chaperon practices were influenced by the gender of the physician and patient, the type of examination, and the availability of an assistant. CONCLUSIONS: No standard of care exists regarding chaperon practices among Ohio family physicians.

Age Factors↗
PubMed2006

Risky behaviors among Ohio Appalachian adults.

This article describes the prevalence of risky behaviors known to be associated with increased cancer morbidity and mortality among Ohio Appalachian adults. These behaviors, or risk factors, include: 1) tobacco use; 2) energy imbalance (involving poor diet, obesity, and physical inactivity); and 3) sexual behaviors. We report current estimates of the prevalence of these behaviors among Ohio Appalachian adult residents and review social, psychological, and biological variables associated with these risky behaviors. We also present recent empirical studies that have been completed or are in progress in Ohio Appalachia. Finally, we discuss how these studies help bridge well-documented gaps in the literature.

Adult↗
PubMed1991

Attitudes of Ohio hospital pharmacists toward pharmacy technicians.

A survey was conducted to determine the attitudes of Ohio pharmacists toward pharmacy technicians. A questionnaire was developed with questions about the current and future scope of technician responsibilities; training, certification and licensure; and possible displacement of pharmacist positions. The questionnaire was mailed in January 1990 to a random sample of 357 hospital pharmacists registered with the Ohio State Board of Pharmacy. There were 182 usable questionnaires returned, for a response rate of 51%. Nearly all the respondents (98.4%) employed pharmacy technicians. Of 32 functions listed in the questionnaire, 16 were performed by technicians at more than half of the responding hospitals. The functions performed by technicians varied depending on the size and location of the hospital; and the education, experience, and current position of respondents influenced their opinions on the appropriateness of having technicians perform several functions now and in the future. Most respondents agreed that all technicians should receive standardized training and education, and more than a third believed that technicians should be certified. The respondents did not believe that increased use of technicians would eliminate present pharmacist positions in their department but were neutral toward a statement that technicians would eliminate pharmacist positions in general. Ohio pharmacists' attitudes toward the expanding role of pharmacy technicians seemed in concert with the recommendations that have emerged in the profession.

Attitude of Health Personnel↗
PubMedDate not supplied

Type A influenza viruses in waterfowl in Ohio and implications for domestic turkeys.

Because ducks are considered an important reservoir for type A influenza virus, and type A influenza viruses had not been recovered from ducks in Ohio, a 3-year virus surveillance study was conducted in Ohio waterfowl and waterfowl passing through Ohio to determine if domestic turkeys were at risk of exposure to avian influenza (AI) viruses from the waterfowl reservoir. The prevalence of AI infections in ducks during the fall migration averaged about 5.9%. The 55 waterfowl-origin type A influenza viruses recovered from ducks during fall 1986, 1987, and 1988 represented 23 different hemagglutinin-neuraminidase sub-type combinations of type A influenza viruses. Virus recovery frequencies ranged from 3.6% to 7.8% between years, from 2.0% to 8.2% between study sites, from 0.0% to 16.7% for sampling days, and from 0.0% to 14.3% among species of ducks sampled.

Animals↗
PubMed1989

A retrospective death certificate study of AIDS and AIDS-related conditions in Ohio: 1984-1986.

AIDS surveillance data are used routinely to define the magnitude of the epidemic, project future case numbers, delineate risk behaviors, and to assist in health planning and resource allocation. The purposes of this study are: (1) to evaluate the effectiveness of the Ohio Department of Health (ODH) AIDS Surveillance System in Ohio from 1984 through 1986 and (2) to identify additional cases which may have been overlooked through normal case identification procedures. A review of all deaths occurring in Ohio among males between the ages 20 and 50 was conducted for several diseases and conditions commonly associated with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Translocation Down syndrome in Ohio 1970-1981: epidemiologic and cytogenetic factors and mutation rate estimates.

Sixteen hundred eighty-eight Down syndrome live births, including 65 (5.2%) translocations, were ascertained in Ohio between 1970 and 1981. Translocations of known origin were 24.4% maternal, 2.2% paternal, and 73.3% de novo. Translocation subtypes were 14/21 (45.7%), 15/21 (2.9%), 21/21 (40.0%), 21/22 (2.9%), and other (8.5%). Among 14/21 translocations, 33.3% were maternal in origin and 66.7% were de novo, while 100% of 21/21 translocations were de novo. No differences were found when the maternal- and paternal-age distributions of all translocations or various translocation subsets were compared with the live-birth control distributions. However, mean maternal and paternal ages of de novo translocations were significantly lower than that of the live-birth controls. Ohio data showed the average maternal age of de novo D/21 cases to be significantly lower than the control. Ages of both parents of de novo G/21 cases and paternal age of D/21 cases were not different from the control. De novo translocation mutation rate estimates were 0.8 X 10(-5) for 14/21, 1.2 X 10(-5) for 21/21, and 2.2 X 10(-5) overall. Ohio estimates (3.2 X 10(-5) for 1970-1972 and 1.4 X 10(-5) for 1973-1975) did not reflect the increase in mutation rate previously found in New York during 1973-1977.

Adult↗
PubMed1988

Treatment limitations in nursing homes in northwest Ohio.

Eighty-eight nursing homes in northwest Ohio were surveyed by telephone regarding the acceptance of "do not resuscitate" (DNR) and "do not hospitalize" (DNH) orders. Written protocols addressing these issues were requested, if available. Eighty-three of the 88 homes participated in the survey. Seventy-five percent of nursing homes accept DNR orders, while 35% accept DNH orders. The most common qualifying condition for a DNR/DNH order was the approval of the family. Although 32 homes stated that they have written protocols, only eight were made available for review. The authors concluded that DNR orders are widely accepted in nursing homes in northwestern Ohio. However, DNH orders are less likely to be accepted in northwest Ohio long-term facilities and the use of written protocols is even more limited.

Clinical Protocols↗
PubMed1983

An analysis for paternal-age effect in Ohio's Down syndrome births, 1970-1980.

The purpose of this study was to analyze Down syndrome (DS) births during 1970-1980 in the State of Ohio for a paternal-age effect independent of maternal age. Birth certificates and chromosome analysis records were used to ascertain 1,244 white DS births, which by capture-recapture methodology were estimated to comprise two-thirds of all white DS births in Ohio for this period. The control data consisted of 1,667,210 white live births in Ohio during the same period. One method of statistical analysis was a case-control comparison, which for each single-year maternal age compares the mean paternal age for controls with each observed DS paternal age. No statistically significant paternal-age effect was found in nine of the 11 years. For two of the years, and for all years combined, the DS fathers were significantly younger than the fathers of controls. When the data were subdivided according to ascertainment, one subpopulation--those DS individuals obtained from birth certificates alone--also showed a statistically significant negative paternal-age effect. The Mantel-Haenszel test was also applied to these data. Assuming no paternal-age effect, a lower rate of DS births than expected was found at paternal ages greater than or equal to 40, but not at greater than or equal to 45, greater than or equal to 50, or greater than or equal to 55. These same methods were used to test for a maternal-age effect. In each of the 11 years and over all 11 years combined, a strong and statistically significant positive maternal-age effect was detected.

Adolescent↗
PubMed1983

Cost analysis of the Ohio nursing home industry.

This study was part of a major review of long-term care policy in the state of Ohio. The authors analyzed 1532 cost reports filed by nursing homes in 1975-1976 with the Ohio Medical Assistance (Medicaid) program. The objective was to guide policy on size (economies of scale), ownership, certification status, and reimbursement. Economies of scale were not found important: skilled nursing facilities (SNFs) offered the only evidence of operation below optimal scale, and the savings attributable to achieving optimal scale (increasing average bed size from 108 to 143) amounted to only $0.20 per patient day. Proprietary facilities were consistently less costly than voluntary or governmental facilities; however, quality measures were not available, and the largest cost differential was in direct cost where quality might be affected. Hypothesized greater efficiency in proprietary facilities could not be rejected--if accurate, the cost savings were very large ($3.92 to $9.14 per patient day for all homes together). As expected, skilled facilities were more costly than intermediate care facilities (ICFs), and the differential ($3.31 per patient day) was large enough to suggest transfer of misplaced patients. High proportional Medicaid utilization of a home tended to reduce cost, possibly because of the very low ceiling rates paid by the Ohio Medicaid program during the period of this study (1975-76 data). High utilization in general reduced average cost, presumably by spreading fixed cost.

Certification↗
PubMed1995

Occupational silicosis--Ohio, 1989-1994.

Silicosis is a chronic lung disease associated with the inhalation and pulmonary deposition of dust that contains crystalline silica. Through the Sentinel Event Notification System for Occupational Risks (SENSOR)* program, CDC's National Institute for Occupational Safety and Health (NIOSH) is assessing practical models for implementing state-based surveillance of silicosis and linking follow-up intervention activities to surveillance reports. From 1989 through 1992, the Ohio Department of Health (ODH) SENSOR program identified silicosis cases through reports of Bureau of Workers' Compensation (BWC) claims, physician reports, and death certificates. The addition in 1993 of hospital discharge reports as an ascertainment source resulted in a substantial increase in the number of silicosis case reports identified annually (Table 1). This report describes the investigation of a case of occupational silicosis in Ohio and summarizes the impact of hospital-based reporting on surveillance for silicosis in Ohio during 1993-1994.

Hospitalization↗
PubMedDate not supplied

An epidemiologic investigation of a rubella outbreak among the Amish of northeastern Ohio.

From April 1990 to April 1991, 278 cases of rubella were reported to the Ohio Department of Health. Of these, 276 (99 percent) were among the Amish of northeastern Ohio. The outbreak involved eight counties in an area that contains large settlements of Old Order Amish. Members of this community of Amish frequently take religious exemption from recommended immunization practices and are believed to represent a high proportion of Ohio's rubella-susceptible persons. Vaccination history was known only for 146 of the Amish people. Of those, only four had a positive history of rubella vaccination. Of the 276 Amish with cases of rubella, 65 (24 percent) were younger than age 5 years, 104 (38 percent) were ages 5-14, 46 (17 percent) were ages 15-19, 32 (12 percent) were ages 20-29, 6 (2 percent) were ages 30 or older, and age was not reported for 23 (8 percent). The ratio of males to females with rubella was 1:1. Five women of the Amish community were pregnant; four had been ill with symptoms consistent with rubella. Three were in their first trimester. Congenital rubella syndrome did not occur in any of the four live births. Serology was available for only the two non-Amish people, and both were acute phase serum-positive for Immunoglobulin M.

Adolescent↗