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Teachers are frequently expected to support children psychologically in the aftermath of mass casualty events, yet they generally have not been trained to do so. This study of a small private school in New York City reports the reactions, needs, and interests in preparedness training among teachers in response to the September 11, 2001, terrorist attacks. By and large, teachers coped by talking to others and/or a health professional, but felt ill-equipped to intervene with students and expressed substantial need for assistance. [ABSTRACT FROM AUTHOR]

Increasingly, providers of health services and medical groups are required to negotiate with managed care organizations and evaluate the adequacy of capitation rates. An intelligent assessment of the rate of payment requires an accurate projection of the costs per member per month that have been adjusted for the risk present in the insured population. This article develops a practical model for incorporating risk in forecasts of the full cost per member per month. Copyright (c) 1998 by Aspen Publishers, Inc. [ABSTRACT FROM AUTHOR]

You don't have to be an eminent authority or a superhero to help victims of family violence. A few basic skills are all that's needed. The statistics suggest you will definitely have opportunities to use whatever you learn. [ABSTRACT FROM AUTHOR]

Background: It is widely accepted that all-terrain vehicles (ATVs) can be dangerous to operators. Understanding the mechanisms of ATV crashes, especially rollovers, can provide important insight to consumers, legislators, and manufacturers on ATV safety and protection of the users., Methods: From March 1, 2003 to July 31, 2005, all patients with ATV-related injuries presenting to a regional trauma center were enrolled in an ATV crash data bank. Data were collected on the patients and the circumstances surrounding each crash., Results: A total of 193 persons were treated during the study period for ATV-related injuries. Among the 190 nonfatally injured patients, almost half (47%) were diagnosed with a head injury. In 63% of crashes the ATV rolled over. The direction of the rollover was strongly associated with the type of riding terrain or slope. ATVs traveling on flat or uneven surfaces were strongly associated with right-side rollovers (odds ratio [OR] = 32.9, 95% confidence interval [CI] = 6.6-221.5). ATVs traveling uphill were strongly associated with backward rollovers (OR = 173.6, 95% CI = 27.2-1,497.0). Children had a significantly greater risk compared with adults of right-side rollovers on flat and uneven surfaces (OR = 4.7, 95% CI = 1.2-17.5) Adults were more likely to be injured in rollover crashes where the ATV was traveling uphill; in all of these cases the vehicle rolled backwards., Conclusions: These findings suggest that nonrandom, modifiable factors are likely involved. Our data provide unique insight into specific mechanisms of ATV crashes, particularly rollovers, and those involving children. Findings may be applicable to changes in ATV design and education of users.

This study assessed teachers' reactions to the Oklahoma City bombing. Peritraumatic reactions, the interaction of media exposure with stress from media coverage, feelings toward the perpetrators, and worry about safety predicted posttraumatic stress. Twenty percent reported difficulty handling demands; 5% sought counseling. Outreach efforts should assess and assist teachers.

The enactment of Medicare and Medicaid created a new demand for medical services in Oklahoma, particularly in rural areas. The state of Oklahoma responded by creating The Oklahoma Physician Manpower Training Commission in 1975. The overall purpose of the Commission was to increase the number of primary care physicians and influence distribution into non-metro areas. This analysis concerns the public policy value of this ongoing program. The PMTC has provided resident stipend funding to each of Oklahoma's publicly funded Family Medicine residency programs. Since 1975, the PMTC has provided over 139 million dollars in resident stipend funding and support; and there have been 749 program graduates with 431 practicing in Oklahoma. This model calculates that the Oklahoma-based physicians have created a cumulative 3.7 billion dollars of economic impact on the state; and conservatively estimates that only 10% of the practice decisions/locations were influenced by the PMTC. This creates an estimated return of 370 million dollars on an "investment" of 139 million dollars. Additionally the model demonstrates that the current cohort of physicians is annually responsible for 15,530 jobs and an associated payroll of 428 million dollars.

The enactment of Medicare and Medicaid created a sudden and significant increase in demand for physician services in Oklahoma. As a response, the Oklahoma Legislature established the Physician Manpower Training Commission in 1975. The intent was to provide incentives for graduating physicians to remain in Oklahoma, especially in rural areas. This analysis examines the retention rates experienced during the 25-year period of 1976-2001. It is observed that 82% of program physicians are currently practicing in Oklahoma. This retention proportion compares to only 36% for National Health Service Corps physicians who were obligated to practice in Oklahoma. Additionally, Oklahoma has experienced a 67% retention proportion in rural areas. During this period, 633 physicians have received an estimated dollar 19 million in loans and scholarships. This is an average of dollar 30,000 per recipient. In return, each of these physicians will create 34 jobs and almost dollar 1 million of annual income.

This study assessed indirect interpersonal exposure to the 1995 Oklahoma City bombing, broadcast and print media exposure in the aftermath of the explosion, emotional reactions to media coverage, and posttraumatic stress reactions in children distant from the explosion. A survey was administered to 88 sixth-grade students in the public middle school in a community 100 miles from Oklahoma City 2 years after the bombing. Many children reported indirect interpersonal exposure and most reported bomb-related media exposure. Print media exposure was more strongly associated with enduring posttraumatic stress than broadcast exposure. Indirect interpersonal exposure and the interaction of media exposure with emotional reaction to media coverage in the aftermath of the explosion each predicted ongoing posttraumatic stress. The results suggest that children may have lingering reactions to highly publicized terrorist incidents. Concern about the influence of television viewing has long been proclaimed. This study implicates print media exposure as well. Media exposure to terrorist incidents, therefore, should be monitored and those working with children should assess exposure and stress even in children not directly impacted.

Medicare beneficiaries often need to purchase supplemental coverage or join a federally approved HMO to gain prescription coverage and other benefits. In general, obtaining additional coverage may include a premium payment that is dependent on age. There is an array of choices in Oklahoma.

An Institute of Medicine committee was convened to explore the links between biological, psychosocial, and behavioral factors and health and to review effective applications of behavioral interventions. Based on the evidence about interactions of the physiological responses to stress, behavioral choices, and social influences, the committee encouraged additional research efforts to explore the integration of these variables and to evaluate their mechanisms. An understanding of the social factors influencing behavior is growing and should be considered in programs and policies for public health, in addition to individual behavior and physiological status. Interventions to change behaviors have been directed toward individuals, communities, and society. Many intervention trials have documented the capacity of interventions to modify risk factors. However, more trials that include measures of morbidity and mortality to determine if the strategy has the desired health effects are needed. Behavior can be changed and new behaviors can be taught. Maintaining behavior changes is a greater challenge. Although short-term changes in behavior following interventions are encouraging, long-duration efforts are needed to improve health outcomes and to provide long-term assessments of effectiveness. Interventions aimed at any level can influence behavior change; however, existing research suggests that concurrent interventions at multiple levels are most likely to sustain behavior change and should be encouraged.

Despite a number of efforts by states and the federal government over several years, millions of low-income children still lack health insurance coverage and, therefore, have limited access to healthcare services. To address these problems, Congress has created, and states are now implementing, the new State Children's Health Insurance Program (SCHIP). Policymakers and agency officials who design, operate, and sponsor health coverage programs such as SCHIP must determine what constitutes an effective program. Efforts to maximize the number of children with coverage are important. The challenge for each state and its communities is to effectively identify and enroll eligible low-income children. They must create outreach strategies to find and enroll children in Medicaid and SCHIP. However, a truly effective program must go beyond simply enrolling children in health coverage programs. They must also assure that newly enrolled children receive quality comprehensive health care.

The purpose of this study is to examine differences in the use of preventive or early-detection services by the temporarily and chronically uninsured. The use of preventive care was measured by an index that depicts the use of nine preventive or early-detection services and the use or nonuse of each procedure on the index. Respondents whose lapse in insurance coverage was one year or more were identified as chronically uninsured, while those whose lapse in coverage was less than one year were identified as temporarily uninsured. The analysis indicates that the chronically uninsured and, to a lesser extent, the temporarily uninsured use significantly fewer preventive or early-detection services than their insured counterparts.

Intimate partner violence is an important health problem. Approximately 1.5 million women are assaulted or raped (and nearly 1,100 are killed) by a current or former intimate partner yet it is preventable if recognized by the women and their physicians.

Shaken Baby Syndrome may have life-long consequences, but it can be prevented. It is far too common and usually arises when the parent or caretaker gets angry, frustrated or impatient, but it can also be caused by inappropriate play. There are pathognomonic signs but suspicion must be high to suspect it. Physicians play an important role in diagnosis, management and most importantly, prevention.

Type 2 ("adult-onset") diabetes in young adults and children has become increasingly common over the last 10 years, and has been described as an "emerging epidemic." The financial and societal ramifications of such a development are substantial and demand a prompt and aggressive public health response. Emphasis must be placed upon preventive behaviors and early detection, and creation of new public policy to address the related societal issues. Recommendations for prevention and screening of high-risk children and adolescents are provided.

Diseases have ravaged the human race throughout history. Although medical science has progressed rapidly over the past few decades and increased the average life span from 56 to 84, the quest for a disease-free life process has been elusive. But the history of human biology was altered forever nearly 40 years ago by a bold decision to launch a research program effort to characterize in ultimate detail the complete set of genetic instructions of the human being. In 1988, Congress appropriated funds to the Department of Energy and the National Institutes of Health to begin planning the Human Genome Project. Planners set a 15-year time frame, estimated that the price tag would be $3 billion, and laid formal goals to get the job done. On October 1, 1990, the Human Genome Project officially began. The Project aimed that by 2005, the "Holy Grail" of life would be deciphered. This revelation would provide a new understanding of the genetic contributions to human diseases and help in the development of rational strategies to minimize or prevent diseases in the future.

This article describes Posttraumatic Stress Disorder (PTSD) symptomatology in 69 sixth-grade youths who resided within 100 miles of Oklahoma City at the time of the 1995 bombing of the Alfred P. Murrah Federal Building. These youths neither had any direct physical exposure nor personally knew anyone killed or injured in the explosion. A survey conducted two years after the bombing assessed exposure, PTSD symptoms, and functioning. PTSD symptom frequency was measured with the Impact of Event Scale--Revised. Our BCD criteria for defining PTSD caseness was modeled after DSM-IV B, C, and D criteria requiring one reexperiencing, three avoidance/numbing, and two arousal symptoms for diagnosis. Those who met our BCD criteria had significantly higher PTSD symptom scores than those who did not. Both increased mean PTSD symptom score and meeting our caseness definition were associated with increased functioning difficulties. Media exposure and indirect interpersonal exposure (having a friend who knew someone killed or injured) were significant predictors of symptomatology. These findings suggest that children geographically distant from disaster who have not directly experienced an interpersonal loss report PTSD symptoms and functional impairment associated with increased media exposure and indirect loss.

Adolescent violence is a major public health problem. The factors influencing boys to become violent are now known; hence, physicians may now recognize adolescents who may become violent. Physicians can be involved in the prevention of violence by either counseling young adolescents who demonstrate factors that influence violence, or by referring those at-risk individuals to a counselor.

Throughout its 100-year existence, the College of Medicine has faced numerous crises, mostly due to inadequate funding. Furthermore, at various times there has been significant political interference, the worst of which was the Executive Order issued by Governor William H. Murray. However, these four Deans exhibited great leadership during especially difficult times. In several instances, they were aided by sympathetic and effective Governors including Robert L. Williams, Roy S. Turner, and Henry Bellmon. The College of Medicine was fortunate that they were willing to proceed through adverse conditions, because without them, many of us would not have had the opportunity to attend medical school in Oklahoma.

Motor vehicle collisions are a significant cause of morbidity and mortality in the Oklahoma population. The cost associated with this morbidity and mortality is exacerbated by the failure of individuals to use seat belts. Numerous organizations believe that seat belt compliance can be improved through physician counseling. This would allow medical resources to be redirected towards other health problems. Analysis was performed using the Oklahoma Department of Public Safety (ODPS) crash file and the hospital in-patient data discharge file from the Oklahoma State Department of Health (OSDH). These provide a profile of Oklahoma drivers who do not use seat belts. This analysis allows physicians to pinpoint and advise those individuals most likely to not utilize seat belts about the benefits of seat belt use. The results of the analysis show that non-seat belt-users tend to be young and male. Significant predictors of seat belt use are age, gender, alcohol use, time of day (day versus night), driver location (urban versus rural), vehicle type (pick up versus passenger car), and decreased hospital charges. These results show that increased seat belt use can lead to significant decreases in fatalities related to motor vehicle crashes and a decline in associated hospital charges for those who survive. Physicians should encourage seat belt use by their patients and inform them of the risks associated with failure to use seat belts.

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.

Do old people drink? Community surveys suggest that alcohol consumption is lowest among elders compared to any other age group, and that patterns of drinking are relatively stable across mid-to-late life. But is this an accurate portrayal of those individuals seeking medical guidance? In other words, what is the likelihood of alcohol abuse or misuse among the typical hospital, outpatient clinic, or emergency room patient? How difficult is it to spot potential alcohol misuse among the elderly? The purpose of this paper is to address these questions and to assist physicians of the medical community in the important function of early detection and prevention of alcohol abuse/misuse in patient populations.

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.

Smoking is the leading preventable cause of death in the United States. The US Centers for Disease Control and Prevention (CDC) estimate that smoking kills approximately 419,000 people in the United States each year. Cigarette smoking is the nation's leading cause of premature mortality, and is responsible for one-third of all deaths among working-age Americans. Smoking cigarettes is both psychologically and physiologically addictive. Smoking is an important risk factor for cardiovascular diseases, especially coronary artery disease, stroke, carcinoma of the lung, chronic bronchitis, chronic obstructive pulmonary disease, and emphysema. It also increases the risk for peripheral vascular disease and is associated with cancers of the larynx, oral cavity, esophagus, pancreas, and urinary bladder. Smoking by pregnant women can cause adverse health effects on their babies, like low birth weight and preterm delivery; increases the risk of miscarriage; and has also been found to be an important cause of sudden infant death syndrome. Careless smoking also can cause severe burn injuries and death. Many of these adverse effects of smoking occur in "second-hand" smokers.

Colorectal cancer is a common disease in the Western world. Most, if not all, colorectal cancers develop from previously benign adenomas. There are a number of genetic abnormalities including mutations in oncogenes and tumor suppressor genes which either present as a germline, or acquired defects lead to the development of colorectal cancer. Two well-defined hereditary colorectal cancer syndromes exist, hereditary nonpolyposis colorectal cancer syndrome and familial adenomatous polyposis coli, for which genetic testing is possible and advised. Guidelines for screening for colorectal cancer in average, moderate, and high risk patients are available from the American Cancer Society and were updated in 1997. The American Society of Clinical Oncology has published guidelines for genetic testing in a variety of cancers including colorectal cancer.

The objective of this article is to describe the National Committee on Quality Assurance (NCQA). The NCQA is one of many organizations that is addressing the issues of quality assurance of health care for HMOs. It is of concern that when HMOs focus on cost they may stint on services. Also it is difficult for HMOs to compete for both quality and cost if there is not a comparable objective standard of measurement. The NCQA offers a level of accreditation that is representative of organizational structure and resources. The Health Plan Employer Data and Information Set (HEDIS) is used to compare outcomes and professional resources. The results of both the accreditation and the HEDIS measures are compiled in a national data base, The Quality Compass. There is skepticism that the NCQA is measuring the correct data for basing quality measurement decisions and also the data obtained is severely underutilized by health care purchasers (employers with less than 1,000 employees).

This paper addresses health aspects of juvenile delinquency in American Indian youths. Comorbid conditions such as substance abuse and depression often complicate diagnosis and treatment. A survey of the literature and an examination of cultural, family, and school issues that influence the presentation and management of conduct problems in Native American youths are included. Cases are presented to emphasize the importance of cultural sensitivity in clinical assessment and intervention.

Homicide is a leading manner of injury to cause death in children. To assess this phenomenon in Oklahoma, the demographic characteristics and causes of death of the victims of child homicide in Oklahoma have been reviewed. One hundred eleven consecutive cases of homicide in children less than age 13 years were reviewed and the demographic characteristics of the victims were analyzed. The majority of homicides occurred in Tulsa and Oklahoma Counties (55.8%). The ratio of male to female victims was approximately equal. The races of the victims were 66.6 percent White, 24.3 percent Black, 8.1 percent Native American and 0.9 percent Asian. The most common cause of death was head injury (45.9%). An unexpected finding was that in 23.4 percent of cases, an additional fatality occurred in the family due to family violence. This fatality involved either suicide of the perpetrator or homicide of a sibling. These findings indicate a continuing family violence problem in Oklahoma.

This paper uses regression analysis to explore the relation of network membership to the financial performance of rural hospitals in Oklahoma during fiscal year 1995. After adjusting for the scope of service, as measured by the number of facilities or services offered by the hospital, indicators of fiscal status are (1) the cash receipts derived from net patient revenue; (2) the cash disbursements related to operating costs, net of interest and depreciation expense, labor costs and nonlabor costs; and (3) net cash flow, defined as the difference between cash receipts and disbursements. Controlling for the effects of the hospital's structural attributes, operating characteristics and market conditions, the results indicate that members of a network reported lower net operating costs, labor costs and nonlabor expenses per service than nonmembers. Hence, the analysis seems to suggest that the membership of rural hospitals in a network is associated with lower cash disbursements and an improved net cash flow, outcomes that may preserve their fiscal viability and the access of the population at risk to service.

Medicaid has been the "safety net" for certain low-income people. In recent years, many states, including Oklahoma, have determined to enroll beneficiaries in managed care plans in an attempt to hold down the costs. Oklahoma began enrolling people in 1995, and the issue will be: was the managed care approach successful at least in controlling costs? To prepare, expenditures for the four years prior to the managed care approach have been analyzed. Comparison with surrounding states indicates that Oklahoma was already successful with negative average annual growth rates for the period 1992-1994, and that Oklahoma was more successful than surrounding states.

The curricular principles presented here arose from a national conference of experts in dealing with family violence from medicine, nursing, and dentistry. The conference, held in March 1994 in Oklahoma City, Oklahoma, was supported by The Robert Wood Johnson Foundation. The conference's work was based upon the premise that an integrated approach to health-professional education in family violence would be more effective than single approaches. The group developed a set of principles for identification of specific goals in knowledge, skills and practices. With those in mind, three levels of education were identified: knowledge, skills, and practices that should be taught to all health professionals (called "Family Violence 101"); advanced levels for primary care practitioners for comprehensive, longitudinal care; and knowledge, skills, and attitudes for specialty practitioners for specific, directed, intensive interventions appropriate to the specialties (called "Family Violence 201"); and additional education and training for those practitioners who wish to be consultants, investigators, and teachers of intervention in cases of family violence (called "Family Violence 301"). These recommendations are presented in the hope that health-professional schools and societies will implement them, thereby improving the health professions responses to this epidemic.

Using discriminant analyses of data on 916 returned questionnaires from a mailing to 1,650 administrators in 82 South Carolina hospitals, this study examines the allocation of interpersonal, informational, decisional, and treatment roles among executive, administrative, and clinical directors. Educational attainment, years of experience, and gender were found to influence respondents' positions. Results also indicate that executive directors assume responsibility for the organization and its relation to the environment. As expected, those in clinical and administrative positions assume more responsibility for interpersonal and treatment roles than do executive directors.

There are compelling reasons to promote the education of medical students about family violence. First, such violence is a significant health problem, but one that has been hidden or ignored for too long by the medical and health communities and even by law enforcement agencies. Once physicians look for family violence among their patients, however, they will find it. Second, it is important for physicians to know about family violence because they typically are the first line of defense and will see victims of family violence who cannot, or are afraid to, call the police. A third reason for including family violence in the curriculum is that this topic is eminently teachable. Obstacles to greater emphasis on family violence in the curriculum are akin to the obstacles in physicians' practices: ignorance, denial, a feeling that the problem is a law enforcement one, and a mistaken notion about how easy it is for an abused woman to leave her abuser. Also, medical students often come from sheltered backgrounds and will have to be taught about the prevalence and importance of family violence. Curricula in family violence should be multidisiplinary, integrated into current teaching, and have an emphasis on experiential learning. Also, change must be built into the curriculum so that it can reflect the latest understanding of the problem. Faculty who have the interest and training to teach this topic are limited, so they must teach their colleagues to prevent misinformed teaching. Finally, community resource people should be involved, since they are responsible for much of the management and rehabilitation of abused persons.

Deaths of Oklahoma women can be prevented by early detection using mammography and clinical breast examinations. This study summarizes the responses from the Oklahoma Behavioral Risk Factor Study, and the results indicate that Oklahoma women, especially low income and less well educated women, are not receiving these screening tests in adequate numbers. Physicians have a major responsibility to correct this by recommending such tests and encouraging women to take advantage of them.

Oklahoma leads the nation in the proportion of women who smoke, and is sixth in the proportion in the childbearing ages. Furthermore, the incidence of deaths from carcinoma of the lung in women is increasing, as is the number of low birthweight babies. Both of these conditions are associated with smoking. It is clear that Oklahoma physicians should become aggressive in encouraging women to stop smoking.

Over 10,000 Oklahomans die each year from coronary artery disease or stroke. This study examined the behavioral risk factors for these illnesses present in Oklahomans. Oklahomans are at considerably higher risk than the desirable national goals for such risk factors. For example, too many Oklahomans smoke and too few exercise. The data to support these findings are included herein, and some steps to reverse these trends are recommended.

Medicaid expenditures in Oklahoma increased 98.2% from 1986 through 1991 while those of the United States went up 111.0%. Of this increase, 21.6% was due to inpatient care and 25.9% to nursing home care. With respect to beneficiaries, 34.9% of the increase was attributable to the aged and 31.4% to the disabled. AFDC recipients accounted for only 19.1% of the increase.