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PubMed1992

The epidemiology of toxoplasmosis on Iowa swine farms with an emphasis on the roles of free-living mammals.

Multiparous sows from 19 central Iowa swine farms were tested for antibodies against Toxoplasma gondii by the modified direct agglutination test. Antibody titers of 1:32 or greater were considered positive. Rodents, domestic cats, opossums (Didelphis virginiana), raccoons (Procyon lotor) and striped skunks (Mephitis mephitis) were live-trapped on each farm and similarly tested for antibodies. The overall prevalence of T. gondii antibodies in the species tested was 39/273 (14.3%) swine, 31/74 (41.9%) cats, 2/588 (0.3%) house mice (Mus musculus), 0/21 mice of the genus Peromyscus, 0/9 Norway rats (Rattus norvegicus), 1/34 (2.9%) opossums, 4/14 (28.6%) raccoons and 2/7 (28.6%) striped skunks. The overall prevalence was significantly greater in adult cats versus juvenile cats, adult male cats versus adult female cats, and adult raccoons versus juvenile raccoons. The prevalence of T. gondii antibodies in sows was compared with the prevalence in each non-swine species on a farm basis in order to identify existing associations. The prevalence in sows (and each of the non-swine species) was also analyzed on a farm basis for association with farm characteristics or swine management practices, including the degree of confinement of swine, population size and average parity of breeding female swine, estimated cat population size, and estimated mouse and rat abundance. Average titers of seropositive animals were compared on a species basis. The prevalence in sows which were totally and continuously confined was lower than that in sows which were not totally and continuously confined. The prevalence in sows from farms with an average parity of less than 2.0 was significantly lower than that in sows from farms with an average parity of 2.0 or greater. These results suggested that the prevalence of T. gondii antibodies in swine increased with age and that prevalence in swine could be reduced through total confinement. No associations could be established between prevalence in sows and prevalence in non-swine species or other farm characteristics/swine management practices. However, the high prevalence of T. gondii antibodies in cats suggested that fecal contamination of the environment by cats may be the most significant source of toxoplasmosis for swine. The extremely low prevalence of T. gondii antibodies in house mice suggested that this species was not an important source of T. gondii for swine in Iowa.

Animals↗
PubMed2005

Clinical information technology in hospitals: a comparison between the state of Iowa and two provinces in Canada.

Despite the growing interest in adopting information technology (IT) in healthcare, the degree of technology sophistication varies among healthcare organizations. Changes in the health care sector and continuous pressure to improve the quality of care have driven the evolution of IT in hospitals. This paper provides an overview of clinical IT sophistication in a sample of U.S. hospitals, and compares clinical IT capacities in this sample with a sample of Canadian hospitals. The instrument used for the comparison measures three clinical dimensions of IT sophistication: functional sophistication, technological sophistication and integration level. Clinical areas that were considered include patient management, patient care activities and clinical support activities. The comparison between hospitals in Iowa and Canada shows differences in clinical IT sophistication between the two settings. Hospitals in Iowa appear to have more technologies but fewer computerized processes and integration of patient management activities. Technological sophistication however, was low in both samples. Our findings confirm the construct validity of the measurement instrument and show initial evidence of its generalizability. More initiatives using the instrument would lead to enhancement in IT assessment tools that can be used for evaluation of IT in relation to patient management and quality outcomes.

Biomedical Technology↗
PubMed2004

Readiness to implement Hazard Analysis and Critical Control Point (HACCP) systems in Iowa schools.

OBJECTIVE: To evaluate current food-handling practices, food safety prerequisite programs, and employee knowledge and food safety attitudes and provide baseline data for implementing Hazard Analysis and Critical Control Point (HACCP) systems in school foodservice. DESIGN: One member of the research team visited each school to observe food-handling practices and assess prerequisite programs using a structured observation form. A questionnaire was used to determine employees' attitudes, knowledge, and demographic information. SUBJECTS/SETTING: A convenience sample of 40 Iowa schools was recruited with input from the Iowa Department of Education. STATISTICAL ANALYSES: Descriptive statistics were used to summarize data. One-way analysis of variance was used to assess differences in attitudes and food safety knowledge among managers, cooks, and other foodservice employees. Multiple linear regression assessed the relationship between manager and school district demographics and the food safety practice score. RESULTS: Proper food-handling practices were not being followed in many schools and prerequisite food safety programs for HACCP were found to be inadequate for many school foodservice operations. School foodservice employees were found to have a significant amount of food safety knowledge (15.9+/-2.4 out of 20 possible points). School districts with managers (P=.019) and employees (P=.030) who had a food handler certificate were found to have higher food safety practice scores. APPLICATIONS/CONCLUSIONS: Emphasis on implementing prerequisite programs in preparation for HACCP is needed in school foodservice. Training programs, both basic food safety such as ServSafe and HACCP, will support improvement of food-handling practices and implementation of prerequisite programs and HACCP.

Adolescent↗
PubMed2004

Food safety practices and readiness to implement HACCP programs in assisted-living facilities in Iowa.

OBJECTIVE: To evaluate current food-handling practices and employee food safety knowledge and attitudes and to provide baseline data for implementing the Hazard Analysis and Critical Control Point (HACCP) program in assisted-living foodservices for elderly persons. DESIGN: Food-handling practices were observed at each assisted-living facility using a structured observation form. A validated questionnaire was used to determine demographic information and employees' attitudes and knowledge about food safety. SUBJECTS/SETTING: A convenience sample of 40 assisted-living facilities in Iowa was recruited from a list obtained from the Iowa Department of Elder Affairs. STATISTICAL ANALYSES PERFORMED: Descriptive statistics were used to summarize data. One-way analysis of variance was used to assess differences in attitudes and food safety knowledge among the managers, cooks, and other foodservice employees. Multiple linear regression determined the relationship between manager and facility demographics and the food safety practice score. RESULTS: Proper food-handling practices were followed in many assisted-living facilities, but areas in need of improvement were identified. Some HACCP prerequisite programs were found to be inadequate, including a lack of written standard operating procedures, documentation of food safety practices, and training. Temperatures and chemical concentrations need to be checked routinely. Foodservice employees had a significant amount of food safety knowledge (14.6+/-3.0 out of 20 possible points), and employees with food safety certification scored higher than those with no certification (15.6+/-2.6 and 13.9+/-3.1, respectively; P </=.001). CONCLUSIONS: Training programs, both basic food safety and the HACCP program, will support improvement of safe food-handling practices and implementation of prerequisite programs and the HACCP program. Developing prerequisite programs, including sanitation standard operating procedures, will aid assisted-living facilities in moving toward HACCP program implementation.

Adult↗
PubMed2006

Iowa nursing home characteristics associated with reported abuse.

OBJECTIVE: To evaluate the association of nursing home abuse reported by employees in Iowa licensed nursing homes with nursing home characteristics, inspection results, nursing staff hours, and census demographics. DESIGN: Mailed survey. SETTING: Iowa's 409 Medicare-certified stand-alone nursing homes. PARTICIPANTS: Administrators and directors of nursing. RESULTS: The annual rate of abusive events was 20.7 per 1000 nursing home residents, with a rate of 18.4 reported events and 5.2 substantiated events. A higher number of residents and a higher number of certified beds were significantly associated with higher incident, report, and substantiation rates. Higher incident and report rates were associated with nursing homes in metropolitan areas. Higher substantiation rates were associated with for-profit nursing homes. CONCLUSION: Recognized abuse in nursing homes is not uncommon. Approximately 90% of events are reported to the state authorities with 29% of those being substantiated. Differences associated with nursing facility abuse rates are metropolitan area, ownership, occupancy rate, and number of residents and certified beds.

Aged↗
PubMed2001

The Iowa radon lung cancer study--phase I: Residential radon gas exposure and lung cancer.

Exposure to high concentrations of radon (222Rn) progeny produces lung cancer in both underground miners and experimentally-exposed laboratory animals. The goal of the study was to determine whether or not residential radon exposure exhibits a statistically significant association with lung cancer in a state with high residential radon concentrations. A population-based, case-control epidemiologic study was conducted examining the relationship between residential radon gas exposure and lung cancer in Iowa females who occupied their current home for at least 20 years. The study included 413 incident lung cancer cases and 614 age-frequency-matched controls. Participant information was obtained by a mailed-out questionnaire with face-to-face follow-up. Radon dosimetry assessment consisted of five components: (1) on-site residential assessment survey; (2) on-site radon measurements; (3) regional outdoor radon measurements; (4) assessment of subjects' exposure when in another building; and (5) linkage of historic subject mobility with residential, outdoor, and other building radon concentrations. Histologic review was performed for 96% of the cases. Approximately 60% of the basement radon concentrations and 30% of the first floor radon concentrations of study participants' homes exceeded the US Environmental Protection Agency action level of 150 Bq m(-3) (4 pCi l(-1)). Large areas of western Iowa had outdoor radon concentrations comparable to the national average indoor value of 55 Bq m(-3) (1.5 pCi l(-1)). Excess odds of 0.24 (95% CI = -0.05-0.92) and 0.49 (95% CI = 0.03-1.84) per 11 WLM(5-19) were calculated using the continuous radon exposure estimates for all cases and live cases, respectively. Slightly higher excess odds of 0.50 (95% CI = 0.004-1.80) and 0.83 (CI = 0.11-3.34) per 11 WLM(5-19) were noted for the categorical radon exposure estimates for all cases and the live cases. A positive association between cumulative radon gas exposure and lung cancer was demonstrated using both categorical and continuous analyses. The risk estimates obtained in this study indicate that cumulative radon exposure presents an important environmental health hazard.

Adult↗
PubMed1998

Iowa record-linkage study: death rates in psychiatric patients.

The Iowa record-linkage study was developed to investigate death rates in psychiatric patients, and involved computer matching of death certificates with a roster of patients. A list of all patients admitted to our hospital from 1972 through 1981 was obtained and after removing duplicate entries the list was pared to 5412 names. The record included multiple identifiers (e.g., name, gender, date-of-birth, hospital number). This information was then linked by computer with all Iowa death certificates for the same period; a total of 331 deaths were identified. Patients were assigned to a single psychiatric diagnostic category based on a computer program that reviewed each patient's clinical diagnoses and picked the one with the highest priority in a hierarchy we had created. Age and sex adjusted mortality tables were constructed, allowing us to compute expected numbers of deaths. Relative risk for premature death was greatest among women, and those under 20 years. Risk was associated with all psychiatric diagnoses and was significantly higher among patients of either gender with an organic mental disorder or schizophrenia; women with acute schizophrenia, depressive neuroses, alcoholism, drug abuse, and psychophysiological disorders; and men with neuroses. Death from natural causes, especially from heart disease, was significantly excessive among women, while death from accidents and suicides was excessive for both men and women. The overall SMR was 1.65 (P < 0.001). Most importantly, we found that the greatest excess of mortality occurred within the first 2 years following hospital discharge. Thus, we were able to demonstrate that risk of mortality in general, and of suicide specifically, differed according to age, gender, diagnosis, and portion of the follow-up. We have subsequently used this method to investigate specific risk factors associated with mortality in mood disorders, schizophrenia, and antisocial personality disorder. Findings from these studies are reported.

Adult↗
PubMed2001

Lung cancer risk and red meat consumption among Iowa women.

OBJECTIVE: Some epidemiologic studies suggest that diets high in total fat, saturated fat, or cholesterol are associated with increased risk of lung cancer. Others suggest that diets high in red meat consumption, particularly well-done red meat, are a lung cancer risk factor. In Iowa, we had the opportunity to investigate concurrently the role of meat intake and macronutrients in lung cancer etiology. METHODS: A population-based case-control study of both non-smoking and smoking women was conducted in Iowa. A 70-item food frequency questionnaire (FFQ) was completed by 360 cases and 574 frequency-matched controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression. Multivariate models included age, education, pack-years of smoking, yellow-green vegetable intake, fruit/fruit juice intake, nutrient density calories, previous non-malignant lung disease, alcohol consumption and body mass index (BMI). RESULTS: When comparing the fifth (highest) to the first (lowest) quintile of consumption of total fat, saturated fat and cholesterol, we obtained odds ratios of 2.0 (1.3-3.1), 3.0 (1.9-4.7), and 2.0 (1.3-3.0) respectively. However, when red meat was entered into the model along with total fat, saturated fat or cholesterol, the excess risk for the macronutrients disappeared while an odds ratio of 3.3 (1.7-7.6) was obtained for red meat. The odds ratios for red meat consumption were similar among adenocarcinoma cases, OR=3.0 (1.1-7.9) and non-adenocarcinoma cases, OR=3.2 (1.3-8.3) and among life-time nonsmokers and ex-smokers OR=2.8 (1.4-5.4), and current smokers, OR=4.9 (1.1-22.3). Yellow-green vegetables were protective with an odds ratio of 0.4 (0.2-0.7). CONCLUSIONS: Consumption of red meat, was associated with an increased risk of lung cancer even after controlling for total fat, saturated fat, cholesterol, fruit, yellow-green vegetable consumption and smoking history, while yellow-green vegetables are associated with a decreased risk of lung cancer.

Adenocarcinoma↗
PubMed1997

The independent pathology laboratory as a reporting source for cutaneous melanoma incidence in Iowa, 1977-1994.

BACKGROUND: Health care changes during the past decade have resulted in a greater proportion of cutaneous melanoma (CM) cases diagnosed in nonhospital settings, increasing the potential for cases to be missed by population-based cancer registries. OBJECTIVE: Our purpose was to assess changes in case-finding sources in Iowa from 1977 to 1994 and to determine the extent of underreporting for the State Health Registry of Iowa, a population-based cancer registry. METHODS: This study examines changing trends in the incidence of CM and compares case-finding sources (hospitals/clinics, hospital pathology laboratories, and independent pathology laboratories). A survey of dermatologists serving Iowans provides estimates of underreporting. RESULTS: During the period 1977 to 1994, invasive CM increased 82%, whereas in situ CM increased 900%. The proportion of CM cases diagnosed in independent pathology laboratories increased to 25% of all cases. A range of 10.4% to 17.1% underreporting was estimated based on the survey of dermatologists. CONCLUSION: To improve the accuracy of surveillance, population-based cancer registries need to make a greater effort accessing pathology reports from nonhospital settings.

Dermatology↗
PubMed2001

Health risk factors and occupation among Iowa workers.

BACKGROUND: Health behaviors represent major risks for premature morbidity and mortality. This study aimed to establish whether health risks varied substantially across occupational groups. METHODS: We focused on the 2223 Iowa Behavioral Risk Factor Surveillance System (BRFSS) subjects who reported, in 1999, that they were currently working. RESULTS: Even after controlling for age and gender, we found significant associations between occupation and health risk factors. We found these associations among the different categories of health risk factors, including insurance/access, health conditions, preventive behaviors, and screening behaviors. CONCLUSIONS: The considerable differences in the prevalence of risk factors for chronic disease and injury across occupational groups in Iowa underscore the need for nationwide ongoing collection of occupational status in the BRFSS. These national data on the distribution of risk factors across occupations will support development of more targeted prevention interventions.

Adolescent↗
PubMed2003

An international comparison of breast cancer survival: Winnipeg, Manitoba and Des Moines, Iowa, metropolitan areas.

PURPOSE: Extending previous Canadian-United States cancer survival comparisons in large metropolitan areas, this study compares breast cancer survival in smaller metropolitan areas: Winnipeg, Manitoba and Des Moines, Iowa. METHODS: Manitoba and Iowa cancer registries, respectively, provided a total of 2,383 and 1,545 women with breast cancer (1984 to 1992, followed until December 31, 1997). Socioeconomic data for each person's residence at the time of diagnosis was taken from population censuses. RESULTS: Socioeconomic status and breast cancer survival were directly associated in the US cohort, but not in the Canadian cohort. Compared with similar patients in Des Moines, residents of the lowest fifth of income areas in Winnipeg experienced a significant 5-year survival advantage (survival rate ratio [SRR] = 1.14). In these lowest income areas, the Canadian survival advantage was larger among women aged 25 to 64 years (SRR = 1.23), and this was observed in the middle fifth of income areas among this younger cohort (SRR = 1.11). The Canadian survival advantage even seemed apparent in the poorest neighborhoods with relatively high representations of Aboriginal people (SRR = 1.16). CONCLUSION: This study replicated the finding of advantaged Canadian cancer survival in smaller metropolitan areas that had been consistently observed in larger metropolitan areas. Canada's single payer health care system seems to offer similar advantages across a number of diverse urban contexts.

Adult↗
PubMed2002

Menstrual and reproductive factors and risk of non-Hodgkin lymphoma: the Iowa women's health study (United States).

BACKGROUND: Endogenous sex hormones, particularly estrogens, modulate the immune system, and non-Hodgkin lymphoma (NHL) is a tumor that is related to immunologic status. METHODS: Self-reported menstrual and reproductive history and risk of NHL were evaluated in a cohort of 37,934 Iowa women who were aged 55-69 years when first enrolled in 1986. Through 1998, 261 cases of NHL were identified by linkage to the Iowa SEER Cancer Registry. RESULTS: After multivariate adjustment there was no association between NHL incidence and age at menarche, age at menopause, type of menopause, history of infertility, number of miscarriages, or history of induced abortion, while there were suggestive inverse associations with nulliparity (RR=0.65; 95% CI 0.36-1.16) and years of ovulation (RR = 0.76 for >37 compared to <28 ovulatory years: p-trend = 0.07). Among parous women there was no association with number of livebirths or age at first livebirth, but there was an inverse association with number of children who were breast-fed (RR=0.52 for breast-feeding >2 children versus none; 95% CI 0.33-0.82). CONCLUSIONS: Overall, menstrual and reproductive factors were not strongly related to NHL incidence. The inverse association with breast-feeding is novel but requires confirmation in other studies.

Abortion, Induced↗
PubMed2004

Analyzing geographic patterns of disease incidence: rates of late-stage colorectal cancer in Iowa.

This study, using geocodes of the locations of residence of newly diagnosed colorectal cancer patients from the Iowa Cancer Registry, computed continuous spatial patterns of late-stage rates of colorectal cancer in Iowa. Variations in rates in intrahospital service regions were as great as interhospital service regions, shown by analysis of variance tests. Some of the spatial variations observed could be explained, using a general linear regression model on individual-level data, by spatial variations in attributes of individuals and their relationships to health resources. We show how this source of variation can be removed from the original map leaving a new map showing the remaining variation in late-stage rate not explained by these relationships. We argue that it would be more appropriate to organize prevention and control activities targeted at the areas with higher than expected late-stage rates shown on this map. The originality of this approach is in the integration of geocoded data from a cancer registry with methods of spatial analysis that provide considerable geographic detail in the cancer rate while controlling for rate stabilization and reliability due to the small number problem.

Colorectal Neoplasms↗
PubMed1999

Phylogeography and conservation genetics of the Iowa pleistocene snail.

The Iowa Pleistocene snail, Discus macclintocki, is an endangered species that survives only in relictual populations on algific (cold-air) talus slopes in northeast Iowa and northwest Illinois in the central region of the USA. These populations are believed to have been isolated since the temperatures began to warm at the end of the last glacial period around 16 500 years ago. DNA sequencing of the 16s rRNA gene of the mitochondria was used to determine the genetic relationship among 10 populations and the genetic diversity within these populations. Genetic diversity is extremely high within this species with 40 haplotypes spread across the 10 populations sampled within a 4000 km2 region. Phylogenetic analyses showed that haplotypes formed monophyletic groups by the watershed on which they were found, suggesting that watersheds were important historical avenues of gene flow. Genetic distances were strongly related to the geographical distance among all populations, but this relationship was dependent on the scale being considered.

Animals↗
PubMed1999

Application of a subjective health and safety rating system to Iowa farm operations.

A rapid, subjective health and safety assessment tool was developed and applied to 121 farm operations visited during a cross-sectional, on-farm industrial hygiene (IH) study of the Iowa Farm Family Health and Hazard Surveillance Project (IFFHHSP). The study utilized a single field investigator who conducted visits of farm operations from August 1995 to July 1996. The farm operations visited were randomly selected from a stratified, two-stage cluster sample of Iowa farm operations. The tool developed and applied to each farm operation--the Site Rank System--was based on the average of scores assigned to four different farm characteristics, which we believed would predict the health and safety status of the farm operations. Two of these characteristics were based on an assessment of each farm's operator (operator attitude and operator practices) and the other two were based on weighted scores assigned to physical components of the farm operation (status of facilities and status of equipment). The Site Rank System was found to have been assigned consistently, but an analysis comparing the Site Rank System scores to initial in-depth medical and environmental data gathered from the visited farm operations via self-reported questionnaires showed little correlation with outcomes. However, self-reported injuries (11 total) which occurred to the principal farm operators of the farm operations visited during the on-farm IH study phase (August 1995 to July 1996) correlated with low Site Rank System scores.

Agriculture↗
PubMed2007

Risk factors for low back injury among farmers in Iowa: A case-control study nested in the agricultural health study.

The aim of this study was to assess risk factors for low back injury requiring medical advice or treatment among Iowa farmers. Although farmers are at risk for low back injury, few studies have addressed risk factors for farm work-related low back injury. We screened 6999 participants in the Iowa portion of the Agricultural Health Study to identify 49 male farmers who reported farm work-related low back injury requiring medical advice or treatment in the previous year. We compared them with 465 uninjured male farmer controls. Multivariable modeling identified four risk factors significantly associated with low back injury: age less than 45 years (OR = 3.32; 95% CI 1.75-6.20), doctor-diagnosed asthma (OR = 4.26; 95% CI 1.49-12.10), education beyond high school (OR = 2.12; 95% CI 1.13-3.90), and difficulty hearing normal conversation (even with a hearing aid, in the case of those using one) (OR = 1.98; 95% CI 1.02-3.80). Although hearing difficulty may be a general risk factor for occupational injury, asthma may be a more specific risk factor for low back injury. Future research to assess the risk factors, asthma and difficulty hearing, may be particularly important, since farmers are at increased risk for hearing loss, and farmers come into contact with many inhaled agents that can cause asthma.

Adult↗
PubMed2006

Serosurveillance for Anaplasma phagocytophilum antibodies in white-tailed deer (Odocoileus virginianus) in Iowa, USA.

Cases of human granulocytic anaplasmosis have increased in number and are being identified in new geographic areas since its discovery in 1994. White-tailed deer (WTD) become infected with the causative agent, Anaplasma phagocytophilum, and serve as natural sentinels for this organism. In order to determine if A. phagocytophilum is present in the state of Iowa, sera collected from 628 WTD in 2004 from 13 sites and from 282 WTD in 1999 from a single, common site were tested by enzyme-linked immunosorbent assay and Western immunoblotting. A seroprevalence of 9.1% was found among the 2004 samples, and there was no change in seropositivity rates from 1999 to 2004 at the single, common site. As A. phagocytophilum is another tick-borne human pathogen to be identified in the state of Iowa, this study has important implications for health care providers.

Anaplasma phagocytophilum↗
PubMed2000

Residential radon gas exposure and lung cancer: the Iowa Radon Lung Cancer Study.

Exposure to high concentrations of radon progeny (radon) produces lung cancer in both underground miners and experimentally exposed laboratory animals. To determine the risk posed by residential radon exposure, the authors performed a population-based, case-control epidemiologic study in Iowa from 1993 to 1997. Subjects were female Iowa residents who had occupied their current home for at least 20 years. A total of 413 lung cancer cases and 614 age-frequency-matched controls were included in the final analysis. Excess odds were calculated per 11 working-level months for exposures that occurred 5-19 years (WLM(5-19)) prior to diagnosis for cases or prior to time of interview for controls. Eleven WLM(5-19) is approximately equal to an average residential radon exposure of 4 pCl/liter (148 Bq/m3) during this period. After adjustment for age, smoking, and education, the authors found excess odds of 0.50 (95% confidence interval: 0.004, 1.81) and 0.83 (95% percent confidence interval: 0.11, 3.34) using categorical radon exposure estimates for all cases and for live cases, respectively. Slightly lower excess odds of 0.24 (95 percent confidence interval: -0.05, 0.92) and 0.49 (95 percent confidence interval: 0.03, 1.84) per 11 WLM(5-19) were noted for continuous radon exposure estimates for all subjects and live subjects only. The observed risk estimates suggest that cumulative ambient radon exposure presents an important environmental health hazard.

Adult↗