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PubMed1980

Epidemiologic relationships of the bovine population and human leukemia in Iowa.

Data from the Third National Cancer Survey and data collected under the auspices of the National Cancer Institute's Surveillance, Epidemiologic and End Results (SEER) Program were used to perform a descriptive epidemiologic study of leukemia in Iowa. Data were also collected on livestock population patterns in the state, and a survey was performed to locate cases of lymphosarcoma within the cattle population. Ecologic relationships between human leukemia, livestock populations and bovine lymphosarcoma were investigated. Iowa has higher rates than the national average for human leukemias. The lymphoid leukemias make up the majority of the excess leukemias. Excessive acute lymphoid leukemia (ALL) is seen in the ages under 20 years and over 60 years. The excess ALL is in males living in rural counties. There is no sex difference for chronic lymphoid leukemia (CLL), but there is a slight urban-rural differential. There is a high positive correlation between ALL in males and cattle density. This relationship is greater for daily cattle than for beef cattle. There is an additional positive relationship between counties with excessive ALL and the presence of dairy herds affected with bovine lymphosarcoma.

Adolescent↗
PubMed2002

Iowa Case Management: innovative social casework.

This article describes the development of an innovative approach to case management for rural clients in drug abuse treatment. This innovative approach is discussed in the context of the broader field of case management-including social casework, public health, nursing, modern case management, and managed care. Because case management has been defined in many different ways, making comparisons of programs and models is difficult. The article presents an expanded set of criteria for comparing case management models. The Iowa Case Management model is compared with these other models across several dimensions. This article also describes the philosophy and goals of the Iowa model, as well as key activities in which clients and case managers participate. The authors discuss implications for practice and issues related to evaluation of case management.

Case Management↗
PubMed1982

226Ra and 228Ra in Iowa drinking water.

The University Hygienic Laboratory has been performing radiochemical analyses on drinking water in the state of Iowa for over 20 yr. Approximately one half of the 1250 community water supplies that exist in Iowa have been sampled roughly once every 3 yr for the past decade. Originally, raw and finished waters that showed a gross alpha activity of greater than or equal to 3.0 pCi/L were analyzed for 226Ra, but starting in July 1976, finished waters were analyzed for both 226Ra and 228Ra if the gross alpha activity was greater than or equal to 2.0 pCi/L. As of 10 June 1981, 604 community water supplies had submitted composited samples that have been analyzed for gross alpha, 226Ra, and 228Ra concentrations in compliance with the federal Safe Drinking Water Act (Public Law 93-523). Approximately 10% of these supplies were found to exceed the EPA-established maximum contaminant level (MCL) for 226Ra plus 228Ra of 5 pCi/L. The results revealed, consistent with several other investigators (Mc81; Mi80; Mic80), that some supplies had higher concentrations of 228Ra than of 226Ra. It was also concluded, in agreement with McCurdy and Mellor (Mc81), that some ground water samples cannot be accurately measured for gross alpha activity due to their high dissolved solids content.

Iowa↗
PubMed1993

Factors associated with elevated 222Rn levels in Iowa.

The University of Iowa, in conjunction with the Environmental Protection Agency's State Radon Survey Assistance Program, performed a 222Rn screening survey of 582 rural households in the winter of 1989. The distribution of maximum indoor 222Rn concentrations throughout Iowa as well as the relationship between 222Rn screening measurements, detector placement, and housing characteristics are summarized. This report is unique in that site-specific home construction characteristics were collected in the field from participants prior to 222Rn monitoring. The findings of the survey indicate that the significance of a particular housing characteristic on a 222Rn screening measurement is dependent on the placement of the radon detector.

Air Pollution, Indoor↗
PubMed1994

The central Iowa project.

This project developed and tested a population-based survey, the HS Form, to examine health and health care in the Central Iowa community. Data from this new collection of proven sets of items were used to compare competing health plans, doctor offices, hospitals, and to develop preliminary norms of the community's insured, in two areas: system performance and health burden. The results showed that the survey: (1) was both feasible and efficient in delivering a comprehensive and generic assessment of consumers and patients; (2) revealed consistent, noteworthy differences between plans and between providers across both sets of criteria; and (3) indicated that there is substantial room for improvement in Central Iowa's health care delivery system from the public's perspective. Recommendations for next steps include: (1) following through on the June 1993 community forum (held to discuss the project's methods and results with local decision makers); (2) broadening the evaluation design to increase sample representativeness; and (3) implementing a pre/post approach to measure changes in plan and provider performance.

Community Health Planning↗
PubMed1996

The Iowa CHMIS (Community Health Management Information System): work in progress.

The Iowa Community Health Management Information System (CHMIS) is a legislatively authorized system that is designed to meet Iowa's shared information needs and reduce administrative costs. A public/private partnership has been planning this system for over three years, implementation is scheduled to begin in July 1996. At that time, certified transaction networks will route claims data between providers and payors, a subset of that data will be stored by a centralized data repository. As the system evolves, provider access will be expanded and additional data elements will be captured.

Community Networks↗
PubMed1976

28. The nursing home project of the Iowa Health Services Data System.

The long-term care project of the Iowa Hospital Association has demonstrated the feasibility and utility of a multipurpose data system for nursing homes and related institutions. Important features of the Iowa system are emphasis on the needs and constraints of those providing care and collecting the data; prior establishment of specific criteria for the content of the system; the use of three related forms (admission, evaluation, and discharge) to produce current reports; and ease, flexibility, and transferability. A significant byproduct of the demonstration project was improved record keeping and patient care planning by the 14 participating facilities. Major problems encountered were lack of experience on the part of nursing homes and external regulatory agencies in defining their data needs and using data effectively, and financial support. Contribution to cost by external agencies in return for data and a major commitment to educational programs, both initial and continuing, are seen as essential to the success of long-term care data systems.

Health Occupations↗
PubMed1989

The ratio of impaired elderly in the community to those in nursing homes in two rural Iowa counties.

The Iowa 65+ Rural Health Study gathered health status information on all elderly persons living in two rural Iowa counties. In this report these data are used to determine the ratio of persons with activities of daily living (ADL) dependencies living in the community to those in institutions. Results indicated that the "community/institutional dependency ratio" is about 1 to 1 for these counties, which is about half the ratio representing conventional wisdom. Possible explanations for this difference are discussed. In addition, it was found that the level of ADL dependency (need) can serve alone as an almost certain predictor of institutionalization for some elderly. For others, ADL dependency (need) is only one factor. The likely variability of the community/institutional dependency ratio across different geographic areas has implications for government funding of home health care, for long-term care insurance, and for eliminating excess demand. These implications are discussed.

Activities of Daily Living↗
PubMed1997

Assessing public health performance in Iowa's counties.

Local health agencies in Iowa were surveyed to assess the performance of public health practices in their communities. Responses were received from 97 percent of counties. Less than 50 percent of counties were performing half of the indicators of the Assessment function. Policy Development functions also were frequently not performed. Performance was best in the Assurance function, with 86 percent of counties reporting that they inform and educate the public. However, the other three types of Assurance practices (Manage, Implement, and Evaluate) were performed less frequently. Comparison of the performance of Iowa's rural counties reveals a profile nearly identical to that reported elsewhere for a group of six other states.

Benchmarking↗
PubMed1992

Consequences of increasing alcohol availability: the Iowa experience revisited.

Before/after survey data were used to investigate the effect that a sudden and dramatic wine and spirits availability increase in Iowa might have had on heavy and problem drinker rates. Three state surveys representing the age 18+ non-institutionalized population of Iowa were conducted in 1985, 1986 and 1989. Neither previous sales analyses nor this survey data analysis support the Distribution of Consumption Prevention Model prediction that increased wine and spirits availability would produce significant and lasting consumption increases and, in turn, heavy drinker and problem drinker prevalence rate increases.

Adolescent↗
PubMed1988

Rural-urban differences in access to Iowa child health services.

Indicators of access, utilization, and quality of available child health services as well as health status were obtained through a telephone survey of Iowa households with children under age six. These indicators were compared for rural-urban subsamples within an AFDC sample drawn from Iowa Department of Human Service files (N = 637), and within poverty (N = 129) and nonpoverty groups (N = 631) drawn from the population of all households in the state with children under age six. About 55 percent of all households studied were rural. Rural households were generally larger than urban households, more likely to be intact maritally, white, and earning a living from farming. The findings support the hypothesis that place of residence has an impact on access, utilization, and quality of child health services over and above family income, although not always to the disadvantage of rural children. Typical problems for rural children, irrespective of income, were access to pediatric care, greater travel time to providers, and discontinuity of well care and sick care. Rural children in all income groups had lower seat belt use than urban children; they were also less likely to have well visits and their providers showed less attentiveness to behavioral and developmental issues at these visits. Rural residency exacerbated problems in access to care for low income children, who were less likely to be eligible for AFDC/Medicaid than their urban counterparts. Medicaid coverage, however, did not eliminate rural-urban differences in receiving desired medical care.

Child↗
PubMed2002

Vascular changes in Iowa-type hereditary cerebral amyloid angiopathy.

Vascular dysfunction due to cerebral amyloid angiopathy (CAA) may contribute to cognitive impairment. The Iowa D694N amyloid precursor protein mutation, a recently identified cause of hereditary CAA with dementia, offers an opportunity to explore the anatomic basis of CAA-related vascular dysfunction. Examination by immunolabeling and confocal microscopy demonstrated extensive loss of smooth muscle cells in affected segments as well as a perivascular inflammatory reaction of astrocytes and microglia. On 3-D reconstruction, vessels appeared tortuous with twiglike projections that may represent areas of vascular degeneration. The observed changes in the Iowa brain suggest pathophysiologic mechanisms for vascular dysfunction in CAA and possible approaches to treatment of CAA-related cognitive impairment.

Cerebral Amyloid Angiopathy, Familial↗
PubMed2006

Association between nonsteroidal anti-inflammatory drug use and the incidence of lung cancer in the Iowa women's health study.

BACKGROUND: Previous studies have suggested that use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with reduced risk of lung cancer, but the data are inconsistent and are limited particularly with respect to the effects of aspirin, separate from other NSAIDs. METHODS: The Iowa Women's Health Study is a prospective cohort of 41,836 Iowa women ages 55 to 69 years old at baseline in 1986. NSAID use was assessed in 1992. Over 10 years of follow-up, 403 incident cases of lung cancer were identified. The association of incident lung cancer with current use of aspirin or non-aspirin NSAIDs was analyzed after adjustment for lung cancer risk factors. Hazard ratios (HR) were estimated using multivariate COX proportional hazards regression. RESULTS: There were 27,162 women in the analytic cohort. After controlling for age, education, alcohol intake, pack-years, smoking status, body mass index, and total fruit intake, the RR of women taking six or more aspirin weekly was 1.21 (95% confidence interval, 0.92-1.59). The HR was 1.23 for women taking six or more non-aspirin NSAIDs weekly (95% confidence interval, 0.92-1.65). There was no statistically significant trend by frequency of use for either aspirin (P(trend) = 0.22) or non-aspirin NSAIDs (P(trend) = 0.53). Analyses by histologic type and smoking status yielded similar null results. Information on dosage and duration of use were not available for this analysis. CONCLUSION: These findings do not suggest that aspirin or other NSAIDs reduce risk of lung cancer in this cohort of postmenopausal women.

Aged↗
PubMed1984

Uveitis in London and Iowa.

The pattern of uveitis seen in a caucasian population in Iowa was found to be very similar to that seen in London in spite of geographical and climatic differences in the two locations. Acute anterior uveitis was the commonest type of uveitis but fewer of the Iowa patients showed radiological evidence of ankylosing spondylitis or Reiter's syndrome. Toxoplasmosis was responsible for 9% of cases in both series. It is concluded that genetic factors are more important than geographic location in determining the types of uveitis which occur in a caucasian population.

Female↗
PubMed2002

Neuroaxonal dystrophy in raccoons (Procyon lotor) from Iowa.

During a 12-month period (1998-1999), microscopic evidence of neuroaxonal dystrophy (NAD) in medullae oblongata of raccoons (Procyon lotor) was observed in 17/39 (47% prevalence in adults) from Iowa, USA. Three of the animals were kits (<3 months), 26 were between 1 and 2 years, and 10 were over 7 years. Lesions were not seen in the medullae of the 3 kits. In young adults, the lesions were mild and were seen in 7 animals. More severe lesions were present in the 10 older raccoons. Grossly, the brains were unremarkable. Microscopically, NAD was confined to the dorsal caudal medulla, where certain nuclei (predominantly gracilis and cuneate) were bilaterally affected. Severely affected animals had vacuolar degeneration of neurons or neuronal loss and extensive areas of spongiosis. Tests for the presence of PrP(res) in the brain were negative. Spongiotic areas often contained axonal spheroids. Degenerate neurons and axons occasionally contained amphophilic periodic acid-Schiff-positive granular material. There was a paucity of inflammatory cells in the affected areas. Since lesions were not present in kits, were either absent or mild in young adults, and were severe in older raccoons, the findings may be related to advancing age. Neuroaxonal dystrophy has not been previously reported in raccoons. Retrospective examination of raccoon brains from the eastern and northwestern areas of the country revealed very low prevalence of NAD. Because of the apparently high prevalence of this condition at this geographic location, factors other than age (genetic, nutritional, and/or environmental) may influence this degenerative process in the brains of raccoons in Iowa.

Animal Diseases↗
PubMed1990

Porcine leptospirosis in Iowa.

The epidemiology of leptospirosis in Iowa swine was examined on the basis of serologic results and herd data from 55 herds in the National Animal Health Monitoring System (NAHMS) program and culture results and histories from 578 cases of reproductive failure submitted to the Iowa Veterinary Diagnostic Laboratory during a 3-year period. Thirty-eight percent of sera from NAHMS herds contained antibodies against 1 or more of 12 leptospira antigens. Leptospires were isolated from 9 (1.6%) of 578 cases of reproductive failure. Seven (78%) of the isolates were identified as Leptospira interrogans serovar kennewicki and 2 (22%) as serovar grippotyphosa. In 7 herds from which leptospires were isolated, attack rates ranged from 1% to 84%. Clinical leptospirosis, characterized by reproductive failure and confirmed by isolation of leptospires, was sporadic. No significant differences in farrowing averages and reproductive problems were observed between vaccinated and nonvaccinated NAHMS herds or between herds with higher (43-63%) or lower (14-40%) percentages of animals that were serologically positive against serovar bratislava.

Abortion, Veterinary↗
PubMedDate not supplied

The effect of physician characteristics and their practice environment on surgical referral patterns for early-stage breast cancer in Iowa.

The objective of this article was to examine whether characteristics of referring physicians and their practice environment were associated with surgical referral behavior for early-stage breast cancer patients. A total of 2801 women diagnosed with early-stage breast cancer and their referring physicians were identified from the Iowa Surveillance, Epidemiology, and End Results (SEER) database during 1989-1996. The Iowa Physician Inventory was used to collect information on characteristics of referring physicians. Multiple logistic regression analyses were conducted to evaluate characteristics of the referring physicians and their practice environment to explain surgical referral behavior. Affiliation with physicians' networks and professional diversity among area specialists were associated with increased referrals to surgeons more likely to perform breast-conserving surgery. Promoting interaction among physicians, particularly among those with different specialties, may increase the diffusion of new behaviors into clinical practice.

Breast Neoplasms↗
PubMed2002

Effect of CAHPS performance information on health plan choices by Iowa Medicaid beneficiaries.

This evaluation tested if Consumer Assessment of Health Plans Study (CAHPS) information on plan performance affected health plan choices by new beneficiaries in Iowa Medicaid. New cases entering Medicaid in selected counties during February through May 2000 were assigned randomly to experimental or control groups. The control group received standard Medicaid enrollment materials, and the experimental group received these materials plus a CAHPS report. We found that CAHPS information did not affect health plan choices by Iowa Medicaid beneficiaries, similar to previously reported findings for New Jersey Medicaid. However, it did affect plan choice in an earlier laboratory experiment. The value of this information may be limited to a subset of receptive consumers who actively study information received, even then only when (1) ratings of available plans differ greatly, (2) ratings differ from prior beliefs about plan quality, and (3) reports are easy to understand.

Case Management↗