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PubMed2006

Proximity to crops and residential exposure to agricultural herbicides in iowa.

Rural residents can be exposed to agricultural pesticides through the proximity of their homes to crop fields. Previously, we developed a method to create historical crop maps using a geographic information system. The aim of the present study was to determine whether crop maps are useful for predicting levels of crop herbicides in carpet dust samples from residences. From homes of participants in a case-control study of non-Hodgkin lymphoma in Iowa (1998-2000), we collected vacuum cleaner dust and measured 14 herbicides with high use on corn and soybeans in Iowa. Of 112 homes, 58% of residences had crops within 500 m of their home, an intermediate distance for primary drift from aerial and ground applications. Detection rates for herbicides ranged from 0% for metribuzin and cyanazine to 95% for 2,4-dichlorophenoxyacetic acid. Six herbicides used almost exclusively in agriculture were detected in 28% of homes. Detections and concentrations were highest in homes with an active farmer. Increasing acreage of corn and soybean fields within 750 m of homes was associated with significantly elevated odds of detecting agricultural herbicides compared with homes with no crops within 750 m (adjusted odds ratio per 10 acres = 1.06; 95% confidence interval, 1.02-1.11). Herbicide concentrations also increased significantly with increasing acreage within 750 m. We evaluated the distance of crop fields from the home at < 100, 101-250, 251-500, and 501-750 m. Including the crop buffer distance parameters in the model did not significantly improve the fit compared with a model with total acres within 750 m. Our results indicate that crop maps may be a useful method for estimating levels of herbicides in homes from nearby crop fields.

Case-Control Studies↗
PubMed2005

A comparison of self-reported hearing and pure tone threshold average in the Iowa Farm Family Health and Hazard Survey.

BACKGROUND: Self-reported hearing measures are useful for surveying hearing loss in a population because they are short, and easy to administer by either questionnaire or telephone. This study aims to assess the performance of several self-reported hearing measures to identify hearing loss in a group of Iowa farmers. METHODS: The study subjects were 98 male farmers who participated in the Iowa Farm Family Health and Hazard Survey. We tested three self-reported hearing measures; the hearing screening questions, the Rating Scale for Each Ear (RSEE), and the Health, Education and Welfare-Expanded Hearing Ability Scale (HEW-EHAS), which were originally developed and implemented in the National Health Interview Survey. The sensitivity and specificity of the self-reported hearing measures were assessed by comparing them with pure tone threshold averages. These sensitivity and specificity measures were compared between younger and older age groups. RESULTS: The sensitivities of the screening questions, RSEE, and HEW-EHAS were 73.0%, 66.7%, and 53.3%, respectively. The specificities of the self-reported hearing measures were similar, which ranged from 81.4% to 84.8%. The sensitivities of the self-reported hearing measures were higher in the younger age group while the specificities were higher in the older age group. CONCLUSIONS: The results of this study support the use of simple screening questions in identifying hearing loss among farmers.

Age Distribution↗
PubMed2004

Injuries in the Iowa Certified Safe Farm Study.

The aims of this article are to assess injury characteristics and risk factors in the Iowa Certified Safe Farm (CSF) program and to evaluate the effectiveness of CSF for reducing injuries. This intervention program includes a health screening, on-farm safety review, education, and monetary incentives. Cohorts of farmers in an intervention group (n = 152) and control group (n = 164) in northwestern Iowa were followed for a three-year period. During the follow-up, there were 318 injuries (42/100 person-years), of which 112 (15/100 person-years) required professional medical care. The monetary cost of injuries was $51,764 ($68 per farm per year). There were no differences in the self-reported injury rates and costs between the intervention and control groups. Raising livestock, poor general health, and exposures to dust and gas, noise, chemicals and pesticides, and lifting were among risk factors for injury. Most injuries in this study were related to animals, falls from elevation, slips/trips/falls, being struck by or struck against objects, lifting, and overexertion. Machinery was less prominent than generally reported in the literature. Hurry, fatigue, or stress were mentioned as the primary contributing factor in most injuries. These findings illustrate the need for new interventions to address a multitude of hazards in the farm work environment as well as management and organization of farm work.

Accidental Falls↗
PubMedDate not supplied

Evaluation of the Iowa Medicaid pharmaceutical case management program.

OBJECTIVE: To test the effect of pharmaceutical case management (PCM) on medication safety and health care utilization. DESIGN: Prospective cohort design with 9-month follow-up period (enrollment from October 1, 2000, through July 1, 2001, with follow-up through July 1, 2002). SETTING: Iowa Medicaid program. PARTICIPANTS: 2,211 noninstitutionalized, continuously eligible Iowa Medicaid patients taking four or more chronic medications including at least one agent commonly used in at least 1 of 12 specific diseases who were cared for by pharmacists in 117 pharmacies. INTERVENTIONS: Reimbursement for PCM services (initial patient assessment, written recommendations to physician, follow-up assessments and communication of progress and new problems to physician). MAIN OUTCOME MEASURES: Use of high-risk medications, Medication Appropriateness Index (MAI) score, health care utilization. RESULTS: Pharmacists in 114 pharmacies had eligible patients during at least one quarter during the study period; 28 pharmacies were classified as high intensity based on the number of PCM patients they managed. A total of 524 of the eligible patients received 1,599 PCM services; 90% of claims were filed by pharmacists, and the remainder by physicians. Nearly one half (46.1%) of medications and 92.1% of patients had at least one medication problem before PCM. By closeout, the percentage of medications with problems decreased in 8 of 10 MAI domains for those who received PCM. Compared with baseline, mean MAI score improved significantly from 9.4 to 8.3 among PCM recipients (P < .001). Percentage of PCM recipients using high-risk medications decreased significantly compared with PCM eligibles who did not receive the service. In the 28 pharmacies that adopted the new service most intensely, patients had a significant decrease in high-risk medication use, compared with patients of low-intensity pharmacies (P < .001). No difference was observed between PCM recipients and PCM eligibles who did not receive PCM in health care utilization or charges, even after including reimbursements for PCM. CONCLUSION: Medication safety problems were prevalent in this high-risk population. The PCM program improved medication safety during a 9-month follow-up period.

Adult↗
PubMedDate not supplied

Pharmacist care plans and documentation of follow-up before the Iowa Pharmaceutical Case Management program.

OBJECTIVES: To document drug therapy problems and their causes and assess pharmacist follow-up of patients with identified drug therapy problems. DESIGN: Cross-sectional analysis. SETTING: Iowa. PARTICIPANTS: 160 pharmacists who submitted 754 pharmaceutical care plans in an effort to qualify for participation in the Iowa Pharmaceutical Case Management program. INTERVENTIONS AND MAIN OUTCOME MEASURES: Care plans were assessed for drug therapy problems and causes and for documentation of pharmacist follow-up (actual, none, or intent to follow up). RESULTS: Pharmacists documented a wide variety of drug therapy problems and causes, including adverse drug reactions (20.1% of care plans), need for additional drug therapy (18.9%), lack of patient adherence to therapy (16.3%), incorrect medication being prescribed (14.1%), and drug dose too high (10.0%). Pharmacist follow-up with patients was not optimal, with 31% of care plans providing documentation of actual follow-up. Another 42.2% of plans indicated that the pharmacist intended to contact the patient for follow-up but either did not do so or did not record the intervention. No actual follow-up or intent to follow up was recorded in 26.8% of care plans. Pharmacists practicing in independent pharmacies followed up with patients more frequently than those in other settings (36.4% of care plans, compared with 22.7%, 23.2%, and 28.4% for chain, clinic, and franchise pharmacies). Pharmacists were more likely to follow up when the identified problem involved drug safety rather than effectiveness (36.2% versus 28.3% of care plans). CONCLUSION: Documentation of pharmacist follow-up with patients was less than optimal. In addition to identifying drug therapy problems and causes, pharmacists must complete the care continuum through documentation of patient monitoring and follow-up to transform the philosophy and vision of the pharmaceutical care concept into a practice of pharmacy recognized and rewarded by patients and payers.

Case Management↗
PubMedDate not supplied

The impact of the Iowa S-SCHIP program on access, health status, and the family environment.

OBJECTIVES: To determine the effect of the Iowa Separate State Child Health Insurance Program (S-SCHIP) on need for services, utilization and access to care, child health status, and the family environment. METHODOLOGY: A longitudinal pretest-posttest panel survey was used to evaluate differences in children's access to health care, health status, and family environment at the beginning of the program and after 1 year. Written surveys with telephone follow-up calls were used to collect the data. Pre- and postquestionnaire results for 463 children were matched and compared using the McNemar test for correlated proportions and the Wilcoxon signed rank test. Approximately 71% of families responded to both surveys. PRINCIPAL FINDINGS: Similar rates of perceived need for each of 6 service areas were found after being in the program for a year as before. Unmet need was significantly reduced among those needing services: medical care (27% before, 6% after), specialty care (40% before, 13% after), dental care (30% before, 10% after), vision care (46% before, 12% after), behavioral and emotional care (42% before, 18% after), and prescription medications (21% before, 13% after). Overall health status was rated significantly better (ie, excellent: 37% before, 42% after). Ninety-five percent of families reported a reduction in family stress, and there was significantly less worry about the ability to pay for their child's health care (92% before, 57% after). The activities of fewer children were limited because of potential health care costs. CONCLUSIONS: The Iowa S-SCHIP program improved access to care and the family environment for children enrolled during the first year without a change in perceived need for services.

Adolescent↗
PubMed1980

On the validity of the Iowa Alcoholic Stages Index.

The Iowa Alcoholic Stages Index identified more later-stage than earlier-stage alcoholics in a clinic population and more earlier-stage than later-stage alcoholics in two samples of the general population in Iowa.

Adult↗
PubMed1991

A change from public to private sale of wine: results from natural experiments in Iowa and West Virginia.

Several proposals to change the existing structure of state alcoholic beverage control authorities have been advanced over the past 10 years in the United States. Most call for eliminating or substantially reducing the state's role in retail sales of alcohol, particularly distilled spirits and wines. In recent years the states of Iowa and West Virginia eliminated state monopolies for retail sales of wine, and now allow such sales by privately-owned licensed establishments. Using time-series methods, we assessed the effects of these policy changes on the alcoholic beverage market in each state. Privatization was associated with statistically significant increases in wine sales in Iowa and West Virginia, after controlling for an initial stocking effect and broader nationwide trends in alcohol sales in the 1980s. In addition, there was a net increase in absolute alcohol consumed in both states across all beverages (beer, wine and distilled spirits) associated with privatization.

Alcohol Drinking↗
PubMed2006

Vitamin D deficiency in breastfed infants in Iowa.

OBJECTIVE: The purpose of this work was to assess the vitamin D status of breastfed infants living in Iowa (latitude: 41 degrees N). METHODS: Blood samples and dietary records from 84 breastfed infants participating in another study were used for a survey of vitamin D status at 280 days of age. The vitamin D status of those (35 infants) who did not receive preformed vitamin D at 280 days of age (unsupplemented infants) was assessed longitudinally between 112 days and 15 months of age. Plasma 25-hydroxyvitamin D and, in most cases, parathyroid hormone and alkaline phosphatase were determined. RESULTS: At 280 days of age, 10% of breastfed infants were vitamin D deficient (25-hydroxyvitamin D < 11 ng/mL). Deficiency was significantly more prevalent among dark-skinned infants and during winter and occurred exclusively in unsupplemented infants. During winter, 78% of unsupplemented infants were vitamin D deficient. During summer, only 1 infant who had dark skin pigmentation was vitamin D deficient. Longitudinal assessment of unsupplemented infants similarly showed that the majority of breastfed infants were vitamin D deficient during winter. Severe deficiency (25-hydroxyvitamin D < 5 ng/mL) was common and was accompanied by elevation of parathyroid hormone and alkaline phosphatase. The prevalence of vitamin D deficiency decreased with age but was still 12% at 15 months of age if no preformed vitamin D was received. CONCLUSIONS: Vitamin D deficiency, including severe deficiency, was common among breastfed infants in Iowa who did not receive preformed vitamin D. Deficiency occurred mostly during winter but was not completely absent during summer. It affected infants with light as well as dark skin pigmentation. Consumption of preformed vitamin D from vitamin supplements or formula is effective in preventing vitamin D deficiency. Vitamin D supplementation should be provided to all breastfed infants.

Adult↗
PubMed1994

The driver's license list as a population-based sampling frame in Iowa.

Driver's license lists are infrequently used for population-based sampling, presumably because of suspicions of poor population coverage. The 1990 Iowa driver's license list was compared with the 1990 census to evaluate coverage by 5-year age group, sex, resident county, and urbanicity. Coverage exceeded 90% among 15- to 74-year-old men and 15- to 64-year-old women, with uniform coverage by county and county urbanicity group in these age ranges. In Iowa, these lists are convenient and cost-effective and appear to be representative for 25- to 64-year-olds. The representativeness of driver lists in regard to other factors and in other geographic regions deserves further evaluation.

Adolescent↗
PubMed1995

The rapid implementation of a statewide emergency health information system during the 1993 Iowa flood.

In the face of disastrous flooding, the Iowa Department of Public Health established the statewide Emergency Computer Communications Network to establish rapid electronic reporting of disaster-related health data, provide e-mail communications among all county health departments, monitor the long-range public health effects of the disaster, and institute a general purpose public health information system in Iowa. Based on software (CDC WONDER/PC) provided by the Centers for Disease Control and Prevention and using standard personal computers and modems, this system has resulted in a 10- to 20-fold increase in surveillance efficiency at the health department, not including time saved by county network participants. It provides a critical disaster assessment capability to the health department but also facilitates the general practice of public health.

Computer Communication Networks↗
PubMed1997

Primary care case management and birth outcomes in the Iowa Medicaid program.

OBJECTIVES: This study compares prenatal care utilization and birth outcomes between Iowa Medicaid recipients receiving care in a primary care case management (PCCM) system and those receiving care in a fee-for-service (FFS) system. METHODS: Birth certificates linked with Medicaid hospitalization claims were analyzed for seven PCCM and seven FFS counties. RESULTS: From 1989 through 1992, there was (1) a 20% increase in the number of women who received adequate prenatal care in the FFS counties, vs a 5% increase in the PCCM counties; (2) a 17% increase in the number of women who initiated care within the first trimester in the FFS counties, vs a 6% increase in the PCCM counties; and (3) a 442% increase in the number of women who received enhanced prenatal services in the FFS counties, vs a 278% increase in the PCCM counties. There were no significant differences between groups in mean gestational age or birthweight; however, there was an increase of very-low-birthweight babies in both groups. CONCLUSIONS: PCCM, as implemented by the Iowa Medicaid program, has not appreciably improved prenatal care utilization or birth outcomes.

Case Management↗
PubMed2006

Prevalence of exposure to Salmonella spp in finishing swine marketed in Iowa.

OBJECTIVE: To describe the prevalence of antibodies against Salmonella spp in swine marketed in Iowa. ANIMALS: Swine marketed by 1,044 low-volume producers and 45 high-volume producers. PROCEDURE: Samples of diaphragm muscle collected from swine carcasses were tested by an indirect ELISA based on lipopolysaccharides from Salmonella spp, in particular Salmonella serovar Typhimurium. Prevalence of positive results for antibodies against Salmonella spp for carcasses, lots, and swine for each producer was determined. Producer-level seroprevalence was used to classify swine from producers as having negligible, low, moderate, or widespread evidence of previous or historical exposure to Salmonella spp. RESULTS: From low-volume producers, 23,609 of 25,478 (92.7%; 95% confidence interval [CI], 92.4% to 92.9%) samples had negative results, and 1,863 (7.3%; 95% CI, 7.05% to 7.56%) had antibodies against Salmonella spp. Of the 6,299 lots of swine tested, 1,191 (18.9%) contained at least 1 sample with positive results. From high-volume producers, 203 of 2,486 (8.1%; 95% CI, 6.8% to 9.3%) samples had antibodies against Salmonella spp, and 124 of 629 lots had at least 1 sample with positive results for antibodies against Salmonella spp. CONCLUSIONS AND CLINICAL RELEVANCE: Less than 10% of pigs marketed in Iowa are apparently exposed to Salmonella spp. Most swine marketed by low-volume producers had negligible or little evidence of exposure to Salmonella spp, whereas a higher percentage of swine marketed by high-volume producers had positive results when tested to detect antibodies against Salmonella spp.

Animals↗
PubMed1995

Estimates of variability for somatic cell count measurements in the Iowa dairy industry.

The SCC collected from 15 instruments in 12 laboratories were used to quantify accuracy, repeatability, and reproducibility in the Iowa dairy industry. For each of three trials, milk was sampled at the morning milking from 30 different Holsteins in the Iowa State University herd. Identified samples and unidentified duplicates were provided for each participating instrument. Mean SCC was 418,000 cells/ml, and mean SCC for duplicates ranged from 9000 to 3,966,000. Accuracy for a set of 30 duplicates was lowest for trial 1 (CV = 16.4%) and highest for trial 2 (CV = 7.6%). Intraclass correlations estimated repeatability and were .99 for all but one instrument. Coefficients of variation for repeatability (weighted mean = 11.4%) were similar to estimates for accuracy (weighted mean = 11.0%), but reproducibility was considerably lower (30.0%). Samples were classified by SCC as very low, < 125,000; low, 125,000 to 249,000; medium, 250,000 to 500,000; and high, > 500,000. Repeatability for high samples was higher than repeatability for very low SCC samples; coefficient of variation for high SCC samples was 6.8% but was > 25.0% for samples with < 500,000 cells. Repeatability was within standards set by the industry, but current procedures for quality control may not adequately address reproducibility.

Animals↗
PubMed2000

Effects of fexofenadine, diphenhydramine, and alcohol on driving performance. A randomized, placebo-controlled trial in the Iowa driving simulator.

BACKGROUND: Sedating antihistamines may impair driving performance as seriously as alcohol. OBJECTIVE: To compare the effects of fexofenadine, diphenhydramine, alcohol, and placebo on driving performance. DESIGN: Randomized, double-blind, double-dummy, four-treatment, four-period crossover trial. SETTING: The Iowa Driving Simulator. PARTICIPANTS: 40 licensed drivers with seasonal allergic rhinitis who were 25 to 44 years of age. INTERVENTION: One dose of fexofenadine (60 mg), diphenhydramine (50 mg), alcohol (approximately 0.1% blood alcohol concentration), or placebo, given at weekly intervals before participants drove for 1 hour in the Iowa Driving Simulator. MEASUREMENTS: The primary end point was coherence, a continuous measure of participants' ability to match the varying speed of a vehicle that they were following. Secondary end points were drowsiness and other driving measures, including lane keeping and response to a vehicle that unexpectedly blocked the lane ahead. RESULTS: Participants had significantly better coherence after taking alcohol or fexofenadine than after taking diphenhydramine. Lane keeping (steering instability and crossing the center line) was impaired after alcohol and diphenhydramine use compared with fexofenadine use. Mean response time to the blocking vehicle was slowest after alcohol use (2.21 seconds) compared with fexofenadine use (1.95 seconds). Self-reported drowsiness did not predict lack of coherence and was weakly associated with minimum following distance, steering instability, and leftlane excursion. CONCLUSIONS: Participants had similar performance when treated with fexofenadine or placebo. After alcohol use, participants performed the primary task well but not the secondary tasks; as a result, overall driving performance was poorer. After participants took diphenhydramine, driving performance was poorest, indicating that diphenhydramine had a greater impact on driving than alcohol did. Drowsiness ratings were not a good predictor of impairment, suggesting that drivers cannot use drowsiness to indicate when they should not drive.

Adult↗
PubMed1990

Raptors rehabilitated in Iowa during 1986 and 1987: a retrospective study.

A retrospective study was conducted on 60 raptors representing 13 species treated at the Iowa State University College of Veterinary Medicine during 1986-1987. Eight species (31 individuals) were Falconiformes and five species (29 individuals) were Strigiformes. Seventy-five percent of all injuries were due to trauma and 65% of these were injuries arising from human activity, including car collisions (28%), shooting (17%) and trapping (11%). Thirty-four percent of all raptors admitted were treated and released, 25% were permanently crippled and 41% died during treatment or were euthanized. Data from this study implicate trauma resulting from human activity as a major reason for injury in free-ranging raptors presented for treatment in Iowa.

Animals↗
PubMed1993

Cilia-associated respiratory bacillus in wild rats in central Iowa.

Twenty-eight wild rats were live-trapped in central Iowa (USA) to estimate the prevalence of the cilia-associated respiratory (CAR) bacillus. Both light and electron microscopy were used to look for the Gram-negative, filamentous bacterium among cilia in tracheal and lung tissue sections. The organism was observed in the trachea of 20 rats with chronic respiratory disease and in the trachea of three of eight normal rats. Therefore, the organism appears to be common among wild rats in central Iowa.

Animals↗
PubMedDate not supplied

Survey of Iowa emergency medical services on the effects of the 1993 floods.

INTRODUCTION: From June through August 1993, extensive flooding in the Mississippi and Missouri River basins resulted in 50 deaths and 12 billion dollars [U.S.] in damages in nine Midwestern states. In Iowa (1990 population 2,777,000), the government declared all 99 counties Federal Disaster Areas. This study examines how this event impacted local emergency medical services (EMS). METHODS: All 797 registered prehospital ambulance, rescue, and first-response companies in Iowa received survey questionnaires. Two follow-up mailings were provided for non-responders. RESULTS: A total of 468 EMS companies (59%) returned completed questionnaires. The geographic distribution of responders and non-responders was similar. Of the companies responding, 132 (28%) reported an impact on their operations from the flood disaster. The most frequently reported operational changes included the use of non-traditional vehicles, providing aid to regions outside usual service areas, and involvement in non-medical rescue operations. CONCLUSION: A major flood provides unique challenges for emergency medical services. Cross-sectional surveys can identify areas of improvement for prehospital systems located in flood-prone areas. Results from this study provide a basis for constructing a more refined instrument to study future flood disasters.

Data Collection↗